ITLS Advanced Test Prep 2026 - Recently Tested 100
Questions and Correct Detailed Answers/ International
Trauma Life Support (ITLS) Practice Exam 2026
1. Which of the following mechanisms of injury does not commonly cause damage
to the spinal cord?
A. Hyperextension
B. Hyperflexion
C. Lateral stress
D. Compression - ANSWER-C. Lateral stress
Rationale: Certain mechanisms of trauma can overcome the protective properties,
injuring the spinal column and cord. The most common mechanisms are
hyperextension, hyperflexion, compression, and rotation. Less commonly, lateral
stress or distraction will injure the cord.
2. A 34-year-old man has a gunshot wound to the right groin area. Arterial
bleeding, which cannot be controlled with direct pressure or tourniquet, is coming
from the wound. The patient appears confused, diaphoretic, and has weak
peripheral pulses. What is the appropriate fluid resuscitation regimen for this
patient?
A. Intravenous fluid at a "keep open" rate
B. Intravenous fluid; give enough fluid to maintain peripheral pulses
C. Intravenous fluid at a "wide open" rate
D. Intravenous access should be established in this situation - ANSWER-B.
Intravenous fluid; give enough fluid to maintain peripheral pulses
pg. 1
,Rationale: Give only enough normal saline to maintain a blood pressure high
enough for adequate peripheral perfusion. Maintaining peripheral perfusion may be
defined as producing a peripheral pulse (such as a radial pulse).
3. A 27-year-old male with blunt chest trauma from a motor vehicle collision was
successfully intubated at the scene. While ventilating the patient, you note
resistance with absence of right chest wall movement. You should suspect a:
A. Flail chest
B. Gastric distention
C. Mucus obstruction
D. Tension pneumothorax - ANSWER-D. Tension pneumothorax
Rationale: The development of decreased lung compliance (difficulty in squeezing
the bag-mask device) in the intubated patient should always alert you to the
possibility of a tension pneumothorax.
4. A pericardiocentesis is performed to:
A. To remove fluid from the lining around the lungs
B. To remove fluid from the lining around the heart
C. To inject medications directly into the heart
D. To monitor stroke volume - ANSWER-B. To remove fluid from the lining
around the heart
Rationale: The pericardial sac is an inelastic membrane that surrounds the heart. If
blood collects rapidly between the heart and pericardium from a cardiac injury, the
ventricles of the heart will be compressed, making the heart less able to refill, and
cardiac output falls.
pg. 2
,5. A 56-year-old male sustains a gunshot wound to the abdomen. Vital signs are
BP 74/32, P 136 present only at the carotid, and R 24 and shallow. The target of
fluid resuscitation is:
A. Return of peripheral pulses
B. Maintenance of central pulses
C. Systolic blood pressure of 110-120
D. Pulse rate of 100 - ANSWER-A. Return of peripheral pulses
Rationale: This is an example of internal, uncontrolled hemorrhage. Administer
sufficient normal saline to maintain peripheral perfusion, following local or EMS
agency medical direction policies. Maintaining peripheral perfusion is generally
defined as giving enough fluid—usually in boluses—to return a peripheral pulse,
such as a radial pulse.
6. An unconscious 15-year-old male was struck on the head with a baseball bat.
His arms and legs are extended and his right pupil is dilated and fixed. You should:
A. Insert an oropharyngeal airway, administer oxygen, and restrict fluids
B. Apply a non-rebreather mask, restrict fluids, and administer Mannitol
C. Perform nasotracheal intubation, restrict fluids, and provide adequate ventilation
D. Perform bag-mask ventilation at 20 per minute Exam - ANSWER-D. Perform
bag-mask ventilation at 20 per minute Exam
Rationale: The classic findings of this life-threatening situation are a decreasing
level of consciousness (LOC) that rapidly progresses to coma, dilation of the pupil
and an outward- downward deviation of the eye on the side of the injury, paralysis
of the arm and leg on the side opposite the injury, or decerebrate posturing (arms
and legs extended). The danger of immediate herniation outweighs the risk of
cerebral ischemia that can follow hyperventilation. The cerebral herniation
syndrome is the only situation in which hyperventilation is still indicated. (You
must ventilate every three seconds [20/minute] for adults.)
pg. 3
, 7. In a rear-impact motor vehicle crash, which area of the spine is most susceptible
to injury?
A. Cervical
B. Thoracic
C. Lumbar
D. Sacral-coccygeal - ANSWER-A. Cervical
Rationale: The sudden increase in acceleration produces posterior displacement of
the occupants and possible hyperextension of the cervical spine if the headrest is
not properly adjusted. The potential for cervical-spine injuries is great.
8. A 4-year-old female is unconscious after falling off a bicycle. Which of the
following is the best method to open the airway?
A. Modified jaw-thrust
B. Head tilt
C. Neck flexion
D. Neck lift - ANSWER-A. Modified jaw-thrust
Rationale: Look for signs of airway obstruction in the child, including apnea,
stridor, and "gurgling" respirations. If identified, perform a jaw-thrust maneuver
without moving the neck.
9. When performing the ITLS Primary Survey, the team leader may minimize
errors by:
A. Performing all interventions
B. Limiting crew roles
C. Permitting crew to continue the assessment
pg. 4
Questions and Correct Detailed Answers/ International
Trauma Life Support (ITLS) Practice Exam 2026
1. Which of the following mechanisms of injury does not commonly cause damage
to the spinal cord?
A. Hyperextension
B. Hyperflexion
C. Lateral stress
D. Compression - ANSWER-C. Lateral stress
Rationale: Certain mechanisms of trauma can overcome the protective properties,
injuring the spinal column and cord. The most common mechanisms are
hyperextension, hyperflexion, compression, and rotation. Less commonly, lateral
stress or distraction will injure the cord.
2. A 34-year-old man has a gunshot wound to the right groin area. Arterial
bleeding, which cannot be controlled with direct pressure or tourniquet, is coming
from the wound. The patient appears confused, diaphoretic, and has weak
peripheral pulses. What is the appropriate fluid resuscitation regimen for this
patient?
A. Intravenous fluid at a "keep open" rate
B. Intravenous fluid; give enough fluid to maintain peripheral pulses
C. Intravenous fluid at a "wide open" rate
D. Intravenous access should be established in this situation - ANSWER-B.
Intravenous fluid; give enough fluid to maintain peripheral pulses
pg. 1
,Rationale: Give only enough normal saline to maintain a blood pressure high
enough for adequate peripheral perfusion. Maintaining peripheral perfusion may be
defined as producing a peripheral pulse (such as a radial pulse).
3. A 27-year-old male with blunt chest trauma from a motor vehicle collision was
successfully intubated at the scene. While ventilating the patient, you note
resistance with absence of right chest wall movement. You should suspect a:
A. Flail chest
B. Gastric distention
C. Mucus obstruction
D. Tension pneumothorax - ANSWER-D. Tension pneumothorax
Rationale: The development of decreased lung compliance (difficulty in squeezing
the bag-mask device) in the intubated patient should always alert you to the
possibility of a tension pneumothorax.
4. A pericardiocentesis is performed to:
A. To remove fluid from the lining around the lungs
B. To remove fluid from the lining around the heart
C. To inject medications directly into the heart
D. To monitor stroke volume - ANSWER-B. To remove fluid from the lining
around the heart
Rationale: The pericardial sac is an inelastic membrane that surrounds the heart. If
blood collects rapidly between the heart and pericardium from a cardiac injury, the
ventricles of the heart will be compressed, making the heart less able to refill, and
cardiac output falls.
pg. 2
,5. A 56-year-old male sustains a gunshot wound to the abdomen. Vital signs are
BP 74/32, P 136 present only at the carotid, and R 24 and shallow. The target of
fluid resuscitation is:
A. Return of peripheral pulses
B. Maintenance of central pulses
C. Systolic blood pressure of 110-120
D. Pulse rate of 100 - ANSWER-A. Return of peripheral pulses
Rationale: This is an example of internal, uncontrolled hemorrhage. Administer
sufficient normal saline to maintain peripheral perfusion, following local or EMS
agency medical direction policies. Maintaining peripheral perfusion is generally
defined as giving enough fluid—usually in boluses—to return a peripheral pulse,
such as a radial pulse.
6. An unconscious 15-year-old male was struck on the head with a baseball bat.
His arms and legs are extended and his right pupil is dilated and fixed. You should:
A. Insert an oropharyngeal airway, administer oxygen, and restrict fluids
B. Apply a non-rebreather mask, restrict fluids, and administer Mannitol
C. Perform nasotracheal intubation, restrict fluids, and provide adequate ventilation
D. Perform bag-mask ventilation at 20 per minute Exam - ANSWER-D. Perform
bag-mask ventilation at 20 per minute Exam
Rationale: The classic findings of this life-threatening situation are a decreasing
level of consciousness (LOC) that rapidly progresses to coma, dilation of the pupil
and an outward- downward deviation of the eye on the side of the injury, paralysis
of the arm and leg on the side opposite the injury, or decerebrate posturing (arms
and legs extended). The danger of immediate herniation outweighs the risk of
cerebral ischemia that can follow hyperventilation. The cerebral herniation
syndrome is the only situation in which hyperventilation is still indicated. (You
must ventilate every three seconds [20/minute] for adults.)
pg. 3
, 7. In a rear-impact motor vehicle crash, which area of the spine is most susceptible
to injury?
A. Cervical
B. Thoracic
C. Lumbar
D. Sacral-coccygeal - ANSWER-A. Cervical
Rationale: The sudden increase in acceleration produces posterior displacement of
the occupants and possible hyperextension of the cervical spine if the headrest is
not properly adjusted. The potential for cervical-spine injuries is great.
8. A 4-year-old female is unconscious after falling off a bicycle. Which of the
following is the best method to open the airway?
A. Modified jaw-thrust
B. Head tilt
C. Neck flexion
D. Neck lift - ANSWER-A. Modified jaw-thrust
Rationale: Look for signs of airway obstruction in the child, including apnea,
stridor, and "gurgling" respirations. If identified, perform a jaw-thrust maneuver
without moving the neck.
9. When performing the ITLS Primary Survey, the team leader may minimize
errors by:
A. Performing all interventions
B. Limiting crew roles
C. Permitting crew to continue the assessment
pg. 4
