ACS ATLS Post-Test (pdf) | 2026/2027 | Questions & Answers |
Trauma Surgery
1. A 42-year-old man is trapped from the waist down beneath his overturned
tractor for several hours before medical assistance arrives. He is awake and
alert until just before arriving in the ED. He is now unconscious and responds
only to painful stimuli by moaning. His pupils are 3mm in diameter and
symmetrically reactive to light. Prehospital personnel indicate that they have
not seen the patient move either of his lower extremities. On examination in
the ED, no movement of his lower extremities are detected, even in response
to painful stimuli. The most likely cause for this finding is:
A) An epidural hematoma
B) A pelvic fracture
C) Central cord syndrome
D) Intracerebral hemorrhage
E) Bilateral compartment syndrome
Correct Answer: A pelvic fracture
Rationale: The patient's presentation of being trapped for hours, followed by
acute deterioration with bilateral lower extremity paralysis and preserved
consciousness, is highly suggestive of a pelvic fracture with associated
retroperitoneal hemorrhage. The prolonged crushing mechanism and
subsequent hemodynamic compromise can lead to spinal cord ischemia or
direct injury. The bilateral nature of the paralysis points away from a central
cord syndrome, which typically affects the upper extremities more than the
lower.
2. A 6-year-old boy is struck by an automobile and brought to the ED. He is
lethargic, but withdraws purposefully from painful stimuli. His blood pressure
is 90 mmHg systolic, heart rate 140 beats per minute, and respiratory rate
36 breaths per minute. The preferred route of venous access in this patient
is:
A) Percutaneous femoral vein cannulation
,B) Cutdown on the saphenous vein at the ankle
C) Intraosseous catheter placement in the proximal tibia
D) Percutaneous peripheral veins in the upper extremities
E) Central venous access via the subclavian or internal jugular vein
Correct Answer: Percutaneous peripheral veins in the upper extremities
Rationale: In pediatric trauma patients, peripheral intravenous access in the
upper extremities is the preferred initial route for venous access.
Intraosseous access is reserved for situations where peripheral access
cannot be obtained rapidly. Central venous access and cutdowns are
associated with higher complication rates and are generally avoided as first-
line options in children.
3. A young man sustains a gunshot wound to the abdomen and is brought
promptly to the ED by prehospital personnel. His skin is cool and diaphoretic,
and he is confused. His pulse is thready and his femoral pulse is only weakly
palpable. The definitive treatment in managing this patient is to:
A) Administer O-negative blood
B) Apply external warming devices
C) Control internal hemorrhage operatively
D) Administer tranexamic acid
E) Perform a FAST examination
Correct Answer: Control internal hemorrhage operatively
Rationale: This patient is in uncompensated hemorrhagic shock from an
abdominal gunshot wound. While blood products and adjunctive therapies
are important, the definitive treatment is operative control of the source of
hemorrhage. Delay for further diagnostic studies or non-operative
,management would be detrimental in this hemodynamically unstable
patient.
4. A 24-year-old male pedestrian, struck by an automobile, is admitted to the
ED 1 hour after injury. His BP is 80/60 mmHg, HR 140 bpm, and RR 36
breaths per minute. He is lethargic. Oxygen is delivered via face mask, and
two large-caliber IVs are initiated. An ABG is obtained: PaO2 118, PaCO2 30,
pH 7.21. The treatment of his acid-base disorder is best accomplished by:
A) Hyperventilation
B) Restoration of normal perfusion
C) Initiation of low dose dopamine
D) Administration of sodium bicarbonate
E) Initiation of phenylephrine infusion
Correct Answer: Restoration of normal perfusion
Rationale: The acid-base disorder is a metabolic acidosis secondary to
inadequate tissue perfusion (lactic acidosis). The most effective treatment is
to restore organ perfusion by controlling hemorrhage and administering
appropriate fluid resuscitation. Bicarbonate administration is not
recommended as it can exacerbate intracellular acidosis and does not
address the underlying cause.
5. During an altercation, a 36-year-old man sustains a gunshot wound above
the nipple line on the right, with an exit wound posteriorly above the scapula
on the right. He is transported by ambulance to a community hospital. He is
endotracheally intubated, and a tube thoracostomy is performed. Which of
the following is the most appropriate next step in management?
A) Obtain a CT scan of the chest
B) Perform a laparotomy
C) Transfer to a trauma center
, D) Obtain a chest X-ray
E) Perform a FAST examination
Correct Answer: Transfer to a trauma center
Rationale: A gunshot wound traversing the chest above the nipple line
carries a high risk of injury to the great vessels, mediastinum, and spinal
cord. Following initial stabilization with intubation and chest tube placement,
the patient should be transferred to a trauma center capable of providing
definitive surgical care. The trajectory suggests potential for severe injury
beyond the capabilities of a community hospital.
6. Which of the following signs is LEAST reliable for diagnosing esophageal
intubation?
A) Symmetrical chest wall movement
B) End-tidal CO2 presence by colorimetry
C) Bilateral breath sounds
D) Oxygen saturation > 92%
E) ETT above carina on chest X-ray
Correct Answer: Symmetrical chest wall movement
Rationale: Symmetrical chest wall movement can occur even with
esophageal intubation due to gastric insufflation causing diaphragmatic
movement. End-tidal CO2 detection is the most reliable method for
confirming endotracheal tube placement. Bilateral breath sounds can also be
falsely reassuring if transmitted from the stomach.
7. Which of the following signs necessitates a definitive airway in severe
trauma patients?
Trauma Surgery
1. A 42-year-old man is trapped from the waist down beneath his overturned
tractor for several hours before medical assistance arrives. He is awake and
alert until just before arriving in the ED. He is now unconscious and responds
only to painful stimuli by moaning. His pupils are 3mm in diameter and
symmetrically reactive to light. Prehospital personnel indicate that they have
not seen the patient move either of his lower extremities. On examination in
the ED, no movement of his lower extremities are detected, even in response
to painful stimuli. The most likely cause for this finding is:
A) An epidural hematoma
B) A pelvic fracture
C) Central cord syndrome
D) Intracerebral hemorrhage
E) Bilateral compartment syndrome
Correct Answer: A pelvic fracture
Rationale: The patient's presentation of being trapped for hours, followed by
acute deterioration with bilateral lower extremity paralysis and preserved
consciousness, is highly suggestive of a pelvic fracture with associated
retroperitoneal hemorrhage. The prolonged crushing mechanism and
subsequent hemodynamic compromise can lead to spinal cord ischemia or
direct injury. The bilateral nature of the paralysis points away from a central
cord syndrome, which typically affects the upper extremities more than the
lower.
2. A 6-year-old boy is struck by an automobile and brought to the ED. He is
lethargic, but withdraws purposefully from painful stimuli. His blood pressure
is 90 mmHg systolic, heart rate 140 beats per minute, and respiratory rate
36 breaths per minute. The preferred route of venous access in this patient
is:
A) Percutaneous femoral vein cannulation
,B) Cutdown on the saphenous vein at the ankle
C) Intraosseous catheter placement in the proximal tibia
D) Percutaneous peripheral veins in the upper extremities
E) Central venous access via the subclavian or internal jugular vein
Correct Answer: Percutaneous peripheral veins in the upper extremities
Rationale: In pediatric trauma patients, peripheral intravenous access in the
upper extremities is the preferred initial route for venous access.
Intraosseous access is reserved for situations where peripheral access
cannot be obtained rapidly. Central venous access and cutdowns are
associated with higher complication rates and are generally avoided as first-
line options in children.
3. A young man sustains a gunshot wound to the abdomen and is brought
promptly to the ED by prehospital personnel. His skin is cool and diaphoretic,
and he is confused. His pulse is thready and his femoral pulse is only weakly
palpable. The definitive treatment in managing this patient is to:
A) Administer O-negative blood
B) Apply external warming devices
C) Control internal hemorrhage operatively
D) Administer tranexamic acid
E) Perform a FAST examination
Correct Answer: Control internal hemorrhage operatively
Rationale: This patient is in uncompensated hemorrhagic shock from an
abdominal gunshot wound. While blood products and adjunctive therapies
are important, the definitive treatment is operative control of the source of
hemorrhage. Delay for further diagnostic studies or non-operative
,management would be detrimental in this hemodynamically unstable
patient.
4. A 24-year-old male pedestrian, struck by an automobile, is admitted to the
ED 1 hour after injury. His BP is 80/60 mmHg, HR 140 bpm, and RR 36
breaths per minute. He is lethargic. Oxygen is delivered via face mask, and
two large-caliber IVs are initiated. An ABG is obtained: PaO2 118, PaCO2 30,
pH 7.21. The treatment of his acid-base disorder is best accomplished by:
A) Hyperventilation
B) Restoration of normal perfusion
C) Initiation of low dose dopamine
D) Administration of sodium bicarbonate
E) Initiation of phenylephrine infusion
Correct Answer: Restoration of normal perfusion
Rationale: The acid-base disorder is a metabolic acidosis secondary to
inadequate tissue perfusion (lactic acidosis). The most effective treatment is
to restore organ perfusion by controlling hemorrhage and administering
appropriate fluid resuscitation. Bicarbonate administration is not
recommended as it can exacerbate intracellular acidosis and does not
address the underlying cause.
5. During an altercation, a 36-year-old man sustains a gunshot wound above
the nipple line on the right, with an exit wound posteriorly above the scapula
on the right. He is transported by ambulance to a community hospital. He is
endotracheally intubated, and a tube thoracostomy is performed. Which of
the following is the most appropriate next step in management?
A) Obtain a CT scan of the chest
B) Perform a laparotomy
C) Transfer to a trauma center
, D) Obtain a chest X-ray
E) Perform a FAST examination
Correct Answer: Transfer to a trauma center
Rationale: A gunshot wound traversing the chest above the nipple line
carries a high risk of injury to the great vessels, mediastinum, and spinal
cord. Following initial stabilization with intubation and chest tube placement,
the patient should be transferred to a trauma center capable of providing
definitive surgical care. The trajectory suggests potential for severe injury
beyond the capabilities of a community hospital.
6. Which of the following signs is LEAST reliable for diagnosing esophageal
intubation?
A) Symmetrical chest wall movement
B) End-tidal CO2 presence by colorimetry
C) Bilateral breath sounds
D) Oxygen saturation > 92%
E) ETT above carina on chest X-ray
Correct Answer: Symmetrical chest wall movement
Rationale: Symmetrical chest wall movement can occur even with
esophageal intubation due to gastric insufflation causing diaphragmatic
movement. End-tidal CO2 detection is the most reliable method for
confirming endotracheal tube placement. Bilateral breath sounds can also be
falsely reassuring if transmitted from the stomach.
7. Which of the following signs necessitates a definitive airway in severe
trauma patients?
