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2 026 ATLS Post Test – Advanced Trauma Life Support
MCQs with Correct Answers | Latest 2026/2027 Updated
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A 28 y/o woman sustains multiple injuries in a car crash and is brought by ambulance to a small hospital in full spinal protection. GCS of 4 and is being mechanically ventilated. Intravenous access is established and warmed crystalloid is infused. She remains hemodynamically normal and full spinal protection is maintained. Preparations are made to transfer her to another facility for definitive neurosurgical care. Prior to transport, which of the following tests or treatments is mandatory?: FAST exam. Chest xray.
Lateral cervical spine xray. Administration of methylprednisolone. Computerized tomography of the abdomen. - ✔✔✔ANSWER-Chest xray. A 23 year-old male is stabbed below the right nipple. He is alert, and his oxygen saturation is 98%. Chest tube was placed for treatment of a hemopneumothorax. Blood pressure is 90/60 mm Hg after administration of 1 L of crystalloid solution. What is the next step in treatment?: Place a left sided chest tube. Reexamine the chest. Insert central venous catheter. Perform CT scan of the abdomen and pelvis. Prepare for urgent thoracotomy. - ✔✔✔ANSWER-Reexamine the chest. Regarding airway compromise, which of the following is NOT a sign/symptom of this emergency?:
The deployment of the airbag increases the risk of maternal abdominal injury. - ✔✔✔ANSWER-The risk of premature fetal delivery and death is reduced by the use of restraints. Regarding cardiac tamponade, which of the following statements is CORRECT?: Is definitively managed by needle pericardiocentesis. Is most common with blunt thoracic trauma and anterior rib fractures. Is easily diagnosed by discovery of Beck's triad in the emergency department. Is indicated by Kussmaul breathing. Requires surgical intervention. - ✔✔✔ANSWER-Requires surgical intervention. A 24 year - old man is brought to the Emergency Department after falling from a bull. He is immobilized on a long spine board with a
hard collar and blocks. Which of the following statements is CORRECT regarding cervical spine xrays: Will show cervical spine injury in more than 20% of these patients. Will exclude cervical spine injury if no abnormalities are found on the xrays. Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness. Should be performed before addressing potential breathing or circulatory problems. May show atlantooccipital dislocation if the Power's ratio is less than 1. - ✔✔✔ANSWER-Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness. Regarding injuries of solid abdominal organs, which is the most specific test for their evaluation?: Abdominal x-rays. Abdominal ultrasonography. Diagnostic peritoneal lavage.
Pelvic injury can be ruled out based on the mechanism of injury. Blood loss from the lower limbs is the most likely cause of his hypotension. Xrays of the chest and pelvis are important adjuncts in his initial assessment. Spinal cord injury is the most likely cause of his hypotension. Aortic injury is the most likely cause of his tachycardia. - ✔✔✔ANSWER-Xrays of the chest and pelvis are important adjuncts in his initial assessment. A 29 year - old lady in the third trimester of pregnancy is brought to the Emergency Department following a highspeed motor vehicle crash. She is conscious and immobilized on a long spine board. Her respiratory rate is 25, heart rate is 110, and blood pressure is 75/55. The laboratory results show PaC02of 40 mm Hg (5.3 kPa). Which one of the following statements regarding this patient is true?: Fetal assessment should take priority. Logrolling the patient to the right will decompress the vena cava.
Rh immunoglobulin therapy should be immediately administered. The patient likely has impending respiratory failure. Vasopressors should be given to the patient. - ✔✔✔ANSWER-The patient likely has impending respiratory failure.
- Which is the most important consequence of inadequate organ perfusion?: Multiple organ failure. Decreased base deficit. Acute glomerulonephritis. Increased cellular adenosine triphosphate (ATP) production. Vasodilation. - ✔✔✔ANSWER-Multiple organ failure. 1 0. A 22 year - old man is brought by ambulance to the Emergency Department with a severe traumatic brain injury. On examination he is hypertensive. Which of the following statements is CORRECT?:
A 31 year - old pregnant lady is brought to the Emergency Department after being involved in a car crash with a hit by a car from behind suffering a blunt trauma. Which of the following statements is CORRECT?: Early gastric decompression is important. A hemoglobin level of 10 g/dL (hematocrit 30) indicates recent blood loss. The central venous pressure response to volume resuscitation is blunted in pregnant patients. A lap belt is the best form of restraint due to the size of the gravid uterus. A PaC02of 40 mmHg (5.3 kPa) provides reassurance about the adequacy of respiratory function. - ✔✔✔ANSWER-The central venous pressure response to volume resuscitation is blunted in pregnant patients. A 19 year - old girl with learning disabilities and severe cervical kyphoscoliosis is brought to the Emergency Department with a GCS of 6. Intubation is performed but you are not completely sure that you are in the airway tract. Which of the following signs is least reliable for diagnosing the esophageal intubation?:
Symmetrical chest wall movement. End - tidal CO2. Bilateral breath sounds. Oxygen saturation. Chest x-ray demonstrating endotracheal tube tip positioned above the carina. - ✔✔✔ANSWER-Symmetrical chest wall movement. An 8 month old infant, being held in her mother's arms, is ejected on impact from a vehicle that is struck head on by an oncoming car traveling at 64 kph (40 mph). On arrival to the Emergency Department, the infant presents with multiple facial injuries, is lethargic, and is in severe respiratory distress. Respiratory support is not effective using a bag mask device, and her oxygen saturation is falling. Repeated attempts at orotracheal intubation are unsuccessful. The most appropriate procedure to perform next is: Administer heliox and racemic epinephrine. Perform nasotracheal intubation. Perform surgical cricothyroidotomy.
Mid-thight amputation. Open fracture with bleeding. Unstable pelvic fracture. Bilateral femur fractures with obvious deformity. - ✔✔✔ANSWER- Forearm fracture. An 18 year - old boy is stabbed in the right chest during a gang fight. On arrival to the ED, he is very short of breath. His heart rate is 122 and his blood pressure is 78/47 mm Hg. His neck veins are flat. On auscultation of the chest, there is diminished air entry on the right side, and there is dullness posteriorly on percussion, These findings are most consistent with: Tension pneumothorax. Pericardial tamponade. Hypovolemia from liver injury. Hemothorax. Spinal cord injury. - ✔✔✔ANSWER-Hemothorax.
(Not a tension pneumothorax because during the auscultation there is no hyperresonance.) Regarding thermal injuries, which of the following is CORRECT?: Chemical burns require the immediate removal of clothing. Patients who sustain thermal injury are at lower risk for hypothermia. Patients with circumferential truncal burns need promptfasciotomies. Electrical burns are associated with extensive skin necrosis. The Parkland formula should be used to determine adequacy of resuscitation. - ✔✔✔ANSWER-Chemical burns require the immediate removal of clothing. An 18 year - old man is brought to the ED after being involved in a car crash. He is unconscious and was intubated at the scene by emergency medical personnel. Upon arrival at the ED, the patient's oxygen saturation is 92%, heart rate is 96, and blood pressure is 150/85 mm Hg. Breath sounds are decreased on the left side of the thorax. The next step is:
Autoregulation of cerebral blood flow normally occurs between mean arterial pressures of 50 to 150 mm Hg. Hypotonic fluids should be used to limit brain edema in patients with severe head injury. - ✔✔✔ANSWER-Autoregulation of cerebral blood flow normally occurs between mean arterial pressures of 50 to 150 mm Hg. A 22 year - old man is stabbed in the abdomen. He is brought to the Emergency Department where his blood pressure shows 85/60 mm Hg with heart rate of 130, respiratory rate of 25 bpm, and Glasgow Coma Scale score is 14. Neck veins are flat, and chest examination is clear with bilateral breath sounds. Optimal resuscitation should include: Transfusion of fresh frozen plasma and platelets. 500 mL of hypertonic saline and transfusion of packed red blood cells. Resuscitation with crystalloid and packed red blood cells until base excess is normal. Preparation for laparotomy while initiating fluid resuscitation.
Fluid resuscitation and angioembolization. - ✔✔✔ANSWER- Preparation for laparotomy while initiating fluid resuscitation. Regarding initial resuscitation in an adult trauma patient, which of the following statements is CORRECT?: Use 1 - 2 liters of crystalloid, monitoring the patient's response. Use crystalloid to normalize blood pressure. Use permissive hypotension in patients with head injury. Use a nonblood colloid solution. Use a minimum of 2 liters of crystalloid in all trauma patients prior to administering blood. - ✔✔✔ANSWER-Use 1 - 2 liters of crystalloid, monitoring the patient's response. A 23 year - old woman is brought to the Emergency Department following a bar fight. She has an altered level of consciousness, opens her eyes on command, moans without forming discernible words, and localizes to painful stimuli. Which one of the following statements concerning this patient is true?: Mandatory intubation to protect her airway is required.
Intraosseous cannulation should be the first choice for access. Blood transfusion can be delivered through intraosseous access. - ✔✔✔ANSWER-Blood transfusion can be delivered through intraosseous access. A 32 y/o man is assaulted in a bar. He is immobilized on a spine board. On initial examination, his vital signs are normal, and his Glasgow Coma Scale score is 15. Which of the following is an indication for CT in this patient with possible minor traumatic brain injury?: Presence of hemotympanum. Blood alcohol concentration of 0.16% (160 mg/100 ml). Presence of an isolated 10 cm scalp laceration. Presence of a mandibular fracture. History of assault. - ✔✔✔ANSWER-Presence of hemotympanum. 55 + 28. Regarding supraglottic airway devices, which of the following statements is CORRECT?: Are equivalent to endotracheal intubation. Require neck extension for proper placement.
Are preferable to endotracheal intubation in a patient who cannot lie flat. Are of value as part of a difficult or failed intubation plan. Provide one form of definitive airway. - ✔✔✔ANSWER-Are of value as part of a difficult or failed intubation plan. A 74 y/o gentleman suffers blunt chest trauma after falling down the stairs. On presentation, his Glasgow Coma Scale score is 15, blood pressure is 145/90 mm Hg, heart rate is 72 bpm, respiratory rate is 24 bpm, and Sa02 on 5 L is 91%. Chest ray demonstrates multiple right - sided rib fractures. ECG demonstrates normal sinus rhythm with no conduction abnormalities. Management should include: Placement of a 22 French, right - sided chest tube. Serial troponins and cardiac monitoring. C Thoracic splinting, taping, and immobilization. Monitored intravenous analgesia. Bronchoscopy to exclude tracheobronchial injury. - ✔✔✔ANSWER- Monitored intravenous analgesia. A 15 year - old boy is brought to the ED following a motorcycle crash. Initial examination reveals normal vital signs. There is a large bruise over his epigastrium that extends to the left flank. He has no other apparent injuries. A CT scan of the abdomen demonstrates a ruptured spleen surrounded by a large hematoma and fluid in the pelvis. The next step in this patient's management is:
