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ATLS Test 1 American College of Surgeons 2025-2026 Verified Questions & Correct
Answers – Advanced Trauma Life Support Prep
A |22-year-old |man |is |hypotensive |and |tachycardic |after |a |shotgun |wound |to |the |left |shoulder. |His | blood |pressure |is |initially |80/40 |mm |Hg. |After |initial |fluid |resuscitation |his |blood |pressure |increases |to |122/84 |mm |Hg. |His |heart |rate |is |now | 100 |beats |per |minute |and |his |respiratory |rate |is | 28 |breaths |per |minute. |A |tube |thoracostomy |is |performed |for |decreased |left |chest |breath |sounds |with |the |return |of |a |small |amount |of |blood |and |no |air |leak. |After |chest |tube |insertion, |the |most |appropriate |next |step | is: Select |one: a. reexamine |the |chest b. perform |an |aortogram c. obtain |a |CT |scan |of |the |chest d. obtain |arterial |blood |gas |analyses e. perform |transesophageal |echocardiography |- |answersA) |Reexamine |the |chest A |construction |worker |falls |two |stories |from |a |building |and |sustains |bilateral |calcaneal |fractures. |In | the |emergency |department, |he |is |alert, |vital |signs |are |normal, |and |he |is |complaining |of |severe |pain |in |both |heels |and |his |lower |back. |Lower |extremity |pulses |are |strong |and |there |is |no |other |deformity. | The |suspected |diagnosis |is |most |likely |to |be |confirmed |by: Select |one: a. angiography b. compartment |pressures c. retrograde |urethrogram
d. Doppler |ultrasound |studies e. complete |spine |x-ray |series |- |answerse) |Complete |spine |x-ray |series Which |of |the |following |is |true |regarding |the |initial |resuscitation |of |a |trauma |patient? Select |one: a. A |patient |that |presents |with |a |torso |gunshot |wound |and |is |hypotensive |should |receive |crystalloid | fluid |resuscitation |until |the |blood |pressure |is |normal b. Evidence |of |improved |perfusion |after |fluid |resuscitation |could |include |improvement |in |Glasgow |coma | scale |score |on |reevaluation c. Massive |transfusion |is |defined |as |transfusion |of |more |than |>10 |of |packed |red |blood |cells |and |plasma | in | 24 |hours d. When |tranexamic |acid |is |administered |by |pre-hospital |providers |a |second |dose |is |required |within | 24 | hours e. Fluid |resuscitation |is |far |more |important |than |bleeding |control |in |trauma |patients |- |answersb. Evidence |of |improved |perfusion |after |fluid |resuscitation |could |include |improvement |in |Glasgow |coma | scale |score |on |reevaluation In |managing |a |patient |with |a |severe |traumatic |brain |injury, |the |most |important |initial |step |is |to: Select |one: a. Secure |the |airway b. obtain |a |c-spine |film c. support |the |circulation
complicating |the |management |of |closed |head |injury d. reducing |the |volume |of |crystalloid |required |for |resuscitation e. increasing |the |volume |of |blood |loss |to |produce |maternal |hypotension |- |answerse. increasing |the |volume |of |blood |loss |to |produce |maternal |hypotension The |best |assessment |of |fluid |resuscitation |of |the |adult |burn |patient |is: Select |one: a. Urine |output |of |0.5 |mL/kg/hr b. normalization |of |blood |pressure c. normalization |of |the |heart |rate d. measuring |a |normal |central |venous |pressure e. providing | 4 |mL/kg/percent |body |burn/24 |hours |of |crystalloid |fluid |- |answersa. Urine |output |of |0.5 |mL/kg/hr The |diagnosis |of |shock |must |include: Select |one: a. hypoxemia b. acidosis c. hypotension d. increased |vascular |resistance
e. evidence |of |inadequate |organ |perfusion |- |answerse. evidence |of |inadequate |organ |perfusion A |7-year-old |boy |is |brought |to |the |emergency |department |by |his |parents |several |minutes |after |he |fell |through |a |window. |He |is |bleeding |profusely |from |a |6-cm |wound |of |his |medial |right |thigh. |Immediate | management |of |the |wound |should |consist |of: Select |one: a. application |of |a |tourniquet b. direct |pressure |on |the |wound c. packing |the |wound |with |gauze d. direct |pressure |on |the |femoral |artery |at |the |groin e. debridement |of |devitalized |tissue |- |answersb. direct |pressure |on |the |wound For |the |patient |with |severe |traumatic |brain |injury, |profound |hypocarbia |should |be |avoided |to | prevent: Select |one: a. respiratory |acidosis b. metabolic |acidosis c. cerebral |vasoconstriction |with |diminished |perfusion d. neurogenic |pulmonary |edema e.
The |secondary |survey |follows |a |different |pattern |from |that |of |the |nonpregnant |patient. |- |answersb. Leakage |of |amniotic |fluid |is |an |indication |for |hospital |admission. The |first |maneuver |to |improve |oxygenation |after |chest |injury |is |to: Select |one: a. intubate |the |patient b. assess |arterial |blood |gases c. administer |supplemental |oxygen d. ascertain |the |need |for |a |chest |tube e. obtain |a |chest |x-ray |- |answersc. administer |supplemental |oxygen A |25-year-old |man, |injured |in |a |motor |vehicular |crash, |is |admitted |to |the |emergency |department. |His | pupils |react |sluggishly |and |his |eyes |open |to |pressure. |He |does |not |follow |commands, |but |he |does | moan |periodically. |His |right |arm |is |deformed |and |does |not |respond |to |pressure; |however, |his |left | hand |reaches |purposefully |toward |the |stimulus. |Both |legs |are |stiffly |extended. |His |GCS |score |is: Select |one: a: | 2 b: | 4 c: | 6 d: | 9 e: | 12 |- |answersd: | 9 Which |one |of |the |following |findings |in |an |adult |is |most |likely |to |require |immediate |management | during |the |primary |survey? Select |one: a. distended |abdomen
b. Glasgow |Coma |Scale |score |of | 11 c. temperature |of |36.5°C |(97.8°F) d. deformity |of |the |right |thigh e. respiratory |rate |of | 40 |breaths |per |minute |- |answerse. respiratory |rate |of | 40 |breaths |per |minute A |20-year-old |woman |that |is | 32 |weeks |gestation |, |is |stabbed |in |the |upper |right |chest. |In |the | emergency |department, |her |blood |pressure |is |80/60 |mm |Hg. |She |is |gasping |for |breath, |extremely | anxious, |and |yelling |for |help. |Breath |sounds |are |diminished |in |the |right |chest. |The |most |appropriate | first |step |is |to: Select |one: a. perform |tracheal |intubation b. insert |an |oropharyngeal |airway c. perform |needle |or |finger |decompression |of |the |right |chest d. manually |displace |the |gravid |uterus |to |the |left |side |of |the |abdomen e. initiate |2, |large-caliber |peripheral |IV |lines |and |crystalloid |infusion |- |answersc. perform |needle |or |finger |decompression |of |the |right |chest An |important, |immediate |step |in |the |management |of |an |open |pneumothorax |is: Select |one: a. endotracheal |intubation b.
pulse |volume c. breath |sounds d. pulse |pressure e. jugular |venous |pressure |- |answersc. breath |sounds Bronchial |intubation |of |the |right |or |left |mainstem |bronchus |can |easily |occur |during |infant | endotracheal |intubation |because: Select |one: a. The |trachea |is |relatively |short. b. The |distance |from |the |lips |to |the |larynx |is |relatively |short. c. The |use |of |cuffed |endotracheal |tubes |eliminates |this |issue. d. The |mainstem |bronchi |are |less |angulated |in |their |relation |to |the |trachea. e. So |little |friction |exists |between |the |endotracheal |tube |and |the |wall |of |the |trachea. |- |answersa. The |trachea |is |relatively |short. A |23-year-old |man |sustains | 4 |stab |wounds |to |the |upper |right |chest |during |an |altercation |and |is | brought |by |ambulance |to |a |hospital |that |has |full |surgical |capabilities. |His |wounds |are |all |above |the | nipple. |He |is |endotracheally |intubated, |closed |tube |thoracostomy |is |performed, |fluid |resuscitation |is | initiated |through | 2 |large-caliber |IVs. |FAST |exam |does |not |reveal |intraabdominal |injuries. |His |blood | pressure |now |is |60/0 |mm |Hg, |heart |rate |is | 160 |beats |per |minute, |and |respiratory |rate |is | 14 |breaths | per |minute |(ventilated |with |100% |O2). | 1500 |mL |of |blood |has |drained |from |the |right |chest. |The |most | appropriate |next |step |in |managing |this |patient |is |to Select |one: a.
perform |diagnostic |peritoneal |lavage b. obtain |a |CT |of |the |chest c. perform |an |angiography d. urgently |transfer |the |patient |to |the |operating |room e. immediately |transfer |the |patient |to |a |trauma |center |- |answersd. urgently |transfer |the |patient |to |the |operating |room A |39-year-old |man |is |admitted |to |the |emergency |department |after |an |automobile |collision. |He |is | cyanotic, |has |insufficient |respiratory |effort, |and |has |a |GCS |score |of |6. |His |full |beard |makes |it |difficult | to |fit |the |oxygen |facemask |to |his |face. |The |most |appropriate |next |step |is |to Select |one: a. perform |a |surgical |cricothyroidotomy b. attempt |nasotracheal |intubation c. ventilate |him |with |a |bag-mask |device |until |c-spine |injury |can |be |excluded d. restrict |cervical |motion |and |attempt |orotracheal |intubation |using | 2 |people e. ventilate |the |patient |with |a |bag-mask |device |until |his |beard |can |be |shaved |for |better |mask |fit a. perform |a |surgical |cricothyroidotomy b. attempt |nasotracheal |intubation c.
d. vasodilators |and |heparin e. topical |application |of |silver |sulfadiazine |- |answersa. moist |heat A |32-year-old |man's |right |leg |is |trapped |beneath |his |overturned |car |for |nearly | 2 |hours |before |he |is | extricated. |On |arrival |to |the |emergency |department, |his |right |lower |extremity |is |cool, |mottled, | insensate, |and |motionless. |Despite |normal |vital |signs, |a |pulse |cannot |be |palpated |below |the |right | femoral |artery |and |the |muscles |of |the |lower |extremity |are |firm |and |hard. |During |the |management |of | this |patient, |which |of |the |following |is |most |likely |to |improve |the |chances |for |limb |salvage? Select |one: a. applying |skeletal |traction b. administering |anticoagulant |drugs c. administering |thrombolytic |therapy d. surgical |consultation |for |right |lower |extremity |fasciotomy e. transferring |the |patient |to |the |trauma |center | 120 |km |away |- |answersd. surgical |consultation |for |right |lower |extremity |fasciotomy A |patient |arrives |in |the |emergency |department |after |being |beaten |about |the |head |and |face |with |a | wooden |club. |He |is |comatose |and |has |a |palpable |depressed |skull |fracture. |His |face |is |swollen |and | ecchymotic. |He |has |gurgling |respirations |and |vomitus |on |his |face |and |clothing. |The |most |appropriate | step |after |providing |supplemental |oxygen |and |elevating |his |jaw |is |to: Select |one: a. request |a |CT |scan b. insert |a |gastric |tube
c. suction |the |oropharynx d. obtain |a |lateral |cervical |spine |x-ray e. ventilate |the |patient |with |a |bag-mask |- |answersc. suction |the |oropharynx A |22-year-old |man |sustains |a |gunshot |wound |to |the |left |chest |and |is |transported |to |a |small | community |hospital; |no |surgical |capabilities |are |available. |In |the |emergency |department, |a |chest |tube |is |inserted |and | 700 |mL |of |blood |is |evacuated. |The |trauma |center |accepts |the |patient |in |transfer. |Just |before |the |patient |is |placed |in |the |ambulance |for |transfer, |his |blood |pressure |decreases |to |80/68 | mm |Hg |and |his |heart |rate |increases |to | 136 |beats |per |minute. |The |next |step |should |be |to: Select |one: a. clamp |the |chest |tube b. cancel |the |patient's |transfer c. perform |an |emergency |department |thoracotomy d. repeat |the |primary |survey |and |proceed |with |transfer e. delay |the |transfer |until |the |referring |doctor |can |contact |a |thoracic |surgeon |- |answersd. repeat |the |primary |survey |and |proceed |with |transfer A |64-year-old |man |involved |in |a |high-speed |car |crash, |is |resuscitated |initially |in |a |small |hospital | without |surgical |capabilities. |He |has |a |closed |head |injury |with |a |GCS |score |of |13. |He |has |a |widened | mediastinum |on |chest |x-ray |with |fractures |of |left |ribs | 2 |through |4, |but |no |pneumothorax. |After | initiating |fluid |resuscitation, |his |blood |pressure |is |110/74 |mm |Hg, |heart |rate |is | 100 |beats |per |minute, | and |respiratory |rate |is | 18 |breaths |per |minute. |He |has |gross |hematuria |and |a |pelvic |fracture. |You | decide |to |transfer |this |patient |to |a |facility |capable |of |providing |a |higher |level |of |care. |The |facility |is | 128 |km |(80 |miles) |away. |Before |transfer, |you |should |first: Select |one:
Aspiration |of |bone |marrow |confirms |appropriate |positioning |of |the |needle. c. Intraosseous |infusion |is |the |preferred |route |for |volume |resuscitation |in |small |children. d. Intraosseous |infusion |may |be |utilized |indefinitely. e. Swelling |in |the |soft |tissues |around |the |intraosseous |site |is |not |a |reason |to |discontinue |infusion. |- | answersb. Aspiration |of |bone |marrow |confirms |appropriate |positioning |of |the |needle. A |young |female |sustains |a |severe |head |injury |as |the |result |of |a |motor |vehicle |crash. |In |the | emergency |department, |her |GCS |is |6, |blood |pressure |is |140/90 |mm |Hg, |and |her |heart |rate |is | 80 | beats |per |minute. |She |is |intubated |and |mechanically |ventilated. |Her |pupils |are | 3 |mm |in |size |and | equally |reactive |to |light. |There |is |no |other |apparent |injury. |The |most |important |principle |to |follow |in | the |early |management |of |her |head |injury |is |to: Select |one: a. avoid |hypotension b. administer |an |osmotic |diuretic c. aggressively |treat |systemic |hypertension d. reduce |metabolic |requirements |of |the |brain e. distinguish |between |intracranial |hematoma |and |cerebral |edema |- |answersa. avoid |hypotension A |33-year-old |female |is |involved |in |a |head-on |motor |vehicle |crash. |It |took | 30 |minutes |to |extricate |her |from |the |car. |Upon |arrival |in |the |emergency |department, |her |heart |rate |is | 120 |beats |per |minute, |BP | is |90/70 |mm |Hg, |respiratory |rate |is | 16 |breaths |per |minute, |and |her |GCS |score |is |15. Examination |reveals |bilaterally |equal |breath |sounds, |anterior |chest |wall |ecchymosis, |and |distended | neck |veins. |Her |abdomen |is |flat, |soft, |and |not |tender. |Her |pelvis |is |stable. |Palpable |distal |pulses |are | found |in |all | 4 |extremities. |Of |the |following, |the |most |likely |diagnosis |is:
Select |one: a. hemorrhagic |shock b. cardiac |tamponade c. massive |hemothorax d. tension |pneumothorax e. diaphragmatic |rupture |- |answersb. cardiac |tamponade A |hemodynamically |normal |10-year-old |girl |is |hospitalized |for |observation |after |a |Grade |III | (moderately |severe) |splenic |injury |has |been |confirmed |by |computed |tomography |(CT). |Which |of |the | following |mandates |prompt |celiotomy |(laparotomy)? Select |one: a. a |serum |amylase |of | 200 b. a |leukocyte |count |of |14, c. evidence |of |retroperitoneal |hematoma |on |CT |scan d. development |of |peritonitis |on |physical |exam e. a |fall |in |the |hemoglobin |level |from | 12 |g/dL |to | 8 |g/dL |over | 24 |hours |- |answersd. development |of |peritonitis |on |physical |exam A |40-year-old |woman |who |was |a |restrained |driver |in |a |motor |vehicle |crash |is |evaluated |in |the | emergency |department. |She |is |hemodynamically |normal |and |found |to |be |paraplegic |at |the |level |of | T10. |Which |of |the |following |are |true |regarding |her |evaluation |and |management?
a. It |is |not |reliable. b. The |body |is |proportionally |larger |in |infants |than |in |adults. c. The |head |is |proportionally |larger |in |infants |than |in |adults. d. The |legs |are |proportionally |larger |in |infants |than |in |adults. e. The |arms |are |proportionally |larger |in |infants |than |in |adults. |- |answersc. The |head |is |proportionally |larger |in |infants |than |in |adults. A |healthy |young |male |is |brought |to |the |emergency |department |following |a |motor |vehicle |crash. |His | vital |signs |are |a |blood |pressure |of |84/60, |pulse |123, |GCS |10. |The |patient |moans |when |his |pelvis |is | palpated. |After |initiating |fluid |resuscitation, |the |next |step |in |management |is: Select |one: a. placement |of |a |pelvic |binder b. transfer |to |a |trauma |center c. pelvic |x-ray d. insert |urinary |catheter e. repeat |examination |of |pelvis |- |answersa. placement |of |a |pelvic |binder Which |situation |requires |Rh |immunoglobulin |administration |to |an |injured |female? Select |one: a.
negative |pregnancy |test, |Rh |negative, |and |has |torso |trauma b. positive |pregnancy |test, |Rh |positive, |and |has |torso |trauma c. positive |pregnancy |test, |Rh |negative, |and |has |torso |trauma d. positive |pregnancy |test, |Rh |positive, |and |has |an |isolated |wrist |fracture e. positive |pregnancy |test, |Rh |negative, |and |has |an |isolated |wrist |fracture |- |answersc. positive |pregnancy |test, |Rh |negative, |and |has |torso |trauma A |22-year-old |female |athlete |is |stabbed |in |her |left |chest |at |the |third |interspace |in |the |anterior |axillary |line. |On |admission |to |the |ED |and | 15 |minutes |after |the |incident, |she |is |awake |and |alert. |Her |heart | rate |is | 100 |beats |per |minute, |blood |pressure |is |80/60 |mm |Hg, |and |respiratory |rate |is | 20 |breaths |per | minute. |A |chest |x-ray |reveals |a |large |left |hemothorax. |A |left |chest |tube |is |placed |with |an |immediate | return |of | 1600 |mL |of |blood. |The |next |management |step |for |this |patient |is |to: Select |one: a. perform |a |thoracoscopy b. perform |an |arch |aortogram c. insert |a |second |left |chest |tube d. prepare |for |an |exploratory |thoracotomy e. perform |a |chest |CT |- |answersd. prepare |for |an |exploratory |thoracotomy A |6-year-old |boy |walking |across |the |street |is |struck |by |the |front |bumper |of |a |sports |utility |vehicle | traveling |at | 32 |kph |(20 |mph). |Which |one |of |the |following |statements |is |TRUE |about |this |patient? Select |one:
