What is NELS? (The Question Everyone Asks First!)

NELS stands for National Emergency Life Support – India’s groundbreaking initiative that revolutionized how medical professionals handle emergency situations. Think of NELS as the “Swiss Army Knife” of emergency medicine training – it combines multiple specialized tools into one powerful, comprehensive system that every Indian medical professional can master.

Interactive Scenario-Based Mock Tests

Test your real-world emergency response skills with our comprehensive online mock tests designed specifically for NELS certification. Our platform features realistic patient scenarios including cardiac arrests, trauma cases, and multi-system emergencies – exactly what you’ll encounter in actual practice. With instant feedback on each decision you make, you’ll understand not just what the correct answer is, but why it matters for patient survival. Perfect for doctors and paramedics preparing to clear their NELS exam with confidence!

NELS Mock Test

1 / 12

: Which three domains of learning, often referred to as the 'Three H's', are depicted by the Logo of the National Emergency Life Support (NELS) course?

1) Head, Hands, Heart

2) Hypovolemia, Hypoxia, Hypothermia

3) History, Hypoxia, Heart

4) Haemodynamics, Hypoxia, Hypovolemia

Explanation: The logo of the National Emergency Life Support (NELS) course depicts the three domains of learning known as the 'Three H's'. These domains are Head for cognitive skills (knowledge/mental skills), Hands for psychomotor skills (manual or physical skills), and Heart for affective skills (feeling/emotional or attitude). Acquiring all three domains in equal proportion is considered essential for a health care giver to provide the best care to patients.

2 / 12

What primary motivation led to the development of the economically viable NELS course relevant to the Indian scenario?

1) To focus solely on cardiac arrest situations.

2) To replace the Advanced Trauma Life Support (ATLS) course entirely.

3) To provide comprehensive life-saving skills training for all types of emergencies, unlike existing international courses that focus narrowly

4) To decrease the cost of emergency training.

Explanation: The need for NELS arose because existing international training courses like BLS and ACLS are mainly relevant for cardiac problems or cardiac arrest situations, and ATLS is focused solely on trauma victims. These courses fail to train in comprehensive life-saving skills required to manage all types of emergencies in an Emergency Department (ED). Additionally, the NELS course was designed to be economically viable and relevant to the Indian scenario, providing a comprehensive training tool for front-line medical care providers.

3 / 12

Which component of the Glasgow Coma Scale (GCS) is considered the most important component and is predictive of patient outcome?

1) Eye opening response

2) Verbal response

3) Motor response

4) Pupillary response

Explanation: The Glasgow Coma Scale (GCS) is a rapid assessment method with three components: Eye (E), Verbal (V), and Motor (M) response. While all components are assessed, the motor response component is the most important of the three and is predictive of patient outcome. The best motor response should be elicited by applying painful stimulus on the head and neck region (such as supraorbital notch or sternal pressure) and observing arm movement.

4 / 12

What is the mandatory priority sequence for initial assessment and management in all critically ill or injured patients according to the NELS approach?

1) Circulation, Airway, Breathing, Disability (CABD)

2) Airway, Breathing, Circulation, Disability, Exposure (ABCDE)

3) Diagnosis, Assessment, Management, Transfer

4) History, Examination, Investigation, Treatment

Explanation: The NELS approach includes a continuous circle of assessment and action using the sequence A (Airway), B (Breathing), C (Circulation), D (Disability/Neurological), and E (Exposure & Environment) to find and treat life-threatening conditions. The priority for initial assessment and management, in all patients, must adhere to the ABCD principle. The NELS approach advocates for the rapid and simultaneous application of this sequence without delay to correct physiological derangement.

5 / 12

What Glasgow Coma Scale (GCS) score is generally an indication for placing a definitive airway to protect against aspiration or maintain patency?

1) GCS less than 15

2) GCS less than 12

3) GCS less than 9

4) GCS less than 5

Explanation: A definitive airway, such as a cuffed Endotracheal tube or cricothyroidotomy tube, may be required for airway patency and airway protection. The airway must be protected in patients with absent airway reflexes or decreased level of consciousness. Specifically, one of the key indications listed for placing a definitive airway is a Glasgow Coma Scale (GCS) score of less than 9.

6 / 12

In a patient presenting with severe head injury and hypotension/haemorrhagic shock, what is the most important associated principle to remember regarding the cause of hypotension?

1) Hypotension is solely caused by the isolated head injury.

2) Hypotension is very rarely caused by isolated head injury, and other associated injuries should always be ruled out as the primary cause.

3) Hypotension indicates inevitable brain death

4) Hypotension should be treated with glucose containing fluids immediately.

Explanation: A crucial principle in managing head trauma is that hypotension or hemorrhagic shock is very rarely caused by isolated head injury. Therefore, if a head-injured patient presents with hypotension, other associated systemic injuries must always be actively ruled out, as they are typically responsible for the circulatory compromise. Prompt management of hypotension and hypoxia is essential to prevent secondary brain injury.

7 / 12

Shock results from inadequate tissue perfusion leading to an imbalance between oxygen delivery and requirement. This inadequacy causes the body to shift primarily to what type of metabolism?

1) Aerobic metabolism

2) Gluconeogenesis

3) Ketogenesis

4) Anaerobic metabolism

Explanation: Shock is fundamentally defined as inadequate tissue perfusion. When tissue hypoperfusion occurs, there is insufficient oxygen supply to meet cellular demands. Consequently, the body shifts from efficient aerobic metabolism to anaerobic metabolism, which results in the production and intracellular accumulation of lactic acid, leading to acidosis. If this state is not promptly corrected, cellular dysfunction progresses to organ failure and potentially death.

8 / 12

A patient presents with a Peri-arrest Tachycardia rhythm (HR > 100 bpm) and is hemodynamically unstable (e.g., hypotension, shock, chest pain). What immediate intervention is required?

1) Vagal maneuver

2) IV adenosine

3) Synchronized Cardioversion

4) Observe and monitor

Explanation: In managing peri-arrest arrhythmias, the presence of danger signs such as shock, acutely altered mental status, chest pain, hypotension, or acute heart failure indicates that the patient is unstable and requires urgent intervention. For an unstable patient presenting with tachycardia (heart rate over 100 bpm), the required urgent specific management is Synchronized Cardioversion.

9 / 12

In trauma patients with suspected pelvic injury, what caution must be observed regarding urinary tract procedures if blood is found at the external urethral meatus?

1) Immediate Foley catheterization is required

2) Never catheterize the patient until a urethral injury is excluded.

3) Perform retrograde urethrography immediately followed by Foley catheter insertion.

4) Urinary catheterization is safe as long as the patient is unstable.

Explanation: When assessing a trauma patient with a suspected urethral injury (indicated by blood at the external urethral meatus or perineal ecchymosis), catheterization must never be performed. Catheterization in this situation can cause further damage to the urethra. Once a urethral injury is ruled out, urinary catheterization can be performed to monitor urine output and haematuria.

10 / 12

When should high-flow oxygen be initiated in critically ill patients, and what is the target oxygen saturation (SpO2) in acute situations?

1) Only after diagnosis is confirmed, targeting 90-92%.

2) Must be started at the earliest possible, aiming for the maximum percentage of oxygen initially, and later de-escalated to keep SpO2 above 94%.

3) Only if SpO2 drops below 85%.

4) Only via nasal prongs at 1 L/min.

Explanation: High-flow oxygen must be started in all critically ill patients at the earliest possible opportunity. In the acute situation, oxygen should be given at the maximum percentage available to the patient. Once the acute phase is stabilized, oxygen percentage is de-escalated to keep the Oxygen saturation (SpO2) at more than 94%. The initial priority is to correct hypoxemia, as hypoxia presents a greater threat to life than hypercapnia.

11 / 12

To diagnose STEMI (ST Elevation MI), what magnitude of ST elevation is generally required in two contiguous leads, according to ACC/AHA definition (excluding V2 and V3 in specific groups)?

1) 0.5

2) 1

3) 1.5

4) 2

Explanation: STEMI is diagnosed based on sustained chest pain suggestive of myocardial infarction alongside acute ST segment elevation found on the ECG. The diagnostic criterion generally requires 1 mm of ST elevation in 2 contiguous leads. Notable exceptions to this rule exist for specific leads and demographics, particularly regarding V2 and V3, where 2 mm or 2.5 mm of elevation may be required, or 1.5 mm for women.

12 / 12

Which of the following oxygen administration devices is classified as a 'fixed performance device' according to the sources?

1) Simple face mask

2) Nasal prongs

3) Non-rebreather mask

4) Venturi mask

Explanation: Oxygen administration devices are classified as variable or fixed performance devices. Variable performance devices, such as nasal prongs, simple face masks, and non-rebreathing masks, vary the inspired oxygen concentration (FiO2) with the phase and pattern of respiration. Fixed performance devices, like the Venturi mask and Bag Valve Mask (BVM) device, are patient-independent and deliver a constant, predetermined inhaled oxygen percentage.

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Your score is

The average score is 70%

ATLS(Advanced Trauma Life Support)

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1 / 10

Which airway maneuver should be avoided if cervical spine injury is suspected?

jaw thrust

Head tilt & chin lift

Oropharyngeal airway

Nasopharyngeal airway

Avoiding head tilt–chin lift

Suspected cervical spine injury changes airway strategy.
Head tilt–chin lift may worsen spinal cord injury and is avoided.
The jaw thrust maneuver is preferred in these patients.
This preserves airway patency while minimizing neck movement.
Protecting the spine remains a simultaneous priority.

It is crucial for safe airway management in trauma

2 / 10

Target systolic blood pressure during permissive hypotension in trauma is:

90-110 mm Hg

80-100 mm Hg

100-120 mm Hg

70-100 mm Hg

Permissive hypotension

Target systolic blood pressure is 80–100 mmHg initially.
This is maintained until major bleeding is controlled.
The strategy preservesusion without dislodging clots.
Excessive fluids can worsen hemorrhage, so they are restrained.
It is especially relevant in active bleeding scenarios.
The aim is balance: adequate flow with minimal rebleeding risk.

3 / 10

A patient requires activation of the Massive Transfusion Protocol (MTP) due to uncontrolled hemorrhage. According to ATLS guidelines for damage control resuscitation, what is the target ratio for the administration of blood products (Packed Red Blood Cells : Fresh Frozen Plasma : Platelets)?

1:2:1

1:1:1

1:1:2

2:1:1

Massive transfusion protocols

A 1:1:1 ratio of PRBC:FFP:Platelets is recommended.
This aims to rapidly restore hemostatic balance during hemorrhage.
Early correction of coagulopathy is a central goal.
Balanced resuscitation correlates with improved survival.
Protocols focus on speed and coordinated delivery of products.
It is a cornerstone strategy in severe bleeding control.

4 / 10

A motor vehicle crash victim presents in the ED with severe shortness of breath, marked tachypnea, absent breath sounds on the right hemithorax, and tracheal shifting to the left. Which life-saving intervention must be performed immediately, even before obtaining a Chest X-ray, based on core ATLS principles?

Chest tube insertion

Needle thoracostomy

Occlusive dressing

mechanical dressing

Explanation: The presentation of absent breath sounds, tachypnea, and tracheal deviation is highly suggestive of a tension pneumothorax, which is an immediate life threat identified during the Breathing assessment (B). ATLS emphasizes identifying life-threatening conditions and performing necessary interventions as soon as possible, without waiting for confirmatory investigations. For a tension pneumothorax, the management is immediate needle decompression (needle thoracostomy). Other interventions, like chest tube insertion, are used for conditions like massive hemothorax.

5 / 10

Which imaging is performed during the primary survey?

Whole Body CT

Abdominal USG

X ray chest

CT thorax

Primary survey imaging

Chest X-ray is performed during the primary survey.
It screens for immediate threats like tension pneumothorax.
Massive hemothorax is another critical target finding.
Early imaging enables prompt, life-saving interventions.
Results provide real-time guidance for decision-making.

It supports rapid, directed resuscitation efforts.

6 / 10

Scenario: A 35 y male patient presented with with suspected pelvic fractures after high-energy trauma. his airway is clear, RR- 18/min, b/l vesicular breath sounds, BP-90/70mm Hg, What is the appropriate initial intervention to control potential pelvic bleeding?

Surgical intervention

Pelvic binder

Torniquet

Internal artery ligation

Pelvic binder purpose

A binder stabilizes pelvic fractures promptly.
Stabilization helps control hemorrhage from the pelvis.
Rapid application reduces ongoing blood loss.
Improved hemodynamic stability is a key benefit.
It is integrated early in trauma protocols.
The device is a critical adjunct in pelvic injury.

7 / 10

The first ATLS course was developed in response to:

Car accident

Plane crash

natural disaster

nuclear disaster

The ATLS course was developed by initiation of Dr. James Styner, after he had plane crash while flying his own chartered plane . The plane crashed in Nebraska leading to death of his wife and serious injurirs to his 4 children. The kind of facility he saw at community hospital Nebraska led him to think about developing a course for uniform trauma management guidelines

8 / 10

Which parameter is emphasized for assessing hypovolemic shock in the latest ATLS guidance?

Heart rate

Shock Index

Blood pressure

Amount of blood loss

Hypovolemic shock assessment

Current guidance emphasizes using the Shock Index alongside vital signs.
The Shock Index offers a quick view of hemodynamic compromise.
It supports decisions about fluid resuscitation and transfusion needs.
Combining SI with standard vitals increases precision.
This approach refines early triage and management in trauma.
It aligns with more targeted, data-informed resuscitation.

9 / 10

A 72-year-old male on chronic beta-blockers presents after a severe fall. His initial vital signs are HR 80 bpm and BP 110/70 mmHg. He is pale and confused. The trauma team suspects significant internal hemorrhage, but his traditional heart rate is not tachycardic due to his medication. Based on the 11th edition ATLS recommendations for assessing occult shock, which calculation derived from his vitals should guide the urgency of fluid/blood resuscitation?

Mean arterial pressure >65 mm Hg

Shock Index

GCS Trend with Blood pressure

amount of blood loss

Explanation: The 11th edition of ATLS recommends using the Shock Index (SI) and Pulse Pressure (PP) as key metrics to assess the degree of hypovolemic shock, especially when traditional vital signs might be masked or deceptive. Since this patient is on beta-blockers, his heart rate (80 bpm) is artificially suppressed and may not accurately reflect his circulatory stress. The calculation of the SI (80/110 = 0.73) allows for a more sensitive and immediate assessment of the patient's physiological state than relying on the single, potentially unreliable, heart rate or blood pressure measurements alone. While pulse pressure is also a recommended metric, the SI (HR divided by SBP) provides a quick ratio emphasizing the relationship between heart rate compensation and arterial pressure, making it a critical tool for determining transfusion requirements early in the assessment.

10 / 10

Scenario: A pregnant patient is brought after a car crash. What is the most critical initial management step?

Maternal stabilization

Fetal monitoring

Immediate Caesarian

immediate Transfer to specialist facility

Maternal stabilization is the priority in a pregnant trauma patient because maternal health directly determines fetal outcomes. Initial management focuses on ensuring adequate airway, breathing (high-flow oxygen), and circulation (maintaining blood pressure and readiness for resuscitation). Once the mother is stable, continuous fetal monitoring should be started to assess fetal well-being. Positioning the patient in the left lateral decubitus position helps prevent supine hypotensive syndrome and improves venous return. Early involvement of obstetrics is important, especially in severe trauma, to guide decisions affecting both mother and fetus. Prompt, coordinated care that prioritizes the mother can greatly improve outcomes for both patients.

Your score is

The average score is 84%

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ATLS protocol

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Advanced Tramua Life Support (ATLS) 2

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1 / 10

According to ATLS guidelines, when should the Secondary Survey—the detailed head-to-toe evaluation and patient history—begin?

Immediately upon patient arrival to the emergency department

Simultaneously with the Primary Survey as time permits.

After the Primary Survey is completed and the patient is hemodynamically stable or responding to resuscitation.

Only after all imaging adjuncts, including CT scans, are finalized.

The Secondary Survey begins only after the Primary Survey is complete and immediate life threats have been managed,,. It should proceed only when the patient is hemodynamically stable or shows a sustained response to initial resuscitation,. If the patient's condition deteriorates during the Secondary Survey, the clinician must immediately revert to repeating the Primary Survey,.

2 / 10

The first ATLS course was developed in response to:

Car accident

Plane crash

natural disaster

nuclear disaster

3 / 10

Which diagnostic tool is routinely included in the Primary Survey (or its adjuncts) specifically because it rapidly identifies an obstructive cause of shock?

Chest X-ray (CXR)

Focused Assessment with Sonography for Trauma (FAST) exam.

. Diagnostic Peritoneal Lavage (DPL).

Computed Tomography (CT) scan.

The FAST exam is an adjunct often performed during the Primary Survey (C) and resuscitation,. FAST is extremely helpful because it rapidly detects pericardial fluid, which indicates potential cardiac tamponade, an obstructive cause of shock,. Since the primary survey focuses on diagnosing immediate life threats, FAST's ability to identify pericardial tamponade makes it a critical tool in this phase,.

4 / 10

The Exposure and Environmental Control (E) phase of the Primary Survey includes implementing measures to prevent which condition that exacerbates coagulopathy and acidosis, forming the lethal trauma triad?

Hyperthermia

Hypothermia

Neurogenic Shock

Respiratory alkalosis

The Exposure and Environmental Threats phase requires implementing measures to prevent hypothermia,. Hypothermia, defined as a core temperature < 35 degree Celsius is a critical component of the trauma "lethal triad," alongside acidosis and coagulopathy,. Prevention of hypothermia is paramount because core body temperatures below 35 degree Celsius inhibit the coagulation cascade, making hemorrhage control significantly more challenging,.

5 / 10

What is the appropriate management strategy if a patient with an extremity tourniquet remains hemodynamically normal after the Primary Survey is complete?

. Immediately remove the tourniquet and check the limb viability.

Keep the tourniquet in place and proceed immediately to the operating room for definitive repair.

Assess the need for tourniquet conversion during the Secondary Survey once the patient is adequately resuscitated.

Give intravenous vasodilators to counteract peripheral ischemia.

Following completion of the Primary Survey and confirmation of adequate resuscitation, the deliberate process of exchanging a tourniquet for another method of hemorrhage control (tourniquet conversion) is performed during the Secondary Survey. Tourniquets are typically left in place until the patient is hemodynamically stable. If the tourniquet has been in place for less than 2 hours, the risk of amputation or adverse events is not increased.

6 / 10

Which anatomical location of hemorrhage is typically not included in the "four and the floor" mnemonic for potential sources of major blood loss identified during the Primary Survey (C)?

Pelvic/Retroperitoneal space

Thoracic cavity

Intracranial cavity

Long bones

The "four and the floor" mnemonic assists clinicians in recalling the most common life-threatening locations for hemorrhage: the chest (thoracic cavity), the peritoneal cavity (abdomen), the retroperitoneum/pelvis, and long bone fracture sites (muscle compartments/subcutaneous tissue),,. External hemorrhage ("the floor") accounts for the fifth site,. Bleeding in the brain parenchyma/intracranial cavity rarely causes systemic hemorrhagic shock unless the patient is a young infant with open cranial sutures,.

7 / 10

In the Circulation (C) phase of the Primary Survey, which combination of findings strongly suggests a patient is progressing toward decompensated shock, even if initial blood pressure appears relatively stable?

Bradycardia and warm extremities

Anxiety, tachycardia, and cool, clammy skin.

Normal heart rate and normal blood pressure.

. Absent peripheral pulses and normal urine output.

Physiologic compensation to blood loss begins with progressive vasoconstriction of cutaneous, muscular, and visceral circulation. Tachycardia and cutaneous vasoconstriction (resulting in cool, clammy skin) are the initial physiologic responses and the earliest measurable signs of hypovolemia,,. An injured patient exhibiting cool skin and tachycardia should be presumed to be in shock until proven otherwise.

8 / 10

During the Breathing (B) phase of the Primary Survey, which condition must be identified and treated immediately because it compromises both ventilation and circulation, leading to obstructive shock?

Simple hemothorax.

Massive pulmonary contusion

Flail chest

Tension pneumothorax

Tension pneumothorax is a life-threatening injury that must be identified during the Breathing phase of the Primary Survey. This condition causes obstructive shock by acutely compromising ventilation while also impairing venous return to the right heart due to increased intrathoracic pressure,,. Prompt chest decompression is required to restore both ventilatory and circulatory function,.

9 / 10

What is the primary rationale for the ATLS 11th Edition expanding the initial assessment mnemonic from ABCDE to xABCDE?

To mandate cervical spine clearance before airway evaluation.

To emphasize that traumatic brain injury (TBI) prevention precedes breathing assessment.

To prioritize rapid control of exsanguinating external hemorrhage before initiating airway maneuvers.

The central tenet of ATLS is to treat the greatest threat to life first,. The inclusion of 'x' for eXsanguinating external hemorrhage acknowledges that rapid control of massive, compressible bleeding is often the most immediate threat to life,. Military and civilian research supported adopting this approach, placing immediate hemorrhage control interventions ahead of traditional airway maneuvers in appropriate clinical contexts,,. These life-saving bleeding control interventions should be initiated immediately upon patient arrival and generally take only seconds to perform.

10 / 10

Target systolic blood pressure during permissive hypotension in trauma is:

90-110 mm Hg

80-100 mm Hg

100-120 mm Hg

70-100 mm Hg

Permissive hypotension

Target systolic blood pressure is 80–100 mmHg initially.
This is maintained until major bleeding is controlled.
The strategy preservesusion without dislodging clots.
Excessive fluids can worsen hemorrhage, so they are restrained.
It is especially relevant in active bleeding scenarios.
The aim is balance: adequate flow with minimal rebleeding risk.

Your score is

The average score is 80%

What is NELS? (The Question Everyone Asks First!)

Interactive Scenario-Based Mock Tests

The Ultimate Guide to NELS: India's Revolutionary Emergency Life Support Training

ATLS protocol

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