Quiz 4: Trauma and Trauma Systems
Nursing
Q 1Q 1
The purpose of determining the mechanism of injury and the index of suspicion for the trauma patient at the same time is to allow you to:
A) decide whether to transport the patient.
B) identify comorbid factors.
C) document a complete scene size-up.
D) anticipate your patient's injuries.
Free
Multiple Choice
D
Q 2Q 2
Which of the following accounts for the highest number of trauma deaths in the United States of America?
A) Motor vehicle crashes
B) Falls
C) Assaults
D) Firearms injuries
Free
Multiple Choice
A
Q 3Q 3
Which of the following acts resulted in the development of modern EMS systems?
A) Ryan White Act
B) Highway Safety Act of 1966
C) Good Samaritan Act
D) The Trauma Care Systems Planning and Development Act of 1990
Free
Multiple Choice
B
Q 4Q 4
In addition to handling all types of specialty trauma, which level of trauma center provides continuing medical and public education programs?
A) IV
B) III
C) I
D) II
Free
Multiple Choice
Q 5Q 5
Upon arriving on a scene where the mechanism of injury indicates a potentially life-threatening injury, you should employ which of the following interventions to best help deliver the care that is needed?
A) Reevaluate the scene size-up.
B) Initiate transport immediately, delaying more extensive care until you are en route.
C) Ask a surgeon to respond to the scene.
D) Call immediately for air medical transport to reduce the "Golden Period."
Free
Multiple Choice
Q 6Q 6
Which of the following physical findings indicates the need for immediate transport?
A) Vital signs: systolic blood pressure 80, respiratory rate 8
B) Glasgow Coma Scale score of 15
C) Second-degree burns involving 9 percent of total body surface area in an adult patient
D) Fractured right femur
Free
Multiple Choice
Q 7Q 7
Which of the following requires immediate transport to a trauma center?
A) A 40-year-old who fell 12 feet from a garage roof with a radius fracture
B) A 36-year-old woman in a motor vehicle crash who has a blood pressure of 100/60
C) A 22-year-old soccer player with lower leg pain
D) A 47-year-old involved in a motor vehicle crash that resulted in the death of his passenger
Free
Multiple Choice
Q 8Q 8
As a paramedic, your role in trauma care consists of all of the following, EXCEPT:
A) providing rapid transport to appropriate facilities.
B) promoting injury prevention.
C) providing care to seriously injured trauma patients.
D) providing surgical interventions to stop hemorrhage.
Free
Multiple Choice
Q 9Q 9
Trauma triage criteria application, field skill performance, response times, patient assessment, patient care and transport are all monitored through which of the following?
A) Quality improvement
B) Trauma registry
C) Centers for Disease Control and Prevention
D) Public healthcare model
Free
Multiple Choice
Q 10Q 10
Which of the following is the best definition of the Golden Period?
A) The ideal time it takes to assess a multi-system trauma patient
B) The ideal timeframe from time of injury until surgery
C) The ideal time from requesting a helicopter to it landing on scene
D) The ideal timeframe from call dispatch to arrival on scene
Free
Multiple Choice
Q 11Q 11
Which of the following is NOT an example of trauma?
A) An abrasion to the knee
B) Chest pain
C) Cerebral contusion
D) A stab wound to the abdomen
Free
Multiple Choice
Q 12Q 12
Establishment of educational programs and improved auto technology are examples of which part of the public health model?
A) Surveillance
B) Risk identification
C) Intervention
D) Implementation
Free
Multiple Choice
Q 13Q 13
Which level of trauma facility has minimal surgical support but can stabilize before transferring to a higher-level trauma facility?
A) III
B) II
C) IV
D) I
Free
Multiple Choice
Q 14Q 14
Which of the following statements about trauma is FALSE?
A) Life-threatening injuries may exist with little external evidence.
B) Dramatic-appearing extremity injuries draw the paramedic's focus away from life-threatening injuries.
C) Life-threatening injury occurs in less than 10 percent of trauma patients.
D) Most patients with life-threatening trauma will have sustained external injury to the extremities (arms/legs).
Free
Multiple Choice
Q 15Q 15
The leading cause of death in people under age 44 is:
A) heart attack.
B) trauma.
C) cancer.
D) cardiovascular disease.
Free
Multiple Choice
Q 16Q 16
Which of the following patients is NOT a candidate for air medical transport?
A) Combative trauma patient
B) Seriously injured patient with cardiac tamponade
C) Patient with prolonged extrication time
D) Burn patient with over 50 percent second-degree burns
Free
Multiple Choice
Q 17Q 17
Which of the following trauma patients would be classified as "stable"?
A) Patient with facial burns and associated hoarseness and stridor
B) Patient who is unconscious, with no ventilations and no pulse
C) Patient with controlled bleeding from a laceration to the right forearm from a glass cut
D) Patient with closed, bilateral femur fractures but adequate ventilations
Free
Multiple Choice
Q 18Q 18
Modern medicine treats trauma as a:
A) crisis.
B) disease.
C) life threat.
D) medical problem.
Free
Multiple Choice
Q 19Q 19
A trauma center that has surgical care capability available at all times and can handle all but the most seriously injured specialty and multisystem trauma patients is a Level ________ trauma center.
A) III
B) I
C) IV
D) II
Free
Multiple Choice
Q 20Q 20
Which of the following is the best, most cost-effective way for EMS personnel to help reduce trauma-related morbidity and mortality?
A) Participate in injury prevention programs.
B) Keep up to date on trauma management knowledge and skills.
C) Transport all trauma patients to a trauma center.
D) Provide complete patient care reports so that accurate data can be entered into the trauma registry.
Free
Multiple Choice
Q 21Q 21
Which level of trauma facility strictly stabilizes trauma patients and prepares to transport, often by helicopter, to a more distant and higher-level trauma center?
A) I
B) II
C) IV
D) III
Free
Multiple Choice
Q 22Q 22
Which of the following mechanisms would yield the greatest index of suspicion for serious injury?
A) Helmeted bicyclist losing control and falling off his bike onto a grassy surface at 15 miles per hour
B) Adult falling 5 feet from a ladder and landing in the mud
C) Seventy-mile-per-hour motor vehicle crash with partial ejection
D) Pedestrian struck by a car travelling 5 miles/hour
Free
Multiple Choice
Q 23Q 23
Which level of trauma facility can provide neurosurgery, microsurgery, and care for multisystem trauma?
A) III
B) II
C) I
D) IV
Free
Multiple Choice
Q 24Q 24
Which of the following patients does NOT require specialty-center capabilities beyond that offered by a trauma center?
A) A 67-year-old with second- and third-degree burns over 50 percent of the body
B) A 25-year-old with amputation of three fingers
C) A 4-year-old with a closed-head injury
D) A 22-year-old with bilateral open femur fractures
Free
Multiple Choice
Q 25Q 25
Which of the following best differentiates medical and trauma patient assessment?
A) There is no concept for "medical load and go" patients.
B) Trauma triage guidelines are not critical with medical patients.
C) Scene safety is not an issue with the medical patient.
D) Assessing breath sounds is not crucial to trauma assessment.
Free
Multiple Choice
Q 26Q 26
Which of the following is the only way to determine which patient care procedures benefit trauma patients?
A) Surveillance
B) Risk identification
C) Implementation
D) Evaluation
Free
Multiple Choice
Q 27Q 27
Which of the following is an acceptable way of reducing prehospital time to maximize the use of the "Golden Period" for trauma patients?
A) Skip spinal immobilization in the blunt trauma patient.
B) Start all IVs on the scene to allow for more rapid transport.
C) Load the patients and begin transport before doing a primary assessment.
D) Call for air medical transport, if indicated.
Free
Multiple Choice
Q 28Q 28
Which of the following is a "mental summation of suspected injuries based on the event analysis"?
A) Index of injury
B) Index of suspicion
C) Newton's First Law of Motion
D) Mechanism of injury
Free
Multiple Choice
Q 29Q 29
You assess a trauma patient who has an airway that cannot be maintained or secured. How should this patient be classified?
A) Critical
B) Unstable
C) Potentially unstable
D) Stable
Free
Multiple Choice
Q 30Q 30
According to the Haddon Matrix, which of the following would be a pre-event host factor affecting the risk for injury in a vehicle collision?
A) Level of EMS providers responding to the scene
B) Presence of crash barriers near bridge abutments
C) Texting and/or talking on a cellphone while driving
D) Advanced automatic collision notification
Free
Multiple Choice
Q 31Q 31
Vehicle supplemental restraint systems (air bags) are meant to:
A) prevent unrestrained occupants from taking the down-and-under pathway in frontal impacts.
B) protect infants and children who ride in the front seat of the vehicle.
C) prevent injury from secondary impacts.
D) absorb the energy exchange of rapid deceleration.
Free
Multiple Choice
Q 32Q 32
When assessing a patient with a crush injury, which of the following findings would indicate that toxins have entered the central circulation?
A) Hot, red skin
B) Increased urine output
C) Cardiac arrhythmia
D) Central hyperventilation syndrome
Free
Multiple Choice
Q 33Q 33
People in which of the following age groups are prone to significant trauma due to falls?
A) College-aged adults
B) Geriatric population
C) Pediatric population
D) Teenagers
Free
Multiple Choice
Q 34Q 34
Which of the following is NOT a complication of crush injury?
A) Renal failure
B) Difficult-to-control hemorrhage
C) Cardiac arrhythmias
D) Systemic alkalosis
Free
Multiple Choice
Q 35Q 35
The two factors that refer to the rate of change of speed are:
A) deceleration and velocity.
B) mass and weight.
C) acceleration and deceleration.
D) acceleration and inertia.
Free
Multiple Choice
Q 36Q 36
Which of the following injuries is MOST likely in a rear-end collision?
A) Thoracic and abdominal injuries
B) Head and neck injuries
C) Pelvic fractures
D) Lumbar spine injuries
Free
Multiple Choice
Q 37Q 37
You are called to the scene of a vehicle crash in which a car was rear-ended while stopped at a stop sign. Which of the following laws of physics serves as the basis for analyzing the mechanism of injury and the associated index of suspicion for injuries?
A) The amount of energy transmitted to an object is inversely proportional to its rate of deceleration.
B) Energy can neither be created nor destroyed.
C) A body at rest will remain at rest unless acted on by an outside force.
D) A body in motion will remain in motion unless acted on by an outside force.
Free
Multiple Choice
Q 38Q 38
When a patient falls, which section of the spinal column is the most prone to compression injury?
A) Sacral
B) Cervical
C) Thoracic
D) Lumbar
Free
Multiple Choice
Q 39Q 39
Which of the following injuries is NOT associated with the use of vehicle restraint systems?
A) Traumatic brain injury
B) Abrasions and contusions to the clavicle and chest area
C) Lumbar spine trauma
D) Abdominal injury
Free
Multiple Choice
Q 40Q 40
Applying Newton's second law of motion to a vehicle traveling 70 miles per hour, crashing into which of the following would transfer the most force to the patient?
A) Bridge abutment
B) Shrubbery
C) A body of water
D) Signpost
Free
Multiple Choice
Q 41Q 41
Which of the following is TRUE of the differences between adult and pediatric pedestrians when struck by a vehicle?
A) Adults tend to be thrown under the vehicle.
B) Children tend to be thrown onto the hood of the vehicle.
C) Children tend to be thrown under the vehicle.
D) Adults tend to have injuries higher on the body.
Free
Multiple Choice
Q 42Q 42
Which of the following is MOST likely to be fractured from a fall onto outstretched hands?
A) Carpals
B) Metacarpals
C) Clavicle
D) Ulna
Free
Multiple Choice
Q 43Q 43
Your patient, a 23-year-old woman who is 6 months pregnant, was the unrestrained driver of a vehicle that rear-ended a parked car. The air bag deployed. Considering the likelihood of organ collision, for which of the following injuries should you maintain a high index of suspicion?
A) Cardiac contusion
B) Anterior flail segment
C) Abruptio placentae
D) Fractured sternum
Free
Multiple Choice
Q 44Q 44
Which of the following best describes why the occupants of a vehicle moving at 50 miles per hour will be injured when the vehicle strikes a tree, but not when it brakes to a stop?
A) Braking allows the kinetic energy to be absorbed evenly into the frame of the vehicle, rather than concentrating it at the point of impact.
B) The energy gradually dissipates as heat due to the friction of braking, rather than transferring to the vehicle and its occupants.
C) The inertia of the tree increases the kinetic energy transmitted to the occupants by a factor of 10.
D) None of the above describes why.
Free
Multiple Choice
Q 45Q 45
Which pathway of patient travel results in higher mortality with a frontal impact collision?
A) Vertical
B) Straight
C) Up-and-over
D) Down-and-under
Free
Multiple Choice
Q 46Q 46
Upon arriving at the scene of a single-vehicle collision in which the vehicle struck a utility pole, you note that the windshield is "starred," and that the driver is not restrained. Which of the following injuries is MOST likely?
A) Whiplash injury of the neck muscles
B) Compression injury of the cervical spine
C) Distraction injury of the cervical spine
D) Ligamentous neck injury due to rotation beyond the range of motion
Free
Multiple Choice
Q 47Q 47
Which of the following factors is NOT a consideration in the severity of injury related to falls?
A) Landing surface
B) Wind resistance
C) The initial point of impact
D) Distance of the fall
Free
Multiple Choice
Q 48Q 48
Which of the following is TRUE regarding a motorcycle collision?
A) Frontal impact can result in intraabdominal, pelvic, and femur injuries.
B) A rider who "lays down the bike" will generally receive more severe injuries than a rider who stays with the bike.
C) The structural steel of the vehicle absorbs most of the kinetic energy in a motorcycle collision.
D) The use of helmets has drastically reduced the incidence of cervical spine injuries.
Free
Multiple Choice
Q 49Q 49
For which of the following impacts should you maintain a higher index of suspicion because the degree of injury may be greater than the damage alone indicates?
A) Rear-end
B) Oblique
C) Lateral
D) Frontal
Free
Multiple Choice
Q 50Q 50
Which of the following best defines the term energy?
A) The ability to deform solid objects
B) The rate of motion related to time
C) The capacity to do work
D) The amount of heat generated through friction
Free
Multiple Choice
Q 51Q 51
Which of the following contributes to a greater degree of injury than anticipated from vehicle damage alone in a lateral-impact motor vehicle collision?
A) Increased gravitational forces due to multiple changes in direction and velocity
B) Lack of a crumple zone
C) Taking the up-and-over pathway
D) The force of side-impact air bag deployment
Free
Multiple Choice
Q 52Q 52
Which of the following injuries is NOT commonly related to snowmobiling?
A) Ejections
B) Crush injuries
C) Drowning
D) Glancing blows against obstructions in the snow
Free
Multiple Choice
Q 53Q 53
Which of the following is the most important priority when caring for a patient with a shallow-water diving injury?
A) Assessing the cervical spine for deformity
B) Maintaining cervical spine stabilization while opening the airway
C) Removing the patient from the water as soon as possible
D) Initiating rescue breathing once out of the water
Free
Multiple Choice
Q 54Q 54
Which of the following affects the severity of injury sustained in a motor vehicle collision?
A) Gross vehicle weight
B) Rate of acceleration or deceleration
C) Vehicle speed
D) All of the above
Free
Multiple Choice
Q 55Q 55
Which of the following is NOT a type of collision that must be considered when analyzing a motor vehicle collision?
A) The vehicle strikes an object.
B) The occupants' organs strike the interior of the body cavity.
C) The body of the occupant strikes the interior of the vehicle.
D) A hubcap flies off and strikes a tree.
Free
Multiple Choice
Q 56Q 56
Which of the following best describes what happens to the kinetic energy of a vehicle traveling at 65 miles per hour when it collides into a concrete barrier wall?
A) The energy dissipates as sound waves.
B) The body of the vehicle and its occupants absorb the energy.
C) The wall's foundation absorbs the energy.
D) The energy converts to heat through friction.
Free
Multiple Choice
Q 57Q 57
Which two of the following factors proportionately affect the kinetic energy of a bullet fired from a gun?
A) Friction and distance
B) Mass and friction
C) Velocity and mass
D) Friction and velocity
Free
Multiple Choice
Q 58Q 58
Which of the following injuries is associated with the pressure wave produced by a blast?
A) Pneumothorax
B) Lacerated liver
C) Fractures
D) Ruptured spleen
Free
Multiple Choice
Q 59Q 59
Axial loading is MOST likely to occur in which type of impact?
A) Frontal with an up-and-over pathway
B) Frontal with a down-and-under pathway
C) Rear with the headrest too low
D) Lateral on the side of the vehicle opposite the occupant
Free
Multiple Choice
Q 60Q 60
Which of the following "paper bag syndrome" injuries may occur due to sudden compression of the thorax or abdomen?
A) Pulmonary and myocardial contusions
B) Pneumothorax and diaphragmatic rupture
C) Cardiac tamponade and aortic dissection
D) Pneumothorax and myocardial contusion
Free
Multiple Choice
Q 61Q 61
Which of the following statements about lateral impact collisions is TRUE?
A) The substantial lateral crumple zone prevents most injuries.
B) Damage to the vehicle is a reliable indication of the seriousness of injuries.
C) The degree of injury may be greater than the damage alone would indicate.
D) Fatalities are rare because the upper extremities absorb the energy.
Free
Multiple Choice
Q 62Q 62
Which of the following mechanisms is most consistent with fractured vertebrae from a rapid lateral twisting motion?
A) Direct trauma, such as from a blow to the head
B) Low-velocity penetrating trauma from an ice pick
C) High-velocity penetrating trauma from a gunshot wound
D) Lateral-impact motor vehicle collision
Free
Multiple Choice
Q 63Q 63
Frontal impacts in which the patient takes a "down-and-under" pathway typically result in which of the following injury patterns?
A) Traumatic brain injury
B) Hip and femur fractures
C) Rupture of the diaphragm
D) Rupture of hollow organs
Free
Multiple Choice
Q 64Q 64
Which of the following scenarios would likely lead to the development of compartment syndrome?
A) A crush injury to the lower leg
B) A loose-fitting cast that covers the thigh and leg
C) An excessive release of intracellular potassium
D) A tennis shoe that doesn't fit correctly
Free
Multiple Choice
Q 65Q 65
Which of the following is TRUE of the injuries sustained by the elderly due to falls?
A) The injuries sustained by the elderly are less likely to result in hospitalization.
B) Only more significant falls cause fractures.
C) Less-significant falls may cause fractures.
D) The elderly sustain injuries similar to other age groups in comparable falls.
Free
Multiple Choice
Q 66Q 66
Which of the following is NOT one of the major types of recreational vehicles involved in crashes?
A) Snowmobiles
B) Jet skis
C) All-terrain vehicles
D) Go-karts
Free
Multiple Choice
Q 67Q 67
Infants and very small children (up to two years of age) should have their child safety seat positioned where in a car?
A) The front seating area, facing backward
B) The rear seating area, facing backward
C) The front seating area, facing frontward
D) The rear seating area, facing frontward
Free
Multiple Choice
Q 68Q 68
When the driver's chest strikes the steering wheel during a motor vehicle collision, what produces the next injury?
A) The air bag deploys a second time.
B) The steering column shears off, causing penetrating trauma.
C) Unsecured objects in the vehicle become projectiles.
D) The heart continues its forward motion until it strikes the chest wall.
Free
Multiple Choice
Q 69Q 69
When inspecting the interior of a vehicle involved in a frontal collision, you note that the dash panel beneath the steering wheel is broken. Which of the following injuries might this indicate?
A) Fracture of the acetabulum
B) Femur fracture
C) Knee injury
D) All of the above
Free
Multiple Choice
Q 70Q 70
Which of the following injuries is associated with the tertiary phase of a blast?
A) Crush injuries
B) Barotrauma
C) Burns
D) Projectile injuries
Free
Multiple Choice
Q 71Q 71
Which of the following statements about the impact of motorcycle helmet usage is TRUE?
A) Helmet use moderately increases the incidence of cervical spine injury.
B) Helmet use moderately decreases the incidence of cervical spine injury.
C) Helmet use substantially decreases the incidence of cervical spine injury.
D) Helmet use neither increases nor decreases the incidence of cervical spine injury.
Free
Multiple Choice
Q 72Q 72
Which of the following mechanisms in a motor vehicle collision would MOST likely result in a tear of the liver at the ligamentum teres?
A) Gradual deceleration
B) Sudden acceleration
C) Sudden deceleration
D) Gradual acceleration
Free
Multiple Choice
Q 73Q 73
Which of the following statements is NOT true of occupant ejection in motor vehicle collisions?
A) Ejection accounts for 27 percent of motor vehicle fatalities.
B) The number of occupant impacts increases with ejection.
C) Ejection has not been reported with lateral-impact collisions.
D) Ejection is most often associated with frontal-impact collisions.
Free
Multiple Choice
Q 74Q 74
Which of the following may result from aggressive ventilation of the blast patient?
A) Emboli
B) Pericardial tamponade
C) Hemorrhage
D) Acidosis
Free
Multiple Choice
Q 75Q 75
A vehicle is struck in its right front as it passes through an intersection, resulting in an oblique impact. Which of the passengers is subjected to the greatest acceleration forces?
A) The right-rear passenger
B) The left-rear passenger
C) The front-seat passenger
D) The driver
Free
Multiple Choice
Q 76Q 76
You have responded to a soccer field on which two 13-year-olds have collided during a game. Which of the following findings in either patient requires ambulance transport for further evaluation in the emergency department?
A) Weakness in the upper extremities
B) Complaint of "getting the wind knocked out of me"
C) Contusion to the thigh
D) Minor epistaxis
Free
Multiple Choice
Q 77Q 77
Which type of motor vehicle collision is most common in rural areas?
A) Frontal
B) Lateral
C) Rollover
D) Rear-end
Free
Multiple Choice
Q 78Q 78
The branch of physics dealing with objects in motion and energy exchanges that occur as these objects collide is called what?
A) Kinematics
B) Kinetics
C) Inertia
D) Force
Free
Multiple Choice
Q 79Q 79
Which of the following is TRUE of supplemental restraint systems?
A) They may deploy during rescue operations, injuring the patient and/or EMS personnel.
B) When worn incorrectly, they may cause spinal injury or decapitation.
C) They guard against thoracic impact with the steering wheel.
D) They are primarily useful in preventing injury to infants and children riding in the front seat.
Free
Multiple Choice
Q 80Q 80
Which of the following mechanisms may result in a conventional explosion?
A) Fumes
B) Dust
C) Natural gas
D) All of the above
Free
Multiple Choice
Q 81Q 81
Which of the following statements about low-velocity penetrating trauma is TRUE?
A) Shorter knives and ice picks may be removed if they are left in the wound.
B) There is no pressure shock wave with a knife wound as there is with an arrow wound.
C) More injuries are sustained from arrows than from knives.
D) Knives, arrows, ice picks, and similar weapons cause damage only in their direct path.
Free
Multiple Choice
Q 82Q 82
Your patient is an 8-year-old boy with a pencil impaled 2 centimeters inferior to the xiphoid process. You note that the pencil is pulsating. Which of the following is the best action?
A) Start an IV and request orders for analgesia and sedation.
B) Remove the pencil and apply direct pressure to the wound; transport to a trauma center if the bleeding does not stop with direct pressure.
C) Stabilize the pencil in place and transport to a trauma center.
D) Stabilize the pencil in place and transport to the nearest medical facility.
Free
Multiple Choice
Q 83Q 83
The pathway of injury left in the wake of a penetrating mechanism of injury is called:
A) cone of injury.
B) cavitation.
C) profile.
D) trajectory.
Free
Multiple Choice
Q 84Q 84
Which of the following statements is TRUE of the permanent cavity created by penetrating trauma?
A) It is filled with disrupted tissues, some air, fluid, and debris.
B) It is the damage done when the projectile fragments penetrate.
C) It is a space created by a projectile as tissue moves rapidly away in its path.
D) It is a potential space, not an actual space.
Free
Multiple Choice
Q 85Q 85
Which of the following is TRUE of the pressure wave that accompanies high-velocity penetrating trauma?
A) Hollow organs are less tolerant of the stress than solid organs are.
B) Pressure waves cause no injury to surrounding tissues; they only momentarily disrupt function.
C) Elastic tissues are less tolerant of the stress than non-elastic tissues.
D) The pressure wave may be transmitted through blood, resulting in damage to blood vessels some distance from the primary wound.
Free
Multiple Choice
Q 86Q 86
Your patient is a 50-year-old man with a gunshot wound to the right anterior chest. He is unresponsive. Which of the following should you do first?
A) Check for a carotid pulse.
B) Seal the chest wound.
C) Auscultate breath sounds.
D) Check for breathing.
Free
Multiple Choice
Q 87Q 87
Your patient is a 30-year-old woman with a stab wound to the neck. She is sitting up and appears very anxious and short of breath. Minimal external bleeding is noted, but there is bubbling from the wound. Which of the following should you suspect, based on the mechanism of injury and assessment findings?
A) Laceration of the trachea
B) An injury to the spinal cord at the level of the stab wound
C) Laceration of the ipsilateral carotid artery
D) All of the above
Free
Multiple Choice
Q 88Q 88
If you were to design a bullet to have the highest energy exchange, what would you do?
A) Decrease the drag.
B) Increase the caliber.
C) Decrease the bullet's trajectory.
D) Design the bullet to become more unstable.
Free
Multiple Choice
Q 89Q 89
Which of the following is most important when assessing the damage done by a gunshot?
A) The type of gun used
B) The size of the bullet
C) The distance from the shooter
D) Whether there was an upward or a downward trajectory when the bullet was fired
Free
Multiple Choice
Q 90Q 90
A penetrating injury to which of the following organs is LEAST likely to result in severe hemorrhage?
A) Liver
B) Kidney
C) Spleen
D) Ureter
Free
Multiple Choice
Q 91Q 91
Which of the following is TRUE of shotgun ammunition?
A) A shotgun may either fire one slug or use ammunition with multiple pellets.
B) The shot is dispersed from the cartridge with high velocity.
C) The closer the shooter is to the victim, the larger the area of visible damage.
D) "Double ought" or #00 shot contains a large number of relatively small pellets.
Free
Multiple Choice
Q 92Q 92
Which of the following abdominal organs is the LEAST affected by the pressure wave associated with penetrating trauma?
A) Spleen
B) Bowel
C) Kidneys
D) Liver
Free
Multiple Choice
Q 93Q 93
The study of the characteristics of projectiles in motion and their effects on the objects they impact is called:
A) trajectory.
B) cavitation.
C) ballistics.
D) forensics.
Free
Multiple Choice
Q 94Q 94
You have arrived on the scene of a 17-year-old male patient with a gunshot wound to the thigh. Police are on the scene. There is significant ongoing hemorrhage from the wound. The patient is screaming for someone to help him. Which of the following should you do first?
A) Control hemorrhage with direct pressure.
B) Perform a rapid trauma assessment.
C) Ask the police if they have searched the patient for weapons yet.
D) Begin high-concentration oxygen administration.
Free
Multiple Choice
Q 95Q 95
As a bullet tumbles, the potential to inflict damage:
A) increases.
B) remains the same.
C) is determined by the trajectory.
D) decreases.
Free
Multiple Choice
Q 96Q 96
The path a projectile follows during a flight is called its:
A) cavity.
B) ballistics.
C) trajectory.
D) drag.
Free
Multiple Choice
Q 97Q 97
Which of the following is TRUE of body armor use?
A) There are no reported cases of penetrating trauma among victims who were shot while wearing body armor.
B) Blunt trauma may be significant, but the potential for life-threatening injury is less than if armor had not been worn.
C) Blunt trauma occurs only if ceramic inserts are placed in the vest.
D) Ceramic inserts are dangerous and should not be used, because they generally fragment and create secondary projectiles when they are struck by a bullet.
Free
Multiple Choice
Q 98Q 98
Which of the following is most susceptible to damage from the pressure wave when a bullet enters it?
A) Intestines
B) Femoral artery
C) Liver
D) Lungs
Free
Multiple Choice
Q 99Q 99
Which of the following is TRUE about determining the pathway of the bullet when assessing a patient with a gunshot wound?
A) You should try to determine the bullet's pathway.
B) The purpose of determining the bullet's pathway is to anticipate which organs may have been affected, which will help to guide your priorities for on-scene care or rapid transport.
C) It is difficult to determine the pathway of a bullet because it may not travel in a straight line, possibly being deflected by structures in its path or being shifted by natural movements of the diaphragm and other organs and structures of the body.
D) All of the above
Free
Multiple Choice
Q 100Q 100
Which statement about ballistics is TRUE?
A) Damage is less when the bullet does not exit the body.
B) When a bullet tumbles, it decreases the damage.
C) In penetrating trauma, the mass of a projectile is more significant than its velocity when determining kinetic energy.
D) When a bullet yaws, it increases the damage.
Free
Multiple Choice
Q 101Q 101
When you are assessing someone with a gunshot wound from a rifle, which of the following is important to remember?
A) The zone of injury is larger than that expected with other types of weapons.
B) The muzzle velocity is less than that of a handgun.
C) The trajectory is longer, allowing more energy to be dissipated by drag before it strikes the victim.
D) The cavitation is limited to the direct path of the bullet.
Free
Multiple Choice
Q 102Q 102
Which of the following is typical of the trajectory of a knife when a female assailant stabs someone?
A) The trajectory is lateral: right-to-left if she is right-handed and left-to-right if she is left-handed.
B) The movement is downward, as the assailant raises the knife and swings downward.
C) The movement is upward, as the assailant drives upward with the knife.
D) The trajectory tends to be in a horizontal plane at the level of the assailant's shoulder.
Free
Multiple Choice
Q 103Q 103
Greater velocity of a bullet will cause a ________ path of travel and a ________ trajectory.
A) wavier; straighter
B) flatter; wavier
C) more rounded; curved
D) flatter; straighter
Free
Multiple Choice
Q 104Q 104
Which of the following is TRUE of the temporary cavity formed by penetrating trauma?
A) It heals more slowly than the permanent cavity because of the nature of the tissue damage.
B) It fills with disrupted tissues, some air, fluid, and debris.
C) It is a space indirectly created by a projectile as tissue moves rapidly away from its path.
D) It is the damage that occurs when the projectile fragments.
Free
Multiple Choice
Q 105Q 105
Which of the following is TRUE of defense wounds in the victim of a knife attack?
A) They usually occur to the shoulder as the victim attempts to turn away from the attack.
B) They often occur to the neck and head as the victim doubles over into a protective posture.
C) They usually occur to the hands and arms as the victim raises them to ward off the attacker.
D) They rarely occur because the victim is usually taken by surprise.
Free
Multiple Choice
Q 106Q 106
To gain an appreciation for the potential for trauma from high-velocity projectiles, it is important to remember that the shock wave produced can exceed atmospheric pressure by up to ________ times.
A) 25
B) 100
C) 50
D) 80
Free
Multiple Choice
Q 107Q 107
Which of the following is associated with assault rifle wounds but not hunting rifle wounds?
A) Permanent cavitation
B) Multiple wounds
C) Smaller exit wounds
D) Larger exit wounds
Free
Multiple Choice
Q 108Q 108
Which of the following statements about bullets is TRUE?
A) A high-velocity bullet is three times less likely to do major harm.
B) The larger the bullet, the smaller its energy.
C) A small, light bullet can do significant harm.
D) The hunting rifle's bullet is usually a lighter bullet, but it travels faster.
Free
Multiple Choice
Q 109Q 109
During the scene size-up on a call for a patient with penetrating trauma due to a stab wound, which of the following should you do?
A) Collect anything that could be used as evidence.
B) Check for weapons on or near the patient.
C) Try to find out in which direction the assailant fled.
D) Assume that the patient has no weapons if law enforcement is on the scene.
Free
Multiple Choice
Q 110Q 110
Which of the following statements about stab wounds is TRUE?
A) The presence of defense wounds decreases the likelihood of trauma to the neck, thorax, and abdomen.
B) Damage is usually limited to physical injury caused by direct contact between the blade and the victim's tissue.
C) The size and shape of the weapon allow precise prediction of the injury.
D) Stab wounds by female attackers are seldom lethal.
Free
Multiple Choice
Q 111Q 111
Which of the following statements about entrance and exit wounds is TRUE?
A) Exit wounds are usually the size of the bullet's profile.
B) Entrance wounds most often appear as stellate.
C) Cavitational wave energy is greatest at a bullet's point of entrance.
D) Only a thorough forensic examination by a qualified expert can determine with certainty whether a given wound is an entrance wound or an exit wound.
Free
Multiple Choice
Q 112Q 112
Which of the following is best described as "the area of contused tissue resulting from penetrating trauma that may be slow to heal due to disrupted blood flow and tissue damage"?
A) Temporary cavity
B) Zone of injury
C) Zone of coagulation
D) Permanent cavity
Free
Multiple Choice
Q 113Q 113
Penetrating trauma to the face can complicate airway management by which of the following mechanisms?
A) Laryngotracheal edema
B) Airway obstruction
C) Destruction of anatomical landmarks
D) Both B and C
Free
Multiple Choice
Q 114Q 114
The primary assessment of a patient with a gunshot wound to the chest should focus on detecting which of the following?
A) Pancreatitis
B) Tension pneumothorax
C) Cardiac contusion
D) Peritonitis
Free
Multiple Choice
Q 115Q 115
Which two factors related to kinetic energy proportionately affect the damage a projectile will do?
A) Velocity and yaw
B) Velocity and mass
C) Mass and fragmentation
D) Fragmentation and velocity
Free
Multiple Choice
Q 116Q 116
Which type of firearm usually limits trauma to direct injury?
A) Hunting rifle
B) Military rifle
C) Automatic weapon
D) Handgun
Free
Multiple Choice
Q 117Q 117
Your patient is a construction worker who fell 15 feet and has a 3-foot metal concrete reinforcement bar (rebar) impaled in his right thigh. Which of the following is the best action?
A) Administer sodium bicarbonate to combat acidosis resulting from the destruction of muscle tissue.
B) If the proper tools and personnel are present, have rescuers cut the rebar to a manageable length.
C) If you can see both ends of the rebar, gently remove it and irrigate the wound with sterile saline.
D) Transport the patient without attempting to shorten or remove the rebar.
Free
Multiple Choice
Q 118Q 118
Which of the following bullet characteristics would create the most damage?
A) Lack of tumble
B) A small profile
C) A full metal jacket
D) "Mushrooming" or flattening on impact
Free
Multiple Choice
Q 119Q 119
As the mass of an object increases, which of the following occurs?
A) The maximum speed it can attain increases.
B) The amount of energy decreases.
C) The maximum speed it can attain decreases.
D) The amount of energy increases.
Free
Multiple Choice
Q 120Q 120
Which of the following statements about rifles is TRUE?
A) Assault rifles generally increase the number of wounds the victim sustains.
B) Hunting rifles have larger magazines and operate semiautomatically.
C) Assault rifles do not accept domestic hunting ammunition and thus create a projectile profile that is smaller and causes less damage.
D) Assault rifles have greater velocity than hunting rifles and only operate automatically.
Free
Multiple Choice
Q 121Q 121
Which of the following is NOT considered penetrating trauma?
A) Receiving a wood splinter in the foot while walking on an unfinished deck
B) A superficial wound resulting from a pellet from a pellet gun being lodged under the skin
C) A laceration from a kitchen knife
D) A laceration on the forehead as a result of being struck with a metal pipe
Free
Multiple Choice
Q 122Q 122
Which of the following increases a bullet's profile?
A) "Mushrooming" on impact
B) The use of rifling in the barrel of the firearm
C) Tumbling 180 degrees on impact
D) Both A and C
Free
Multiple Choice
Q 123Q 123
As the energy from a medium- or high-velocity projectile pushes tissue from its path, which of the following occurs?
A) Damage depends on the net difference between pressure at the entrance wound and pressure at the exit wound.
B) No vacuum is created when there are both an entrance and an exit wound.
C) Negative pressure is generated inside the cavity, drawing debris into the wound.
D) There is negative pressure at the entrance wound and positive pressure at the exit wound.
Free
Multiple Choice
Q 124Q 124
Which of the following is MOST likely to occur to the bullet when military ammunition is used?
A) It will "mushroom" or flatten.
B) It will remain intact.
C) It will fragment.
D) It will explode.
Free
Multiple Choice
Q 125Q 125
Which of the following is considered a high-velocity weapon?
A) Shotgun
B) Arrow
C) Handgun
D) Rifle
Free
Multiple Choice
Q 126Q 126
Which of the following guidelines applies to the prehospital administration of IV fluids in the patient with hemorrhagic shock?
A) Administer hypertonic saline solution or colloids at a keep-open rate.
B) Administer synthetic oxygen-carrying fluids as necessary to increase the level of consciousness.
C) Begin with a 2,000 mL bolus of isotonic crystalloid solution infused under pressure.
D) Administer isotonic crystalloid fluids only as necessary to maintain perfusion.
Free
Multiple Choice
Q 127Q 127
Your patient is a 23-year-old man with a gunshot wound to the abdomen and an exit wound in the right flank. He responds to verbal stimuli; has pale, cool, diaphoretic skin; and has a heart rate of 128, respirations at 24, and a blood pressure of 82/60. These findings indicate which of the following kind of shock?
A) Compensated
B) Irreversible
C) Decompensated
D) Neurogenic
Free
Multiple Choice
Q 128Q 128
As a patient with hemorrhagic blood loss becomes more acidotic, what homeostatic process is usually impaired?
A) Coagulation
B) Hemoptysis
C) Vascular phase
D) Aerobic metabolism
Free
Multiple Choice
Q 129Q 129
Your patient is a 42-year-old man with multiple lacerations on his arms, head, and torso after falling through a plate-glass window. On your arrival, he appears to be unresponsive, lying prone on the sidewalk. Which of the following is the correct sequence of actions in caring for this patient? 1. Control major hemorrhage.
2) Take Standard Precautions.
3) Check the area for broken glass before kneeling next to the patient.
4) Turn him to a supine position.
5) Open his airway.
A) 2, 3, 1, 4, 5
B) 2, 5, 1, 3, 4
C) 2, 3, 4, 1, 5
D) 2, 3, 4, 5, 1
Free
Multiple Choice
Q 130Q 130
Managing a laceration with arterial bleeding most often requires:
A) cauterization.
B) a tourniquet.
C) PASG.
D) direct pressure.
Free
Multiple Choice
Q 131Q 131
Which of the following patients with hemorrhagic shock is likely to be internally bleeding, solely?
A) A 50-year-old man with a stab wound to the neck
B) A 45-year-old woman with a suspected ruptured ectopic pregnancy
C) A 38-year-old man with an open femur fracture
D) A 26-year-old man with a gunshot wound involving the popliteal artery
Free
Multiple Choice
Q 132Q 132
When a patient has lost 2 liters or more of blood from hemorrhage, which classification is that?
A) I
B) III
C) IV
D) II
Free
Multiple Choice
Q 133Q 133
Which of the following is defined as the volume of blood ejected from the heart with each beat?
A) Stroke volume
B) Ventricular capacitance
C) Cardiac output
D) Afterload
Free
Multiple Choice
Q 134Q 134
A fracture of the femur may result in a hematoma that contains enough blood to make it a class ________ hemorrhage.
A) I
B) III
C) IV
D) II
Free
Multiple Choice
Q 135Q 135
Your patient is a 45-year-old man who has received several stab wounds to the chest and abdomen. Although bleeding was significant at first, the rate of bleeding had slowed considerably before your arrival. The patient is agitated and confused, pale, diaphoretic, and cool to the touch. He lacks a radial pulse, and his carotid pulse is weak and rapid. Respirations are 28 and shallow. Which of the following is certain with this patient?
A) He is in irreversible shock.
B) He is in decompensated shock.
C) He is in compensated shock.
D) None of the above is certain.
Free
Multiple Choice
Q 136Q 136
Peripheral vascular resistance is measured as which of the following?
A) Pulse pressure
B) Mean arterial pressure
C) Hydrostatic pressure
D) Oncotic pressure
Free
Multiple Choice
Q 137Q 137
Which of the following is the preferred in-hospital fluid for resuscitation in hemorrhagic shock?
A) Fresh frozen plasma
B) Lactated Ringer's
C) Whole blood
D) Normal saline
Free
Multiple Choice
Q 138Q 138
The phase of blood clotting in which the smooth muscle of an injured blood vessel contracts is known as the ________ phase.
A) hemolytic
B) hemostatic
C) vascular
D) ischemic
Free
Multiple Choice
Q 139Q 139
Which of the following findings indicates a progression from compensated shock to decompensated shock?
A) Narrowing pulse pressure
B) Tachycardia
C) Altered mental status
D) Diaphoresis
Free
Multiple Choice
Q 140Q 140
When assessing the chest during a rapid trauma assessment, what is MOST likely to indicate major internal hemorrhage?
A) Hyporesonance to percussion
B) Increased respiratory rate
C) Distended neck veins
D) Muffled heart tones
Free
Multiple Choice
Q 141Q 141
Which type of wound facilitates the effectiveness of normal blood clotting mechanisms?
A) Vessels torn by stretching, such as when a limb is caught in farm machinery
B) Transverse laceration of the vessel
C) Longitudinal laceration of the vessel
D) Crushing injuries
Free
Multiple Choice
Q 142Q 142
Which of the following mechanisms is responsible for accumulating lactic acid in shock?
A) The citric acid cycle
B) Gluconeogenesis
C) Hemostasis
D) Anaerobic metabolism
Free
Multiple Choice
Q 143Q 143
A hematoma resulting from a fracture of the humerus may contain enough blood to make it a class ________ hemorrhage.
A) II
B) IV
C) III
D) I
Free
Multiple Choice
Q 144Q 144
Which of the following does NOT indicate compensated shock?
A) Anxiety
B) Altered mental status
C) Weakness
D) Thirst
Free
Multiple Choice
Q 145Q 145
What is the best course of action in the case of hemorrhage from either the nose or ear canal?
A) Cover the area with a soft, porous dressing
B) Apply direct pressure to the upper face
C) Squeeze the nostrils closed
D) Apply pressure to the forehead
Free
Multiple Choice
Q 146Q 146
Even with intervention, survival is unlikely with blood loss over ________ percent of the total blood volume.
A) 25
B) 15
C) 50
D) 35
Free
Multiple Choice
Q 147Q 147
Which of the following indicates that a patient has transitioned from compensated to decompensated shock?
A) Widening pulse pressure
B) Increased respiratory rate
C) Hypotension
D) Peripheral vasoconstriction
Free
Multiple Choice
Q 148Q 148
Red blood cells make up approximately ________ percent of whole blood volume.
A) 45
B) 60
C) 30
D) 15
Free
Multiple Choice
Q 149Q 149
Which of the following is a manifestation of orthostatic hypotension?
A) Your patient's pulse is 76 when he is supine but 88 when he sits up.
B) Your patient's blood pressure is 142/90 when she is supine but 116/88 when she sits up.
C) Your patient's blood pressure is 150/100 when he is supine but 134/90 when he sits up.
D) Your patient's pulse is 80 when she is supine but 96 when she sits up.
Free
Multiple Choice
Q 150Q 150
What method of controlling hemmorage should be done as a last resort?
A) Elevation
B) Direct pressure
C) Tourniquet
D) Packing the wound with bandages and dressings
Free
Multiple Choice
Q 151Q 151
The blood flowing to the heart best describes:
A) contractility.
B) afterload.
C) preload.
D) vascular phase.
Free
Multiple Choice
Q 152Q 152
Under normal circumstances, at any given moment most of the blood is in the ________ system.
A) venous
B) capillary
C) hematopoietic
D) arterial
Free
Multiple Choice
Q 153Q 153
Which of the following best describes definitive care for the trauma patient with ongoing, significant hemorrhage?
A) Administration of blood or blood products
B) Administration of hypertonic crystalloid or colloid solution
C) Invasive hemodynamic monitoring and serial hematocrits
D) Immediate surgery
Free
Multiple Choice
Q 154Q 154
Which of the following impairs blood clotting?
A) Hypothermia
B) Administration of IV fluids
C) Use of nonsteroidal, anti-inflammatory medications
D) All of the above
Free
Multiple Choice
Q 155Q 155
The rapid trauma exam focuses on finding injuries that may cause shock by quickly assessing which of the following body areas? 1. Head
2) Neck
3) Chest
4) Abdomen
5) Pelvis
6) Proximal extremities
7) Distal extremities
A) 1, 2, 3, 4, and 5
B) 1, 4, 5, and 6
C) 1, 2, 3, 4, 5, 6, and 7
D) 3, 4, 5, and 6
Free
Multiple Choice
Q 156Q 156
Which of the following statements about the patient in neurogenic shock is FALSE?
A) Signs of hypovolemic shock may be masked.
B) Unopposed sympathetic nervous stimulation results in systemic pallor and diaphoresis.
C) Can present with neck and/or back pain.
D) Neurogenic shock may require IV fluid resuscitation.
Free
Multiple Choice
Q 157Q 157
Your patient is an obese 39-year-old woman involved in a lateral-impact motor vehicle collision. Which of the following should you remember when assessing and treating this patient?
A) Relative to body size, this patient can tolerate a larger amount of hemorrhage before showing signs of shock.
B) This patient will tolerate blood loss well, as only non-vital tissues will become ischemic.
C) Relative to body weight, a smaller amount of hemorrhage may result in shock.
D) Blood volume increases proportionally with body weight, and the patient will experience signs of shock consistent with the classic stages of hemorrhage.
Free
Multiple Choice
Q 158Q 158
Which of the following fluids is appropriate for the prehospital management of hypovolemic shock?
A) Five percent dextrose in water
B) Lactated Ringer's
C) A 0.2% sodium chloride solution
D) A 0.45% sodium chloride solution
Free
Multiple Choice
Q 159Q 159
Which of the following would be the MOST likely cause of neurogenic shock?
A) Pericardial tamponade
B) Spinal cord injury
C) Systemic infection
D) Massive histamine release
Free
Multiple Choice
Q 160Q 160
Rapid volume replacement is best achieved under which of the following conditions?
A) Use of a long catheter with a large internal diameter
B) Use of a long catheter with a small internal diameter
C) Use of a short catheter with a small internal diameter
D) Use of a short catheter with a large internal diameter
Free
Multiple Choice
Q 161Q 161
Which of the following vessels has the greatest ability to change diameter?
A) Arteriole
B) Capillary
C) Systemic artery
D) Aorta
Free
Multiple Choice
Q 162Q 162
Your patient is a 29-year-old man who works in a meat-processing plant. He received a knife wound in the proximal anteromedial thigh, which is continuing to bleed on your arrival. He is restless and thirsty and has pale, cool skin. He has a weak radial pulse of 130 and a blood pressure of 118/88 mmHg. This patient is exhibiting signs and symptoms consistent with a class ________ hemorrhage.
A) III
B) II
C) IV
D) I
Free
Multiple Choice
Q 163Q 163
Which of the following early signs of shock is easily missed?
A) Tachycardia
B) Decrease in respiratory rate and volume
C) Decrease in blood pressure
D) Narrowing pulse pressure
Free
Multiple Choice
Q 164Q 164
Which of the following is TRUE of the elderly trauma patient?
A) The elderly trauma patient is more likely to experience myocardial ischemia as a result of hemorrhage.
B) Medications like beta-blockers may interfere with normal compensatory mechanisms.
C) Hemorrhage may not result in tachycardia as expected.
D) All of the above are true.
Free
Multiple Choice
Q 165Q 165
Which of the following is NOT a characteristic of arterial bleeding?
A) Rapid blood loss
B) Spurting or pumping as it leaves the body
C) Clots quickly on its own
D) Bright red
Free
Multiple Choice
Q 166Q 166
In responding to a trauma patient at the scene of a motor vehicle crash, which of the following is an early sign or signs of shock you might encounter during the primary assessment?
A) Rapid heart rate and anxiety
B) Rapidly dropping blood pressure
C) Rapid breathing and air hunger
D) Rapidly dropping level of responsiveness
Free
Multiple Choice
Q 167Q 167
Which of the following represents the correct sequence for controlling hemorrhage from an extremity?
A) Direct pressure on the dressing and wound, finger pressure through the dressing to the leaking vessel, and, if pressure fails, application of a tourniquet
B) Direct pressure on the dressing and wound, elevation, ice
C) Finger pressure through the dressing to the leaking vessel, splinting, ice, elevation
D) Direct pressure on the dressing and wound, elevation, ice, tourniquet as a last resort
Free
Multiple Choice
Q 168Q 168
Which of the following terms is best described as the loss of blood from the vascular space?
A) Hypovolemia
B) Hemorrhage
C) Hemostasis
D) Shock
Free
Multiple Choice
Q 169Q 169
Brighter red, slow, oozing blood flow is characteristic of which type of hemorrhage?
A) Arterial
B) Venous
C) Capillary
D) Arteriole
Free
Multiple Choice
Q 170Q 170
Which of the following may move more slowly through the early stages of hemorrhage with greater loss percentages needed to transition from one stage class to another?
A) Elderly patients
B) Infants
C) Alcoholics
D) Athletes
Free
Multiple Choice
Q 171Q 171
In which stage of shock are the body's cells are so badly injured and die in such quantities that organs no longer are able to function normally?
A) Decompensated
B) Irreversible
C) Compensated
D) Class I
Free
Multiple Choice
Q 172Q 172
Which of the following findings is NOT likely with a patient in cardiogenic shock?
A) Pulmonary edema
B) Excessive urination
C) Arrhythmias
D) Jugular vein distention
Free
Multiple Choice
Q 173Q 173
What is the mechanism of TXA?
A) Antifibrinolytic
B) Coagulopathy
C) Thrombocytopenia
D) Development of metabolic acidosis
Free
Multiple Choice
Q 174Q 174
Which of the following vessels does NOT make up the microcirculation in the circulatory system?
A) Arterioles
B) Capillaries
C) Venules
D) Veins
Free
Multiple Choice
Q 175Q 175
Blood present in the stool of a patient is known as:
A) hemoptysis.
B) hematemesis.
C) hematochezia.
D) hemorrhage.
Free
Multiple Choice
Q 176Q 176
You are called to a commercial creamery, where an employee got his arm trapped in the ice cream mixing machinery. You note that the skin has been pulled off his hand and arm from the mid forearm down. The patient's muscles, tendons, and bones are exposed. This type of injury is a(n):
A) amputation.
B) skinning injury.
C) degloving injury.
D) crush injury.
Free
Multiple Choice
Q 177Q 177
You are assessing an assault victim and note a contusion over the abdomen. Which of the following should you remember while caring for this patient?
A) Unless the contusion is over a critical area, such as the spleen or liver, the likelihood of serious injury is minimal.
B) A contusion to the abdomen should always increase your index of suspicion for underlying injury.
C) If there is no rigidity or distension of the abdomen, serious injury is unlikely.
D) The significance of the trauma is related to the amount of pain the patient experiences on palpation.
Free
Multiple Choice
Q 178Q 178
A nonpenetrating injury caused by blunt trauma that damages blood vessels, causing pain and discoloration, is a(n):
A) ecchymosis.
B) strain.
C) abrasion.
D) contusion.
Free
Multiple Choice
Q 179Q 179
You have responded for an injured person at an address you know to be a motorcycle clubhouse. Your patient was attacked by another party with a broken beer bottle. Your patient has a large laceration on her neck with moderate bleeding. Which property of your dressing material is most important in caring for this patient?
A) Occlusive
B) Sterile
C) Absorbent
D) Adherent
Free
Multiple Choice
Q 180Q 180
The tough, fibrous sheaths that bundle skeletal muscle are called:
A) tendons.
B) fibers.
C) sarcolemma.
D) fascia.
Free
Multiple Choice
Q 181Q 181
Which of the following statements about crush injuries is most accurate?
A) Only closed injuries can be classified as crush injuries.
B) The actual source of bleeding in crush injuries may be hard to identify.
C) A spongy sensation on palpation of the injured area indicates crush injury.
D) Crush injuries are easily identifiable because they invariably result in deformity.
Free
Multiple Choice
Q 182Q 182
Which of the following is best described as the accumulation of a pocket of blood in the tissues?
A) Hematoma
B) Abrasion
C) Compartment syndrome
D) Contusion
Free
Multiple Choice
Q 183Q 183
The acute breakdown of muscle fibers in crushing injury is called:
A) myoglobinemia.
B) sarcoidosis.
C) rouleaux formation.
D) rhabdomyolysis.
Free
Multiple Choice
Q 184Q 184
When caring for an amputated part, which of the following principles apply? 1. Place the unwrapped part in a dry plastic bag, and seal it.
2) Place the part in a plastic bag with the part wrapped in gauze moistened with lactated Ringer's solution or normal saline, and seal it.
3) Always transport the part with the patient.
4) Keep the part moist, and place it in a container of cold water.
5) Keep the part dry, and place it in an ice-filled container.
A) 2, 4
B) 2, 3, 4
C) 1, 3, 5
D) 2, 5
Free
Multiple Choice
Q 185Q 185
You arrive on the scene of a patient with severe blunt trauma to the face. You hear gurgling as you approach the patient. After opening the airway with a manual maneuver, what should your next action be?
A) Ventilate
B) Apply a cervical collar
C) Control the source of hemorrhage
D) Suction
Free
Multiple Choice
Q 186Q 186
Which of the following are likely to accumulate in the bloodstream following a large crush injury?
A) Myoglobin
B) Potassium
C) Lactic acid
D) All of the above
Free
Multiple Choice
Q 187Q 187
Your patient is an 18-year-old man who stepped on a nail in the barnyard. The nail penetrated his tennis shoe and punctured his foot. On your arrival, the patient has removed the nail and the shoe. The wound is about 2 mm in diameter with minor bleeding that has been controlled. The skin around the wound is red. The patient does not want to be transported but asks if you can give him "some ointment and a Band-Aid." You should explain to the patient that this type of injury is associated with an increased risk of:
A) infection.
B) delayed bleeding.
C) scarring.
D) nerve damage.
Free
Multiple Choice
Q 188Q 188
In which of the following ways does the integumentary system prevent pathogens from entering the body?
A) Via humoral immunity
B) Via cell-mediated immunity
C) By secreting chemotactic factors
D) By providing a barrier to the environment
Free
Multiple Choice
Q 189Q 189
In which type of soft tissue injury is the skin cut or torn, leaving a flap of skin attached?
A) Avulsion
B) Laceration
C) Amputation
D) Abrasion
Free
Multiple Choice
Q 190Q 190
Your patient is a 35-year-old man who has his leg trapped under a section of concrete from an industrial accident. While awaiting removal of the concrete, which type of IV fluid is indicated for administration to this patient?
A) Five percent dextrose in water
B) Normal saline
C) Lactated Ringer's
D) Whole blood
Free
Multiple Choice
Q 191Q 191
The layer of skin that contains adipose tissue is the ________ layer.
A) dermal
B) connective
C) epidermal
D) subcutaneous
Free
Multiple Choice
Q 192Q 192
Which of the following medications may be indicated in the treatment of a patient with a crush injury?
A) Sodium bicarbonate
B) Potassium chloride
C) Lactated Ringer's
D) Furosemide
Free
Multiple Choice
Q 193Q 193
For most open soft tissue wounds managed by the paramedic in the prehospital setting, which of the following is a desirable characteristic of the dressing applied?
A) Occlusive
B) Dry
C) Adherent
D) Nonabsorbent
Free
Multiple Choice
Q 194Q 194
Your patient is a 19-year-old man who received a penetrating knife wound to his chest. On your arrival, he is lying supine with a visible chest wound that is bleeding slightly. You can hear the sucking sound of air moving in and out of the wound. This wound is best managed with:
A) a bulky dressing held in place with adhesive strips.
B) an occlusive bandage sealed on three sides and open on the fourth side.
C) a dry dressing covered by an adherent bandage.
D) a sterile, wet dressing held in place with an elastic bandage.
Free
Multiple Choice
Q 195Q 195
The first stage of wound healing is:
A) hemostasis.
B) neovascularization.
C) inflammation.
D) epithelialization.
Free
Multiple Choice
Q 196Q 196
A laceration that is perpendicular to the tension lines of the body is more likely to:
A) become infected.
B) heal without a scar.
C) be caused by blunt trauma.
D) gape open.
Free
Multiple Choice
Q 197Q 197
Your patient is a 30-year-old machinist who had his right hand caught in a press. Upon extrication, there is no evidence of significant trauma. You should:
A) splint the hand in the position found, elevate above the heart, apply ice.
B) splint in position of function, start an IV of normal saline, consider morphine for analgesia.
C) wrap the hand in a bulky dressing held in place by an elastic bandage.
D) apply oxygen by nonrebreather, splint using a sling and swath, insert a large-bore IV of lactated Ringer's.
Free
Multiple Choice
Q 198Q 198
Which of the following most accurately describes the injury that removes the epidermis and the upper portion of the dermis?
A) Avulsion
B) Incision
C) Laceration
D) Abrasion
Free
Multiple Choice
Q 199Q 199
Which of the following is a principle that should be used when considering application of a tourniquet to control bleeding?
A) A tourniquet should be used for severe bleeding that cannot be controlled by any other means.
B) Every 15 minutes, the tourniquet will need to be removed for 5 minutes, then reapplied.
C) A narrow, nonelastic material is best for generating the pressure needed to stop bleeding.
D) A blood pressure cuff used as a tourniquet will maintain its pressure if it has been properly applied.
Free
Multiple Choice
Q 200Q 200
Your patient is a 15-year-old soccer player who was kicked in the calf by another player. She has a contusion on her calf, but the amount of pain she is experiencing seems out of proportion to the apparent injury. You note that although you can palpate a pedal pulse, there is swelling in the foot and ankle, and the skin is cool to the touch. You should suspect which of the following at this time?
A) Compartment syndrome
B) Volkmann's ischemic contracture
C) Crush syndrome
D) Degloving injury
Free
Multiple Choice
Q 201Q 201
The bacteria most often associated with infection of open soft tissue injury is:
A) Pasteurella multocida.
B) Pseudomonas aeruginosa.
C) Staphylococcus.
D) Clostridium tetani.
Free
Multiple Choice
Q 202Q 202
Your patient is a three-year-old boy who has struck his head on a concrete patio. He has a linear wound that penetrates the dermis and is approximately 2 cm long. This wound would be best described as a(n):
A) contusion.
B) puncture.
C) avulsion.
D) laceration.
Free
Multiple Choice
Q 203Q 203
Your patient is a 45-year-old type 2 diabetic man who has a non-healing wound on his right foot. You note that the right leg is discolored and edematous and has subcutaneous emphysema and a foul odor. Which of the following should you suspect?
A) MRSA
B) Gangrene
C) Tetanus
D) Compartment syndrome
Free
Multiple Choice
Free
Multiple Choice
Q 205Q 205
You are reassessing the distal circulation on a patient's forearm you have bandaged. The distal hand and wrist are cool to the touch and turning pale. The patient complains of numbness and tingling in that hand. What is your next course of action?
A) Loosen the bandage and see if that relieves the signs and symptoms.
B) Keep the dressing and bandage in place and expedite transport.
C) Administer pain medication to help relieve the symptoms.
D) Sling and swathe the arm to the chest and reassess the distal circulation.
Free
Multiple Choice
Q 206Q 206
The three primary factors that determine the severity of radiation are:
A) distance, shielding, and symptoms.
B) duration, shielding, and dose.
C) duration, distance, and shielding.
D) dose, symptoms, and shielding.
Free
Multiple Choice
Q 207Q 207
Which of the following has contributed most significantly to the decline in U.S. burn mortality?
A) Public service announcements on radio, television, and billboards
B) Paramedic involvement in public education
C) Visits to elementary schools by firefighters
D) Improved building codes and construction and sprinkler and smoke detector use
Free
Multiple Choice
Q 208Q 208
Which classification of burn is characterized mainly by blisters?
A) Full thickness
B) Superficial
C) Partial thickness
D) Minor
Free
Multiple Choice
Q 209Q 209
Based on total body surface area and burn depth, you have determined that an 88-year-old woman has a moderate burn. Considering the age of the patient, this burn is classified as:
A) critical.
B) significant.
C) fatal.
D) moderate.
Free
Multiple Choice
Q 210Q 210
An area of burned tissue that is not painful is MOST likely a ________ burn injury.
A) second-degree
B) full thickness
C) superficial
D) partial thickness
Free
Multiple Choice
Q 211Q 211
You have been dispatched to a call for a burn patient. Upon arriving, you find a 23-year-old woman who was sunbathing and fell asleep. She is alert and oriented and in moderate pain. She has blisters covering her extremities, abdomen, face, and chest. This patient's burns fall into which one of the following categories?
A) Superficial
B) Critical
C) Minor
D) Moderate
Free
Multiple Choice
Q 212Q 212
Which of the following stages of burn injury is best described as including a pain response, an outpouring of catecholamines, tachycardia, tachypnea, mild hypertension, and anxiety?
A) Resolution
B) Emergent
C) Fluid shift
D) Hypermetabolic
Free
Multiple Choice
Q 213Q 213
Which tissue layer(s) is (are) affected by partial thickness burns? 1. Epidermis
2) Dermis
3) Subcutaneous
4) Muscle
A) 1, 2, 3, and 4
B) 1 and 2
C) 1, 2, and 3
D) 1
Free
Multiple Choice
Q 214Q 214
Contact with strong alkalis results in burns involving ________ necrosis of the tissue.
A) coagulation
B) liquefaction
C) thermal
D) ischemic
Free
Multiple Choice
Q 215Q 215
Your patient has circumferential full thickness burns of the thorax. He is intubated, and you have noticed an increase in resistance as you bag him. His skin is very tight and inflexible as you try to ventilate. Which of the following is required to improve this patient's ventilatory status?
A) IV sedation
B) Needle thoracostomy
C) Escharotomy
D) Fasciotomy
Free
Multiple Choice
Q 216Q 216
Which of the following body areas warrant special attention when burned?
A) Legs
B) Arms
C) Abdomen
D) Feet
Free
Multiple Choice
Q 217Q 217
Which of the following patient factors increases the criticality of the patient's burn injuries?
A) Taking antidepressants
B) Male gender
C) Prior history of burns
D) Being in the geriatric age group
Free
Multiple Choice
Q 218Q 218
You are dispatched to a structure fire at which there is a report of a burned person. Your patient is a 32-year-old man with blisters on his anterior chest and circumferential superficial burns to both lower extremities. Using the "rule of nines," the percentage of burn is:
A) 54.
B) 27.
C) 36.
D) 45.
Free
Multiple Choice
Q 219Q 219
Which of the following agents is the best choice for analgesia in a patient with 9 percent partial thickness burns involving the right lower extremity?
A) Naproxen sodium
B) Ketorolac
C) Acetaminophen
D) Fentanyl
Free
Multiple Choice
Q 220Q 220
The type of electricity supplied to homes is ________ current. Contact with this type of current may result in ________.
A) indirect; rhabdomyolysis
B) direct; rhabdomyolysis
C) direct; muscle tetany
D) alternating; muscle immobolization
Free
Multiple Choice
Q 221Q 221
You are caring for a patient with 30 percent full and partial thickness burns. He is an 80 kg man. According to the Parkland formula, he should receive ________ liters of fluid over 24 hours, with ________ liters infused in the first 8 hours.
A) 9.6; 4.8
B) 5; 3
C) 8.2; 2
D) 4.5; 1.25
Free
Multiple Choice
Q 222Q 222
According to Jackson's theory of thermal wounds, which of the following zones has suffered the greatest damage?
A) Coagulation
B) Hyperemia
C) Stasis
D) Disintegration
Free
Multiple Choice
Q 223Q 223
Which type of radiation particle can travel through 6 to 10 feet of air, penetrate a few layers of clothing, and cause external and internal injuries?
A) Gamma
B) Alpha
C) Neutron
D) Beta
Free
Multiple Choice
Q 224Q 224
Which of the following accounts for the most severe thermal burns of the airway?
A) Inhalation of toxic gases
B) Inhalation of radioactive particles in smoke
C) Inhalation of superheated steam
D) Inhalation of superheated air
Free
Multiple Choice
Q 225Q 225
Which of the following may occur from watching arc welding without proper protection?
A) Hyphema
B) Retinal detachment
C) Ultraviolet keratitis
D) Radial keratotomy
Free
Multiple Choice
Q 226Q 226
For which of the following burn patients could you use local cooling?
A) An 18-month-old child with partial and full thickness scald burns on the lower extremities, buttocks, genitalia, and lower abdomen
B) A 19-year-old woman with approximately 40 percent superficial and 45 percent partial thickness burns from sunbathing
C) A 15-year-old man with partial thickness burns of his left upper extremity, anterior chest, and neck resulting from playing with gasoline and matches
D) A 52-year-old man with a 1-inch-wide full thickness burn across the entire width of the palm of his right hand resulting from picking up a hot grate from a barbecue grill
Free
Multiple Choice
Q 227Q 227
A burn patient who has signs and symptoms of inhalation injury with associated respiratory compromise should be classified as:
A) serious.
B) moderate.
C) critical.
D) minor.
Free
Multiple Choice
Q 228Q 228
You are assessing a 17-year-old male patient with a burn on the lateral aspect of his thigh. Which of the following guidelines is most helpful when estimating the percentage of total body surface area involved?
A) The rule of palms
B) The Parkland formula
C) The rule of nines
D) The modified pediatric rule of nines
Free
Multiple Choice
Q 229Q 229
Which of the following is TRUE of the heat generated when electricity flows through the body?
A) Dry skin offers less resistance to electricity, generating more heat.
B) Wet skin offers less resistance to electricity, generating more heat.
C) Wet skin offers greater resistance to electricity, generating more heat.
D) Dry skin offers more resistance to electricity, generating more heat.
Free
Multiple Choice
Q 230Q 230
Cool-water immersion of a burned part effectively reduces burning only when done within which of the following time frames?
A) The first 24 hours
B) The first 10 to 15 minutes
C) The first 1 to 2 minutes
D) The first hour
Free
Multiple Choice
Q 231Q 231
Paralysis of the muscles of respiration may occur when there is body contact with electrical currents as low as ________ mA.
A) 60
B) 100
C) 20
D) 5
Free
Multiple Choice
Q 232Q 232
The first step for treating a patient who has been contaminated with dry lime is to:
A) neutralize the lime with a mild acidic solution, such as vinegar and water.
B) brush away as much of the powder as possible.
C) flush the skin with large amounts of isopropyl alcohol.
D) flush with copious amounts of tepid water.
Free
Multiple Choice
Q 233Q 233
Which of the following best describes the pathophysiology of most burns to the human body?
A) Heat causes evaporation of water and denatures protein.
B) Radiation, including solar radiation and radiant heat, alters cell structures.
C) Chemicals cause an endothermic reaction that destroys tissue.
D) The skin, and sometimes deeper tissues, are destroyed through combustion.
Free
Multiple Choice
Q 234Q 234
Which of the following represents the modified body surface area percentages in the "rule of nines" for pediatric patients?
A) Posterior chest is 7 percent.
B) Upper extremities are 13.5 percent each.
C) External genitalia is 1 percent.
D) Lower extremities are 13.5 percent each.
Free
Multiple Choice
Q 235Q 235
The voltage of a bolt of lightning may be as much as ________ volts, and its temperature may reach ________ degrees Fahrenheit.
A) 5,000; 150,000
B) 150,000; 5,000
C) 50,000; 100,000
D) 100,000; 50,000
Free
Multiple Choice
Q 236Q 236
Most inhalation injuries in burn patients are due to which of the following?
A) Toxic inhalation
B) Radiation burns of the airway
C) Thermal burns of the lower airway
D) Thermal burns of the upper airway
Free
Multiple Choice
Q 237Q 237
During which phase of a burn injury does extravasation of proteins, water, and electrolytes occur, resulting in edema and potential hypovolemia?
A) Emergent
B) Hyperemia
C) Hypermetabolic
D) Fluid shift
Free
Multiple Choice
Q 238Q 238
Your patient is a 23-year-old woman who was rescued from a burning house. She was asleep in a back bedroom when the fire started, and there was no smoke alarm. She has a pulse oximetry reading of 99 percent after receiving oxygen by nonrebreather mask. What is the most appropriate interpretation of this finding?
A) Effects of smoke inhalation have been resolved by oxygen administration.
B) You cannot rely on this alone to assess oxygenation.
C) There was minimal smoke inhalation.
D) Carboxyhemoglobin is less than 1 percent.
Free
Multiple Choice
Q 239Q 239
Which of the following body structures is the best electricity conductor?
A) Bones
B) Nerves
C) Muscle
D) Skin
Free
Multiple Choice
Q 240Q 240
Which of the following burns would be classified as moderate?
A) Superficial < 50 percent BSA
B) Full thickness < 2 percent BSA
C) Partial thickness < 30 percent BSA
D) Partial thickness > 30 percent BSA
Free
Multiple Choice
Q 241Q 241
Patients who survive the first several days of a moderate to critical burn are MOST likely to die from which of the following complications?
A) Hypovolemia
B) Organ failure
C) Infection
D) Hypothermia
Free
Multiple Choice
Q 242Q 242
Flash burns associated with electricity occur because:
A) air is a moderately good conductor of electricity, generating moderate heat.
B) air is an excellent conductor of electricity, generating moderate heat.
C) air is mildly resistant to the passage of electricity, generating only enough heat to cause superficial burns.
D) air is highly resistant to the passage of electricity, generating intense heat.
Free
Multiple Choice
Q 243Q 243
You are assessing a 37-year-old woman who was rescued from an apartment fire. She has a harsh, stridorous, "brassy"-sounding cough productive of sooty sputum. Her eyebrows and the hair around her face are singed. Respirations = 28, heart rate = 108, and blood pressure = 124/84. You have a 30-minute transport time. Which of the following is the best intervention for this patient?
A) One hundred percent oxygen by nonrebreather mask
B) Sedation and cricothyrotomy
C) A nebulized albuterol treatment
D) Rapid sequence intubation and endotracheal intubation
Free
Multiple Choice
Q 244Q 244
The seriousness of burns in the pediatric population is put into perspective by realizing that burns are the ________ leading cause of death in children under age 12 years.
A) first
B) second
C) third
D) fourth
Free
Multiple Choice
Q 245Q 245
Which of the following chemicals must be brushed off the skin, then covered with oil?
A) Phenol
B) Sodium metal
C) Oleoresin capsicum
D) Dry lime
Free
Multiple Choice
Q 246Q 246
Which of the following best describes the effect of hyperventilation in the brain-injured patient?
A) It is beneficial, because vasodilation results in increased cerebral blood flow.
B) It is detrimental, because vasodilation causes an increase in tissue edema.
C) It is beneficial, because vasoconstriction results in decreased tissue edema.
D) It is detrimental, because vasoconstriction results in decreased cerebral perfusion.
Free
Multiple Choice
Q 247Q 247
Your patient is a 45-year-old man with extensive blunt trauma to the face. He has decorticate posturing in response to pain; weak, irregular respiratory effort at 6 per minute; and a heart rate of 50 with a good radial pulse. The patient appears to have nasal and mandibular fractures, and an oropharyngeal airway is insufficient to keep the tongue from the posterior pharynx. Which of the following has the most potential to negatively impact the patient?
A) Retrograde intubation
B) Oral intubation under direct laryngoscopy
C) Nasotracheal intubation
D) A non-visualized dual-lumen airway
Free
Multiple Choice
Q 248Q 248
Which of the following medications may be indicated in the prehospital management of the patient with traumatic brain injury?
A) Methylprednisolone
B) Diazoxide
C) Mannitol
D) Furosemide
Free
Multiple Choice
Q 249Q 249
Circulation to the face is provided by the ________ artery.
A) external carotid
B) internal carotid
C) midfacial
D) mandibular
Free
Multiple Choice
Q 250Q 250
Which of the following correctly describes the impact of motorcycle helmet use?
A) Helmet usage is associated with a 10 percent reduction in serious head injuries.
B) There have been no reported fatalities from motorcycle collisions in which the riders were wearing helmets.
C) Helmet usage decreases the risk of serious head injuries but increases the risk of cervical-spine injuries.
D) Helmet usage results in a more than 50 percent reduction in serious head injuries.
Free
Multiple Choice
Q 251Q 251
Which of the following parameters should be used to guide the oxygenation and ventilation of the patient with a traumatic brain injury?
A) Maintain an oxygen saturation level of at least 96 percent and a capnography reading between 35 and 40 mmHg.
B) Maintain an oxygen saturation level of at least 90 percent and a capnography level < 45 mmHg.
C) Maintain an oxygen saturation level of at least 98 percent and a capnography reading > 45 mmHg.
D) Maintain an oxygen saturation level of at least 90 percent and a capnography reading < 35 mmHg.
Free
Multiple Choice
Q 252Q 252
You are caring for a 22-year-old amateur boxer who complained of a sudden obstruction of part of his visual field. This complaint is most consistent with which of the following conditions?
A) Extrusion of the eyeball
B) Subconjunctival hemorrhage
C) Hyphema
D) Retinal detachment
Free
Multiple Choice
Q 253Q 253
Regarding the primary assessment of the patient with suspected traumatic brain injury, which of the following describes the best approach to assessing the patient's neurological functioning?
A) The use of AVPU
B) Assessing the patient for level of consciousness and orientation to person, place, and time
C) Assessing a revised trauma score
D) Assessing a Champion trauma scale score
Free
Multiple Choice
Q 254Q 254
Which of the following best describes the percentage of mortality from penetrating gunshot wounds to the cranium?
A) 35 to 50
B) 75 to 80
C) 90 to 95
D) 10 to 15
Free
Multiple Choice
Q 255Q 255
Your patient has received blunt facial trauma due to an assault. For which of the following injuries should you maintain a high index of suspicion?
A) Airway obstruction
B) Hypoxia due to aspiration of blood
C) Basilar skull fracture
D) Lumbar spine trauma
Free
Multiple Choice
Q 256Q 256
The ________ is one of the thinnest and most frequently fractured cranial bones.
A) temporal
B) ethmoid
C) parietal
D) occipital
Free
Multiple Choice
Q 257Q 257
Which of the following patients fit the criteria for application of spinal precautions in the prehospital setting?
A) An 85-year-old man who has fallen down three steps and has a large laceration to the occipital region of the skull, but no complaints of pain
B) A 21-year-old man who was diving into a pool and states he hit his head, but is out of the pool and ambulatory upon your arrival with no complaint of neck or back pain
C) A 36-year-old woman who was involved in a minor motor vehicle crash with an obvious closed tibia fracture
D) None of the above
Free
Multiple Choice
Q 258Q 258
During the early care for a patient with a basilar skull fracture in the prehospital setting, which of the following would be an unexpected finding?
A) Periorbital ecchymoses or "raccoon eyes"
B) CSF otorrhea
C) Blood mixed with cerebral spinal fluid flowing from the mouth
D) CSF rhinorrhea
Free
Multiple Choice
Q 259Q 259
Which of the following skull fractures is most common?
A) Linear
B) Basilar
C) Depressed
D) Comminuted
Free
Multiple Choice
Q 260Q 260
Which of the following features of the cranium exacerbates the severity of intracranial trauma?
A) It is rigid.
B) It is formed of dense, heavy bone.
C) It is relatively thin in the frontal region.
D) The sutures allow for separation of the bones.
Free
Multiple Choice
Q 261Q 261
Your patient is a 7-year-old male pedestrian who was struck by a vehicle. Your assessment reveals bleeding from the right auditory canal. Which of the following describes the most appropriate way to manage this?
A) Determining the presence or absence of cerebrospinal fluid is a low priority. Pack the auditory canal with sterile gauze to control bleeding.
B) Use a "halo" test to determine whether cerebrospinal fluid is in the blood. If it is, loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. If cerebrospinal fluid is not present, pack the ear canal with sterile gauze to control bleeding.
C) Determining the presence or absence of cerebrospinal fluid in the blood is a low priority. Loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear.
D) Check the glucose level in the blood draining from the ear. If it is less than the patient's blood glucose level, there is cerebrospinal fluid present. Cover the ear loosely with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. If the glucose level of the blood from the ear is the same as the patient's blood glucose level, pack the auditory canal with sterile gauze to control bleeding.
Free
Multiple Choice
Q 262Q 262
When developing a spinal clearance policy, age:
A) should never be considered, as age does not matter.
B) should be considered only when the patient is a man between the ages of 21 and 35.
C) should be considered, as the very old may not be able to describe their symptoms accurately.
D) should be considered only if the patient is a minor.
Free
Multiple Choice
Q 263Q 263
Your patient is a 22-year-old female assault victim. She has blunt trauma to the face with swelling around the right eye and zygomatic area. Upon assessing her eye movement, you note that the right eye cannot follow your finger and does not move. Which of the following MOST likely explains this finding?
A) She has a fracture of the orbit that has trapped the optic nerve, thereby paralyzing her gaze.
B) She has direct trauma to the eyeball that has damaged the intrinsic muscles of the eye.
C) She has a fracture of the orbit that has trapped the extrinsic eye muscles.
D) She has direct trauma to the eyeball that has damaged the optic nerve, thereby paralyzing her gaze.
Free
Multiple Choice
Q 264Q 264
Which of the following groups is NOT among those with the highest incidence of serious head trauma?
A) The elderly
B) Young men
C) Middle-aged men
D) Infants
Free
Multiple Choice
Q 265Q 265
For the head injury patient without signs of herniation, adjust ventilation rates to maintain a capnography reading of between:
A) 15 and 20 mmHg.
B) 25 and 30 mmHg.
C) 45 and 50 mmHg.
D) 35 and 40 mmHg.
Free
Multiple Choice
Q 266Q 266
Your patient is a 37-year-old male unrestrained driver of a vehicle. You find him with his upper body across the console and his head hanging down into the passenger's side floorboard area. You note pooled blood from a scalp wound. After immobilizing him and loading him into the ambulance, where you have more light for your examination, you note that he has a large, full-thickness avulsion of the scalp. The patient's heart rate is 112, respirations are 20, and blood pressure is 82/50. Which of the following statements about this patient are TRUE? 1. The scalp wound itself cannot account for the patient's vital signs.
2) The scalp wound itself may account for the patient's vital signs.
3) The patient's vital signs are consistent with increasing intracranial pressure.
4) Nothing about the vital signs indicates increased intracranial pressure.
A) 1 and 4
B) 2 and 3
C) 1 and 3
D) 2 and 4
Free
Multiple Choice
Q 267Q 267
When palpating the spine of a patient during your assessment, you are feeling the:
A) spinous processes.
B) vertebral bodies.
C) transverse vertebral processes.
D) vertebral pedicles.
Free
Multiple Choice
Q 268Q 268
A patient who has dived into a shallow pool and hit his head on the bottom is MOST likely to have which of the following types of injuries?
A) Cervical hyperextension
B) Cervical hyperflexion
C) Axial distraction
D) Axial loading
Free
Multiple Choice
Q 269Q 269
Recent research has provided evidence of which of the following regarding spinal injury assessment?
A) Only trauma patients with signs and symptoms of neurological deficit need to receive spinal immobilization.
B) Paramedics cannot reliably identify patients who are likely to have spinal injuries.
C) All trauma patients should be assumed to have spinal injuries.
D) There are reliable criteria for determining the likelihood of spinal injury.
Free
Multiple Choice
Q 270Q 270
Which of the following is a common mechanism of injury associated with spinal cord injuries?
A) Falls greater than 20 feet
B) Bungee jumping
C) Shallow water diving
D) All of the above
Free
Multiple Choice
Q 271Q 271
Which of the following best describes the goals of manual cervical spine stabilization?
A) Preventing movement of the head in any direction; prevent any flexion/extension, rotation, or lateral bending
B) Keeping the head in an "eyes forward" position; applying enough traction to cause axial unloading, which is 18 to 22 pounds in the average adult
C) Preventing rotation of the head; avoiding any upward lifting or downward pressure on the cervical spine
D) Preventing movement of the head in any direction; applying gentle axial pressure to stabilize the vertebral column
Free
Multiple Choice
Q 272Q 272
Which of the following statements about the administration of dextrose to the patient with a traumatic brain injury is TRUE?
A) Hypoglycemia is associated with a poorer neurologic outcome; if the blood glucose level is less than 60 mg/dL, administer 25 grams of dextrose.
B) Hypoglycemia is inconsequential to neurologic outcome; assessing the blood glucose level is not a priority.
C) Hyperglycemia is associated with a poorer neurologic outcome; never administer dextrose to a patient with traumatic brain injury.
D) Hypoglycemia is associated with a poorer neurologic outcome. All patients with suspected traumatic brain injury who have an altered mental status should receive 25 grams of dextrose intravenously.
Free
Multiple Choice
Q 273Q 273
You are caring for a 20-year-old skateboarder who crashed into a brick retaining wall at the bottom of a steep hill. He has blunt trauma to his face with nose deformity, loose teeth, and bleeding from the nose and mouth. Although you have answered him several times, he keeps repeating to you, "What happened? It seems like I'm having a bad day." This is most indicative of which of the following?
A) Aphasia
B) Retrograde amnesia
C) Decorticate disorientation
D) Anterograde amnesia
Free
Multiple Choice
Q 274Q 274
Which of the following are the two most important prehospital considerations for head injury patients?
A) Cervical spine immobilization and ventilation
B) ICP monitoring and administering corticosteroids
C) Ventilation and administering corticosteroids
D) Ventilation and maintaining adequate blood pressure
Free
Multiple Choice
Q 275Q 275
Your patient states that he had a traumatic brain injury from a motorcycle collision three years ago. You notice that his gait is unsteady and his movements are a bit jerky. You suspect that he has damage to which of the following structures?
A) Falx cerebri
B) Reticular activating system
C) Third cranial nerve
D) Cerebellum
Free
Multiple Choice
Q 276Q 276
Which of the following is NOT a component of the Glasgow Coma Scale?
A) Eye opening
B) Motor ability
C) Pupillary reaction
D) Verbal response
Free
Multiple Choice
Q 277Q 277
Which of the following is the largest element of the nervous system?
A) Cerebellum
B) Pons
C) Medulla oblongata
D) Cerebrum
Free
Multiple Choice
Q 278Q 278
Which of the following Glasgow Coma Scale scores indicates serious brain injury?
A) < 3
B) Between 12 and 15
C) < 8
D) < 15
Free
Multiple Choice
Q 279Q 279
The cerebral perfusion pressure is represented by which of the following equations?
A) CPP = MAP - CVP
B) CPP = CVP - ICP
C) CPP = MAP - ICP
D) CPP = ICP - MAP
Free
Multiple Choice
Q 280Q 280
Which of the following mechanisms causes indirect brain injury?
A) Coup/contrecoup injuries
B) Systemic hypotension combined with increasing intracranial pressure
C) Cushing's reflex
D) Acceleration/deceleration forces without a direct blow to the cranium
Free
Multiple Choice
Q 281Q 281
Which of the following best describes consensual reactivity of the pupils?
A) It is a pathological phenomenon. When a penlight is shone into one eye, both pupils constrict.
B) It is a normal phenomenon. When a penlight is shone into one eye, only that pupil will constrict, while the other pupil is unaffected.
C) It is a normal phenomenon. When a penlight is shone into one eye, both pupils constrict.
D) It is a pathological phenomenon. When a penlight is shone into one eye, only that pupil constricts, while the other pupil is unaffected.
Free
Multiple Choice
Q 282Q 282
Your patient is a 12-year-old boy who was struck in the right temporal area of the head with a baseball. He had a brief loss of consciousness and is alert on your arrival. You note that he is becoming drowsy and has a strong radial pulse of 60, a blood pressure of 140/70, and a respiratory rate of 12. Which of the following best describes this patient's condition?
A) He is stable, and he most likely has a subarachnoid hemorrhage with no increase in intracranial pressure.
B) He is critical, and he most likely has an epidural hematoma with rapidly increasing intracranial pressure.
C) He is stable, and he most likely has a mild diffuse axonal injury with no increase in intracranial pressure.
D) He is serious, and he most likely has a subdural hematoma with an increase in intracranial pressure.
Free
Multiple Choice
Q 283Q 283
The shearing, stretching, and tearing associated with rapid acceleration/deceleration forces acting on the brain result in which of the following types of brain injury?
A) Direct, diffuse
B) Indirect, diffuse
C) Indirect, focal
D) Direct, focal
Free
Multiple Choice
Q 284Q 284
A concussion is best described as which of the following types of brain injuries?
A) Indirect, diffuse
B) Indirect, focal
C) Direct, focal
D) Direct, diffuse
Free
Multiple Choice
Q 285Q 285
For the patient with suspected traumatic brain injury, the ideal positioning of the patient for transport is:
A) in a left lateral recumbent position on the backboard.
B) on a long backboard with the foot of the backboard in a 15-degree Trendelenburg position.
C) on a long backboard with the patient's feet elevated on pillows to achieve a 15-degree angle.
D) on a long backboard with the head of the backboard elevated 15 to 30 degrees.
Free
Multiple Choice
Q 286Q 286
When CPP falls below the critical level of 50 mmHG, autoregulation does which of the following to maintain CPP and cerebral perfusion?
A) Decreases blood pressure
B) Increases blood pressure
C) Decreases intracranial pressure
D) Increases intracranial pressure
Free
Multiple Choice
Q 287Q 287
Which of the following about the use of prehospital fluid resuscitation in the patient with a traumatic brain injury is TRUE?
A) Administer fluids aggressively regardless of the patient's blood pressure.
B) Do not administer fluids unless the patient's blood pressure drops below 60 mmHg, because the administration of fluids leads to increased cerebral edema.
C) Administer fluids as needed to maintain a systolic blood pressure above 90 mmHg.
D) The use of hypertonic fluids is indicated to maintain vascular volume while reducing tissue edema.
Free
Multiple Choice
Q 288Q 288
Which of the following best describes the role of rapid sequence intubation (RSI) in the prehospital management of patients with traumatic brain injury?
A) It is beneficial and should be used for all patients with traumatic brain injury who are experiencing trismus or who have an intact gag reflex.
B) It is supported by anecdotal evidence, but no studies have been done to determine its feasibility or usefulness.
C) It is controversial because of conflicting study results.
D) It is detrimental, resulting in poorer neurological outcomes than in patients who received standard airway management.
Free
Multiple Choice
Q 289Q 289
Which of the following statements about the patient in neurogenic shock is NOT true?
A) The patient's heart rate may be slow.
B) The patient's blood pressure is decreasing.
C) Signs of hypovolemic shock may be masked.
D) Unopposed sympathetic nervous system stimulation results in generalized pallor and diaphoresis.
Free
Multiple Choice
Q 290Q 290
Coup injuries commonly occur in which region of the brain?
A) Frontal region
B) Occipital region
C) Temporal region
D) Neuronal region
Free
Multiple Choice
Q 291Q 291
Anterior cord syndrome is caused by which of the following mechanisms?
A) Tearing of the anterior cord due to hyperextension mechanisms
B) Disruption of arterial blood supply to the anterior cord
C) Laceration of the anterior cord caused by bone fragments
D) Contusion of the anterior cord caused by blunt trauma
Free
Multiple Choice
Q 292Q 292
The diaphragm is controlled by peripheral nerve roots ________ through ________.
A) C-3; C-7
B) C-3; C-5
C) C-1; C-7
D) C-1; C-5
Free
Multiple Choice
Q 293Q 293
The spinal cord is continuous from the brain to the level of:
A) T-12 or T-13.
B) L-5 or L-6.
C) the coccyx.
D) L-1 or L-2.
Free
Multiple Choice
Q 294Q 294
You are treating a 16-year-old male patient who fell while practicing a new move on his skateboard. Bystanders relate that the patient was not wearing a helmet. The bystanders also relate that the patient was alert and oriented following the fall; however, while waiting for you to arrive, the patient became unconscious. While performing your physical exam, you note that the patient has a hematoma to the right temporal area. Your assessment leads you to believe that your patient has an epidural hematoma. You know that an epidural hematoma is caused by what type of bleeding?
A) Venous bleeding
B) Capillary bleeding
C) Arterial bleeding
D) Venous and capillary bleeding
Free
Multiple Choice
Q 295Q 295
You have intubated a 5-year-old girl with a suspected head injury. You note that the patient is exhibiting signs of herniation. What is the desired range for this patient's end-tidal CO2?
A) 35 to 40
B) 30 to 35
C) 25 to 30
D) 40 to 45
Free
Multiple Choice
Q 296Q 296
The phrenic nerve consists of peripheral nerve roots ________ through ________.
A) C-1; C-3
B) C-5; C-8
C) C-3; C-5
D) C-1; C-8
Free
Multiple Choice
Q 297Q 297
Your patient is a 17-year-old female who fell from a horse. She is complaining of being unable to move. During your assessment, you have placed her arms at her sides, but her arms keeping returning to a "stick-up" or "hold-up" position. Based on this, which of the following is MOST likely?
A) The patient has a spinal-cord injury at T-1.
B) The patient has Brown-Séquard syndrome.
C) The patient is feigning the injury.
D) The patient has a spinal cord injury in the midcervical region.
Free
Multiple Choice
Q 298Q 298
All the following are seen in Cushing's triad, EXCEPT:
A) increased blood pressure.
B) irregular respirations.
C) tachycardia.
D) All of the above are seen in Cushing's triad.
Free
Multiple Choice
Q 299Q 299
Which of the following spinal cord injuries is LEAST likely to result in residual neurologic deficit?
A) Compression
B) Transection
C) Contusion
D) Laceration
Free
Multiple Choice
Q 300Q 300
Pediatric patients are ________ likely to become hypovolemic from head injuries than adult patients.
A) more
B) less
C) equally
D) Pediatric patients always become hypovolemic due to the movable fontanels.
Free
Multiple Choice
Q 301Q 301
A spinal cord lesion may result in paralysis of both lower extremities. This condition is known as:
A) hemiplegia.
B) hemiparesis.
C) quadriplegia.
D) paraplegia.
Free
Multiple Choice
Q 302Q 302
When assessing an individual who has lost sensation below the umbilicus, at what level do you suspect injury?
A) T-10
B) T-4
C) L-1
D) T-8
Free
Multiple Choice
Q 303Q 303
Which of the following is a function of the sympathetic nervous system?
A) Digestion
B) Sexual functioning
C) Constriction of the pupils
D) Increased heart rate
Free
Multiple Choice
Q 304Q 304
All of the following are used in the sedation of patients for rapid sequence intubation, EXCEPT:
A) Valium.
B) Romazicon.
C) etomidate.
D) ketamine.
Free
Multiple Choice
Q 305Q 305
A patient unable to extend the leg or flex the hip is MOST likely to have incurred an injury in which nerve plexus?
A) Cervical
B) Lumbar
C) Brachial
D) Sacral
Free
Multiple Choice
Q 306Q 306
Which of the following is noted in the patient with a positive Babinski's sign?
A) Fanning of the toes with plantar flexion of the great toe
B) Dorsiflexion of the second to fifth toes with plantar flexion of the great toe
C) Fanning of the toes with dorsiflexion of the great toe
D) Plantar flexion of the second to fifth toes with dorsiflexion of the great toe
Free
Multiple Choice
Q 307Q 307
The cerebrum, cerebellum, and brainstem account for what percentage of the cranial volume?
A) 60 percent
B) 80 percent
C) 50 percent
D) 75 percent
Free
Multiple Choice
Q 308Q 308
A patient who had a spinal cord T4 injury two years ago calls 911 for a pounding headache, blurred vision, and flushing. On your arrival, her vital signs include a blood pressure of 240/120 and pulse of 58. What is this condition called?
A) Autonomic hyperreflexia syndrome
B) Spinal shock
C) Malignant hypertension
D) Brown-Séquard syndrome
Free
Multiple Choice
Q 309Q 309
You are on the scene of a domestic assault in which the female victim defended herself against further attack by stabbing her attacker. Your patient is a 36-year-old man who has been stabbed in the posterior thorax about 1 centimeter to the right of the spinous process of T6. Your assessment reveals loss of motor and sensory function on the right side distal to T6 but intact motor function with some loss of sensation on the left side distal to T6. Which of the following best explains this patient's presentation?
A) "Pseudoneurologic" deficit to avoid being arrested
B) Brown-Séquard syndrome
C) Central cord syndrome
D) Autonomic hyperreflexia
Free
Multiple Choice
Q 310Q 310
In a subdural hematoma, the vessel most commonly involved is the:
A) superior sagittal sinus.
B) inferior sagittal sinus.
C) middle meningeal artery.
D) superior meningeal artery.
Free
Multiple Choice
Free
Multiple Choice
Q 312Q 312
Which of the following mechanisms are involved in neurogenic shock? 1. Unopposed vasodilation
2) Loss of innervation to the adrenal medulla
3) Decreased preload
4) Unopposed sympathetic tone
A) 1, 2, 3
B) 1, 3, 4
C) 1, 2, 3, 4
D) 1, 3
Free
Multiple Choice
Q 313Q 313
When providing fluid resuscitation for a 1-year-old child with hypovolemia from a head injury, the goal is to maintain a systolic blood pressure of:
A) 90 mmHg.
B) 85 mmHg.
C) 75 mmHg.
D) 65 mmHg.
Free
Multiple Choice
Q 314Q 314
Which syndrome causes motor weakness that affects the upper extremities and usually occurs in patients older than 50 years of age?
A) Central cord
B) Anterior cord
C) Brown-Séquard
D) Cauda equina
Free
Multiple Choice
Q 315Q 315
A ________ fracture characteristically involves the entire facial region below the brow ridge, including the zygoma, nasal bone, and maxilla.
A) Le Fort I
B) Le Fort II
C) Le Fort III
D) Le Fort IV
Free
Multiple Choice
Q 316Q 316
Intracranial Volume = Brain Volume + CSF Volume + Blood Volume is the basis behind which of the following?
A) Cerebral perfusion pressure
B) Monroe-Kellie doctrine
C) Mean arterial pressure
D) Traumatic brain injury
Free
Multiple Choice
Q 317Q 317
Which of the following trauma patients is MOST likely to have SCIWORA when examined in the hospital?
A) 5-year-old male
B) 80-year-old female
C) 21-year-old male
D) 45-year-old female
Free
Multiple Choice
Q 318Q 318
Which of the cervical vertebrae is quite pronounced and can be felt as the first bony prominence along the spine and just above the shoulders?
A) C3
B) C1
C) C6
D) C7
Free
Multiple Choice
Q 319Q 319
When assessing the eyes of a patient with head trauma, you can tell the function of all the following cranial nerves, EXCEPT:
A) II.
B) VII.
C) IV.
D) VI.
Free
Multiple Choice
Q 320Q 320
Your patient has sustained trauma to the eye. Upon examination, you see blood pooling in the anterior chamber and in front of the iris and pupil. What is this condition called?
A) Mediastinitis
B) Otorrhea
C) Icterus
D) Hyphema
Free
Multiple Choice
Q 321Q 321
Which of the following is the correct description of a wound that is below the fifth rib, directly in line with the armpit?
A) Sixth intercostal space, midclavicular
B) Sixth intercostal space, midaxillary line
C) Fifth intercostal space, midclavicular line
D) Fifth intercostal space, midaxillary line
Free
Multiple Choice
Q 322Q 322
The morbidity associated with simple pneumothorax is primarily due to which of the following?
A) Occlusion of pulmonary circulation
B) Increased intrathoracic pressure
C) Loss of chest wall integrity
D) Ventilation/perfusion mismatch
Free
Multiple Choice
Q 323Q 323
On maximal expiration, the diaphragm may be:
A) as high as the fourth intercostal space anteriorly.
B) as high as the second intercostal space anteriorly.
C) as low as the ninth intercostal space anteriorly.
D) as low as the eleventh intercostal space anteriorly.
Free
Multiple Choice
Q 324Q 324
Which of the following occurs during the onset of inspiration?
A) Intrathoracic pressure increases and venous return to the heart is impeded.
B) Intrathoracic pressure increases and venous return to the heart is facilitated.
C) Intrathoracic pressure decreases and venous return to the heart is impeded.
D) Intrathoracic pressure decreases and venous return to the heart is facilitated.
Free
Multiple Choice
Q 325Q 325
The trachea divides into the right and left mainstem bronchi at the:
A) carina.
B) hilum.
C) lingual.
D) thoracic inlet.
Free
Multiple Choice
Q 326Q 326
Which of the following has the greatest likelihood of resulting in an open pneumothorax?
A) Any opening between the pleural cavity and the atmosphere
B) Open defects that are two-thirds the size of the trachea or larger
C) Open defects that are larger in diameter than the trachea
D) Open defects that are one-quarter the size of the trachea or larger
Free
Multiple Choice
Q 327Q 327
Your patient is a 38-year-old man who was pinned beneath the frame of a vehicle when it slipped off the makeshift jacks he was using to elevate it. The patient's brother thinks he may have been trapped for up to 20 minutes. The rescue unit is preparing to use airbags to lift the vehicle off the patient. Which of the following medications could you consider giving this patient?
A) Magnesium sulfate
B) Calcium chloride
C) Sodium bicarbonate
D) Potassium chloride
Free
Multiple Choice
Q 328Q 328
Your patient is a 27-year-old man with one stab wound at the fifth intercostal space posteriorly, on the right. He is ambulatory at the scene, but dyspneic and has air movement at the site of the injury. Which of the following should you do first?
A) Apply oxygen by nonrebreather.
B) Cover the wound with your gloved hand.
C) Prepare an occlusive dressing.
D) Perform a needle thoracostomy.
Free
Multiple Choice
Q 329Q 329
Which of the following statements is NOT true of pericardial tamponade?
A) It is most often associated with penetrating trauma.
B) The systolic blood pressure increases significantly on inspiration.
C) As little as 150 mL of blood can cause pericardial tamponade.
D) The pathophysiology results in increased venous pressure and decreased cardiac output.
Free
Multiple Choice
Q 330Q 330
Which of the following statements concerning blunt thoracic trauma in the pediatric population is most accurate?
A) Children are more likely than adults to suffer both rib fracture and organ injury.
B) Children are less likely than adults to suffer either rib fractures or organ injury.
C) Children are more likely than adults to suffer rib fractures but less likely to suffer significant organ injury.
D) Children are less likely than adults to suffer rib fractures but more likely to have significant organ injury.
Free
Multiple Choice
Q 331Q 331
An individual is struck in the left ventricle with a low-velocity projectile. As compared to high-velocity penetrating trauma, you should have a higher index of suspicion for:
A) ventricular rupture.
B) pericardial tamponade.
C) simple penetrating injury.
D) blunt cardiac injury.
Free
Multiple Choice
Q 332Q 332
Your patient received a blow to the left lateral chest at the level of the sixth and seventh ribs. You should suspect fractures at:
A) the point of impact of the sixth rib only.
B) the point of impact and the posterior axillary line of the sixth rib only.
C) the point of impact on both ribs.
D) the point of impact and the posterior axillary line of both ribs.
Free
Multiple Choice
Q 333Q 333
You have arrived on the scene of a paramedic who was shot as she approached a residence on a call. The scene has since been secured. Your patient is a 38-year-old woman with one gunshot wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and difficulty breathing. The patient's EMT partner has applied oxygen by nonrebreather mask and placed an occlusive dressing over the entry wound before your arrival. As you continue your assessment, the patient's level of consciousness decreases. She responds to verbal stimuli. Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side. The patient lacks a radial pulse, and her abdomen is non-guarded and non-tender. Which of the following best explains the presentation of this patient?
A) Simple pneumothorax
B) Tension pneumothorax
C) Pericardial tamponade
D) Hemothorax
Free
Multiple Choice
Q 334Q 334
You have arrived on the scene of a paramedic who was shot as she approached a residence on a call. The scene has since been secured. Your patient is a 38-year-old woman with one gunshot wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and difficulty breathing. The patient's EMT partner has applied oxygen by nonrebreathing mask and placed an occlusive dressing over the entry wound before your arrival. As you continue your assessment, the patient's level of consciousness decreases. She responds to verbal stimuli. Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side. The patient lacks a radial pulse, and the abdomen is non-guarded and non-tender. Which of the following should you do first?
A) Start a large-bore IV of isotonic crystalloid solution.
B) Do a rapid trauma assessment.
C) Assist ventilations with a bag-valve-mask device.
D) Do an immediate needle chest decompression.
Free
Multiple Choice
Q 335Q 335
Which of the following is TRUE of pulmonary contusion?
A) Signs and symptoms generally develop gradually.
B) Pulmonary contusion is typically an isolated injury.
C) The primary pathophysiology is that the alveoli are filled with blood.
D) Pulmonary contusion results in paradoxical motion of the chest wall.
Free
Multiple Choice
Q 336Q 336
Which of the following is the primary prehospital concern with a simple, isolated fracture of the fifth rib in the right posterior-axillary line?
A) Hemorrhage
B) Pneumonia
C) Hypoventilation
D) Liver contusion
Free
Multiple Choice
Q 337Q 337
Which of the following best describes the threat to life associated with traumatic rupture of the esophagus?
A) Entry of gastric contents into the mediastinum
B) Hypoxia
C) Decreased cardiac output
D) Massive hemorrhage
Free
Multiple Choice
Q 338Q 338
Which of the following best describes the epidemiology of sternal fracture?
A) Low incidence, low mortality
B) High incidence, high mortality
C) High incidence, low mortality
D) Low incidence, high mortality
Free
Multiple Choice
Q 339Q 339
Abdominal trauma should be suspected with penetrating thoracic wounds below the ________ rib anteriorly and the ________ rib posteriorly.
A) fourth; ninth
B) second; fifth
C) fourth; sixth
D) second; tenth
Free
Multiple Choice
Q 340Q 340
Your patient is an 80-year-old man who was the unrestrained driver of a vehicle without airbags that was involved in a frontal collision with a parked car. Your assessment reveals that he is dyspneic, tachypneic, and tachycardic. He is awake but unable to respond to questions. There are no obvious signs of injury to the head or neck. The patient has paradoxical movement of the sternum with breathing, along with crepitus and subcutaneous air noted on palpation. Chest excursion is limited, and the patient has cyanosis of his lips, ears, and nail beds. Which of the following is most needed in this patient?
A) Infusion of isotonic crystalloid solution using a large-bore IV
B) Application of bulky dressings over the site of paradoxical motion
C) Being placed in a prone position to stabilize the chest wall
D) Intubation and positive-pressure ventilation
Free
Multiple Choice
Q 341Q 341
Traumatic asphyxia is a(n) ________ type of injury.
A) compression
B) deceleration
C) decompression
D) acceleration
Free
Multiple Choice
Q 342Q 342
Which of the following is a complication of positive-pressure ventilation in the patient with significant chest trauma?
A) Pulmonary contusion
B) Atelectasis
C) Exacerbation of flail chest
D) Impaired venous return to the heart
Free
Multiple Choice
Q 343Q 343
Which of the following most accurately characterizes simple pneumothorax?
A) Untreated, it will lead to mediastinal shift and compression of the contralateral lung.
B) It is a problem of ventilation-perfusion mismatch.
C) It results from air entering the pleural cavity through a defect in the chest wall.
D) It results from the creation of a one-way valve that continues to allow air into, but not out of, the pleural cavity.
Free
Multiple Choice
Q 344Q 344
Which of the following findings differentiates a simple pneumothorax from a tension pneumothorax?
A) Decreased breath sounds on the affected side
B) Hemodynamic compromise
C) Absent breath sounds on the affected side
D) An open defect in the chest wall
Free
Multiple Choice
Q 345Q 345
Hemothorax is primarily a problem of:
A) blood loss.
B) impaired ventilation.
C) ventilation/perfusion mismatch.
D) increased intrathoracic pressure.
Free
Multiple Choice
Q 346Q 346
Your patient is a 15-year-old male who was struck in the chest with a baseball. He is unresponsive, pulseless, and apneic. The monitor shows ventricular fibrillation. This condition is most accurately described as:
A) pericardial tamponade.
B) blunt cardiac injury.
C) commotio cordis.
D) traumatic asphyxia.
Free
Multiple Choice
Q 347Q 347
Your patient is a 21-year-old man with a single, small-caliber gunshot wound to the left anterior chest, just lateral to the sternum at the fourth intercostal space. Bleeding from the wound is minimal. The patient is initially anxious, combative, and diaphoretic. Initial vital signs include a heart rate of 100, respirations of 20, and a blood pressure of 110/80. Breath sounds are clear bilaterally and equal. En route, the patient becomes quieter but still restless. The heart rate increases to 120, respirations are 24, blood pressure 106/88, and breath sounds remain clear and equal. The patient has also developed significant JVD. You are 15 minutes from a Level I trauma center and 5 minutes away from a large community hospital. You should:
A) immediately decompress the left chest and divert to the community hospital for chest tube insertion.
B) immediately decompress the left chest and continue to the trauma center for chest tube insertion.
C) continue to the Level I trauma center for pericardiocentesis.
D) divert to the community hospital for pericardiocentesis.
Free
Multiple Choice
Q 348Q 348
Which of the following best describes the mechanism of blunt thoracic trauma associated with blast injuries?
A) Deceleration
B) Acceleration
C) Compression
D) Compression and decompression
Free
Multiple Choice
Q 349Q 349
Thoracic trauma accounts for approximately ________ percent of mortality from trauma.
A) 20 to 25
B) 10 to 15
C) 75 to 80
D) 45 to 50
Free
Multiple Choice
Q 350Q 350
Which of the following is the primary concern in the patient with a hemothorax?
A) Hypovolemia
B) Increased intrathoracic pressure
C) Mediastinal shift
D) Atelectasis
Free
Multiple Choice
Q 351Q 351
Your patient was the unrestrained driver of a motor vehicle without airbags. The vehicle struck a large utility pole at about 45 miles per hour. Your patient has a contusion over his chest and upper abdomen consistent with the shape of the steering wheel. You should suspect which of the following types of injury in this patient?
A) Compression
B) Compression and acceleration
C) Compression and deceleration
D) Deceleration
Free
Multiple Choice
Q 352Q 352
The location of the neurovascular bundles containing the intercostal arteries is best described as the bundle that runs along the:
A) intercostal space equally distant from both associated ribs.
B) posterior surface of the associated rib.
C) superior margin of the associated rib.
D) lower rib margin of the associated rib.
Free
Multiple Choice
Q 353Q 353
Your patient is a 24-year-old man who was struck just below the left scapula with a 3-inch-diameter metal pipe. He is awake but having difficulty breathing. His pulse is 112 at the radial artery, and his respiratory rate is 28 per minute and shallow. His breath sounds are present bilaterally but diminished on the left. He has a blood pressure of 108/68. The patient is coughing up some bloody sputum. He has no other complaints, and a rapid trauma survey reveals no additional life-threatening injuries. Which of the following represents the best sequence of interventions for this patient?
A) Begin transport immediately, positive pressure ventilation, a large-bore IV of isotonic solution to maintain a systolic blood pressure of 120 mmHg or greater.
B) High-concentration oxygen by nonrebreather mask, begin transport, a 16-gauge IV at a keep-open rate.
C) Positive-pressure ventilation, a large-bore IV of normal saline solution at a keep-open rate, transport.
D) High-concentration oxygen by nonrebreather mask, begin transport, two 14-gauge IVs of 50 percent dextrose solution wide open.
Free
Multiple Choice
Q 354Q 354
Which of the following best describes the incidence of pericardial tamponade?
A) It occurs in 10 to 15 percent of all trauma patients.
B) It occurs in less than 2 percent of all patients with serious chest trauma.
C) It occurs in 10 to 15 percent of patients with serious chest trauma.
D) It occurs in 2 percent of all trauma patients.
Free
Multiple Choice
Q 355Q 355
The angle of Louis serves as a landmark for performing needle thoracostomy at which of the following locations?
A) Second intercostal space anteriorly
B) Second intercostal space laterally
C) Fourth intercostal space anteriorly
D) Fourth intercostal space laterally
Free
Multiple Choice
Q 356Q 356
The central area in the thorax that contains the heart, great vessels, trachea, and esophagus is the:
A) mediastinum.
B) pulmonary hilum.
C) hemothorax.
D) carina.
Free
Multiple Choice
Q 357Q 357
You have just inserted a large-bore catheter into the chest of a patient with a tension pneumothorax and received a return of air. Which of the following should NOT be done?
A) Insert a second, or even a third, catheter if the patient is symptomatic, despite the release of air.
B) Leave the catheter in place, and create a flutter valve.
C) Leave the catheter in place and open to air.
D) Remove the catheter.
Free
Multiple Choice
Q 358Q 358
Another name for an open pneumothorax is:
A) tension pneumothorax.
B) sucking chest wound.
C) flail chest.
D) hemopneumothorax.
Free
Multiple Choice
Q 359Q 359
Which of the following is LEAST likely to be a sign of an open pneumothorax?
A) Large, open thoracic wound
B) Frothy blood around the opening
C) Jugular vein distention
D) Dyspnea
Free
Multiple Choice
Q 360Q 360
Which of the following best describes the finding of tracheal shift in the trauma patient?
A) Its absence rules out tension pneumothorax.
B) It is the earliest sign of tension pneumothorax.
C) It is a rare finding in patients with tension pneumothorax.
D) It is a contraindication to needle thoracostomy in tension pneumothorax.
Free
Multiple Choice
Q 361Q 361
The finding of jugular venous distention in the patient with thoracic trauma is LEAST likely to be associated with which of the following?
A) Traumatic asphyxia
B) Hemothorax
C) Tension pneumothorax
D) Pericardial tamponade
Free
Multiple Choice
Q 362Q 362
Which of the following may improve breathing in the patient with isolated rib fractures?
A) Nitrous oxide
B) Taping circumferentially around the chest
C) Morphine sulfate
D) None of the above
Free
Multiple Choice
Q 363Q 363
Which of the following are the most commonly fractured ribs?
A) 1 to 3
B) 4 to 8
C) 7 to 12
D) 5 to 10
Free
Multiple Choice
Q 364Q 364
You are treating a patient whose open chest wound has been sealed by EMTs on the scene before your arrival. During transport the patient becomes more dyspneic, tachycardic, and hypotensive. There are no breath sounds on the affected side, and the patient has JVD. Which of the following is the best action?
A) Reinforce the dressing with additional tape, using tincture of benzoin, if necessary, to improve the seal.
B) Perform a needle thoracostomy at the second intercostal space in the midclavicular line.
C) Perform a needle thoracostomy at the fourth intercostal space in the midaxillary line.
D) Remove the dressing and see if the patient's clinical status improves, then replace the dressing.
Free
Multiple Choice
Q 365Q 365
Which of the following patients may have trauma to abdominal organs? 1. A 30-year-old construction worker who fell from a second-story roof but managed to land on his feet
2) A 17-year-old male with a gunshot wound to the right buttock
3) A 50-year-old male with a stab wound 4 cm inferior to the right scapula
4) A 45-year-old female restrained driver of an SUV with a moderate-speed frontal impact
A) 1, 2, 3, 4
B) 3, 4
C) 4
D) 1, 3, 4
Free
Multiple Choice
Q 366Q 366
Which of the following changes is NOT of concern in the pregnant trauma patient?
A) Disproportionate increase in vascular volume as compared to red blood cells
B) The high likelihood of trauma to the uterus in the first trimester
C) Compression of the inferior vena cava
D) Rupture of the urinary bladder
Free
Multiple Choice
Q 367Q 367
The ________ is a double peritoneal fold containing blood vessels, lymphatic vessels, nerves, and fatty tissue.
A) retroperitoneal space
B) pancreas
C) peritoneum
D) mesentery
Free
Multiple Choice
Q 368Q 368
Which of the following best describes shear injuries to the abdominal organs?
A) Sudden compression of gas-containing hollow organs, resulting in their rupture
B) Sudden decompression of solid or hollow organs
C) Tearing of the organ in which the organ is fixed at its point of attachment but free to move otherwise
D) Impact of solid organs with the abdominal wall in rapid deceleration
Free
Multiple Choice
Q 369Q 369
The liver is injured ________ percent of the time with penetrating abdominal trauma.
A) 10
B) 40
C) 25
D) 75
Free
Multiple Choice
Q 370Q 370
Your patient is a 30-year-old pregnant woman at 36 weeks' gestation. She was injured in a fall from a horse and is complaining of painful contractions. Her abdomen is tender to palpation over the uterus, and the uterus becomes firm with contractions, but she denies vaginal bleeding. The patient is anxious, but her skin is warm and dry. Her blood pressure is 112/70, her heart rate is 92, and her respirations are 24. Which of the following statements best describes this situation?
A) The mechanism and patient complaints are suspicious for abruptio placentae. The mother's condition is not life threatening, but fetal demise has most likely already occurred.
B) The mechanism and patient complaints are consistent with placenta previa. The mother is stable, but the fetus is in jeopardy.
C) The mechanism and patient complaints are consistent with uterine rupture. Both the mother and fetus are in jeopardy.
D) The mechanism and patient complaints are suspicious for abruptio placentae. Both the mother and the fetus are in jeopardy.
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Multiple Choice
Q 371Q 371
Which of the following can reduce the potential for abdominal injury?
A) Proper placement of automobile lap belts in adults
B) Side-impact airbags
C) Proper placement of automobile lap belts in children
D) All of the above
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Multiple Choice
Q 372Q 372
Which of the following is TRUE of abdominal trauma?
A) A soft, non-tender, non-distended abdomen with intact bowel sounds reliably rules out hollow organ injury.
B) Due to the vascular nature of abdominopelvic organs, the onset of signs and symptoms is abrupt and severe.
C) A soft, non-tender, non-distended abdomen reliably rules out solid organ injury.
D) A significant amount of blood can accumulate in the abdominal cavity before signs and symptoms of abdominal injury appear.
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Multiple Choice
Q 373Q 373
Which of the following describes definitive care of the patient with traumatic intraabdominal hemorrhage?
A) Admission to the ICU for observation
B) Aggressive oxygenation and fluid resuscitation
C) Administration of blood or blood products
D) Rapid surgical intervention
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Multiple Choice
Q 374Q 374
The suspicion of blunt abdominal trauma should be based primarily on:
A) the mechanism of injury.
B) distension of the abdomen on palpation.
C) the patient's complaint of abdominal pain.
D) the presence of contusions.
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Multiple Choice
Q 375Q 375
Which of the following is a special consideration when managing the pregnant trauma patient?
A) She is at increased risk for vomiting and aspiration.
B) She may have a 30 percent blood volume loss before experiencing signs and symptoms of shock.
C) Placing her supine may decrease cardiac output.
D) All of the above are special considerations.
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Multiple Choice
Q 376Q 376
Your patient is a 17-year-old male driver of a vehicle that received a lateral impact at the driver's side door. There are no side-impact airbags, and there is about 8 inches of intrusion into the passenger compartment at the left door. Your patient is complaining of left shoulder pain and pain "in his left side." He has a contusion on the left shoulder and deformity of the left clavicle. He has erythema over the left lateral thorax from ribs 6 through 12 with crepitus on palpation. Which of the following injuries should you suspect? 1. Blunt trauma to the spleen
2) Blunt trauma to the liver
3) Penetrating trauma to the spleen
4) Penetrating trauma to the liver
5) Left pneumothorax
6) Fracture of the left clavicle
A) 1, 2, 6
B) 2, 4, 6
C) 1, 5, 6
D) 2, 5, 6
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Multiple Choice
Q 377Q 377
Which of the following guidelines applies to prehospital fluid resuscitation of hypotensive patients with intraabdominal hemorrhage?
A) In most cases, fluid administration should be limited to 3 liters.
B) IV access should be obtained using a saline lock, but fluid resuscitation is contraindicated in the prehospital setting.
C) Fluid administration rate should be titrated to maintain a systolic blood pressure of 60 mmHg.
D) IV access is necessary only if the use of PASG fails to improve the patient's clinical condition.
Free
Multiple Choice
Q 378Q 378
Which of the following organs is NOT part of the digestive system?
A) Liver
B) Spleen
C) Stomach
D) Pancreas
Free
Multiple Choice
Q 379Q 379
Damage to which of the following organs is MOST likely to induce severe infection in the abdominal cavity?
A) Urinary bladder
B) Colon
C) Stomach
D) Ureter
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Multiple Choice
Q 380Q 380
Your patient is an 18-year-old man who was slashed across the abdomen with a machete. He has a mass of omentum and small bowel protruding from the wound. Which of the following is your primary concern with this patient?
A) Immediately covering the wound with an occlusive dressing, using your gloved hand if nothing else is available
B) Irrigating the exposed organs with sterile saline to remove debris and gently tucking them back into the opening to keep them warm and moist and to prevent further contamination
C) Covering the wound with a sterile, saline-moistened dressing covered by an occlusive dressing
D) Having the patient hold the omentum and placing him on the stretcher in a position of comfort to transport rapidly
Free
Multiple Choice
Q 381Q 381
Which of the following may affect the pattern of injury in abdominal trauma?
A) A full-term uterus
B) A full stomach
C) A full bladder
D) All of the above
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Multiple Choice
Q 382Q 382
Which of the following is TRUE of the epidemiology of abdominal trauma?
A) Morbidity and mortality due to blunt trauma are decreasing, but morbidity and mortality due to penetrating trauma are increasing.
B) Morbidity and mortality due to blunt trauma are increasing, but morbidity and mortality due to penetrating are decreasing.
C) Morbidity and mortality due to blunt and penetrating trauma are both increasing.
D) Mortality and morbidity due to blunt and penetrating trauma are both decreasing.
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Multiple Choice
Q 383Q 383
Which of the following organs is LEAST likely to be injured in penetrating trauma to the abdomen?
A) Spleen
B) Kidney
C) Pancreas
D) Small intestine
Free
Multiple Choice
Q 384Q 384
The injury in which abdominal organs protrude through a large, deep laceration of the abdominal wall is best described as:
A) disimpaction.
B) a gutting injury.
C) herniation.
D) evisceration.
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Multiple Choice
Q 385Q 385
Your patient is a 60-year-old female restrained driver involved in a moderate-speed frontal impact collision. When you arrive at the scene, she is sitting up in the driver's seat with a chief complaint of a burning sensation in her face. You note abrasions from deployment of the airbag. After immobilizing the patient on a long backboard, you begin transport. As you perform a detailed examination, the patient complains of developing right shoulder pain. Which of the following should you suspect?
A) Myocardial contusion
B) Intraabdominal bleeding
C) Exacerbation of the patient's arthritis due to immobilization on the backboard
D) Shoulder contusion or possible clavicle fracture due to restraint by the shoulder harness
Free
Multiple Choice
Q 386Q 386
How much blood loss can occur in a third-trimester pregnant female before she will show signs or symptoms of hypovolemia?
A) 30 percent
B) 25 percent
C) 40 percent
D) 15 percent
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Multiple Choice
Q 387Q 387
Which of the following is MOST likely to occur as a result of rapid deceleration without actual contact between the patient's body and the interior of the vehicle?
A) Blunt trauma to the pancreas
B) Rupture of the colon
C) Kidney contusion
D) Shearing injury of the liver
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Multiple Choice
Q 388Q 388
Which of the following is TRUE of the patient with a suspected penetrating injury to or rupture of the diaphragm?
A) This is the only abdominal injury for which removal of an impaled object is recommended.
B) This is one of the primary indications for the use of PASG.
C) Shallow respirations may be due to abdominal contents in the thorax.
D) Breathing is not impaired unless abdominal organs migrate into the thoracic cavity.
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Multiple Choice
Q 389Q 389
Which of the following is NOT part of the prehospital examination of the patient with suspected abdominal trauma?
A) Asking the patient about abdominal pain first, then palpating the abdomen in all four quadrants
B) Checking for blood in the urine
C) Checking for stability of the pelvis
D) Assessment of the thorax for injury
Free
Multiple Choice
Q 390Q 390
Which of the following is NOT part of the axial skeleton?
A) Sacrum
B) Pubis
C) Sternum
D) Mandible
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Multiple Choice
Q 391Q 391
Your patient is a 27-year-old male ice skater whose left skate was planted when he was struck and knocked down by another skater. He is agitated and complaining of severe pain in his leg. Your examination reveals an open fracture 6 inches proximal to the ankle joint. Which of the following describes the most appropriate management of this patient?
A) Focused exam, oxygen, spinal immobilization, splint from the foot to above the knee, begin transport, start a large-bore IV, and request orders for analgesia
B) Focused exam, cover the open wound, apply a lower extremity traction splint, begin transport, start an IV, and request orders for analgesia
C) Focused exam, cover the open wound, splint from the foot to above the knee, begin transport, start an IV, and request orders for analgesia
D) Rapid trauma exam, high-concentration oxygen, cervical spine immobilization, cover the open wound, use the long backboard for initial splinting, initiate transport, start a large-bore IV, perform a detailed examination, use padded board splints to immobilize from the ankle to above the knee, and reassess the patient every 5 minutes
Free
Multiple Choice
Q 392Q 392
Your patient is a football player who had his right foot planted and was tackled from the left rear, causing his body to rotate around the axis of his right lower extremity. This mechanism is most consistent with which of the following types of fractures?
A) Oblique
B) Spiral
C) Impacted
D) Comminuted
Free
Multiple Choice
Q 393Q 393
Which of the following is the highest priority when managing a patient with bilateral closed femur fractures?
A) Assessing distal neurovascular function
B) Anticipating hypovolemia
C) Providing analgesia
D) Anticipating pulmonary embolism as a complication
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Multiple Choice
Q 394Q 394
Upon assessing a patient with a hip injury, you find that his right lower extremity is moved away from the midline of the body. You should describe the right lower extremity as being:
A) abducted.
B) externally rotated.
C) angulated.
D) adducted.
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Multiple Choice
Q 395Q 395
Which of the following is a consideration in preventing orthopedic injury?
A) Proper footwear
B) Well-designed railings
C) Appropriate stepladder use
D) All of the above
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Multiple Choice
Q 396Q 396
Your patient is a 20-year-old woman complaining of ankle pain after stepping off a curb. She states that she is concerned because she had a grade III sprain a year and a half ago that required extensive treatment and rehabilitation. Which of the following most accurately describes the patient's previous injury?
A) The ankle ligaments were stretched but not torn.
B) The ankle ligaments had a minor tear.
C) The ankle ligaments were torn but not all the way.
D) The ankle ligaments were completely torn.
Free
Multiple Choice
Q 397Q 397
Tendons connect ________ to ________.
A) muscles; bones
B) bones; bones
C) cartilage; bones
D) muscles; fascia
Free
Multiple Choice
Q 398Q 398
The use of a binder is indicated in the treatment of which of the following musculoskeletal injuries?
A) Bilateral tibia/fibula fractures
B) Knee dislocation
C) Lumbar vertebral compression fracture
D) Pelvic fracture
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Multiple Choice
Q 399Q 399
Which of the following supplies articular cartilage with oxygen and nutrients?
A) Bursae
B) Capillary beds
C) Synovial fluid
D) The Haversian system
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Multiple Choice
Q 400Q 400
A partial displacement of a bone end from its position in the joint is called a:
A) sprain.
B) dislocation.
C) subluxation.
D) contracture.
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Multiple Choice
Q 401Q 401
A fracture in which significant energy exchange shatters or splinters bone, creating many fragments, is called a(n) ________ fracture.
A) impacted
B) comminuted
C) oblique
D) spiral
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Multiple Choice
Q 402Q 402
Your patient is a seven-year-old boy with a fracture of the proximal tibia. Which of the following is the MOST likely and serious complication of this injury?
A) Juvenile onset arthritis
B) Formation of a bone callus
C) Disruption of the epiphyseal plate
D) Fat embolism
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Multiple Choice
Q 403Q 403
Which of the following best describes the function of cancellous bone of the medullary canal?
A) It produces erythrocytes.
B) It acts as a growth plate in long bones.
C) Its dense, compact structure is well adapted to weight bearing.
D) It contains yellow bone marrow.
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Multiple Choice
Q 404Q 404
A dislocated knee is MOST likely to damage which of the following vascular structures?
A) Femoral vein
B) Popliteal artery
C) Femoral artery
D) Great saphenous vein
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Multiple Choice
Q 405Q 405
Which of the following types of fractures occurs in pediatric age groups but not in adults?
A) Oblique
B) Transverse
C) Greenstick
D) Impacted
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Multiple Choice
Q 406Q 406
Your patient is a 50-year-old motorcyclist who received a lateral impact from an automobile as he went through an intersection. He has an open right tibia/fibula fracture. He also has a fracture of his left forearm and some abrasions. He was wearing a helmet and suffered no loss of consciousness. He currently has a strong radial pulse of 100, his skin is warm and moist, and he has adequate respirations at 20 per minute. Assuming no significant findings during a rapid trauma exam and intact distal neurovascular status, which of the following is the best way to manage this patient's lower extremity trauma?
A) Use anatomical splinting provided by placing the patient on a long backboard.
B) Secure padded long board splints laterally and medially.
C) Apply PASG.
D) Apply a traction splint.
Free
Multiple Choice
Q 407Q 407
Not considering other injuries, which of the following musculoskeletal findings warrants immediate transport of your patient?
A) Unstable pelvis
B) Clavicle fracture
C) Posterior shoulder dislocation
D) Open fracture of the tibia and fibula
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Multiple Choice
Q 408Q 408
Your patient is an 80-year-old woman who fractured a vertebra while coughing. This type of fracture is best described as a(n) ________ fracture.
A) pathological
B) greenstick
C) epiphyseal
D) comminuted
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Multiple Choice
Q 409Q 409
When assessing a long bone injury, you should assume that you are dealing with a joint injury when the site of injury is within ________ inch(es) of the joint.
A) 3
B) 2
C) 1
D) 6
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Multiple Choice
Q 410Q 410
One of the earliest indications that compartment syndrome is developing in an injured extremity is:
A) burning pain.
B) pallor of the overlying skin.
C) loss of distal pulses.
D) sensation of pressure in the limb.
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Multiple Choice
Q 411Q 411
A sprain is an injury best defined as which of the following?
A) Bone ends not anatomically aligned
B) Muscle fibers stretched and torn
C) Partial or complete tearing of the ligaments of the joint capsule
D) A violent muscle spasm that tears away a small piece of bone
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Multiple Choice
Q 412Q 412
Your patient has an abrasion on the bony prominence on the inside of her right ankle. This abrasion should be described as being over which of the following structures?
A) Thenar eminence
B) Medial malleolus
C) Lateral malleolus
D) Styloid process
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Multiple Choice
Q 413Q 413
The pain associated with skeletal fractures is transmitted by nerves in the:
A) epiphysis.
B) yellow bone marrow.
C) osteoclasts.
D) periosteum.
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Multiple Choice
Q 414Q 414
Your patient complains of elbow pain and states his doctor told him he had "the bursitis" in his elbow. The patient's condition is characterized by inflammation of the:
A) articular cartilage.
B) synovial sacs.
C) tendons.
D) bone.
Free
Multiple Choice
Q 415Q 415
Your patient is a 21-year-old football player who was struck in the lateral aspect of the left knee by another player's shoulder. The patient is in extreme pain, and the knee is significantly deformed and swollen. The pedal pulse is weak, but present, and capillary refill is less than 2 seconds. The patient is screaming at you to "fix" his knee. You are 10 minutes from the emergency department. You should:
A) splint the knee as found, start an IV, consider narcotic analgesia.
B) apply gentle axial traction and realign the limb, splint in alignment.
C) flex the knee to a 45-degree angle, splint in position of function.
D) start an IV, administer narcotic analgesia, apply firm axial traction until the pulse returns to normal or resistance is met, then splint.
Free
Multiple Choice
Q 416Q 416
The difference in temperature between the environment and the body is known as the:
A) thermal gradient.
B) ambient temperature.
C) thermal temperature.
D) ambient gradient.
Free
Multiple Choice
Q 417Q 417
Heat loss occurs in all the following ways EXCEPT:
A) conduction.
B) evaporation.
C) convection.
D) ingestion.
Free
Multiple Choice