EMT Chapter 25-31 JBL Review
10.A 40-year-old man, who was the unrestrained driver of a car that hit a tree at a high rate of speed, struck the steering wheel with his chest. He has a large bruise over the sternum and an irregular pulse rate of 120 beats/min. You should be MOST concerned that he: A.has injured his myocardium. B.has a collapsed lung and severe hypoxia. C.has extensive bleeding into the pericardial sac. D.is at extremely high risk for ventricular fibrillation.
Answer: A Rationale: A myocardial contusion, or bruising of the heart muscle, is usually the result of blunt trauma—specifically to the center of the chest. In some cases, the injury may be so severe that it renders the heart unable to maintain adequate cardiac output; as a result, blood pressure falls. The pulse rate is often irregular; however, lethal cardiac dysrhythmias such as ventricular tachycardia and ventricular fibrillation are uncommon.
5.While inspecting the interior of a wrecked automobile, you should be MOST suspicious that the driver experienced an abdominal injury if you find: A.a deformed steering wheel. B.that the airbags deployed. C.a crushed instrument panel. D.damage to the lower dashboard.
Answer: A Rationale: Airbags save lives when used in conjunction with properly worn seatbelts. Unfortunately, however, not all drivers wear their seatbelts. If unrestrained, the driver's abdomen may strike the steering wheel, resulting in significant trauma. Suspect this if you lift the airbag and note that the lower part of the steering wheel is deformed.
10.Which of the following mechanisms of injury would MOST likely cause a crushing injury of the larynx and/or trachea? A.Attempted suicide by hanging B.Gunshot wound to the lateral neck C.Car crash involving lateral impact D.Patient whose head hits the windshield
Answer: A Rationale: Any crushing injury of the upper part of the neck is likely to involve the larynx or trachea. Examples include the anterior neck impacting a steering wheel, hanging (distraction) mechanisms, and clothesline injuries.
7.A 22-year-old male was attacked by a rival gang and has a large knife impaled in the center of his chest. Your assessment reveals that he is apneic and pulseless. You should: A.carefully remove the knife, control any bleeding, begin CPR, and transport. B.stabilize the knife in place, provide rescue breathing, and transport at once. C.remove the knife and control any bleeding, apply the AED, and analyze his rhythm. D.begin CPR, control any external bleeding, and transport rapidly to a trauma center.
Answer: A Rationale: As a rule, impaled objects should be stabilized in place. However, if they interfere with the patient's breathing or your ability to perform CPR, they should be removed. You cannot perform CPR on a patient if a knife is impaled in the center of the chest. Carefully remove the knife, control any bleeding, begin CPR, and transport at once. The AED is not indicated for patients with traumatic cardiac arrest; their arrest is usually caused by massive blood loss, not a primary cardiac dysrhythmia.
10.When caring for a female with trauma to the external genitalia, the EMT should: A.use local pressure to control bleeding. B.carefully pack the vagina to reduce bleeding. C.remove any impaled objects from the vagina. D.cover any open wounds with moist, sterile dressings.
Answer: A Rationale: Bleeding from the external genitalia should be controlled by applying a dry, sterile dressing and local direct pressure. Never pack anything into the vagina to try to control bleeding; this increases the risk of infection, and anything you place into the vagina will only need to be removed at the hospital. Impaled objects in the genitalia should be carefully stabilized in place, not removed.
3.A patient who experiences an immediate loss of consciousness followed by a lucid interval has a(n): A.epidural hematoma. B.subdural hematoma. C.concussion. D.contusion.
Answer: A Rationale: Epidural hematomas are caused by injury to an artery—usually the middle meningeal artery—that lies in between the skull and brain. Patients with an epidural hematoma typically experience an immediate loss of consciousness followed by a brief period of consciousness (lucid interval) as intracranial pressure increases. Subdural hematomas are the result of injury to a vein; therefore, they tend to bleed slowly and usually cause a progressive decline in level of consciousness. Concussions and contusions may cause a loss of consciousness, but it is typically brief.
3.A 45-year-old convenience store clerk was shot in the right anterior chest during a robbery. Your assessment reveals that the wound has blood bubbling from it every time the patient breathes. Your MOST immediate action should be to: A.prevent air from entering the wound. B.cover the wound with a bulky dressing. C.assess the patient's back for an exit wound. D.transport the patient promptly to the closest trauma center.
Answer: A Rationale: Immediate treatment for a sucking chest wound (open pneumothorax) involves covering the wound with an occlusive dressing. This will prevent air from being drawn into the chest cavity. After covering the wound, assess for an exit wound, apply high-flow oxygen (if not already done), and transport promptly.
4.Which of the following sets of vital signs is LEAST indicative of internal bleeding? A.BP, 140/90 mm Hg; pulse rate, 58 beats/min; respirations, 8 breaths/min B.BP, 100/50 mm Hg; pulse rate, 120 beats/min; respirations, 24 breaths/min C.BP, 98/60 mm Hg; pulse rate, 110 beats/min; respirations, 28 breaths/min D.BP, 102/48 mm Hg; pulse rate, 100 beats/min; respirations, 22 breaths/min
Answer: A Rationale: Internal hemorrhage typically reveals vital signs that are consistent with shock: hypotension, tachycardia, and tachypnea. Hypertension, bradycardia, and bradypnea (choice "A") is consistent with a closed head injury, not internal bleeding.
9.Paradoxical chest movement is typically seen in patients with: A.a flail chest. B.a pneumothorax. C.isolated rib fractures. D.a ruptured diaphragm
Answer: A Rationale: Paradoxical chest movement occurs when an area of the chest wall bulges out during exhalation and collapses during inhalation. This type of abnormal chest movement is seen in patients with a flail chest—a condition in which several adjacent ribs are fractured in more than one place, resulting in a free-floating segment of fractured ribs.
8.A 70-year-old man is experiencing a severe nosebleed. When you arrive, you find him leaning over a basin, which contains an impressive amount of blood. He has a history of coronary artery disease, diabetes, and migraine headaches. His BP is 180/100 and his heart rate is 100 beats/min. Which of the following is the MOST likely contributing factor to his nosebleed? A.His blood pressure B.His history of diabetes C.The fact that he is elderly D.His heart rate of 100 beats/min
Answer: A Rationale: Several conditions can cause a nosebleed (epistaxis), including skull fractures, facial injuries, sinusitis (inflamed sinuses), high blood pressure, coagulation disorders (ie, hemophilia), and digital trauma (ie, nose picking). A BP of 180/100 indicates a significant amount of pressure on the arteries, which is no doubt the main contributing factor to this patient's nosebleed.
1.The brain, a part of the central nervous system (CNS), is divided into the: A.cerebrum, cerebellum, and brain stem. B.cerebrum, brain stem, and spinal cord. C.cerebellum, cerebrum, and spinal cord. D.spinal cord, cerebrum, and cerebral cortex.
Answer: A Rationale: The brain and spinal cord comprise the central nervous system (CNS). The brain is divided into three major regions: the cerebrum (the largest portion), the cerebellum, and the brain stem. Each region of the brain carries out specific functions.
2.Which of the following organs would be the MOST likely to bleed profusely if severely injured? A.Liver B.Kidney C.Stomach D.Gallbladder
Answer: A Rationale: The liver is a highly vascular solid organ, and contains approximately 40% of the body's total blood volume at any given time. If severely injured, bleeding from the liver would be profuse and rapid. Other solid organs, such as the spleen and kidneys, may also produce severe bleeding if injured, though not as rapid as the liver. The stomach and gallbladder are hollow organs; if lacerated, they would spill their contents into the abdominal cavity, resulting in peritonitis.
1.Which of the following statements regarding the "Adam's apple" is FALSE? A.It is inferior to the cricoid cartilage. B.It is formed by the thyroid cartilage. C.It is the uppermost part of the larynx. D.It is more prominent in men than in women.
Answer: A Rationale: The most obvious prominence in the center of the anterior neck is the Adam's apple. This prominence is the upper part of the larynx, formed by the thyroid cartilage. It is more prominent in men than in women. The other portion of the larynx is the cricoid cartilage, a firm ridge that is inferior to the thyroid cartilage.
9.Which of the following musculoskeletal injuries has the GREATEST risk for shock due to blood loss? A.Pelvic fracture B.Posterior hip dislocation C.Unilateral femur fracture D.Proximal humerus fracture
Answer: A Rationale: The pelvic cavity can accommodate a large volume of blood. Shock in a patient with a pelvic injury is usually due to injury to femoral veins or arteries. Bilateral femur fractures can also cause severe blood loss (up to 1 liter per femur).
6.To effectively immobilize a fractured clavicle, you should apply a(n): A.sling and swathe. B.air splint over the entire arm. C.rigid splint to the upper arm, then a sling. D.traction splint to the arm of the injured side.
Answer: A Rationale: The quickest and most effective way to immobilize a fractured clavicle (collarbone) is to apply a sling and swathe. The sling will help minimize movement of the clavicle itself, while the swath will minimize movement of the arm on the affected side.
4.When caring for a chemical burn to the eye, the EMT should: A.prevent contamination of the opposite eye. B.immediately cover the injured eye with a sterile dressing. C.avoid irrigating the eye, as this may cause further injury. D.irrigate both eyes simultaneously, even if only one eye is injured.
Answer: A Rationale: When irrigating a chemical burn to the eye, it is important to direct the stream away from the uninjured eye. If you do not, you will likely flush the chemical into the unaffected eye. After irrigating the eye for the appropriate amount of time, cover both eyes with a sterile dressing.
4.A 44-year-old man was struck in the back of the head and was reportedly unconscious for approximately 30 seconds. He complains of a severe headache and "seeing stars," and states that he regained his memory shortly before your arrival. His presentation is MOST consistent with a(n): A.contusion. B.concussion. C.subdural hematoma. D.intracerebral hemorrhage.
Answer: B Rationale: A concussion occurs when the brain is jarred around inside the skull. It may result in a brief loss of consciousness and occasionally, amnesia. Seeing stars is a common finding following trauma to the back of the head (occiput), as this region is primarily responsible for vision. A concussion—the least severe of all closed head injuries—typically does not result in physical damage to the brain. Compared to a concussion, a contusion, subdural hematoma, and intracerebral hemorrhage are usually associated with a more prolonged loss of consciousness.
1.A young male was struck in the forearm with a baseball and complains of pain to the area. Slight swelling and ecchymosis are present, but no external bleeding. Which type of injury does this describe? A.Abrasion B.Contusion C.Hematoma D.Avulsion
Answer: B Rationale: A contusion (bruise) is caused by direct blunt force trauma. The epidermis remains intact, but small blood vessels in the dermis are injured. The depth of the injury varies, depending on the amount of energy absorbed. Pain and swelling occur as fluid and blood leak into the damaged area. The buildup of blood produces a characteristic blue and black discoloration called ecchymosis.
5.What purpose does a one-way "flutter valve" serve when used on a patient with an open pneumothorax? A.It prevents air escape from within the chest cavity. B.It allows the release of air trapped in the pleural space. C.It only prevents air from entering an open chest wound. D.It allows air to freely move in and out of the chest cavity.
Answer: B Rationale: A one-way flutter valve is used to treat patients with an open pneumothorax (sucking chest wound), and serves two purposes: it allows air trapped in the pleural space to escape during exhalation, and it prevents air from entering the pleural space during inhalation. These combined effects alleviate pressure on the affected lung, which allows it to reexpand.
5.The primary reason for applying a sterile dressing to an open injury is to: A.prevent contamination. B.control external bleeding. C.reduce the risk of infection. D.minimize any internal bleeding.
Answer: B Rationale: Although prevention of contamination is an important reason for applying a sterile dressing to an open injury, the primary reason is to control the external bleeding associated with it.
2.As you are assessing a 24-year-old man with a large laceration to the top of his head, you should recall that: A.the scalp, unlike other parts of the body, has relatively fewer blood vessels. B.blood loss from a scalp laceration may contribute to hypovolemic shock in adults. C.any avulsed portions of the scalp should be carefully cut away to facilitate bandaging. D.most scalp injuries are superficial and are rarely associated with more serious injuries.
Answer: B Rationale: Although the scalp is highly vascular and tends to bleed heavily when injured, scalp injuries are rarely the sole cause of hypovolemic shock in adults. However, they can contribute to hypovolemia caused by injuries elsewhere in the body. Scalp lacerations, whether deep or superficial, should prompt you to look for more serious underlying injuries, such as a skull fracture. If the injury involves an avulsion, the avulsed flap of skin should be carefully replaced to its original position, not cut away.
9.The term "hematuria" is defined as: A.blood in the stool. B.blood in the urine. C.vomiting up blood. D.urinary bladder rupture.
Answer: B Rationale: Blood in the urine is called hematuria. Following trauma, the presence of hematuria suggests injury to the urinary bladder or kidneys. Bright red blood in the stool is called hematochezia; dark, tarry stools are called melena. Vomiting up blood is called hematemesis.
1.Which of the following is NOT a component of the cardiovascular system? A.Heart B.Lungs C.Venules D.Plasma
Answer: B Rationale: Components of the cardiovascular system include the heart, blood vessels (arteries, arterioles, capillaries, venules, and veins), and blood (plasma and blood cells). The lungs are a component of the respiratory system.
10.Controlling internal bleeding requires: A.applying a tourniquet. B.surgery in a hospital. C.positioning the patient in the sitting position. D.providing slow and considerate transport.
Answer: B Rationale: Controlling internal bleeding usually requires surgery that must be done in the hospital. To care for the patient in the field, administer high-flow oxygen and assist ventilations, if needed; control all obvious external bleeding; monitor and record the vital signs every 5 minutes; place the nontrauma patient in a shock position; keep the patient warm; and provide immediate transport.
6.The quickest and MOST effective way to control external bleeding from an extremity is: A.a pressure bandage. B.direct pressure. C.a splint. D.a tourniquet.
Answer: B Rationale: Direct pressure is the quickest, most effective way to control external bleeding from an extremity. This will effectively control external bleeding in most cases.
7.When applying a tourniquet to an amputated arm, the EMT should: A.use the narrowest bandage possible. B.avoid applying the tourniquet over a joint. C.cover the tourniquet with a sterile bandage. D.use rope to ensure that the tourniquet is tight.
Answer: B Rationale: If you must apply a tourniquet, never apply it directly over a joint. You should use the widest bandage possible and make sure it is secured tightly. Never use wire, rope, a belt, or any other narrow material, as it could cut the skin. The tourniquet should never be covered with a bandage; leave it open and in full view.
9.When caring for a patient with severe epistaxis, the MOST effective way to prevent aspiration of blood is to: A.insert a nasopharyngeal airway and lean the patient back. B.tilt the patient's head forward while he or she is leaning forward. C.place the patient supine with his or her head in the flexed position. D.tilt the patient's head forward while he or she is leaning backward.
Answer: B Rationale: Leaning forward, with the head tilted forward, will stop blood from trickling down the throat. This decreases the risk that the patient will swallow the blood, which may cause vomiting, or aspirating the blood into the lungs.
7.During immobilization of a patient with a possible spinal injury, manual stabilization of the head must be maintained until: A.an appropriate-size extrication collar has been placed. B.the patient is fully immobilized on a long backboard. C.a range of motion test of the neck has been completed. D.pulse, motor, and sensory functions are found to be intact.
Answer: B Rationale: Manual stabilization of the patient's head must be maintained until he or she is fully secured to the long backboard. This includes the application of an extrication collar, straps, and lateral immobilization (head blocks). Pulse, motor, and sensory functions must be checked before and after the immobilization process. Do not assess range of motion in a patient with a possible spinal injury; this involves moving the patient's neck and may cause further injury.
7.When caring for a patient with facial trauma, the EMT should be MOST concerned with: A.spinal trauma. B.airway compromise. C.associated eye injuries. D.severe external bleeding.
Answer: B Rationale: No airway, no patient! Injuries to the face often cause obstruction of the upper airway, either by clotted blood or associated swelling. Additionally, large amounts of blood can be swallowed, which increases the risks of vomiting and aspiration. Bleeding control, spinal trauma, and associated injuries are important factors and should be treated accordingly; however, the airway comes first.
7.You are transporting a patient with possible peritonitis following trauma to the abdomen. Which position will he MOST likely prefer to assume? A.Sitting up B.Legs drawn up C.Legs outstretched D.On his right side
Answer: B Rationale: Patients with peritonitis often lie very still and tend to have their legs drawn up into the abdomen. This relieves strain on the abdominal muscles and may provide pain relief.
8.When treating an open extremity fracture, you should: A.apply a splint and then dress the wound. B.dress the wound before applying a splint. C.irrigate the wound before applying a dressing. D.allow the material that secures the splint to serve as the dressing.
Answer: B Rationale: Prior to splinting an open extremity fracture, you should cover the wound with a dry, sterile dressing. This will help control any bleeding and decreases the risk of infection. Irrigating an open fracture should be avoided in the field; this also increases the risk of infection—especially if foreign material is flushed into the wound.
2.Signs and symptoms of a chest injury include all of the following, EXCEPT: A.hemoptysis. B.hematemesis. C.asymmetrical chest movement. D.increased pain with breathing
Answer: B Rationale: Signs and symptoms of a chest injury include bruising to the chest, chest wall instability, increased pain with breathing, asymmetrical (unequal) chest movement if a pneumothorax is present, and hemoptysis (coughing up blood) if intrapulmonary bleeding is occurring. Hematemesis (vomiting blood) indicates bleeding in the gastrointestinal tract—usually the esophagus or stomach—not the chest cavity.
1.Skeletal muscle is also referred to as: A.smooth muscle. B.striated muscle. C.autonomic muscle. D.involuntary muscle.
Answer: B Rationale: Skeletal muscle, also called striated muscle because of its characteristic stripes (striations), attaches to the bones and usually crosses at least one joint, forming the major muscle mass of the body. This type of muscle is also called voluntary muscle because it is under direct voluntary control of the brain.
10.A patient injured her knee while riding a bicycle. She is lying on the ground, has her left leg flexed, is in severe pain, and cannot move her leg. Your assessment reveals obvious deformity to her left knee. Distal pulses are present and strong. The MOST appropriate treatment for her injury involves: A.wrapping her entire knee area with a pillow. B.splinting the leg in the position in which it was found. C.straightening her leg and applying two rigid board splints. straightening her leg and applying and inflating an air splint.
Answer: B Rationale: The patient likely has a dislocated knee. You should immobilize any joint injury in the position in which it was found—especially if distal pulses are present and strong. Attempting to straighten a dislocated joint may cause damage to the nerves and/or vasculature.
5.Which of the following signs is least indicative of a head injury? A.Asymmetrical pupils B.Pupillary constriction to bright light C.Both eyes moving in opposite directions D.Inability to look upward when instructed to
Answer: B Rationale: The pupils normally constrict in bright light and dilate in dim light. Suspect a head injury if the pupils do not react appropriately, are asymmetrical (unequal), do not move together, or if the patient is unable to look upward.
3.When a person is looking at an object up close, the pupils should: A.dilate. B.constrict. C.remain the same size. D.dilate, and then constrict.
Answer: B Rationale: The pupils, which allow light to move to the back of the eye, constrict in bright light and dilate in dim light. The pupils should also constrict when looking at an object up close and dilate when looking at an object farther away; this is called pupillary accommodation. These pupillary adjustments occur almost instantaneously.
4.The purpose of splinting a fracture is to: A.reduce the fracture if possible. B.prevent motion of bony fragments. C.reduce swelling in adjacent soft tissues. D.force the bony fragments back into anatomic alignment.
Answer: B Rationale: The purpose of splinting a fracture is to prevent motion of the bony fragments, thus minimizing the possibility of neurovascular damage. Splinting is not intended to force bony fragments into anatomic alignment, nor will it reduce swelling (ice reduces swelling). You should never try to reduce a fracture.
7.A patient experienced a severe compression to the chest when trapped between a vehicle and a brick wall. You suspect traumatic asphyxia due to the hemorrhage into the sclera of his eyes and which other sign? A.Flat neck veins B.Cyanosis in the face and neck C.Asymmetrical chest movement D.Irregular heart rate
Answer: B Rationale: The sudden increase in intrathoracic pressure results in a characteristic appearance, including distended neck veins, and hemorrhage into the sclera of the eyes, signaling the bursting of small blood vessels.
9.A 5-year-old boy was burned when he pulled a barbecue grill over on himself. He has partial- and full-thickness burns to his anterior chest and circumferentially on both arms. What percentage of his body surface area has been burned? A.18% B.27% C.36% D.45%
Answer: B Rationale: Using the pediatric rules of nines, the anterior chest accounts for 9% of the BSA (the entire anterior trunk, which includes the chest and abdomen, accounts for 18% of the BSA), and each arm accounts for 9% of the BSA. Therefore, this child has experienced 27% BSA burns.
7.A patient tripped, fell, and landed on her elbow. She is in severe pain and has obvious deformity to her elbow. You should: A.assess distal pulses. B.manually stabilize her injury. C.assess her elbow for crepitus. apply rigid board splints to her arm.
Answer: B Rationale: When caring for a patient with an orthopaedic injury, you should first manually stabilize the injury site; this will prevent further injury. You should then assess pulse, motor functions, and sensory functions distal to the injury. Splint the injury using the appropriate technique, and then reassess pulse, motor functions, and sensory functions. Do not intentionally assess for crepitus; this is a coincidental finding that you may encounter during your assessment and should not be elicited.
1.When the chest impacts the steering wheel during a motor vehicle crash with rapid deceleration, the resulting injury that kills almost one third of patients, usually within seconds, is: A.a hemothorax. B.aortic shearing. C.a pneumothorax. D.a ruptured myocardium.
Answer: B Rationale: When the chest impacts the steering wheel following rapid forward deceleration, aortic injuries (shearing or rupture) are the cause of death in nearly two thirds of patients. The aorta is the largest artery in the body; when it is sheared from its supporting structures or ruptures outright, exsanguination (bleeding to death) occurs—usually within a matter of seconds.
4.When caring for a patient with signs of a pneumothorax, your MOST immediate concern should be: A.hypovolemia. B.intrathoracic bleeding. C.ventilatory inadequacy. D.associated myocardial injury.
Answer: C Rationale: A pneumothorax occurs when air enters the pleural space and progressively collapses the lung. This impairs the ability of the lung to move air in and out (ventilate). As the lung collapses further, ventilatory efficiency decreases, resulting in hypoxemia; this should be your most immediate concern. Some patients with a pneumothorax may also experience intrathoracic bleeding and associated myocardial injury, depending on the mechanism of injury and the force of the trauma.
2.You respond to a soccer game for a 16-year-old male with severe ankle pain. When you deliver him to the hospital, the physician tells you that he suspects a sprain. This means that: A.there is a disruption of the joint and the bone ends are no longer in contact. B.the patient has an incomplete fracture that passes only partway through the bone. C.stretching or tearing of the ligaments with partial or temporary dislocation of the bone ends has occurred. D.the muscles of the ankle have been severely stretched, resulting in displacement of the bones from the joint.
Answer: C Rationale: A sprain is a joint injury in which there is both partial or temporary dislocation of the bone ends and partial stretching or tearing of the supporting ligaments. Sprains are typically marked by swelling, pain, and ecchymosis.
8.Your patient is a 21-year-old male who has massive face and head trauma after being assaulted. He is lying supine, is semiconscious, and has blood in his mouth. You should: A.insert a nasal airway, assess his respirations, and give 100% oxygen. B.suction his airway and apply high-flow oxygen via a nonrebreathing mask. C.manually stabilize his head, log roll him onto his side, and suction his mouth. D.apply a cervical collar, suction his airway, and begin assisting his ventilations.
Answer: C Rationale: Blood or other secretions in the mouth place the airway in immediate jeopardy and must be removed before they are aspirated. At the same time, you must protect the patient's spine due the mechanism of injury. Therefore, you should manually stabilize the patient's head, log roll him onto his side (allows drainage of blood from his mouth), and suction his mouth for up to 15 seconds. After ensuring that his airway is clear, assess his breathing and give high-flow oxygen or assist his ventilations. Nasal airways should not be used in patients with severe facial or head trauma.
6.Signs of a cardiac tamponade include all of the following, EXCEPT: A.muffled heart tones. B.a weak, rapid pulse. C.collapsed jugular veins. D.narrowing pulse pressure.
Answer: C Rationale: Cardiac tamponade, which is almost always caused by penetrating chest trauma, occurs when blood accumulates in the pericardial sac. This impairs the heart's ability to contract and relax; as a result, the systolic blood pressure decreases and the diastolic blood pressure increases (narrowing pulse pressure). Because the heart cannot adequately eject blood, blood backs up beyond the right atrium, resulting in jugular venous distention. In some cases, heart tones may be muffled or distant. Other signs include a weak, rapid pulse and hypotension.
8.A 14-year-old baseball player was hit in the chest with a line drive. He is in cardiac arrest. Which of the following is the most likely explanation? A.Myocardial contusion B.Traumatic asphyxia C.Commotio cordis D.Hemothorax
Answer: C Rationale: Commotio cordis is a blunt chest injury caused by a sudden, direct blow to the chest that occurs only during the critical portion of a person's heartbeat. The result may be immediate cardiac arrest. The blunt force causes ventricular fibrillation that responds positively to defibrillation within the first 2 minutes after the injury.
8.The presence of subcutaneous emphysema following trauma to the face and throat is MOST suggestive of: A.esophageal injury. B.cervical spine fracture. C.crushing tracheal injury. D.carotid artery laceration.
Answer: C Rationale: Crushing injuries or fractures of the larynx or trachea can result in a leakage of air into the soft tissues of the neck. The presence of air in the soft tissues produces a characteristic crackling sensation called subcutaneous emphysema.
10.Which of the following statements regarding chemical burns is FALSE? A.Most chemical burns are caused by strong acids or alkalis. B.Fumes of strong chemicals can cause burns to the respiratory tract. C.Prior to removing a dry chemical, you should flush the area with sterile water. D.You should not attempt to neutralize an acid burn with an alkaline chemical.
Answer: C Rationale: Dry chemicals should be brushed off the patient before irrigating the wound with sterile water or saline. Failure to do so may increase the burning process and cause further tissue damage.
5.A motorcyclist crashed his bike and has closed deformities to both of his midshaft femurs. He is conscious, but restless; his skin is cool and clammy; and his radial pulses are rapid and weak. The MOST appropriate splinting technique for this patient involves: A.applying rigid board splints. B.applying two traction splints. C.securing him to a long backboard. D.immobilizing his femurs with air splints.
Answer: C Rationale: In this particular case, it is more practical—and less time-consuming—to secure the patient to a long backboard. He is in shock and requires rapid transport. Taking the time to apply traction splints, air splints, or board splints will only delay transport.
3.Which of the following statements regarding intra-abdominal bleeding is FALSE? A.Intra-abdominal bleeding often causes abdominal distention. B.Intra-abdominal bleeding is common following blunt force trauma. C.The absence of pain and tenderness rules out intra-abdominal bleeding. D.Bruising may not occur immediately following blunt abdominal trauma.
Answer: C Rationale: Intra-abdominal bleeding is common following blunt trauma to the abdomen. Signs include abdominal distention, rigidity, bruising (may not occur immediately), and in some cases, pain to palpation. However, unlike gastric juices and bacteria, blood within the abdominal cavity does not provoke an inflammatory response; therefore, the absence of pain and tenderness does not rule out internal bleeding.
9.A 21-year-old male has a large laceration to his neck. When you assess him, you note that bright red blood is spurting from the left side of his neck. You should immediately: A.apply a pressure dressing to his neck. B.sit the patient up to slow the bleeding. C.place your gloved hand over the wound. D.apply 100% oxygen via nonrebreathing mask.
Answer: C Rationale: Laceration of the carotid artery—as evidenced by bright red blood spurting from the wound—can cause profuse bleeding, profound shock, and death very quickly. You must immediately control the bleeding with the use of direct pressure. Cover the wound with your gloved hand initially and then apply a bulky pressure dressing. After the bleeding has been controlled, apply high-flow oxygen and transport promptly.
2.Perfusion is MOST accurately defined as: A.the removal of adequate amounts of carbon dioxide during exhalation. B.the intake of adequate amounts of oxygen during the inhalation phase. C.circulation of blood within an organ with sufficient amounts of oxygen. D.the production of carbon dioxide, which accumulates at the cellular level.
Answer: C Rationale: Perfusion is the circulation of blood within an organ and tissues with sufficient amounts of oxygen and other nutrients. Carbon dioxide is the by-product of normal cellular metabolism; it should be returned to the lungs for removal from the body, it should not accumulate at the cellular level.
4.Even when seatbelts are worn properly and the airbags deploy, injury may occur to the: A.chest. B.extremities. C.iliac crests. D.lower ribcage.
Answer: C Rationale: Seatbelts should be positioned over the iliac crests of the pelvis. If they are positioned higher, significant intra-abdominal injury can occur. Even when seatbelts are properly positioned and the airbags deploy, injury to the iliac crests may occur as the locking mechanism of the seatbelt engages during a motor vehicle crash that involves rapid deceleration.
8.A 16-year-old boy was playing football and was struck in the left flank during a tackle. His vital signs are stable; however, he is in severe pain. You should be MOST concerned that he has injured his: A.liver. B.spleen. C.kidney. D.bladder.
Answer: C Rationale: The flanks are located laterally in the back and overlie the kidneys. During football, spearing injuries occur when a player is struck in the flank by another player's helmet. This can result in injury to the kidney ranging from bruising to severe bleeding. Injury to the liver, spleen, and bladder would more likely occur following blunt trauma to the anterior abdomen.
6.The purpose of the eustachian tube is to: A.move in response to sound waves. B.transmit impulses from the brain to the ear. C.equalize pressure in the middle ear when external pressure changes. D.house fluid within the inner chamber of the ear and support balance.
Answer: C Rationale: The middle ear is connected to the nasal cavity by the eustachian tube, which permits equalization of pressure in the middle ear when external atmospheric pressure changes.
5.A young male was involved in a motor vehicle accident and experienced a closed head injury. He has no memory of the events leading up to the accident, but remembers that he was going to a birthday party. What is the correct term to use when documenting his memory loss? A.Concussion B.Cerebral contusion C.Retrograde amnesia D.Anterograde amnesia
Answer: C Rationale: The term amnesia means loss of memory; it is common in patients who have experienced a cerebral concussion. Amnesia of events leading up to an injury is called retrograde amnesia. Anterograde amnesia—also called posttraumatic amnesia—is the inability to remember events that occurred—or will occur—after the injury.
6.The MOST appropriate way to dress and bandage an open abdominal wound with a loop of bowel protruding from it is to: A.cover the wound with a dry, sterile dressing and apply firm pressure. B.apply a moist, sterile dressing to the wound and apply firm pressure. C.apply a moist, sterile dressing to the wound and secure with an occlusive dressing. D.carefully replace the protruding bowel into the abdomen and cover the wound.
Answer: C Rationale: Treatment for an abdominal evisceration includes applying a moist, sterile dressing to the wound and covering the moist dressing with an occlusive dressing. Do not replace a protruding bowel back into the wound or apply firm pressure, which may force the bowel back into the wound; these actions increase the risk of infection.
5.When caring for a patient with internal bleeding, the EMT must first: A.ensure a patent airway. B.obtain baseline vital signs. C.control any external bleeding. D.take appropriate standard precautions
Answer: D Rationale: All of the interventions in this question must be performed. However, before providing patient care—whether the patient is bleeding or not—the EMT must first ensure that he or she has taken the appropriate standard precautions.
6.Other than applying a moist, sterile dressing covered with a dry dressing to treat an abdominal evisceration, an alternative form of management may include: A.placing dry towels over the open wound. B.cleaning the exposed bowel with sterile saline. C.applying the PASG to stop the associated bleeding. D.applying an occlusive dressing, secured by trauma dressings.
Answer: D Rationale: Although the preferred management for an abdominal evisceration includes the application of a moist, sterile dressing covered by a dry dressing, protocols in some EMS systems call for an occlusive dressing, secured by trauma dressings. An occlusive dressing may help prevent the loss of body heat through the abdominal wound.
4.What effects will the application of an ice have on a hematoma? A.Vasodilation and increased pain B.Vasodilation and decreased bleeding C.Vasoconstriction and increased swelling D.Vasoconstriction and decreased bleeding
Answer: D Rationale: Applying an ice pack to a closed wound, such as a hematoma, will decrease bleeding, pain, and swelling by causing constriction of the blood vessels.
3.A man involved in a motorcycle crash has multiple abrasions and lacerations. Which of the following injuries has the HIGHEST treatment priority? A.Widespread abrasions to the back with pinkish ooze B.3" laceration to the forehead with dark red, flowing blood C.Laceration to the forearm with obvious debris in the wound D.1" laceration to the thigh with spurting, bright red blood
Answer: D Rationale: Bleeding from an artery produces bright red bleeding that spurts with the pulse. The pressure that causes the blood to spurt also makes this type of bleeding difficult to control. Blood loss from an arterial wound is more severe—and thus, more life threatening—than from a venous wound.
2.A compression injury that is severe enough to cut off blood flow below the injury is called: A.a contusion. B.a hematoma. C.a local thrombus. D.compartment syndrome.
Answer: D Rationale: Compartment syndrome can occur when a part of the body has been compressed for a prolonged period of time—usually greater than 4 hours. The injured tissue begins to swell, which can impede arterial blood flow and venous return. As a result, the part of the body distal to the compression site becomes hypoxic and metabolic waste products (ie, lactic acid) begin to accumulate.
6.A distraction injury to the cervical spine would MOST likely occur following: A.a diving accident. B.blunt neck trauma. C.hyperextension of the neck. D.hanging-type mechanisms.
Answer: D Rationale: Excessive traction on the neck, such as what occurs during hanging-type mechanisms, can cause a distraction injury of the cervical spine. Distraction injuries can cause separation of the vertebrae and stretching or tearing of the spinal cord.
3.During your assessment of a patient who was stabbed, you see an open wound to the left anterior chest. Your MOST immediate action should be to: A.position the patient on the affected side. B.transport immediately. C.assess the patient for a tension pneumothorax. D.cover the wound with an occlusive dressing.
Answer: D Rationale: If you encounter an open chest wound, you must cover it with an occlusive dressing. This will prevent air from moving in and out of the wound. After the dressing is applied, you must monitor the patient for signs of a developing tension pneumothorax.
1.Peritonitis would MOST likely result following injury to the: A.liver. B.spleen. C.kidney. D.stomach.
Answer: D Rationale: In general, solid organs bleed when injured and hollow organs spill their contents into the abdominal cavity, resulting in peritonitis—inflammation of the intra-abdominal lining. Of the choices listed, the stomach is the only hollow organ. Peritonitis= organs spill their contents into the abdominal cavity.
10.You should NOT remove an injured football player's helmet if: A.a cervical spine injury is suspected, even if the helmet fits loosely. B.the patient has a patent airway, even if he has breathing difficulty. C.he has broken teeth, but only if the helmet does not fit snugly in place. D.the face guard can easily be removed and there is no airway compromise.
Answer: D Rationale: In general, you should leave a helmet on if it fits snugly and does not allow movement of the head within the helmet, the patient's airway is patent, no airway problems are anticipated, and the patient is breathing without difficulty. If you can easily remove the face guard (often the case with football helmets) and there are no airway problems, do so but leave the helmet on. If the helmet is loose, the airway is in anyway compromised, or the patient has difficulty breathing or is in cardiac arrest, the helmet must be removed.
3.A young male has a musculoskeletal injury and is unresponsive. You will NOT be able to assess: A.false motion. B.distal pulses. C.capillary refill. D.sensory and motor functions.
Answer: D Rationale: In order to assess sensory and motor functions (eg, Can you feel? Can you move?), the patient must be conscious, alert, and able to follow commands. False motion, distal pulses, and capillary refill are objective findings; therefore, they can be assessed in unresponsive patients.
8.Which of the following is considered a severe burn? A.Any full-thickness burn B.20% partial-thickness burn C.10% full-thickness burn with abrasions D.5% full-thickness burn with a fracture
Answer: D Rationale: Severe burns include the following: full-thickness burns involving the hands, feet, face, airway, or genitalia; full-thickness burns covering more than 10% of the body's total surface area (BSA); partial-thickness burns covering more than 30% of the BSA; burns involving the respiratory tract (eg, smoke inhalation); burns complicated by fractures; and burns on patients younger than 5 years or older than 55 years that would otherwise be classified as "moderate" burns on younger adults.
2.The globe of the eye is also called the: A.lens. B.orbit. C.retina. D.eyeball.
Answer: D Rationale: The globe of the eye is also called the eyeball. The lens, which sits behind the iris, focuses images on the retina—the light-sensitive area at the back of the globe. The globe is located within a bony socket in the skull called the orbit.
9.A man is found slumped over the steering wheel, unconscious and making snoring sounds, after an automobile accident. His head is turned to the side and his neck is flexed. You should: A.gently rotate his head to correct the deformity. B.carefully hyperextend his neck to open his airway. C.apply an extrication collar with his head in the position found. D.manually stabilize his head and move it to a neutral, in-line position.
Answer: D Rationale: The patient's snoring sounds indicate an airway problem, which must be corrected or he may die. Manually stabilize his head; carefully move it to a neutral, in-line position; and reassess his breathing. Do not rotate or hyperextend the neck of a patient with a possible spinal injury; the results could be disastrous.
