Orthopaedic Injuries
Which of the following scenarios is an example of a direct injury?
A passenger fractures her patella after it strikes the dashboard.
Decrease in the size of a muscle and its inherent ability to function is called: A. atrophy. B. myalgia. C. cephalgia. D. hypertrophy.
A. atrophy
Proximal humeral fractures MOST commonly occur: A. as a result of minor trauma. B. in the pediatric population. C. in the elderly population. D. during stretching injuries.
C. in the elderly population
In which of the following situations would it NOT be appropriate to splint a patient's fractures before moving him or her? A. Upset patient with abrasions and capillary bleeding B. Conscious patient in severe pain with stable vital signs C. Alert patient with a history of uncontrolled hypertension D. Confused patient with tachycardia and shallow breathing
D. Confused patient with tachycardia and shallow breathing
In addition to splinting the injured extremity, appropriate management for a patient with suspected compartment syndrome includes: A. applying traction to the extremity, keeping it at the level of the heart, and transporting. B. lowering the limb below the level of the heart, transporting, and frequently assessing pulses. C. elevating the limb above the level of the heart, transporting, and reassessing distal pulses. D. keeping the limb at the level of the heart, transporting, and frequently assessing distal pulses.
D. keeping the limb at the level of the heart, transporting, and frequently assessing distal pulses
You receive a call to a local gymnasium for a basketball player with a dislocated shoulder. Upon arrival, you find the patient, a 17-year-old male, sitting on the ground. He is holding his left arm in a fixed position away from his body. There is an obvious anterior bulge to the area of injury. You should
assess distal pulse, motor, and sensory functions.
A 21-year-old male was thrown over the handlebars of his motorcycle when he rear- ended a car that was stopped at a red light. He was wearing a helmet, which he removed prior to your arrival. He is conscious, but restless, and has closed deformities to both of his femurs. His skin is pale, his heart rate is rapid and weak, and his respirations are rapid and shallow. In addition to applying high-flow oxygen and protecting his spine, you should:
bind his legs together on the backboard, keep him warm, and transport without delay.
The MOST commonly fractured bone(s) in the body is the:
clavicle.
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compare it to the uninjured leg.
Common signs and symptoms of a sprain include all of the following, EXCEPT:
deformity.
A supracondylar or intercondylar fracture is also known as a fracture of the:
distal humerus.
Assessing a person's neurovascular status following a musculoskeletal injury includes all of the following, EXCEPT:
evaluating proximal pulses.
Traction splints are used primarily to immobilize and secure fractures of the:
femur.
In which of the following situations should the EMT splint an injured limb in the position of deformity?
if resistance is encountered or the patient experiences severe pain
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immobilize the injury with a sling and swathe.
A 17-year-old football player collided with another player and has pain to his left clavicular area. He is holding his arm against his chest and refuses to move it. Your assessment reveals obvious deformity to the midshaft clavicle. After assessing distal pulse, sensory, and motor functions, you should:
immobilize the injury with a sling and swathe.
When splinting a possible fracture of the foot, it is MOST important for the EMT to:
leave the toes exposed.
The MOST common and significant complication associated with fractures or dislocations of the knee is:
ligament and cartilage damage.
Bones are connected to other bones by bands of tough fibrous tissues called:
ligaments.
A person who experiences a calcaneus fracture after jumping and landing on his or her feet would MOST likely experience an accompanying fracture of the
lumbar spine.
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proximal femur.
A ____________ is a musculoskeletal injury in which there is partial or temporary separation of the bone ends as well as partial stretching or tearing of the supporting ligaments.
sprain
Skeletal muscle is also referred to as __________ muscle.
striated
Which of the following statements regarding hip dislocations is correct? A. Most hip dislocations are caused by posterior displacement of the femoral head. B. Most hip dislocations are caused by anterior displacement of the femoral head. C. Anterior hip dislocations are characterized by lateral rotation of the lower extremity. D. Posterior hip dislocations are characterized by medial rotation of the lower extremity.
A. Most hip dislocations are caused by posterior displacement of the femoral head
When assessing a patient with multiple systems trauma, which of the following musculoskeletal injuries would pose the GREATEST threat to the patient's life? A. Multiple open fractures B. Dislocation of a major joint C. Single open long bone fracture D. Displaced fracture of the pelvis
A. Multiple open fractures
Which of the following is the MOST effective method of immobilizing a fractured clavicle? A. Sling and swathe B. Modified wrist sling C. Short arm rigid splint D. Pillow or other padding
A. Sling and swathe
A 29-year-old male was struck in the upper back by a solid object. During your assessment, you note ecchymosis, pain, and crepitus to the left scapula. His blood pressure is 124/68 mm Hg, pulse is 110 and strong, and respirations are 24 breaths/min and labored. You should provide supplemental oxygen, immobilize his spine, and: A. be alert for intrathoracic injuries. B. pad under the scapula with a pillow. C. give a crystalloid bolus of 20 mL/kg. D. transport to a local community hospital.
A. be alert for intrathoracic injuries
You have delivered your patient, a 14-year-old female with a possible femur fracture, to the emergency department. After radiographic evaluation, the physician tells you that the patient has a comminuted fracture. This means that the femur: A. has fractured into more than two fragments. B. fractured as a result of an osteopathic condition. C. will prematurely stop developing and growing. D. was fractured as a result of an impacting injury.
A. has fractured into more than two fragments
A 50-year-old male fell approximately 20 feet and landed on his side. He is conscious and alert and denies loss of consciousness. During your assessment, you note pain and crepitus when palpating the iliac crests. In addition to the potential for spinal injury, you should be MOST concerned about: A. internal hemorrhaging. B. retroperitoneal injuries. C. neurovascular compromise. D. the cause of the patient's fall.
A. internal hemorrhaging
An injury that may result in complete separation of a joint due to stretching or tearing of the supporting ligaments is called a: A. sprain. B. strain. C. dislocation. D. subluxation.
A. sprain
A patient with developing compartment syndrome following a fracture typically complains of or presents with: A. tension or pressure in the affected extremity. B. extreme cyanosis to the affected extremity. C. increased sensation distal to site of the injury. D. a lesser degree of pain than would be expected.
A. tension or pressure in the affected extremity
Which of the following musculoskeletal injuries poses the GREATEST risk for compartment syndrome? A. Ankle fracture in an adult B. Humeral fracture in a child C. Hip fracture in an older adult D. Wrist fracture in an adolescent
B. Humeral fracture in a child
Which of the following muscles is attached to the skeleton and forms the bulk of tissue of the arms and legs? A. Smooth B. Skeletal C. Autonomic D. Involuntary
B. Skeletal
A 29-year-old male was involved in a rollover motor-vehicle crash. The patient was removed from his vehicle prior to your arrival. During your general impression, you note that he is conscious, yelling in pain, and has an actively bleeding open fracture of his left leg. As your partner assumes manual stabilization of the patient's head and communicates with him, you should: A. determine if his airway is patent. B. apply direct pressure to his leg. C. administer supplemental oxygen. D. apply a splint to his injured leg.
B. apply direct pressure to his leg
Following blunt force trauma to the elbow, a 40-year-old female complains of severe pain and the feeling that her elbow is "locked". Your assessment reveals marked deformity and swelling. This patient has MOST likely experienced a/an: A. fracture. B. dislocation. C. severe sprain. D. epiphyseal injury.
B. dislocation
A Colles fracture is caused by injury to the: A. carpal bones. B. distal radius. C. proximal ulna. D. midshaft forearm.
B. distal radius
General principles of splinting an injured extremity include: A. immobilizing the joint below a suspected fracture. B. frequently assessing gross neurovascular functions. C. immobilizing the bone above a suspected dislocation. D. splinting all extremity injuries en route to the hospital.
B. frequently assessing gross neurovascular functions
A 55-year-old male fell from the roof of his house and sustained a closed, displaced femur fracture. He is restless, diaphoretic, and tachycardic. After appropriately managing his ABCs and performing a rapid head-to-toe assessment, you should: A. apply a traction splint, immobilize him on a long backboard, and begin transport. B. immobilize him on a long backboard, transport, and start a large-bore IV en route.
B. immobilize him on a long backboard, transport, and start a large-bore IV en route
A 29-year-old male fell approximately 5 feet from a ladder and landed on his right shoulder. He is conscious and alert, denies loss of consciousness, and complains of pain to the shoulder. His vital signs are stable. You should: A. perform a rapid scan of the body, start and IV of normal saline, transport, and splint the injury en route to the hospital. B. manually stabilize the injury until it is splinted, perform a secondary assessment, splint the injury appropriately, and transport. C. allow the patient to stabilize his shoulder with his opposite hand, perform a secondary assessment, and transport. D. start an IV of normal saline, appropriately splint his shoulder, transport, and perform a secondary assessment en route.
B. manually stabilize the injury until it is splinted, perform a secondary assessment, splint the injury appropriately, and transport
A 34-year-old male sustained a twisting injury to his left lower leg when he stepped into a hole. Your assessment reveals ecchymosis and pain to the area, but no deformity or crepitus. You should suspect a: A. displaced fracture. B. nondisplaced fracture. C. comminuted fracture. D. transverse fracture.
B. nondisplaced fracture
A 59-year-old male patient impacted the dashboard with his knees when his car struck a tree at 50 mph. During your primary assessment, you note bleeding from an obvious open femur fracture. After controlling the bleeding, applying oxygen, and extricating him from the car, you should: A. apply a traction splint, immobilize his spine, and transport. B. perform a head-to-toe assessment, immobilize his spine, and transport. C. immobilize his spine with a vest-style device and transport immediately. D. perform a detailed secondary assessment, immobilize his spine, and transport.
B. perform a head-to-toe assessment, immobilize his spine, and transport
A young female has a closed, unstable deformity to her left femur. In this situation, the primary reason for applying a splint is to: A. relieve the patient's pain and anxiety. B. prevent conversion to an open fracture. C. minimize any bleeding within the thigh. D. prevent severe spasms of the thigh muscle.
B. prevent conversion to an open fracture
A 21-year-old male presents with a severely angulated forearm and extreme pain. Distal sensory, motor, and circulatory functions are intact. You should: A. apply a zippered air splint to relieve the pain. B. splint the forearm in the position of deformity. C. apply chemical heat packs to help reduce swelling. D. carefully straighten the forearm and apply a splint.
B. splint the forearm in the position of deformity
Tough, cord-like structures that are extensions of the fascia covering all skeletal muscles are known as: A. menisci. B. tendons. C. ligaments. D. cartilage.
B. tendons
Which of the following injuries would pose the LEAST threat to the patient? A. Single open long bone fracture B. Displaced fracture of the pelvis C. Major sprains at a major joint
C. Major sprains at a major joint
On which of the following injuries would it be MOST appropriate to apply a traction splint? A. Pain and crepitus upon palpation of the pelvis B. Posterior bulge of the hip with intact circulation C. Swelling and ecchymosis to the midshaft femur D. Deformity and swelling just proximal to the knee
C. Swelling and ecchymosis to the midshaft femur
When assessing the pelvis of a patient with multiple systems trauma, you should: A. gently rock the pelvis back and forth. B. percuss the pubic symphysis to elicit pain. C. apply gentle inward pressure to the iliac crests. D. avoid palpation due to the potential for injury.
C. apply gentle inward pressure to the iliac crests
Fractures of the proximal femur MOST commonly occur at the: A. acetabular region of the pelvis. B. superior aspect of the femoral head. C. intertrochanteric region of the femur. D. epiphyseal region of the femoral head.
C. intertrochanteric region of the femur
You and your partner are applying a Hare traction splint to a patient with a deformed midshaft femur. As you expose the injured femur and assess neurovascular functions, your partner should: A. elevate the leg and apply an ankle hitch. B. measure the splint beside the uninjured leg. C. manually support and stabilize the injured leg. D. apply gentle in-line traction to the injured leg.
C. manually support and stabilize the injured leg
An 80-year-old male tripped and fell and complains of pain to his left hip. Your assessment reveals that his knee is flexed and his left leg is shortened and medially rotated. Distal neurovascular functions are grossly intact. You should immobilize this patient's injury by: A. straightening his leg and immobilizing him with a scoop stretcher. B. applying a Hare traction splint and immobilizing him on a longboard. C. placing him on a scoop stretcher and padding the injury with pillows. D. attempting to reduce the injury and immobilizing him on a longboard.
C. placing him on a scoop stretcher and padding the injury with pillows
Pathologic fractures are typically caused by all of the following, EXCEPT: A. osteoporosis. B. bone cancer. C. previous fractures. D. minor injury force.
C. previous fractures
You arrive at the scene of a motor-vehicle crash in which a 30-year-old male was ejected from his truck. As you approach the patient, who is not moving, you can see that he has gross deformity to both of his femurs and an angulated left humerus. You should: A. perform a rapid secondary assessment. B. assess the adequacy of his respirations. C. stabilize his head and open his airway. D. assess his femurs for gross bleeding.
C. stabilize his head and open his airway
Which of the following statements regarding compartment syndrome is correct?
Compartment syndrome typically develops within 6 to 12 hours after an injury.
Which of the following injuries MOST accurately depicts an open fracture? A. Deformity to the radius and ulna with an overlying healing laceration B. Swelling and deformity to the tibia with a bulge from the fractured bone C. Deformity to the midshaft femur with ecchymosis and a large hematoma D. Swelling and deformity to the lateral humerus with an overlying abrasion
D. Swelling and deformity to the lateral humerus with an overlying abrasion
When assessing a 14-year-old male with an injured arm, you note gross deformity just distal to the elbow. Distal neurovascular functions are grossly intact. You should: A. apply a pediatric traction splint to the arm. B. immobilize the injury with a sling and swath. C. ensure immobilization of the hand and shoulder. D. assume that growth plate damage has occurred.
D. assume that growth plate damage has occurred
Goals of in-line traction for musculoskeletal injuries in the prehospital setting include all of the following, EXCEPT: A. reduction of the fracture. Correct B. stabilization of the fracture site. C. alignment of the injured extremity. D. avoiding neurovascular compromise.
D. avoiding neurovascular compromise
You have applied an air splint to the deformed forearm of a critically injured patient while waiting for a helicopter to arrive. When the helicopter arrives, the flight medic asks you to accompany the patient. During the flight, you should: A. remove the air splint and apply a rigid splint. B. inflate the air splint by approximately 50%. C. deflate the air splint by approximately 50%. D. monitor the splint and let air out as needed.
D. monitor the splint and let air out as needed
A 30-year-old male fell while rollerblading and landed on his right arm. There is obvious deformity to the elbow and the patient complains of severe pain. The patient's hand is cool and pale and his radial pulse is difficult to palpate. The hospital is approximately 10 minutes away. You should: A. gently flex the elbow so that you can apply a sling and swathe. B. align the arm and apply a padded board splint and then transport. C. make one attempt to restore distal circulation and then transport. D. splint the arm in the position found and then transport immediately.
D. splint the arm in the position found and then transport immediately
Which of the following statements regarding striated muscle is correct?
It forms the major muscle mass of the body and usually crosses at least one joint.
A subluxation occurs when
a joint is incompletely dislocated.
During your assessment of a 29-year-old female with significant deformity to her left elbow, you are unable to palpate a radial pulse. Your transport time to the hospital is approximately 40 minutes. You should:
apply gentle manual traction in line with the limb and reassess for a pulse.
A 76-year-old male experienced sudden pain to his left thigh when he was standing in line at the grocery store. Your assessment reveals ecchymosis and deformity to the distal aspect of his left femur, just above the knee. Distal circulation and sensory and motor functions are intact. The MOST appropriate method of splinting this injury involves:
applying padded board splints to both sides of the leg.
In moving joints, the ends of the bones are covered with:
articular cartilage.
Which of the following structures is regulated by smooth muscle?
blood vessels
The musculoskeletal system refers to the:
bones and voluntary muscles of the body.
A fracture is MOST accurately defined as a(n
break in the continuity of the bone.
When caring for a patient with a possible fracture of the scapula, the EMT should:
carefully assess the patient for breathing problems.
When assessing a patient with a possible fracture of the leg, the EMT should:
compare it to the uninjured leg.
A 54-year-old male accidentally shot himself in the leg while cleaning his gun. Your assessment reveals a small entrance wound to the medial aspect of his right leg. The exit wound is on the opposite side of the leg and is actively bleeding. The patient complains of numbness and tingling in his right foot. You should:
control the bleeding and cover the wound with a sterile dressing.
The disruption of a joint in which the bone ends are no longer in contact is called a:
dislocation.
Which of the following musculoskeletal injuries would MOST likely result in deformity?
displaced fracture
During your rapid secondary assessment of a 19-year-old female with multiple trauma, you note bilateral humeral deformities and a deformity to the left midshaft femur. Her skin is diaphoretic and her pulse is rapid and weak. Your partner has appropriately managed her airway and is maintaining manual stabilization of her head. The MOST appropriate treatment for this patient includes:
immobilizing her to a backboard and rapidly transporting.
Which of the following musculoskeletal injuries would pose the greatest threat to a patient's life?
pelvic fracture with hypotension
The MOST reliable indicator of an underlying fracture is:
point tenderness.
Crepitus and false motion are
positive indicators of a fracture.
A 45-year-old female was the unrestrained passenger of a small car that rear-ended another vehicle at a moderate rate of speed. She is conscious and alert, but complains of pain to both of her knees. There is visible damage to the dashboard on the passenger's side of the vehicle. In addition to fractures or dislocations of the knees, you should be MOST suspicious for:
posterior hip dislocation.
The primary purpose for splinting a musculoskeletal injury is to:
prevent further injury.
A "hip" fracture is actually a fracture of the:
proximal femur.
The PASG is absolutely contraindicated in patients who have:
pulmonary edema.
Applying ice to and elevating an injured extremity are performed in order to:
reduce pain and swelling.
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scapulae and clavicles.
The pectoral girdle consists of the:
scapulae and clavicles.
Which of the following types of muscle is under direct voluntary control of the brain?
skeletal
Which of the following joints allows no motion?
skull sutures
What type of muscle contracts and relaxes to control the movement of the contents within its structures?
smooth
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sprain
A 22-year-old female was ejected from her car after striking a tree head-on. As you approach her, you note obvious closed deformities to both of her femurs. She is not moving and does not appear to be conscious. You should:
stabilize her head and perform a primary assessment.
During your rapid secondary assessment of a 30-year-old male who fell 25′, you note crepitus when palpating his pelvis. Your partner advises you that the patient's blood pressure is 80/50 mm Hg and his heart rate is 120 beats/min and weak. After completing your assessment, you should:
stabilize the pelvis with a pelvic binder and protect the spine.
Deformity caused by a fracture would MOST likely be masked by:
swelling.
An open fracture is MOST accurately defined as a fracture in which:
the overlying skin is no longer intact.
If a dislocated shoulder has spontaneously reduced before your arrival, the only way to confirm the injury is by noting:
the patient history.
If a dislocated shoulder has spontaneously reduced before your arrival, the only way to confirm the injury is by noting
the patient history.
In general, musculoskeletal injuries should be splinted before moving the patient unless:
the patient is clinically unstable.
The act of pulling on a body structure in the direction of its normal alignment is called:
traction.
