Chapter 32
1) Which statement is most accurate regarding the processes needed for a patient to clench the hand into a fist? A) The central nervous system must send a message through the spinal cord and then to the peripheral nerves B) The central nervous system must send a message through the spinal cord and then to the autonomic nervous system C) The peripheral nervous system must send a message to the brain and then back through the peripheral nervous system D) The muscles must signal the brain to send a message through the autonomic nervous system
A
11) A young intoxicated male patient cannot move his left arm and leg after diving into the shallow end of a pool and hitting the bottom head first. The EMT would recognize which mechanism as most likely responsible for this injury? A) Compression B) Rotation C) Distraction D) Penetration
A
14) You have arrived at the scene of a shooting where a middle-aged male sustained a single gunshot wound to the abdomen. As you approach the patient, you note that he is sitting up and attempting to talk with the police officers while holding a blood-soaked towel over the left upper quadrant of his abdomen. Once you get beside the patient, you realize he is speaking in a different language that neither you nor the officers understand. Your initial action in caring for this patient is to: A) Initiate spine motion restriction precautions B) Determine the need for airway management C) Expose the abdomen to assess the gunshot wound D) Obtain a pulse rate, respiratory rate, blood pressure, and SpO2
A
22) A patient dove into a shallow pool and struck his head on the bottom. Your assessment findings indicate that he has no motor or sensation in his legs, but can move his arms. The EMT should recognize this condition to be: A) Paraplegia B) Quadriplegia C) Hemiplegia D) Tetraplegia
A
26) Which statement about the care and treatment of a patient with a spinal injury in the prehospital setting is true? A) Prehospital care for the patient with a spine injury involves spine motion restriction precautions and the identification of life-threatening conditions B) It is important to identify the level of spinal injury so the proper prehospital care can be rendered C) Before transporting the critically injured patient with a spinal injury, the EMT must perform a detailed, head-to-toe neurologic assessment D) If a patient has a possible spine injury but is in shock, it is permissible to forego spine motion restriction precautions since this takes time and keeps the patient from definitive care in the hospital
A
27) A restrained driver was in a car that struck another car from behind at a low rate of speed. The driver has a bruise to her forehead and complains of tingling in her left leg. She is lying on the side of the road, and another EMT has established manual cervical spine motion restriction precautions. A quick scan of her as you approach indicates that the patient is in little to no distress. What should you do first? A) Check her breathing and radial pulse B) Perform a secondary assessment C) Palpate her cervical spine and apply a cervical collar D) Administer high-concentration oxygen
A
28) A patient who was involved in a diving accident is found with his head positioned so that his left cheek is touching his left shoulder. He states that he has severe pain in his neck and it hurts to move his head. He denies numbness, tingling, or decreased strength in his arms or legs. What is the EMT's best course of action? A) Carefully straighten the head and neck so that a cervical collar can be placed B) Stabilize and maintain the head in the position in which the patient is holding it C) Straighten his neck, and position the patient on his left side on a long spinal board D) Avoid palpation of the cervical spine and apply a short vest-type device
A
33) A teenage boy was found by friends as he attempted to hang himself in a garage using chains suspended from the ceiling. As you approach, you note that the patient is conscious, struggling significantly to breathe, is ashen in color around the mouth and to the hands, and has contusions and swelling that encircle his neck from the chains. After taking manual cervical spine motion restriction and opening the airway, your next action would be to: A) Start positive pressure ventilation B) Size and apply a cervical collar C) Perform a secondary assessment D) Log roll the patient onto a long spine board
A
40) You are securing a patient to the long backboard. Of the options listed, which has the elements of securing the patient in the correct order? A) Chest and pelvis, head, legs B) Head, chest and pelvis, legs C) Head, legs, chest, pelvis D) Legs, head, chest and pelvis
A
45) Which of the following findings in a patient with a traumatic mechanism of injury is sufficient to prevent the EMT from "clearing the spine" and necessitate the implementation of spine motion restriction precautions? A) GCS score of 12 B) Blood glucose of 90 mg/dL C) Pulse oximeter of 96% on 2 lpm oxygen D) Pulse pressure of 24 mmHg
A
48) You pull up to the scene of a single-car motor vehicle collision. Emergency Medical Responders (EMRs) are maintaining inline manual cervical spine motion restriction of the 56-year-old driver, who was unrestrained when she struck a tree at a high rate of speed. As you approach the vehicle, you note that the patient appears unresponsive, with blood coming from her nose and ears. Which instruction to the EMRs is most appropriate? A) "Let me conduct the primary assessment and place a cervical collar on the patient, and then we can start to get her out of this car." B) "Let me conduct the primary assessment, and then we can place a vest-type extrication device on the patient to get her outside the vehicle." C) "After I do the primary and secondary assessment, we will need to get the patient onto the stretcher for immediate transport." D) "Let's suction the airway and get the patient out of the car fast; we can put on a cervical collar once we are outside the vehicle."
A
54) A window washer fell 20 feet from scaffolding while washing the windows on an office building. He is alert and oriented, but states that he cannot move or feel his legs. Additionally, because his blood pressure is 72/48 mmHg, you suspect spinal shock. Which other assessment finding reinforces your suspicion of spinal shock? A) Warm and dry skin B) Heart rate of 144 beats/min C) Pulse pressure of 24 mmHg D) SpO2 of 92%
A
57) The EMT should recognize a possible spinal column injury with no spinal cord involvement when he discovers which assessment finding? A) Tenderness to the thoracic spine with intact motor and sensory abilities to each extremity B) Intact motor ability to all four extremities with loss of sensation to the legs C) Pain to the cervical spine with loss of sensation to the right arm and leg D) Intact sensation to all four extremities with loss of motor ability to the arms
A
60) A patient was ejected from a car during a rollover collision at a moderate to high rate of speed. Which presentation in this patient is most characteristic of the incomplete spinal cord injury referred to as a "central cord syndrome"? A) Loss of motor function to the arms with intact motor function to the legs B) Loss of motor function and sensation to one side of the body only C) Loss of sensation to one side of the body, and loss of motor function to the opposite side of the body D) Loss of perfusion to the spinal cord that results in complete loss of motor function and sensation to both the arms and legs
A
64) Research by the American College of Surgeons Committee on Trauma has shown a higher death rate for patients who were immobilized to a backboard when: A) The injury was the result of penetrating trauma to the head or torso B) The patient was intoxicated at the time of injury C) The injury resulted from a lateral impact automobile accident D) The patient was ambulatory upon EMS arrival
A
65) Prior to the revisions in prehospital spinal assessment and care, the primary criterion for determining the need for spine motion restriction was: A) The mechanism of injury B) Evidence of multisystem trauma C) Decided by medical command D) A patient history of kyphosis
A
12) A young female driver, who was involved in a motor vehicle collision, complains of cervical pain resulting from a lateral-type mechanism of neck injury. Based on this information, which type of collision most likely took place? A) The patient's car was struck from behind B) The patient's car was struck from the side C) The patient's car struck a utility pole head-on D) The patient's car rear-ended another car
B
15) While performing the primary assessment on a patient with an isolated spinal cord injury, you note that he is in severe respiratory distress and struggling to breathe. Where should you suspect the spinal cord injury has occurred? A) Diaphragm B) Cervical spine C) Thoracic spine D) Lumbar spine
B
19) An elderly patient fell down a flight of stairs and now complains of neck and back pain as well as weakness to both legs. The primary assessment reveals no life threats to the airway, breathing, or circulation. Manual cervical spine motion restriction is being maintained. What should the EMT do next? A) Apply high-concentration oxygen and move the patient to the stretcher for transport B) Complete the secondary assessment, looking for additional injuries C) Place an oral airway and begin positive pressure ventilation D) Place a cervical collar and secure the patient to the long spine board
B
20) Which response shows that the EMT is correctly assessing motor function in the arms of a patient with a potential spine injury? A) "Can you tell me which finger I am touching?" B) "I need you to flex both arms across your chest." C) "I am going to move your arm; tell me if it hurts." D) "I am going to feel for a pulse in your wrist."
B
3) The EMT is caring for a patient who has a problem with the autonomic component of his nervous system. Which sign or symptom would most likely be caused by this condition? A) Inability to swallow B) Slowing of the heart rate C) Inability to move facial muscles D) Trouble remembering his name
B
31) A patient complains of lower back pain after falling down five stairs. Assessment of the patient's cervical spine reveals no displacement, tenderness, or instability. The patient does state that each leg has feelings of "electrical shocks" shooting through them. How should the EMT care for this patient? A) Release manual spine motion restriction precautions B) Apply a properly sized cervical collar after initiating manual spine motion restriction C) Secure the patient to a backboard without a cervical collar D) Inform the team that spine motion restriction precautions are not needed
B
34) While transporting a 38-year-old female who fell from a second-story window, you note that she is becoming confused and her pulse rate is increasing. Additionally, her blood pressure has dropped and her skin is now cool and clammy. Based on these assessment findings, you would recognize: A) Spinal shock B) Hypovolemic shock C) Neurogenic shock D) Head injury
B
39) A patient is being extricated from a car using a short vest-type device. After the patient has been extricated, the EMT should: A) Remove the vest-type device and secure the patient to a long backboard B) Secure the patient with the vest-type device to a long backboard C) Place the patient in semi-Fowler's position on the stretcher for transport to the hospital D) Secure the patient with the vest device in a supine position on the stretcher with the legs flexed
B
42) You are maintaining manual cervical spine motion restriction for a patient who is being log rolled, transferred, and secured to a long backboard. At which point will you release the manual spine motion restriction hold? A) Once the patient has been log rolled onto the long backboard B) After the patient has been properly secured with straps to the long board C) After the patient has been secured to the backboard and transferred to the wheeled stretcher D) After the chest has been secured with a head immobilization device
B
43) The "EMS Management of Patients with Potential Spinal Injury" document published by the American College of Emergency Physicians in 2015 discusses which principle regarding the immobilization of patients? A) The use of a long spine board without a cervical collar is recommended because cervical collars do not achieve a full degree of immobilization B) Current out-of-hospital management of potential spinal injury lacks evidentiary scientific support C) A review of the related literature has demonstrated clinical support for ongoing use of spine motion restriction equipment in all patients with either a minor or major mechanism of injury D) Only a licensed and board-certified emergency department physician is capable of determining whether spine motion equipment is necessary
B
46) A minivan has struck a utility pole. The driver is unresponsive and has life-threatening injuries. Which option would be most appropriate when extricating the patient from the vehicle? A) Apply a vest-type immobilization device B) Perform rapid extrication with a cervical collar applied C) Pull the patient from the car and provide spine motion restriction precautions away from the vehicle D) Remove the patient and place him on a long spinal board in the ambulance during rapid transport
B
47) Which device can be used to replace the long spine board when providing full spine motion restriction precautions to an adult? A) Folding stair chair B) Full vacuum mattress C) Half spine board D) Full-body air splints
B
49) Which statement about removing a helmet in the prehospital setting is true? A) Helmets should be removed only if they are too tight or if spine motion restriction will be required B) It is acceptable to leave the helmet on a patient if the patient has no airway or breathing problems C) Any patient wearing a helmet should have it removed so the airway and breathing can be properly assessed D) Since helmets should never be removed, the EMT must be creative in providing care around the obstacle of a helmet
B
52) A football player was struck in the head during a hard tackle, and is reportedly demonstrating retrograde amnesia to the event. Currently the patient complains of a headache and nausea and reports that he has pain to his upper back and tingling in his left hand. The EMT is providing proper care for the patient when he: A) Removes the helmet to immediately assess the patient's head B) Leaves the helmet in place but removes the face mask first C) Removes the shoulder pads to apply a cervical collar D) Does not place the patient on a long board due to the presence of shoulder pads
B
55) A male patient fell 20 feet from a cliff to a trail below while hiking with his girlfriend. The primary assessment shows him to be confused, with an open airway and shallow breathing. His pulse is 72 beats/min and his blood pressure is 78/50 mmHg. The skin is warm and flushed. The patient has no motor ability or sensation in his legs. What is the most likely cause of this patient's presentation? A) Internal bleeding B) Spinal shock C) Hemorrhagic shock D) Hypoglycemia
B
59) A 43-year-old male fell from a roof and cannot move or feel his arms or legs. When assessing the patient, which sign would lead the EMT to suspect the patient is developing spinal shock? A) Cool and moist skin B) Heart rate of 62 beats/min C) Cyanosis to the fingertips D) Seizure activity
B
66) Which statement is most accurate concerning spine motion restriction of an ambulatory patient? A) Self-restriction is not permitted if a rigid cervical collar is used B) If the patient is reliable, he can self-restrict while the cervical collar is applied C) If the patient is unconscious, self-restriction cannot be used D) The patient should be reminded to continue self-restriction while being seated on the stretcher
B
7) In which area of the spinal column do the ribs originate? A) Cervical spine B) Thoracic spine C) Lumbar spine D) Sacral spine
B
16) As you approach a motorcyclist who was thrown from his bike, you hear him saying that he cannot feel or move his legs. You note obvious deformity to both femurs as well as to his left wrist and forearm. Emergency Medical Responders are holding manual cervical spine motion restriction and have already assessed the PMS in the extremities. Given this information, which assessment should be done next? A) Check for motor function and sensation in the feet B) Expose the legs and look for bleeding C) Check the patient's rate and effort of breathing D) Apply the pulse oximeter
C
17) Which sign or symptom best indicates the patient has experienced a spinal cord injury to the thoracic spine? A) Bruising to the back B) Paralysis of the arms only C) Tingling in the legs D) Cool and diaphoretic skin
C
18) Assessment of a young girl who was hit by a car while riding her bike reveals her to be responsive to painful stimuli with flexion of the extremities; she is also in respiratory distress. There is marked deformity to her thoracic spine and bruising noted to her anterior chest and abdomen. She does not move her legs when a noxious stimulus is applied to the lower extremities. Manual cervical spine motion restriction is being maintained and a cervical collar has been applied by fire department EMRs. Given the critical nature of this patient, which action is most appropriate for her care? A) Rapidly transfer her to the stretcher and secure her to the long board while en route to the hospital B) Transfer her to the long board already placed on the stretcher and secure with straps en route to the hospital C) Quickly but carefully provide full spine motion restriction precautions on scene prior to rapid transport to the hospital D) Wait for family members to arrive and give consent for treatment prior to moving her to the stretcher for immediate transport
C
2) Based on the structure of the nervous system, which statement is true? A) A stroke represents an injury to the peripheral nervous system B) A gunshot wound to the spinal cord will directly damage the peripheral nerves C) A deep laceration to the arm can sever peripheral nerves D) Numbness in a fractured leg indicates damage to the autonomic nervous system fibers
C
21) A 25-year-old male jail inmate was pushed over the railing of a walkway 20 feet above the ground. He is unresponsive and has an open fracture of the left upper arm. How would you determine if the patient has sensation in his legs? A) Since the patient is unresponsive, this assessment would be impossible B) Check for the presence and strength of a pedal pulse C) Pinch his foot and look for movement on the leg D) Lift his leg and look for a facial grimace
C
24) A patient is lying under a tree after being involved in a motor vehicle collision. She states that immediately after the crash, she felt okay, but now her legs are numb and tingling. She also has lower back discomfort. Which question is it most important for the EMT to ask next? A) "Do you think that you had a seizure?" B) "Are you allergic to any medications?" C) "How did you get out of the car?" D) "Do you have a history of back problems?"
C
32) Which instruction would you provide to your team immediately after securing a patient with head, neck, and back pain to the long backboard with appropriate spine motion restriction equipment? A) "Loosen the collar so you can palpate the back of the neck." B) "Maintain manual cervical spine motion restriction until the patient is on the stretcher." C) "Let's check for extremity PMS before we move the patient to the stretcher." D) "Remove the chest strap so the patient can breathe more easily now that his head and legs are secured."
C
35) Which of the instructions from one EMT to another shows the correct application of a cervical collar? A) "Carefully flex his head forward a little so I can pass the collar underneath his neck." B) "Let's log roll the patient to one side so I can apply the cervical collar." C) "Keep his head in neutral position while I apply the cervical collar." D) "I need you to extend the patient's chin backward a little so I can fit the collar under his chin."
C
37) You have been called for an 87-year-old male who fell in his kitchen while making breakfast. The patient states that he hit his forehead but managed to catch himself on the way down and did not hit the ground "too hard." Your assessment reveals him to have kyphosis of the thoracic and cervical spine, but no neurologic deficits. His legs, however, "feel weaker." Which action is appropriate given these assessment findings? A) Avoid application of a cervical collar due to the natural deformity of the cervical spine B) Disregard application of a cervical collar since the patient has no neurologic deficits C) Apply a cervical collar and prepare the patient for any discomfort that the collar may cause D) Place a soft cervical collar instead of the rigid cervical collar
C
41) A patient has just been log rolled and positioned onto the long backboard. Which care measure should be performed next, assuming it was not previously completed? A) Apply a properly sized cervical collar B) Secure the patient's head C) Secure the patient's torso with straps D) Release manual cervical spine motion restriction
C
5) An Emergency Medical Responder reports that a male patient, who was injured while playing football, has bruising to the lumbar region of the body. Based on this statement, the EMT should expect to find bruising in which area? A) Upper back B) Lower neck C) Lower back D) Buttocks
C
50) A motorcyclist wearing a full helmet was thrown from his motorcycle after hitting a patch of oil on the road. The bike had been traveling at a high rate of speed. Manual spine motion restriction is being maintained by an off-duty EMT. The primary assessment reveals the patient to be responsive to painful stimuli and breathing rapidly with slight sonorous airway sounds. His radial pulse is weak and fast. As you quickly scan his body, you note deformity to the left femur and lower leg. Your immediate action should be to: A) Apply a cervical collar B) Place a nonrebreather oxygen mask C) Remove his helmet D) Expose his left lower extremity
C
53) A 2-year-old boy fell down a flight of stairs, is crying loudly, and is very difficult to communicate with. Because you are unable to clear the spine, you elect to initiate spine motion restriction precautions. Which instruction would you provide to other EMTs who are initiating this care for the patient? A) "After he is on the board, place a towel behind his head to keep the airway open." B) "It is better if the collar is a little too big; that is more comfortable for him." C) "Let's place a folded towel under his shoulders and back to help maintain head alignment." D) "Use an adult 'no neck' collar since those fit almost everyone."
C
58) The EMT is properly assessing for a spinal cord injury when she: A) Asks the patient if he has pain anywhere along his spinal column B) Palpates the entire spinal column for tenderness C) Asks the patient to spread his fingers apart on both hands D) Checks for distal pulses in all four extremities
C
6) A 42-year-old man has called 911 because of severe back pain. He informs you that his back pain is related to a recent fracture of his coccyx. Based on this information, where should the EMT expect the patient to be complaining of pain? A) Neck B) Upper back C) Pelvic area D) Lower back
C
9) Which injury is possible based on the anatomy of the spine? A) Fracture to the ninth cervical vertebra B) Dislocation of lumbar vertebra number 6 C) Disk injury between thoracic vertebrae 11 and 12 D) Compression fracture to lumbar vertebra 12
C
10) You arrive on the scene of a motor vehicle collision. Walking toward you is the unrestrained driver of the vehicle that sustained moderate front-end damage. The patient complains of some back pain, but is walking around after the crash and does not appear to be suffering from any neurologic deficits. Although he answers your questions appropriately, he keeps asking you, "What happened?" What is your initial action in caring for this patient? A) Perform the primary assessment B) Obtain the patient's vital signs C) Look for injuries to the patient's head D) Initiate spine motion restriction precautions
D
13) You arrive on the scene of a two-car motor vehicle collision. The patient was the unrestrained driver of a car that struck another car from behind while moving at a speed of 25 mph. During the collision, the patient flew forward and struck the windshield with his head. No air bags were deployed. The patient extricated himself and denies head, neck, or back pain; however, you do note a small cut on his hand, which occurred as he was getting out of the car. When asked about preexisting medical problems, he tells you that he did have herniated disks in his lumbar spine that were surgically repaired several years ago. Based on this information, your strongest reason to initiate spine motion restriction precautions for this patient would be: A) History of back surgery B) Laceration to the hand C) Self-extrication of the patient D) Mechanism of injury
D
23) A patient was struck in the back by a heavy piece of wood that was being bent to make a form for a concrete arch. He is responsive, but cannot feel or move his legs. He has bruising to his back and is incontinent of urine. The skin below the injury site is red and warm. As a knowledgeable EMT, you should realize that: A) The paralysis is permanent B) The ability to feel will return C) A cervical collar is unnecessary D) The paralysis may resolve
D
29) A male driver was ejected from his vehicle after it rolled several times at a high rate of speed. As you approach the patient, you note that he is unresponsive and struggling to breathe. He also has a laceration to the left side of his face and multiple contusions to his legs. After assigning another EMT to take manual cervical spine motion restriction, what should you do? A) Start positive pressure ventilation B) Insert an oropharyngeal airway C) Apply a properly sized cervical collar D) Open the airway using the jaw-thrust maneuver
D
30) A patient complains of back pain and numbness to both legs after being thrown from a bicycle. When should the EMT first check the motor function, sensory function, and pulses in the legs of this patient? A) Immediately after taking manual spine motion restriction precautions B) Immediately after applying a cervical collar C) During the primary assessment D) As the secondary assessment is performed
D
36) When applying a cervical collar to a young boy who fell out of a tree, the EMT realizes the main purpose of the collar is to: A) Prevent the head and neck from moving B) Maintain spine motion restriction C) Increase the blood flow to the spinal cord in the cervical region D) Remind the patient not to move his head or neck
D
38) When it is necessary to secure a patient to a long spine board during a spine motion restriction process, which of these regions is typically secured last to the spine board? A) Chest region B) Pelvic region C) Abdominal region D) Head and neck region
D
4) You have been called for a patient with severe back pain. When you are obtaining a medical history, the patient tells you that he has a history of damaged disks in his vertebrae. As a knowledgeable EMT, you should recognize that: A) The ligaments on the side of the spinal column were overstretched B) The vertebrae making up the spinal column were fractured C) The nerves making up the spinal cord have been damaged D) The fluid-filled structures between the vertebrae have been injured
D
44) Which statement shows that the EMTs are correctly using a vest-type device while removing a patient from an entrapped vehicle location? A) The cervical collar is applied after the torso and legs have been secured to the device B) The head is secured first, followed by the torso and legs C) The head is secured to the device immediately after the cervical collar is placed D) The head is secured to the device after the torso has been secured
D
51) A high school football player was hit from behind and now complains of severe back pain and numbness to his right leg. Manual spine motion restriction is being maintained by an assistant coach. The trainer has already removed the face mask from the helmet. Once at the patient's side, what should you do next? A) Remove the shoulder pads as you prepare to place the patient on a backboard B) Carefully remove the helmet C) Apply a cervical collar D) Assess the airway and breathing
D
56) A male patient experienced an injury that completely severed his spinal cord in the thoracic spine. Which presentation would be associated with this injury? A) He will have no sensation in his arms B) He will feel pain below the injury in his legs C) He will have decreased motor ability above the injury D) He will experience paralysis to the legs
D
61) An elderly patient fell down a flight of basement stairs and is found at the bottom by family members about 20 minutes later. Your assessment reveals that the patient cannot feel painful stimuli to his hips and legs, nor can he move his legs, but he can feel you lightly touching the skin of his legs. Which type of injury may this be? A) Posterior cord syndrome B) Lateral cord syndrome C) Central cord syndrome D) Anterior cord syndrome
D
62) At a scene where a vehicle was involved in a single-car accident, you find the driver walking around at the scene. As you approach, the driver states that he felt fine when he exited the vehicle but is now concerned that his legs feel like they are "going to sleep." What is your first step in treating the driver? A) Place a backboard behind the driver, against his spine B) Assess his airway and circulation C) Assist him in sitting on the cot D) Instruct him to hold his head in a neutral inline position
D
63) An injury to a hemisection of the spinal cord that disrupts the spinal tracts on only one side of the cord is: A) Posterior cord syndrome B) Anterior cord syndrome C) Central cord syndrome D) Brown-Séquard syndrome
D
8) A patient who was injured in a motor vehicle collision has a separation of the rib and its associated spinal vertebrae. Based on the anatomy of the spine, where has this injury occurred? A) Lumbar spine B) Cervical spine C) Middle spine D) Thoracic spine
D
25) When performing the secondary assessment, which sign is most suggestive of a spinal cord injury? A) Pain in the right leg B) Headache and nausea C) Bruising on the back D) Persistent penile erection
d
