Chapter 37

Which of the following is the BEST example of an indirect injury? Select one: A. Patellar fracture after the knee strikes an automobile's dashboard B. Shoulder dislocation secondary to falling on an outstretched hand C. Fractured ankle after stepping in a hole and twisting the lower leg D. Dislocated olecranon process following direct trauma to the elbow

Shoulder dislocation secondary to falling on an outstretched hand

A 40-year-old woman has an unstable pelvis following a motor vehicle crash. She is conscious but confused. Her blood pressure is 80/50 mm Hg, pulse is 120 beats/min and weak at the radial arteries, and respirations are 24 breaths/min and shallow. After starting at least one large-bore IV line, you should: Select one: A. run it wide open until her systolic blood pressure is greater than 100 mm Hg. B. administer a 250-mL normal saline bolus and then reassess her blood pressure. C. set the IV flow rate to keep the vein open unless her systolic blood pressure falls below 70 mm Hg. D. give enough isotonic crystalloid fluids to improve her mental status and radial pulse quality.

give enough isotonic crystalloid fluids to improve her mental status and radial pulse quality.

The MOST significant immediate risk associated with an open fracture is: Select one: A. infection. B. hemorrhage. C. nerve damage. D. bone marrow loss.

hemorrhage.

Swelling and inflammation associated with musculoskeletal injuries are reduced: Select one: A. if cold packs are applied during the acute stage of the injury. B. if an appropriate dose of a narcotic analgesic is administered. C. when heat therapy is used within 48 to 72 hours after the injury. D. if a vasodilator drug is given within 12 hours following the injury.

if cold packs are applied during the acute stage of the injury.

A young man has an isolated injury to his left lower leg. Your assessment reveals obvious deformity and ecchymosis. Distal circulation, as well as motor and sensory functions, are grossly intact, and the patient is hemodynamically stable. In addition to stabilizing the suspected fracture site, you should: Select one: A. carefully palpate to elicit crepitus. B. immobilize the knee and the ankle. C. apply a traction splint for pain relief. D. place a chemical heat pack over the injury.

immobilize the knee and the ankle.

A patient standing with his or her head cocked toward a knocked-down left shoulder MOST likely has a fracture of the: Select one: A. right clavicle. B. left shoulder. C. left clavicle. D. right shoulder.

left clavicle.

You have applied board splints to a suspected lower leg fracture in a young woman and have given her fentanyl for pain. En route to the hospital, the patient states that the pain is excruciating. Further narcotics fail to relieve the pain. Reassessment of the injured area reveals that the overlying skin is taut and the pedal pulse is weak. You should: Select one: A. start a second IV line and administer 1 mEq/kg of sodium bicarbonate. B. remove the splint to prevent excessive swelling of the extremity. C. loosen the splint, elevate the leg, apply ice, and notify the hospital. D. remove the board splints, apply an air splint, and then reassess her.

loosen the splint, elevate the leg, apply ice, and notify the hospital.

You arrive at the scene of a motorcycle crash and find the rider lying supine approximately 20 feet from his bike; he is still wearing his helmet. As you approach him, you note that he has bilaterally deformed femurs. You should: Select one: A. immediately stabilize both lower extremities. B. remove his helmet and apply a cervical collar. C. manually stabilize his head and assess his airway. D. carefully straighten his legs and assess distal pulses.

manually stabilize his head and assess his airway.

Eliciting for crepitus during your exam of a deformed extremity: Select one: A. should only be performed if the patient is not in significant pain. B. may cause further injury to the bone and surrounding soft tissues. C. should be performed to help confirm the presence of a fracture. D. is generally not performed, but will likely not cause further injury.

may cause further injury to the bone and surrounding soft tissues.

The return of myoglobin to the systemic circulation following a crush injury would result in all of the following conditions, EXCEPT: Select one: A. a decreased pH. B. metabolic alkalosis. C. hyperkalemia. D. renal dysfunction.

metabolic alkalosis.

A dislocation is considered an urgent injury because of its potential to cause: Select one: A. neurovascular compromise. B. significant internal bleeding. C. severe hemodynamic instability. D. proximal sensory and motor loss.

neurovascular compromise.

Isolated musculoskeletal injuries: Select one: A. generally require high doses of analgesia. B. are difficult to identify during assessment. C. prove fatal in a significant number of cases. D. often result in short- or long-term disability.

often result in short- or long-term disability.

Common signs and symptoms of an acute pulmonary embolism include all of the following, EXCEPT: Select one: A. pulmonary edema. B. pleuritic chest pain. C. right-sided heart failure. D. tachycardia and tachypnea.

pulmonary edema.

The __________ supports 90% of the weight of the upper body. Select one: A. pelvis B. tibia C. fibula D. femur

tibia

In a closed femur fracture, blood loss may exceed _______ before enough pressure develops to tamponade the bleeding. Select one: A. 250 mL B. 500 mL C. 750 mL D. 1,000 mL

1,000 mL

Closed bilaterally fractured femurs can result in internal blood loss of up to: Select one: A. 1,000 mL. B. 1,500 mL. C. 2,000 mL. D. 3,000 mL.

3,000 mL.

Immediate pain from the heel to the calf and a sudden inability for plantar flexion of the foot is MOST indicative of: Select one: A. acute tendonitis. B. ligament disruption. C. a dislocated ankle. D. Achilles tendon rupture.

Achilles tendon rupture.

During your assessment of a patient with a femur fracture, you discover a rapidly expanding hematoma on the medial aspect of his thigh. What should you suspect? Select one: A. Fasciitis B. Arterial injury C. Venous thrombus D. Compartment syndrome

Arterial injury

Which of the following statements regarding open-book pelvic fractures is correct? Select one: A. Bleeding into the pelvic cavity is generally less than 2 liters. B. Despite IV fluids, patients may remain hypotensive in the field. C. Prehospital treatment should focus on relieving the patient's pain. D. Stabilization involves applying lateral pressure to the iliac crests.

Despite IV fluids, patients may remain hypotensive in the field.

Which of the following is typically the first complaint in a patient who is developing compartment syndrome? Select one: A. Absent distal pulses B. Numbness and tingling C. Pallor to the extremity D. Disproportionate pain

Disproportionate pain

Which of the following structures is NOT part of the axial skeleton? Select one: A. Femoral shaft B. Vertebral column C. Ribs and sternum D. Basilar skull and face

Femoral shaft

Treatment for suspected compartment syndrome includes: Select one: A. IV boluses of a crystalloid solution. B. elevating the extremity above the heart. C. calcium chloride to prevent rhabdomyolysis. D. warm packs over the affected extremity.

IV boluses of a crystalloid solution.

Which of the following musculoskeletal injuries would MOST likely occur together? Select one: A. Scaphoid and femur fractures B. Calcaneal and c-spine fractures C. Scapular and clavicular fractures D. Knee dislocation and tibial fracture

Knee dislocation and tibial fracture

Which of the following statements regarding a nondisplaced fracture is correct? Select one: A. Nondisplaced fractures are generally caused by low-energy trauma and are typically not associated with deformity. B. Nondisplaced fractures occur when a massive compressive force is applied to the bone, causing it to become wedged into another bone. C. In a nondisplaced fracture, muscles pull the distal fracture fragment alongside the proximal one, causing them to overlap. D. Nondisplaced fractures are caused by low-energy trauma and occur when the ends of the fracture move from their normal positions.

Nondisplaced fractures are generally caused by low-energy trauma and are typically not associated with deformity.

What type of fracture occurs at an angle across the bone and is typically caused by direct or twisting force? Select one: A. Spiral B. Linear C. Oblique D. Transverse

Oblique

A 68-year-old woman presents with an acute onset of dyspnea and sharp chest pain. Her medical history is significant for a hip replacement 2 weeks ago. The patient is conscious and alert, with a blood pressure of 112/58 mm Hg, pulse rate of 90 beats/min and irregular, and respirations of 22 breaths/min and labored. Which of the following treatment interventions is MOST appropriate for this patient? Select one: A. Pharmacologically assisted intubation and IV therapy B. Oxygenation and ventilation support and rapid transport C. 324 mg of aspirin and ventilation support with a bag-mask D. Supplemental oxygen and elevation of the lower extremities

Oxygenation and ventilation support and rapid transport

Which of the following is NOT one of the 6 Ps of musculoskeletal injury assessment? Select one: A. Pallor B. Parasthesias C. Pulselessness D. Passive extension

Passive extension

Which of the following is NOT an intervention the paramedic can perform to help reduce the risk of long-term disability following a musculoskeletal injury? Select one: A. Prehospital fracture reduction B. Prevention of gross contamination C. Pain reduction with cold and analgesia D. Transport to an appropriate medical facility

Prehospital fracture reduction

A 20-year-old female has a midshaft humeral fracture. Assessment reveals the presence of wrist drop. What should you suspect? Select one: A. Radial nerve injury B. Radial artery injury C. Brachial nerve injury D. Brachial artery compression

Radial nerve injury

Avascular necrosis is a major complication of a fracture of which bone? Select one: A. Scaphoid B. Metacarpal C. Calcaneus D. Clavicle

Scaphoid

Pain and tenderness in the anatomic snuffbox is a classic finding in fractures of which bone? Select one: A. Clavicle B. Scaphoid C. Calcaneus D. Metacarpal

Scaphoid

A subluxation occurs when: Select one: A. a joint is partially dislocated. B. a dislocation spontaneously reduces. C. a fracture occurs through both cortices. D. dislocated bones are locked in position.

a joint is partially dislocated.

A 60-year-old woman slipped and fell on an icy sidewalk and landed on her outstretched hand. Your assessment reveals that she has an obvious Colles fracture. The patient denies any other injuries and is conscious and alert. Her vital signs are stable and she describes her pain as a 2 on a scale of 0 to 10. Given this patient's current status, the MOST appropriate way to treat her injury involves: Select one: A. gently straightening the fracture site and then applying a splint. B. administering analgesia and then properly splinting her injury. C. giving her a sedative for pain relief and then applying an air splint. D. manually stabilizing her wrist as your partner applies a vacuum splint.

administering analgesia and then properly splinting her injury.

A pathologic fracture occurs when: Select one: A. an occult medical condition causes abnormal bone weakness. B. greater-than-usual forces are required to fracture a large bone. C. a particular mechanism of injury cannot be identified readily. D. underdeveloped bones sustain a low-impact traumatic injury.

an occult medical condition causes abnormal bone weakness.

When a person jumps from a height and lands on his or her feet, direct trauma occurs to the: Select one: A. tarsals. B. malleolus. C. calcaneus. D. metatarsals.

calcaneus.

The BEST way to detect deformity or any other abnormality in an injured extremity is to: Select one: A. gently palpate the entire length of the extremity. B. compare it to the extremity on the opposite side. C. manipulate the extremity to assess for false motion. D. reduce any swelling with ice before performing the exam.

compare it to the extremity on the opposite side.

When assessing distal pulses in a patient with a lower extremity injury, it is MOST important to: Select one: A. suspect severe shock if a unilateral pulse deficit is present. B. compare the strength of the pulses in both lower extremities. C. remember that most people do not have a palpable pedal pulse. D. count the pedal pulse rate and compare it to the radial pulse rate.

compare the strength of the pulses in both lower extremities.

Signs of bursitis include all of the following, EXCEPT: Select one: A. warmth. B. swelling. C. deformity. D. erythema.

deformity.

The MOST reliable sign of a fracture is: Select one: A. deformity. B. ecchymosis. C. localized pain. D. severe swelling.

deformity.

The FIRST step in splinting a musculoskeletal injury involves: Select one: A. thoroughly assessing range of motion. B. exposing and assessing the injury site. C. assessing distal neurovascular functions. D. straightening the injury if it is angulated.

exposing and assessing the injury site.

You should NOT apply a pneumatic splint on a patient if he or she: Select one: A. has an open fracture in which bone ends are exposed. B. is experiencing severe pain despite narcotic analgesia. C. has a closed fracture involving the lower leg or forearm. D. experienced a fracture or dislocation involving a major joint.

has an open fracture in which bone ends are exposed.

In contrast to osteoarthritis, rheumatoid arthritis: Select one: A. is a disease of the joints that occurs as they age and begin to wear. B. generally does not respond well to anti-inflammatory medication therapy. C. is a systemic inflammatory disease that affects joints and other body systems. D. causes severe pain secondary to crystallized uric acid accumulation in a joint.

is a systemic inflammatory disease that affects joints and other body systems.

The appendicular skeleton is composed of the: Select one: A. bones of the spinal column, scapulae, and clavicles. B. bones of the upper extremities and the structures of the torso. C. pectoral girdle, pelvic girdle, and bones of the extremities. D. thoracic ribs, cervical vertebrae, and bones of the cranium.

pectoral girdle, pelvic girdle, and bones of the extremities.

Compartment syndrome occurs when: Select one: A. metabolic waste products accumulate within a large hematoma that develops near a fracture site. B. yellow and red bone marrow seep from a fractured bone, resulting in excessive soft tissue swelling. C. blood accumulates in the medullary canal of a bone, resulting in decreased oxygenation of the bone tissue. D. pressure in the fascial compartment leads to impaired circulation, sensory changes, and progressive muscle death.

pressure in the fascial compartment leads to impaired circulation, sensory changes, and progressive muscle death.

After ensuring your own safety, your next priority when caring for a patient with an extremity injury is to: Select one: A. prevent further injury. B. assess neurovascular function. C. splint the injured extremity. D. administer an analgesic.

prevent further injury.

The MOST practical method of splinting multiple fractures in a critically injured patient is to: Select one: A. apply vacuum splints en route to the hospital. B. splint the axial skeleton using a scoop stretcher. C. use air splints so you can visualize the injuries. D. sedate the patient before applying any splints.

splint the axial skeleton using a scoop stretcher.

A 19-year-old man experienced direct trauma to his left elbow. Your assessment reveals gross deformity and ecchymosis. His arm is pink and warm, and he has a strong radial pulse. Your transport time to the hospital will be delayed. You should: Select one: A. splint the elbow in the position found and reassess distal circulation. B. carefully straighten the arm to facilitate placement of a vacuum splint. C. apply a sling and swathe to immobilize the injury and then apply heat. D. administer fentanyl for pain relief and then carefully straighten the arm.

splint the elbow in the position found and reassess distal circulation.

The likelihood of experiencing systemic complications from a musculoskeletal injury is related to all of the following factors, EXCEPT the: Select one: A. patient's overall health. B. anatomic location of the injury. C. splinting method used in the field. D. degree of force that caused the injury.

splinting method used in the field.

The sudden twisting of a joint beyond its normal range of motion, causing a temporary subluxation, is called a: Select one: A. strain. B. sprain. C. dislocation. D. fracture-dislocation.

sprain.

An open-book pelvis fracture has the potential for massive blood loss because: Select one: A. the femoral vein is often injured. B. the femur is usually also fractured. C. the volume of the pelvis is increased. D. the abdominal aorta is often injured.

the volume of the pelvis is increased.