Paramedic Trauma Quiz 6 & 7

When CPP falls below the critical level of 50 mmHG, autoregulation does which of the following to maintain CPP and cerebral perfusion? Select one: a. Decreases blood pressure b. Increases blood pressure c. Decreases intracranial pressure d. Increases intracranial pressure

b. Increases blood pressure

Which of the following most accurately characterizes simple pneumothorax? Select one: a. Untreated, it will lead to mediastinal shift and compression of the contralateral lung. b. It is a problem of ventilation—perfusion mismatch. c. It results from air entering the pleural cavity through a defect in the chest wall. d. It results from the creation of a one-way valve that continues to allow air into, but not out of, the pleural cavity.

b. It is a problem of ventilation—perfusion mismatch.

A patient unable to extend the leg or flex the hip is MOST likely to have incurred an injury in which nerve plexus? Select one: a. Cervical b. Lumbar c. Brachial d. Sacral

b. Lumbar

Intracranial Volume = Brain Volume + CSF Volume + Blood Volume is the basis behind which of the following? Select one: a. Cerebral perfusion pressure b. Monroe-Kellie doctrine c. Mean arterial pressure d. Traumatic brain injury

b. Monroe-Kellie doctrine

Which of the following has the greatest likelihood of resulting in an open pneumothorax? Select one: a. Any opening between the pleural cavity and the atmosphere b. Open defects that are two-thirds the size of the trachea or larger c. Open defects that are larger in diameter than the trachea d. Open defects that are one-quarter the size of the trachea or larger

b. Open defects that are two-thirds the size of the trachea or larger

All of the following are used in the sedation of patients for rapid sequence intubation, EXCEPT: Select one: a. Valium. b. Romazicon. c. etomidate. d. ketamine.

b. Romazicon.

Which of the following mechanisms causes indirect brain injury? Select one: a. Coup/contrecoup injuries b. Systemic hypotension combined with increasing intracranial pressure c. Cushing's reflex d. Acceleration/deceleration forces without a direct blow to the cranium

b. Systemic hypotension combined with increasing intracranial pressure

Which of the following statements is NOT true of pericardial tamponade? Select one: a. It is most often associated with penetrating trauma. b. The systolic blood pressure increases significantly on inspiration. c. As little as 150 mL of blood can cause pericardial tamponade. d. The pathophysiology results in increased venous pressure and decreased cardiac output.

b. The systolic blood pressure increases significantly on inspiration.

When assessing the eyes of a patient with head trauma, you can tell the function of all the following cranial nerves, EXCEPT: Select one: a. II. b. VII. c. IV. d. VI.

b. VII

An individual is struck in the left ventricle with a low-velocity projectile. As compared to high-velocity penetrating trauma, you should have a higher index of suspicion for: Select one: a. ventricular rupture. b. pericardial tamponade. c. simple penetrating injury. d. blunt cardiac injury.

b. pericardial tamponade.

Which of the following Glasgow Coma Scale scores indicates serious brain injury? Select one: a. < 3 b. Between 12 and 15 c. < 8 d. < 15

c. < 8

Which of the following about the use of prehospital fluid resuscitation in the patient with a traumatic brain injury is TRUE? Select one: a. Administer fluids aggressively regardless of the patient's blood pressure. b. Do not administer fluids unless the patient's blood pressure drops below 60 mmHg, because the administration of fluids leads to increased cerebral edema. c. Administer fluids as needed to maintain a systolic blood pressure above 90 mmHg. d. The use of hypertonic fluids is indicated to maintain vascular volume while reducing tissue edema.

c. Administer fluids as needed to maintain a systolic blood pressure above 90 mmHg.

Your patient is a 37-year-old male unrestrained driver of a vehicle. You find him with his upper body across the console and his head hanging down into the passenger's side floorboard area. You note pooled blood from a scalp wound. After immobilizing him and loading him into the ambulance, where you have more light for your examination, you note that he has a large, full-thickness avulsion of the scalp. The patient's heart rate is 112, respirations are 20, and blood pressure is 82/50. Which of the following statements about this patient are TRUE? 1. The scalp wound itself cannot account for the patient's vital signs. 2. The scalp wound itself may account for the patient's vital signs. 3. The patient's vital signs are consistent with increasing intracranial pressure. 4. Nothing about the vital signs indicates increased intracranial pressure. Select one: a. 1 and 4 b. 2 and 3 c. 1 and 3 d. 2 and 4

d. 2 and 4

For the head injury patient without signs of herniation, adjust ventilation rates to maintain a capnography reading of between: a. 15 and 20 mmHg. b. 25 and 30 mmHg. c. 45 and 50 mmHg. d. 35 and 40 mmHg

d. 35 and 40 mmHg

When providing fluid resuscitation for a 1-year-old child with hypovolemia from a head injury, the goal is to maintain a systolic blood pressure of: a. 90 mmHg. b. 85 mmHg. c. 75 mmHg. d. 65 mmHg.

d. 65 mmHg.

The morbidity associated with simple pneumothorax is primarily due to which of the following? a. Occlusion of pulmonary circulation b. Increased intrathoracic pressure c. Loss of chest wall integrity d. Ventilation/perfusion mismatch

d. Ventilation/perfusion mismatch

Which of the following is a common mechanism of injury associated with spinal cord injuries? Select one: a. Falls greater than 20 feet b. Bungee jumping c. Shallow water diving d. All of these

d. all of these

A patient who has dived into a shallow pool and hit his head on the bottom is MOST likely to have which of the following types of injuries? Select one: a. Cervical hyperextension b. Cervical hyperflexion c. Axial distraction d. Axial loading

d. axial loading

Which of the following is the largest element of the nervous system? Select one: a. Cerebellum b. Pons c. Medulla oblongata d. Cerebrum

d. cerebrum

Which syndrome causes motor weakness that affects the upper extremities and usually occurs in patients older than 50 years of age? a. Central cord b. Anterior cord c. Brown-Séquard d. Cauda equina

a. Central Cord

The shearing, stretching, and tearing associated with rapid acceleration/deceleration forces acting on the brain result in which of the following types of brain injury? Select one: a. Direct, diffuse b. Indirect, diffuse c. Indirect, focal d. Direct, focal

a. Direct, diffuse

Which of the following best describes the threat to life associated with traumatic rupture of the esophagus? Select one: a. Entry of gastric contents into the mediastinum b. Hypoxia c. Decreased cardiac output d. Massive hemorrhage

a. Entry of gastric contents into the mediastinum

Which of the following mechanisms are involved in neurogenic shock? 1. Unopposed vasodilation 2. Loss of innervation to the adrenal medulla 3. Decreased preload 4. Unopposed sympathetic tone Select one: a. 1, 2, 3 b. 1, 3, 4 c. 1, 2, 3, 4 d. 1, 3

a. 1,2,3

Thoracic trauma accounts for approximately ________ percent of mortality from trauma. Select one: a. 20 to 25 b. 10 to 15 c. 75 to 80 d. 45 to 50

a. 20 to 25

Which of the following trauma patients is MOST likely to have SCIWORA when examined in the hospital? Select one: a. 5-year-old male b. 80-year-old female c. 21-year-old male d. 45-year-old female

a. 5-year-old male

A patient who had a spinal cord T4 injury two years ago calls 911 for a pounding headache, blurred vision, and flushing. On your arrival, her vital signs include a blood pressure of 240/120 and pulse of 58. What is this condition called? Select one: a. Autonomic hyperreflexia syndrome b. Spinal shock c. Malignant hypertension d. Brown-Séquard syndrome

a. Autonomic hyperreflexia syndrome

Coup injuries commonly occur in which region of the brain? Select one: a. Frontal region b. Occipital region c. Temporal region d. Neuronal region

a. Frontal region

Which of the following statements about the administration of dextrose to the patient with a traumatic brain injury is TRUE? Select one: a. Hypoglycemia is associated with a poorer neurologic outcome; if the blood glucose level is less than 60 mg/dL, administer 25 grams of dextrose. b. Hypoglycemia is inconsequential to neurologic outcome; assessing the blood glucose level is not a priority. c. Hyperglycemia is associated with a poorer neurologic outcome; never administer dextrose to a patient with traumatic brain injury. d. Hypoglycemia is associated with a poorer neurologic outcome. All patients with suspected traumatic brain injury who have an altered mental status should receive 25 grams of dextrose intravenously.

a. Hypoglycemia is associated with a poorer neurologic outcome; if the blood glucose level is less than 60 mg/dL, administer 25 grams of dextrose.

Which of the following skull fractures is most common? a. Linear b. Basilar c. Depressed d. Comminuted

a. Linear

Which of the following parameters should be used to guide the oxygenation and ventilation of the patient with a traumatic brain injury? Select one: a. Maintain an oxygen saturation level of at least 96 percent and a capnography reading between 35 and 40 mmHg. b. Maintain an oxygen saturation level of at least 90 percent and a capnography level < 45 mmHg. c. Maintain an oxygen saturation level of at least 98 percent and a capnography reading > 45 mmHg. d. Maintain an oxygen saturation level of at least 90 percent and a capnography reading < 35 mmHg.

a. Maintain an oxygen saturation level of at least 96 percent and a capnography reading between 35 and 40 mmHg.

During the early care for a patient with a basilar skull fracture in the prehospital setting, which of the following would be an unexpected finding? a. Periorbital ecchymoses or "raccoon eyes" b. CSF otorrhea c. Blood mixed with cerebral spinal fluid flowing from the mouth d. CSF rhinorrhea

a. Periorbital ecchymoses or "raccoon eyes"

Which of the following best describes the goals of manual cervical spine stabilization? Select one: a. Preventing movement of the head in any direction; prevent any flexion/extension, rotation, or lateral bending b. Keeping the head in an "eyes forward" position; applying enough traction to cause axial unloading, which is 18 to 22 pounds in the average adult c. Preventing rotation of the head; avoiding any upward lifting or downward pressure on the cervical spine d. Preventing movement of the head in any direction; applying gentle axial pressure to stabilize the vertebral column Feedback

a. Preventing movement of the head in any direction; prevent any flexion/extension, rotation, or lateral bending

Which of the following is TRUE of pulmonary contusion? a. Signs and symptoms generally develop gradually. b. Pulmonary contusion is typically an isolated injury. c. The primary pathophysiology is that the alveoli are filled with blood. d. Pulmonary contusion results in paradoxical motion of the chest wall.

a. Signs and symptoms generally develop gradually.

On maximal expiration, the diaphragm may be: a. as high as the fourth intercostal space anteriorly. b. as high as the second intercostal space anteriorly. c. as low as the ninth intercostal space anteriorly. d. as low as the eleventh intercostal space anteriorly.

a. as high as the fourth intercostal space anteriorly.

Hemothorax is primarily a problem of: Select one: a. blood loss. b. impaired ventilation. c. ventilation/perfusion mismatch. d. increased intrathoracic pressure.

a. blood loss.

The trachea divides into the right and left mainstem bronchi at the: Select one: a. carina. b. hilum. c. lingual. d. thoracic inlet.

a. carina

Traumatic asphyxia is a(n) ________ type of injury. Select one: a. compression b. deceleration c. decompression d. acceleration

a. compression

Which of the following is the primary concern in the patient with a hemothorax? Select one: a. Hypovolemia b. Increased intrathoracic pressure c. Mediastinal shift d. Atelectasis

a. hypovolemia

Pediatric patients are ________ likely to become hypovolemic from head injuries than adult patients. Select one: a. more b. less c. equally d. Pediatric patients always become hypovolemic due to the movable fontanels.

a. more

When palpating the spine of a patient during your assessment, you are feeling the: Select one: a. spinous processes. b. vertebral bodies. c. transverse vertebral processes. d. vertebral pedicles.

a. spinous processes

In a subdural hematoma, the vessel most commonly involved is the: Select one: a. superior sagittal sinus. b. inferior sagittal sinus. c. middle meningeal artery. d. superior meningeal artery.

a. superior sagittal sinus.

The ________ is one of the thinnest and most frequently fractured cranial bones. a. temporal b. ethmoid c. parietal d. occipital

a. temporal

You have intubated a 5-year-old girl with a suspected head injury. You note that the patient is exhibiting signs of herniation. What is the desired range for this patient's end-tidal CO2? Select one: a. 35 to 40 b. 30 to 35 c. 25 to 30 d. 40 to 45

b. 30 to 35

The cerebrum, cerebellum, and brainstem account for what percentage of the cranial volume? Select one: a. 60 percent b. 80 percent c. 50 percent d. 75 percent

b. 80 percent

Regarding the primary assessment of the patient with suspected traumatic brain injury, which of the following describes the best approach to assessing the patient's neurological functioning? a. The use of AVPU b. Assessing the patient for level of consciousness and orientation to person, place, and time c. Assessing a revised trauma score d. Assessing a Champion trauma scale score

b. Assessing the patient for level of consciousness and orientation to person, place, and time

You are on the scene of a domestic assault in which the female victim defended herself against further attack by stabbing her attacker. Your patient is a 36-year-old man who has been stabbed in the posterior thorax about 1 centimeter to the right of the spinous process of T6. Your assessment reveals loss of motor and sensory function on the right side distal to T6 but intact motor function with some loss of sensation on the left side distal to T6. Which of the following best explains this patient's presentation? Select one: a. "Pseudoneurologic" deficit to avoid being arrested b. Brown-Séquard syndrome c. Central cord syndrome d. Autonomic hyperreflexia

b. Brown-Sequard syndrom

Anterior cord syndrome is caused by which of the following mechanisms? Select one: a. Tearing of the anterior cord due to hyperextension mechanisms b. Disruption of arterial blood supply to the anterior cord c. Laceration of the anterior cord caused by bone fragments d. Contusion of the anterior cord caused by blunt trauma

b. Disruption of arterial blood supply to the anterior cord

Your patient is a 12-year-old boy who was struck in the right temporal area of the head with a baseball. He had a brief loss of consciousness and is alert on your arrival. You note that he is becoming drowsy and has a strong radial pulse of 60, a blood pressure of 140/70, and a respiratory rate of 12. Which of the following best describes this patient's condition? Select one: a. He is stable, and he most likely has a subarachnoid hemorrhage with no increase in intracranial pressure. b. He is critical, and he most likely has an epidural hematoma with rapidly increasing intracranial pressure. c. He is stable, and he most likely has a mild diffuse axonal injury with no increase in intracranial pressure. d. He is serious, and he most likely has a subdural hematoma with an increase in intracranial pressure.

b. He is critical, and he most likely has an epidural hematoma with rapidly increasing intracranial pressure.

Which of the following findings differentiates a simple pneumothorax from a tension pneumothorax? Select one: a. Decreased breath sounds on the affected side b. Hemodynamic compromise c. Absent breath sounds on the affected side d. An open defect in the chest wall

b. Hemodynamic compromise

You are treating a 16-year-old male patient who fell while practicing a new move on his skateboard. Bystanders relate that the patient was not wearing a helmet. The bystanders also relate that the patient was alert and oriented following the fall; however, while waiting for you to arrive, the patient became unconscious. While performing your physical exam, you note that the patient has a hematoma to the right temporal area. Your assessment leads you to believe that your patient has an epidural hematoma. You know that an epidural hematoma is caused by what type of bleeding? Select one: a. Venous bleeding b. Capillary bleeding c. Arterial bleeding d. Venous and capillary bleeding

c. Arterial bleeding

You have arrived on the scene of a paramedic who was shot as she approached a residence on a call. The scene has since been secured. Your patient is a 38-year-old woman with one gunshot wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and difficulty breathing. The patient's EMT partner has applied oxygen by nonrebreathing mask and placed an occlusive dressing over the entry wound before your arrival. As you continue your assessment, the patient's level of consciousness decreases. She responds to verbal stimuli. Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side. The patient lacks a radial pulse, and the abdomen is non-guarded and non-tender. Which of the following should you do first? Select one: a. Start a large-bore IV of isotonic crystalloid solution. b. Do a rapid trauma assessment. c. Assist ventilations with a bag-valve-mask device. d. Do an immediate needle chest decompression.

c. Assist ventilations with a bag-valve-mask device.

Your patient has received blunt facial trauma due to an assault. For which of the following injuries should you maintain a high index of suspicion? a. Airway obstruction b. Hypoxia due to aspiration of blood c. Basilar skull fracture d. Lumbar spine trauma

c. Basilar skull fracture

The phrenic nerve consists of peripheral nerve roots ________ through ________. Select one: a. C-1; C-3 b. C-5; C-8 c. C-3; C-5 d. C-1; C-8

c. C-3; C-5

The cerebral perfusion pressure is represented by which of the following equations? Select one: a. CPP = MAP - CVP b. CPP = CVP - ICP c. CPP = MAP - ICP d. CPP = ICP - MAP

c. CPP = MAP - ICP

Which of the following spinal cord injuries is LEAST likely to result in residual neurologic deficit? Select one: a. Compression b. Transection c. Contusion d. Laceration

c. Contusion

Your patient is a 7-year-old male pedestrian who was struck by a vehicle. Your assessment reveals bleeding from the right auditory canal. Which of the following describes the most appropriate way to manage this? Select one: a. Determining the presence or absence of cerebrospinal fluid is a low priority. Pack the auditory canal with sterile gauze to control bleeding. b. Use a "halo" test to determine whether cerebrospinal fluid is in the blood. If it is, loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. If cerebrospinal fluid is not present, pack the ear canal with sterile gauze to control bleeding. c. Determining the presence or absence of cerebrospinal fluid in the blood is a low priority. Loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. d. Check the glucose level in the blood draining from the ear. If it is less than the patient's blood glucose level, there is cerebrospinal fluid present. Cover the ear loosely with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. If the glucose level of the blood from the ear is the same as the patient's blood glucose level, pack the auditory canal with sterile gauze to control bleeding.

c. Determining the presence or absence of cerebrospinal fluid in the blood is a low priority. Loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear.

Which of the following is noted in the patient with a positive Babinski's sign? Select one: a. Fanning of the toes with plantar flexion of the great toe b. Dorsiflexion of the second to fifth toes with plantar flexion of the great toe c. Fanning of the toes with dorsiflexion of the great toe d. Plantar flexion of the second to fifth toes with dorsiflexion of the great toe

c. Fanning of the toes with dorsiflexion of the great toe

Which of the following is the primary prehospital concern with a simple, isolated fracture of the fifth rib in the right posterior—axillary line? Select one: a. Hemorrhage b. Pneumonia c. Hypoventilation d. Liver contusion

c. Hypoventilation

Which of the following best describes consensual reactivity of the pupils? Select one: a. It is a pathological phenomenon. When a penlight is shone into one eye, both pupils constrict. b. It is a normal phenomenon. When a penlight is shone into one eye, only that pupil will constrict, while the other pupil is unaffected. c. It is a normal phenomenon. When a penlight is shone into one eye, both pupils constrict. d. It is a pathological phenomenon. When a penlight is shone into one eye, only that pupil constricts, while the other pupil is unaffected.

c. It is a normal phenomenon. When a penlight is shone into one eye, both pupils constrict.

Which of the following best describes the role of rapid sequence intubation (RSI) in the prehospital management of patients with traumatic brain injury? Select one: a. It is beneficial and should be used for all patients with traumatic brain injury who are experiencing trismus or who have an intact gag reflex. b. It is supported by anecdotal evidence, but no studies have been done to determine its feasibility or usefulness. c. It is controversial because of conflicting study results. d. It is detrimental, resulting in poorer neurological outcomes than in patients who received standard airway management.

c. It is controversial because of conflicting study results.

A ________ fracture characteristically involves the entire facial region below the brow ridge, including the zygoma, nasal bone, and maxilla. Select one: a. Le Fort I b. Le Fort II c. Le Fort III d. Le Fort IV

c. Le Fort III

Your patient is a 27-year-old man with one stab wound at the fifth intercostal space posteriorly, on the right. He is ambulatory at the scene, but dyspneic and has air movement at the site of the injury. Which of the following should you do first? a. Apply oxygen by nonrebreather. b. Cover the wound with your gloved hand. c. Prepare an occlusive dressing. d. Perform a needle thoracostomy. Feedback

c. Prepare an occlusive dressing.

Which of the following is NOT a component of the Glasgow Coma Scale? Select one: a. Eye opening b. Motor ability c. Pupillary reaction d. Verbal response

c. Pupillary reaction

Your patient is a 22-year-old female assault victim. She has blunt trauma to the face with swelling around the right eye and zygomatic area. Upon assessing her eye movement, you note that the right eye cannot follow your finger and does not move. Which of the following MOST likely explains this finding? Select one: a. She has a fracture of the orbit that has trapped the optic nerve, thereby paralyzing her gaze. b. She has direct trauma to the eyeball that has damaged the intrinsic muscles of the eye. c. She has a fracture of the orbit that has trapped the extrinsic eye muscles. d. She has direct trauma to the eyeball that has damaged the optic nerve, thereby paralyzing her gaze. Feedback

c. She has a fracture of the orbit that has trapped the extrinsic eye muscles.

Your patient is a 38-year-old man who was pinned beneath the frame of a vehicle when it slipped off the makeshift jacks he was using to elevate it. The patient's brother thinks he may have been trapped for up to 20 minutes. The rescue unit is preparing to use airbags to lift the vehicle off the patient. Which of the following medications could you consider giving this patient? Select one: a. Magnesium sulfate b. Calcium chloride c. Sodium bicarbonate d. Potassium chloride

c. Sodium bicarbonate

Your patient is a 15-year-old male who was struck in the chest with a baseball. He is unresponsive, pulseless, and apneic. The monitor shows ventricular fibrillation. This condition is most accurately described as: Select one: a. pericardial tamponade. b. blunt cardiac injury. c. commotio cordis. d. traumatic asphyxia.

c. commotio cordis.

Concussion is a(n) ________ injury. a. direct. b. indirect. c. diffuse. d. delayed.

c. diffuse.

Abdominal trauma should be suspected with penetrating thoracic wounds below the ________ rib anteriorly and the ________ rib posteriorly. Select one: a. fourth; ninth b. second; fifth c. fourth; sixth d. second; tenth

c. fourth, sixth

Which of the following medications may be indicated in the prehospital management of the patient with traumatic brain injury? Select one: a. Methylprednisolone b. Diazoxide c. Mannitol d. Furosemide

c. mannitol

Your patient is a 45-year-old man with extensive blunt trauma to the face. He has decorticate posturing in response to pain; weak, irregular respiratory effort at 6 per minute; and a heart rate of 50 with a good radial pulse. The patient appears to have nasal and mandibular fractures, and an oropharyngeal airway is insufficient to keep the tongue from the posterior pharynx. Which of the following has the most potential to negatively impact the patient? Select one: a. Retrograde intubation b. Oral intubation under direct laryngoscopy c. Nasotracheal intubation d. A non-visualized dual-lumen airway

c. nasotracheal intubation

When developing a spinal clearance policy, age: Select one: a. should never be considered, as age does not matter. b. should be considered only when the patient is a man between the ages of 21 and 35. c. should be considered, as the very old may not be able to describe their symptoms accurately. d. should be considered only if the patient is a minor.

c. should be considered, as the very old may not be able to describe their symptoms accurately.

All the following are seen in Cushing's triad, EXCEPT: Select one: a. increased blood pressure. b. irregular respirations. c. tachycardia. d. All of these are seen in Cushing's triad.

c. tachycardia.

You are caring for a 20-year-old skateboarder who crashed into a brick retaining wall at the bottom of a steep hill. He has blunt trauma to his face with nose deformity, loose teeth, and bleeding from the nose and mouth. Although you have answered him several times, he keeps repeating to you, "What happened? It seems like I'm having a bad day." This is most indicative of which of the following? a. Aphasia b. Retrograde amnesia c. Decorticate disorientation d. Anterograde amnesia

d. Anterograde amnesia

The diaphragm is controlled by peripheral nerve roots ________ through ________. Select one: a. C-3; C-7 b. C-3; C-5 c. C-1; C-7 d. C-1; C-5

d. C-1; C-5

Which of the cervical vertebrae is quite pronounced and can be felt as the first bony prominence along the spine and just above the shoulders? Select one: a. C3 b. C1 c. C6 d. C7

d. C7

Your patient states that he had a traumatic brain injury from a motorcycle collision three years ago. You notice that his gait is unsteady and his movements are a bit jerky. You suspect that he has damage to which of the following structures? Select one: a. Falx cerebri b. Reticular activating system c. Third cranial nerve d. Cerebellum

d. Cerebellum

Which of the following statements concerning blunt thoracic trauma in the pediatric population is most accurate? Select one: a. Children are more likely than adults to suffer both rib fracture and organ injury. b. Children are less likely than adults to suffer either rib fractures or organ injury. c. Children are more likely than adults to suffer rib fractures but less likely to suffer significant organ injury. d. Children are less likely than adults to suffer rib fractures but more likely to have significant organ injury.

d. Children are less likely than adults to suffer rib fractures but more likely to have significant organ injury

Which of the following best describes the mechanism of blunt thoracic trauma associated with blast injuries? Select one: a. Deceleration b. Acceleration c. Compression d. Compression and decompression

d. Compression and decompression

Which of the following is the correct description of a wound that is below the fifth rib, directly in line with the armpit? Select one: a. Sixth intercostal space, midclavicular b. Sixth intercostal space, midaxillary line c. Fifth intercostal space, midclavicular line d. Fifth intercostal space, midaxillary line

d. Fifth intercostal space, midaxillary line

Which of the following correctly describes the impact of motorcycle helmet use? Select one: a. Helmet usage is associated with a 10 percent reduction in serious head injuries. b. There have been no reported fatalities from motorcycle collisions in which the riders were wearing helmets. c. Helmet usage decreases the risk of serious head injuries but increases the risk of cervical-spine injuries. d. Helmet usage results in a more than 50 percent reduction in serious head injuries.

d. Helmet usage results in a more than 50 percent reduction in serious head injuries.

Which of the following is a complication of positive-pressure ventilation in the patient with significant chest trauma? Select one: a. Pulmonary contusion b. Atelectasis c. Exacerbation of flail chest d. Impaired venous return to the heart

d. Impaired venous return to the heart

Which of the following is a function of the sympathetic nervous system? Select one: a. Digestion b. Sexual functioning c. Constriction of the pupils d. Increased heart rate

d. Increased heart rate

Which of the following occurs during the onset of inspiration? Select one: a. Intrathoracic pressure increases and venous return to the heart is impeded. b. Intrathoracic pressure increases and venous return to the heart is facilitated. c. Intrathoracic pressure decreases and venous return to the heart is impeded. d. Intrathoracic pressure decreases and venous return to the heart is facilitated.

d. Intrathoracic pressure decreases and venous return to the heart is facilitated.

Your patient is an 80-year-old man who was the unrestrained driver of a vehicle without airbags that was involved in a frontal collision with a parked car. Your assessment reveals that he is dyspneic, tachypneic, and tachycardic. He is awake but unable to respond to questions. There are no obvious signs of injury to the head or neck. The patient has paradoxical movement of the sternum with breathing, along with crepitus and subcutaneous air noted on palpation. Chest excursion is limited, and the patient has cyanosis of his lips, ears, and nail beds. Which of the following is most needed in this patient? Select one: a. Infusion of isotonic crystalloid solution using a large-bore IV b. Application of bulky dressings over the site of paradoxical motion c. Being placed in a prone position to stabilize the chest wall d. Intubation and positive-pressure ventilation

d. Intubation and positive-pressure ventilation

Which of the following best describes the effect of hyperventilation in the brain-injured patient? Select one: a. It is beneficial, because vasodilation results in increased cerebral blood flow. b. It is detrimental, because vasodilation causes an increase in tissue edema. c. It is beneficial, because vasoconstriction results in decreased tissue edema. d. It is detrimental, because vasoconstriction results in decreased cerebral perfusion. Feedback

d. It is detrimental, because vasoconstriction results in decreased cerebral perfusion

The spinal cord is continuous from the brain to the level of: Select one: a. T-12 or T-13. b. L-5 or L-6. c. the coccyx. d. L-1 or L-2.

d. L-1 or L-2

You are caring for a 22-year-old amateur boxer who complained of a sudden obstruction of part of his visual field. This complaint is most consistent with which of the following conditions? a. Extrusion of the eyeball b. Subconjunctival hemorrhage c. Hyphema d. Retinal detachment

d. Retinal detachment

Your patient is a 17-year-old female who fell from a horse. She is complaining of being unable to move. During your assessment, you have placed her arms at her sides, but her arms keeping returning to a "stick-up" or "hold-up" position. Based on this, which of the following is MOST likely? Select one: a. The patient has a spinal-cord injury at T-1. b. The patient has Brown-Séquard syndrome. c. The patient is feigning the injury. d. The patient has a spinal cord injury in the midcervical region.

d. The patient has a spinal cord injury in the midcervical region

Recent research has provided evidence of which of the following regarding spinal injury assessment? Select one: a. Only trauma patients with signs and symptoms of neurological deficit need to receive spinal immobilization. b. Paramedics cannot reliably identify patients who are likely to have spinal injuries. c. All trauma patients should be assumed to have spinal injuries. d. There are reliable criteria for determining the likelihood of spinal injury.

d. There are reliable criteria for determining the likelihood of spinal injury.

Which of the following statements about the patient in neurogenic shock is NOT true? Select one: a. The patient's heart rate may be slow. b. The patient's blood pressure is decreasing. c. Signs of hypovolemic shock may be masked. d. Unopposed sympathetic nervous system stimulation results in generalized pallor and diaphoresis.

d. Unopposed sympathetic nervous system stimulation results in generalized pallor and diaphoresis

Which of the following are the two most important prehospital considerations for head injury patients? Select one: a. Cervical spine immobilization and ventilation b. ICP monitoring and administering corticosteroids c. Ventilation and administering corticosteroids d. Ventilation and maintaining adequate blood pressure

d. Ventilation and maintaining adequate blood pressure

Your patient is a 21-year-old man with a single, small-caliber gunshot wound to the left anterior chest, just lateral to the sternum at the fourth intercostal space. Bleeding from the wound is minimal. The patient is initially anxious, combative, and diaphoretic. Initial vital signs include a heart rate of 100, respirations of 20, and a blood pressure of 110/80. Breath sounds are clear bilaterally and equal. En route, the patient becomes quieter but still restless. The heart rate increases to 120, respirations are 24, blood pressure 106/88, and breath sounds remain clear and equal. The patient has also developed significant JVD. You are 15 minutes from a Level I trauma center and 5 minutes away from a large community hospital. You should: Select one: a. immediately decompress the left chest and divert to the community hospital for chest tube insertion. b. immediately decompress the left chest and continue to the trauma center for chest tube insertion. c. continue to the Level I trauma center for pericardiocentesis. d. divert to the community hospital for pericardiocentesis.

d. divert to the community hospital for pericardiocentesis.

You have arrived on the scene of a paramedic who was shot as she approached a residence on a call. The scene has since been secured. Your patient is a 38-year-old woman with one gunshot wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and difficulty breathing. The patient's EMT partner has applied oxygen by nonrebreather mask and placed an occlusive dressing over the entry wound before your arrival. As you continue your assessment, the patient's level of consciousness decreases. She responds to verbal stimuli. Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side. The patient lacks a radial pulse, and her abdomen is non-guarded and non-tender. Which of the following best explains the presentation of this patient? Select one: a. Simple pneumothorax b. Tension pneumothorax c. Pericardial tamponade d. Hemothorax

d. hematoma

Your patient has sustained trauma to the eye. Upon examination, you see blood pooling in the anterior chamber and in front of the iris and pupil. What is this condition called? Select one: a. Mediastinitis b. Otorrhea c. Icterus d. Hyphema

d. hyphema

Which of the following best describes the epidemiology of sternal fracture? Select one: a. Low incidence, low mortality b. High incidence, high mortality c. High incidence, low mortality d. Low incidence, high mortality

d. low incidence, high mortality

Which of the following patients fit the criteria for application of spinal precautions in the prehospital setting? a. An 85-year-old man who has fallen down three steps and has a large laceration to the occipital region of the skull, but no complaints of pain b. A 21-year-old man who was diving into a pool and states he hit his head, but is out of the pool and ambulatory upon your arrival with no complaint of neck or back pain c. A 36-year-old woman who was involved in a minor motor vehicle crash with an obvious closed tibia fracture d. None of these

d. none of these

For the patient with suspected traumatic brain injury, the ideal positioning of the patient for transport is: Select one: a. in a left lateral recumbent position on the backboard. b. on a long backboard with the foot of the backboard in a 15-degree Trendelenburg position. c. on a long backboard with the patient's feet elevated on pillows to achieve a 15-degree angle. d. on a long backboard with the head of the backboard elevated 15 to 30 degrees.

d. on a long backboard with the head of the backboard elevated 15 to 30 degrees.

A spinal cord lesion may result in paralysis of both lower extremities. This condition is known as: Select one: a. hemiplegia. b. hemiparesis. c. quadriplegia. d. paraplegia.

d. paraplegia

Your patient received a blow to the left lateral chest at the level of the sixth and seventh ribs. You should suspect fractures at: Select one: a. the point of impact of the sixth rib only. b. the point of impact and the posterior axillary line of the sixth rib only. c. the point of impact on both ribs. d. the point of impact and the posterior axillary line of both ribs.

d. the point of impact and the posterior axillary line of both ribs.

When assessing an individual who has lost sensation below the umbilicus, at what level do you suspect injury? Select one: a. T-10 b. T-4 c. L-1 d. T-8

t-10