Chapter 28: Abdominal and Genitourinary Injuries

You are transporting a patient with blunt abdominal trauma. The patient is unstable and is experiencing obvious signs and symptoms of shock. Your estimated time of arrival at the hospital is less than 10 minutes. After treating the patient appropriately, you should: A. closely monitor him and reassess him frequently. B. perform a comprehensive secondary assessment. C. begin documenting the call on the patient care form. D. forgo the hospital radio report because of his condition.

A

A 16-year-old boy was playing football and was struck in the left flank during a tackle. His vital signs are stable; however, he is in severe pain. You should be MOST concerned that he has injured his: A. liver. B. spleen. C. kidney. D. bladder.

C

The presence of tachycardia following a significant abdominal injury: A. is always accompanied by hypotension. B. indicates a state of decompensated shock. C. should be assumed to be a sign of shock. D. is most commonly caused by severe pain.

C

______ takes place in the solid organs. A. digestion B. Excretion C. Energy production D. Absorption

C

All of the following systems contain organs that make up the contents of the abominal cavity EXCEPT: A. the digestive system B. the urinary system C. the genitourinary system D. the limbic system

D

When performing a history on a patient with abdominal trauma, which of the following questions would be appropriate regarding trauma? A. Is there any blood in your stool? B. Does your pain go anywhere? C. Do you have any nausea, vomiting or diarrhea? D. All of the above

D

A 54-year-old male experienced an avulsion to his penis when his foreskin got caught in the zipper of his pants. He was able to unzip his pants and remove the foreskin prior to your arrival. Your assessment reveals that he is in severe pain and that the avulsion is bleeding moderately. The MOST appropriate treatment for this patient includes: A. applying direct pressure with a dry, sterile dressing. B. covering the avulsion with moist, sterile dressings. C. requesting a paramedic to administer pain medication. D. administering 100% oxygen via a nonrebreathing mask.

A

A sign of kidney damage following blunt trauma is: A. hematuria. B. hemoptysis. C. hematemesis. D. hematochezia.

A

Accumulation of blood in the abdominal cavity will MOST likely cause: A. distention. B. referred pain. C. diffuse bruising. D. nausea or vomiting.

A

All of the following are hollow abdominal organs, EXCEPT for the: A. liver. B. bladder. C. ureters. D. stomach.

A

Because solid organs have a rich supply of blood, any injury can result in major: A. hemorrhaging B. damage C. pain D. guarding

A

Bruising to the right upper quadrant of the abdomen following blunt trauma is MOST suggestive of injury to the: A. liver. B. spleen. C. kidney. D. stomach.

A

Following blunt abdominal trauma, a 30-year-old male complains of referred pain to the left shoulder. This finding is called the: A. Kehr sign. B. Cullen sign. C. Grey Turner sign. D. Brudzinski sign.

A

Patients with open abdominal injures often complain of: A. pain B. nausea C. vomiting D. dyspnea

A

Placing a pregnant patient in a supine position during the third trimester of pregnancy: A. may decrease the amount of blood that returns to the heart. B. often causes hypotension secondary to cardiac compression. C. results in spontaneous urinary incontinence if the bladder is full. D. is recommended if the patient has severe abdominal discomfort.

A

Suspect a possible injury of the urinary bladder in all of the following findings EXCEPT: A. bruising to the left upper quadrant B. blood at the urethral opening C. blood at the tip of the penis or a stain on the patient's underwear D. physical signs of trauma on the lower abdomen, pelvis or perineum

A

The abdomen is divided into four: A. quadrants B. planes C. sections D. angles

A

The largest organ in the abdomen is the: A. liver B. spleen C. pancreas D. kidneys

A

The major complaint of patients with abdominal injury is: A. pain B. tachycardia C. rigidity D. swelling

A

The solid organs of the urinary system include the: A. kidneys B. ureters C. bladder D. urethra

A

When caring for a female with trauma to the external genitalia, the EMT should: A. use local pressure to control bleeding. B. carefully pack the vagina to reduce bleeding. C. remove any impaled objects from the vagina. D. cover any open wounds with moist, sterile dressings.

A

When worn properly, a seatbelt should lie: A. below the anterior superior iliac spines of the pelvis and against the hip joints. B. across the abdominal wall at the level of the diaphragm and below the hip joints. C. above the anterior posterior iliac spines of the pelvis and below the hip joints. D. across the abdominal wall at the level of the umbilicus and against the hip joints.

A

Which of the following organs would be the MOST likely to bleed profusely if severely injured? A. Liver B. Kidney C. Stomach D. Gallbladder

A

While assessing a 21-year-old female who struck a tree head-on with her small passenger car, you not that her air bag deployed. You should: A. life the air bag and look for deformity to the steering wheel. B. carefully assess her upper chest for seat belt-related injuries C. perform a head-to-toe assessment while she is in the car D. extricate her immediately and transport to a trauma center

A

While inspecting the interior of a wrecked automobile, you should be MOST suspicious that the driver experienced an abdominal injury if you find: A. a deformed steering wheel. B. that the airbags deployed. C. a crushed instrument panel. D. damage to the lower dashboard.

A

A 20-year-old male was accidentally shot in the right upper abdominal quadrant with an arrow during an archery contest. Prior to your arrival, the patient removed the arrow. Your assessment reveals that he is conscious and alert with stable vital signs. The entrance wound is bleeding minimally and appears to be superficial. You should: A. carefully probe the wound to determine its depth B. assume that the arrow injured an internal organ C. clean the wound and apply a dry, sterile dressing D. transport only if signs of shock begin to develop.

B

A 40-year-old male presents with severe abdominal pain following blunt trauma. He is diaphoretic, intensely thirsty, and has a weak and rapid pulse. Appropriate treatment for this patient includes all of the following, EXCEPT: A. covering him with a warm blanket. B. giving him small sips of plain water. C. promptly transporting to the hospital. D. administering supplemental oxygen.

B

Air in the abdominal cavity can cause all of the following EXCEPT: A. pain B. diarrhea C. infection D. tissue ischemia and infarction

B

Because the depth of an open abdominal wound is often difficult to determine: A. vital signs should be monitored frequently. B. prompt transport to the hospital is essential. C. the EMT must perform a thorough exam. D. the abdomen must be vigorously palpated.

B

Blunt abdominal injuries may result from: A. a stab wound B. seat belts C. a gunshot wound D. an impaled object

B

Early bruising following abdominal trauma often manifests as: A. localized pain. B. red areas of skin. C. gross distention. D. dark purple marks.

B

In any case of trauma to a female patient, you should always determine if the patient: A. is on birth control B. is pregnant C. is currently menstruating D. has a history of ovarian cysts

B

In cases of sexual assault, which of the following is true? A. You should always examine the genitalia for any sign of injury B. Advise the patient not to wash, urinate or defecate C. In addition to recording the facts, it is important to include your personal thoughts D. You should use plastic bags when collecting items such as clothes

B

Late signs of abdominal injury include all of the following EXCEPT: A. distention B. increased blood pressure C. change in mental status D. pale,cool, moist skin

B

Late signs of peritonitis may include: A. soft abdomen B. nausea C. normal bowel sounds D. diarrhea

B

The most common sign of significant abdominal injury is: A. pain B. tachycardia C. rigidity D. distention

B

The term "hematuria" is defined as: A. blood in the stool. B. blood in the urine. C. vomiting up blood. D. urinary bladder rupture.

B

When a hollow organ is punctured during a penetrating injury to the abdomen: A. the abdomen will become instantly distended. B. peritonitis may not develop for several hours. C. it will bleed profusely and rapidly cause shock. D. it commonly protrudes through the injury site.

B

When treating a patient with an amputation of the penile shaft, your top priority is: A. locating the amputated part B. controlling bleeding C. keeping the remaining tissue dry D. delaying transport until bleeding is controlled

B

Which of the following is NOT a hollow organ of the abdomen? A. Stomach B. Liver C. Bladder D. Urters

B

Which of the following organs would MOST likely bleed profusely when injured? A. bladder B. liver C. stomach D. intestine

B

Which of the following statements regarding abdominal eviscerations is correct? A. Most eviscerations occur to the left upper quadrant. B. The protruding organs should be kept warm and moist. C. The organs should be replaced carefully to avoid heat loss. D. Adherent material is preferred when covering an evisceration.

B

Which of the following statements regarding abdominal trauma is correct? A. Most of the vital abdominal organs lie within the retroperitoneal space. B. The absence of abdominal pain does not rule out intra-abdominal bleeding. C. The liver is well protected and is rarely injured during a traumatic event. D. Hollow abdominal organs are vascular and bleed profusely when injured.

B

While assessing a 21-year-old female who struck a tree head-on with her small passenger car, you note that her air bag deployed. You should: A. perform a head-to-toe assessment while she is in the car. B. lift the air bag and look for deformity to the steering wheel. C. carefully assess her upper chest for seatbelt-related injuries. D. extricate her immediately and transport to a trauma center.

B

You are dispatched to a residence for a young female who was kicked in the abdomen by her boyfriend. While en route to the scene, you should ask the dispatcher if: A. the patient is conscious. B. law enforcement is at the scene. C. there are other patients involved. D. the severity of the injury is known.

B

You are transporting a 42-year-old male who experienced blunt abdominal trauma. He is receiving oxygen at 12 L/min via a nonrebreathing mask, and full spinal precautions have been applied. During your reassessment, you note his level of consciousness has decreased and his respirations have become shallow. You should: A. perform a comprehensive secondary assessment to determine why his clinical status has changed. B. insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a bag-mask device. C. reassess his vital signs and then notify the receiving hospital of the change in his clinical status. D. suction his oropharynx to ensure it is clear of secretions and then increase the oxygen flow rate to 15 L/min.

B

You are transporting a patient with possible peritonitis following trauma to the abdomen. Which position will he MOST likely prefer to assume? A. Sitting up B. Legs drawn up C. Legs outstretched D. On his right side

B

You respond to an 18-year-old high school football player who was hit in the right flank with a helmet several hours ago. He is complaining of pain in the area. He is alert and oriented. His airway is open and his respirations are within normal limits. His pulse is regular. He has a radial pulse. He tells you that he is noticing blood in his urine. Based on this information, the patient is likely to have an injury to the: A. liver B. kidney C. gallbladder D. appendix

B

Your primary concern when dealing with an unresponsive patient with an open abdominal injury is: A. covering the wound with a moist dressing B. maintaining the airway C. controlling the bleeding D. monitoring vital signs

B

A 20-year-old male was accidentally shot in the right upper abdominal quadrant with an arrow during an archery contest. Prior to your arrival, the patient removed the arrow. Your assessment reveals that he is conscious and alert with stable vital signs. The entrance wound is bleeding minimally and appears to be superficial. You should: A. transport only if signs of shock begin to develop. B. carefully probe the wound to determine its depth. C. assume that the arrow injured an internal organ. D. clean the wound and apply a dry, sterile dressing.

C

A football player was struck by another player in the right flank area just below the posterior rib cage. He complains of severe pain and point tenderness to the area. Your assessment reveals that there is a small amount of blood in his underwear. You should be MOST suspicious for: A. external genitalia injury. B. a lacerated liver or spleen. C. blunt injury to the kidney. D. a ruptured urinary bladder.

C

Air bags, in conjunction with properly worn seatbelts, are MOST beneficial when a person is involved in a: A. rollover crash. B. lateral collision. C. head-on crash. D. rear-end collision.

C

All of the following male genitalia lie outside the pelvis cavity EXCEPT the: A. urethra B. penis C. seminal vesicles D. testes

C

Compression injuries to the abdomen that occur during a motor vehicle crash are typically the result of: A. air bag deployment. B. failure to wear seatbelts. C. a poorly placed lap belt. D. rapid vehicle deceleration.

C

Contraction or tensing of the abdominal muscles in an effort to ease pain is called: A. flexing. B. referring. C. guarding. D. withdrawing.

C

During your assessment of a patient who experienced blunt trauma to the abdomen, you notice bruising around the umbilicus. This is a sign of: A. a ruptured spleen. B. a severe liver laceration. C. intra-abdominal bleeding. D. rupture of a hollow organ.

C

Even when seatbelts are worn properly and the airbags deploy, injury may occur to the: A. chest. B. extremities. C. iliac crests. D. lower ribcage.

C

Open abdominal injuries are also known as: A. blunt injuries B. eviscerations C. penetrating injuries D. peritoneal injuries

C

Signs of injury to the kidney may include any of the following EXCEPT: A. bruises or lacerations on the overlying skin B. shock C. increased urgency of urination D. hematuria

C

Which of the following organs is at MOST risk for injury as the result of a pelvic fracture? A. pancreas B. fallopian tubes C. urinary bladder D. liver or spleen

C

Which of the following statements regarding intra-abdominal bleeding is FALSE? A. Intra-abdominal bleeding often causes abdominal distention. B. Intra-abdominal bleeding is common following blunt force trauma. C. The absence of pain and tenderness rules out intra-abdominal bleeding. D. Bruising may not occur immediately following blunt abdominal trauma.

C

You are dispatched to a motor vehicle collision. You see a 25-year-old woman who was restrained but is complaining of abdominal pain. She is alert and oriented. The patient's airway is open, and she is breathing normally. Her pulse is regular but weak and rapid. She has a radial pulse. You inspect the abdomen for possible bleeding. You would expect to see all of the following EXCEPT: A. pain or tenderness B. rigidity C. urticaria D. distention

C

You are dispatched to a motor vehicle collision. Your patient is a 42-year-old restrained woman. The air bag did deploy, and the woman has abrasions on her face. She is complaining of pain to both her chest and abdomen. Her airway is open and respirations are within normal limits. Her pulse is a little rapid but strong and regular. She has distal pulses. In assessing this patient, which of the following statements is NOT true? A. Bowel sounds can be difficult to hear in the field B. Palpation is typically performed first with light touch C. If light touch elicits pain, perform deep palpation to assess further injury D. If you find an entry wound, you should always assess for an exit wound.

C

A 22-year-old male was punched in the abdomen several times. You find him lying on his left side with his knees drawn up. He is conscious and alert and complains of increased pain and nausea when he tries to straighten his legs. His blood pressure is 142/82 mm Hg, his pulse rate is 110 beats/min and strong, and his respirations are 22 breaths/min and regular. In addition to administering high-flow oxygen, you should: A. apply full spinal motion restriction precautions. B. keep him on his side but gently straighten his legs. C. place him supine but allow him to keep his knees bent. D. transport him in the position in which you found him.

D

A 66-year-old male presents with dark red rectal bleeding and abdominal pain. He is conscious and alert; however, his skin is cool and clammy and his heart rate is elevated. Further assessment reveals that his blood pressure is 112/60 mm Hg. Which of the following questions would be MOST pertinent to ask him? A. What does your blood pressure normally run? B. Do you take any over-the-counter medications? C. Has blood soaked through your undergarments? D. Have you experienced recent abdominal trauma?

D

Difficulty breathing and a sunken appearance of the anterior abdominal wall is MOST indicative of a ruptured: A. aorta. B. spleen. C. stomach. D. diaphragm.

D

Other than applying a moist, sterile dressing covered with a dry dressing to treat an abdominal evisceration, an alternative form of management may include: A. placing dry towels over the open wound. B. cleaning the exposed bowel with sterile saline. C. applying the PASG to stop the associated bleeding. D. applying an occlusive dressing, secured by trauma dressings.

D

Peritonitis would MOST likely result following injury to the: A. liver. B. spleen. C. kidney. D. stomach.

D

Peritonitis, an intense inflammatory reaction of the abdominal cavity, usually occurs when: A. solid abdominal organs bleed secondary to penetrating trauma. B. the vessels that supply the abdominal organs become inflamed. C. bacteria or viruses invade the walls of the gastrointestinal tract. D. hollow abdominal organs are damaged and spill their contents.

D

Suspect kidney damage if the patient has a history or physical evidence of all of the following EXCEPT: A. an abrasion, laceration, or contusion in the flank B. a penetrating wound in the lower rib cage or the upper abdomen C. fractures on either side of the lower rib cage D. a hematoma in the umbilical region

D

The first signs of peritonitis include all of the following EXCEPT: A. severe abdominal pain B. tenderness C. muscular spasm D. nausea

D

The mesentery is: A. the point of attachment between the small and large intestines. B. a layer of thick skeletal muscles that protects the abdominal organs. C. a complex network of blood vessels that supply blood to the liver. D. a membranous fold that attaches the intestines to the walls of the body.

D

When documenting a call involving a female patient who was sexually assaulted, the EMT should: A. theorize as to why the sexual assault occurred. B. include the results of his or her internal vaginal exam. C. include a description of the suspected perpetrator. D. avoid speculation and document only factual data.

D

When treating a patient with an evisceration, you should: A. attempt to replace the abdominal contents B. cover the protruding organs with a dry, sterile dressing C. cover the protruding contents with moist, sterile gauze compresses D. cover the protruding contents with moist, sterile gauze compresses

D

When used alone, diagonal shoulder safety belts can cause all of the following EXCEPT: A. a bruised chest B. a lacerated liver C. decapitation D. a ruptured appendix

D

Which of the following statements regarding abdominal eviscerations is correct? A. Adherent material is preferred when covering an evisceration. B. The organs should be replaced carefully to avoid heat loss. C. Most evisceration's occur to the left upper quadrant D. The protruding organs should be kept warm and moist.

D

You are called to the local bar where a fight has taken place. The police department tells you that you have a 36-year-old man who has been stabbed twice in the abdomen. Upon your arrival, the patient is alert and oriented. His airway is open. His respirations are at 24 breaths/min, pulse is rapid, regular and weak. He has distal pulses. With the penetrating trauma, you should assume that the object: A. has penetrated the peritoneum B. has entered the abdominal cavity C. has possibly injured one or more organs D. all of the above

D

Your presence is requested by law enforcement to assess a 33-year-old female who was sexually assaulted. The patient is conscious and obviously upset. As you are talking to her, you note an impressive amount of blood on her clothes in the groin area. Her blood pressure is 98/58 mm Hg, her pulse is 130 beats/min, and her respirations are 24 breaths/min. You should: A. visualize the vaginal area and pack the vagina with sterile dressings. B. allow her to change her clothes and take a shower before you transport. C. arrange for a rape crisis center representative to speak with the patient. D. control any external bleeding, administer oxygen, and transport at once.

D