Ch. 31 - Orthopaedic Injuries

Signs and symptoms of a dislocated joint include all of the following, EXCEPT: A) marked deformity. B) tenderness on palpation. C) locked joint. D) ecchymosis.

Correct Answer D) ecchymosis.

Femoral shaft fractures can result in up to _____ mL of internal blood loss. A) 1,000 B) 1,500 C) 2,000 D) 4,000

Correct Response A) 1,000

Which of the following statements regarding compartment syndrome is correct? A) Compartment syndrome typically develops within 6 to 12 hours after an injury. B) Compartment syndrome occurs because of increased pressure within the bone cavity. C) In most cases, compartment syndrome develops within a few minutes after an injury. D) Most cases of compartment syndrome occur following a severe fracture of the pelvis.

Correct Response A) Compartment syndrome typically develops within 6 to 12 hours after an injury.

Which of the following joints allows no motion? A) Skull sutures B) Sacroiliac joint C) Shoulder joint D) Sternoclavicular joint

Correct Response A) Skull sutures

In moving joints, the ends of the bones are covered with: A) articular cartilage. B) synovial tendons. C) muscular fascia. D) gliding cartilage.

Correct Response A) articular cartilage.

You receive a call to a local gymnasium for a basketball player with a dislocated shoulder. Upon arrival, you find the patient, a 17-year-old male, sitting on the ground. He is holding his left arm in a fixed position away from his body. There is an obvious anterior bulge to the area of injury. You should: A) assess distal pulse, motor, and sensory functions. B) gently attempt to move his arm toward his body. C) place a pillow under his arm and apply a swathe. D) flex his arm at the elbow and then apply a sling.

Correct Response A) assess distal pulse, motor, and sensory functions.

The musculoskeletal system refers to the: A) bones and voluntary muscles of the body. B) nervous system's control over the muscles. C) connective tissue that supports the skeleton. D) involuntary muscles of the nervous system.

Correct Response A) bones and voluntary muscles of the body.

When caring for a patient with a possible fracture of the scapula, the EMT should: A) carefully assess the patient for breathing problems. B) apply rigid board splints across the chest and back. C) assume that minimal force was applied to the back. D) recognize that scapular fractures are life threatening.

Correct Response A) carefully assess the patient for breathing problems.

Improperly applying a splint can cause all of the following, EXCEPT: A) increase of distal circulation if the splint is too tight. B) delay in transport of a patient with a life-threatening injury. C) aggravation of the distal circulation. D) compression of nerves, tissues, and blood vessels.

Correct Response A) increase of distal circulation if the splint is too tight.

The MOST common and significant complication associated with fractures or dislocations of the knee is: A) neurovascular compromise. B) internal bleeding and shock. C) ligament and cartilage damage. D) total depletion of synovial fluid.

Correct Response A) neurovascular compromise.

You and your partner are preparing to apply a traction splint to a patient's deformed thigh. As you apply manual traction, the patient resists your efforts and states that the pain is getting worse. You should: A) stop and splint the leg in the deformed position. B) assess distal pulses and continue pulling traction. C) gently massage the thigh muscles to relax them. D) flex the knee and place a pillow under the thigh.

Correct Response A) stop and splint the leg in the deformed position.

Deformity caused by a fracture would MOST likely be masked by: A) swelling. B) guarding. C) crepitus. D) ecchymosis.

Correct Response A) swelling.

The act of pulling on a body structure in the direction of its normal alignment is called: A) traction. B) reduction. C) stabilization. D) immobilization.

Correct Response A) traction.

Which of the following types of muscle is under direct voluntary control of the brain? A) Cardiac B) Skeletal C) Smooth D) Autonomic

Correct Response B) Skeletal

During your assessment of a 29-year-old female with significant deformity to her left elbow, you are unable to palpate a radial pulse. Your transport time to the hospital is approximately 40 minutes. You should: A) splint the elbow in the position of deformity and transport immediately. B) apply gentle manual traction in line with the limb and reassess for a pulse. C) carefully straighten the injured arm and secure it with padded board splints. D) make two or three attempts to restore distal circulation by manipulating the elbow.

Correct Response B) apply gentle manual traction in line with the limb and reassess for a pulse.

Bone marrow produces: A) cartilage. B) blood cells. C) lymphocytes. D) electrolytes.

Correct Response B) blood cells.

A fracture is MOST accurately defined as a(n): A) total loss of function in a bone. B) break in the continuity of the bone. C) disruption in the midshaft of a bone. D) abnormality in the structure of a bone.

Correct Response B) break in the continuity of the bone.

Common signs and symptoms of a sprain include all of the following, EXCEPT: A) swelling. B) deformity. C) ecchymosis. D) point tenderness.

Correct Response B) deformity.

A supracondylar or intercondylar fracture is also known as a fracture of the: A) radial head B) distal humerus. C) proximal radius. D) olecranon process.

Correct Response B) distal humerus.

A Colles fracture involves a fracture of the: A) distal ulna. B) distal radius. C) proximal radius. D) radius and ulna.

Correct Response B) distal radius.

Because of local tenderness and swelling, it is easy to confuse a nondisplaced or minimally displaced fracture of the knee with a: A) tendon injury. B) ligament injury. C) dislocation. D) fracture-dislocation.

Correct Response B) ligament injury.

A person who experiences a calcaneus fracture after jumping and landing on his or her feet would MOST likely experience an accompanying fracture of the: A) thoracic spine. B) lumbar spine. C) coccygeal spine. D) symphysis pubis.

Correct Response B) lumbar spine.

A fracture caused by minimal force that is associated with diseases such as cancer and osteoporosis is called a __________ fracture. A) greenstick B) pathologic C) transverse D) comminuted

Correct Response B) pathologic

In general, musculoskeletal injuries should be splinted before moving the patient unless: A) the patient is in severe pain. B) the patient is clinically unstable. C) deformity and swelling are present. D) transport time is less than 15 minutes.

Correct Response B) the patient is clinically unstable.

In which of the following situations should the EMT splint an injured limb in the position of deformity? A) When distal circulation and neurological functions are absent B) If transport time to the hospital is greater than 20 to 30 minutes C) If resistance is encountered or the patient experiences severe pain D) If a traction splint will be used to immobilize the injured extremity

Correct Response C) If resistance is encountered or the patient experiences severe pain

With regard to musculoskeletal injuries, the zone of injury is defined as the: A) area of obvious deformity over the site of impact. B) exact part of the bone or joint that was disrupted. C) area of soft-tissue damage surrounding the injury. D) part of the body that sustained secondary injury.

Correct Response C) area of soft-tissue damage surrounding the injury.

A(n) __________ fracture occurs in the growth section of a child's bone and may lead to bone growth abnormalities. A) greenstick B) diaphyseal C) epiphyseal D) metaphyseal

Correct Response C) epiphyseal

Traction splints are used primarily to immobilize and secure fractures of the: A) hip. B) pelvis. C) femur. D) humerus.

Correct Response C) femur.

Atrophy is a condition that occurs when: A) increased use of skeletal muscle causes an increase in its strength. B) the tendons that attach muscle to bone become stretched or injured. C) muscle decreases in size and function. D) carbon dioxide, lactic acid, and other wastes accumulate in the muscle.

Correct Response C) muscle decreases in size and function.

Crepitus and false motion are: A) indicators of a severe sprain. B) only seen with open fractures. C) positive indicators of a fracture. D) most common with dislocations.

Correct Response C) positive indicators of a fracture.

A 20-year-old male collided with another player during a hockey game and complains of severe pain to the left shoulder. Assessment reveals that the clavicle is bulging anteriorly at the shoulder. The EMT should suspect: A) dislocation of the glenohumeral joint. B) posterior dislocation of the shoulder. C) separation of the acromioclavicular joint. D) multiple fractures of the proximal humerus.

Correct Response C) separation of the acromioclavicular joint.

During your secondary assessment of a 30-year-old male who fell 25 feet, you note crepitus when palpating his pelvis. Your partner advises you that the patient's blood pressure is 80/50 mm Hg and his heart rate is 120 beats/min and weak. After completing your assessment, you should: A) defer spinal immobilization and transport to a trauma center. B) perform a focused physical exam with emphasis on the pelvis. C) stabilize the pelvis with a pelvic binder and protect the spine. D) log roll the patient onto a long backboard and transport at once.

Correct Response C) stabilize the pelvis with a pelvic binder and protect the spine.

Which of the following musculoskeletal injuries would MOST likely result in deformity? A) Severe strain B) Moderate sprain C) Hairline fracture D) Displaced fracture

Correct Response D) Displaced fracture

Which of the following statements regarding striated muscle is correct? A) Striated muscle is involuntary because you have no conscious control over it. B) Most of the body's striated muscle is found within the walls of the blood vessels. C) Striated muscle tissue is attached directly to the bones by tough bands of cartilage. D) It forms the major muscle mass of the body and usually crosses at least one joint.

Correct Response D) It forms the major muscle mass of the body and usually crosses at least one joint.

Which of the following musculoskeletal injuries would pose the greatest threat to a patient's life? A) An amputated extremity B) Bilateral femur fractures C) Nondisplaced long bone fractures D) Pelvic fracture with hypotension

Correct Response D) Pelvic fracture with hypotension

Following direct trauma to the left upper back, a 44-year-old male presents with diaphoresis and restlessness. His blood pressure is 100/50 mm Hg, his pulse rate is 120 beats/min and weak, and his respirations are 24 breaths/min and labored. Your assessment reveals abrasions and contusions over the left scapula. You should: A) hyperventilate him with a BVM and monitor his oxygen saturation. B) apply high-flow oxygen, perform a detailed secondary assessment, and transport. C) focus your assessment on his scapulae and clavicles and apply high-flow oxygen. D) apply high-flow oxygen, consider spinal precautions, and transport without delay.

Correct Response D) apply high-flow oxygen, consider spinal precautions, and transport without delay.

A 54-year-old male accidentally shot himself in the leg while cleaning his gun. Your assessment reveals a small entrance wound to the medial aspect of his right leg. The exit wound is on the opposite side of the leg and is actively bleeding. The patient complains of numbness and tingling in his right foot. You should: A) assess distal pulses as well as sensory and motor functions. B) manually stabilize the leg above and below the site of injury. C) gently manipulate the injured leg until the numbness dissipates. D) control the bleeding and cover the wound with a sterile dressing.

Correct Response D) control the bleeding and cover the wound with a sterile dressing.

The MOST significant hazard associated with splinting is: A) aggravation of the injury or worsened pain. B) reduction in circulation distal to the injury site. C) compression of nerves, tissues, and vasculature. D) delaying transport of a critically injured patient.

Correct Response D) delaying transport of a critically injured patient.

When splinting an injury of the wrist, the hand should be placed: A) into a fist. B) in a straight position. C) in an extended position. D) in a functional position.

Correct Response D) in a functional position.

What type of muscle contracts and relaxes to control the movement of the contents within its structures? A) Cardiac B) Skeletal C) Striated D) Smooth

Correct Answer D) Smooth

The MOST commonly fractured bone(s) in the body is/are the: A) clavicle. B) scapula. C) radius and ulna. D) midshaft femur.

Correct Response A) clavicle.

A 17-year-old female dislocated her patella while playing soccer. Her knee is flexed and she complains of severe pain. You should: A) make one attempt to return the patella to its normal position. B) gently straighten her knee and apply a padded board splint. C) flex her knee slightly more and assess for distal circulation. D) keep her knee flexed and secure it with padded board splints.

Correct Response D) keep her knee flexed and secure it with padded board splints.

A "hip" fracture is actually a fracture of the: A) pelvic girdle. B) femoral shaft. C) pubic symphysis. D) proximal femur.

Correct Response D) proximal femur.

A 22-year-old female was ejected from her car after striking a tree head-on. As you approach her, you note obvious closed deformities to both of her femurs. She is not moving and does not appear to be conscious. You should: A) apply manual stabilization to both of her femurs. B) administer oxygen and perform a rapid assessment. C) assess for a carotid pulse and assist her ventilations. D) stabilize her head and perform a primary assessment.

Correct Response D) stabilize her head and perform a primary assessment.

An open fracture is MOST accurately defined as a fracture in which: A) bone ends protrude through the skin. B) a large laceration overlies the fracture. C) a bullet shatters the underlying bone. D) the overlying skin is no longer intact.

Correct Response D) the overlying skin is no longer intact.

Blood in the urine is known as: A) hematuria. B) hemotysis. C) hematocrit. D) hemoglobin.

Correct Response A) hematuria.

Bones are connected to other bones by bands of tough fibrous tissues called: A) bursa. B) tendons. C) cartilage. D) ligaments.

Correct Answer D) ligaments.

Which of the following statements about compartment syndrome is NOT true? A) It occurs 6 to 12 hours after an injury. B) It most commonly occurs with a fractured femur. C) It is usually a result of excessive bleeding, a severely crushed extremity, or the rapid return of blood to an ischemic limb. D) It is characterized by pain that is out of proportion to the injury.

Correct Answer B) It most commonly occurs with a fractured femur.

Care for a patient with a fractured tibia and suspected compartment syndrome includes: A) applying traction to maintain distal pulses. B) keeping the leg at the level of the heart. C) immobilizing the leg with an air splint. D) applying chemical hot packs to the leg.

Correct Answer B) keeping the leg at the level of the heart.

A 45-year-old female was the unrestrained passenger of a small car that rear-ended another vehicle at a moderate rate of speed. She is conscious and alert, but complains of pain to both of her knees. There is visible damage to the dashboard on the passenger's side of the vehicle. In addition to fractures or dislocations of the knees, you should be MOST suspicious for: A) anterior hip dislocation. B) posterior hip dislocation. C) a thoracic spine fracture. D) fracture of the tibia or fibula.

Correct Response B) posterior hip dislocation.

Skeletal muscle is attached to the bone by tough, ropelike, fibrous structures called: A) fascia. B) tendons. C) cartilage. D) ligaments.

Correct Response B) tendons.

If a dislocated shoulder has spontaneously reduced before your arrival, the only way to confirm the injury is by noting: A) distal circulation. B) the patient history. C) bruising to the shoulder. D) the presence of deformity.

Correct Response B) the patient history.

A 77-year-old woman slipped and fell on a throw rug and landed on her left hip. She denies striking her head or losing consciousness. Assessment of her left leg reveals that it is shortened and externally rotated. Distal pulses, sensory, and motor functions are intact. You should: A) manually stabilize her left leg, apply a traction splint, and then secure her to a long backboard or scoop. B) carefully slide a long backboard underneath her, keep her in a supine position, and apply a splint to her leg. C) place her onto a scoop stretcher, pad around her left hip with pillows, and secure her to the scoop with straps. D) bind both of her legs together with triangular bandages and carefully secure her onto the ambulance stretcher.

Correct Response C) place her onto a scoop stretcher, pad around her left hip with pillows, and secure her to the scoop with straps.