Chapter 29: Chest Injuries, Chapter 30: Abdominal and Genitourinary Injuries

A man called EMS 12 hours after injuring his chest. Your assessment reveals a flail segment to the right side of the chest. The patient is experiencing respiratory distress and his oxygen saturation is 78%. His breath sounds are equal bilaterally and his jugular veins are normal. You should suspect: Select one: A. pulmonary contusion. B. massive hemothorax. C. traumatic asphyxia. D. tension pneumothorax.

A

Abdominal pain, vomiting, and fever are most likely due to _______. Select one: A. infection B. hemorrhage C. evisceration D. hypovolemia

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

Patients with chest injuries will often present with _______. Select one: A. tachypnea B. agonal respirations C. Kussmaul respirations D. Cheyne-Stokes respirations

A

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

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 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

The thoracic cavity is separated from the abdominal cavity by the: Select one: A. diaphragm. B. intercostal margin. C. costovertebral angle. D. anterior rib cage.

A

Which of the following is true regarding injury to the kidneys? Select one: A. Injury to the kidneys usually indicates injury to other organs. B. Only minimal force is needed to damage the kidneys. C. The kidneys are not well protected. D. Kidney injuries are rarely caused by blunt trauma.

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

You arrive at the scene of a major motor vehicle crash. The patient, a 50-year-old female, was removed from her vehicle prior to your arrival. Bystanders who removed her state that she was not wearing a seatbelt. The patient is unresponsive, tachycardic, and diaphoretic. Your assessment reveals bilaterally clear and equal breath sounds, a midline trachea, and collapsed jugular veins. You should be MOST suspicious that this patient has experienced a: Select one: A. laceration of the aorta. B. massive hemothorax. C. pericardial tamponade. D. tension pneumothorax.

A

You respond to a residence for a 40-year-old female who was assaulted by her husband; the scene has been secured by law enforcement. Upon your arrival, you find the patient lying supine on the floor in the kitchen. She is semiconscious with severely labored breathing. Further assessment reveals a large bruise to the left anterior chest, jugular venous distention, and unilaterally absent breath sounds. As your partner is supporting her ventilations, you should: Select one: A. immediately request ALS support. B. obtain a set of baseline vital signs. C. insert an oropharyngeal airway. D. perform a focused secondary exam.

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 assesment reveals that he is conscious and alert with stable vital signs. The entrance wound is bleeding minimally and appears to be superifical. 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 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. Do you take any over-the-counter medications? B. Have you experienced recent abdominal trauma? C. Has blood soaked through your undergarments? D. What does your blood pressure normally run?

B

A flail chest occurs when: Select one: A. a segment of fractured ribs bulges during the inhalation phase. B. a segment of the chest wall is detached from the thoracic cage. C. multiple ribs are fractured on both sides of the thoracic cage. D. more than three ribs are fractured on the same side of the chest.

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: Select one: A. the abdomen must be vigorously palpated. B. prompt transport to the hospital is essential. C. vital signs should be monitored frequently. D. the EMT must perform a thorough exam.

B

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

B

Children are often "belly breathers" because _______. Select one: A. they are routinely hypoxic B. their intercostal muscles are not developed C. they are consciously controlling ventilations D. their diaphragm is not functional

B

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

B

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

B

Immediately life-threatening chest injuries must be found and managed during the _______. Select one: A. scene size-up B. primary assessment C. secondary assessment D. patient history

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 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

When a person is lying supine at the end of exhalation, the diaphragm: Select one: A. contracts and flattens inferiorly. B. may rise as high as the nipple line. C. descends below the level of the navel. D. is less prone to penetrating trauma.

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 is most likely to cause immediate death? Select one: A. Aortic dissection B. Aortic rupture C. Pulmonary contusion D. Myocardial contusion

B

While jogging, a 19-year-old male experienced an acute onset of shortness of breath and pleuritic chest pain. He is conscious and alert with stable vital signs. Your assessment reveals that he has diminished breath sounds over the left side of the chest. You should: Select one: A. immediately perform a rapid head-to-toe exam. B. administer oxygen and transport to the hospital. C. recognize that he needs a needle decompression. D. circumferentially tape a dressing around his chest.

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 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. arrange for a rape crisis center representative to speak with the patient. B. control any external bleeding, administer oxygen, and transport at once. C. visualize the vaginal area and pack the vagina with sterile dressings D. allow her to change her clothes and take a shower before you transport

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

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

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

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

C

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

C

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

C

A 28-year-old male was struck in the chest with a baseball bat during an altercation. He is conscious and alert and complains of severe chest pain. Your assessment reveals a large area of ecchymosis over the sternum and a rapid, irregular pulse. In addition to providing supplemental oxygen, you should: Select one: A. determine if he has cardiac problems. B. apply bulky dressings to the sternum. C. apply an AED and assess his BP. D. prepare for immediate transport.

D

A simple pneumothorax: Select one: A. often has a nontraumatic cause. B. is caused by penetrating chest trauma. C. heals on its own without any treatment. D. is commonly caused by blunt chest trauma.

D

A spinal cord injury at the level of C7 would MOST likely result in: Select one: A. paralysis of the diaphragm. B. paralysis of all the respiratory muscles. C. immediate cardiac arrest. D. paralysis of the intercostal muscles.

D

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

An open pneumothorax occurs when: Select one: A. air enters the pleural space from a perforated lung. B. extreme pleural pressure causes the lung to rupture. C. a fractured rib perforates the tissue of the lung. D. air enters the pleural space from outside the body.

D

Closed chest injuries are typically caused by _______. Select one: A. high-velocity weapons B. penetrating trauma C. flying debris D. blunt trauma

D

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

D

Following a stab wound to the left anterior chest, a 25-year-old male presents with a decreased level of consciousness and signs of shock. Which of the following additional assessment findings should increase your index of suspicion for a cardiac tamponade? Select one: A. Diminished breath sounds B. A rapid, irregular pulse C. Widening pulse pressure D. Engorged jugular veins

D

If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she: Select one: A. often breathes at a slower rate because of lung damage caused by the injury. B. will maintain adequate minute volume if his or her respiratory rate stays the same. C. will eliminate more carbon dioxide than if he or she were breathing deeply. D. must increase his or her respiratory rate to maintain adequate minute volume.

D

In order to avoid exacerbating a patient's injury, it is especially important to use extreme caution when providing positive-pressure ventilation to patients with a: Select one: A. cardiac tamponade. B. myocardial contusion. C. flail chest. D. pneumothorax.

D

In pediatric patients, the liver and spleen are _______. Select one: A. more protected by the thorax compared to adults B. smaller in proportion to the abdomen C. less likely to bleed when injured D. larger in proportion to the abdomen

D

Injuries to the external male genitalia _______. Select one: A. usually result in permanent damage B. are often life-threatening C. frequently lead to hypovolemic shock D. are rarely life-threatening

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

When a patient stiffens the muscles of the abdomen, it is known as _______. Select one: A. crepitus. B. distention. C. instability. D. guarding.

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

Which of the following statements regarding abdominal evisceration's 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

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 severity of the injury is known. B. the patient is conscious. C. there are other patients involved. D. law enforcement is at the scene.

D

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: Select one: A. perform a comprehensive secondary assessment to determine why his clinical status has changed. B. reassess his vital signs and then notify the receiving hospital of the change in his clinical status. C. suction his oropharynx to ensure it is clear of secretions and then increase the oxygen flow rate to 15 L/min. D. insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM.

D

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: Select one: A. begin documenting the call on the patient care form. B. perform a comprehensive secondary assessment. C. forgo the hospital radio report because of his condition. D. closely monitor him and reassess him frequently.

D

You have sealed the open chest wound of a 40-year-old male who was stabbed in the anterior chest. Your reassessment reveals that he is experiencing increasing respiratory distress and tachycardia, and is developing cyanosis. You should: Select one: A. begin rapid transport at once. B. call for a paramedic ambulance. C. begin ventilatory assistance. D. partially remove the dressing.

D

Your documentation on a sexual assault victim should _______. Select one: A. include your opinion of the nature of the incident B. describe the status of the suspect(s) C. be subjective and summarize the crime D. be objective and factual

D