Ch. 30 Orthopaedic Injuries

Which of the following assessment findings would you expect to see in a patient with a posterior hip dislocation and sciatic nerve involvement? A. Inability to dorsiflex the foot B. Weak or absent distal pulses C. Loss of flexion of the knee D. Hyperactive tendon reflexes

A. Inability to dorsiflex the foot

Which of the following statements regarding hip dislocations is correct? A. Most hip dislocations are caused by posterior displacement of the femoral head. B. Most hip dislocations are caused by anterior displacement of the femoral head. C. Anterior hip dislocations are characterized by lateral rotation of the lower extremity. D. Posterior hip dislocations are characterized by medial rotation of the lower extremity.

A. Most hip dislocations are caused by posterior displacement of the femoral head

When assessing a patient with multiple systems trauma, which of the following musculoskeletal injuries would pose the GREATEST threat to the patient's life? A. Multiple open fractures B. Dislocation of a major joint C. Single open long bone fracture D. Displaced fracture of the pelvis

A. Multiple open fractures

Which of the following is the MOST effective method of immobilizing a fractured clavicle? A. Sling and swathe B. Modified wrist sling C. Short arm rigid splint D. Pillow or other padding

A. Sling and swathe

When palpating an injured extremity, a patient complains of point tenderness. On the basis of this clinical finding, you: A. are unable to determine the type of fracture. B. cannot identify the associated zone of injury. C. can definitively diagnose an underlying fracture. D. can conclude that gross distal motor function is intact.

A. are unable to determine the type of fracture

Decrease in the size of a muscle and its inherent ability to function is called: A. atrophy. B. myalgia. C. cephalgia. D. hypertrophy.

A. atrophy

A 29-year-old male was struck in the upper back by a solid object. During your assessment, you note ecchymosis, pain, and crepitus to the left scapula. His blood pressure is 124/68 mm Hg, pulse is 110 and strong, and respirations are 24 breaths/min and labored. You should provide supplemental oxygen, immobilize his spine, and: A. be alert for intrathoracic injuries. B. pad under the scapula with a pillow. C. give a crystalloid bolus of 20 mL/kg. D. transport to a local community hospital.

A. be alert for intrathoracic injuries

You have delivered your patient, a 14-year-old female with a possible femur fracture, to the emergency department. After radiographic evaluation, the physician tells you that the patient has a comminuted fracture. This means that the femur: A. has fractured into more than two fragments. B. fractured as a result of an osteopathic condition. C. will prematurely stop developing and growing. D. was fractured as a result of an impacting injury.

A. has fractured into more than two fragments

Compartment syndrome is caused by: A. increased pressure in the fascial compartment. B. excessive synovial fluid inside a joint capsule. C. hyperperfusion to a fractured upper extremity. D. lactic acid release in the region of a fracture.

A. increased pressure in the fascial compartment

A 50-year-old male fell approximately 20 feet and landed on his side. He is conscious and alert and denies loss of consciousness. During your assessment, you note pain and crepitus when palpating the iliac crests. In addition to the potential for spinal injury, you should be MOST concerned about: A. internal hemorrhaging. B. retroperitoneal injuries. C. neurovascular compromise. D. the cause of the patient's fall.

A. internal hemorrhaging

Appropriate stabilization of an anterior shoulder dislocation includes: A. pillow or towel under the arm and a sling and swathe. B. adducting the arm and applying a sling and swathe. C. internally rotating the arm and applying two swathes. D. bulky dressing under the arm and a modified wrist sling.

A. pillow or towel under the arm and a sling and swathe

An injury that may result in complete separation of a joint due to stretching or tearing of the supporting ligaments is called a: A. sprain. B. strain. C. dislocation. D. subluxation.

A. sprain

Joints are bathed and lubricated by: A. synovial fluid. B. articular fluid. C. viscous fluid. D. sebaceous fluid.

A. synovial fluid

A patient with developing compartment syndrome following a fracture typically complains of or presents with: A. tension or pressure in the affected extremity. B. extreme cyanosis to the affected extremity. C. increased sensation distal to site of the injury. D. a lesser degree of pain than would be expected.

A. tension or pressure in the affected extremity

When assessing a patient with a grossly deformed humerus, you note that the radial pulse is absent and the extremity is becoming cyanotic. You should: A. use constant, gentle manual traction to align the humerus. B. manipulate the humerus until distal circulation is restored. C. splint the humerus in the position found and begin transport. D. begin transport and continue attempts to restore circulation.

A. use constant, gentle manual traction to align the humerus

In an average-sized adult male, a closed unilateral femur fracture can result in internal blood loss of up to: A. 500 mL. B. 1,000 mL.

B. 1,000 mL

When using a Sager traction splint, you should apply traction that is approximately ____% of the patient's body weight to a maximum of ____ pounds. A. 5, 10 B. 10, 15 C. 15, 20

B. 10, 15

Which of the following musculoskeletal injuries poses the GREATEST risk for compartment syndrome? A. Ankle fracture in an adult B. Humeral fracture in a child C. Hip fracture in an older adult D. Wrist fracture in an adolescent

B. Humeral fracture in a child

Which of the following muscles is attached to the skeleton and forms the bulk of tissue of the arms and legs? A. Smooth B. Skeletal C. Autonomic D. Involuntary

B. Skeletal

During a hockey game, a 19-year-old male player was pushed and he landed on his left shoulder. He complains of pain and point tenderness to the area. Your assessment reveals an anterior bulge of the lateral clavicle. This patient has MOST likely experienced a/an: A. fracture of the lateral clavicle. B. acromioclavicular separation. C. dislocation of the left shoulder. D. sternoclavicular joint fracture.

B. acromioclavicular separation

A 29-year-old male was involved in a rollover motor-vehicle crash. The patient was removed from his vehicle prior to your arrival. During your general impression, you note that he is conscious, yelling in pain, and has an actively bleeding open fracture of his left leg. As your partner assumes manual stabilization of the patient's head and communicates with him, you should: A. determine if his airway is patent. B. apply direct pressure to his leg. C. administer supplemental oxygen. D. apply a splint to his injured leg.

B. apply direct pressure to his leg

The MOST accurate definition of a fracture is a: A. crack on the surface of a bone. B. break in the continuity of a bone.

B. break in the continuity of a bone

Articular cartilage functions by: A. preventing joints from extending beyond their normal range of motion. B. covering the bone ends and cushioning them from damage and wear. C. connecting the two bone ends of a joint together and allowing range of motion. D. strengthening the articulation point of immovable joints and providing support.

B. covering the bone ends and cushioning them from damage and wear

Following blunt force trauma to the elbow, a 40-year-old female complains of severe pain and the feeling that her elbow is "locked". Your assessment reveals marked deformity and swelling. This patient has MOST likely experienced a/an: A. fracture. B. dislocation. C. severe sprain. D. epiphyseal injury.

B. dislocation

A Colles fracture is caused by injury to the: A. carpal bones. B. distal radius. C. proximal ulna. D. midshaft forearm.

B. distal radius

A 70-year-old female slipped on a throw rug, but grabbed an adjacent table before she fell to the ground. When assessing her, you should recall that: A. most mishaps in the elderly patient occur as a result of near syncope. B. even minor mechanisms of injury can result in fractures in the elderly.

B. even minor mechanisms of injury can result in fractures in the elderly

A patient with a displaced fracture of the proximal femur typically presents with: A. internal leg rotation, with the injured leg longer than the opposite leg. B. external leg rotation, with the injured leg shorter than the opposite leg. C. internal leg rotation, with the injured leg shorter than the opposite leg. D. external leg rotation, with the injured leg longer than the opposite leg.

B. external leg rotation, with the injured leg shorter than the opposite leg

General principles of splinting an injured extremity include: A. immobilizing the joint below a suspected fracture. B. frequently assessing gross neurovascular functions. C. immobilizing the bone above a suspected dislocation. D. splinting all extremity injuries en route to the hospital.

B. frequently assessing gross neurovascular functions

The energy needed for muscular contraction is derived from the metabolism of ___________ and results in the production of: A. oxygen; pyruvic acid. B. glucose; lactic acid. C. calcium; pyruvic acid. D. oxygen; carbon dioxide.

B. glucose; lactic acid

A 55-year-old male fell from the roof of his house and sustained a closed, displaced femur fracture. He is restless, diaphoretic, and tachycardic. After appropriately managing his ABCs and performing a rapid head-to-toe assessment, you should: A. apply a traction splint, immobilize him on a long backboard, and begin transport. B. immobilize him on a long backboard, transport, and start a large-bore IV en route.

B. immobilize him on a long backboard, transport, and start a large-bore IV en route

A 21-year-old male presents with a severely angulated forearm and extreme pain. Distal sensory, motor, and circulatory functions are intact. You should: A. apply a zippered air splint to relieve the pain. B. splint the forearm in the position of deformity. C. apply chemical heat packs to help reduce swelling. D. carefully straighten the forearm and apply a splint.

B. splint the forearm in the position of deformity

A 29-year-old male fell approximately 5 feet from a ladder and landed on his right shoulder. He is conscious and alert, denies loss of consciousness, and complains of pain to the shoulder. His vital signs are stable. You should: A. perform a rapid scan of the body, start and IV of normal saline, transport, and splint the injury en route to the hospital. B. manually stabilize the injury until it is splinted, perform a secondary assessment, splint the injury appropriately, and transport. C. allow the patient to stabilize his shoulder with his opposite hand, perform a secondary assessment, and transport. D. start an IV of normal saline, appropriately splint his shoulder, transport, and perform a secondary assessment en route.

B. manually stabilize the injury until it is splinted, perform a secondary assessment, splint the injury appropriately, and transport

A 34-year-old male sustained a twisting injury to his left lower leg when he stepped into a hole. Your assessment reveals ecchymosis and pain to the area, but no deformity or crepitus. You should suspect a: A. displaced fracture. B. nondisplaced fracture. C. comminuted fracture. D. transverse fracture.

B. nondisplaced fracture

A 59-year-old male patient impacted the dashboard with his knees when his car struck a tree at 50 mph. During your primary assessment, you note bleeding from an obvious open femur fracture. After controlling the bleeding, applying oxygen, and extricating him from the car, you should: A. apply a traction splint, immobilize his spine, and transport. B. perform a head-to-toe assessment, immobilize his spine, and transport. C. immobilize his spine with a vest-style device and transport immediately. D. perform a detailed secondary assessment, immobilize his spine, and transport.

B. perform a head-to-toe assessment, immobilize his spine, and transport

A young female has a closed, unstable deformity to her left femur. In this situation, the primary reason for applying a splint is to: A. relieve the patient's pain and anxiety. B. prevent conversion to an open fracture. C. minimize any bleeding within the thigh. D. prevent severe spasms of the thigh muscle.

B. prevent conversion to an open fracture

To align a severe deformity associated with a humeral shaft fracture, you should: A. place one hand above and one hand below the fracture site and apply gentle downward traction. B. support the fracture site with one hand and apply gentle traction by grasping the humeral condyles.

B. support the fracture site with one hand and apply gentle traction by grasping the humeral co

Tough, cord-like structures that are extensions of the fascia covering all skeletal muscles are known as: A. menisci. B. tendons. C. ligaments. D. cartilage.

B. tendons

Which of the following describes an injury caused by indirect force? A. Rupture of the stomach following the blast phase of an explosion B. Knee striking the dashboard during a car crash and fracturing the patella C. A fall on an outstretched hand with a fractured wrist and a dislocated elbow D. Being struck by a car and sustaining a pelvic fracture and a closed head trauma

C. A fall on an outstretched hand with a fractured wrist and a dislocated elbow

Which of the following injuries would pose the LEAST threat to the patient? A. Single open long bone fracture B. Displaced fracture of the pelvis C. Major sprains at a major joint

C. Major sprains at a major joint

On which of the following injuries would it be MOST appropriate to apply a traction splint? A. Pain and crepitus upon palpation of the pelvis B. Posterior bulge of the hip with intact circulation C. Swelling and ecchymosis to the midshaft femur D. Deformity and swelling just proximal to the knee

C. Swelling and ecchymosis to the midshaft femur

When assessing the pelvis of a patient with multiple systems trauma, you should: A. gently rock the pelvis back and forth. B. percuss the pubic symphysis to elicit pain. C. apply gentle inward pressure to the iliac crests. D. avoid palpation due to the potential for injury.

C. apply gentle inward pressure to the iliac crests

Proximal humeral fractures MOST commonly occur: A. as a result of minor trauma. B. in the pediatric population. C. in the elderly population. D. during stretching injuries.

C. in the elderly population

Fractures of the proximal femur MOST commonly occur at the: A. acetabular region of the pelvis. B. superior aspect of the femoral head. C. intertrochanteric region of the femur. D. epiphyseal region of the femoral head.

C. intertrochanteric region of the femur

You and your partner are applying a Hare traction splint to a patient with a deformed midshaft femur. As you expose the injured femur and assess neurovascular functions, your partner should: A. elevate the leg and apply an ankle hitch. B. measure the splint beside the uninjured leg. C. manually support and stabilize the injured leg. D. apply gentle in-line traction to the injured leg.

C. manually support and stabilize the injured leg

An 80-year-old male tripped and fell and complains of pain to his left hip. Your assessment reveals that his knee is flexed and his left leg is shortened and medially rotated. Distal neurovascular functions are grossly intact. You should immobilize this patient's injury by: A. straightening his leg and immobilizing him with a scoop stretcher. B. applying a Hare traction splint and immobilizing him on a longboard. C. placing him on a scoop stretcher and padding the injury with pillows. D. attempting to reduce the injury and immobilizing him on a longboard.

C. placing him on a scoop stretcher and padding the injury with pillows

When assessing a 40-year-old female with an injury to her left wrist, you should recall that the MOST reliable indicator of an underlying fracture is: A. ecchymosis. B. gross swelling. C. point tenderness.

C. point tenderness

Pathologic fractures are typically caused by all of the following, EXCEPT: A. osteoporosis. B. bone cancer. C. previous fractures. D. minor injury force.

C. previous fractures

When assessing a patient with a scapular fracture, you should also be alert for: A. a myocardial contusion. B. fractures of the sacral spine. C. ribs fractures and a pneumothorax. D. an associated midshaft clavicular fracture.

C. ribs fractures and a pneumothorax.

You arrive at the scene of a motor-vehicle crash in which a 30-year-old male was ejected from his truck. As you approach the patient, who is not moving, you can see that he has gross deformity to both of his femurs and an angulated left humerus. You should: A. perform a rapid secondary assessment. B. assess the adequacy of his respirations. C. stabilize his head and open his airway. D. assess his femurs for gross bleeding.

C. stabilize his head and open his airway

In which of the following situations would it NOT be appropriate to splint a patient's fractures before moving him or her? A. Upset patient with abrasions and capillary bleeding B. Conscious patient in severe pain with stable vital signs C. Alert patient with a history of uncontrolled hypertension D. Confused patient with tachycardia and shallow breathing

D. Confused patient with tachycardia and shallow breathing

Which of the following injuries MOST accurately depicts an open fracture? A. Deformity to the radius and ulna with an overlying healing laceration B. Swelling and deformity to the tibia with a bulge from the fractured bone C. Deformity to the midshaft femur with ecchymosis and a large hematoma D. Swelling and deformity to the lateral humerus with an overlying abrasion

D. Swelling and deformity to the lateral humerus with an overlying abrasion

If your assessment of a patient with a possible musculoskeletal injury reveals no external signs of injury, it would be appropriate to: A. allow the patient to walk to the ambulance. B. forgo complete immobilization of the spine. C. skip your assessment of distal neurologic function. D. ask the patient to move each extremity carefully.

D. ask the patient to move each extremity carefully

When assessing a 14-year-old male with an injured arm, you note gross deformity just distal to the elbow. Distal neurovascular functions are grossly intact. You should: A. apply a pediatric traction splint to the arm. B. immobilize the injury with a sling and swath. C. ensure immobilization of the hand and shoulder. D. assume that growth plate damage has occurred.

D. assume that growth plate damage has occurred

Goals of in-line traction for musculoskeletal injuries in the prehospital setting include all of the following, EXCEPT: A. reduction of the fracture. Correct B. stabilization of the fracture site. C. alignment of the injured extremity. D. avoiding neurovascular compromise.

D. avoiding neurovascular compromise

A 34-year-old male twisted his lower leg and ankle while skiing. He complains of severe pain and swelling to the area. When assessing for deformity, you should: A. gently manipulate the injured limb to elicit crepitus. B. place heat on his leg to force blood away from the area. C. apply an icepack and reassess after the swelling subsides. D. compare the injured extremity to the uninjured extremity.

D. compare the injured extremity to the uninjured extremity

A 38-year-old female sustained a high-velocity injury to her pelvis. Your assessment reveals severe pain and crepitation upon palpation of the iliac crests. Her blood pressure is 84/54 mm Hg, pulse is 120 and weak, and respirations are 26 breaths/min and unlabored. In addition to administering 100% oxygen, the MOST appropriate management should include: A. immobilizing the patient with a scoop stretcher, administering a 20 mL/kg bolus of normal saline, and rapidly transporting. B. immobilizing her spine, applying and inflating the abdominal compartment of the PASG, and promptly transporting. C. logrolling the patient onto a long backboard, immobilizing her spine, starting a large-bore IV to keep the vein open, and rapidly transporting. D. immobilizing her spine, applying a pelvic binder device, transporting, and administering 20 mL/kg normal saline boluses en route.

D. immobilizing her spine, applying a pelvic binder device, transporting, and administering 20 mL/kg normal saline boluses en route

In addition to splinting the injured extremity, appropriate management for a patient with suspected compartment syndrome includes: A. applying traction to the extremity, keeping it at the level of the heart, and transporting. B. lowering the limb below the level of the heart, transporting, and frequently assessing pulses. C. elevating the limb above the level of the heart, transporting, and reassessing distal pulses. D. keeping the limb at the level of the heart, transporting, and frequently assessing distal pulses.

D. keeping the limb at the level of the heart, transporting, and frequently assessing distal pulses

You have applied an air splint to the deformed forearm of a critically injured patient while waiting for a helicopter to arrive. When the helicopter arrives, the flight medic asks you to accompany the patient. During the flight, you should: A. remove the air splint and apply a rigid splint. B. inflate the air splint by approximately 50%. C. deflate the air splint by approximately 50%. D. monitor the splint and let air out as needed.

D. monitor the splint and let air out as needed

In addition to providing the framework for the human body, bones also: A. allow the muscles to contract. B. produce electrolytes for the body. C. destroy nonfunctional erythrocytes. D. produce blood cells in the marrow.

D. produce blood cells in the marrow

A 30-year-old male fell while rollerblading and landed on his right arm. There is obvious deformity to the elbow and the patient complains of severe pain. The patient's hand is cool and pale and his radial pulse is difficult to palpate. The hospital is approximately 10 minutes away. You should: A. gently flex the elbow so that you can apply a sling and swathe. B. align the arm and apply a padded board splint and then transport. C. make one attempt to restore distal circulation and then transport. D. splint the arm in the position found and then transport immediately.

D. splint the arm in the position found and then transport immediately