PMED CH 37

When assessing a multisystems trauma patient, it is MOST important to: A) administer an analgesic promptly to minimize pain. B) avoid being distracted by visually impressive injuries. C) splint swollen, painful extremities as soon as possible. D) only splint fractures involving long bones at the scene.

B

The fibula: A) can be felt just beneath the skin. B) forms the distal medial malleolus. C) is not a component of the knee joint. D) is more easily fractured than the tibia.

C

Which of the following musculoskeletal injuries would MOST likely occur together? A) Scaphoid and femur fractures B) Calcaneal and c-spine fractures C) Scapular and clavicular fractures D) Knee dislocation and tibial fracture

D

Which of the following is NOT an intervention the paramedic can perform to help reduce the risk of long-term disability following a musculoskeletal injury? A) Prehospital fracture reduction B) Prevention of gross contamination C) Pain reduction with cold and analgesia D) Transport to an appropriate medical facility

A

Which of the following medical conditions would MOST likely cause changes in sensation in a patient with an extremity injury? A) Diabetes B) Hypertension C) Renal insufficiency D) Rheumatoid arthritis

A

Which of the following structures is NOT part of the axial skeleton? A) Femoral shaft B) Vertebral column C) Ribs and sternum D) Basilar skull and face

A

Which of the following is the BEST example of an indirect injury? A) Patellar fracture after the knee strikes an automobile's dashboard B) Shoulder dislocation secondary to falling on an outstretched hand C) Fractured ankle after stepping in a hole and twisting the lower leg D) Dislocated olecranon process following direct trauma to the elbow

B

___________ is a dense, fibrous membrane that is important for bone repair and maintenance. A) Cartilage B) Periosteum C) Synovium D) Endosteum

B

You arrive at the scene of a motorcycle crash and find the rider lying supine approximately 20 feet from his bike; he is still wearing his helmet. As you approach him, you note that he has bilaterally deformed femurs. You should: A) immediately stabilize both lower extremities. B) remove his helmet and apply a cervical collar. C) manually stabilize his head and assess his airway. D) carefully straighten his legs and assess distal pulses.

C

You have applied board splints to a suspected lower leg fracture in a young woman and have given her fentanyl for pain. En route to the hospital, the patient states that the pain is excruciating. Further narcotics fail to relieve the pain. Reassessment of the injured area reveals that the overlying skin is taut and the pedal pulse is weak. You should: A) start a second IV line and administer 1 mEq/kg of sodium bicarbonate. B) remove the splint to prevent excessive swelling of the extremity. C) loosen the splint, elevate the leg, apply ice, and notify the hospital. D) remove the board splints, apply an air splint, and then reassess her.

C

Swelling and inflammation associated with musculoskeletal injuries are reduced: A) if cold packs are applied during the acute stage of the injury. B) if an appropriate dose of a narcotic analgesic is administered. C) when heat therapy is used within 48 to 72 hours after the injury. D) if a vasodilator drug is given within 12 hours following the injury.

A

The MOST reliable sign of a fracture is: A) deformity. B) ecchymosis. C) localized pain. D) severe swelling.

A

A 19-year-old man experienced direct trauma to his left elbow. Your assessment reveals gross deformity and ecchymosis. His arm is pink and warm, and he has a strong radial pulse. Your transport time to the hospital will be delayed. You should: A) splint the elbow in the position found and reassess distal circulation. B) carefully straighten the arm to facilitate placement of a vacuum splint. C) apply a sling and swathe to immobilize the injury and then apply heat. D) administer fentanyl for pain relief and then carefully straighten the arm.

A

A ____________ is a padlike sac or cavity located within the connective tissue, usually in proximity to a joint. A) bursa B) ligament C) joint capsule D) synovial membrane

A

A dislocation is considered an urgent injury because of its potential to cause: A) neurovascular compromise. B) significant internal bleeding. C) severe hemodynamic instability. D) proximal sensory and motor loss.

A

A pathologic fracture occurs when: A) an occult medical condition causes abnormal bone weakness. B) greater-than-usual forces are required to fracture a large bone. C) a particular mechanism of injury cannot be identified readily. D) underdeveloped bones sustain a low-impact traumatic injury.

A

A subluxation occurs when: A) a joint is partially dislocated. B) a dislocation spontaneously reduces. C) a fracture occurs through both cortices. D) dislocated bones are locked in position

A

After ensuring your own safety, your next priority when caring for a patient with an extremity injury is to: A) prevent further injury. B) assess neurovascular function. C) splint the injured extremity. D) administer an analgesic.

A

Common signs and symptoms of an acute pulmonary embolism include all of the following, EXCEPT: A) pulmonary edema. B) pleuritic chest pain. C) right-sided heart failure. D) tachycardia and tachypnea.

A

Hip fractures are actually fractures of the: A) femoral neck. B) pelvic girdle. C) femoral head. D) ischial tuberosity.

A

Skeletal muscles that are not used or exercised tend to: A) atrophy. B) develop necrosis. C) hypertrophy. D) increase in size.

A

Which of the following statements regarding a nondisplaced fracture is correct? A) Nondisplaced fractures are generally caused by low-energy trauma and are typically not associated with deformity. B) Nondisplaced fractures occur when a massive compressive force is applied to the bone, causing it to become wedged into another bone. C) In a nondisplaced fracture, muscles pull the distal fracture fragment alongside the proximal one, causing them to overlap. D) Nondisplaced fractures are caused by low-energy trauma and occur when the ends of the fracture move from their normal positions

A

You should NOT apply a pneumatic splint on a patient if he or she: A) has an open fracture in which bone ends are exposed. B) is experiencing severe pain despite narcotic analgesia. C) has a closed fracture involving the lower leg or forearm. D) experienced a fracture or dislocation involving a major joint.

A

A 17-year-old man jumped from a second-story balcony and landed on his feet. He complains of pain to both of his heels and knees. Your assessment reveals swelling and ecchymosis to both of his feet. His vital signs are stable and he is breathing without difficulty. In addition to caring for his lower-extremity injuries, it is MOST important that you: A) administer high-flow supplemental oxygen. B) apply spinal motion restriction precautions. C) try to determine why he jumped from the balcony. D) start a large-bore IV line of an isotonic crystalloid.

B

A 60-year-old woman slipped and fell on an icy sidewalk and landed on her outstretched hand. Your assessment reveals that she has an obvious Colles fracture. The patient denies any other injuries and is conscious and alert. Her vital signs are stable and she describes her pain as a 2 on a scale of 0 to 10. Given this patient's current status, the MOST appropriate way to treat her injury involves: A) gently straightening the fracture site and then applying a splint. B) administering analgesia and then properly splinting her injury. C) giving her a sedative for pain relief and then applying an air splint. D) manually stabilizing her wrist as your partner applies a vacuum splint.

B

A 68-year-old woman presents with an acute onset of dyspnea and sharp chest pain. Her medical history is significant for a hip replacement 2 weeks ago. The patient is conscious and alert, with a blood pressure of 112/58 mm Hg, pulse rate of 90 beats/min and irregular, and respirations of 22 breaths/min and labored. Which of the following treatment interventions is MOST appropriate for this patient? A) Pharmacologically assisted intubation and IV therapy B) Oxygenation and ventilation support and rapid transport C) 324 mg of aspirin and ventilation support with a bag-mask D) Supplemental oxygen and elevation of the lower extremities

B

A young man has an isolated injury to his left lower leg. Your assessment reveals obvious deformity and ecchymosis. Distal circulation as well as motor and sensory functions are grossly intact, and the patient is hemodynamically stable. In addition to stabilizing the suspected fracture site, you should: A) carefully palpate to elicit crepitus. B) immobilize the knee and the ankle. C) apply a traction splint for pain relief. D) place a chemical heat pack over the injury.

B

After 35 years of age, age-related decrease in bone density is accelerated in females because: A) females have an inherently weak bone structure. B) of decreased estrogen levels secondary to menopause. C) excess estrogen levels destroy the bone's periosteum. D) of decreased bone marrow levels in the medullary canal. Ans: B

B

By maintaining a state of partial contraction, __________ muscle allows the body to maintain its posture. A) smooth B) skeletal C) involuntary D) non-striated muscle

B

Eliciting for crepitus during your exam of a deformed extremity: A) should only be performed if the patient is not in significant pain. B) may cause further injury to the bone and surrounding soft tissues. C) should be performed to help confirm the presence of a fracture. D) is generally not performed, but will likely not cause further injury.

B

The BEST way to detect deformity or any other abnormality in an injured extremity is to: A) gently palpate the entire length of the extremity. B) compare it to the extremity on the opposite side. C) manipulate the extremity to assess for false motion. D) reduce any swelling with ice before performing the exam.

B

The FIRST step in splinting a musculoskeletal injury involves: A) thoroughly assessing range of motion. B) exposing and assessing the injury site. C) assessing distal neurovascular functions. D) straightening the injury if it is angulated.

B

The MOST practical method of splinting multiple fractures in a critically injured patient is to: A) apply vacuum splints en route to the hospital. B) splint the axial skeleton using a long backboard. C) use air splints so you can visualize the injuries. D) sedate the patient before applying any splints.

B

The MOST significant immediate risk associated with an open fracture is: A) infection. B) hemorrhage. C) nerve damage. D) bone marrow loss.

B

The anterior and posterior tibial arteries are direct subdivisions of the: A) femoral artery. B) popliteal artery. C) descending aorta. D) external iliac artery.

B

The carpals, especially the scaphoid, are MOST vulnerable to fracture when a person: A) experiences a crush injury. B) falls on an outstretched hand. C) also dislocates his or her elbow. D) excessively supinates the hand.

B

The return of myoglobin to the systemic circulation following a crush injury would result in all of the following conditions, EXCEPT: A) a decreased pH. B) metabolic alkalosis. C) hyperkalemia. D) renal dysfunction.

B

The risk of a pulmonary embolism following musculoskeletal trauma is HIGHEST in patients with: A) upper extremity fractures that result in lengthy hospital admissions. B) pelvic and lower extremity injuries that lead to prolonged immobilization. C) numerous rib fractures who are taking anticoagulant medications. D) any proximal long bone fracture that occurred greater than 72 hours prior to medical intervention.

B

The sudden twisting of a joint beyond its normal range of motion, causing a temporary subluxation, is called a: A) strain. B) sprain. C) dislocation. D) fracture-dislocation.

B

What structure helps maintain the stability of a joint and determines the degree of joint motion? A) Tendon B) Ligament C) Cartilage D) Joint capsule

B

When assessing distal pulses in a patient with a lower extremity injury, it is MOST important to: A) suspect severe shock if a unilateral pulse deficit is present. B) compare the strength of the pulses in both lower extremities. C) remember that most people do not have a palpable pedal pulse. D) count the pedal pulse rate and compare it to the radial pulse rate.

B

Which of the following bones is MOST vulnerable to injury? A) Sternum B) Clavicle C) Scapula D) Humerus

B

A 45-year-old man was cutting down a large tree when it collapsed, pinning him at the thighs. The patient's wife found him approximately 4 hours after the incident. The patient is conscious and in severe pain. His blood pressure is 128/68 mm Hg, pulse is 120 beats/min and regular, and respirations are 22 breaths/min with adequate depth. In addition to supplemental oxygen and cardiac monitoring, which of the following treatments should you provide BEFORE the tree is removed from his legs? A) Two large-bore IV lines with a 3- to 4-L crystalloid bolus and 1 mEq/kg of sodium bicarbonate B) A large-bore IV line set to keep the vein open and 10 mL of a 10% solution of calcium chloride C) IV therapy with a crystalloid fluid bolus and albuterol via nebulizer or mucosal atomizer device D) An IV of normal saline, fluid restriction, and amiodarone if the ECG shows a widened QRS complex

C

A function of the musculoskeletal system is hematopoiesis, which is defined as the process of: A) filtering the blood. B) destroying platelets. C) generating blood cells. D) producing bone marrow.

C

A patient standing with his or her head cocked toward a knocked-down left shoulder MOST likely has a fracture of the: A) right clavicle. B) left shoulder. C) left clavicle. D) right shoulder.

C

A stress fracture would MOST likely occur when: A) a person with a relatively weak bone structure does not engage regularly in strenuous activities. B) a person with large musculature regularly engages in strenuous activity using the upper extremities. C) the muscle develops faster than the bone and places exaggerated stress on the bone. D) an underlying medical condition causes progressive weakening of the bones, making them prone to fracture.

C

Diarthroses: A) are also referred to as fused joints. B) is the process of bone deterioration. C) are the most mobile joints of the body. D) secrete synovial fluid into the joint cavity.

C

In contrast to osteoarthritis, rheumatoid arthritis: A) is a disease of the joints that occurs as they age and begin to wear. B) generally does not respond well to anti-inflammatory medication therapy. C) is a systemic inflammatory disease that affects joints and other body systems. D) causes severe pain secondary to crystallized uric acid accumulation in a joint.

C

Signs of bursitis include all of the following, EXCEPT: A) warmth. B) swelling. C) deformity. D) erythema.

C

Skeletal muscle is innervated by: A) sympathetic nerve fibers. B) involuntary nerves. C) somatic motor neurons. D) the autonomic nervous system.

C

The appendicular skeleton is composed of the: A) bones of the spinal column, scapulae, and clavicles. B) bones of the upper extremities and the structures of the torso. C) pectoral girdle, pelvic girdle, and bones of the extremities. D) thoracic ribs, cervical vertebrae, and bones of the cranium.

C

The energy for muscular contraction is derived from the metabolism of _______ and results in the production of _______. A) oxygen, glucose B) pyruvic acid, oxygen C) glucose, lactic acid D) lactate, carbon dioxide

C

The goal of prehospital pain control in a patient with a musculoskeletal injury should be to: A) use cryotherapy instead of narcotic analgesics. B) sedate the patient with diazepam or lorazepam. C) diminish the patient's pain to a tolerable level. D) give enough analgesia to make the patient pain-free.

C

The likelihood of experiencing systemic complications from a musculoskeletal injury is related to all of the following factors, EXCEPT the: A) patient's overall health. B) anatomic location of the injury. C) splinting method used in the field. D) degree of force that caused the injury.

C

The upper extremity's blood supply originates from the: A) radial artery. B) brachial artery. C) subclavian artery. D) axillary artery.

C

What type of fracture occurs at an angle across the bone and is typically caused by direct or twisting force? A) Spiral B) Linear C) Oblique D) Transverse

C

When a person jumps from a height and lands on his or her feet, direct trauma occurs to the: A) tarsals. B) malleolus. C) calcaneus. D) metatarsals.

C

Compartment syndrome occurs when: A) metabolic waste products accumulate within a large hematoma that develops near a fracture site. B) yellow and red bone marrow seep from a fractured bone, resulting in excessive soft tissue swelling. C) blood accumulates in the medullary canal of a bone, resulting in decreased oxygenation of the bone tissue. D) pressure in the fascial compartment leads to impaired circulation, sensory changes, and progressive muscle death.

D

A 40-year-old woman has an unstable pelvis following a motor vehicle crash. She is conscious but confused. Her blood pressure is 80/50 mm Hg, pulse is 120 beats/min and weak at the radial arteries, and respirations are 24 breaths/min and shallow. After starting at least one large-bore IV line, you should: A) run it wide open until her systolic blood pressure is greater than 100 mm Hg. B) administer a 250-mL normal saline bolus and then reassess her blood pressure. C) set the IV flow rate to keep the vein open unless her systolic blood pressure falls below 70 mm Hg. D) give enough isotonic crystalloid fluids to improve her mental status and radial pulse quality.

D

A 71-year-old man slipped on wet grass and landed on his left side. He denies losing consciousness before or after the fall and is presently conscious and alert. He complains of pain to his left hip and in his neck. Your assessment reveals a hematoma to the left side of his head and an external rotation and shortening of his left leg. His vital signs are stable. The MOST appropriate treatment for this patient includes: A) spinal motion restriction precautions, stabilization of his hip with a traction splint, an IV of normal saline, 5 µg/kg of fentanyl, and transport. B) supplemental oxygen, application and inflation of the PASG to stabilize his hip, an IV line of lactated Ringer's, midazolam to relieve his pain, and transport. C) placing him on a scoop stretcher and stabilizing his hip with pillows, applying a cervical collar, starting an IV line set to keep the vein open, and transport. D) supplemental oxygen, spinal motion restriction precautions, an IV line of normal saline, stabilization of his hip with pillows, fentanyl if needed, and transport.

D

Closed bilaterally fractured femurs can result in internal blood loss of up to: A) 1,000 mL. B) 1,500 mL. C) 2,000 mL. D) 3,000 mL.

D

Correctly splinting an injured extremity: A) typically provides complete pain relief without the need to administer narcotic analgesia. B) effectively reduces swelling and inflammation by shunting blood away from the injured area. C) eliminates the need to elevate the extremity because immobilization causes blood stasis. D) helps to control internal bleeding by allowing clots to form where vessels are damaged.

D

Immediate pain from the heel to the calf and a sudden inability for plantar flexion of the foot is MOST indicative of: A) acute tendonitis. B) ligament disruption. C) a dislocated ankle. D) Achilles tendon rupture.

D

In a closed femur fracture, blood loss may exceed _______ before enough pressure develops to tamponade the bleeding. A) 250 mL B) 500 mL C) 750 mL D) 1,000 mL

D

Isolated musculoskeletal injuries: A) generally require high doses of analgesia. B) are difficult to identify during assessment. C) prove fatal in a significant number of cases. D) often result in short- or long-term disability.

D

Osteoporosis is MOST accurately defined as a(n): A) progressive loss of bone marrow. B) reduced range of motion in the joints. C) estrogen-related change in bone strength. D) significant decrease in bone density.

D

The ischium, ilium, and pubis are fused together to form the: A) hip socket. B) acetabulum. C) sacroiliac joint. D) innominate bone.

D

The joints that connect the ribs to the sternum are examples of: A) fused joints. B) fibrous joints. C) synovial joints. D) cartilaginous joints.

D

The upper extremity joins the shoulder girdle at the: A) acromion. B) olecranon process. C) acromioclavicular joint. D) glenohumeral joint.

D

Which of the following is NOT one of the 6 Ps of musculoskeletal injury assessment? A) Pallor B) Parasthesias C) Pulselessness D) Passive extension

D