West Coast EMT Chapter 30 -- Abdominal and Genitourinary Injuries, West Coast EMT Chapter 29 -- Chest Injuries

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. Injury to the kidneys usually indicates injury to other organs.

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

A. a segment of the chest wall is detached from the thoracic cage.

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. administer oxygen and transport to the hospital. B. immediately perform a rapid head-to-toe exam. C. circumferentially tape a dressing around his chest. D. recognize that he needs a needle decompression.

A. administer oxygen and transport to the hospital.

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

A. guarding.

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

A. may rise as high as the nipple line.

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

A. primary assessment

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

A. their intercostal muscles are not developed

Compression injury is most likely due to which of the following? Select one: A. Hollow-organ rupture B. Improperly placed lab belt C. Stabbing D. Ejection of unrestrained driver

B. Improperly placed lab belt

Which of the following statements regarding abdominal eviscerations is correct? Select one: 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. The protruding organs should be kept warm and moist.

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

B. air enters the pleural space from outside the body.

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

B. are rarely life-threatening

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

B. be objective and factual

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

B. control any external bleeding, administer oxygen, and transport at once.

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. insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM. C. suction his oropharynx to ensure it is clear of secretions and then increase the oxygen flow rate to 15 L/min. D. reassess his vital signs and then notify the receiving hospital of the change in his clinical status.

B. insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM.

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. pericardial tamponade. B. laceration of the aorta. C. massive hemothorax. D. tension pneumothorax.

B. laceration of the aorta.

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

B. larger in proportion to the abdomen

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. must increase his or her respiratory rate to maintain adequate minute volume. C. will eliminate more carbon dioxide than if he or she were breathing deeply. D. will maintain adequate minute volume if his or her respiratory rate stays the same.

B. must increase his or her respiratory rate to maintain adequate minute volume.

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

B. paralysis of the intercostal muscles.

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 ventilatory assistance. B. partially remove the dressing. C. call for a paramedic ambulance. D. begin rapid transport at once.

B. partially remove the dressing.

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. pneumothorax. C. myocardial contusion. D. flail chest.

B. pneumothorax.

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. apply an AED and assess his BP. B. prepare for immediate transport. C. apply bulky dressings to the sternum. D. determine if he has cardiac problems.

B. prepare for immediate transport.

All of the following are hollow abdominal organs, EXCEPT the: Select one: A. ureters. B. spleen. C. bladder. D. stomach.

B. spleen.

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. A rapid, irregular pulse B. Widening pulse pressure C. Engorged jugular veins D. Diminished breath sounds

C. Engorged jugular veins

Which of the following organs would MOST likely bleed profusely when injured? Select one: A. Bladder B. Stomach C. Liver D. Intestine

C. Liver

When should you visually inspect the external genitalia on your patient? Select one: A. Only when ordered by medical direction B. Anytime the patient agrees to treatment and transport C. Only when there is a complaint of severe pain or other injury D. Always during the secondary assessment

C. Only when there is a complaint of severe pain or other injury

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

C. blunt trauma

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

C. diaphragm.

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. perform a focused secondary exam. B. insert an oropharyngeal airway. C. immediately request ALS support. D. obtain a set of baseline vital signs.

C. immediately request ALS support.

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

C. infection

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

C. is commonly caused by blunt chest trauma.

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

C. may decrease the amount of blood that returns to the heart.

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. massive hemothorax. B. tension pneumothorax. C. pulmonary contusion. D. traumatic asphyxia.

C. pulmonary contusion.

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

C. tachypnea

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

D. Aortic rupture

You should suspect a kidney injury anytime the patient presents with _______. Select one: A. abdominal distention B. nausea C. dyspnea D. a hematoma in the flank region

D. a hematoma in the flank region

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: Select one: A. covering the avulsion with moist, sterile dressings. B. administering 100% oxygen via a nonrebreathing mask. C. requesting a paramedic to administer pain medication. D. applying direct pressure with a dry, sterile dressing.

D. applying direct pressure with a dry, sterile dressing.

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. closely monitor him and reassess him frequently.

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

D. diaphragm.

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

D. peritonitis may not develop for several hours.

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

D. prompt transport to the hospital is essential.