Chapter 29
Bilateral femur fractures can result in up to _____ mL of internal blood loss.
2000
Which of the following scenarios is an example of a direct injury?
A passenger fractures her patella after it struck the dashboard
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
A) 1,000
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.
A) assess distal pulse, motor, and sensory functions.
A 21-year-old male was thrown over the handlebars of his motorcycle when he rear-ended a car that was stopped at a red light. He was wearing a helmet, which he removed prior to your arrival. He is conscious, but restless, and has closed deformities to both of his femurs. His skin is pale, his heart rate is rapid and weak, and his respirations are rapid and shallow. In addition to applying high-flow oxygen and protecting his spine, you should: A) bind his legs together on the backboard, keep him warm, and transport without delay. B) apply traction splints to both of his legs, keep him warm, and transport without delay. C) splint each of his deformed femurs with long board splints and transport immediately. D) apply the PASG to stabilize his femurs and transport at once.
A) bind his legs together on the backboard, keep him warm, and transport without delay.
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.
A) bones and voluntary muscles of the body.
The MOST commonly fractured bone(s) in the body is the: A) clavicle. B) scapula. C) radius and ulna. D) midshaft femur.
A) clavicle.
Of the following musculoskeletal injuries, which is considered to be the LEAST severe? A) nondisplaced pelvic fracture B) open fractures of a long bone C) an amputation of an extremity D) multiple closed long bone fractures
A) nondisplaced pelvic fracture
The primary purpose for splinting a musculoskeletal injury is to: A) prevent further injury. B) maximize distal circulation. C) make the patient comfortable. D) facilitate ambulance transport.
A) prevent further injury.
Deformity caused by a fracture would MOST likely be masked by: A) swelling. B) guarding. C) crepitus. D) ecchymosis.
A) swelling.
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.
B) apply gentle manual traction in line with the limb and reassess for a pulse.
A fracture is MOST accurately defined as a: 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.
B) break in the continuity of the bone.
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.
B) distal humerus.
A Colles fracture involves a fracture of the: A) distal ulna. B) distal radius. C) proximal radius. D) radius and ulna.
B) distal radius.
During your rapid trauma assessment of a 19-year-old female with multiple trauma, you note bilateral humeral deformities and a deformity to the left midshaft femur. Her skin is diaphoretic and her pulse is rapid and weak. Your partner has appropriately managed the patient's airway and is maintaining manual stabilization of her head. The MOST appropriate treatment for this patient includes: A) applying and inflating the pneumatic antishock garment (PASG) and transporting. B) immobilizing her to a backboard and rapidly transporting. C) applying a traction splint to immobilize her femur. D) carefully splinting each of her deformed extremities.
B) immobilizing her to a backboard and rapidly transporting.
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.
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
B) pathologic
The PASG is absolutely contraindicated in patients who have: A) pelvic fractures. B) pulmonary edema. C) bilateral femur fractures. D) any trauma below the pelvis.
B) pulmonary edema.
Applying ice to and elevating an injured extremity are performed in order to: A) prevent further injury. B) reduce pain and swelling. C) enhance tissue circulation. D) maintain extremity perfusion
B) reduce pain and swelling.
Which of the following types of muscle is under direct voluntary control of the brain? A) cardiac B) skeletal C) smooth D) autonomic
B) skeletal
Skeletal muscle is also referred to as __________ muscle. A) smooth B) striated C) connective D) involuntary
B) striated
Skeletal muscle is attached to the bone by tough, ropelike fibrous structures called: A) fascia. B) tendons. C) cartilage. D) ligaments.
B) tendons.
A subluxation occurs when: A) ligaments are partially severed. B) a fracture and a dislocation exist. C) a joint is incompletely dislocated. D) a bone develops a hairline fracture.
C) a joint is incompletely dislocated.
During your rapid secondary assessment of a 19-year-old female with multiple trauma, you note bilateral humeral deformities and a deformity to the left midshaft femur. Her skin is diaphoretic and her pulse is rapid and weak. Your partner has appropriately managed her airway and is maintaining manual stabilization of her head. The MOST appropriate treatment for this patient includes: A) applying and inflating the pneumatic antishock garment (PASG) and transporting. B) immobilizing her to a backboard and rapidly transporting. C) applying a traction splint to immobilize her femur. D) carefully splinting each of her deformed extremities.
C) applying a traction splint to immobilize her femur.
A 76-year-old male experienced sudden pain to his left thigh when he was standing in line at the grocery store. Your assessment reveals ecchymosis and deformity to the distal aspect of his left femur, just above the knee. Distal circulation and sensory and motor functions are intact. The MOST appropriate method of splinting this injury involves: A) applying a traction splint to realign the deformity. B) applying and fully inflating the pneumatic antishock garment (PASG). C) applying padded board splints to both sides of the leg. D) binding the legs together and elevating them 6' to 8'.
C) applying padded board splints to both sides of the leg.
You have applied a zippered air splint to a patient's left arm. During transport, the patient complains of increased numbness and tingling in his left hand. You reassess distal circulation and note that it remains present. Your MOST appropriate action should be to: A) elevate the injured arm and reassess distal sensory function. B) inflate the splint with more air until the patient is comfortable. C) assess the amount of air in the splint and let air out as necessary. D) remove the air splint and reimmobilize with padded board splints.
C) assess the amount of air in the splint and let air out as necessary.
Which of the following structures is regulated by smooth muscle? A) heart B) skeleton C) blood vessels D) diaphragm
C) blood vessels
Assessing a person's neurovascular status following a musculoskeletal injury includes all of the following, EXCEPT: A) assessing motor function. B) assessing sensory function. C) evaluating proximal pulses. D) determining capillary refill.
C) evaluating proximal pulses.
Traction splints are used primarily to immobilize and secure fractures of the: A) hip. B) pelvis. C) femur. D) humerus.
C) femur.
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
C) if resistance is encountered or the patient experiences severe pain
A 17-year-old football player collided with another player and has pain to his left clavicular area. He is holding his arm against his chest and refuses to move it. Your assessment reveals obvious deformity to the midshaft clavicle. After assessing distal pulse, sensory, and motor functions, you should: A) perform a rapid secondary assessment. B) straighten his arm and apply a board splint. C) immobilize the injury with a sling and swathe. D) place a pillow under his arm and apply a sling.
C) immobilize the injury with a sling and swathe.
Which of the following fractures has the greatest potential for internal blood loss and shock? A) hip B) femur C) pelvis D) humerus
C) pelvis
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.
C) place her onto a scoop stretcher, pad around her left hip with pillows, and secure her to the scoop with straps.
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.
C) positive indicators of a fracture.
During your rapid secondary assessment of a 30-year-old male who fell 25′, 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.
C) stabilize the pelvis with a pelvic binder and protect the spine.
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.
D) delaying transport of a critically injured patient.
The disruption of a joint in which the bone ends are no longer in contact is called a: A) strain. B) sprain. C) fracture. D) dislocation.
D) dislocation
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.
D) in a functional position.
Bones are connected to other bones by bands of tough fibrous tissues called: A) bursa. B) tendons. C) cartilage. D) ligaments.
D) ligaments.
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
D) pelvic fracture with hypotension
The MOST reliable indicator of an underlying fracture is: A) guarding. B) severe swelling. C) obvious bruising. D) point tenderness.
D) point tenderness.
A "hip" fracture is actually a fracture of the: A) pelvic girdle. B) femoral shaft. C) pubic symphysis. D) proximal femur.
D) proximal femur.
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
D) smooth
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.
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.
D) the overlying skin is no longer intact.
Which of the following statements regarding shoulder dislocations is MOST correct?
Most shoulder dislocations occur anteriorly
The pneumatic antishock garment (PASG) would be MOST appropriate to use when immobilizing:
a fractured pelvis
Which of the following statements regarding compartment syndrome is correct? a) Pressure within the fascial compartment is increased b) It most commonly occurs following a pelvic fracture c) It is caused by elevated pressure within the bone cavity d) It most commonly develops within minutes of the injury
a) Pressure within the fascial compartment is increased
A 31-year-old male fell and landed on his left elbow. Your assessment reveals that the elbow is grossly deformed, his forearm is cool and pale, and the distal pulse on the side of the injury is barely palpable. His vital signs are stable and he denies any other injuries. Your transport time to the closest appropriate hospital is approximately 15 minutes. You should:
apply gentle manual traction in line with the limb and reassess for a pulse.
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:
apply high-flow oxygen, consider spinal precautions, and transport without delay
With regard to musculoskeletal injuries, the zone of injury is defined as the:
area of soft-tissue damage surrounding the injury
In moving joints, the ends of the bones are covered with:
articular cartilage
Bone marrow produces:
blood cells.
When caring for a patient with a possible fracture of the scapula, the EMT should:
carefully assess the patient for breathing problems.
When assessing a patient with a possible fracture of the leg, the EMT-B should:
compare to the uninjured leg
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:
control the bleeding and cover the wound with a sterile dressing.
Prior to splinting an open extremity fracture, the EMT-B should first:
cover all bleeding or open wounds
Common signs and symptoms of a sprain include all of the following, EXCEPT:
deformity
Which of the following musculoskeletal injuries would MOST likely result in deformity?
displaced fracture
A(n) __________ fracture occurs in the growth section of a child's bone and may lead to bone growth abnormalities.
epiphyseal
When splinting a possible fracture of the foot, it is MOST important for the EMT to:
leave the toes exposed
Atrophy is a condition that occurs when:
muscle decreases in size and function because of disease or trauma
Smooth muscle is found in all of the following organs, EXCEPT for the:
myocardium
The MOST common and significant complication associated with fractures or dislocations of the knee is:
neurovascular compromise
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:
posterior hip dislocation
A ____________ is a musculoskeletal injury in which there is partial or temporary separation of the bone ends as well as partial stretching or tearing of the supporting ligaments.
sprain
When splinting a suspected fracture of the radius and ulna, the EMT-B should immobilize the:
the elbow and wrist
If a dislocated shoulder has spontaneously reduced before your arrival, the only way to confirm the injury is by noting:
the patient history.
In general, musculoskeletal injuries should be splinted before moving the patient unless:
the patient is clinically unstable
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.
traction
