Chapter 30: Abdominal and Genitourinary injuries.

A sign of kidney damage following blunt trauma is: A) hematuria. B) hemoptysis. C) hematemesis. D) hematochezia.

A) hematuria.

What is the most common mechanism of injury in geriatric patients? A. Falls B. motor vehicle accidents C. assaults D. suicide

A. Falls

An unresponsive trauma patient has a large open abdominal wound with massive external bleeding. You should: A. open the patient's airway B. apply direct pressure to the wound C. apply oxygen via a nonrebreathing mask D. ventilate the patient with a BVM

B. apply direct pressure to the wound

Airbags, in conjunction with properly worn seatbelts, are MOST beneficial when a person is involved in a: A. rollover crash. B. lateral collision. C. head-on crash. D. rear-end collision.

C. head-on crash.

Which of the following statements is true? A. Low-velocity injuries produce extensive temporary wound channels. B. There are four levels of velocity. C. The higher the velocity of a projectile, the larger the cavity it produces. D. The velocity of an object is not a critical determination in your assessment.

C. The higher the velocity of a projectile, the larger the cavity it produces. That's Correct!

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

C. infection

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. the limbic system

Kehr Sign

Left shoulder pain caused by blood in the peritoneal cavity

A man has a large laceration across his lower abdominal wall and a loop of bowel is protruding from the wound. He is conscious and alert and there is minimal bleeding from the wound. You should: A. Cover the exposed bowel with a moist sterile dressing and then secure it in place with a dry bandage. B. gently irrigate the exposed bowel with sterile saline and then cover the wound with a dry sterile dressing. C. cover the bowel with a dry sterile dressing, elevate his lower extremities, and cover him with a blanket. D. make one attempt to replace the bowel back into the abdomen and then cover the wound with a sterile dressing

A. Cover the exposed bowel with a moist sterile dressing and then secure it in place with a dry bandage.

You are assessing a patient who reports pain that is tearing and describes it as going from the abdomen posteriorly. What should you suspect? A. Dissecting abdominal aneurysm B. Kidney damage C. Ruptured appendix D. Gallbladder inflammation

A. Dissecting abdominal aneurysm That's Correct! Patients with a dissecting abdominal aneurysm report tearing going from the abdomen posteriorly.

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

A. Improperly placed lap belt

When worn properly, a seatbelt should lie: A. below the anterior superior iliac spines of the pelvis and against the hip joints. B. across the abdominal wall at the level of the diaphragm and below the hip joints. C. above the anterior-posterior iliac spines of the pelvis and below the hip joints. D. across the abdominal wall at the level of the umbilicus and against the hip joints.

A. below the anterior superior iliac spines of the pelvis and against the hip joints.

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. bruising to the left upper quadrant

Accumulation of blood in the abdominal cavity will MOST likely cause: A. distention. B. referred pain. C. diffuse bruising. D. nausea or vomiting.

A. distention.

Bruising to the right upper quadrant of the abdomen following blunt trauma is MOST suggestive of injury to the: A. liver. B. spleen. C. kidney. D. stomach.

A. liver.

The major complaint of patients with abdominal injury is: A. pain B. tachycardia C. rigidity D. swelling

A. pain

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

A. prompt transport to the hospital is essential.

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. Advise the patient not to wash, urinate or defecate

Which of the following is an indication of a spleen injury? A. Referred right shoulder pain B. Referred left shoulder pain C. Radiating pain from left upper quadrant down through the flank D. Hematuria

B. Referred left shoulder pain That's Correct! Referred left shoulder pain is a potential indication of a splenic injury because the spleen is in the upper left quadrant.

Which of the following statements regarding abdominal trauma is correct? A. Most of the vital abdominal organs lie within the retroperitoneal space. B. The absence of abdominal pain does not rule out intra-abdominal bleeding. C. The liver is well protected and is rarely injured during a traumatic event. D. Hollow abdominal organs are vascular and bleed profusely when injured.

B. The absence of abdominal pain does not rule out intra-abdominal bleeding.

What is the purpose of wrapping a sexual assault victim in a burn sheet? A. To maintain body temperature as a result of shock B. To preserve potential evidence C. To protect the patient's privacy D. To keep the patient calm (swaddling)

B. To preserve potential evidence That's Correct! Wrapping a sexual assault victim in a burn sheet helps preserve potential evidence (ie, hair, fluid, or fiber from the alleged offender).

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. controlling bleeding

Air in the abdominal cavity can cause all of the following EXCEPT: A. pain B. diarrhoea C. infection D. tissue ischemia and infarction

B. diarrhoea

A 40-year-old male presents with severe abdominal pain following blunt trauma. He is diaphoretic, intensely thirsty, and has a weak and rapid pulse. Appropriate treatment for this patient includes all of the following, EXCEPT: A. Covering him with a warm blanket B. giving him small sips of plain water C. promptly transporting to the hospital D. administering supplemental oxygen

B. giving him small sips of plain water

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. suction his oropharynx to ensure it is clear of secretions and then increase the oxygen flow rate to 15 L/min. B. insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM. C. perform a comprehensive secondary assessment to determine why his clinical status has changed. 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.

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. is pregnant

You are dispatched to a residence for a young female who was kicked in the abdomen. While en route to the scene, you should ask the dispatcher if: A. the patient is conscious B. law enforcement is at the scene C. there are other patients involved D. the severity of the injury is known.

B. law enforcement is at the scene

When assessing a 21-year-old female who struck a tree head-on with her small passenger car, you note that her air bag deployed. You should: A. perform a head-to-toe assessment while she is in the car. B. lift the air bag and look for deformity to the steering wheel. C. carefully assess her upper chest for seatbelt-related injuries D. extricate her immediately and transport to a trauma centre.

B. lift the air bag and look for deformity to the steering wheel.

Which of the following organs would MOST likely bleed profusely when injured? A. bladder B. liver C. stomach D. intestine

B. liver

Late signs of peritonitis may include: A. soft abdomen B. nausea C. normal bowel sounds D. diarrhoea

B. nausea

The most common sign of significant abdominal injury is: A. pain B. tachycardia C. rigidity D. distention

B. tachycardia

Most of the ________ system lies behind the digestive tract. A. reproductive B. urinary C. endocrine D. peripheral nervous

B. urinary

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

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

Which of the following organs is at MOST risk for injury as a result of a pelvic fracture? A. Pancreas B. Fallopian tubes C. Urinary bladder D. Liver or spleen

C. Urinary bladder

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

C. a haematoma in the flank region

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

C. a poorly placed lap belt

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 assessment reveals that he is conscious and alert with stable vital signs. The entrance wound is bleeding minimally and appears to be superficial. You should: A. Transport only if signs of shock begin to develop B. carefully probe the wound to determine its depth C. assume that the arrow injured an internal organ D. clean the wound and apply a dry, sterile dressing.

C. assume that the arrow injured an internal organ

A football player was struck by another player in the right flank area just below the posterior rib cage. He complains of severe pain and point tenderness to the area. Your assessment reveals that there is a small amount of blood in his underwear. You should be MOST suspicious for: A. external genitalia injury B. a lacerated liver or spleen C. blunt injury to the kidney D. a ruptured urinary bladder

C. blunt injury to the kidney

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

C. diaphragm.

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. increased urgency of urination

Abdominal rigidity and periumbilical bruising are signs of ______ A. infection B. umbilical trauma C. internal bleeding D. intestinal blockage.

C. internal bleeding

During your assessment of a patient who experienced blunt trauma to the abdomen, you notice bruising around the umbilicus. This is a sign of: A. a ruptured spleen. B. a severe liver laceration. C. intra-abdominal bleeding. D. rupture of a hollow organ.

C. intra-abdominal bleeding.

Open abdominal injuries are also known as: A. blunt injuries B. eviscerations C. penetrating injuries D. peritoneal injuries

C. penetrating injuries

Your patient with evisceration becomes tachycardic, cool, and hypotensive during transport; your next action should be to A. replace the dressing. B. support the injury with the patient's arm. C. reevaluate priority status and expedite transport. D. loosen one corner of the dressing.

C. reevaluate priority status and expedite transport.

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

C. seminal vesicles

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. All of the above

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 pulse is rapid. 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. What does your blood pressure normally run? B. Do you take any over-the-counter medications? C. Has blood soaked through your undergarments? D. Have you experienced recent abdominal trauma?

D. Have you experienced recent abdominal trauma?

Management of evisceration injuries includes_________. A. keeping the injury cool and dry B. applying firm, direct pressure C. closing the injury with duct tape D. Keeping the injury moist and warm

D. Keeping the injury moist and warm

Where is abdominal injury most likely to occur in young children? A. Appendix B. Fractured ribs C. Gallbladder D. Liver

D. Liver That's Correct! In paediatric patients, the liver and spleen are very large in proportion to the size of the abdominal cavity and are more easily injured. The soft, flexible ribs of infants and young children do not protect these two organs very well and may allow an injury to underlying organs, even without fracturing the ribs.

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. all of the above

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

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

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

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

The first signs of peritonitis include all of the following EXCEPT: A. severe abdominal pain B. tenderness C. muscular spasm D. nausea

D. nausea

A 22-year-old male was punched in the abdomen several times. You find him lying on his left side with his knees drawn up. He is conscious and alert and complains of increased pain and nausea when he tries to straighten his legs. His blood pressure is 142/82 mm Hg, his pulse rate is 110 beats/min and strong, and his respirations are 22 breaths/min and regular. In addition to administering high-flow oxygen, you should: A. apply full spinal motion restriction precautions. B. keep him on his side but gently straighten his legs. C. place him supine but allow him to keep his knees bent. D. transport him in the position in which you found him.

D. transport him in the position in which you found him.

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

A. Kehr sign.

Bruising over the right upper quadrant could indicate injury to which of the following? A. Liver B. Colon C. Kidney D. Appendix

A. Liver That's Correct! The liver is found in the right upper quadrant, along with the gallbladder, duodenum of the intestines, and a small portion of the pancreas.

A sign of kidney damage following blunt trauma is: A. haematuria B. haemoptysis C. haematemesis D.haematochezia

A. haematuria

The largest organ in the abdomen is the: A. liver B. spleen C. pancreas D. kidneys

A. liver

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

C. peritonitis may not develop for several hours.

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

C. should be assumed to be a sign of shock.

Which of the following statements regarding trauma during pregnancy is correct? A. Uterine trauma in the pregnant patient rarely leads to severe bleeding. B. Uterine trauma is likely to cause shock in the pregnant patient C. Uterine blood supply is greatly reduced during pregnancy D. The uterus serves as a resevoir for blood supply during pregnancy

B. Uterine trauma is likely to cause shock in the pregnant patient

Your patient is the driver of a car that was hit head on. You find her lying on the sidewalk with her knees drawn toward her chest. She has no specific complaints. You suspect A. little or no injury because she has gotten out of the car. B. abdominal trauma due to mechanism of injury and positioning. C. cavitational injuries due to mechanism of injury. D. paradoxical motion due to patient positioning.

B. abdominal trauma due to mechanism of injury and positioning.

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. maintaining the airway

Early bruising following abdominal trauma often manifests as: A. localized pain. B. red areas of skin. C. gross distention. D. dark purple marks.

B. red areas of skin.

The damage that results from ruptured hollow abdominal organs is A. treatable in the field. B. caused by profuse bleeding. C. caused by acids and bacteria. D. non-life-threatening.

C. caused by acids and bacteria.

The temporary wound channel caused by high-velocity weapons is called________ A. ballistics B. a projectile C. cavitation D. wound cycling

C. cavitation

Which of the following statements regarding rebound tenderness is correct? A. it should be assesed for by vigorously palpating the abdomen. B. rebound tenderness is a sign found with a spleen injury C. it is often discovered when the patient is jarred or moved suddenly D. the absence of rebound tenderness rules out intra-abdominal injury.

C. it is often discovered when the patient is jarred or moved suddenly

You should have an index of suspicion that a patient with pain referred to the right shoulder has an injury to which organ? A. Bladder B. Intestine C. Kidney D. Liver

D. Liver That's Correct! injury to the liver (or spleen) may present with referred pain to the shoulders. (LIVER IS RIGHT SHOULDER, SPLEEN IS LEFT) Unlike radiating pain, which is characterized by pain that "moves" from one area of the body to another, referred pain is characterized by pain in two separate locations.

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. Always during the secondary assessment D. Only when there is a complaint of severe pain or other injury

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

Which of the following are considered solid organs? A. Liver and intestines B. Kidneys and bladder C. Spleen and stomach D. Pancreas and spleen

D. Pancreas and spleen That's Correct! Both the pancreas and spleen are solid organs.

What is the major cause of death following injury to a hollow organ in the abdomen? A. Evisceration B. Internal haemorrhage C. Rigidity D. Sepsis

D. Sepsis That's Correct! The major cause of death when hollow abdominal organs are involved is sepsis, which typically occurs later in the hospital.

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 haematoma in the umbilical region

D. a haematoma in the umbilical region

The mesentery is: A. the point of attachment between the small and large intestines. B. a layer of thick skeletal muscles that protects the abdominal organs. C. a complex network of blood vessels that supply blood to the liver. D. a membranous fold that attaches the intestines to the walls of the body.

D. a membranous fold that attaches the intestines to the walls of the body.

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

D. are rarely life-threatening

When documenting a call involving a female patient who was sexually assaulted, the EMT should: A. theorise as to why the sexual assault occured B. include the results of his or her internal vaginal exam C. include a description of the suspected perpetrator D. avoid speculation and document only factual data

D. avoid speculation and document only factual data

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

D. closely monitor him and reassess him frequently.

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

D. guarding.

Damage to solid organs typically leads to ________. A. sepsis B. fever C. hypertension D. haemorrhage

D. haemorrhage

Peritonitis, an intense inflammatory reaction of the abdominal cavity, usually occurs when: A. solid abdominal organs bleed secondary to penetrating trauma. B. the vessels that supply the abdominal organs become inflamed. C. bacteria or viruses invade the walls of the gastrointestinal tract. D. hollow abdominal organs are damaged and spill their contents.

D. hollow abdominal organs are damaged and spill their contents.

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

D. larger in proportion to the abdomen

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. is recommended if the patient has severe abdominal discomfort. C. often causes hypotension secondary to cardiac compression. D. may decrease the amount of blood that returns to the heart.

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