Chapter 30

55.All of the following male genitalia lie outside the pelvis cavity EXCEPT the A. urethraB. penisC. seminal vesiclesD. testes

: Seminal vesicles.

105.Which of the following is true about injuries to the kidneys?

A sign of kidney damage is hematuria. A penetrating wound that reaches the kidneys almost involves other organs.

27.Open abdominal injury

An injury in which there is a break in the surface of the skin or mucous, exposing deeper tissue to potential contamination.

103.melena

Black, foul-smelling, tarry stool containing digested blood

102.hematuria

Blood in the urine.

98.Low-velocity injuries

Caused by hand-held or hand-powered objects such as knives and other edged weapons

32.Which of the following is NOT a solid organ of the abdomen?

Gallbladder.

108.Which of the following signs would indicate that an injury to the kidney has occurred?

Hematuria

106.You should have an index of suspicion that a patient with pain referred to the right shoulder has an injury to which organ?

Liver

34.Late signs of peritonitis may include A. soft abdomenB. nauseaC. normal bowel soundsD. diarrhea

Nausea.

107.Which of the following are considered solid organs?

Pancreas and spleen

112.Which of the following is an indication of a spleen injury?

Referred left shoulder pain

104.The genitourinary system controls

Reproductive functions, The waste discharge system

42.Blunt abdominal injuries may result from A. a stab woundB. seat beltsC. a gunshot woundD. an impaled object

Seatbelts.

110.What is the major cause of death following injury to a hollow organ in the abdomen?

Sepsis

113.Which of the following statements regarding abdominal trauma is MOST correct?

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

95.peritoneum

The membrane lining the abdominal cavity (parietal peritoneum) and covering the abdominal organs (visceral peritoneum).

23.Flank

The posterior region below the margin of the lower rib cage.

101.flank

The region below the rib cage and above the hip.

90.Which of the following organs is at MOST risk for injury as the result of a pelvic fracture?

Urinary bladder

37.You are dispatched to a motor vehicle collision. You see a 25-year- old woman who was restrained but is complaining of abdominal pain. She is alert and oriented. The patient's airway is open, and she is breathing normally. Her pulse is regular but weak ad rapid. She has a radial pulse. You inspect the abdomen for possible bleeding. You would expect to see all of the following EXCEPT

Urticaria.

85.An unresponsive trauma patient has a large open abdominal wound with massive external bleeding. You should

apply direct pressure to the wound.

13.Injuries to the external male genitalia _______. A. are often life-threateningB. usually result in permanent damageC. frequently lead to hypovolemic shockD. are rarely life-threatening

are rarely life-threatening

83.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. carefully probe the wound to determine its depthB. assume that the arrow injured an internal organC. clean the wound and apply a dry, sterile dressingD. transport only if signs of shock begin to develop.

assume that the arrow injured an internal organ.

109.You are assessing a patient who reports pain that is tearing and describes it as going from the abdomen posteriorly. What should you suspect?

dissecting abdominal aneurysm

116.Airbags, in conjunction with properly worn seatbelts, are of MOST benefit when a person is involved in a

head-on crash.

73.Damage to solid organs typically leads to _______.

hemorrhage

4.Abdominal pain, vomiting, and fever are most likely due to _______. A. hemorrhageB. eviscerationC. infectionD. hypovolemia

infection

76.Abdominal rigidity and periumbilical bruising are signs of _______.

internal bleeding

77.Management of evisceration injuries includes _______.

keeping the injury moist and warm

94.Right lower quadrant (RLQ)

large and small intestines that include the ascending colon and the right half of the transverse colon. descending colon, called the appendix

18.In pediatric patients, the liver and spleen are _______. A. less likely to bleed when injuredB. smaller in proportion to the abdomenC. more protected by the thorax compared to adultsD. larger in proportion to the abdomen

larger in proportion to the abdomen

91.Right upper quadrant (RUQ) consist of?

liver, gallbladder, duodenum of the intestines, and a small portion of the pancreas

114.All of the following are signs of a significant abdominal injury, EXCEPT

localized pain.

5.Placing a pregnant patient in a supine position during the third trimester of pregnancy 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.

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

115.The mesentery is/are

membranous folds that attach the intestines to the walls of the body.

117.It can be difficult to assess the severity of injuries to the genitourinary system following sexual assault because

patients may be hesitant to allow you to examine them.

8.When a hollow organ is punctured during a penetrating injury to the abdomen 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.

peritonitis may not develop for several hours.

118.A 30-year-old male has a large laceration to his right lower abdominal quadrant with a loop of bowel protruding through the wound. When treating this patient, the EMT-B should recall that the

protruding bowel should be kept warm and moist.

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

red areas of skin.

70.The presence of tachycardia following a significant abdominal injury A. indicates a state of decompensated shockB. should be assumed to be a sign of shockC. is most commonly caused by severe painD. is always accompanied by hypo tension

should be assumed to be a sign of shock.

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

spleen.

78.Most of the ________ system lies behind the digestive tract.

urinary

56.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 flankB. a penetrating wound in the lower rib cage or the upper abdomenC. fractures on either side of the lower rib cageD. a hematoma in the umbilical region

A hematoma in the umbilical region.

48.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

A. is there an blood in your stool? B. does your pain go anywhere? C. do you have any nausea, vomiting, or diarrhea? =D. all of the above=

61.In cases of sexual assault, which of the following is true? A. You should always examine the genitalia for any sign of injuryB. Advise the patient not to wash, urinate or defecateC. In addition to recording the facts, it is important to include your personal thoughtsD. You should use plastic bags when collecting items such as clothes

Advise the patient not to wash, urinate, or defecate.

21.Closed abdominal injury

An injury in which there is soft-tissue damage inside the body but the skin remains intact.

58.Suspect a possible injury of the urinary bladder in all of the following findings EXCEPT A. bruising to the left upper quadrantB. blood at the urethral openingC. blood at the tip of the penis or a stain on the patient's underwearD. physical signs of trauma on the lower abdomen, pelvis or perineum

Bruising to the left upper quadrant.

100.High-velocity injuries

Caused by larger weapons such as high-powered rifles and the higher-powered handguns

99.Medium-velocity penetrating wounds

Caused by smaller caliber handguns and shotguns

24.Guarding

Contracting the stomach muscles to minimize the pain of abdominal movement; a sign of peritonitis.

59.When treating a patient with an amputation of the penile shaft, your top priority is A. locating the amputated partB. controlling bleedingC. keeping the remaining tissue dryD. delaying transport until bleeding is controlled

Controlling bleeding.

53.When treating a patient with an evisceration, you should A. attempt to replace the abdominal contentsB. cover the protruding organs with a dry, sterile dressingC. cover the protruding contents with moist, sterile gauze compresses

Cover the protruding contents with moist, sterile gauze compresses.

38.Air in the abdominal cavity can cause all of the following EXCEPT A. painB. diarrheaC. infectionD. tissue ischemia and infarction

Diarrhea.

66.A sign of kidney damage following blunt trauma is

Hematuria.

36.Because solid organs have a rich supply of blood, any injury can result in major A. hemorrhagingB. damageC. painD. guarding

Hemorrhaging.

63.Peritonitis, an intense inflammatory reaction of the abdominal cavity, usually occurs when

Hollow abdominal organs are damaged and spill their contents.

1.Compression injury is most likely due to which of the following? A. Improperly placed lab beltB. Hollow-organ ruptureC. Ejection of unrestrained driverD. Stabbing

Improperly placed lab belt

57.Signs of injury to the kidney may include any of the following EXCEPT A. bruises or lacerations on the overlying skinB. shockC. increased urgency of urinationD. hematuria

Increased urgency of urination.

9.Which of the following is true regarding injury to the kidneys? 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.

Injury to the kidneys usually indicates injury to other organs.

81.Which of the following statements regarding rebound tenderness is correct? It should be assessed for by vigorously palpating the abdomen. Rebound tenderness is a specific sign found with a spleen injury .It is often discovered when the patient is jarred or moved suddenly. The absence of rebound tenderness rules out intra-abdominal injury.

It is often discovered when the patient is jarred or moved suddenly.

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

Law enforcement is at the scene.

26.Kehr sign

Left shoulder pain caused by blood in the peritoneal cavity.

15.Which of the following organs would MOST likely bleed profusely when injured? A. BladderB. LiverC. StomachD. Intestine

Liver

6.When should you visually inspect the external genitalia on your patient? A. Only when ordered by medical directionB. Anytime the patient agrees to treatment and transportC. Always during the secondary assessmentD. Only when there is a complaint of severe pain or other injury

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

29.Solid organs

Solid masses of tissue where much of the chemical work of the body takes place (eg. the liver, spleen, pancreas, and kidneys).

25.Hollow organs

Structures through which materials pass, such as the stomach, small intestines, large intestines, ureters, and urinary bladder.

44.The most common sign of significant abdominal injury is A. painB. tachycardiaC. rigidityD. distention

Tachycardia.

28.Peritoneal cavity

The abdominal cavity.

16.Which of the following statements regarding abdominal eviscerations is correct? A. The protruding organs should be kept warm and moist.B. Adherent material is preferred when covering an evisceration.C. The organs should be replaced carefully to avoid heat loss.D. Most eviscerations occur to the left upper quadrant.

The protruding organs should be kept warm and moist.

92.Left upper quadrant (LUQ)

The stomach occupies most of the LUQ, but it shares this space with the spleen. The pancreas occupies some of this space but is mostly posterior to the region.

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

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

3.You should suspect a kidney injury anytime the patient presents with _______. A. abdominal distentionB. dyspneaC. a hematoma in the flank regionD. nausea

a hematoma in the flank region

67.The mesentery is

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

80.Compression injuries to the abdomen that occur during a motor vehicle crash are typically the result of A. air bag deploymentB. a poorly placed lap beltC. failure to wear seat beltsD. rapid vehicle deceleration

a poorly placed lap belt.

89.When documenting a call involving a female patient who was sexually assaulted, the EMT should

avoid speculation and document only factual data.

14.Your documentation on a sexual assault victim should _______. A. be subjective and summarize the crimeB. be objective and factualC. include your opinion of the nature of the incidentD. describe the status of the suspect(s)

be objective and factual

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

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

87.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

blunt injury to the kidney.

75.The temporary wound channel caused by high-velocity weapons is called _______.

cavitation

17.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 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.

closely monitor him and reassess him frequently.

7.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 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.

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

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

diaphragm.

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

distention.

84.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 covering him with a warm blanket. giving him small sips of plain water. promptly transporting to the hospital. administering supplemental oxygen.

giving him small sips of plain water.

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

guarding.

11.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 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.

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

72.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. rupture of a hollow organ.C. a severe liver laceration.D. intra-abdominal bleeding.

intra-abdominal bleeding.

82.While 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. life the air bag and look for deformity to the steering wheel.B. carefully assess her upper chest for seat belt-related injuriesC. perform a head-to-toe assessment while she is in the carD. extricate her immediately and transport to a trauma center

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

12.Because the depth of an open abdominal wound is often difficult to determine 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.

prompt transport to the hospital is essential.

74.What is the most common mechanism of injury in geriatric patients?

Falls

60.In any case of trauma to a female patient, you should always determine if the patient A. is on birth controlB. is pregnantC. is currently menstruatingD. has a history of ovarian cysts

Is pregnant.

54.The solid organs of the urinary system include the A. kidneysB. uretersC. bladderD. urethra

Kidneys.

86.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

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

49.When used alone, diagonal shoulder safety belts can cause all of the following EXCEPT

A ruptured appendix.

35._______ takes place in the solid organs. A. digestionB. ExcretionC. Energy productionD. Absorption

Energy production.

64.Contraction or tensing of the abdominal muscles in an effort to ease pain is called A. referring.B. flexing.C. withdrawing.D. guarding.

Guarding.

52.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 peritoneumB. has entered the abdominal cavityC. has possibly injured one or more organsD. all of the above

Has penetrated the peritoneum, has entered the abdominal cavity, or has possibly injured one or more organs.

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

Have you experienced recent abdominal trauma?

50.You are dispatched to a motor vehicle collision. Your patient is a 42-year-old restrained woman. The air bag did deploy, and the woman has abrasions on her face. She is complaining of pain to both her chest and abdomen. Her airway is open and respirations are within normal limits. Her pulse is a little rapid but strong and regular. She has distal pulses. In assessing this patient, which of the following statements is NOT true?

If light touch elicits pain, perform deep palpation to assess further injury.

45.Late signs of abdominal injury include all of the following EXCEPT

Increased blood pressure.

96.guarding

Involuntary muscle contractions (spasm) of the abdominal wall to minimize the pain of movement and protect the inflamed abdomen; a sign of peritonitis

47.You respond to an 18-year-old high school football player who was hit in the right flank with a helmet several hours ago. He is complaining of pain in the area. He is alert and oriented. His airway is open, and his respirations are within normal limits. His pulse is rapid and regular. He has a radial pulse. He tells you that he is noticing blood in his urine. Based on this information, the patient is likely to have an injury to the A. liverB. kidneyC. gallbladderD. appendix

Kidney.

31.Which of the following is NOT a hollow organ of the abdomen? A. StomachB. LiverC. BladderD. Urters

Liver.

40.The largest organ in the abdomen is the A. liverB. spleenC. pancreasD. kidneys

Liver.

62.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.

Liver.

97.Three levels of velocity that are common in traumatic injuries

Low-velocity injuries; Medium-velocity penetrating wounds; High-velocity injuries

46.Your primary concern when dealing with an unresponsive patient with an open abdominal injury is A. covering the wound with a moist dressingB. maintaining the airwayC. controlling the bleedingD. monitoring vital signs

Maintaining the airway.

33.The first signs of peritonitis include all of the following EXCEPT A. severe abdominal painB. tendernessC. muscular spasmD. nausea

Nausea.

43.The major complaint of patients with abdominal injury is A. painB. tachycardiaC. rigidityD. swelling

Pain.

51.Patients with open abdominal injuries often complain of

Pain.

41.Open abdominal injuries are also known as A. blunt injuriesB. eviscerationsC. penetrating injuriesD. peritoneal injuries

Penetrating injuries.

39.The abdomen is divided into four

Quadrants.

22.Evisceration

The displacement of organs outside of the body.

93.Left lower quadrant (LLQ)

The left lower quadrant holds both the large and small intestines, notably the descending colon and the left half of the transverse colon.

30.All of the following systems contain organs that make up the contents of the abdominal cavity EXCEPT A. the digestive systemB. the urinary systemC. the genitourinary systemD. the limbic system

The limbic system.

111.What is the purpose of wrapping a sexual assault victim in a burn sheet?

To preserve potential evidence

20.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 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.

applying direct pressure with a dry, sterile dressing.