Chapters 25 to 29: Exam 3 Part 2

Pleural fluid is contained between the:

Select one:

A. parietal pleura and the heart.
B. visceral and parietal pleurae.
C. parietal pleura and the chest wall.
D. visceral pleura and the lung.

The nerves control the diaphragm.

Select one:

A. vagus
B. intercostal
C. costal
D. phrenic

The phrenic nerves control the diaphragm and exit the spinal cord at:

Select one:

A. C1 and C2.
B. C3, C4, and C5.
C. C3 and C4.
D. C1, C2, and C3.

Which of the following organs or structures does NOT reside within the mediastinum?

Select one:

A. Vena cavae
B. Lungs
C. Trachea
D. Esophagus

Accumulation of blood in the abdominal cavity will MOST likely cause:

Select one:

A. nausea or vomiting.
B. distention.
C. diffuse bruising.
D. referred pain.

Assuming that no obvious signs of intra-abdominal injury are present, which of the following injuries would MOST likely cause an injury to the liver or spleen to be overlooked?

Select one:

A. Shoulder fracture
B. Pelvic fracture
C. Lumbar spine fracture
D. Femur fracture

Bruising to the right upper quadrant of the abdomen following blunt trauma is MOST suggestive of injury to the:

Select one:

A. kidney.
B. stomach.
C. liver.
D. spleen.

Contraction or tensing of the abdominal muscles in an effort to ease pain is called:

Select one:

A. guarding.
B. flexing.
C. referring.
D. withdrawing.

During your assessment of a patient who experienced blunt trauma to the abdomen, you notice bruising around the umbilicus. This is a sign of:

Select one:

A. intra-abdominal bleeding.
B. rupture of a hollow organ.
C. a ruptured spleen.
D. a severe liver laceration.

Early bruising following abdominal trauma often manifests as:

Select one:

A. red areas of skin.
B. dark-purple marks.
C. localized pain.
D. gross distention.

Peritonitis usually occurs when:

Select one:

A. hollow abdominal organs are damaged and spill their contents into the peritoneal cavity.
B. the vessels that supply the abdominal organs become inflamed.
C. bacteria or viruses invade the walls of the gastrointestinal tract.
D. solid abdominal organs bleed secondary to penetrating trauma.

The mesentery is:

Select one:

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

The presence of tachycardia following a significant abdominal injury:

Select one:

A. should be assumed to be a sign of shock.
B. indicates a state of decompensated shock.
C. is always accompanied by hypotension.
D. is most commonly caused by severe pain.

When worn properly, a seatbelt should lie:

Select one:

A. across the abdominal wall at the level of the diaphragm and below the hip joints.
B. across the abdominal wall at the level of the umbilicus and against the hip joints.
C. below the anterior superior iliac spines of the pelvis and against the hip joints.
D. above the anterior posterior iliac spines of the pelvis and below the hip joints.

A 20-year-old male collided with another player during a hockey game and complains of severe pain to the left shoulder. Assessment reveals that the clavicle is bulging anteriorly at the shoulder. The EMT should suspect:

Select one:

A. separation of the acromioclavicular joint.
B. dislocation of the glenohumeral joint.
C. posterior dislocation of the shoulder.
D. multiple fractures of the proximal humerus.

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:

Select one:

A. a thoracic spine fracture.
B. anterior hip dislocation.
C. fracture of the tibia or fibula.
D. posterior hip dislocation.

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:

Select one:

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.

A Colles fracture involves a fracture of the:

Select one:

A. distal radius.
B. distal ulna.
C. proximal radius.
D. radius and ulna.

A fracture caused by minimal force that is associated with diseases such as cancer and osteoporosis is called a __ fracture.

Select one:

A. comminuted
B. transverse
C. greenstick
D. pathologic

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:

Select one:

A. lumbar spine.
B. symphysis pubis.
C. coccygeal spine.
D. thoracic spine.

A(n) __ fracture occurs in the growth section of a child's bone and may lead to bone growth abnormalities.

Select one:

A. metaphyseal
B. greenstick
C. epiphyseal
D. diaphyseal

Atrophy is a condition that occurs when:
Select one:
A. muscle decreases in size and function.
B. the tendons that attach muscle to bone become stretched or injured.
C. carbon dioxide, lactic acid, and other wastes accumulate in the muscle.
D. increased use of skeletal muscle causes an increase in its strength.

Bone marrow produces:

Select one:

A. cartilage.

B. electrolytes.

C. lymphocytes.

D. blood cells.

Bones are connected to other bones by bands of tough fibrous tissues called:

Select one:

A. bursa.

B. ligaments.

C. cartilage.

D. tendons.

Care for a patient with a fractured tibia and suspected compartment syndrome includes:
Select one:
A. keeping the leg at the level of the heart.
B. applying traction to maintain distal pulses.
C. immobilizing the leg with an air splint.
D. applying chemical hot packs to the leg.

Common signs and symptoms of a sprain include all of the following, EXCEPT:

Select one:

A. swelling.

B. deformity.

C. ecchymosis.

D. point tenderness.

Deformity caused by a fracture would MOST likely be masked by:

Select one:

A. swelling.

B. ecchymosis.

C. crepitus.

D. guarding.

Femoral shaft fractures can result in up to _____ mL of internal blood loss.

Select one:

A. 1,500

B. 4,000

C. 2,000

D. 1,000

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:
Select one:
A. apply high-flow oxygen, perform a detailed secondary assessment, and transport.
B. focus your assessment on his scapulae and clavicles and apply high-flow oxygen.
C. apply high-flow oxygen, consider spinal precautions, and transport without delay.
D. hyperventilate him with a BVM and monitor his oxygen saturation.

If a dislocated shoulder has spontaneously reduced before your arrival, the only way to confirm the injury is by noting:

Select one:

A. the presence of deformity.

B. bruising to the shoulder.

C. distal circulation.

D. the patient history.

In moving joints, the ends of the bones are covered with:

Select one:

A. articular cartilage.

B. gliding cartilage.

C. synovial tendons.

D. muscular fascia.

The act of pulling on a body structure in the direction of its normal alignment is called:

Select one:

A. traction.

B. reduction.

C. stabilization.

D. immobilization.

The MOST common and significant complication associated with fractures or dislocations of the knee is:

Select one:

A. ligament and cartilage damage.

B. total depletion of synovial fluid.

C. neurovascular compromise.

D. internal bleeding and shock.

The MOST commonly fractured bone(s) in the body is/are the:

Select one:

A. clavicle.

B. radius and ulna.

C. midshaft femur.

D. scapula.

A factory worker was splashed in the eyes with a strong acid chemical. He complains of intense pain and blurred vision. Your ambulance does not carry bottles of sterile saline or water. You should:

Select one:

A. irrigate both eyes continuously for 20 minutes with plain water.
B. flush both eyes with an alcohol-based solution and transport.
C. neutralize the acid chemical in his eye with an alkaline chemical.
D. mix baking soda with water and irrigate his eyes with the solution.

A 39-year-old male was struck in the head by a baseball during a game. He is confused and has slurred speech. He has a large hematoma in the center of his forehead and cannot remember the events preceding the injury. After manually stabilizing his head and assessing his airway, you should:

Select one:

A. administer high-flow oxygen.

B. apply ice to the hematoma.

C. perform a neurologic exam.

D. palpate his radial pulses.

Which of the following statements regarding gunshot wounds is correct?

Select one:

A. high- velocity bullets will cause less severe internal injuries
B. the size of a bullet has the greatest impact on producing injury
C. low- velocity bullets will cause the greatest amount of trauma
D. the speed of a bullet has the greatest impact on producing injury

A 4-year-old female has a peanut lodged in the external auditory canal of her right ear. You should:

Select one:

A. transport her to the emergency department.
B. thoroughly flush her ear with sterile saline.
C. remove the peanut with a cotton-tipped swab.
D. use tweezers to try to remove the object.

A 67-year-old male presents with weakness, dizziness, and melena that began approximately 2 days ago. He denies a history of trauma. His blood pressure is 90/50 mm Hg and his pulse is 120 beats/min and thready. You should be MOST suspicious that this patient is experiencing:

Select one:

A. acute appendicitis.
B. an aortic aneurysm.
C. gastrointestinal bleeding.
D. intrathoracic hemorrhaging.

The ideal procedure for moving an injured patient from the ground to a backboard is:

Select one:

A. the use of a scoop stretcher.
B. the clothes drag.
C. the direct patient carry.
D. the four-person log roll.

Which of the following statements regarding the vitreous humor is correct?

Select one:

A. It is a clear, watery fluid surrounding the eye and can be replaced if it is lost.
B. It is a clear, jellylike fluid near the back of the eye that cannot be replaced if it is lost.
C. It is a clear fluid that is produced by the lacrimal glands and cannot be replaced if it is lost.
D. It is a clear, watery fluid that is located in front of the lens and can be replaced if it is lost.

What part of the nervous system controls the body's voluntary activities?

Select one:

A. Central
B. Sensory
C. Somatic
D. Autonomic

A 43-year-old man is experiencing a severe nosebleed. His blood pressure is 190/110 mm Hg and his heart rate is 90 beats/min and bounding. The preferred treatment for this patient includes:

Select one:

A. placing a rolled 4² × 4² dressing between his lower lip and gum.

B. having the patient pinch his own nostrils and then lie supine.

C. pinching the patient's nostrils and having him lean forward.

D. packing both nostrils with gauze pads until the bleeding stops.

In which of the following patients should you remove an impaled object?

Select one:

A. A pulseless and apneic patient with a knife impaled in the back

B. A semiconscious patient with an ice pick impaled in the chest

C. An apneic patient with a shard of glass impaled in the abdomen

D. A conscious and alert patient with a fishhook impaled in the eye

Internal bleeding into a fractured extremity is MOST often controlled by:

Select one:

A. splinting the extremity.

B. applying a tourniquet.

C. keeping the patient warm.

D. applying chemical ice pack.

What mechanism(s) does the body use to control bleeding?

Select one:

A. Clotting

B. Coagulation

C. Vasoconstriction

D. All of these answers are correct.

Which types of motor vehicle collisions present the greatest potential for multiple impacts?

Select one:

A. Lateral and rollover
B. Frontal and rotational
C. Rotational and rollover
D. Rear-end and rotational

Burns to pediatric patients are generally considered more serious than burns to adults because:

Select one:

A. most burns in children are the result of child abuse.

B. pediatric patients have a proportionately larger volume of blood.

C. pediatric patients are more prone to hyperthermia.

D. pediatric patients have more surface area relative to total body mass.

A 21-year-old male was working in an auto repair shop and sustained radiator burns to the anterior aspect of both arms and to his anterior chest. According to the rule of nines, this patient has burns that cover _ of his BSA.

Select one:

A. 45%

B. 27%

C. 18%

D. 36%

Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed unless:

Select one:

A. sensory and motor functions remain intact.
B. the patient adamantly denies neck pain.
C. lateral immobilization has been applied.
D. it causes a problem managing the airway.

A 6-year-old female was riding her bicycle and struck a clothesline with her throat. She is breathing, but with obvious difficulty. Your assessment reveals a crackling sensation in the soft tissues of her neck and facial cyanosis. In addition to the appropriate airway management, the intervention that will MOST likely improve her chance of survival is:

Select one:

A. careful monitoring her vital signs.
B. rapidly transporting her to the hospital.
C. quickly immobilizing her spinal column.
D. requesting a paramedic ambulance.

When assessing a patient who experienced a blast injury, it is important to remember that:

Select one:

A. solid organs usually rupture from the pressure wave.
B. secondary blast injuries are usually the least obvious.
C. primary blast injuries are the most easily overlooked.
D. primary blast injuries are typically the most obvious.

Which of the following statements regarding crush syndrome is correct?

Select one:

A. With crush syndrome, massive blood vessel damage occurs following severe soft-tissue injuries, such as amputation of an extremity.

B. Tissue damage that occurs in crush syndrome is severe, but kidney injury is unlikely because toxins are quickly eliminated from the body.

C. Compromised arterial blood flow leads to crush syndrome and can occur when an area of the body is trapped for longer than 4 hours.

D. Provided that a patient with a crush injury is freed from entrapment within 6 hours, the amount of tissue damaged is generally minimal.

A man jumped from the roof of his house and landed on his feet. He complains of pain to his heels, knees, and lower back. This mechanism of injury is an example of:

Select one:

A. hyperflexion.
B. axial loading.
C. hyperextension.
D. distraction.

Which of the following breathing patterns is MOST indicative of increased intracranial pressure?

Select one:

A. Increased rate with a normal inspiratory time and a prolonged expiratory time

B. Increased rate and depth with the distinct odor of acetone on the patient's breath

C. Irregular rate, pattern, and volume of breathing with intermittent periods of apnea

D. Slow, shallow, occasional gasps that progress to prolonged periods of apnea

A 56-year-old male has an incomplete avulsion to his right forearm. After controlling any bleeding from the wound, you should:

Select one:

A. carefully remove the avulsed flap and wrap it in a moist, sterile trauma dressing.

B. replace the avulsed flap to its original position and cover it with a sterile dressing.

C. thoroughly irrigate the wound with sterile water and cover it with a sterile dressing.

D. carefully probe the wound to determine if the bleeding is venous or arterial.

A tight-fitting motorcycle helmet should be left in place unless:

Select one:

A. the patient must be placed onto a long backboard.
B. the patient complains of severe neck or back pain.
C. the helmet is equipped with a full face shield or visor.
D. it interferes with your assessment of the airway.

While en route to a major motor vehicle crash, an on-scene police officer advises you that a 6-year-old male who was riding in the front seat is involved. He further states that the child was only wearing a lap belt and that the air bag deployed. On the basis of this information, you should be MOST suspicious that the child has experienced:

Select one:

A. neck and facial injuries
B. blunt trauma to the head
C. open abdominal trauma
D. lower extremity fractures

According to the Association of Air Medical Services, you should consider air medical transport of a trauma patient if:

Select one:

A. the patient requires advanced life support care and stabilization, and the nearest ALS-ground ambulance is more than 5 to 10 minutes away.

B. traffic conditions hamper the ability to get the patient to a trauma center by ground within the ideal time frame for the best clinical outcome.

C. ground transport will take your ambulance out of service for an extended period of time, regardless of the severity of the patient's injuries.

D. he or she was involved in a motor vehicle crash in which another occupant in the same vehicle was killed, even if your patient's injuries are minor.

The five sections of the spinal column, in descending order, are the:

Select one:

A. thoracic, cervical, lumbar, coccygeal, and sacral.
B. cervical, coccygeal, thoracic, sacral, and lumbar.
C. cervical, thoracic, lumbar, sacral, and coccygeal.
D. coccygeal, sacral, lumbar, thoracic, and cervical.

During your primary assessment of a 19-year-old unconscious male who experienced severe head trauma, you note that his respirations are rapid, irregular, and shallow. He has bloody secretions draining from his mouth and nose. You should:

Select one:

A. assist his ventilations with a BVM.
B. immobilize his spine and transport immediately.
C. pack his nostrils to stop the drainage of blood.
D. suction his oropharynx for up to 15 seconds.

A 15-year-old female was struck by a small car while riding her bicycle. She was wearing a helmet and was thrown to the ground, striking her head. In addition to managing problems associated with airway, breathing, and circulation, it is MOST important for you to:

Select one:

A. leave her bicycle helmet on.
B. obtain baseline vital signs.
C. stabilize her entire spine.
D. inspect the helmet for cracks.

The severity of bleeding should be based on all of the following findings, EXCEPT:

Select one:

A. clinical signs and symptoms.

B. the mechanism of injury.

C. systolic blood pressure.

D. poor general appearance.

Which of the following interventions is the MOST critical to the outcome of a patient with multisystem trauma?

Select one:

A. Intravenous fluid administration
B. Early administration of oxygen
C. Rapid transport to a trauma center
D. Elevation of the lower extremities

A 33-year-old male sustained an abdominal evisceration to the left lower quadrant of his abdomen after he was cut with a large knife. After appropriately managing his ABCs and assessing him for other life-threatening injuries, how you should care for his wound?

Select one:

A. Carefully replace the exposed bowel into the abdomen and transport.

B. Cover it with moist, sterile gauze and secure with an occlusive dressing.

C. Irrigate it with sterile water and cover it with a dry dressing.

D. Cover the exposed bowel and keep his legs in a straight position.

In older patients, the first indicator of non-traumatic internal bleeding may be:

Select one:

A. a low blood pressure.

B. weakness or dizziness.

C. diaphoresis and pale skin.

D. a heart rate over 120 beats/min.

In contrast to a cerebral concussion, a cerebral contusion:

Select one:

A. does not cause pressure within the skull.
B. involves physical injury to the brain tissue.
C. usually does not cause a loss of consciousness.
D. results from a laceration to the brain tissue.

Common signs and symptoms of a serious head injury include all of the following, EXCEPT:

Select one:

A. widening pulse pressure.
B. a rapid, thready pulse.
C. decerebrate posturing.
D. CSF leakage from the ears.

The index of suspicion is MOST accurately defined as:

Select one:

A. the detection of less obvious life-threatening injuries.
B. a predictable pattern that leads to serious injuries.
C. your awareness and concern for potentially serious underlying injuries.
D. the way in which traumatic injuries occur.

Which of the following statements regarding secondary brain injury is correct?

Select one:

A. Because cerebral edema develops quickly, it is considered to be a primary brain injury.

B. Hypoxia and hypotension are the two most common causes of secondary brain injury.

C. It results from direct brain trauma following an impact to the head.

D. Signs are often present immediately after an impact to the head.

You should be MOST suspicious that a patient has experienced a significant head injury if his or her pulse is:

Select one:

A. rapid.
B. weak.
C. slow.
D. irregular.

When caring for a patient with an open facial injury, the EMT's immediate priority should be to:

Select one:

A. manually stabilize the patient's head.
B. wear gloves and facial protection.
C. consider the mechanism of injury.
D. closely assess the patient's airway

When the speed of a motor vehicle doubles, the amount of kinetic energy:

Select one:

A. quadruples.
B. is not affected.
C. triples.
D. doubles.

The MOST significant complication associated with facial injuries is:

Select one:

A. damage to the eyes.
B. mandibular immobility.
C. cervical spine injury.
D. airway compromise.

Which of the following open soft-tissue injuries is limited to the superficial layer of the skin and results in the least amount of blood loss?

Select one:

A. Avulsion

B. Incision

C. Laceration

D. Abrasion

If your patient swallows blood following facial trauma, there is an increased risk of .

Select one:

A. altered LOC
B. GI trauma
C. hypotension
D. vomiting

Bleeding from soft-tissue injuries to the face is MOST effectively controlled with:

Select one:

A. direct pressure using dry, sterile dressings.
B. pressure dressings and chemical ice packs.
C. ice packs and elevation of the patient's head.
D. digital pressure to an adjacent pulse point.

Which of the following is a severe burn in a 65-year-old patient?

Select one:

A. Superficial burn to 30% of the BSA

B. Second-degree burn covering 10% of the BSA

C. Full-thickness burn to 1% of the BSA

D. Partial-thickness burn to 20% of the BSA

The Adam's apple is:

Select one:

A. below the thyroid cartilage and forms the upper part of the trachea.

B. the lower part of the larynx that is formed by the cricoid cartilage.

C. the small indentation in between the thyroid and cricoid cartilages.

D. the upper part of the larynx that is formed by the thyroid cartilage.

A young male was shot in the abdomen by an unknown type of gun. He is semiconscious, has shallow breathing, and is bleeding externally from the wound. As you control the external bleeding, your partner should:

Select one:

A. apply a nonrebreathing mask.

B. assist the patient's ventilation.

C. obtain baseline vital signs.

D. perform a secondary assessment.

In addition to severe bleeding, the MOST life-threatening complication associated with an open neck injury is:

Select one:

A. a spinal fracture.

B. an ischemic stroke.

C. nerve fiber damage.

D. an air embolism.

Which of the following processes occurs during the inflammation phase of the healing process?

Select one:

A. The veins and arteries at the injury site constrict and platelets aggregate, which stops bleeding and causes a temporary increase in the size of the wound.

B. The blood vessels in and around the injury site constrict, which forces bacteria and other microorganisms away, thus preventing significant infection.

C. White blood cells are forced away from the injury site, thus allowing an increase in the flow of red blood cells, resulting in increased blood flow.

D. The immune system releases histamines, which cause vasodilation and increased capillary permeability, resulting in local redness and swelling.

When immobilizing a trauma patient's spine, the EMT manually stabilizing the head should not let go until:

Select one:

A. the patient has been secured to the ambulance stretcher.

B. the patient has been completely secured to the backboard.

C. an appropriately sized cervical collar has been applied.

D. the head has been stabilized with lateral immobilization.