Paramedic Phase2 Test Flashcards
1
Q
- During an explosion, secondary blast injuries occur when:
A) hollow organs rupture due to the pressure wave.
B) the patient is thrown against a stationary object.
C) the patient sustains severe burns from the intense heat.
D) the patient is struck by flying debris, such as shrapnel.
A
d
2
Q
64. Which of the following organs is LEAST susceptible to pressure changes caused by an explosion? A) Liver B) Lungs C) Tympanic membrane D) Gastrointestinal tract
A
a
3
Q
2. The energy stored in an object, such as a bridge pillar, is called \_\_\_\_\_\_\_\_\_\_ energy, and the energy from motion is called \_\_\_\_\_\_\_\_\_\_ energy. A) kinetic, potential B) barometric, kinetic C) potential, kinetic D) chemical, potential
A
c
4
Q
. Which of the following will be of MOST benefit in helping the paramedic predict the type of injuries that a patient experienced? A) Index of suspicion B) Past medical history C) Age of the patient D) Mechanism of injury
A
d
5
Q
The primary determinants of the extent of trauma a patient sustains are the:
A) type of object that strikes a patient and the part of the body that sustains the most impact.
B) amount of energy in the object and the mechanism by which the object is delivered to the body.
C) size of the object that strikes the body and any secondary injuries that occur if the patient falls.
D) physical size of the patient and the part of the body that sustains direct impact from an object.
A
b
6
Q
- After a motorcyclist is ejected from his or her motorcycle, secondary collisions:
A) most commonly involve a stationary object.
B) cause an unpredictable combination of blunt injuries.
C) typically cause bilateral fractures of the femurs and tibias.
D) result in less severe injuries if the rider is wearing leather.
A
b
7
Q
caused by inflammation of the peritoneum (membrane lining the abdominal organs and cavity).
A
peritonitis
8
Q
. When an adult pedestrian is struck by a motor vehicle, lateral and posterior injuries are most common because:
A) the patient is thrust onto the hood of the vehicle.
B) adults tend to turn to the side or away from the impact.
C) the patient is thrown and lands on his or her side or back.
D) the initial impact by the bumper spins the patient to the side.
A
b
9
Q
- Unlike adults, children who are struck by a motor vehicle are MORE likely to:
A) be run over by the vehicle as they are propelled to the ground.
B) experience injuries to the lower extremities from the initial impact.
C) be propelled onto the hood of the vehicle during the second impact.
D) turn away from the oncoming vehicle, resulting in posterior trauma.
A
a
10
Q
- The forces applied to the driver during a frontal vehicle collision will differ based on all of the following factors, EXCEPT:
A) objects inside the vehicle.
B) the physical size of the patient.
C) the design of the motor vehicle.
D) safety features of the motor vehicle.
A
b
11
Q
26. The third phase of a motor vehicle accident involves: A) crush injuries to the body. B) impact by another vehicle. C) deceleration of internal organs. D) injuries caused by flying debris.
A
c
12
Q
A patient with hemorrhagic shock would be expected to have: A) warm, flushed skin. B) flattened jugular veins. C) a widened pulse pressure. D) an increased hematocrit.
A
b
13
Q
28. Which of the following injuries or mechanisms would MOST likely lead to nonhemorrhagic shock? A) Fractures B) Blunt trauma C) Hemothorax D) Severe burns
A
d
14
Q
. You are treating a 20-year-old man with a large laceration involving the brachial artery. The patient is confused, is pale, and has weak peripheral pulses. Your initial attempts to control the bleeding have failed. You should:
A) administer high-flow oxygen, establish vascular access at the scene, transport, and apply a proximal tourniquet en route.
B) administer high-flow oxygen, transport, and apply a proximal tourniquet and establish vascular access en route.
C) apply a proximal tourniquet, administer high-flow oxygen, transport, and establish vascular access en route.
D) control the bleeding by applying pressure to a proximal pressure point, administer high-flow oxygen, and transport.
A
c
15
Q
When applying a tourniquet to control major external hemorrhage from an extremity injury, you should:
A) apply the tourniquet over a joint, as this will further help compress blood vessels.
B) maintain direct pressure to the wound until the tourniquet has been fully applied.
C) secure the tourniquet in place until the pulses distal to the injury have weakened.
D) apply a pressure dressing over the tourniquet to further help control the bleeding.
A
b
16
Q
33. A healthy adult can tolerate blood loss of up to \_\_\_\_ mL over a period of 15 to 20 minutes without any negative effects. A) 500 B) 750 C) 1,000 D) 1,500
A
a
17
Q
The MOST significant factor that determines how well the body compensates for blood loss is:
A) the patient’s pulse rate at the time of the injury.
B) the period of time over which the blood is lost.
C) whether the bleeding is internal or external.
D) whether the bleeding is venous or arterial.
A
b
18
Q
44. A motorcycle rider struck a parked car and was catapulted over the handlebars of his bike. Your assessment reveals that he is tachypneic, diaphoretic, and tachycardic. There is no gross external bleeding present. What is the MOST likely cause of this patient's clinical presentation? A) Closed head injury B) Bilateral femur fractures C) Proximal upper extremity fractures D) Sympathetic nervous system failure
A
b
19
Q
. Much of the bleeding associated with unsplinted fractures continues because:
A) most fractures are unstable and usually lacerate major blood vessels.
B) swelling associated with such fractures prevents platelet aggregation.
C) bone ends will continue to move and destroy partially formed clots.
D) patient anxiety increases the blood pressure, which exacerbates bleeding.
A
c
20
Q
In contrast to a patient with compensated shock, a patient with decompensated shock would be expected to present with: A) polyuria and weak pulses. B) bounding radial pulses. C) mottled skin and dilated pupils. D) restlessness and pale cool skin.
A
c
21
Q
. Decompensated shock in the adult is characterized by: A) increased tidal volume. B) bounding radial pulses. C) 15% blood loss or more. D) a falling blood pressure.
A
d
22
Q
External bleeding would be the MOST difficult to control in a patient with a large laceration to the \_\_\_\_\_\_\_\_\_\_\_\_\_ and a blood pressure of \_\_\_\_\_\_ mm Hg. A) jugular vein, 96/62 B) brachial artery, 68/46 C) femoral vein, 114/60 D) carotid artery, 100/70
A
d
23
Q
- Afterload is defined as the:
A) pressure in the aorta against which the left ventricle must pump.
B) amount of resistance to blood flow offered by the heart valves.
C) amount of blood ejected from the ventricle with each contraction.
D) volume of blood remaining in the ventricles following contraction.
A
a
24
Q
Which of the following statements regarding blood flow is correct?
A) Ejection fraction is the percentage of blood that the heart pumps per contraction.
B) If more blood returns to the heart, stroke volume decreases and cardiac output falls.
C) As more blood is pumped with each contraction, the ejection fraction increases.
D) The amount of blood that returns to the atrium remains fixed from minute to minute.
A
a
25
The swelling that occurs in conjunction with a contusion is caused by:
A) inflammation of the injured blood vessels.
B) rupture of large blood vessels in the dermis.
C) aggregation of platelets to the injured site.
D) leakage of fluid into spaces between the cells.
d
26
```
In contrast to a contusion, a hematoma is:
A) accompanied by ecchymosis.
B) caused by large vessel damage.
C) rarely accompanied by a bruise.
D) a less significant closed injury.
```
b
27
. You should splint an open soft-tissue injury to an extremity because:
A) most patients do not keep the extremity still when asked to do so.
B) most open soft-tissue injuries are associated with a fracture.
C) splinting is an excellent means of providing relief from pain.
D) motion of the extremity may disrupt the blood-clotting process.
d
28
```
Your MAIN concern when caring for a patient with a soft-tissue injury to the face should be:
A) airway compromise.
B) hypovolemic shock.
C) injuries to the eyes.
D) preventing contamination.
```
a
29
. Which of the following statements regarding soft-tissue injuries is correct?
A) Most soft-tissue injuries require immediate care to prevent blood loss.
B) They are often the most obvious, but are seldom the most life threatening.
C) Soft-tissue injuries should be covered immediately upon patient contact.
D) Most soft-tissue injuries are hidden and require a systematic assessment.
b
30
When the ambient temperature is high:
A) the dermis produces less collagen, which temporarily decreases the skin's ability to retain warmth.
B) blood vessels in the dermis dilate, which increases blood flow to the skin and allows heat to dissipate.
C) sweat glands in the epidermis produce sweat, which is evaporated from the skin surface by the air.
D) constriction of the vessels in the dermis brings warm blood to the surface of the skin, where it is eliminated.
b
31
The skin helps regulate body temperature through:
A) peripheral vasodilation, which shunts cool blood to the core of the body.
B) the production of sweat, which is evaporated from the surface of the skin.
C) increased elastin production, which provides insulation to the epidermis.
D) cutaneous vasoconstriction, which brings warm blood to the skin's surface.
b
32
A 41-year-old man was assaulted during a robbery attempt. Your primary assessment reveals that the patient is semiconscious. He has massive soft-tissue trauma to the face, inadequate breathing, and oropharyngeal bleeding. You should:
A) apply direct pressure to his facial wounds and promptly intubate him.
B) suction the blood from his mouth and assist ventilations with a bag-mask device.
C) insert a nasal airway, apply oxygen via nonrebreathing mask, and transport.
D) suction his oropharynx for 30 seconds and then perform endotracheal intubation.
b
33
A 22-year-old man was struck in the forehead by a softball. He is conscious and alert, but complains of a severe headache. Your assessment reveals a large hematoma to his forehead. His vital signs are stable and his breathing is adequate. You should:
A) apply firm manual pressure to the hematoma to reduce internal bleeding.
B) place him in a sitting position and apply a chemical heat pack to his head.
C) apply an icepack to the hematoma and monitor his level of consciousness.
D) start an IV of normal saline and administer 2 mg of morphine for the pain.
c
34
```
Necrosis of tissue caused by an anaerobic, toxin-producing bacterium is called:
A) tetanus.
B) gangrene.
C) fasciitis.
D) lymphedema.
```
b
35
34. Which of the following statements regarding crush injury is correct?
A) A crush injury can occur if the PASG is left in place for greater than 1 hour.
B) Gangrene often sets in if a body part is entrapped for longer than 30 minutes.
C) Crush syndrome can occur if the body part is entrapped for more than 4 hours.
D) In a crush injury, the external appearance is a good predictor of internal damage.
c
36
```
You and your partner are transferring a severely burned patient from a community hospital to a burn specialty center. The patient, a 110-pound woman, has partial- and full-thickness burns that cover approximately 55% of her body. She has two large-bore IV lines in place, is intubated, and is on a cardiac monitor. According to the Parkland formula, how much normal saline should she receive in 30 minutes?
A) 340 mL
B) 355 mL
C) 370 mL
D) 395 mL
```
a
37
44. A superficial burn is:
A) usually painless because the nerve endings are not exposed.
B) characterized by reddened skin with varying degrees of pain.
C) painful, but will heal spontaneously, often with scar formation.
D) a second-degree burn that is characterized by blister formation.
b
38
Which of the following burn injuries would MOST likely require transport to a burn specialty center?
A) Superficial burns to more than 40% of the body
B) Burns that involve the hands, feet, or genitalia
C) Partial-thickness burns to more than 5% of the body
D) Any burn that occurs in a child under 5 years of age
b
39
```
You and your partner are transferring a severely burned patient from a community hospital to a burn specialty center. The patient, a 110-pound woman, has partial- and full-thickness burns that cover approximately 55% of her body. She has two large-bore IV lines in place, is intubated, and is on a cardiac monitor. According to the Parkland formula, how much normal saline should she receive in 30 minutes?
A) 340 mL
B) 355 mL
C) 370 mL
D) 395 mL
```
a
40
```
According to the rule of nines, an adult man with partial- and full-thickness burns to his head, face, and anterior chest has burns to ____% of his total body surface area.
A) 18
B) 27
C) 36
D) 45
```
a
41
Which of the following statements regarding the rule of palms is correct?
A) The patient's palm, excluding the fingers, represents 1% of his or her total body surface area.
B) The rule of palms is not an accurate estimator of total body surface area burned in pediatric patients.
C) The patient's palm, including the fingers, represents 1% of his or her total body surface area.
D) The rule of palms is most accurate when a patient has experienced burns to less than 20% of his or her total body surface area.
a
42
When assessing a patient with maxillofacial trauma, it is MOST important to:
A) gently palpate the maxilla, mandible, and zygoma to elicit crepitus.
B) protect the cervical spine and monitor the patient's neurologic status.
C) apply a cervical collar and determine if the patient has visual disturbances.
D) have the patient open his or her mouth and assess for dental malocclusion.
b
43
26. If you are unable to orotracheally intubate a patient due to massive maxillofacial trauma and severe oropharyngeal and nasopharyngeal bleeding, you would MOST likely have to perform:
A) nasotracheal intubation.
B) a needle or surgical cricothyrotomy.
C) pharmacologically assisted intubation.
D) digital (tactile) intubation.
b
44
A young man was assaulted and has extensive maxillofacial injuries. Your primary assessment reveals that he is semiconscious, has shallow breathing, and has blood draining from the corner of his mouth. Initial management for this patient involves:
A) inserting an oropharyngeal airway, preoxygenating him with a bag-mask device for 2 minutes, and then intubating his trachea.
B) applying a cervical collar, performing a blind finger sweep to clear his airway, and providing ventilatory assistance with a bag-mask device.
C) fully immobilizing his spine, inserting a nasopharyngeal airway, and hyperventilating him with a bag-mask device at a rate of 20 breaths/min.
D) manually stabilizing his head in a neutral position, suctioning his oropharynx, and assisting ventilations with a bag-mask device and 100% oxygen.
d
45
Hyphema is defined as:
A) severe ecchymosis to the orbital region.
B) blood in the anterior chamber of the eye.
C) marked swelling of the globe of the eye.
D) double vision following blunt eye trauma.
b
46
A fracture of all midfacial bones, separating the entire midface from the cranium:
A) is commonly associated with facial elongation and dental malocclusion.
B) should be stabilized by placing bulky dressings across the fractured area.
C) is almost always accompanied by multiple severe fractures of the mandible.
D) is referred to as a Le Fort I fracture and most commonly results from a fall.
a
47
Because significant force is required to fracture the mandible:
A) most mandibular fractures are associated with a spinal fracture.
B) it is often fractured in more than one place and is unstable to palpation.
C) patients with a possible mandibular fracture should be intubated routinely.
D) a mandibular fracture can be ruled out in cases of minor blunt facial trauma.
b
48
Because significant force is required to fracture the mandible:
A) most mandibular fractures are associated with a spinal fracture.
B) it is often fractured in more than one place and is unstable to palpation.
C) patients with a possible mandibular fracture should be intubated routinely.
D) a mandibular fracture can be ruled out in cases of minor blunt facial trauma.
b
49
```
. If a patient is unable to follow your finger above the midline following blunt trauma to the face, you should be MOST suspicious for a(n):
A) Le Fort II fracture.
B) nasal bone fracture.
C) orbital skull fracture.
D) basilar skull fracture.
```
c
50
```
A flattened appearance to the face and loss of sensation over the cheek following blunt facial trauma is MOST indicative of a(n):
A) zygomatic fracture.
B) orbital skull fracture.
C) Le Fort I fracture.
D) temporomandibular joint dislocation.
```
a
51
```
. Early signs and symptoms of increased intracranial pressure include:
A) headache and vomiting.
B) hypertension and bradycardia.
C) widening of the pulse pressure.
D) arm flexion and leg extension.
```
a
52
41. Common clinical findings associated with a subdural hematoma include all of the following, EXCEPT:
A) rapidly increasing intracranial pressure.
B) an underlying skull fracture.
C) a fluctuating level of consciousness.
D) unilateral hemiparesis or slurred speech.
a
53
```
What type of intracranial hemorrhage would MOST likely be caused by a penetrating head injury?
A) Subdural hematoma
B) Intracerebral hematoma
C) Epidural hematoma
D) Subarachnoid hemorrhage
```
b
54
```
Cerebrospinal fluid drainage from the ears is MOST indicative of:
A) a nasal fracture.
B) intracerebral bleeding.
C) an epidural hematoma.
D) a skull fracture.
```
d
55
A 45-year-old unrestrained man was ejected from his small truck when it struck a tree. The patient is found approximately 20 feet from the wreckage. Your primary assessment reveals that he is unresponsive and has sonorous respirations and a rapid pulse. Your initial actions should include:
A) applying a cervical collar and assisting his ventilations with a bag-mask device.
B) rolling the patient onto his side as a unit and suctioning his mouth for 15 seconds.
C) performing a tongue-jaw lift and looking in his mouth for any obvious obstructions.
D) manually stabilizing his head and opening his airway with the jaw-thrust maneuver.
d
56
129. Upon arriving at the scene of a motor vehicle crash, you find the driver of the car still seated in her two-door vehicle. The passenger side of the vehicle has sustained severe damage and is inaccessible. The driver is conscious and alert and complains only of lower back pain. The backseat passenger, a young child who was unrestrained, is bleeding from the head and appears to be unconscious. You should:
A) ask the driver to step out of the vehicle so you can access the backseat passenger.
B) rapidly extricate the driver so you can gain quick access to the child in the backseat.
C) carefully assess the driver for occult injuries before removing her from the vehicle.
D) apply a vest-type extrication device to the driver and quickly remove her from the car.
b
57
```
A 39-year-old man crashed his vehicle into a wooded area and was not found for approximately 8 hours. When you arrive at the scene and assess him, you note that he is conscious but anxious. He is unable to feel or move below his mid-thoracic area and complains of a severe headache. His blood pressure is 210/130 mm Hg, heart rate is 44 beats/min, and respirations are 22 breaths/min. This patient's clinical presentation is MOST consistent with:
A) neurogenic shock.
B) intracranial pressure.
C) autonomic dysreflexia.
D) symptomatic bradycardia.
```
c
58
```
Most head injuries are the result of:
A) assault or abuse.
B) motor vehicle crashes.
C) sports-related incidents.
D) falls from a significant height.
```
b
59
When an unrestrained passenger's head strikes the windshield of a motor vehicle following rapid deceleration:
A) the anterior portion of the brain sustains stretching or tearing injuries, and the posterior portion of the brain sustains compression injuries.
B) the head falls back against the headrest or seat and the brain collides with the rear of the skull, resulting in direct injury to the occipital lobe.
C) the brain initially strikes the rear of the skull, resulting in direct bruising, and then rebounds and strikes the front part of the skull.
D) compression injuries occur to the anterior portion of the brain, and stretching or tearing injuries occur to the posterior portion of the brain.
d
60
```
According to the National Spinal Cord Injury Database, MOST spinal cord injuries are caused by:
A) acts of violence.
B) athletic activities.
C) falls in the elderly.
D) motor vehicle crashes.
```
d
61
```
Death following a head injury is MOST often the result of:
A) an epidural hematoma.
B) trauma to the brain.
C) airway compromise.
D) spinal cord transection.
```
b
62
```
30. Following a traumatic brain injury, initial swelling of the brain occurs due to:
A) severe ischemia.
B) acute hypertension.
C) cerebral vasodilation.
D) an increase in cerebral water.
```
c
63
. The MOST disastrous consequence of a severe traumatic brain injury is:
A) an increase in intracranial pressure.
B) an increase in mean arterial pressure.
C) severe hypertension and bradycardia.
D) a decrease in cerebral perfusion pressure.
d
64
33. Prehospital treatment of the patient with a traumatic brain injury must focus primarily on:
A) maintaining cerebral perfusion pressure.
B) hyperventilating the patient at 20 breaths/min.
C) maintaining a systolic blood pressure of at least 120 mm Hg.
D) taking measures to decrease intracranial pressure.
a
65
```
46. When assessing the severity of a traumatic brain injury, the MOST important assessment parameter is the patient's:
A) initial Glasgow Coma Scale score.
B) blood pressure.
C) level of consciousness.
D) response to verbal stimuli.
```
c
66
An epidural hematoma typically causes rapid deterioration in the head-injured patient's condition because:
A) numerous axons are severely damaged.
B) the meningeal veins are often disrupted.
C) it is associated with brisk arterial bleeding.
D) concomitant spinal cord injury is often present.
c
67
Common clinical findings associated with a subdural hematoma include all of the following, EXCEPT:
A) rapidly increasing intracranial pressure.
B) an underlying skull fracture.
C) a fluctuating level of consciousness.
D) unilateral hemiparesis or slurred speech.
a
68
A subdural hematoma is classified as acute if clinical signs and symptoms develop:
A) immediately following the injury.
B) within 24 hours following the injury.
C) within 36 hours following the injury.
D) within 48 hours following the injury.
b
69
```
Chronic subdural hematomas are MOST commonly seen in patients who:
A) are less than 2 years of age.
B) have alcoholism.
C) are prone to hypoglycemia.
D) have high cholesterol.
```
b
70
```
. What type of intracranial hemorrhage would MOST likely be caused by a penetrating head injury?
A) Subdural hematoma
B) Intracerebral hematoma
C) Epidural hematoma
D) Subarachnoid hemorrhage
```
b
71
Decerebrate posturing is characterized by:
A) flexion of the arms and extension of the legs.
B) inward flexion of the wrists and flexed knees.
C) extension of the arms and extension of the legs.
D) pulling in of the arms toward the core of the body.
c
72
```
. The __________ is a continuation of the central nervous system and exits the skull through the _______.
A) vagus nerve, spinal cord
B) spinal cord, foramen magnum
C) brainstem, vertebral foramen
D) medulla, cauda equina
```
b
73
```
. The brain connects to the spinal cord through a large opening at the base of the skull called the:
A) cribriform plate.
B) foramen magnum.
C) occipital condyle.
D) palatine bone.
```
b
74
Which of the following statements regarding a cerebral concussion is correct?
A) A cerebral concussion is a moderate focal brain injury.
B) Concussions are usually not associated with structural brain injury.
C) Prolonged loss of consciousness is common with a cerebral concussion.
D) A concussion results in permanent dysfunction of the cerebral cortex.
b
75
Unlike a cerebral concussion, a cerebral contusion is:
A) typically not associated with retrograde amnesia or focal neurologic deficits.
B) a type of diffuse axonal injury that often leads to permanent neurologic damage.
C) a diffuse brain injury that results in severe intracranial hemorrhage and pressure.
D) associated with physical brain damage and more pronounced neurologic deficits.
d
76
```
Signs of neurogenic shock include all of the following, EXCEPT:
A) bradycardia.
B) flushed skin.
C) diaphoresis.
D) hypothermia.
```
c
77
. Hypotension that is associated with neurogenic shock is the result of:
A) loss of alpha receptor stimulation.
B) concomitant internal hemorrhage.
C) increased peripheral vascular tone.
D) profound peripheral vasoconstriction.
a
78
```
Treatment for a patient with neurogenic shock may include all of the following, EXCEPT:
A) a vagolytic medication.
B) a vasopressor medication.
C) prevention of hyperthermia.
D) fluid volume to maintain perfusion.
```
c
79
. Spinal cord injuries that cause neurogenic shock generally produce:
A) cool, clammy skin distal to the site of the spinal cord injury.
B) reflex tachycardia due to sympathetic nervous system stimulation.
C) flaccid paralysis and complete loss of sensation distal to the injury.
D) signs and symptoms that are identical to those of hypovolemic shock.
c
80
55. Most patients with an aortic injury will complain of pain:
A) while taking a shallow breath.
B) behind the sternum or in the scapula.
C) in the region of the posterior pharynx.
D) that radiates from the chest to the flank.
b
81
The visceral pericardial layer:
A) comprises the pericardial sac itself.
B) is attached directly to the diaphragm.
C) is the outermost layer of the pericardium.
D) adheres to the heart and forms the epicardium.
d
82
Which of the following statements regarding a pericardial tamponade is correct?
A) Most pericardial tamponades are caused by blunt chest trauma during an automobile crash.
B) In a pericardial tamponade, blood collects between the visceral and parietal pericardium.
C) Pericardial tamponade is characterized by a marked increase in preload and flat jugular veins.
D) The parietal pericardium stretches easily, so significant blood accumulation is required before signs appear.
b
83
Which of the following statements regarding a pericardial tamponade is correct?
A) Most pericardial tamponades are caused by blunt chest trauma during an automobile crash.
B) In a pericardial tamponade, blood collects between the visceral and parietal pericardium.
C) Pericardial tamponade is characterized by a marked increase in preload and flat jugular veins.
D) The parietal pericardium stretches easily, so significant blood accumulation is required before signs appear.
b
84
```
You should be MOST suspicious that your patient has a pericardial tamponade if he or she presents with hypotension, jugular vein distention, and:
A) loud heart tones.
B) respiratory distress.
C) a bounding pulse.
D) normal lung sounds.
```
d
85
You are assessing a 39-year-old man who experienced blunt chest trauma. He is semiconscious and has poor respiratory effort with stridor. You should:
A) perform laryngoscopy to visualize his airway for an obstruction.
B) administer oxygen via nonrebreathing mask and assess circulation.
C) insert a nasal airway and assist ventilations with a bag-mask device.
D) suction his airway and prepare for immediate orotracheal intubation.
c
86
62. You are transporting a conscious and alert man who experienced an isolated blunt injury to the right anterolateral chest. His vital signs are stable, but he is dyspneic and his breath sounds are diminished over the apex of his right lung. In addition to administering high-flow oxygen, the MOST critical intervention for this patient involves:
A) frequently reassessing him for signs of clinical deterioration.
B) performing a needle thoracentesis to release intrapleural tension.
C) positioning him on his right side to facilitate effective breathing.
D) administering a 500-mL normal saline bolus to maintain perfusion.
a
87
Following blunt trauma to the anterior chest, a 44-year-old man presents with restlessness, respiratory distress, perioral cyanosis, and tachycardia. Further assessment reveals a midline trachea, engorged jugular veins, and absent breath sounds on the right side of his chest. You should:
A) ventilate the patient with a bag-mask device and transport immediately.
B) perform an immediate needle thoracentesis to the right side of the chest.
C) give 100% oxygen and start a large-bore IV line en route to the hospital.
D) transport at once and decompress the chest if tracheal deviation is observed.
b
88
A pulmonary contusion following blunt chest trauma results in:
A) blood leakage from injured lung tissue into the pleural space.
B) decreased pulmonary shunting with rupture of the alveolar sacs.
C) alveolar and capillary damage with intraparenchymal lung hemorrhage.
D) pulmonary vasodilation as the body attempts to shunt blood to the injury.
c
89
Commotio cordis is a phenomenon in which:
A) ventricular fibrillation is induced following blunt trauma to the chest during the heart's repolarization period.
B) excessive pressure within the pericardial sac impairs cardiac contractility as well as venous return to the heart.
C) penetrating thoracic trauma perforates the atria or ventricles, causing acute rupture and massive hemorrhage.
D) myocardial tissue at the cellular level is damaged by blunt or penetrating trauma, resulting in cardiac arrest.
a
90
```
With the exception of the aorta, great vessel injury is MOST likely to occur following:
A) blunt trauma.
B) shearing forces.
C) rotational injury.
D) penetrating trauma.
```
d
91
16. A flail chest is characterized by:
A) a free-floating segment of fractured ribs.
B) bulging of fractured ribs during inspiration.
C) excessive negative intrathoracic pressure.
D) drawing in of fractured ribs during expiration.
a
92
```
With the exception of the aorta, great vessel injury is MOST likely to occur following:
A) blunt trauma.
B) shearing forces.
C) rotational injury.
D) penetrating trauma.
```
d
93
```
You would NOT expect a patient with a flail chest to present with:
A) cyanosis.
B) hyperpnea.
C) shallow breathing.
D) decreased breath sounds.
```
b
94
20. Pneumothorax is MOST accurately defined as:
A) air or gas within the pleural cavity.
B) perforation of a lung by a broken rib.
C) injury to the visceral or parietal pleura.
D) partial or complete collapse of a lung.
a
95
. An open pneumothorax causes ventilatory inadequacy when:
A) positive pressure created by expiration forces air into the pleural space.
B) the heart stops perfusing the lung on the side of the open chest injury.
C) negative pressure created by inspiration draws air into the pleural space.
D) the glottic opening is much larger than the open wound on the chest wall.
c
96
Pneumothoraces create a ventilation-perfusion mismatch when:
A) concomitant myocardial injury prevents adequate pulmonary perfusion and the lung collapses.
B) perfusion of the involved lung continues while the pneumothorax prevents adequate ventilation.
C) the vasculature of the affected lung is not intact and intrapulmonary gas exchange is impaired.
D) the affected lung continues to expand adequately despite a decrease in pulmonary perfusion.
b
97
```
What type of chest injury is characterized by air accumulation in the pleural space when a perforation in the lung parenchyma acts as a one-way valve?
A) Tension pneumothorax
B) Simple pneumothorax
C) Massive hemothorax
D) Spontaneous pneumothorax
```
a
98
38. Any patient with a presumptive diagnosis of a pneumothorax should:
A) receive a prophylactic needle thoracentesis.
B) be intubated and ventilated at a rate of 15 breaths/min.
C) be considered unstable and reassessed every 5 minutes.
D) be transported to a trauma center via air medical transport.
c
99
A patient with a small simple pneumothorax would MOST likely present with diminished breath sounds:
A) in the apices of the affected lung if he or she is sitting upright.
B) after more than 50% of the affected lung has been collapsed.
C) in the posterior bases of the affected lung if he or she is sitting.
D) on the contralateral side as the mediastinum begins to shift.
a
100
Immediate treatment for an open pneumothorax involves:
A) assisting ventilations with a bag-mask device.
B) covering the open wound with a porous dressing.
C) converting the pneumothorax to a closed injury.
D) administering oxygen via nonrebreathing mask.
c
101
46. Jugular venous distention during a tension pneumothorax:
A) indicates a significant increase in atrial preload.
B) is caused by blood accumulation in the vena cava.
C) occurs before a unilateral absence of breath sounds.
D) manifests early as air accumulates in the pleural space.
b
102
A blood pressure of 100/70 mm Hg in the presence of clinical signs of a tension pneumothorax:
A) should be treated with crystalloid fluid boluses to prevent hypotension.
B) indicates that prehospital needle decompression likely will not be required.
C) is likely the result of systemic vasodilation in an attempt to reduce preload.
D) suggests adequate cardiac compensation for the diminished venous return.
d
103
```
Which of the following clinical signs may not be present in a patient with a tension pneumothorax and associated internal bleeding?
A) Tachycardia
B) Jugular vein distention
C) Mediastinal shift
D) Contralateral tracheal deviation
```
b
104
```
51. Unlike a tension pneumothorax, a massive hemothorax would MOST likely present with:
A) signs of shock.
B) tracheal deviation.
C) collapsed jugular veins.
D) severe respiratory distress.
```
c
105
Pneumothorax is MOST accurately defined as:
A) air or gas within the pleural cavity.
B) perforation of a lung by a broken rib.
C) injury to the visceral or parietal pleura.
D) partial or complete collapse of a lung.
a
106
. Pneumothoraces create a ventilation-perfusion mismatch when:
A) concomitant myocardial injury prevents adequate pulmonary perfusion and the lung collapses.
B) perfusion of the involved lung continues while the pneumothorax prevents adequate ventilation.
C) the vasculature of the affected lung is not intact and intrapulmonary gas exchange is impaired.
D) the affected lung continues to expand adequately despite a decrease in pulmonary perfusion.
b
107
Management of a diaphragmatic injury focuses on:
A) maintaining adequate oxygenation and ventilation, and rapid transport.
B) inserting a nasogastric tube to decompress the gastrointestinal organs.
C) applying the pneumatic antishock garment to stabilize the diaphragm.
D) intubation and hyperventilation with 100% supplemental oxygen.
a
108
Which of the following statements regarding diaphragmatic injury is correct?
A) During the latent phase of a diaphragmatic injury, abdominal contents herniate through the defect, cutting off their blood supply.
B) The spleen provides significant protection to the diaphragm on the left side, resulting in a higher incidence of right-sided diaphragmatic injuries.
C) Because the diaphragm is protected by the liver on the right side, most diaphragmatic injuries caused by blunt force trauma occur on the left side.
D) Once the diaphragm has been injured, the healing process is facilitated by the natural pressure differences between the abdominal and thoracic cavities.
c
109
. A pulmonary contusion following blunt chest trauma results in:
A) blood leakage from injured lung tissue into the pleural space.
B) decreased pulmonary shunting with rupture of the alveolar sacs.
C) alveolar and capillary damage with intraparenchymal lung hemorrhage.
D) pulmonary vasodilation as the body attempts to shunt blood to the injury.
c
110
```
Due to intrapulmonary hemorrhage, patients with a pulmonary contusion may present with:
A) hypocarbia.
B) hemoptysis.
C) hematemesis.
D) hematochezia.
```
b
111
```
12. As soon as the aorta exits the left ventricle, it:
A) descends toward the abdomen.
B) branches into the femoral arteries.
C) becomes the brachiocephalic artery.
D) ascends toward the right shoulder.
```
d
112
The preferred site for performing a needle thoracentesis is:
A) superior to the third rib into the intercostal space at the midclavicular line.
B) just below the second rib into the intercostal space at the midaxillary line.
C) just above to the fifth rib into the intercostal space at the midaxillary line.
D) inferior to the third rib into the intercostal space at the midclavicular line.
a
113
Following blunt trauma to the anterior chest, a 44-year-old man presents with restlessness, respiratory distress, perioral cyanosis, and tachycardia. Further assessment reveals a midline trachea, engorged jugular veins, and absent breath sounds on the right side of his chest. You should:
A) ventilate the patient with a bag-mask device and transport immediately.
B) perform an immediate needle thoracentesis to the right side of the chest.
C) give 100% oxygen and start a large-bore IV line en route to the hospital.
D) transport at once and decompress the chest if tracheal deviation is observed.
b
114
What do the spleen and liver have in common?
A) They are both highly vascular and bleed profusely when injured.
B) The liver and spleen are well protected by the abdominal muscles.
C) They are less likely to be crushed by blunt trauma than other organs.
D) The liver and spleen are the only solid organs in the abdominal cavity.
a
115
```
Fractures of the lower rib cage should make you MOST suspicious for injuries to the:
A) liver or spleen.
B) urinary bladder.
C) ascending aorta.
D) kidneys or pancreas.
```
a
116
Left shoulder pain following injury to the spleen:
A) typically precedes hypotension and other signs of shock.
B) usually does not occur until 1 to 2 hours after the injury.
C) is a sign of associated injury to a hollow abdominal organ.
D) is called Cullen sign and indicates intraabdominal bleeding.
b
117
```
A 17-year-old high school football player was struck in the abdomen by another player during a tackle. Your assessment reveals signs of shock and pain to the patient's left shoulder, which is unremarkable for trauma. Examination of the patient's abdomen is also unremarkable for obvious injury. Based on your assessment findings and the patient's clinical presentation, you should be MOST suspicious of:
A) a lacerated liver.
B) acute peritonitis.
C) an injury to the spleen.
D) retroperitoneal bleeding.
```
c
118
Periumbilical ecchymosis is:
A) commonly observed in the prehospital setting following blunt force trauma to the abdomen.
B) referred to as Cullen sign and may take hours or days to develop following abdominal trauma.
C) usually seen in conjunction with flank bruising and is highly suggestive of injury to the liver or spleen.
D) also called Grey Turner sign and manifests almost immediately following blunt abdominal trauma.
b
119
. You are caring for a patient who experienced blunt abdominal trauma. The patient is conscious, but restless. His respirations are rapid and shallow and his pulse is rapid and weak. What will maximize this patient's chances of survival?
A) Basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed en route
B) Administering supplemental oxygen, administering crystalloid IV fluids at the scene, and rapidly transporting to a trauma center
C) Application and inflation of the PASG, ventilation assistance, 2 to 3 L of IV fluid at the scene, and rapid transport to a trauma center
D) Aggressive airway support, a detailed physical exam at the scene, transport to the closest hospital, and IV therapy performed en route
a
120
Which of the following factors can decrease the potential damage caused by trauma to the abdomen?
A) A seat belt that is worn above the iliac crests
B) Toned abdominal muscles and an empty bladder
C) Abdominal muscle tensing at the time of impact
D) Air bags and being younger than 44 years old
b
121
EMS providers can have the MOST positive impact on mortality and morbidity from abdominal trauma by:
A) recognizing the need for rapid transport.
B) initiating fluid resuscitation in the field.
C) contacting medical control immediately.
D) performing a careful abdominal assessment.
a
122
```
At least two thirds of all abdominal injuries:
A) result in death.
B) are caused by falls.
C) are penetrating injuries.
D) involve blunt trauma.
```
d
123
```
Intraperitoneal organs include all of the following, EXCEPT the:
A) pancreas.
B) stomach.
C) small bowel.
D) gallbladder.
```
a
124
. Intraabdominal bleeding may produce few signs and symptoms of trauma because:
A) the intraabdominal cavity can accommodate large amounts of blood.
B) blood in the peritoneum can compress the aorta and maintain perfusion.
C) it takes approximately 4 L of blood loss before signs of shock manifest.
D) the abdominal musculature can sustain massive blunt force without bruising.
a
125
. When blood is released into the peritoneal cavity:
A) the abdomen almost immediately becomes grossly distended.
B) it is most often the result of blunt force trauma to the pancreas.
C) blood pressure falls with as little as 500 mL of internal blood loss.
D) nonspecific signs such as tachycardia and hypotension may occur.
d
126
When assessing a patient with abdominal trauma for distention, you must recall that:
A) a distended abdomen is one of the earliest clinical findings in patients with abdominal trauma.
B) abdominal distention is usually caused by muscle tensing rather than intraabdominal bleeding.
C) a significant amount of blood volume in the abdominal cavity is required to produce distention.
D) because distention is a late sign of intraabdominal bleeding, it should not be assessed for in the field.
c
127
```
. What type of motor vehicle crash poses the LEAST threat for abdominal trauma if the patient is properly restrained?
A) Frontal crash
B) Rear-end crash
C) Lateral crash
D) Rollover crash
```
b
128
. Injuries to the vascular structures in the intraperitoneal space:
A) commonly involve the inferior vena cava and phrenic artery.
B) are most often associated with penetrating injury mechanisms.
C) are generally associated with flank or periumbilical bruising.
D) are often caused by shearing forces secondary to blunt trauma.
d
129
Penetrating abdominal trauma MOST commonly results from:
A) flying debris following an explosion.
B) high-powered rifles or military weapons.
C) low-velocity gunshot or stab wounds.
D) crush forces that separate the abdominal wall.
c
130
```
Which of the following factors does NOT contribute to the extent of injury from a gunshot wound to the abdomen?
A) Size of the patient
B) Profile of the bullet
C) Trajectory of the bullet
D) Distance the bullet traveled
```
a
131
Which of the following statements regarding stomach injuries is correct?
A) Rupture of the stomach following blunt trauma is usually associated with a recent meal or inappropriate seat belt use.
B) The vast majority of injuries to the stomach are caused by blunt force trauma and result in severe peritoneal hemorrhage.
C) Patients taking antacid medications usually experience immediate signs of peritoneal irritation following an injury to the stomach.
D) Penetrating mechanisms are a rare cause of injury to the stomach because the stomach is well protected by the abdominal musculature.
a
132
```
Grey Turner sign is defined as ecchymosis to the _________ and is indicative of _________.
A) umbilicus, peritoneal bleeding
B) epigastrium, stomach rupture
C) flank, retroperitoneal bleeding
D) back, traumatic aortic dissection
```
c
133
```
25. Because of its anatomic position in the retroperitoneum, it typically takes high-energy force to damage the:
A) liver.
B) spleen.
C) stomach.
D) pancreas.
```
d
134
```
. In a closed femur fracture, blood loss may exceed _______ before enough pressure develops to tamponade the bleeding.
A) 250 mL
B) 500 mL
C) 750 mL
D) 1,000 mL
```
d
135
```
Closed bilaterally fractured femurs can result in internal blood loss of up to:
A) 1,000 mL.
B) 1,500 mL.
C) 2,000 mL.
D) 3,000 mL.
```
d
136
The MOST practical method of splinting multiple fractures in a critically injured patient is to:
A) apply vacuum splints en route to the hospital.
B) splint the axial skeleton using a long backboard.
C) use air splints so you can visualize the injuries.
D) sedate the patient before applying any splints.
b
137
When assessing a multisystems trauma patient, it is MOST important to:
A) administer an analgesic promptly to minimize pain.
B) avoid being distracted by visually impressive injuries.
C) splint swollen, painful extremities as soon as possible.
D) only splint fractures involving long bones at the scene.
b
138
Correctly splinting an injured extremity:
A) typically provides complete pain relief without the need to administer narcotic analgesia.
B) effectively reduces swelling and inflammation by shunting blood away from the injured area.
C) eliminates the need to elevate the extremity because immobilization causes blood stasis.
D) helps to control internal bleeding by allowing clots to form where vessels are damaged.
d
139
Osteoporosis is MOST accurately defined as a(n):
A) progressive loss of bone marrow.
B) reduced range of motion in the joints.
C) estrogen-related change in bone strength.
D) significant decrease in bone density.
d
140
Compartment syndrome occurs when:
A) metabolic waste products accumulate within a large hematoma that develops near a fracture site.
B) yellow and red bone marrow seep from a fractured bone, resulting in excessive soft tissue swelling.
C) blood accumulates in the medullary canal of a bone, resulting in decreased oxygenation of the bone tissue.
D) pressure in the fascial compartment leads to impaired circulation, sensory changes, and progressive muscle death.
d
141
A young man has an isolated injury to his left lower leg. Your assessment reveals obvious deformity and ecchymosis. Distal circulation as well as motor and sensory functions are grossly intact, and the patient is hemodynamically stable. In addition to stabilizing the suspected fracture site, you should:
A) carefully palpate to elicit crepitus.
B) immobilize the knee and the ankle.
C) apply a traction splint for pain relief.
D) place a chemical heat pack over the injury.
b
142
A 19-year-old man experienced direct trauma to his left elbow. Your assessment reveals gross deformity and ecchymosis. His arm is pink and warm, and he has a strong radial pulse. Your transport time to the hospital will be delayed. You should:
A) splint the elbow in the position found and reassess distal circulation.
B) carefully straighten the arm to facilitate placement of a vacuum splint.
C) apply a sling and swathe to immobilize the injury and then apply heat.
D) administer fentanyl for pain relief and then carefully straighten the arm.
a
143
```
Any diver who loses consciousness immediately following a dive should be assumed to have experienced:
A) barotrauma.
B) nitrogen narcosis.
C) an air embolism.
D) decompression sickness.
```
c
144
```
Approximately 5 minutes following ascent from the water, a 30-year-old male diver complains of sharp chest pain and mild dyspnea. By the time you arrive at the scene, the patient is unresponsive. You should be MOST suspicious for:
A) nitrogen narcosis.
B) a tension pneumothorax.
C) decompression sickness.
D) an arterial gas embolism.
```
d
145
```
A person blowing on hot food in an attempt to cool it is an example of:
A) radiation.
B) convection.
C) conduction.
D) passive cooling.
```
b
146
```
11. When the outside temperature approaches or exceeds skin surface temperature, heat loss by _________ and _________ diminishes and eventually ceases.
A) convection, conduction
B) conduction, evaporation
C) evaporation, radiation
D) radiation, convection
```
d
147
```
A decreased wind chill factor increases heat loss through:
A) radiation.
B) convection.
C) conduction.
D) evaporation.
```
b
148
```
The venom from a pit viper causes all of the following effects, EXCEPT:
A) local tissue necrosis.
B) increased blood clotting.
C) neuromuscular dysfunction.
D) increased vascular permeability.
```
b
149
The MOST common and reliable sign of pit viper envenomation is:
A) tachycardia within 30 seconds of the bite.
B) patient anxiety and a slow, bounding pulse.
C) swelling of the tongue and marked hypertension.
D) rapidly developing edema around the bite area.
d
150
```
Which of the following factors decreases the body's ability to eliminate excess heat through evaporation?
A) High humidity
B) Wet clothing
C) Low wind chill
D) Hyperventilation
```
a
151
Law enforcement requests your assistance for a 40-year-old man whom they found in an alley. According to one police officer, the patient is “probably drunk.” The outside temperature is 37°F with a light wind and drizzle. The patient, who is conscious but confused, is shivering and has slurred speech. His skin is cold and pale, his heart rate is 68 beats/min and regular, and his respirations are 24 breaths/min and regular. After moving the patient into the warmed ambulance, you should:
A) assess his blood pressure, apply chemical heat packs to his neck, groin, and axillae, infuse 250 to 500 mL of warm normal saline, and administer one or two tubes of oral glucose.
B) remove his wet clothing, apply warm blankets, administer supplemental oxygen, assess his blood glucose level and blood pressure, and start an IV with warm normal saline.
C) apply warm layered blankets, administer 100 mg of thiamine IM, administer oxygen via nasal cannula, start an IV line with lactated Ringer's solution, and administer 25 grams of 50% dextrose.
D) remove his wet clothing, apply chemical heat packs directly to the groin, assess his blood glucose level and treat with dextrose if it is less than 80 mg/dL, and administer high-flow oxygen.
b
152
. Patients with heatstroke:
A) present initially with hot, dry skin.
B) are typically bradypneic and hypotensive.
C) have a core temperature greater than 104°F.
D) should routinely be given 50% dextrose.
c
