Chapter 31 - Abdominal & Genitourinary Injuries

Question 1

A 54-year-old male experienced an avulsion to his penis when his foreskin got caught in the zipper of his pants. He was able to unzip his pants and remove the foreskin prior to your arrival. Your assessment reveals that he is in severe pain and that the avulsion is bleeding moderately. The MOST appropriate treatment for this patient includes:

Select one:

A. requesting a paramedic to administer pain medication.

B. covering the avulsion with moist, sterile dressings.

C. administering 100% oxygen via a nonrebreathing mask.

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

Answer 1

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

Question 2

Abdominal pain, vomiting, and fever are most likely due to _______.

Select one:

A. hemorrhage

B. evisceration

C. infection

D. hypovolemia

Answer 2

C. infection

Question 3

All of the following are hollow abdominal organs, EXCEPT the:

Select one:

A. ureters.

B. stomach.

C. spleen.

D. bladder.

Answer 3

C. spleen.

Question 4

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

Select one:

A. prompt transport to the hospital is essential.

B. the EMT must perform a thorough exam.

C. the abdomen must be vigorously palpated.

D. vital signs should be monitored frequently.

Answer 4

A. prompt transport to the hospital is essential.

Question 5

Compression injury is most likely due to which of the following?

Select one:

A. Improperly placed lab belt

B. Hollow-organ rupture

C. Ejection of unrestrained driver

D. Stabbing

Answer 5

A. Improperly placed lab belt

Question 6

Difficulty breathing and a sunken appearance of the anterior abdominal wall is MOST indicative of a ruptured:

Select one:

A. stomach.

B. aorta.

C. diaphragm.

D. spleen.

Answer 6

C. diaphragm.

Question 7

In pediatric patients, the liver and spleen are _______.

Select one:

A. less likely to bleed when injured

B. smaller in proportion to the abdomen

C. more protected by the thorax compared to adults

D. larger in proportion to the abdomen

Answer 7

D. larger in proportion to the abdomen

Question 8

Injuries to the external male genitalia _______.

Select one:

A. are often life-threatening

B. usually result in permanent damage

C. frequently lead to hypovolemic shock

D. are rarely life-threatening

Answer 8

D. are rarely life-threatening

Question 9

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

Select one:

A. results in spontaneous urinary incontinence if the bladder is full.

B. is recommended if the patient has severe abdominal discomfort.

C. often causes hypotension secondary to cardiac compression.

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

Answer 9

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

Question 10

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

Select one:

A. the abdomen will become instantly distended.

B. it commonly protrudes through the injury site.

C. peritonitis may not develop for several hours.

D. it will bleed profusely and rapidly cause shock.

Answer 10

C. peritonitis may not develop for several hours.

Question 11

When a patient stiffens the muscles of the abdomen, it is known as _______.

Select one:

A. instability.

B. distention.

C. crepitus.

D. guarding.

Answer 11

D. guarding.

Question 12

When should you visually inspect the external genitalia on your patient?

Select one:

A. Only when ordered by medical direction

B. Anytime the patient agrees to treatment and transport

C. Always during the secondary assessment

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

Answer 12

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

Question 13

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

Select one:

A. The kidneys are not well protected.

B. Kidney injuries are rarely caused by blunt trauma.

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

D. Only minimal force is needed to damage the kidneys.

Answer 13

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

Question 14

Which of the following organs would MOST likely bleed profusely when injured?

Select one:

A. Bladder

B. Liver

C. Stomach

D. Intestine

Answer 14

B. Liver

Question 15

Which of the following statements regarding abdominal eviscerations is correct?

Select one:

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.

Answer 15

A. The protruding organs should be kept warm and moist.

Question 16

You are transporting a 42-year-old male who experienced blunt abdominal trauma. He is receiving oxygen at 12 L/min via a nonrebreathing mask and full spinal precautions have been applied. During your reassessment, you note his level of consciousness has decreased and his respirations have become shallow. You should:

Select one:

A. suction his oropharynx to ensure it is clear of secretions and then increase the oxygen flow rate to 15 L/min.

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

C. perform a comprehensive secondary assessment to determine why his clinical status has changed.

D. reassess his vital signs and then notify the receiving hospital of the change in his clinical status.

Answer 16

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

Question 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:

Select one:

A. perform a comprehensive secondary assessment.

B. forgo the hospital radio report because of his condition.

C. begin documenting the call on the patient care form.

D. closely monitor him and reassess him frequently.

Answer 17

D. closely monitor him and reassess him frequently.

Question 18

You should suspect a kidney injury anytime the patient presents with _______.

Select one:

A. abdominal distention

B. dyspnea

C. a hematoma in the flank region

D. nausea

Answer 18

C. a hematoma in the flank region

Question 19

Your documentation on a sexual assault victim should _______.

Select one:

A. be subjective and summarize the crime

B. be objective and factual

C. include your opinion of the nature of the incident

D. describe the status of the suspect(s)

Answer 19

B. be objective and factual

Question 20

Your presence is requested by law enforcement to assess a 33-year-old female who was sexually assaulted. The patient is conscious and obviously upset. As you are talking to her, you note an impressive amount of blood on her clothes in the groin area. Her blood pressure is 98/58 mm Hg, her pulse is 130 beats/min, and her respirations are 24 breaths/min. You should:

Select one:

A. allow her to change her clothes and take a shower before you transport.

B. arrange for a rape crisis center representative to speak with the patient.

C. visualize the vaginal area and pack the vagina with sterile dressings.

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

Answer 20

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

Question 21

Which of the following statements regarding rebound tenderness is correct?

Select One

A. It should be assessed for by vigorously palpating the abdomen.
B. Rebound tenderness is a specific sign found with a spleen injury.
C. It is often discovered when the patient is jarred or moved suddenly.
D. The absence of rebound tenderness rules out intra-abdominal injury.

Answer 21

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

Question 22

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

Select One:

Falls

Motor vehicle accidents

Assaults

Suicide

Answer 22

Falls

Question 23

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:

external genitalia injury.

a lacerated liver or spleen.

blunt injury to the kidney.

a ruptured urinary bladder.

Answer 23

blunt injury to the kidney.

Question 24

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

open the patient’s airway.

apply direct pressure to the wound.

apply oxygen via nonrebreathing mask.

ventilate the patient with a BVM.

Answer 24

apply direct pressure to the wound.

Question 25

Damage to solid organs typically leads to _______.

sepsis

fever

hypertension

hemorrhage

Answer 25

hemorrhage

Question 26

A man has a large laceration across his lower abdominal wall and a loop of bowel is protruding from the wound. He is conscious and alert and there is minimal bleeding from the wound. You should:

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

B. gently irrigate the exposed bowel with sterile saline and then cover the wound with a dry sterile dressing.

C. cover the bowel with a dry sterile dressing, elevate his lower extremities, and cover him with a blanket.

D. make one attempt to replace the bowel back into the abdomen and then cover the wound with a sterile dressing.

Answer 26

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

Question 27

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. perform a head-to-toe assessment while she is in the car.

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

C. carefully assess her upper chest for seatbelt-related injuries.

D. extricate her immediately and transport to a trauma center.

Answer 27

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

Question 28

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?

What does your blood pressure normally run?

Do you take any over-the-counter medications?

Has blood soaked through your undergarments?

Have you experienced recent abdominal trauma?

Answer 28

Have you experienced recent abdominal trauma?

Question 29

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

Pancreas

Fallopian tubes

Urinary bladder

Liver or spleen

Answer 29

Urinary bladder

Question 30

A sign of kidney damage following blunt trauma is:

hematuria.

hemoptysis.

hematemesis.

hematochezia.

Answer 30

hematuria

Question 31

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.

Answer 31

giving him small sips of plain water.

Question 32

You are dispatched to a residence for a young female who was kicked in the abdomen. While en route to the scene, you should ask the dispatcher if:

the patient is conscious.

law enforcement is at the scene.

there are other patients involved.

the severity of the injury is known.

Answer 32

law enforcement is at the scene.

Question 33

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.

Answer 33

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

Question 34

Management of evisceration injuries includes _______.

keeping the injury cool and dry

applying firm, direct pressure

closing the injury with duct tape

keeping the injury moist and warm

Answer 34

keeping the injury moist and warm

Question 35

Compression injuries to the abdomen that occur during a motor vehicle crash are typically the result of:

air bag deployment.

failure to wear seatbelts.

a poorly placed lap belt.

rapid vehicle deceleration.

Answer 35

a poorly placed lap belt

Question 36

Abdominal rigidity and periumbilical bruising are signs of _______.

infection

umbilical trauma

internal bleeding

intestinal blockage

Answer 36

internal bleeding

Question 37

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

theorize as to why the sexual assault occurred.

include the results of his or her internal vaginal exam.

include a description of the suspected perpetrator.

avoid speculation and document only factual data.

Answer 37

avoid speculation and document only factual data.

Question 38

Most of the ________ system lies behind the digestive tract.

reproductive

urinary

endocrine

peripheral nervous

Answer 38

urinary

Question 39

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

ballistics

a projectile

cavitation

wound cycling

Answer 39

cavitation

Question 40

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:

transport only if signs of shock begin to develop.

carefully probe the wound to determine its depth.

assume that the arrow injured an internal organ.

clean the wound and apply a dry, sterile dressing.

Answer 40

assume that the arrow injured an internal organ.

Question 41

Early bruising following abdominal trauma often manifests as:

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

Answer 41

A. red areas of skin.

Question 42

When worn properly, a seatbelt should lie:

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

Answer 42

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

Question 43

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.

Answer 43

D. intra-abdominal bleeding.

Question 44

The presence of tachycardia following a significant abdominal injury:

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

Answer 44

B) should be assumed to be a sign of shock.

Question 45

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. Lumbar spine fracture
C. Femur fracture
D. Pelvic fracture

Answer 45

A. Shoulder fracture

Question 46

Blood may irritate the ____ and cause the patient to report abdominal pain.

Answer 46

peritoneal cavity

Question 47

Severe bleeding may occur with injury to ______ organs.

Answer 47

Solid

Question 48

Another name for the right and left upper quadrants is the _______.

Answer 48

flank

Question 49

The first signs of peritonitis include all of the following, EXCEPT:

A. severe abdominal pain

B. muscular spasm

C. nausea.

D. tenderness

Answer 49

C. nausea.