Exam 3 - Chapters 25 to 29

Question 1

A 19-year-old male was stung multiple times by fire ants. He is experiencing obvious signs and symptoms of anaphylactic shock. You administer high-flow oxygen and give him epinephrine via intramuscular injection. Upon reassessment, you determine that his condition has not improved. You should:

Select one:

A. repeat the epinephrine injection after consulting with medical control.
B. transport him immediately and provide supportive care while en route.
C. consider that he may actually be experiencing an acute asthma attack.
D. request a paramedic unit that is stationed approximately 15 miles away.

Answer 1

A. repeat the epinephrine injection after consulting with medical control.

Question 2

A 56-year-old male is found semiconscious by his wife. Your assessment reveals that his respirations are rapid and shallow, his pulse is rapid and irregular, and his blood pressure is low. The patient’s wife states that he complained of left arm pain and nausea the day before, but would not allow her to call 9-1-1. The MOST likely cause of this patient’s present condition is:

Select one:

A. cardiogenic hypoperfusion.
B. acute myocardial infarction.
C. a ruptured aortic aneurysm.
D. severe septic hypoperfusion.

Answer 2

A. cardiogenic hypoperfusion.

Question 3

Clinical signs of compensated shock include all of the following, EXCEPT:

Select one:

A. cool and clammy skin.
B. restlessness or anxiety.
C. absent peripheral pulses.
D. rapid, shallow breathing.

Answer 3

C. absent peripheral pulses.

Question 4

Neurogenic shock occurs when:

Select one:

A. failure of the nervous system causes widespread vasodilation.
B. massive vasoconstriction occurs distal to a spinal cord injury.
C. there is too much blood to fill a smaller vascular container.
D. the spinal cord is severed and causes massive hemorrhaging.

Answer 4

A. failure of the nervous system causes widespread vasodilation.

Question 5

Which of the following MOST accurately describes septic shock?

Select one:

A. Bacterial infection of the nervous system with widespread vasodilation
B. Viral infection of the blood vessels, vascular damage, and vasoconstriction
C. Bacterial damage to the vessel wall, leaking blood vessels, and vasodilation
D. Widespread vasoconstriction and plasma loss due to a severe viral infection

Answer 5

C. Bacterial damage to the vessel wall, leaking blood vessels, and vasodilation

Question 6

Which of the following statements regarding anaphylactic shock is correct?

Select one:

A. Anaphylactic shock occurs immediately after a person is sensitized to an allergen.
B. Anaphylactic shock is caused by immune system failure due to a toxic exposure.
C. Subsequent exposure after sensitization often produces a more severe reaction.
D. Sensitized people will experience less severe reactions upon subsequent exposure.

Answer 6

C. Subsequent exposure after sensitization often produces a more severe reaction.

Question 7

You are dispatched to a residence for a 40-year-old female who fainted. Upon your arrival, the patient is conscious and alert, and states that she is fine. Her husband tells you that she fainted after receiving news that her sister was killed in a car crash. You offer oxygen to the patient, but she refuses to accept it. At this point, your primary concern should be to:

Select one:

A. provide emotional support regarding her sister.
B. advise her that she needs to go to the hospital.
C. determine if she was injured when she fainted.
D. obtain baseline vital signs and a medical history.

Answer 7

C. determine if she was injured when she fainted.

Question 8

You are transporting a 33-year-old male who was involved in a major motor vehicle crash. You have addressed all immediate and potentially life-threatening conditions and have stabilized his condition with the appropriate treatment. With an estimated time of arrival at the hospital of 20 minutes, you should:

Select one:

A. take his vital signs in 15 minutes.
B. reassess his condition in 5 minutes.
C. arrange for an ALS rendezvous.
D. repeat your secondary assessment.

Answer 8

B. reassess his condition in 5 minutes.

Question 9

You respond to a residence for a patient with a severe leg injury following an accident with a chainsaw. When you arrive, you find the patient, a 44-year-old male, lying supine in the backyard. He has a partial amputation of his right lower leg that is actively bleeding. The patient is conscious and breathing adequately; however, he is restless and his skin is diaphoretic. You should:

Select one:

A. immediately evaluate his airway.
B. assess the rate and quality of his pulse.
C. administer 100% supplemental oxygen.
D. apply direct pressure to the wound.

Answer 9

D. apply direct pressure to the wound.

Question 10

Your assessment of an unresponsive patient reveals that her breathing is inadequate. Your MOST immediate action should be to:

Select one:

A. move her to the ambulance stretcher.
B. check her airway for obstructions.
C. administer high-flow oxygen.
D. ventilate her with a bag-valve mask.

Answer 10

B. check her airway for obstructions.

Question 11

A 39-year-old male sustained a large laceration to his leg during an accident with a chainsaw and is experiencing signs and symptoms of shock. You should first:

Select one:

A. place the patient on high-flow oxygen.
B. perform a rapid head-to-toe assessment.
C. apply direct pressure to the wound.
D. follow appropriate standard precautions.

Answer 11

D. follow appropriate standard precautions.

Question 12

A 70-year-old man presents with a severe nosebleed. His medical history includes COPD, depression, and a hemorrhagic stroke 3 years ago. His BP is 190/110 mm Hg, his pulse is 100 beats/min, and his respirations are 24 breaths/min. His medications include albuterol, sertraline (Zoloft), and multivitamins. Which of the following is MOST likely causing his nosebleed today?

Select one:

A. Diabetic complications
B. High blood pressure
C. His prescribed albuterol
D. Hemorrhagic stroke

Answer 12

B. High blood pressure

Question 13

A patient is bleeding severely from a severed femoral artery high in the groin region. Which of the following would MOST likely control the bleeding?

Select one:

A. Apply a pelvic binder device to stabilize the pelvis
B. Apply a topical hemostatic agent with direct pressure
C. Apply chemical ice packs to the wound and transport
D. Position the patient with his injured side down

Answer 13

B. Apply a topical hemostatic agent with direct pressure

Question 14

An infant with a total blood volume of 800 mL would start showing signs of shock when as little as ______ of blood is lost.

Select one:

A. 100 mL
B. 50 mL
C. 150 mL
D. 200 mL

Answer 14

A. 100 mL

Question 15

An organ or tissue may be better able to resist damage from hypoperfusion if the:

Select one:

A. systolic arterial blood pressure is at least 60 mm Hg.
B. body’s demand for oxygen is markedly increased.
C. body’s temperature is considerably less than 98.6°F (37.0°C).
D. heart rate is maintained at more than 100 beats/min.

Answer 15

C. body’s temperature is considerably less than 98.6°F (37.0°C).

Question 16

Blood stasis, changes in the vessel wall, and certain medications affect the:

Select one:

A. systolic blood pressure exclusively.
B. ability of the blood to effectively clot.
C. ability of red blood cells to carry oxygen.
D. white blood cells’ ability to fight infection.

Answer 16

B. ability of the blood to effectively clot.

Question 17

Early signs and symptoms of intra-abdominal bleeding include:

Select one:

A. bruising only.
B. widespread ecchymosis.
C. significant hypotension.
D. pain and distention.

Answer 17

D. pain and distention.

Question 18

Gastrointestinal bleeding should be suspected if a patient presents with:

Select one:

A. hematemesis.
B. dyspnea.
C. hematuria.
D. hemoptysis.

Answer 18

A. hematemesis.

Question 19

In nontrauma patients, an early indicator of internal bleeding is:

Select one:

A. a decreasing blood pressure.
B. dizziness upon standing.
C. rapid, shallow breathing.
D. a rapid, thready pulse.

Answer 19

B. dizziness upon standing.

Question 20

Most cases of external bleeding from an extremity can be controlled by:

Select one:

A. elevating the injured extremity.
B. compressing a pressure point.
C. packing the wound with gauze.
D. applying local direct pressure.

Answer 20

D. applying local direct pressure.

Question 21

The ability of a person’s cardiovascular system to compensate for blood loss is MOST related to:

Select one:

A. the part of the body injured.
B. how fast his or her heart beats.
C. his or her baseline blood pressure.
D. how rapidly he or she bleeds.

Answer 21

D. how rapidly he or she bleeds.

Question 22

The smaller vessels that carry blood away from the heart and connect the arteries to the capillaries are called the:

Select one:

A. venules.
B. arterioles.
C. vena cavae.
D. capillary arteries.

Answer 22

B. arterioles.

Question 23

The systemic veins function by:

Select one:

A. returning deoxygenated blood back to the heart.
B. delivering oxygen-poor blood to the capillaries.
C. returning oxygen-rich blood back to the left atrium.
D. delivering deoxygenated blood to the capillaries.

Answer 23

A. returning deoxygenated blood back to the heart.

Question 24

Which of the following body systems or components is the LEAST critical for supplying and maintaining adequate blood flow to the body?

Select one:

A. An effectively pumping heart
B. The filtering of blood cells in the spleen
C. Adequate blood in the vasculature
D. An intact system of blood vessels

Answer 24

B. The filtering of blood cells in the spleen

Question 25

Which of the following occurs after tissues are injured?

Select one:

A. Local blood vessels begin to dilate
B. Red blood cells separate from plasma
C. Red blood cells become less sticky
D. Platelets collect at the injury site

Answer 25

D. Platelets collect at the injury site

Question 26

Which of the following organs can tolerate inadequate perfusion for 2 to 3 hours?

Select one:

A. Brain
B. Heart
C. Skeletal muscle
D. Kidneys

Answer 26

C. Skeletal muscle

Question 27

A 17-year-old male was shot in the right anterior chest during an altercation. As your partner is applying oxygen, you perform a rapid assessment and find an open chest wound with a small amount of blood bubbling from it. You should:

Select one:

A. apply an occlusive dressing to the wound and continue your assessment.
B. place a sterile dressing over the wound and apply direct pressure.
C. direct your partner to assist the patient’s ventilations with a BVM.
D. control the bleeding from the wound and prepare to transport at once.

Answer 27

A. apply an occlusive dressing to the wound and continue your assessment.

Question 28

A 38-year-old male was electrocuted while attempting to wire a house. Your assessment reveals that he is unresponsive, pulseless, and apneic. A coworker has shut off the power to the house. You should:

Select one:

A. begin CPR and apply the AED.
B. begin CPR and transport at once.
C. assess for entry and exit wounds.
D. fully immobilize his spinal column.

Answer 28

A. begin CPR and apply the AED.

Question 29

A laceration:

Select one:

A. rarely penetrates through the subcutaneous tissue to the muscle.
B. is a jagged cut caused by a sharp object or blunt force trauma.
C. is an injury that separates various layers of soft tissue.
D. is a sharp, smooth cut that is made by a surgical scalpel.

Answer 29

B. is a jagged cut caused by a sharp object or blunt force trauma.

Question 30

A partial-thickness burn involves the outer layer of skin and a portion of the:

Select one:

A. muscle fascia.
B. fatty layer.
C. epidermis.
D. dermal layer.

Answer 30

D. dermal layer.

Question 31

A utility worker was trimming branches and was electrocuted when he accidentally cut a high-power line. He fell approximately 20 feet and is lying unresponsive on the ground; the power line is lying across his chest. You should:

Select one:

A. rapidly assess the patient after ensuring that the power line is not live.
B. apply insulated gloves and assume manual control of his c-spine.
C. quickly but carefully move the patient away from the power line.
D. manually stabilize his head as your partner assesses for breathing.

Answer 31

A. rapidly assess the patient after ensuring that the power line is not live.

Question 32

All of the following body structures are lined with mucous membranes, EXCEPT for the:

Select one:

A. mouth.
B. nose.
C. anus.
D. lips.

Answer 32

D. lips.

Question 33

An injury that separates various layers of soft tissue, resulting in complete detachment or a flap of skin, is called a(n):

Select one:

A. amputation.
B. laceration.
C. avulsion.
D. incision.

Answer 33

C. avulsion.

Question 34

During an altercation in a bar, two patrons got into a fist fight. The first patient, a 44-year-old female, was struck in the mouth and refuses EMS care. The second patient, a 39-year-old female, has a small laceration to her left knuckle and also refuses EMS care. Which of the following statements regarding this scenario is correct?

Select one:

A. You should contact the police and have the patients arrested.
B. The 39-year-old female is at high risk for an infection.
C. The 44-year-old female is at high risk for an infection.
D. The patient struck in the mouth should be immobilized.

Answer 34

B. The 39-year-old female is at high risk for an infection.

Question 35

During the normal wound-healing process, bleeding may occur from even a minor injury because:

Select one:

A. there is a substantial decrease in the number of platelets in and around the wound, which increases the risk of bleeding.
B. new capillaries that stem from intact capillaries are delicate and take time to become as stable as the preexisting capillaries.
C. bacteria and other microorganisms invade the wound site and damage the capillaries, which makes them more prone to bleeding.
D. histamines released by the immune system constrict the blood vessels, which increases the pressure within them.

Answer 35

B. new capillaries that stem from intact capillaries are delicate and take time to become as stable as the preexisting capillaries.

Question 36

Patients with full-thickness (third-degree) burns generally do not complain of pain because:

Select one:

A. subcutaneous vessels are usually clotted.
B. the nerve endings have been destroyed.
C. blister formation protects the burn.
D. they are generally not conscious.

Answer 36

B. the nerve endings have been destroyed.

Question 37

What layer of the skin forms a watertight, protective seal for the body?

Select one:

A. Muscular layer
B. Epidermis
C. Dermis
D. Subcutaneous layer

Answer 37

B. Epidermis

Question 38

When a person is exposed to a cold environment:

Select one:

A. the skin becomes flushed secondary to peripheral vasodilation.
B. peripheral vessels constrict and divert blood away from the skin.
C. sweat is produced and is warmed when the vessels constrict.
D. blood vessels dilate and divert blood to the core of the body.

Answer 38

B. peripheral vessels constrict and divert blood away from the skin.

Question 39

When assessing a patient with a closed soft-tissue injury, it is MOST important to:

Select one:

A. manipulate the injury site for signs of a fracture.
B. remain alert for more severe underlying injuries.
C. assess circulation distal to the site of the injury.
D. recognize that the integrity of the skin is broken.

Answer 39

B. remain alert for more severe underlying injuries.

Question 40

Which of the following is a severe burn in a 2-year-old child?

Select one:

A. Superficial burn that covers 25% of the BSA
B. Partial-thickness burn that covers 10% of the BSA
C. Any burn that involves the arms, legs, or posterior part of the body
D. Any full-thickness burn, regardless of its location on the body

Answer 40

D. Any full-thickness burn, regardless of its location on the body

Question 41

Which of the following is a severe burn in a 35-year-old patient?

Select one:

A. Partial-thickness burn to 20% of the body surface area
B. Full-thickness burn to 5% of the body surface area
C. Superficial burn covering 50% of the body surface area
D. Circumferential partial-thickness burn to the chest

Answer 41

D. Circumferential partial-thickness burn to the chest

Question 42

Which of the following is of LEAST importance when initially assessing the severity of a burn?

Select one:

A. Past medical history
B. Known drug allergies
C. Age of the patient
D. Area(s) burned

Answer 42

B. Known drug allergies

Question 43

Which of the following statements regarding electrical burns is correct?

Select one:

A. Entrance wounds are small relative to the amount of internal tissue damage.
B. The exit wound caused by electrical burns is smaller than the entrance wound.
C. Respiratory or cardiac arrest following an electrical burn is very uncommon.
D. The size of the entry and exit wounds is a reliable indicator of internal damage.

Answer 43

A. Entrance wounds are small relative to the amount of internal tissue damage.

Question 44

Which of the following statements regarding the dermis is correct?

Select one:

A. The dermis lies above the germinal layer and provides protection.
B. The dermis contains hair follicles, sweat glands, and nerve endings.
C. The dermis produces a substance that provides color to the skin.
D. The cells of the dermis are worn away and are constantly replaced.

Answer 44

B. The dermis contains hair follicles, sweat glands, and nerve endings.

Question 45

Which of the following statements regarding the rule of nines is correct?

Select one:

A. The posterior of a child’s leg is equal to 13.5% of the BSA.
B. The anterior arm in the adult is equal to 9% of the total BSA.
C. The anterior trunk of an adult is equal to 18% of the BSA.
D. A child’s head is equal to 14% of his or her total BSA.

Answer 45

C. The anterior trunk of an adult is equal to 18% of the BSA.

Question 46

With regard to the pediatric rule of nines, the:

Select one:

A. thorax is proportionately larger than an adult’s.
B. head is proportionately smaller than an adult’s.
C. arms are proportionately larger than an adult’s.
D. legs are proportionately smaller than an adult’s.

Answer 46

D. legs are proportionately smaller than an adult’s.

Question 47

A 39-year-old female experienced a severe closed head injury. She is unresponsive with her eyes slightly open; her pupils are bilaterally dilated and slow to react. In addition to managing problems with airway, breathing, and circulation, you should:

Select one:

A. irrigate her eyes with water to prevent mucosal drying.
B. secure her eyes open so you can reassess her pupils.
C. inspect her eyes and gently remove impaled objects.
D. close her eyes and cover them with a moist dressing.

Answer 47

D. close her eyes and cover them with a moist dressing.

Question 48

A patient who is complaining of seeing flashing lights, specks, or “floaters” in his or her field of vision has MOST likely experienced:

Select one:

A. a blowout fracture.
B. acute hyphema.
C. conjunctivitis.
D. a detached retina.

Answer 48

D. a detached retina.

Question 49

A young female experienced a laceration to her left eyeball from flying glass when her boyfriend broke a soda bottle against a wall. There is moderate bleeding and the patient states that she cannot see out of the injured eye. You should:

Select one:

A. apply firm direct pressure to the injured eye and cover the opposite eye.
B. ask her to move the injured eye to assess the integrity of the optic nerve.
C. carefully examine her eye and remove any foreign objects if needed.
D. avoid applying pressure to the globe when you are covering the eye.

Answer 49

D. avoid applying pressure to the globe when you are covering the eye.

Question 50

The cricoid cartilage:

Select one:

A. lies superior to the thyroid cartilage in the neck.
B. is easier to see and palpate than the thyroid cartilage.
C. lies superior to the cricothyroid membrane in the neck.
D. is the only complete circular cartilage of the trachea.

Answer 50

D. is the only complete circular cartilage of the trachea.

Question 51

The eyeball itself is referred to as the:

Select one:

A. sclera.
B. cornea.
C. globe.
D. orbit.

Answer 51

C. globe.

Question 52

The inner surface of the eyelids and the exposed surface of the eye itself are covered by a delicate membrane called the:

Select one:

A. cornea.
B. sclera.
C. retina.
D. conjunctiva.

Answer 52

D. conjunctiva.

Question 53

The lower jawbone is called the:

Select one:

A. mandible.
B. zygoma.
C. mastoid.
D. maxillae.

Answer 53

A. mandible.

Question 54

The mastoid process is located approximately:

Select one:

A. half an inch anterior to the external opening of the ear.
B. 1 inch inferior to the external opening of the ear.
C. 1 inch posterior to the angle of the mandible.
D. 1 inch posterior to the external opening of the ear.

Answer 54

D. 1 inch posterior to the external opening of the ear.

Question 55

The optic nerve endings are located within the:

Select one:

A. pupil.
B. sclera.
C. cornea.
D. retina.

Answer 55

D. retina.

Question 56

The white portion of the eye is called the:

Select one:

A. cornea.
B. retina.
C. sclera.
D. iris.

Answer 56

C. sclera.

Question 57

A 45-year-old male was working on his roof when he fell approximately 12 feet, landing on his feet. He is conscious and alert and complains of an ache in his lower back. He is breathing adequately and has stable vital signs. You should:

Select one:

A. perform a rapid head-to-toe exam and immobilize his spine.
B. allow him to refuse transport if his vital signs remain stable.
C. obtain a Glasgow Coma Score value and give him oxygen.
D. immobilize his spine and perform a focused secondary exam.

Answer 57

D. immobilize his spine and perform a focused secondary exam.

Question 58

A female patient with a suspected head injury has slow, shallow breathing. The MOST appropriate treatment for her includes:

Select one:

A. administering oxygen via a nonrebreathing mask.
B. ventilation assistance to maintain an ETCO2 of 30 to 35 mm Hg.
C. ventilation assistance to maintain an oxygen saturation of 90%.
D. hyperventilating her at 30 breaths/min.

Answer 58

B. ventilation assistance to maintain an ETCO2 of 30 to 35 mm Hg.

Question 59

A reflex arc occurs when:

Select one:

A. the motor nerves function automatically without receiving a message from the CNS.
B. the brain interprets sensory information that it receives from peripheral and cranial nerves and sends a signal to the muscles.
C. a sensory nerve sends a message to the brain but the motor nerve fails to send the appropriate response to the body.
D. a sensory nerve detects an irritating stimulus and bypasses the brain by sending a direct message to the motor nerve.

Answer 59

D. a sensory nerve detects an irritating stimulus and bypasses the brain by sending a direct message to the motor nerve.

Question 60

A short backboard or vest-style immobilization device is indicated for patients who:

Select one:

A. are sitting in their car and are clinically unstable.
B. are in a sitting position and are clinically stable.
C. require prompt extrication from an automobile.
D. are found supine and have stable vital signs.

Answer 60

B. are in a sitting position and are clinically stable.

Question 61

A temporary loss or alteration of part or all of the brain’s abilities to function without physical damage to the brain MOST accurately describes a(n):

Select one:

A. cerebral contusion.
B. cerebral concussion.
C. intracranial hemorrhage.
D. intracerebral hematoma.

Answer 61

B. cerebral concussion.

Question 62

After your partner assumes manual in-line stabilization of the patient’s head, you should:

Select one:

A. assess distal neurovascular status in the extremities.
B. apply an appropriately sized rigid cervical collar.
C. thoroughly palpate the patient’s head for deformities.
D. use four people to log roll the patient onto a backboard.

Answer 62

A. assess distal neurovascular status in the extremities.

Question 63

An epidural hematoma is MOST accurately defined as:

Select one:

A. venous lacerations that occur within the brain.
B. an injury caused by a damaged cerebral artery.
C. bleeding between the skull and dura mater.
D. bleeding between the dura mater and brain.

Answer 63

C. bleeding between the skull and dura mater.

Question 64

Bleeding within the brain tissue itself is called a(n):

Select one:

A. subarachnoid hemorrhage.
B. subdural hematoma.
C. epidural hematoma.
D. intracerebral hematoma.

Answer 64

D. intracerebral hematoma.

Question 65

If you do not have the appropriate-size cervical collar, you should:

Select one:

A. defer cervical immobilization and apply lateral head blocks.
B. use rolled towels to immobilize the patient’s head.
C. place sandbags on either side of the patient’s head.
D. ask the patient to keep his or her head in a neutral position.

Answer 65

B. use rolled towels to immobilize the patient’s head.

Question 66

In a patient with a head injury, hypertension, bradycardia, and Biot respirations indicate:

Select one:

A. an underlying skull fracture.
B. decreased cerebral blood flow.
C. herniation of the brain stem.
D. internal bleeding in the chest.

Answer 66

C. herniation of the brain stem.

Question 67

In which of the following situations would the EMT be the LEAST likely to immobilize a patient’s spine?

Select one:

A. No distracting injuries or evidence of intoxication
B. Unresponsive, but moving all extremities equally
C. No spinal pain, but tingling in the extremities
D. Pain to the c-spine, but no numbness or tingling.

Answer 67

A. No distracting injuries or evidence of intoxication

Question 68

It would be MOST appropriate to perform a focused secondary assessment on a patient who:

Select one:

A. struck his or her head and is experiencing nausea or vomiting.
B. has blood draining from the ears following a head injury.
C. fainted and fell to the ground from a standing position.
D. was restrained during a high-speed motor vehicle crash.

Answer 68

C. fainted and fell to the ground from a standing position.

Question 69

Rapid deceleration of the head, such as when it impacts the windshield, causes:

Select one:

A. compression injuries and contusions to the anterior, posterior, and lateral aspects of the brain.
B. primary impact to the posterior aspect of the brain, resulting in compression injuries, bruising, or torn blood vessels.
C. compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain.
D. stretching or tearing of the anterior aspect of the brain and compression injuries or bruising to the posterior aspect of the brain.

Answer 69

C. compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain.

Question 70

The _________ contain(s) about 75% of the brain’s total volume.

Select one:

A. cerebellum
B. meninges
C. brain stem
D. cerebrum

Answer 70

D. cerebrum

Question 71

The _________ is the best-protected part of the CNS and controls the functions of the cardiac and respiratory systems.

Select one:

A. cerebellum
B. cerebral cortex
C. spinal cord
D. brain stem

Answer 71

D. brain stem

Question 72

The cerebrospinal fluid (CSF) that circulates in between each meningeal layer:

Select one:

A. delivers oxygen directly to the CNS.
B. regenerates brain cells after they have been damaged.
C. acts as a shock absorber for the brain and spinal cord.
D. produces leukocytes that protect the brain from infection.

Answer 72

C. acts as a shock absorber for the brain and spinal cord.

Question 73

The effectiveness of positive-pressure ventilations when treating a head-injured patient can ONLY be determined by:

Select one:

A. a neurosurgeon or emergency department physician.
B. reassessing the patient’s blood pressure after 10 minutes.
C. noting a decrease in the heart rate during ventilations.
D. immediate reassessment following the intervention.

Answer 73

D. immediate reassessment following the intervention.

Question 74

The frontal and parietal bones of the skull are especially susceptible to:

Select one:

A. linear skull fractures.
B. nondisplaced skull fractures.
C. depressed skull fractures.
D. basilar skull fractures.

Answer 74

C. depressed skull fractures.

Question 75

The hormone responsible for the actions of the sympathetic nervous system is:

Select one:

A. epinephrine.
B. thyroxine.
C. aldosterone.
D. insulin.

Answer 75

A. epinephrine.

Question 76

The MOST common and serious complication of a significant head injury is:

Select one:

A. acute hypotension.
B. a skull fracture.
C. cerebral edema.
D. a hypoxic seizure.

Answer 76

C. cerebral edema.

Question 77

A 37-year-old male was pinned between a flatbed truck and a loading dock. On exam, you find bruising to the chest, distended neck veins, bilaterally diminished breath sounds, and bilateral scleral hemorrhaging. You should:

Select one:

A. request a paramedic ambulance.
B. perform a secondary assessment.
C. aggressively manage his airway.
D. suspect a severe hemopneumothorax.

Answer 77

C. aggressively manage his airway.

Question 78

A patient who presents with profound cyanosis following a chest injury:

Select one:

A. should be placed in Trendelenburg position.
B. has most likely experienced a ruptured aorta.
C. requires prompt ventilation and oxygenation.
D. is most likely experiencing severe blood loss.

Answer 78

C. requires prompt ventilation and oxygenation.

Question 79

During your assessment of a patient with blunt chest trauma, you note that the patient has shallow breathing and paradoxical movement of the left chest wall. You should:

Select one:

A. make note of it and continue your assessment.
B. apply high-flow oxygen via nonrebreathing mask.
C. request a paramedic to decompress the chest.
D. assist ventilations with a bag-valve mask.

Answer 79

D. assist ventilations with a bag-valve mask.

Question 80

Elevation of the rib cage during inhalation occurs when:

Select one:

A. intrathoracic pressure decreases.
B. the intercostal muscles contract.
C. abdominal contents descend.
D. the diaphragm descends.

Answer 80

B. the intercostal muscles contract.

Question 81

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.

Answer 81

B. visceral and parietal pleurae.

Question 82

The ________ nerves control the diaphragm.

Select one:

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

Answer 82

D. phrenic

Question 83

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.

Answer 83

B. C3, C4, and C5.

Question 84

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

Select one:

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

Answer 84

B. Lungs

Question 85

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.

Answer 85

B. distention.

Question 86

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

Answer 86

A. Shoulder fracture

Question 87

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.

Answer 87

C. liver.

Question 88

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.

Answer 88

A. guarding.

Question 89

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.

Answer 89

A. intra-abdominal bleeding.

Question 90

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.

Answer 90

A. red areas of skin.

Question 91

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.

Answer 91

A. hollow abdominal organs are damaged and spill their contents into the peritoneal cavity.

Question 92

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.

Answer 92

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

Question 93

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.

Answer 93

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

Question 94

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.

Answer 94

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

Question 95

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.

Answer 95

A. separation of the acromioclavicular joint.

Question 96

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.

Answer 96

D. posterior hip dislocation.

Question 97

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.

Answer 97

C. place her onto a scoop stretcher, pad around her left hip with pillows, and secure her to the scoop with straps.

Question 98

A Colles fracture involves a fracture of the:

Select one:

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

Answer 98

A. distal radius.

Question 99

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

Answer 99

D. pathologic

Question 100

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.

Answer 100

A. lumbar spine.

Question 101

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

Answer 101

C. epiphyseal

Question 102

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.

Answer 102

A. muscle decreases in size and function.

Question 103

Bone marrow produces:
Select one:
A. cartilage.
B. electrolytes.
C. lymphocytes.
D. blood cells.

Answer 103

D. blood cells.

Question 104

Bones are connected to other bones by bands of tough fibrous tissues called:
Select one:
A. bursa.
B. ligaments.
C. cartilage.
D. tendons.

Answer 104

B. ligaments.

Question 105

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.

Answer 105

A. keeping the leg at the level of the heart.

Question 106

Common signs and symptoms of a sprain include all of the following, EXCEPT:
Select one:
A. swelling.
B. deformity.
C. ecchymosis.
D. point tenderness.

Answer 106

B. deformity.

Question 107

Deformity caused by a fracture would MOST likely be masked by:
Select one:
A. swelling.
B. ecchymosis.
C. crepitus.
D. guarding.

Answer 107

A. swelling.

Question 108

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

Answer 108

D. 1,000

Question 109

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.

Answer 109

C. apply high-flow oxygen, consider spinal precautions, and transport without delay.

Question 110

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.

Answer 110

D. the patient history.

Question 111

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.

Answer 111

A. articular cartilage.

Question 112

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.

Answer 112

A. traction.

Question 113

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.

Answer 113

C. neurovascular compromise.

Question 114

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.

Answer 114

A. clavicle.

Question 115

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.

Answer 115

A. irrigate both eyes continuously for 20 minutes with plain water.

Question 116

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.

Answer 116

A. administer high-flow oxygen.

Explanation

The patient is exhibiting signs of a concussion (MOI, altered mental status, slurred speech, cannot remember the event) and needs to see a physician for possible traumatic brain injuries (TBI). Especially since hematomas are associates with severe tissue damage, and this example in the area of the brain, which is sensitive to pressure changes.

Our focus here is to slow down the damage of possible secondary brain injury.Airway compromise from TBI comes in many forms.

Irreversible brain damage can occur in TBI patients after only four minutes of anoxia, which can be caused by a compromised airway, altered respiratory patterns from the head injury, or lung injury in multi-system trauma. Use pulse-oximetry, skin color, and respiratory rate to assess adequate oxygenation. Administer oxygen via nasal cannula, non-rebreather mask, or bag valve to maintain a pulse-ox reading of at least 95%.

Following MARCH algorithm:

M - Massive Bleed Control - None Apparent - move to ABC’s

A - Airway Patent(AVPU, GCS, C-Spine Considerations) - Stabilized

R - Respiration - Administer High Flow Oxygen (Correct Answer)

C- Circulation - Pulse Rate, Blood Pressure

H - Head Injuries & Other Injuries

B. Incorrect - apply ice to the hematoma.

This isnot part of the primary assessment. This may play a role once life-threats have been cared for first.

C. Incorrect - perform a neurologic exam.

This will come into play after the ABC’s have been managed.

D. Incorrect - palpate his radial pulses.

This is the C in both the ABC & MARCH algorithms, which follows breathing. High flow oxygen comes first.

Question 117

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

Answer 117

D. the speed of a bullet has the greatest impact on producing injury

Question 118

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.

Answer 118

A. transport her to the emergency department.

Question 119

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.

Answer 119

C. gastrointestinal bleeding.

Question 120

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.

Answer 120

D. the four-person log roll.

Question 121

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.

Answer 121

B. It is a clear, jellylike fluid near the back of the eye that cannot be replaced if it is lost.

Question 122

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

Select one:

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

Answer 122

C. Somatic

Question 123

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.

Answer 123

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

Explanation

The elevated blood pressure (which may be the cause of the nose bleed) indicates that the blood vessels need to be closed off (i.e. pinch). Leaning forward keeps the blood in one spot and contributes to clotting. Also, this prevents an airway obstruction as the blood doesn’t drain down the throat.

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

This does little to stop the bleed other than waiting on the clotting factors. The increased blood pressure, possibly what caused the bleed, indicates clotting faster may need help.

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

Laying down will keep the blood drawing away from the wound. Keeping the blood at the wound increases clotting factors. Also, this has the potential to create an airway obstruction as the blood drains down the throat.

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

This can make the bleeding worse.

Question 124

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

Answer 124

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

Explanation

“The only exceptions to the rule of not removing an impaled object are the objects in the cheek or mouth that obstruct breathing and objects in the chest that directly interfere with performing CPR on a patient who is already in cardiac arrest.” (pg 920)

Being pulseless and apneic, the patient is already in cardiac arrest and the position of the knife would make it impossible to perform CPR.

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

This patient is not in cardiac arrest as they are semiconscious. Also, depending on the location of the ice pick, it may or may not interfere with CPR. With the provided information, removal is not indicated.

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

This patient has a shard of glass in their abdomen and will not compromise CPR. Also, this patient is apneic, and it is possible to be apneic with cardiac activity, albeit not for long, thus it is not indicated that they are in cardiac arrest.

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

The fishhook does not impair CPR, and there is a high probability that definitive care is required to remove the hook to salvaged function in the eye.

Question 125

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.

Answer 125

A. splinting the extremity (pg 894)

Explanation

“Air splints (commonly known as soft splints or pressure splints) can control internal or external bleeding associated with severe extremity injuries, such as fractures. They also immobilize the fracture itself. An air splint acts like a pressure dressing applied to an entire extremity rather than to a small local area.” (pg 894)

B. applying a tourniquet.

This cuts off blood but would not stop the bone shards from tearing into surrounding tissues increasing bleeding once the tourniquet is removed, and does not stop the bone tissues from being further damaged due to movement.

C. keeping the patient warm.

This will help to treat shock, but will not stop bleeding nor prevent the fracture from becoming worse.

D. applying chemical ice pack.

This can help reduce blood rushing to the area, but it may not stop the bleeding not stabilize the fracture.

Question 126

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.

Answer 126

D. All of these answers are correct.

Question 127

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

Answer 127

C. Rotational and rollover

Question 128

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.

Answer 128

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

Explanation (pg. 927)

“Burns to children are generally considered more serious than burns to adults. The reason is infants and children have more surface area relative to body mass, which means greater fluid and heat loss. In addition, children do not tolerate burns as well as adults do. Children are also more likely to go into shock, have hypothermia develop, and experience airway difficulties because of the unique differences associated with their ages and anatomy.

Many burns in infants and children result from child abuse. The classic burn resulting from deliberate immersion involves the hands and wrists, as well as the feet, lower legs, and buttocks. Similarly burns around the genitals and multiple cigarette burns should be viewed as possible abuse. Report all suspected cases of abuse to the proper authorities, especially those where significant delaying evaluation and treatment is evident.

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

This is a serious concern, that needs to be taken into account. Priority goes to the life-threatening conditions first.

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

1. Despite a smaller stature, burned children have a greater body surface area per mass than adults.
2. Cardiac function, mean blood volume, and normal hemoglobin levels are age-dependent in children; hence, children have a higher blood transfusion/unit volume ratio.

C. Incorrect - pediatric patients are more prone to hyperthermia.

This is secondary to the burn area.

Question 129

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%

Answer 129

C. 18%

Explanation (scroll down and click on the picture for visual)

One side of Right Arm = 4.5%

One side of Left Arm = 4.5%

Upper Chest Area = 9%

Total = 18%

Question 130

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.

Answer 130

D. it causes a problem managing the airway.

Question 131

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.

Answer 131

B. rapidly transporting her to the hospital.

Question 132

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.

Answer 132

C. primary blast injuries are the most easily overlooked.

Explanation: Types of Blast Injuries

1. Primary blast injury: Primary blast injury is due to the supersonic over-pressurization blast wave unique to high-order (HE) explosives. HE devices involve a detonation or the nearly instantaneous transformation of solid or liquid into a gas state. When this blast over-pressure wave strikes body surfaces, it can cause pulmonary barotrauma, rupture of the eardrum, perforation of gas-filled structures like the intestines or gallbladder, ocular rupture and concussion – even in the absence of obvious physical head injury.
2. Secondary blast injury: Low-order (LE) explosions are typically deflagrations whose exothermic wave is subsonic and isn’t nearly as powerful. By definition, LE explosions are unable to cause primary blast injury. However, they may cause injury resulting from flying debris, bomb fragments and projectiles causing blunt and penetrating trauma known as secondary blast injury.

When documenting injury from pieces of a device itself, it is more correct to use the term “fragmentation” as opposed to “shrapnel.” Shrapnel injury technically can only come from actual shrapnel shells where relatively low velocity lead balls are ejected from a casing that remains intact.

3. Tertiary blast injuries: Tertiary blast injury results from the human body actually being thrown by the blast wind and may manifest as fractures, traumatic amputations and brain injuries.
4. Quaternary blast injuries: Quaternary blast injury is everything else not caused by primary, secondary or tertiary mechanisms. Examples include burns, angina, crush injuries, asthma or COPD exacerbations due to dust, smoke or toxic fumes.

Question 133

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.

Answer 133

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.

Explanation

A crushing injury occurs when significant force is applied to the body. The extent of the damage depends on how much force is applied and how long it is applied. In addition to causing direct soft tissue damage, continued compression of the soft tissues cut off circulation, producing further tissue destruction. […]

When an area of the body is trapped for longer than 4 hours and arterial blood is compromised, crushed syndrome can develop. What a patient’s tissues are crisp and repair, muscle cells die and release harmful substances into the surrounding tissues. The opposing force prevents blood from returning to the injured part of the body, so these harmful substances are released into the body circulation after the Lamb is freed and blood flow is returned. (pg 908)

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

With course syndrome, massive blood vessel damage does occur, but not by a severing soft-tissue injury, such as amputation. With crush syndrome, the patient’s tissues are crushed beyond repair, muscle cells die, and release harmful substances into the surrounding tissues while they are still attached to the patient’s body. (pg 908)

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

“Bring the limb or the body part from entrapment not only results in the release of the byproducts of metabolism and harmful products of tissue destruction, but also creates the potential for cardiac and renal failure.” (pg 908)

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

As described above, 4 hours of the body being trapped in arterial blood flow being compromised is sufficient to indicate crushed syndrome.

Question 134

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.

Answer 134

B. axial loading.

Question 135

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

Answer 135

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

Question 136

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.

Answer 136

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

Explanation (pg. 909)

“If the avulsion tissue is hanging from a small piece of skin, the circulation through the flap may be at risk. If you can, replace the flat ovals flap in its original position as long as it is not visibly contaminated with dirt and/or other floor materials.”

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

Removing that flap of skin may prolong the healing process; if it is still vascularized, removing it will cause more damage.

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

Irrigating is a good step to remove debris. This is missing the replacement of the flap (i.e. incomplete avulsion). Only after replacing the flap would you cover an incomplete avulsion with a sterile dressing.

Rinse the wound with water or saline solution, the cleaner the better. Sterile irrigation is the best. This will restart the bleeding in many cases. That’s OK. It’s good to clean the wound as well as stop the bleeding.

If the bleeding was difficult to stop and you are concerned that it will be out of control if you rinse the wound, then don’t worry about it. Get the patient to an emergency department immediately.

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

Probing the wound will cause more damage. Knowing whether it’s capillary, arterial, or venous is not necessary. It’s better to gauge the amount of bleeding and aid in sterilizing & clotting.

Question 137

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.

Answer 137

D. it interferes with your assessment of the airway.

Question 138

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

Answer 138

A. neck and facial injuries

Question 139

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.

Answer 139

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.

Question 140

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.

Answer 140

C. cervical, thoracic, lumbar, sacral, and coccygeal.

Question 141

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.

Answer 141

D. suction his oropharynx for up to 15 seconds.

Question 142

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.

Answer 142

C. stabilize her entire spine.

Question 143

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.

Answer 143

C. systolic blood pressure.

Explanation

“Remember that blood pressure may be the last measurable factor to change in shock. As we have seen, the body has serval automatic mechanisms to compensate for the initial blood loss and to help maintain blood pressure. Thus, by the time you detect a drop in blood pressure, shock is well developed.” (pg 496-497)
The other signs and symptoms can help to decrease the time shock has to develop. Blood Pressure may not be an early nor effective indicator of severe bleeding.

Question 144

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

Answer 144

C. Rapid transport to a trauma center

Question 145

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.

Answer 145

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

Explanation

The wound is managed in the prehospital setting by covering the eviscerated contents with a moist, sterile gauze or trauma dressing to prevent further contamination and drying.

Abdominal eviscerations are a surgical emergency. The protruding organ requires careful cleaning and evaluation prior to reinsertion into the peritoneal cavity by definitive care.

No attempt should be made to replace eviscerated organs into the peritoneal cavity

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

This has a high potential cause harm to the bowels due to exerted force on the bowels by pushing or tugging on them; this is in addition to the high probability to transfer microorganisms to the exposed organs.

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

Only a surgical staff should clean the bowels. A dry dressing would adhere to the organs and cause further damage

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

This does not specify the moist sterile gauze, not the need for an occlusive dressing to maintain the moisture.

Question 146

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.

Answer 146

B. weakness or dizziness. (pg 885)

Explanation

Basically, it’s because the book says so and doesn’t offer more on as to why this is a first indicator.

A. a low blood pressure.

Low blood pressure (LBP) alone is a late stage of shock and would be traumatic. Non-traumatic, LBP can also be caused by certain medications that are more prevalent in older patients

C. diaphoresis and pale skin.

Diaphoresis and pale skin are indicators of shock

D. a heart rate over 120 beats/min.

This is simply tachycardic

Question 147

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.

Answer 147

B. involves physical injury to the brain tissue.

Question 148

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.

Answer 148

B. a rapid, thready pulse.

Question 149

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.

Answer 149

C. your awareness and concern for potentially serious underlying injuries.

Question 150

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.

Answer 150

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

Question 151

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.

Answer 151

C. slow.

Question 152

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

Answer 152

B. wear gloves and facial protection.

Question 153

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.

Answer 153

A. quadruples.

Question 154

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.

Answer 154

D. airway compromise.

Question 155

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

Answer 155

D. Abrasion

Explanation

An abrasion is a wound of the superficial layer of the skin, caused by friction when a body part rubs or scrapes across a rough or hard surface. An abrasion usually does not penetrate completely through the dermis, but blood may ooze from the injured capillaries in the dermis. Also known as road rash, road burn, and rug burn, abrasions can be extremely painful because the nerve endings are located in this area. (pg. 909)

A. Incorrect - Avulsion

An avulsion is an injury that separates various layers of soft tissue (usually between the subcutaneous layer & fascia) so they become either completely detached or hang by a flap. Often there is significant bleeding. (pg 909)

B. Incorrect - Incision

A sharp, smooth cut. The depth and severity of the injury can vary. (pg 909)

C. Incorrect - Laceration

A jagged cut in the skin caused by a sharp object or blunt force that tears the skin. The depth and severity of the injury can vary. (pg 909)

Question 156

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

Answer 156

D. vomiting

Question 157

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.

Answer 157

A. direct pressure using dry, sterile dressings.

Question 158

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

Answer 158

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

Explanation

Burns that would be considered “moderate” on a young adult are classified as “Severe” on patients younger than 5 years or older than 55 years. (pg 925; Table 26-1)

These include: (moderate in young adults, severe in over 55 years old)

Superficial burns covering more than 50% of the Body’s Total Surface Area (BSA)
Partial-Thickness burns covering 15% to 30% of the BSA
Full-Thickness burns involving 2% to 10% of the BSA (excluding hands, feet, face, genitalia, and upper airway)

A. Superficial burn to 30% of the BSA

This superficial burn is under 50% BSA and does not meet the 50% BSA threshold.

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

This is a partial-thickness under 15% BSA and does not meet the 15% to 30% threshold.

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

This is a full-thickness under 2% BSA and does not meet the 2% to 10%​ threshold.

Question 159

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.

Answer 159

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

Question 160

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.

Answer 160

B. assist the patient’s ventilation

Explanation

Semiconscious & shallow breathing indicates that the patient needs aid in increasing their respiration gas exchange (aka ventilation)

A. Incorrect - apply a nonrebreathing mask.

Semiconscious & shallow breathing contraindicate a nonrebreather mask as the patient may not be breathing sufficiently on heir own for this method to be effective

C. Incorrect - obtain baseline vital signs

Once the massive bleeding has received care, the next step is to take care of the ABC’s (airway, breathing, circulation). Vitals are taken in process of the primary assessment & secondary assessment

Another version of this is the MARCH algorithm.

M- Massive Hemorrhage
A - Airway
R - Respiration
C - Circulatory
H - Head-to-Toe, Hypothermia
D. Incorrect - perform a secondary assessment.

Once the massive bleeding has received care, the next step is to take care of the ABC’s (airway, breathing, circulation). These take priority over a secondary assessment.

Question 161

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.

Answer 161

D. an air embolism.

Explanation:

For air to enter a closed system (i.e. vascular system), a connection must occur between the gas, the vessel, and a pressure gradient, that enables the flow of air into the vessel. An open neck injury presents this opportunity.

Venous gas embolism can go to the lungs and block pulmonary blood flow. This can create pulmonary hypertension & right-heart failure quickly.

A gas embolism that enters the heart can cause an “air lock” in the right side of the heart: the heart valves do not work properly, and the heart cannot eject the gas. Cardiac out then falls rapidly. This is fatal.

A gas embolism that enters the arterial system or reaches the left side of the heart can be pumped into the arterial circulation, and then cause an infarction (i.e. blood flow blockage, lack of oxygen delivery, tissue death) in the vital organs, including the heart and brain.

A. Incorrect - a spinal fracture.

Spinal fracture with a neck injury is a consideration, but severe bleeding and an open neck injury indicate a gas embolism is likely.

B. Incorrect - an ischemic stroke.

Ischemic strokes occur in arteries where blood only. A gas embolism can enter either the venous or arterial system. Uniquely saying it can cause an ischemic stroke leaves a venous blockage out and thus is less complete of an answer as “air embolism.”

C. Incorrect - nerve fiber damage.

Nerve fiber damage with a neck injury is a consideration, but severe bleeding and an open neck injury indicate a gas embolism is likely.

Question 162

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.

Answer 162

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

Explanation:

Histamine is not only the major mediator of the acute inflammatory and immediate hypersensitivity responses but has also been demonstrated to affect chronic inflammation and regulate several essential events in the immune response.

A. Incorrect - 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.

This is the process of coagulation, not inflammation. (pg 883)

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

Constricting blood vessels reduces inflammation. The vessels’ permeability drops so they do not leak and blood moves faster through them lessening the time it has to leave the vessel.

C. Incorrect - 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.

White blood cells flood areas of injury along with red blood cells.

Question 163

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.

Answer 163

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