Paramedic Quiz Chapters 23,24
Based on Nancy Caroline's Emergency Care in the streets chapters 23,24
- 1.
Which of the following statements regarding the thorax is most correct
- A.
The thoracic cavity extends to the ninth or tenth rib posteriorly
- B.
The diaphragm inserts into the anterior thoracic cage below the fifth rib
- C.
The dimensions of the thorax are defined inferiorly by the thoracic inlet
- D.
The dimensions of the thorax are defined anteriorly by the thoracic vertebrae
Correct Answer
B. The diaphragm inserts into the anterior thoracic cage below the fifth ribExplanation
The diaphragm is a dome-shaped muscle that separates the thoracic cavity from the abdominal cavity. It inserts into the anterior thoracic cage, specifically attaching to the inner surface of the lower ribs and the xiphoid process of the sternum. The insertion point of the diaphragm is below the fifth rib, which means it does not extend all the way to the ninth or tenth rib. Therefore, the statement that the diaphragm inserts into the anterior thoracic cage below the fifth rib is the most correct statement among the given options.Rate this question:
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- 2.
The eighth, ninth, and tenth ribs are indirectly attached to the sternum by the
- A.
Manubrium
- B.
Angle of louis
- C.
Costal cartilage
- D.
Suprasternal notch
Correct Answer
C. Costal cartilageExplanation
The eighth, ninth, and tenth ribs are indirectly attached to the sternum by the costal cartilage. Costal cartilage is a flexible connective tissue that connects the ribs to the sternum, allowing for movement and flexibility in the ribcage. This attachment helps to protect the organs in the thoracic cavity and provides support for the chest wall. The manubrium, angle of louis, and suprasternal notch are not directly involved in the attachment of the ribs to the sternum.Rate this question:
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- 3.
The space between the second and third ribs is called the
- A.
Third intercostal space
- B.
Intrathoracic margin
- C.
Second intercostal space
- D.
Second subcostal margin
Correct Answer
C. Second intercostal spaceExplanation
The space between the second and third ribs is called the second intercostal space. The intercostal spaces are the spaces between adjacent ribs, and they are numbered according to the rib above them. In this case, the space between the second and third ribs is referred to as the second intercostal space.Rate this question:
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- 4.
The visceral pericardial layer
- A.
Comprises the pericadial sac itself
- B.
Is attached directly to the diaphragm
- C.
Is the outermost layer of the pericardium
- D.
Adheres to the heart and forms the epicardium
Correct Answer
D. Adheres to the heart and forms the epicardiumExplanation
The correct answer is that the visceral pericardial layer adheres to the heart and forms the epicardium. The epicardium is the outermost layer of the heart and is also known as the visceral pericardium. It is a thin, protective layer that covers the surface of the heart and is directly attached to the heart muscle. This layer helps to protect the heart and also plays a role in lubricating the heart to reduce friction during its contractions.Rate this question:
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- 5.
The pressure within the right ventricle is
- A.
Less than the pressure within the right atrium
- B.
One fourth of the pressure within the left ventricle
- C.
Nearly equal to the pressure within the left ventricle
- D.
Three times greater than the pressure in the left ventricle
Correct Answer
B. One fourth of the pressure within the left ventricleExplanation
The pressure within the right ventricle is one fourth of the pressure within the left ventricle. This is because the right ventricle pumps blood to the lungs to be oxygenated, while the left ventricle pumps oxygenated blood to the rest of the body. The left ventricle has a thicker muscular wall and needs to generate more pressure to pump blood to the entire body, whereas the right ventricle only needs to pump blood to the lungs which are closer in proximity. Therefore, the pressure within the right ventricle is lower compared to the left ventricle.Rate this question:
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- 6.
What is the cardiac output for an 80kg man who has a heart rate of 80 beats/min and a stroke volume of 60mL
- A.
4,800
- B.
5,200
- C.
6,000
- D.
6,400
Correct Answer
A. 4,800Explanation
The cardiac output is calculated by multiplying the heart rate by the stroke volume. In this case, the heart rate is 80 beats per minute and the stroke volume is 60 mL. Therefore, the cardiac output would be 80 beats/min * 60 mL = 4,800 mL/min, which is equivalent to 4.8 L/min.Rate this question:
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- 7.
Which of the following is not a sight of potential injury when the aorta is subjected to shearing forces during rapid deceleration
- A.
Anulus
- B.
Coronary sinus
- C.
Aortic hiatus
- D.
Ligamentum arteriosum
Correct Answer
B. Coronary sinusExplanation
The coronary sinus is not a sight of potential injury when the aorta is subjected to shearing forces during rapid deceleration. The coronary sinus is a vein located in the heart that collects blood from the coronary veins and returns it to the right atrium. It is not directly connected to the aorta and therefore is not at risk of injury from shearing forces during rapid deceleration.Rate this question:
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- 8.
The diaphragm
- A.
Is an accessory muscle used during respiratory distress
- B.
Works in conjunction with the sternum during inspiration
- C.
Forms a barrier between the thoracic and abdominal cavities
- D.
Creates positive intrathoracic pressure when it increases in size
Correct Answer
C. Forms a barrier between the thoracic and abdominal cavitiesExplanation
The diaphragm forms a barrier between the thoracic and abdominal cavities. This means that it separates the chest cavity (thoracic cavity) from the abdominal cavity. This separation is important for various reasons. It helps to protect the organs in the thoracic cavity, such as the heart and lungs, from the organs in the abdominal cavity, such as the liver and intestines. It also helps to maintain the pressure differences between these two cavities, allowing for proper functioning of the respiratory and digestive systems.Rate this question:
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- 9.
Isolated rib fractures may result in inadequate ventilation because
- A.
The patient often purposely limits chest wall movement
- B.
Most rib fractures cause paradoxical chest wall movement
- C.
The pain associated with the fracture causes hyperventilation
- D.
Preferential use of the intercostal muscles reduces tidal volume
Correct Answer
D. Preferential use of the intercostal muscles reduces tidal volumeExplanation
Isolated rib fractures may result in inadequate ventilation because the patient often purposely limits chest wall movement. When a rib is fractured, the patient may instinctively try to minimize movement in order to avoid exacerbating the pain. This can lead to reduced chest wall expansion and inadequate ventilation. The other options, such as paradoxical chest wall movement, hyperventilation due to pain, or preferential use of the intercostal muscles reducing tidal volume, do not provide a plausible explanation for inadequate ventilation in isolated rib fractures.Rate this question:
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- 10.
The self splinting effect observed in patients with chest wall trauma
- A.
Allows the body to compensate for the injury
- B.
May cause atelectasis, hypoxemia, or pneumonia
- C.
Is often accompanied by subcutaneous emphysema
- D.
Is characterized by a markedly increased tidal volume
Correct Answer
B. May cause atelectasis, hypoxemia, or pneumoniaExplanation
The self-splinting effect observed in patients with chest wall trauma refers to the natural reflex of the body to immobilize the injured area by limiting movement. While this can help in reducing pain and protecting the injured area, it can also have negative consequences. One of these consequences is the potential development of atelectasis, which is the collapse of a portion of the lung due to reduced ventilation. This can lead to hypoxemia, which is a decrease in the oxygen levels in the blood, and can further predispose the patient to developing pneumonia, an infection in the lungs. Therefore, the self-splinting effect may cause atelectasis, hypoxemia, or pneumonia.Rate this question:
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- 11.
An open pneumothorax causes ventilatory inadequacy when
- A.
Positive pressure created by expiration forces air into the pleural space
- B.
The heart stops perfusing the lung on the side of an open chest injury
- C.
Negative pressure created by inspiration draws air into the pleural space
- D.
The glottic opening is much larger than the open wound on the chest wall
Correct Answer
C. Negative pressure created by inspiration draws air into the pleural spaceExplanation
An open pneumothorax occurs when there is an opening in the chest wall that allows air to enter the pleural space, the space between the lungs and the chest wall. During inspiration, the diaphragm contracts and the chest cavity expands, creating a negative pressure that draws air into the pleural space through the open wound. This can lead to a collapsed lung and ventilatory inadequacy.Rate this question:
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- 12.
As air accumulates in the pleural space, the first thing to occur is
- A.
Decreased pulmonary function
- B.
Contralateral tracheal deviation
- C.
Compression of the great vessels
- D.
Marked decrease in venous return
Correct Answer
A. Decreased pulmonary functionExplanation
When air accumulates in the pleural space, it can cause a condition known as pneumothorax. This leads to decreased pulmonary function because the air in the pleural space prevents the lung from fully expanding and filling with air. As a result, the affected lung is unable to effectively exchange oxygen and carbon dioxide, leading to decreased pulmonary function.Rate this question:
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- 13.
By definition, a massive hemothorax is characterized by
- A.
Pulmonary injury with secondary myocardial injury
- B.
10% of circulating blood volume in the pleural space
- C.
Cardiac arrest secondary to severe intrapleural bleeding
- D.
More than 1,500 mL of blood within the pleural space
Correct Answer
D. More than 1,500 mL of blood within the pleural spaceExplanation
A massive hemothorax is defined as the accumulation of more than 1,500 mL of blood within the pleural space. This condition is characterized by pulmonary injury with secondary myocardial injury, but it is not specifically defined by this feature. Additionally, a massive hemothorax does not necessarily lead to cardiac arrest, although severe intrapleural bleeding can be life-threatening. Therefore, the most accurate and specific criterion for diagnosing a massive hemothorax is the presence of more than 1,500 mL of blood in the pleural space.Rate this question:
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- 14.
Dysrhythmias following a myocardial contusion are usually secondary to
- A.
Excess tachycardia that accompanies the injury
- B.
Damage to myocardial tissue at the cellular level
- C.
Aneurysm formation caused by vascular damage
- D.
Direct damage to the vasculature of the epicardium
Correct Answer
B. Damage to myocardial tissue at the cellular levelExplanation
Dysrhythmias following a myocardial contusion are usually secondary to damage to myocardial tissue at the cellular level. This is because a myocardial contusion refers to a bruise or injury to the heart muscle, which can disrupt the normal functioning of the heart cells. This damage at the cellular level can lead to abnormal electrical signals and rhythm disturbances, resulting in dysrhythmias.Rate this question:
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- 15.
Traumatic injuries to the aorta are most commonly the result of
- A.
Shearing forces
- B.
Rear-end collisions
- C.
Penetrating trauma
- D.
Motorcycle crashes
Correct Answer
A. Shearing forcesExplanation
Traumatic injuries to the aorta are most commonly the result of shearing forces. Shearing forces occur when there is a sudden deceleration or acceleration of the body, causing the aorta to move in different directions. This can lead to tearing or rupture of the aorta, which is a life-threatening condition. Rear-end collisions, penetrating trauma, and motorcycle crashes can also cause aortic injuries, but shearing forces are the most common cause.Rate this question:
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- 16.
Anatomically, the abdominal cavity extends from the
- A.
Fifth rib to the pelvis
- B.
Umbilicus to the pelvis
- C.
Diaphragm to the pelvis
- D.
Nipple line to the diaphragm
Correct Answer
C. Diaphragm to the pelvisExplanation
The correct answer is "diaphragm to the pelvis". The abdominal cavity is the space within the abdomen that contains various organs such as the stomach, liver, intestines, and reproductive organs. It is bounded by the diaphragm, which is a muscle that separates the abdomen from the chest cavity, and the pelvis, which is the bony structure at the lower part of the abdomen. This answer accurately describes the anatomical boundaries of the abdominal cavity.Rate this question:
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- 17.
EMS providers can have the most positive impact on mortality and morbity from abdominal trauma by
- A.
Recognizing the need for rapid transport
- B.
Initiating fluid resuscitation in the field
- C.
Contracting medical control immediately
- D.
Performing a careful abdominal assessment
Correct Answer
A. Recognizing the need for rapid transportExplanation
Recognizing the need for rapid transport is the correct answer because in cases of abdominal trauma, time is of the essence. Rapid transport ensures that the patient reaches a medical facility quickly, where they can receive the necessary surgical interventions or specialized care. Delaying transport can lead to an increase in mortality and morbidity as the patient's condition may worsen without timely medical attention. Therefore, recognizing the urgency for rapid transport is crucial for EMS providers to have the most positive impact on the outcome of patients with abdominal trauma.Rate this question:
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- 18.
The periumbilical area refers to the
- A.
Space behind the navel
- B.
External umbilical orifice
- C.
Areas lateral to the umbilicus
- D.
Area around the umbilicus
Correct Answer
D. Area around the umbilicusExplanation
The periumbilical area refers to the area around the umbilicus or belly button. It includes the skin and tissues that surround the belly button. This area is commonly used in medical examinations to assess for any abnormalities or signs of disease.Rate this question:
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- 19.
Intraperitoneal organs include all of the following, except the
- A.
Panceas
- B.
Stomach
- C.
Small bowel
- D.
Gallbladder
Correct Answer
A. PanceasExplanation
The correct answer is pancreas. Intraperitoneal organs are organs that are located within the peritoneal cavity, which is the space between the abdominal organs and the abdominal wall. The pancreas is located behind the stomach and is retroperitoneal, meaning it is situated outside the peritoneal cavity. Therefore, it is not considered an intraperitoneal organ.Rate this question:
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- 20.
Which of the following statements regarding the liver is most correct
- A.
The liver is the largest hollow organ in the abdomen and is responsible for producing and storing bile
- B.
The liver is a relatively avascular organ that is uncommonly injured during blunt abdominal trauma
- C.
The liver is a solid organ that lies in the right upper abdominal quadrant and detoxifies the blood
- D.
The liver is partially protected by the left lower ribcage and serves the function of filtering bacteria from the blood
Correct Answer
C. The liver is a solid organ that lies in the right upper abdominal quadrant and detoxifies the bloodExplanation
The liver is a solid organ that lies in the right upper abdominal quadrant and detoxifies the blood. This statement is the most correct because the liver is indeed a solid organ and is located in the right upper abdominal quadrant. It is responsible for various functions, including detoxifying the blood by removing toxins and metabolizing drugs. The liver also plays a role in producing bile, but it is not the largest hollow organ in the abdomen. Additionally, the liver is well-vascularized and can be injured during blunt abdominal trauma.Rate this question:
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- 21.
As the contents exit the stomach, they first pass through the
- A.
Pylorus
- B.
Duodenum
- C.
Gallbladder
- D.
Cardiac sphincter
Correct Answer
A. PylorusExplanation
The correct answer is pylorus. The pylorus is the part of the stomach that connects to the duodenum, which is the first part of the small intestine. It acts as a valve, regulating the flow of partially digested food from the stomach into the small intestine. This allows for proper digestion and absorption of nutrients. The gallbladder is not directly involved in the passage of contents from the stomach, and the cardiac sphincter is the valve that controls the flow of food from the esophagus into the stomach.Rate this question:
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- 22.
Intraabdominal bleeding may produce few signs and symptoms of trauma because
- A.
The intraabdominal cavity can accommodate large amounts of blood
- B.
Blood in the peritoneum can compress the aorta and maintain perfusion
- C.
It takes approximately 4 liters of blood loss before signs of shock manifest
- D.
The abdominal muscular can sustain massive blunt force without bruising
Correct Answer
A. The intraabdominal cavity can accommodate large amounts of bloodExplanation
The correct answer is that the intraabdominal cavity can accommodate large amounts of blood. This means that even if there is bleeding within the abdominal cavity, there may not be obvious signs or symptoms of trauma. The abdominal cavity has a lot of space to accommodate the blood, so it may not cause immediate symptoms such as pain or swelling. This can make it difficult to detect intraabdominal bleeding without further investigation or imaging techniques.Rate this question:
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- 23.
The major complications associated with hollow organ injury is
- A.
Massive internal hemorrhage and profound shock
- B.
Peritonitis caused by rupture and spillage of toxins
- C.
Immediate death secondary to a massive infection
- D.
Delayed treatment due to the absence of external signs
Correct Answer
B. Peritonitis caused by rupture and spillage of toxinsExplanation
Hollow organ injury can lead to peritonitis, which is inflammation of the peritoneum (the lining of the abdominal cavity). When a hollow organ, such as the stomach or intestines, ruptures, it can cause the contents of the organ to spill into the abdominal cavity. This can introduce bacteria and toxins into the peritoneum, leading to infection and inflammation. Peritonitis can be a serious complication and can cause symptoms such as abdominal pain, fever, and tenderness. Prompt medical intervention is necessary to treat peritonitis and prevent further complications.Rate this question:
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- 24.
During the third collision in a motor vehicle crash
- A.
Hollow abdominal organs rupture upon impact
- B.
The persons abdomen collides with the steering wheel
- C.
Rapid deceleration propels an unrestrained person forward
- D.
Abdominal organs shear from their points of attachment
Correct Answer
D. Abdominal organs shear from their points of attachmentExplanation
During a motor vehicle crash, the rapid deceleration causes the unrestrained person to be propelled forward. This forward motion leads to the person's abdomen colliding with the steering wheel, resulting in a significant force being exerted on the abdominal organs. As a result of this force, the abdominal organs shear or detach from their points of attachment, causing them to rupture upon impact.Rate this question:
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- 25.
Which of the following factors does not contribute to the extent of injury from a gunshot wound to the abdomen
- A.
Size of the patient
- B.
Profile of the bullet
- C.
Trajectory of the bullet
- D.
Distance the bullet traveled
Correct Answer
A. Size of the patientExplanation
The size of the patient does not contribute to the extent of injury from a gunshot wound to the abdomen. The factors that do contribute to the extent of injury include the profile of the bullet, trajectory of the bullet, and the distance the bullet traveled. However, the size of the patient does not directly affect the injury caused by a gunshot wound to the abdomen.Rate this question:
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- 26.
Fractures of the lower rib cage should make you most suspicious for injuries to the
- A.
Liver or spleen
- B.
Urinary bladder
- C.
Ascending aorta
- D.
Kidneys or pancreas
Correct Answer
A. Liver or spleenExplanation
Fractures of the lower rib cage should make you most suspicious for injuries to the liver or spleen. The liver and spleen are located in the upper abdomen and are protected by the rib cage. Fractures in the lower rib cage suggest a significant force or impact to the area, which can result in damage to these organs. The location of the fractures and the proximity to the liver and spleen make them the most likely organs to be affected. Injuries to the urinary bladder, ascending aorta, kidneys, or pancreas are less likely in this scenario.Rate this question:
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- 27.
When blood is released into the peritoneal cavity
- A.
The abdomen almost immediately becomes grossly distended
- B.
It is most often the result of blunt force trauma to the pancreas
- C.
Blood pressure falls with as little as 500 mL of internal blood loss
- D.
Nonspecific signs such as tachycardia and hypotension may occur
Correct Answer
D. Nonspecific signs such as tachycardia and hypotension may occurExplanation
When blood is released into the peritoneal cavity, it can cause the abdomen to become grossly distended. This is often a result of blunt force trauma to the pancreas. Additionally, even with as little as 500 mL of internal blood loss, blood pressure can fall. In such cases, nonspecific signs such as tachycardia (rapid heart rate) and hypotension (low blood pressure) may occur. These signs are not specific to any particular condition or injury, but can be indicators of internal bleeding in the peritoneal cavity.Rate this question:
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- 28.
Because of its anatomical position in the retroperitoneum, it typically takes high energy force to damage the
- A.
Liver
- B.
Spleen
- C.
Stomach
- D.
Pancreas
Correct Answer
D. PancreasExplanation
The pancreas is located in the retroperitoneum, which is a deep position in the abdomen. Due to its deep location, it is protected by other organs and structures. Therefore, it usually requires a high amount of force or trauma to cause damage to the pancreas. In contrast, the liver, spleen, and stomach are located in more superficial positions and are more susceptible to injury from lower energy forces.Rate this question:
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- 29.
Gross hematuria and suprapubic pain following a pelvic injury is most indicative of injury to the
- A.
Ureters
- B.
Urethra
- C.
Bladder
- D.
Kidney
Correct Answer
C. BladderExplanation
Gross hematuria (visible blood in the urine) and suprapubic pain (pain above the pubic bone) after a pelvic injury suggest injury to the bladder. The bladder is located in the lower abdomen and is susceptible to injury during trauma to the pelvic region. The presence of blood in the urine indicates damage to the bladder's blood vessels, while suprapubic pain is a common symptom of bladder trauma. Injury to the ureters, urethra, or kidneys may also occur in pelvic injuries, but the combination of gross hematuria and suprapubic pain is most indicative of bladder injury.Rate this question:
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- 30.
Periumbilical ecchymosis is
- A.
Commonly observed in the prehospital setting following blunt force trauma to the abdomen
- B.
Referred to as cullen's sign and may take hours or days to develop following abdominal trauma
- C.
Usually seen in conjunction with flank bruising and is highly suggestive of injury to the liver or spleen
- D.
Also called grey turner's sign and manifests almost immediately following blunt abdominal trauma
Correct Answer
B. Referred to as cullen's sign and may take hours or days to develop following abdominal traumaExplanation
Periumbilical ecchymosis, commonly known as Cullen's sign, is a condition observed in the prehospital setting after blunt force trauma to the abdomen. This sign may take hours or even days to develop following abdominal trauma. It is often seen alongside flank bruising and is highly indicative of injury to the liver or spleen. It should not be confused with Grey Turner's sign, which manifests almost immediately after blunt abdominal trauma.Rate this question:
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- 31.
You are dispatched to a senior citizens center where an elderly woman apparently fainted. When you arrive, you find the patient sitting in a chair. An employee of the center tells you that he caught the patient before she fell to the ground. Your initial assessment reveals that the patient is conscious and alert and is breathing adequately. You should
- A.
Forego spinal immobilization and transport only
- B.
Obtain vital signs and assess her blood glucose level
- C.
Apply oxygen at 15 liters per min via nonrebreathing mask
- D.
Perform a rapid trauma assessment to detect injuries
Correct Answer
B. Obtain vital signs and assess her blood glucose levelExplanation
Based on the information provided, the patient is conscious, alert, and breathing adequately. This suggests that the patient did not experience a significant trauma or injury. The most appropriate next step would be to obtain vital signs to assess the patient's overall condition, and to assess her blood glucose level as a potential cause for her fainting episode. This will help determine if there are any underlying medical issues that need to be addressed. Spinal immobilization and rapid trauma assessment are not necessary in this case as there are no indications of trauma.Rate this question:
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- 32.
You have intubated an unconscious, apneic patient with a suspected spinal injury. After confirming proper ET tube placement and securing the tube, you should
- A.
Request medical control authorization to give solu-medrol
- B.
Ventilate at 10-12 breaths/min and monitor end-tidal CO2
- C.
Maintain an end-tidal CO2 reading of greater than 45 mmHg
- D.
Provide mild hyperventilation in case a head injury is present
Correct Answer
B. Ventilate at 10-12 breaths/min and monitor end-tidal CO2Explanation
After intubating an unconscious, apneic patient with a suspected spinal injury, it is important to ventilate at a rate of 10-12 breaths per minute and monitor the end-tidal CO2. This is because maintaining proper ventilation is crucial for oxygenation and preventing hypercapnia. Monitoring the end-tidal CO2 helps ensure that the patient is adequately ventilated and that the ET tube is properly placed. This allows for prompt recognition of any changes in ventilation status and allows for appropriate adjustments to be made if necessary.Rate this question:
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- 33.
A skier wiped out while skiing down a large hill. He is conscious and alert and complains of being very cold, he also complains of neck stiffness and numbness and tingling in all of his extremities. A quick assessment reveals that his airway is patent and his breathing is adequate. You should
- A.
Perform a detailed neurologic exam and carefully palpate his neck
- B.
Apply a cervical collar and start and IV line with warm normal saline
- C.
Immobilize his spine a quickly move him to a warmer environment
- D.
Administer oxygen and perform a focused history and physical exam
Correct Answer
C. Immobilize his spine a quickly move him to a warmer environmentExplanation
The skier's complaints of neck stiffness and numbness and tingling in all extremities suggest a potential spinal injury. Immobilizing his spine will help prevent further damage and potential paralysis. Moving him to a warmer environment is important to prevent hypothermia, which can worsen his condition. Therefore, immobilizing his spine and quickly moving him to a warmer environment is the most appropriate action to take in this situation.Rate this question:
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- 34.
You have just completed spinal immobilization of a hemodynamically stable patient with a possible spinal injury. Prior to moving the patient to the ambulance, it is most important to
- A.
Start an IV of normal saline in case the patient deteriorates
- B.
Apply a cardiac monitor and obtain a full set of vital signs
- C.
Performed a detailed physical exam to detect other injuries
- D.
Reassess pulse, motor, and sensory functions in all extremities
Correct Answer
D. Reassess pulse, motor, and sensory functions in all extremitiesExplanation
After completing spinal immobilization, it is most important to reassess pulse, motor, and sensory functions in all extremities. This is because spinal injuries can cause nerve damage and compromise the patient's ability to move or feel sensations in their extremities. By reassessing these functions, the healthcare provider can determine if there are any changes or worsening of the patient's condition, which may require immediate intervention. Starting an IV of normal saline, applying a cardiac monitor and obtaining vital signs, and performing a detailed physical exam are also important steps in the management of a patient with a possible spinal injury, but reassessing pulse, motor, and sensory functions takes priority to evaluate the patient's neurologic status.Rate this question:
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- 35.
Upon arriving at the scene of a motor vehicle crash, you find the driver of the car still seated i her two door vehicle. The passenger side of the vehicle has sustained severe damage and is inaccessible. The driver is conscious and alert and complains only of lower back pain. The backseat passenger, a young child who was unrestrained, is bleeding from the head and appears to be unconscious. You should
- A.
Ask the driver to step out the vehicle so can access the backseat passenger
- B.
Rapidly extricate the driver so you can gain quick access to the child in the backseat
- C.
Carefully assess the driver for occult injuries before removing her from the vehicle
- D.
Apply a vest-type extrication device to the driver and quickly remove her from the car
Correct Answer
B. Rapidly extricate the driver so you can gain quick access to the child in the backseatExplanation
In this scenario, the driver is conscious and complaining of lower back pain, while the backseat passenger, a young child, is bleeding from the head and appears to be unconscious. The priority should be to quickly access and provide care to the unconscious child, as they may have a more serious injury and require immediate medical attention. Therefore, the correct answer is to rapidly extricate the driver so that quick access can be gained to the child in the backseat.Rate this question:
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- 36.
A young man was assaulted and has extensive maxillofacial injuries. Your initial assessment reveals that he is semiconscious, has poor respiratory effort, and has blood draining from the corner of his mouth. Initial management for this patient involves
- A.
Inserting an oropharyngeal airway, preoxygenating him with a BVM for 2 minutes, and then intubating his trachea
- B.
Applying a cervical collar, performing a blind finger sweep to clear his airway, and providing ventilatory assistance with a BVM
- C.
Fully immobilizing his spine, inserting a nasopharyngeal airway, and hyperventilating him wit a BVM device at a rate of 20 beaths/min
- D.
Manually stabilizing his head in a neutral position, suctioning his oropharynx, and assisting ventilations with a BVM device and 100% O2
Correct Answer
D. Manually stabilizing his head in a neutral position, suctioning his oropharynx, and assisting ventilations with a BVM device and 100% O2Explanation
The correct answer is to manually stabilize the patient's head in a neutral position, suction his oropharynx, and assist ventilations with a BVM device and 100% O2. This is the appropriate initial management for a patient with extensive maxillofacial injuries and compromised respiratory effort. Stabilizing the head prevents further injury to the spine, suctioning the oropharynx clears any obstruction, and assisting ventilations with a BVM device and 100% O2 ensures adequate oxygenation. This approach addresses the immediate concerns of airway management and respiratory support in this critically injured patient.Rate this question:
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- 37.
Following blunt trauma to the face, a 30 year old man presents with epistaxis, double vision and an inability to look upward. You should be most suspicious of
- A.
Traumatic conjunctivitis
- B.
An orbital blowout fracture
- C.
Traumatic retinal detachment
- D.
Fracture of the cribiform plate
Correct Answer
B. An orbital blowout fractureExplanation
After experiencing blunt trauma to the face, the patient is presenting with epistaxis (nosebleed), double vision, and an inability to look upward. These symptoms are indicative of an orbital blowout fracture, which occurs when there is a fracture of the bones surrounding the eye socket. This fracture can cause entrapment or damage to the muscles and nerves responsible for eye movement, leading to double vision and limited upward gaze. Additionally, the epistaxis may be a result of the trauma causing damage to blood vessels in the nasal cavity.Rate this question:
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- 38.
You are caring for a man with a chemical burn to both eyes. The patient, who has contact lenses in place, is in severe pain and tells you that he can't see. Proper care for this patient includes
- A.
Carefully removing his contact lenses, flushing both eyes for at least 20 minutes, and transporting with continuous eye irrigation
- B.
Leaving his contact lenses in place to avoid further injury and transporting at once with irrigation of both eyes performed en route
- C.
Removing his contact lenses, covering both eyes with moist, sterile dressings, administering a narcotic analgesic, and transporting
- D.
Asking the patient to remove his contact lenses, irrigating both eyes for no more than 10 minutes, covering both eyes with sterile dressings, and transporting
Correct Answer
A. Carefully removing his contact lenses, flushing both eyes for at least 20 minutes, and transporting with continuous eye irrigationExplanation
The correct answer is to carefully remove the patient's contact lenses, flush both eyes for at least 20 minutes, and transport with continuous eye irrigation. This is the proper care for a patient with a chemical burn to both eyes. Removing the contact lenses is important to prevent further injury, and flushing the eyes for at least 20 minutes helps to remove the chemical and reduce the risk of damage. Transporting with continuous eye irrigation ensures that the eyes continue to be flushed during transportation.Rate this question:
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- 39.
During an explosion, a 42 year old construction worker sustained a large laceration to the lateral aspect of his neck when he was struck by a piece of flying debris. The patient is conscious, but complains of difficulty hearing. In addition to protecting his spine, you hould be most concerned with
- A.
Administering high flow oxygen via non rebreathing mask as soon as possible
- B.
Covering the laceration with an occlusive dressing and controlling the bleeding
- C.
Carefully examining his ear to determine if his tympanic membrane is ruptured
- D.
Applying a bulky dressing to the laceration and securing it firmly with a bandage
Correct Answer
B. Covering the laceration with an occlusive dressing and controlling the bleedingExplanation
The correct answer is to cover the laceration with an occlusive dressing and control the bleeding. In this scenario, the patient sustained a large laceration to the lateral aspect of his neck. This type of injury can be life-threatening due to the risk of severe bleeding and potential damage to vital structures in the neck. By covering the laceration with an occlusive dressing, it helps to create a seal and prevent further bleeding. Controlling the bleeding is crucial to prevent excessive blood loss and maintain the patient's hemodynamic stability.Rate this question:
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- 40.
A 19 year old woman fell from a secondary window and landed on her head. She is unconscious with a blood pressure of 148/94 mm Hg, heart rate of 58 beats/min , and irregular respirations of 8 breaths/ minute. Further assessment reveals blood draining from her nose and bilaterally dilated pupils that are slow to react. In addition to employing full spinal precautions, the most appropriate treatment for this patient involves
- A.
Hyperventilating her with a BVM at a rate of 20 breaths/min, starting two large bore IVs applying a cardiac monitor, administering 5 mg of valium to prevent seizures, and transporting to a trauma center.
- B.
Preoxygenating her with a BVM and 100% oxygen for 2-3 minutes with a BVM , transporting immediately, starting at least one large bore IV en route, and obtaining her glasgow coma scale score
- C.
Intubating her trachea after preoxygenating her for 2-3 minutes with a BVM, transporting immediately, starting at least one large bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments
- D.
Applying oxygen via nonrebreathing mask, covering her with blankets, starting an IV of normal saline set to keep the vein open, applying a cardiac monitor, initiating transport, and monitoring her pupils while en route to the hospital
Correct Answer
C. Intubating her trachea after preoxygenating her for 2-3 minutes with a BVM, transporting immediately, starting at least one large bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessmentsExplanation
The correct answer is to intubate the patient's trachea after preoxygenating her for 2-3 minutes with a BVM, transporting immediately, starting at least one large bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments. This is the most appropriate treatment because the patient is unconscious with signs of a severe head injury, including a fall from a height, blood draining from her nose, and bilaterally dilated pupils. Intubating her trachea will help maintain her airway and ensure adequate oxygenation. Transporting immediately and starting IV access will allow for further treatment and monitoring, while applying a cardiac monitor and performing neurologic assessments will help detect any changes in her condition.Rate this question:
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- 41.
You are caring for a 41 year old man who was trapped in his burning house before being rescued by fire fighters. He has full thickness burns to his head and anterior trunk, and mixed partial and full thickness burns to both anterior upper extremities. What percent of his total body surface area has been burned
- A.
18%
- B.
27%
- C.
36%
- D.
45%
Correct Answer
C. 36%Explanation
The Rule of Nines is commonly used to estimate the percentage of total body surface area (TBSA) burned in adults. According to this rule, the head and neck account for 9% of TBSA, each upper limb accounts for 9% (18% total), the anterior trunk accounts for 18%, and the posterior trunk accounts for 18%. In this case, the patient has full thickness burns to his head and anterior trunk, which accounts for 27% (9% + 18%) of TBSA. Additionally, he has mixed partial and full thickness burns to both anterior upper extremities, which accounts for another 9% (2 x 4.5%). Therefore, the total percentage of TBSA burned is 36%.Rate this question:
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- 42.
You and your partner are transporting a severely burned patient from a community hospital to a burn specialty center. The patient, a 33 year old, 110 lb woman, has partial and full thickness burns that cover approximately 55% of her body. She has two large bore IV lines in place, is intubated, and is on a cardiac monitor. According to the parkland formula, how much normal saline should she receive in 30 minutes
- A.
340mL
- B.
355mL
- C.
370mL
- D.
395mL
Correct Answer
A. 340mLExplanation
According to the Parkland formula, the amount of normal saline that should be administered to a burn patient in the first 24 hours is calculated by multiplying the patient's weight in kilograms by the percentage of body surface area burned, and then multiplying that by 4. The result is the total amount of fluid to be administered over the first 24 hours, with half of it given in the first 8 hours. Since the question asks for the amount to be given in 30 minutes, we need to divide the total amount by 16 (since 8 hours is equal to 480 minutes, and 480 divided by 30 is 16). Given that the patient weighs 110 lbs, which is approximately 50 kg, and has burns covering 55% of her body, the calculation would be: 50 kg x 55% x 4 / 16 = 340 mL. Therefore, the correct answer is 340 mL.Rate this question:
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- 43.
A 33 year old man was burned when the hot water heater he was working on exploded. The patient has superficial and partial thickness burns to his face, neck and arms. your initial assessment reveals that he is restless and tachypneic. His BP is 80/54 and his heart rate is 120 beats/min and weak. you should
- A.
Conclude that he is experiencing burn shock, start two large bore IV lines of normal saline, and administer fluids based on the parkland formula
- B.
Assist his ventilations with a BVM, cover him with a blanket, and start a large bore IV of normal saline set at TKO
- C.
Apply oxygen via nonrebreathing mask, cover his burns with cold moist dressings, start and IV with normal saline and give up to 4 mg of morphine for pain
- D.
Administer high flow oxygen, keep him warm, start at least one large bore IV of normal saline, and administer fluid boluses to maintain adequate perfusion
Correct Answer
D. Administer high flow oxygen, keep him warm, start at least one large bore IV of normal saline, and administer fluid boluses to maintain adequate perfusionExplanation
The patient's symptoms, such as restlessness, tachypnea, hypotension, weak pulse, and increased heart rate, indicate that he is experiencing burn shock. Burn shock occurs when there is a significant loss of fluids and electrolytes due to the burn injury. Administering high flow oxygen will help improve oxygenation, keeping the patient warm will prevent hypothermia, starting an IV of normal saline will replenish fluid volume, and administering fluid boluses will maintain adequate perfusion. This approach will help stabilize the patient's condition and prevent further complications.Rate this question:
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- 44.
A 74 year old man experienced partial and full thickness burns to his arms and chest resulting from a fire that started after he fell asleep while smoking. The patient's son, who arrived at the scene shortly after you, states that his father has congestive heart failure, rheumatoid arthritis, and artrial fibrillation. In addition to administering supplemental O2, it is most important for you to
- A.
Avoid narcotic analgesics because of his medical history
- B.
Auscultate his breath sounds before administering IV fluids
- C.
Obtain a 12 lead ECG to assess for signs of cardiac ischemia
- D.
Apply cold, moist dressings to his burns to provide pain relief
Correct Answer
B. Auscultate his breath sounds before administering IV fluidsExplanation
The correct answer is to auscultate his breath sounds before administering IV fluids. This is important because the patient has suffered burns to his arms and chest, which can lead to airway compromise and respiratory distress. By auscultating his breath sounds, the healthcare provider can assess for any signs of airway obstruction or lung injury that may require immediate intervention. Administering IV fluids without assessing the patient's respiratory status could potentially worsen his condition and lead to further complications.Rate this question:
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- 45.
A 24 year old woman was struck by lightning. Bystanders moved the patient to an area of safety but did not provide any other care before your arrival. Your initial assessment reveals that the patient is pulseless and apneic. After performing CPR for 2 minutes, you assess her cardiac rhythm, which reveals asystole. After requesting a backup paramedic unit, the most appropriate treatment for this patient involves
- A.
Instructing your partner to resume one rescuer CPR, establishing an IV of normal saline, and reassessing her cardiac rhythm in 5 minutes
- B.
Continuing CPR, providing full spinal precautions, intubating her trachea, and ventilating her at a rate of 20-24 breaths/min
- C.
Performing adequate BLS, following standard ACLS protocol, and considering terminating your efforts if asystole persists after 10 minutes
- D.
Continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessary
Correct Answer
D. Continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessaryExplanation
The most appropriate treatment for this patient involves continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessary. This is because the patient is pulseless and apneic, indicating cardiac arrest. CPR should be continued to provide circulation and oxygenation to the vital organs. Protecting the spine while ventilating is important to prevent any potential spinal injury. After 2 minutes of CPR, reassessing the cardiac rhythm is necessary to determine if a shockable rhythm, such as ventricular fibrillation or pulseless ventricular tachycardia, is present, which would require defibrillation.Rate this question:
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- 46.
A 63 year old diabetic woman presents with an open wound to her forearm that she experienced when she fell a week ago. She tells you that the wound has been draining purulent fluid, but has not been bleeding. The wound itself is red, inflamed, and warm to the touch. You should
- A.
Carefully irrigate the wound with sterile water for 5 minutes
- B.
Apply a moist, sterile dressing and transport to the hospital
- C.
Apply a dry, sterile dressing and transport her to the hospital
- D.
Apply a light coat of antibiotic ointment and cover the wound
Correct Answer
C. Apply a dry, sterile dressing and transport her to the hospitalExplanation
The correct answer is to apply a dry, sterile dressing and transport her to the hospital. This is because the wound is showing signs of infection, such as redness, inflammation, and purulent drainage. Applying a dry, sterile dressing will help protect the wound from further contamination, and transporting her to the hospital will allow for proper evaluation and treatment of the infection.Rate this question:
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- 47.
While hiking, a 24 year old woman was pinned from the waist down under a rock that collapsed on her. Upon your arrival, tha patient is conscious and alert, and states that she can't feel her legs. She further tells you that she thinks she's been pinned for about 5 hours. She is breathing adequately and has stable vital signs. In addition to administering supplemental oxygen, you should
- A.
Start 2 large bore IVs of normal saline, apply a cardiac monitor, and contact medical control before removing the rock from her legs
- B.
Quickly remove the rock from her legs to restore distal neurovascular function, and administer a 20 mL/kg blous of lactated ringers solution
- C.
Administer 2 meq/kg of sodium bicarbonate followed by 25 gm of 50% dextrose as you slowly and carefully remove the rock from her legs
- D.
Start at least one large bore IV line and administer 2-4 liters of normal saline before attempting to remove the rock from her legs
Correct Answer
A. Start 2 large bore IVs of normal saline, apply a cardiac monitor, and contact medical control before removing the rock from her legsExplanation
In this scenario, the correct answer is to start 2 large bore IVs of normal saline, apply a cardiac monitor, and contact medical control before removing the rock from her legs. This is because the patient is conscious and alert, indicating that she has a patent airway and is able to breathe adequately. However, she is experiencing a potential neurovascular compromise due to being pinned under the rock for several hours. By starting IVs of normal saline, it helps to maintain her fluid balance and prevent hypovolemia. Applying a cardiac monitor allows for continuous monitoring of her heart rhythm. Contacting medical control ensures that the appropriate medical guidance is obtained before attempting to remove the rock, which could potentially cause further harm if not done correctly.Rate this question:
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- 48.
A 41 year old man was assaulted during a robbery attempt. Your initial assessment reveals that the patient is semiconscious. He has massive soft tissue trauma to the face, inadequate breathing, and oropharyngeal bleeding. You should
- A.
Apply direct pressure to his facial wounds and promptly intubate him
- B.
Suction the blood from his mouth and assist ventilations with a BVM
- C.
Insert a nasal airway, apply oxygen via nonrebreathing mask, and transport
- D.
Suction his oropharynx for 30 seconds and then perform endotracheal intubation
Correct Answer
B. Suction the blood from his mouth and assist ventilations with a BVMExplanation
The correct answer is to suction the blood from his mouth and assist ventilations with a BVM. This is the most appropriate action to take in a patient with inadequate breathing and oropharyngeal bleeding. Suctioning the blood will help clear the airway and improve ventilation, while assisting ventilations with a BVM will ensure that the patient is receiving adequate oxygenation. Intubation may be necessary later on, but the immediate priority is to address the airway obstruction and provide ventilation support.Rate this question:
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- 49.
You have dressed and bandaged a laceration to the arm of a 16 year old woman and are transporting her to the hospital. En route, the patient complains that her fingers are tingling. You touch her hand and not that it is cool. You should
- A.
Readjust the bandage if needed and reassess distal neurovascular function
- B.
Conclude that the laceration has probably severed a major nerve in her arm
- C.
Elevate her arm, apply an icepack over the bandage, and reassess her hand
- D.
Contact the receiving facility and have them place a neurosurgeon on standby
Correct Answer
A. Readjust the bandage if needed and reassess distal neurovascular functionExplanation
The patient's complaint of tingling in her fingers and the coolness of her hand suggest a potential issue with blood flow and nerve function. Therefore, the correct course of action is to readjust the bandage if needed and reassess distal neurovascular function. This will help ensure that there is no further compromise to the blood supply or nerve function in the injured arm.Rate this question:
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- 50.
You are the first unit to arrive at the scene of a small building collapse. As you exit the ambulance, you can see a man pinned under a large metal beam. You should
- A.
Free patient first and then assess him
- B.
Carefully access the patient and assess him
- C.
Contact medical control for further guidance
- D.
Immediately request a special rescue team
Correct Answer
D. Immediately request a special rescue teamExplanation
In this scenario, the man is pinned under a large metal beam, indicating a potentially life-threatening situation. As the first unit on the scene, it is crucial to prioritize the safety and well-being of the patient. Requesting a special rescue team immediately is the most appropriate action to ensure that the patient receives the necessary specialized equipment, expertise, and manpower to safely free him from the debris. This will minimize the risk of further injury and provide the best chance for a successful rescue.Rate this question:
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