Fisdap Trauma Test
Questions With Complete
Solutions
Patients with significant closed head injuries often have pupillary abnormalities and:
A) paralysis.
B) paresthesia.
C) hypertension.
D) tachycardia. -ANSWERS C) hypertension.
Closed head injuries can cause a variety of signs and symptoms. In addition to pupillary
abnormalities (ie, unequal pupils, sluggishly reactive pupils), a classic
finding that indicates a significant increase in intracranial pressure is Cushing's triad.
This trio of findings includes hypertension; bradycardia; and abnormal
breathing, which can vary from slow and irregular to rapid and deep.
In contrast to an incision, a laceration:
A) is a jagged cut.
B) is a superficial injury.
C) bleeds more severely.
D) usually involves an artery. -ANSWERS A) is a jagged cut.
A laceration is a jagged cut caused by a sharp object or a blunt force that tears the
tissue, whereas an incision is a sharp, smooth cut. The depth of the injury
can vary; it can extend through the skin and subcutaneous tissue or into the underlying
muscles and adjacent nerves and blood vessels. Lacerations and
incisions can involve arteries, veins, or both, potentially resulting in severe bleeding.
Which of the following clinical findings is consistent with decompensated shock?
A) Diaphoresis and pallor
B) Falling blood pressure
C) Restlessness and anxiety
D) Tachycardia and tachypnea -ANSWERS B) Falling blood pressure
During shock, the compensatory mechanisms of the body attempt to maintain the blood
pressure. This is accomplished by increasing the heart rate, shunting
blood from the skin to more vital organs, and increasing the respiratory rate to increase
the oxygen content of the blood. Once these compensatory
mechanisms fail, the blood pressure will fall (hypotension). Hypotension signifies a state
of decompensated shock. You must not rely on the patient's blood pressure as an
indicator of overall perfusion. Restlessness, anxiety, tachycardia, tachypnea, and cool,
clammy skin (diaphoresis) are earlier signs of shock and do not necessarily indicate a
decompensated state.
Which of the following injury mechanisms involves axial loading?
A) skater slips and falls, landing on her outstretched arm.
,Fisdap Trauma Test
Questions With Complete
Solutions
B) A construction worker falls off a roof and lands feet first.
C) A woman's knees impact the dash during a frontal collision.
D) A man's neck is forced laterally during a side impact collision. -ANSWERS
B) A construction worker falls off a roof and lands feet first.
Axial loading injuries occur when a sudden, excessive compression force drives the
long axis of the body toward the head, or the head toward the feet.
Common injuries that involve axial loading are heavy objects falling on a patient's head,
diving head first into shallow water, and falls in which the patient lands
feet first. All of these mechanisms cause compression of the spine, potentially resulting
in serious injury. None of the other injury mechanisms described are
consistent with axial loading.
A man was stabbed in the cheek with a dinner fork, and the fork is still impaled in his
cheek. He is conscious and alert, breathing adequately,
and has blood in his oropharynx. You should:
A) apply high-flow oxygen via a nonrebreathing mask, carefully remove the fork, and
control any external bleeding.
B) suction his oropharynx, control any external bleeding, stabilize the fork in place, and
protect it with bulky dressings.
C) carefully remove the fork, suction his oropharynx as needed, and pack the inside of
his cheek with sterile gauze pads.
D) suction his oropharynx, carefully cut the fork to make it shorter, control any external
bleeding, and secure the fork in place. -ANSWERS B) suction his oropharynx,
control any external bleeding, stabilize the fork in place, and protect it with bulky
dressings.
An impaled object in the cheek should be removed if it interferes with your ability to
manage the patient's airway. In this case, however, the patient is
breathing adequately and does not require aggressive airway care (eg, ventilatory
assistance). The most practical approach is to suction the blood from his
oropharynx, which will prevent him from swallowing it, vomiting it, or aspirating it.
Stabilize the fork in place and protect it with bulky dressings; removing
an impaled object from the cheek in the opposite direction it entered would clearly
cause further soft-tissue injury and bleeding. Transport the patient in a
sitting position and suction his oropharynx en route as needed. There is no reason to
cut the fork to make it shorter; this will only unnecessarily manipulate
it, potentially causing further soft tissue damage and increased bleeding.
A 40-year-old man was hit in the nose during a fight. He has bruising under his left eye
and a nosebleed. What should you do?
,Fisdap Trauma Test
Questions With Complete
Solutions
A) Place a chemical ice pack over his nose.
B) Determine if he has any visual disturbances.
C) Ensure that he is sitting up and leaning forward.
D) Apply direct pressure by pinching his nostrils together. -ANSWERS C)
Ensure that he is sitting up and leaning forward.
During a nosebleed (epistaxis), much of the blood may pass down the throat into the
stomach as the patient swallows; this is especially true if the patient is
lying supine. Blood is a gastric irritant; a person who swallows a large amount of blood
may become nauseated and vomit, which increases the risk of
aspiration. Therefore, your first action should be to ensure that the patient is sitting up
and leaning forward. This will prevent blood from draining down the
back of the throat. Next, apply direct pressure by pinching the fleshy part of the nostrils
together; you or the patient may do this. Placing a chemical ice pack
over the nose may further help control the bleeding by constricting the nasal
vasculature. After controlling the nosebleed, continue your assessment, which
includes assessing for facial deformities and visual disturbances.
The presence of subcutaneous emphysema following blunt trauma to the anterior neck
should make you MOST suspicious for a:
A) pneumothorax.
B) fractured larynx.
C) ruptured esophagus.
D) carotid artery injury. -ANSWERS B) fractured larynx.
Crushing or blunt trauma to the anterior neck can injure the trachea or larynx. Once the
cartilages of the upper airway and larynx are fractured, they do not
spring back to their normal position. Such a fracture can lead to loss of voice, airway
obstruction, and leakage of air into the soft tissues of the neck. Air leakage
into the soft tissues is called subcutaneous emphysema. Subcutaneous emphysema
may also be observed in patients with a tension pneumothorax, although it
is typically located in the chest. Esophageal rupture would likely present with difficulty
swallowing (dysphagia) and vomiting blood (hematemesis). You should suspect injury to
a carotid artery or jugular vein if you observe a rapidly expanding hematoma to the neck
following blunt trauma.
A 22-year-old man had a strong acid chemical splashed into both of his eyes. He is
conscious and alert, is experiencing intense pain, and
states that he is wearing contact lenses. Treatment should include:
A) leaving the contact lenses in and beginning irrigation of both eyes.
B) removing the contact lenses and beginning irrigation of both eyes.
, Fisdap Trauma Test
Questions With Complete
Solutions
C) leaving the contact lenses in and covering both eyes with sterile gauze.
D) removing the contact lenses and covering both eyes with sterile gauze. -ANSWERS
B) removing the contact lenses and beginning irrigation of both eyes.
As a general rule, contact lenses should be left in place. Chemical eye burns are an
exception to this rule. If left in place, the chemical could get behind the
contact lens and continue to cause injury. Therefore, you should remove the contact
lenses and immediately irrigate the eyes with sterile saline or water. If
needed, continue to irrigate the eyes throughout transport.
Following blunt force trauma to the anterior chest, a man presents with difficulty
breathing, distended jugular veins, absent breath soundsover the left side of the chest,
and hypotension. Which of the following BEST describes the pathophysiology of this
patient's injury?
A) Increased pressure in the pleural space is compressing the great vessels
B) Blood is filling the pleural space and is collapsing the lung on the left side
C) Blood is filling the pericardia! sac and is restricting cardiac relaxation
D) The aorta has been injured and blood is rapidly filling the thoracic cavity -ANSWERS
A) Increased pressure in the pleural space is compressing the great vessels
The patient is experiencing a tension pneumothorax. This type of injury occurs when air
fills the pleural space and progressively collapses the lung. In the
process, the vena cavae are compressed and blood return to the heart is reduced;
clinically, this manifests as jugular vein distention because blood is backing
up into the systemic venous system. If blood return to the heart is reduced, the amount
of blood that leaves the heart will also be reduced; as a result, cardiac
output falls and the patient becomes hypotensive. Breath sounds are markedly
decreased or absent on the affected side of the chest because the lung is
being collapsed. In a hemothorax, blood fills the pleural space instead of air. Breath
sounds are decreased or absent on the affected side; however, because
the patient is losing blood volume into the chest, the jugular veins would be collapsed,
not distended as they are with a tension pneumothorax. Pericardia!
tamponade also causes jugular vein distention; however, the patient's breath sounds
are equal bilaterally (unless a pneumothorax is also present). Aortic injury would be
expected to cause collapsed jugular veins; like the hemothorax, the patient is losing
blood volume into the chest cavity. By itself, aortic injury
does not cause unequal breath sounds.
A patient is unresponsive with snoring respirations. His arm is amputated just above the
elbow and is bleeding heavily. The EMT should:
A) open the patient's airway.
Questions With Complete
Solutions
Patients with significant closed head injuries often have pupillary abnormalities and:
A) paralysis.
B) paresthesia.
C) hypertension.
D) tachycardia. -ANSWERS C) hypertension.
Closed head injuries can cause a variety of signs and symptoms. In addition to pupillary
abnormalities (ie, unequal pupils, sluggishly reactive pupils), a classic
finding that indicates a significant increase in intracranial pressure is Cushing's triad.
This trio of findings includes hypertension; bradycardia; and abnormal
breathing, which can vary from slow and irregular to rapid and deep.
In contrast to an incision, a laceration:
A) is a jagged cut.
B) is a superficial injury.
C) bleeds more severely.
D) usually involves an artery. -ANSWERS A) is a jagged cut.
A laceration is a jagged cut caused by a sharp object or a blunt force that tears the
tissue, whereas an incision is a sharp, smooth cut. The depth of the injury
can vary; it can extend through the skin and subcutaneous tissue or into the underlying
muscles and adjacent nerves and blood vessels. Lacerations and
incisions can involve arteries, veins, or both, potentially resulting in severe bleeding.
Which of the following clinical findings is consistent with decompensated shock?
A) Diaphoresis and pallor
B) Falling blood pressure
C) Restlessness and anxiety
D) Tachycardia and tachypnea -ANSWERS B) Falling blood pressure
During shock, the compensatory mechanisms of the body attempt to maintain the blood
pressure. This is accomplished by increasing the heart rate, shunting
blood from the skin to more vital organs, and increasing the respiratory rate to increase
the oxygen content of the blood. Once these compensatory
mechanisms fail, the blood pressure will fall (hypotension). Hypotension signifies a state
of decompensated shock. You must not rely on the patient's blood pressure as an
indicator of overall perfusion. Restlessness, anxiety, tachycardia, tachypnea, and cool,
clammy skin (diaphoresis) are earlier signs of shock and do not necessarily indicate a
decompensated state.
Which of the following injury mechanisms involves axial loading?
A) skater slips and falls, landing on her outstretched arm.
,Fisdap Trauma Test
Questions With Complete
Solutions
B) A construction worker falls off a roof and lands feet first.
C) A woman's knees impact the dash during a frontal collision.
D) A man's neck is forced laterally during a side impact collision. -ANSWERS
B) A construction worker falls off a roof and lands feet first.
Axial loading injuries occur when a sudden, excessive compression force drives the
long axis of the body toward the head, or the head toward the feet.
Common injuries that involve axial loading are heavy objects falling on a patient's head,
diving head first into shallow water, and falls in which the patient lands
feet first. All of these mechanisms cause compression of the spine, potentially resulting
in serious injury. None of the other injury mechanisms described are
consistent with axial loading.
A man was stabbed in the cheek with a dinner fork, and the fork is still impaled in his
cheek. He is conscious and alert, breathing adequately,
and has blood in his oropharynx. You should:
A) apply high-flow oxygen via a nonrebreathing mask, carefully remove the fork, and
control any external bleeding.
B) suction his oropharynx, control any external bleeding, stabilize the fork in place, and
protect it with bulky dressings.
C) carefully remove the fork, suction his oropharynx as needed, and pack the inside of
his cheek with sterile gauze pads.
D) suction his oropharynx, carefully cut the fork to make it shorter, control any external
bleeding, and secure the fork in place. -ANSWERS B) suction his oropharynx,
control any external bleeding, stabilize the fork in place, and protect it with bulky
dressings.
An impaled object in the cheek should be removed if it interferes with your ability to
manage the patient's airway. In this case, however, the patient is
breathing adequately and does not require aggressive airway care (eg, ventilatory
assistance). The most practical approach is to suction the blood from his
oropharynx, which will prevent him from swallowing it, vomiting it, or aspirating it.
Stabilize the fork in place and protect it with bulky dressings; removing
an impaled object from the cheek in the opposite direction it entered would clearly
cause further soft-tissue injury and bleeding. Transport the patient in a
sitting position and suction his oropharynx en route as needed. There is no reason to
cut the fork to make it shorter; this will only unnecessarily manipulate
it, potentially causing further soft tissue damage and increased bleeding.
A 40-year-old man was hit in the nose during a fight. He has bruising under his left eye
and a nosebleed. What should you do?
,Fisdap Trauma Test
Questions With Complete
Solutions
A) Place a chemical ice pack over his nose.
B) Determine if he has any visual disturbances.
C) Ensure that he is sitting up and leaning forward.
D) Apply direct pressure by pinching his nostrils together. -ANSWERS C)
Ensure that he is sitting up and leaning forward.
During a nosebleed (epistaxis), much of the blood may pass down the throat into the
stomach as the patient swallows; this is especially true if the patient is
lying supine. Blood is a gastric irritant; a person who swallows a large amount of blood
may become nauseated and vomit, which increases the risk of
aspiration. Therefore, your first action should be to ensure that the patient is sitting up
and leaning forward. This will prevent blood from draining down the
back of the throat. Next, apply direct pressure by pinching the fleshy part of the nostrils
together; you or the patient may do this. Placing a chemical ice pack
over the nose may further help control the bleeding by constricting the nasal
vasculature. After controlling the nosebleed, continue your assessment, which
includes assessing for facial deformities and visual disturbances.
The presence of subcutaneous emphysema following blunt trauma to the anterior neck
should make you MOST suspicious for a:
A) pneumothorax.
B) fractured larynx.
C) ruptured esophagus.
D) carotid artery injury. -ANSWERS B) fractured larynx.
Crushing or blunt trauma to the anterior neck can injure the trachea or larynx. Once the
cartilages of the upper airway and larynx are fractured, they do not
spring back to their normal position. Such a fracture can lead to loss of voice, airway
obstruction, and leakage of air into the soft tissues of the neck. Air leakage
into the soft tissues is called subcutaneous emphysema. Subcutaneous emphysema
may also be observed in patients with a tension pneumothorax, although it
is typically located in the chest. Esophageal rupture would likely present with difficulty
swallowing (dysphagia) and vomiting blood (hematemesis). You should suspect injury to
a carotid artery or jugular vein if you observe a rapidly expanding hematoma to the neck
following blunt trauma.
A 22-year-old man had a strong acid chemical splashed into both of his eyes. He is
conscious and alert, is experiencing intense pain, and
states that he is wearing contact lenses. Treatment should include:
A) leaving the contact lenses in and beginning irrigation of both eyes.
B) removing the contact lenses and beginning irrigation of both eyes.
, Fisdap Trauma Test
Questions With Complete
Solutions
C) leaving the contact lenses in and covering both eyes with sterile gauze.
D) removing the contact lenses and covering both eyes with sterile gauze. -ANSWERS
B) removing the contact lenses and beginning irrigation of both eyes.
As a general rule, contact lenses should be left in place. Chemical eye burns are an
exception to this rule. If left in place, the chemical could get behind the
contact lens and continue to cause injury. Therefore, you should remove the contact
lenses and immediately irrigate the eyes with sterile saline or water. If
needed, continue to irrigate the eyes throughout transport.
Following blunt force trauma to the anterior chest, a man presents with difficulty
breathing, distended jugular veins, absent breath soundsover the left side of the chest,
and hypotension. Which of the following BEST describes the pathophysiology of this
patient's injury?
A) Increased pressure in the pleural space is compressing the great vessels
B) Blood is filling the pleural space and is collapsing the lung on the left side
C) Blood is filling the pericardia! sac and is restricting cardiac relaxation
D) The aorta has been injured and blood is rapidly filling the thoracic cavity -ANSWERS
A) Increased pressure in the pleural space is compressing the great vessels
The patient is experiencing a tension pneumothorax. This type of injury occurs when air
fills the pleural space and progressively collapses the lung. In the
process, the vena cavae are compressed and blood return to the heart is reduced;
clinically, this manifests as jugular vein distention because blood is backing
up into the systemic venous system. If blood return to the heart is reduced, the amount
of blood that leaves the heart will also be reduced; as a result, cardiac
output falls and the patient becomes hypotensive. Breath sounds are markedly
decreased or absent on the affected side of the chest because the lung is
being collapsed. In a hemothorax, blood fills the pleural space instead of air. Breath
sounds are decreased or absent on the affected side; however, because
the patient is losing blood volume into the chest, the jugular veins would be collapsed,
not distended as they are with a tension pneumothorax. Pericardia!
tamponade also causes jugular vein distention; however, the patient's breath sounds
are equal bilaterally (unless a pneumothorax is also present). Aortic injury would be
expected to cause collapsed jugular veins; like the hemothorax, the patient is losing
blood volume into the chest cavity. By itself, aortic injury
does not cause unequal breath sounds.
A patient is unresponsive with snoring respirations. His arm is amputated just above the
elbow and is bleeding heavily. The EMT should:
A) open the patient's airway.
