Question 1

You arrive at a scene where a 25-year-old male has been stabbed in the thigh. Bright red blood is spurting from the wound. Your FIRST action should be to:

Accepted Answer

For severe external hemorrhage, the first step is immediate direct pressure. If direct pressure fails to control arterial bleeding (spurting), or if the wound is amenable to a tourniquet immediately due to size/location, a tourniquet is the next step. However, NREMT algorithms typically prioritize direct pressure first unless the scenario indicates it is insufficient or impossible.

Question 2

A patient has a sucking chest wound (open pneumothorax). You should immediately:

Accepted Answer

Immediate life threat. The first action is to seal the hole with a gloved hand to stop air from entering the pleural space. This is later replaced with an occlusive dressing (3-sided or vented chest seal).

Question 3

Beck's Triad is a sign of Cardiac Tamponade. It consists of:

Accepted Answer

Cardiac Tamponade (fluid compressing the heart) restricts filling, causing low BP (hypotension), blood backup (JVD), and fluid insulation (muffled sounds).

Question 4

Cushing's Triad indicates increased Intracranial Pressure (ICP). It consists of:

Accepted Answer

As ICP rises, the body raises BP to force blood to the brain (Hypertension). The vagus nerve senses this and slows the heart (Bradycardia). Brainstem compression causes irregular breathing (Cheyne-Stokes/Biot's).

Question 5

You are assessing a patient with a chemical burn to the eye from a dry powder. You should:

Accepted Answer

Water can activate dry chemicals, causing a thermal burn on top of the chemical burn. Brush dry chemicals off first, then flush for at least 20 minutes.

Question 6

An abdominal evisceration (organs protruding) should be treated by:

Accepted Answer

Organs must be kept moist and warm. Do not replace them (risk of infection/damage). Cover with moist sterile gauze, then seal to retain moisture and heat.

Question 7

Which of the following findings would MOST likely suggest a Tension Pneumothorax over a simple Pneumothorax?

Accepted Answer

While both have decreased lung sounds and pain, Tension Pneumothorax causes a massive pressure buildup that shifts the mediastinum (tracheal deviation - late sign) and compresses the heart/vena cava (obstructive shock/hypotension).

Question 8

Using the Rule of Nines, an adult with burns to the entire left arm and the entire front of the torso has burns covering what percentage of their body?

Accepted Answer

Entire arm = 9%. Entire front torso (chest + abdomen) = 18%. 9 + 18 = 27%.

Question 9

Which type of shock is caused by a loss of blood or fluid?

Accepted Answer

Hypovolemic shock (low volume) results from hemorrhage (blood loss) or dehydration (fluid loss). It is the most common shock in trauma.

Question 10

A patient with a hip fracture typically presents with a leg that is:

Accepted Answer

The classic presentation of a proximal femur (hip) fracture is a leg that is shortened and rotated outward (external rotation). Posterior hip *dislocations* are usually internally rotated.

Question 11

You respond to a motor vehicle accident. The patient is found wandering the scene, confused. He asks the same questions repeatedly ('What happened?'). This repetitive questioning is best described as:

Accepted Answer

Anterograde amnesia is the inability to form new memories after the event. The patient cannot 'record' the answers you give, so they ask again. This is common in concussions.

Question 12

The correct placement of a tourniquet is:

Accepted Answer

Place the tourniquet high and tight (proximal to the wound, on the single bone if possible, or simply high on the limb) to compress the artery against the bone. Never place over a joint.

Question 13

Which of the following is a sign of a basilar skull fracture?

Accepted Answer

Battle's sign (bruising behind ears) and Raccoon Eyes (periorbital ecchymosis) are late signs of a fracture at the base of the skull.

Question 14

You are splinting a mid-shaft tibia fracture. You must immobilize:

Accepted Answer

The rule of splinting is to immobilize the joint above and the joint below the fracture site to prevent movement of the bone ends.

Question 15

A 'flail chest' occurs when:

Accepted Answer

Flail chest results in a free-floating segment of the chest wall that moves paradoxically (in during inhalation, out during exhalation) relative to the rest of the chest.

Question 16

Treatment for a flail chest includes:

Accepted Answer

The priority is oxygenation. Positive pressure ventilation acts as an internal splint. Bulky dressings can help stabilize the segment externally. Do not weigh it down with sandbags (restricts breathing).

Question 17

What is the earliest sign of shock (hypoperfusion)?

Accepted Answer

The body compensates first by increasing heart rate and shunting blood. This causes anxiety/restlessness and tachycardia. Hypotension is a late (decompensated) sign.

Question 18

Neurogenic shock is characterized by:

Accepted Answer

Spinal cord injury cuts off the sympathetic nervous system signals. Blood vessels dilate (warm skin/hypotension) and the heart cannot beat faster (bradycardia/normal rate). It is the only shock with warm skin/low HR.

Question 19

An impaled object should only be removed if:

Accepted Answer

Impaled objects act as a plug (tamponade). Removing them causes massive bleeding. Only remove if it blocks the airway (cheek) or prevents CPR (center of chest). Otherwise, stabilize in place.

Question 20

When assessing a patient with a gunshot wound, you must always look for:

Accepted Answer

Exit wounds are often larger and cause more damage than entrance wounds. Failing to find/treat an exit wound can lead to fatal hemorrhage.

Question 21

A hematoma is:

Accepted Answer

A contusion is a bruise. A hematoma is a larger collection of blood that separates tissue, forming a lump/pool.

Question 22

Which of the following zones of the neck is most dangerous for an injury due to the risk of air embolism?

Accepted Answer

If the jugular veins are lacerated, negative pressure in the chest during inhalation can suck air into the vein (air embolism). Occlusive dressing is required immediately.

Question 23

The GCS (Glasgow Coma Scale) score for a patient who opens eyes to pain, uses inappropriate words, and withdraws from pain is:

Accepted Answer

Eyes: To Pain (2). Verbal: Inappropriate Words (3). Motor: Withdraws (4). Total = 9.

Question 24

You are treating a patient with a severe head injury. You should ventilate to maintain an ETCO2 of:

Accepted Answer

Avoid hyperventilation. Low CO2 causes cerebral vasoconstriction, starving the brain of oxygen. Maintain ETCO2 35-40 (or 35-45). Hyperventilate only if signs of herniation are present (posturing/blown pupil).

Question 25

A 'Subdural Hematoma' is bleeding between the:

Accepted Answer

Subdural = Below the Dura. It is usually venous and slow developing. Epidural = Above the Dura (Arterial, fast).

Question 26

When using a KED (Kendrick Extrication Device), which strap is secured LAST?

Accepted Answer

Order: Torso -> Legs -> Head. You cannot secure the head until the torso is fixed, or the neck will move if the patient shifts.

Question 27

A burn that involves the epidermis and the dermis, characterized by blisters and severe pain, is a:

Accepted Answer

Blisters are the hallmark of partial-thickness burns. Superficial is red/dry. Full-thickness is charred/leathery/insensate.

Question 28

If a patient has a deformed knee and no distal pulse, you should:

Accepted Answer

A pulseless limb is an emergency. NREMT protocol allows ONE attempt to gently realign a deformed fracture/dislocation to restore circulation before splinting.

Question 29

Which organ is most commonly injured in blunt abdominal trauma (e.g., steering wheel impact)?

Accepted Answer

The spleen (LUQ) and liver (RUQ) are solid, vascular organs that fracture/bleed easily upon impact. The stomach is hollow and more resilient.

Question 30

Epistaxis is the medical term for:

Accepted Answer

Epistaxis = Nosebleed. Hematemesis = Vomiting blood. Hemoptysis = Coughing blood.

Question 31

A patient has sustained a large open wound to the neck. You should immediately cover it with:

Accepted Answer

Open neck wounds risk air embolism (air entering the jugular vein). An occlusive (airtight) dressing must be applied immediately to seal the wound.

Question 32

Which of the following patients should be transported to a Trauma Center?

Accepted Answer

CDC Trauma Triage Guidelines state that a GCS < 14 indicates significant neurological compromise and warrants transport to a designated trauma center.

Question 33

A 22-year-old male was hit in the chest with a baseball bat. He has paradoxical movement of the left chest wall. You should:

Accepted Answer

Paradoxical movement indicates a flail chest. The underlying lung injury (contusion) causes hypoxia. Positive pressure ventilation (BVM) splints the chest internally and oxygenates the patient.

Question 34

When assessing a patient with a gunshot wound to the chest, you find an entrance wound but no exit wound. You should:

Accepted Answer

You must perform a thorough rapid trauma assessment to find all wounds. A missed exit wound can bleed fatally. Check hidden areas like the axilla (armpits) and back.

Question 35

A patient with a suspected spinal injury is found in a prone position. You should:

Accepted Answer

To manage the airway and transport, the patient must be supine. The log roll maneuver with manual C-spine stabilization is the standard method to turn a prone patient.

Question 36

Which of the following signs indicates that a patient is in decompensated shock?

Accepted Answer

Tachycardia, anxiety, and pale skin are signs of compensated shock. When the blood pressure drops (hypotension), the body can no longer compensate, and perfusion to vital organs fails.

Question 37

You are treating a patient with an amputation of the right hand. You should wrap the amputated part in:

Accepted Answer

Never place tissue directly on ice or in water (causes frostbite/osmotic damage). Wrap it dry, seal it in a bag, and keep the bag cool.

Question 38

The most appropriate splint for a fractured clavicle (collarbone) is:

Accepted Answer

A sling supports the arm weight, and a swathe secures the arm to the chest, immobilizing the shoulder girdle and clavicle.

Question 39

A 16-year-old male struck a tree while skiing. He complains of left upper quadrant abdominal pain and left shoulder pain (Kehr's sign). You suspect injury to the:

Accepted Answer

The spleen is in the LUQ. Rupture causes blood to irritate the diaphragm, causing referred pain to the left shoulder (Kehr's sign).

Question 40

Hemostatic agents (e.g., combat gauze) are used when:

Accepted Answer

Hemostatic gauze is packed into junctional wounds (groin, axilla, neck) where tourniquets cannot fit, to promote rapid clotting.

Question 41

A 'coup-contrecoup' injury refers to:

Accepted Answer

The brain strikes the skull at the impact site (coup) and then rebounds to strike the opposite side (contrecoup), causing dual contusions.

Question 42

The rule for tightening a tourniquet is:

Accepted Answer

Tighten until the hemorrhage ceases and you can no longer feel a distal pulse. It will be very painful.

Question 43

Which patient requires manual stabilization of the cervical spine?

Accepted Answer

Significant mechanism of injury (fall) + unconsciousness = assumption of spinal injury until proven otherwise. Manual stabilization is the first step.

Question 44

A traction splint is indicated for:

Accepted Answer

Traction splints (Hare/Sager) are SPECIFICALLY for isolated, mid-shaft femur fractures. They are contraindicated for hip, knee, or lower leg injuries.

Question 45

A patient has a large laceration to the forearm. After applying direct pressure and a pressure dressing, the wound continues to bleed heavily. You should:

Accepted Answer

If direct pressure/pressure dressing fails to control hemorrhage, proceed immediately to a tourniquet. Do not remove soaked dressings (it breaks clots). Elevation/pressure points are no longer recommended as primary steps.

Question 46

Commotio Cordis is a condition where:

Accepted Answer

A sudden impact to the chest (like a baseball) during the repolarization phase of the cardiac cycle (T-wave) triggers Ventricular Fibrillation.

Question 47

In a multisystem trauma patient, the 'Golden Hour' refers to:

Accepted Answer

Survival rates drop significantly after 1 hour. EMS has the 'Platinum 10 minutes' on scene to initiate transport to the Trauma Center.

Question 48

Which of the following is an early sign of compartment syndrome?

Accepted Answer

Pain that is severe and not relieved by splinting/meds is the hallmark early sign. Pulselessness and paralysis are late, irreversible signs.

Question 49

A patient with a pelvic fracture is at high risk for:

Accepted Answer

The pelvis contains large volumes of blood vessels. A fracture can hide 1-2 liters of blood loss internally, leading to rapid shock. Use a pelvic binder.

Question 50

Hypothermia in a trauma patient is dangerous because it:

Accepted Answer

The 'Trauma Triad of Death' is Hypothermia, Acidosis, and Coagulopathy. Cold blood does not clot well, worsening hemorrhage. Keep trauma patients warm!

Question 51

When caring for a patient with a dry chemical powder on their skin, you should:

Accepted Answer

Water can activate dry chemicals (causing thermal burns). Brush first, then flush.

Question 52

Decorticate posturing (flexion of arms, extension of legs) indicates:

Accepted Answer

Decorticate (flexing towards the 'cord' or core) indicates severe brain damage (high GCS concern). Decerebrate (extension) is worse.

Question 53

A 30-year-old male has a piece of metal impaled in his leg. It is stable and not bleeding heavily. You should:

Accepted Answer

Stabilize in place to prevent further damage. Removing it may release a tamponaded vessel.

Question 54

Subcutaneous emphysema (crackling under the skin) in the neck or chest indicates:

Accepted Answer

Air escaping from a ruptured lung/trachea gets trapped under the skin, feeling like Rice Krispies (crepitus).

Question 55

A patient with a suspected head injury has a BP of 180/100 and a pulse of 50. This is:

Accepted Answer

Hypertension + Bradycardia = Cushing's Reflex, indicating increasing intracranial pressure.

Question 56

The primary goal of the secondary assessment in a trauma patient is to:

Accepted Answer

Primary assessment finds life threats (ABC). Secondary assessment (head-to-toe) finds non-life-threatening injuries (fractures, cuts).

Question 57

A 4-year-old child has burns to the entire head and entire left arm. Using the pediatric Rule of Nines, the percentage is:

Accepted Answer

Pediatric head = 18%. Arm = 9%. Total = 27%. (Note: Adult head is 9%).

Question 58

Which injury would cause the trachea to deviate away from the affected side?

Accepted Answer

Massive air pressure buildup pushes the mediastinum (heart/trachea) toward the uninjured side. This is a late sign.

Question 59

An avulsion is:

Accepted Answer

Avulsions involve tearing of tissue, often leaving a flap. Place the flap back in position if possible before bandaging.

Question 60

Treatment for a patient with an eye injury involves:

Accepted Answer

Eyes move together (sympathetic movement). To stop the injured eye from moving, you must cover/patch BOTH eyes.

Question 61

You respond to a blast injury (explosion). A 'secondary' blast injury is caused by:

Accepted Answer

Primary = Pressure wave (hollow organs). Secondary = Shrapnel (penetrating). Tertiary = Impact with ground/wall (blunt). Quaternary = Burns/gas.

Question 62

Ideally, a patient with a severe head injury should be transported with the head:

Accepted Answer

Elevating the head 30 degrees helps promote venous drainage from the brain, potentially lowering ICP. (If on a backboard, tilt the whole board).

Question 63

Which pulse is a reliable indicator of a systolic blood pressure of at least 80 mmHg?

Accepted Answer

Rule of thumb: Radial pulse present = Systolic > 80. Femoral > 70. Carotid > 60.

Question 64

A bite from a spider that causes a painless bite followed by a blister and tissue necrosis (ulcer) is likely from a:

Accepted Answer

Brown Recluse venom is cytotoxic (kills tissue), causing a non-healing ulcer. Black Widow venom is neurotoxic (muscle spasms).

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