Deck 35: Chest Trauma

Question 1

The rib cage includes

A) the ribs, major blood vessels, lungs, and heart.
B) the ribs, thoracic vertebrae, lungs, and heart.
C) the ribs, lungs, heart, and sternum.
D) the ribs, thoracic vertebrae, and sternum.

Answer 1

the ribs, thoracic vertebrae, and sternum.

Question 2

Which mechanism of injury will likely cause a closed chest injury?

A) A motor vehicle crash
B) A gunshot
C) Physical overexertion
D) Chronic coughing

Answer 2

A motor vehicle crash

Question 3

Select the BEST response: A rib fracture is classified as

A) a pulmonary injury.
B) an open chest injury.
C) a pleural cavity injury.
D) a closed chest injury.

Answer 3

a closed chest injury.

Question 4

Fractures of the 5-9 ribs on the right side are associated with injury to the

A) lungs.
B) spleen.
C) stomach.
D) liver.

Question 5

If you palpate the chest and hear a grating sound, you are hearing

A) pulmonary contusion.
B) pulmonary embolism.
C) subcutaneous emphysema.
D) crepitus.

Question 6

What are the steps you should perform when caring for a rib fracture?

A) Put on PPE, maintain an airway, assess ventilation, give oxygen if necessary, and allow the patient to hold a pillow for comfort.
B) Put on PPE, assess ventilation, give oxygen if necessary, and transport to the nearest hospital.
C) Put on PPE, maintain an airway, assess ventilation, give oxygen if necessary, and then tape the affected ribs.
D) Put on PPE, maintain an airway, give oxygen if necessary, and place an occlusive bandage over the damaged area.

Question 7

What is flail chest?

A) Bruising of the lung caused by blunt force trauma.
B) Multiple fractures to several adjacent ribs.
C) A broken rib that "flails" out and protrudes from the skin.
D) A laceration on the lung caused by a broken rib.

Question 8

An older man says he was awoken by sharp pain on the right side of his chest, accompanied by rapid breathing and a cough. He was recently diagnosed with pneumonia. You should suspect

A) pulmonary contusion.
B) pulmonary edema.
C) a simple pneumothorax.
D) an asthma attack.

Question 9

A massive hemothorax is

A) a bleed from the aorta into the abdominal cavity.
B) a blood loss of more than 1,500 mL into the pleural cavity.
C) the presence of blood in a tension pneumothorax.
D) a blood loss of 1,000 mL into the alveoli and bronchioles.

Question 10

A cardiac tamponade is

A) the presence of blood within the pleural space.
B) a laceration of one of the major blood vessels.
C) the entrance of blood into the pericardial sac.
D) a contusion of the heart and the pulmonary wall.

Question 11

A victim of a motor vehicle crash who exhibits deep red and purple colors on the head and neck likely has

A) cardiac tamponade.
B) jugular venous distension.
C) open pneumothorax.
D) traumatic asphyxia.

Question 12

What occurs in about 75% of patients with flail chest?

A) Simple pneumothorax
B) Tension pneumothorax
C) Pulmonary contusion
D) Myocardial contusion

Question 13

In this image, the dark red tissue of the heart illustrates

A) myocardial contusion.
B) pulmonary contusion.
C) cardiac laceration.
D) pericardial effusion.

Question 14

A young male was hit in the front of his chest with a baseball and fell over with no pulse. You should suspect

A) rib fracture.
B) commotio cordis.
C) pulmonary contusion.
D) myocardial contusion.

Question 15

Your patient was stabbed in the chest and the knife was removed prior to your arrival. You notice blood and bubbles leaking from the wound. You should

A) pack the wound with sterile gauze and tape down two sides.
B) place an occlusive dressing over the wound and tape down three sides.
C) control bleeding before applying an occlusive dressing and administering high-flow oxygen.
D) apply a dry, sterile dressing and administer oxygen.

Question 16

A man attacked with a baseball bat is coughing up blood, exhibits bluish skin, and has trouble breathing. You should suspect

A) a tension pneumothorax.
B) commotio cordis.
C) a hemothorax.
D) a pulmonary contusion.

Question 17

This displacement of the internal organs is called

A) myocardial contusion.
B) tracheal deviation.
C) traumatic asphyxiation.
D) mediastinal shift.

Question 18

What is a tension pneumothorax?

A) A compression of the chest that prevents blood flow and sometimes causes partial lung collapse.
B) A gradual accumulation of air in the pleural space, causing a partial to total lung collapse.
C) A non-increasing amount of air in the pleural space that causes a partial lung collapse.
D) Blood that collects in the pleural space and does not cause a lung collapse.

Question 19

A patient presents with a closed chest injury, jugular vein distension, unequal breath sounds, and a chest with asymmetrical rise on inspiration. He likely has a(n)

A) tension pneumothorax.
B) simple pneumothorax.
C) open pneumothorax.
D) secondary pneumothorax.

Question 20

Your patient has a penetrating chest injury. She is cyanotic and is sweating severely. She has normal breath sounds with equal rise and is tachycardic. You should suspect

A) a myocardial contusion.
B) a cardiac tamponade.
C) traumatic asphyxia.
D) None of these are correct.

Question 21

In the late stage of a tension pneumothorax, blood backs up into the venous system, which causes

A) jugular venous distension.
B) subcutaneous emphysema.
C) crepitus.
D) All of these are correct.

Question 22

According to the text, because of the force involved in a flail chest injury, you should also suspect

A) pulmonary and myocardial contusions, commotio cordis, and cardiac tamponade.
B) pulmonary and myocardial contusions, hemothorax, and pneumothorax.
C) commotio cordis, myocardial contusions, and cardiac tamponade.
D) hemothorax, pneumothorax, and commotio cordis.

Question 23

Select the BEST response: After a vehicle rollover, the patient displays tachycardia and tachypnea and has immense pain caused by severe bruising across his chest. You should suspect

A) a broken rib.
B) a simple pneumothorax.
C) myocardial contusions.
D) flail chest.

Question 24

A 24 year old male called EMS to his home in the middle of the night. You notice him cough repeatedly. He says a pain courses through his chest as if he is being stabbed and complains of shortness of breath. He says that he has no known chest problems. You should suspect

A) traumatic asphyxia.
B) spontaneous pneumothorax.
C) pulmonary contusion.
D) chronic obstructive pulmonary disorder.

Question 25

What is a difference between a tension pneumothorax and a cardiac tamponade?

A) A tension pneumothorax has absent breath sounds on one side, while a cardiac tamponade has equal breath sounds on both sides.
B) A tension pneumothorax has the trachea in the midline position, while a cardiac tamponade has a deviated trachea.
C) A tension pneumothorax has a narrowing pulse pressure, while a cardiac tamponade has a normal pulse pressure.
D) A tension pneumothorax has tachycardia, while a cardiac tamponade has a normal heart rate.

Question 26

Hemoptysis is a sign of

A) tension pneumothorax.
B) myocardial contusion.
C) pulmonary contusion.
D) simple pneumothorax.

Question 27

You are coaching a high school hockey practice when a player is hit in the chest with a hockey stick. He falls immediately, has a seizure, and then lies motionless. In addition to contacting EMS dispatch, you should first

A) begin spinal stabilization and refrain from moving the patient until ALS arrives.
B) reposition the victim's airway and wait for him to catch his breath.
C) assess mental awareness with the Glasgow Coma Scale.
D) check breathing and pulse and begin CPR if necessary.

Question 28

How many sets of ribs are there?

A) 11 in men, 12 in women
B) 12 for both sexes
C) 12 in men, 11 in women
D) 11 for both sexes

Question 29

Which of the following rib fractures might injure the liver?

A) Fractures of ribs 5-9 on the left side
B) Fractures of ribs 5-9 on the right side
C) Fractures of ribs 11-12 on the left side
D) Fractures of ribs 11-12 on the right side

Question 30

Your patient tells you that he was kicked in the chest by his horse. You notice that he is holding his arm tightly against his body and seems hesitant to move. You suspect

A) a dislocated shoulder.
B) a radius fracture.
C) a dislocated elbow.
D) a rib fracture.

Question 31

What is crepitus?

A) The grating, crackling, and popping sounds associated with joint erosion or bone fracture.
B) A popping sound, similar to crushing crisped rice, heard when palpating the skin.
C) A natural deformity of the long bones that often appears like swelling.
D) The "pins and needles" sensation felt when nerve damage begins.

Question 32

Which is likely a symptom of rib fracture?

A) Tenderness down the spinal column
B) A throbbing pain extending down the arms
C) Pain down the lower abdomen that worsens when palpated
D) Localized pain in the ribs that worsens upon deep breathing

Question 33

You should encourage a patient with a rib fracture to

A) inhale slowly and exhale rapidly.
B) take rapid, shallow breaths.
C) cough and breathe deeply.
D) breathe through his nose rather than his mouth.

Question 34

What is flail chest?

A) A broken floating rib that protrudes from the skin.
B) Multiple broken ribs that puncture internal organs or blood vessels.
C) A broken rib that punctures the lung.
D) Multiple adjacent ribs that are broken in multiple different places.

Question 35

In a patient with flail chest, paradoxical movement occurs when the flail section

A) moves inward with inspiration, and outward with exhalation.
B) moves freely throughout the chest cavity.
C) disintegrates within the chest cavity.
D) damages lung tissue such that it cannot expand.

Question 36

In chest trauma injuries, crepitus is a sign of

A) flail chest and open pneumothorax.
B) rib fracture and flail chest.
C) simple and open pneumothorax.
D) simple pneumothorax and rib fracture.

Question 37

Which injury can be associated with flail chest?

A) Myocardial contusion
B) Myocarditis
C) Myocardial perfusion
D) Myocardial infarction

Question 38

What is the name of the condition in which air collects within the chest cavity and does NOT increase in volume with each breath?

A) Tension pneumothorax
B) Simple pneumothorax
C) Hemothorax
D) Hemopneumothorax

Question 39

What is a tension pneumothorax?

A) A condition in which air exists in the pleural cavity but does not progressively accumulate, causing only a partial lung collapse.
B) A condition in which blood and air collects in the pleural cavity and causes a pressure build-up and difficulty breathing.
C) A condition in which a tear in the lung tissue causes blood to collect in the pleural cavity and causes a partial lung collapse.
D) A condition in which air progressively accumulates in the pleural cavity, cannot escape, and causes a life threatening pressure build-up in the chest.

Question 40

This image shows

A) paradoxical movement.
B) mediastinal shift.
C) tracheal deviation.
D) pneumothorax.

Question 41

An adult male is tachycardic, hypotenive, and has cool, clammy skin. You note that lung sounds are absent on the left side of his chest. You should suspect

A) hemothorax.
B) open pneumothorax.
C) simple pneumothorax.
D) tension pneumothorax.

Question 42

Select the BEST response: Your patient was in a motorcycle crash. Before your arrival, a bystander covered a "nasty looking hole" in the patient's chest with a clean cloth. You should

A) remove the bandage, determine the extent of bleeding, and then dress appropriately.
B) place an occlusive dressing over the cloth and bandage tightly.
C) cover the cloth with dressing and bandage tightly.
D) remove the cloth, listen for sounds of escaping air, and then dress appropriately.

Question 43

A "sucking chest wound" is another name for a(n)

A) tension pneumothorax.
B) hemothorax.
C) simple pneumothorax.
D) open pneumothorax.

Question 44

When a chest wound presents a sucking sound with each breath, it is a sign of

A) hypoxia.
B) subcutaneous emphysema.
C) crepitus.
D) open pneumothorax.

Question 45

A 29 year old man was involved in a boating accident. You notice blood bubbling from an avulsion on his chest. You do not have any medical supplies with you. What should you use to dress the wound?

A) A t-shirt
B) A bathing suit
C) A plastic bag
D) A towel

Question 46

Why is it important to tape an occlusive dressing on 3-sides?

A) It allows for Easy removal of the bandage at the hospital.
B) The caregiver has room to clean blood from the wound.
C) It acts as a one-way valve, letting air out but not in.
D) It allows air to enter and escape as needed.

Question 47

After applying an occlusive bandage to a sucking chest wound, the patient exhibits tachycardia, hypotension, and begins to feel extreme pain on the affected side. You should

A) warm the patient and recheck vital signs.
B) give oxygen by nonrebreather mask at 15L/min.
C) release the bandage and listen for escaping air.
D) begin treating the patient for shock.

Question 48

How are chest wounds categorized?

A) Closed and open
B) Puncture and blunt force
C) Internal and external
D) Simple, tension, and open pneumothoraxes

Question 49

What condition does this image depict?

A) Complex pneumothorax
B) Basic pneumothorax
C) Simple pneumothorax
D) Open pneumothorax

Question 50

What does JVD stand for?

A) Juvenile venous dysmorphia
B) Jugular venous distension
C) Jugular vein dysmorphia
D) Juvenile vascular diabetes

Question 51

Rib fractures most commonly occur in

A) older adults.
B) adults.
C) children.
D) babies.

Question 52

According to the text, in treating a rib fracture, it is acceptable to

A) place an occlusive dressing on the injury.
B) apply tape to the affected ribs.
C) permit the patient shallow breathing.
D) allow the patient to hold a pillow to his chest.

Question 53

The twelfth floating rib is attached to which vertebra?

A) T11
B) T12
C) L1
D) L2

Question 54

What motor vehicle safety accessory can occasionally cause rib fractures?

A) Tempered windows
B) Lap belt
C) Frontal airbag
D) 3-point seat belt

Question 55

A patient has a chest injury. She exhibits extreme localized pain upon inspiration, shallow breathing, and you can hear breath sounds on each side of the chest. You suspect a

A) tension pneumothorax.
B) flail chest.
C) fractured rib.
D) None of these are correct.

Question 56

Which sign is associated with flail chest?

A) Mediastinal shift
B) Tracheal deviation
C) Paradoxical movement
D) Pulmonary contusion

Question 57

If you put on PPE, request advanced ALS, check for spinal injuries, maintain an open airway, and apply petroleum gauze to a wound, you are caring for

A) a flail chest.
B) a tension pneumothorax.
C) a rib fracture.
D) an open pneumothorax.

Question 58

This diagram of the rib cage shows that fractures to ribs 7, 8, or 9 can also damage which organs?

A) Spleen and stomach
B) Liver and stomach
C) Liver and spleen
D) Diaphragm and stomach