Deck 30: Musculoskeletal Trauma and Nontraumatic Fractures

Question 1

A patient has a history of tendonitis to the right elbow. Based on this, the EMT would understand that the:

A) patient suffered a previous fracture to the right elbow.
B) tissue connecting the muscle to the bones of the elbow is inflamed.
C) muscles surrounding the elbow are inflamed.
D) bones making up the elbow joint are infected.

Answer 1

B

Question 2

Which of the following bodily activities is a function of a voluntary muscle?

A) Contraction of the heart
B) Movement of food through the intestines
C) Blinking of the eyes
D) Protection of the abdominal organs

Answer 2

C

Question 3

A patient you transported several days ago stops by your station to thank you. He reports that he was diagnosed with a strain to the lower right leg. As such, you recognize what structure as being affected by that injury?

A) Joint
B) Ligament
C) Muscle
D) Bone

Answer 3

C

Question 4

A young man riding a motorcycle was hit head on and ejected from the bike. Your scene size-up reveals him to be lying supine in the roadway with obvious deformity to his right thigh and left ankle, with blood noted on his pants in these areas. Patient assessment reveals he is unresponsive with snoring respirations and is breathing irregularly at 16 times per minute. His radial pulse is moderate in strength, and his skin is warm and dry. Which one of the following actions should be performed first?

A) Open the airway using the head-tilt, chin-lift.
B) Expose and splint both legs to prevent further injury.
C) Check for distal pulses in both lower extremities.
D) Take and maintain manual in-line spinal stabilization.

Question 5

The rapid secondary assessment of a male patient who was ejected from a motorcycle indicates instability and pain on palpation to the pelvic area. What is the EMT's primary concern related to this injury?

A) Risk for infection
B) Internal blood loss
C) Severe pain
D) Pelvic or hip fracture

Question 6

Which type of muscle tissue is found in the forearm?

A) Voluntary
B) Involuntary
C) Integumentary
D) Contraction

Question 7

A young female patient was walking on a 7-foot-high retaining wall when she stumbled and fell. She impacted a concrete sidewalk surface with her left foot and left hand. Your assessment reveals ecchymosis, deformity, and edema to both the left foot and left hand. Based on the concept of injury caused by indirect force, where else should the EMT look for injury?

A) Left toes
B) Left ankle
C) Left hip
D) Left fingers

Question 8

The secondary assessment of a patient complaining of right leg pain after falling down several stairs reveals a break in the skin where a fractured tibia bone broke through and then retreated back into the leg. The EMT should recognize this as what type of injury?

A) Open fracture
B) Laceration
C) Closed fracture
D) Partial fracture

Question 9

Family members report that their 62-year-old mother complained of dizziness and right leg weakness just before falling down a flight of stairs. Your assessment indicates that she is responsive, but confused and talking with garbled speech. Her breathing is adequate and her radial pulse is strong. Vital signs are: pulse 84, respirations 18, blood pressure 188/110 mmHg, and SpO₂ 96%. There is an open fracture to her right forearm. When instructed to do so, she does not move her right arm. When caring for this patient, you should do which one of the following?

A) Immobilize her on the long spine board, and then place a splint on her right arm prior to lights and sirens transport.
B) Immobilize her to the long board and extricate her to the ambulance for immediate transport.
C) Make sure that a radial pulse is present and splint the right arm prior to moving her to the stretcher.
D) Splint the right arm in the position found and transfer her to the stretcher for immediate transport to the hospital.

Question 10

Which assessment finding, on a 32-year-old female involved in an MVC, should the EMT recognize as potentially life threatening?

A) Deformity of the left femur
B) Open fracture to the right forearm
C) Dislocation of two fingers on the left hand
D) Crepitus palpated to the right humerus

Question 11

A patient was struck in the right upper arm with a baseball bat. Which of the following signs or symptoms indicates the highest probability that the humerus has been fractured?

A) Crepitus felt on palpation
B) Pain to the right upper arm
C) Deformity to the upper arm
D) Decreased sensation in the right hand

Question 12

A 9-year-old boy has fallen from a swing. Assessment findings reveal no threats to the airway, breathing, or circulation, but do indicate deformity, pain, and swelling to his right wrist. The right radial pulse is strong and is accompanied by skin that is pink and warm to the touch. Which one of the following actions indicates that the EMT is properly caring for this patient?

A) Straightening the wrist to promote blood flow to the hand
B) Maintaining the wrist below the level of the heart to decrease swelling
C) Applying cold packs to the wrist to reduce swelling
D) Massaging the wrist gently to decrease the pain

Question 13

Which one of the following bone injuries would be classified as occurring in the appendicular skeletal system?

A) Rib fracture
B) Spinal fracture
C) Right-hip fracture
D) Skull fracture

Question 14

Your partner is off from work for an extended period of time because he is having surgery for a torn ligament. Which one of the following structures needs that surgery?

A) Thick muscle that surrounds a joint
B) Tissue that connects one bone to other bones
C) Muscle that connects to a bone
D) Connective tissue that connects muscle and bone

Question 15

A 57-year-old male patient has fallen 20 feet while setting up holiday lights on his roof. He impacted the ground feet first and has suffered open fractures to both tibias, with both bones protruding through the skin. Your assessment reveals him to be responsive to painful stimuli. His airway is open, his breathing is rapid, and his radial pulse is weak. The skin is cool and diaphoretic. Vital signs are: pulse 132, respirations 24, and BP 106/90 mmHg. According to family, he has no medical history. Your partner is providing positive pressure ventilation. At this point in the patient's care, it is a priority for you to:

A) cover the patient with a blanket.
B) look for other injuries.
C) notify the hospital.
D) immobilize the fractures.

Question 16

A football player injured his knee during practice and is in pain. His left knee is swollen, ecchymotic, and flexed in an upward position. Your partner reports that the distal skin is warm, and he has located a weak pedal pulse. Which one of the following should you perform immediately?

A) Place the patient on a long spine board and apply the traction splint en route to the hospital.
B) Realign and straighten the injured knee and then immobilize it by binding it to the other leg.
C) Splint the knee in the position found prior to providing transport to the hospital.
D) Apply a traction splint and straighten the knee until the pain is decreased.

Question 17

Which one of the following statements describes the benefit of using the pneumatic antishock garment (PASG) to splint a potential pelvic fracture?

A) It applies even pressure to the pelvis, forcing the pelvic bones to realign.
B) It increases blood flow into both the pelvis and distal leg.
C) In addition to the pelvis, it immobilizes the thoracic and lumbar spine.
D) It can effectively stabilize the pelvis and help to control internal bleeding.

Question 18

What statement regarding voluntary muscles is true?

A) Voluntary muscles are primarily located on the torso.
B) Voluntary muscles comprise less mass in the body than involuntary muscles.
C) Voluntary muscles produce movement by extending.
D) Voluntary muscles connect to the bones of the skeletal system.

Question 19

Firefighters are extricating the driver of a small car that was struck broadside by a delivery truck at a moderate rate of speed. The patient was unrestrained, and the car sustained severe damage to the driver's side. As the man is pulled from the car, you note severe deformity to his left thigh area. Your primary assessment shows the patient to be responsive to painful stimuli, with an open airway and adequate breathing at 20 breaths per minute. His radial pulse is present but rapid at a rate of 124. After applying oxygen, the EMT should immediately:

A) examine the left leg.
B) check for a pedal pulse in the left foot.
C) conduct a rapid secondary assessment.
D) apply a traction splint to the left leg.

Question 20

Which statement about different musculoskeletal injuries is true?

A) A sprain is an injury to a joint with possible damage to or tearing of ligaments.
B) Strains are injuries that occur to ligaments and the joints to which they are attached.
C) A fracture occurs when a tendon connecting muscle to a bone is overstretched and injured.
D) A dislocation occurs when the bone contained within a joint is broken.

Question 21

A lifeguard has fallen 10 feet from his chair and has deformity, swelling, and ecchymosis to her right lower leg. The leg also is rotated medially. Another lifeguard has taken and is maintaining manual in-line spinal stabilization. As your partner conducts the primary assessment, you should take which one of the following actions?

A) Check the right foot for pulses and motor ability.
B) Ready the traction splint for application.
C) Align the leg in a neutral position.
D) Manually stabilize the lower right leg.

Question 22

Which one of the following questions is best asked when attempting to determine the degree of sensation in the hand of a patient who has suffered an elbow injury?

A) "Do you have feeling in your hand?"
B) "Does your hand feel as though it is asleep?"
C) "Can you tell me what finger I am touching?"
D) "Can you tell me if you have paresthesia in your hand?"

Question 23

What assessment finding would contraindicate the use of the traction splint?

A) Deformity to the hip
B) Decreased pedal pulse
C) Numbness to the foot
D) Open fracture

Question 24

Which one of the following statements shows that an EMT understands field care of a patient with a possible joint dislocation?

A) "If a joint injury is suspected, ice packs and not splints are indicated."
B) "The care for a patient with a joint injury is identical to that of a fracture."
C) "If a distal pulse is absent, three attempts to straighten the joint can be made."
D) "Warm packs, not cold packs, are indicated for a patient with a possible joint injury."

Question 25

An alert and oriented 22-year-old male has fallen off a tractor and is complaining of pain to his right leg. As you quickly scan the patient, you note deformity to the tibia-fibula area of the lower extremity. After conducting the primary assessment and manually stabilizing the leg, what action should the EMT take?

A) Apply the traction splint.
B) Transfer the patient to the stretcher.
C) Check for a pedal pulse.
D) Splint the leg in the position found.

Question 26

Your patient has an injury to the elbow and forearm. While you are conducting the reassessment, which one of the following statements made by the patient should concern you most?

A) "It hurts when I move my fingers."
B) "My hand feels like it is going to sleep."
C) "My arm seems to be bruising more."
D) "I am still having a hard time moving my arm."

Question 27

A patient fell and sustained an open fracture to the left humerus. However, assessment reveals the bone to have pulled back into the arm. Bleeding from the site is controlled. How will splinting the left arm benefit this patient?

A) Decreases the opportunity for further injury to nerves and blood vessels
B) Starts the process of healing by aligning and connecting the bone ends
C) Eliminates the possibility of infection through the open wound
D) Converts the open fracture to a closed fracture and maintains it as such

Question 28

When using an air splint, the EMT must remember that air splints:

A) should never be applied circumferentially.
B) do not fully immobilize a possible fracture.
C) can decrease circulation in the extremity.
D) are contraindicated for joint injuries.

Question 29

Which one of the following emergency care measures for a patient with a possible bone fracture can be an effective means to reduce pain?

A) Administering oxygen
B) Applying warm packs to the fracture site
C) Splinting the fracture
D) Gently massaging the injury site

Question 30

A female patient with osteoporosis stepped sideways on her foot and has suffered an open tibial fracture to the distal portion of her right leg. Which one of the following interventions indicates that appropriate care is being given for this injury?

A) The protruding bone is gently replaced back under the skin.
B) The EMT cleans dirt from within the wound and off the bone prior to splinting.
C) A pressure dressing is tightly applied to the open wound prior to splinting.
D) The bone end and soft tissue wounds are covered with a sterile dressing.

Question 31

You arrive at a hunting camp for a hunter who stumbled over a rock and caught himself on his outstretched arm. He denies hitting his head or neck. There are no threats to the airway, breathing, or circulation. He has swelling and ecchymosis to his left wrist. A radial pulse is readily palpated and the skin in the hand is warm to the touch. Which one of the following instructions given by the EMT to other rescuers indicates proper care of this patient?

A) "After we splint his wrist, we will need to elevate it during transport to decrease the opportunity for swelling."
B) "When you splint that arm, make sure that it is somewhat loose so the patient can move it if he becomes uncomfortable."
C) "Make sure to wrap that splint as tightly as you can; we need a lot of pressure to prevent additional swelling."
D) "Since he still has a pulse in that arm, the swelling must be from a muscle injury. We can forego the splint and just apply ice packs."

Question 32

While on standby at a semi-professional baseball game, you are summoned onto the field for a player complaining of severe leg pain after colliding with the catcher of the opposing team. The primary assessment shows no threats to the airway, breathing, or circulation. The secondary assessment reveals a severely deformed knee that is swollen and ecchymotic. The leg is pale and cool, and the patient cannot move his leg when asked to do so. In addition, you cannot palpate a pedal pulse. Which one of the following is your priority at this time?

A) Apply cold packs to the knee and transport immediately.
B) Apply a traction splint and enough traction until a pulse returns.
C) Check the patient's radial or carotid pulse.
D) Attempt to straighten the leg until a pulse returns.

Question 33

A vacuum splint has just been applied to the arm of a patient who fell backward from a chair while hanging drapes. Which one of the following statements or questions should the EMT make or ask next?

A) "I am going to feel your wrist for a pulse now."
B) "Can you rate your pain for me?"
C) "I need to feel your arm for tenderness."
D) "I am wrapping the splint with roller gauze to secure it."

Question 34

An alert and oriented worker had his right thigh pinned between the bumpers of two trucks. Assessment findings include deformity and swelling to the right hip area and mid-thigh, along with ecchymosis and swelling to the right knee. The patient complains of excruciating pain to the right leg. Which one of the following instructions given to other EMTs on the scene would be appropriate?

A) "Let's put his leg in the traction splint to help align the femur and reduce pain."
B) "Check for a pedal pulse and then carefully move him to the stretcher for transport."
C) "We need to wrap the right leg in a pressure dressing and then elevate it for transport."
D) "Let's immobilize him to the long spine board and then transport him to the hospital."

Question 35

A patient has swelling and deformity to the wrist. After splinting, which one of the following positions of the hand is most appropriate?

A) Fingers curled inward
B) Fingers extended and spread
C) Hand in a fist with thumb inside fist
D) Wrist flexed with fingers extended

Question 36

The EMT recognizes that a splint applied too loosely can result in which one of the following?

A) Laceration of previously intact blood vessels
B) Conversion of an open fracture to a closed fracture
C) Increased risk for infection
D) New fractures along the bone

Question 37

The EMT recognizes that a benefit of applying a traction splint to a deformed femur and thigh is that it:

A) corrects the fracture.
B) decreases pain.
C) increases perfusion to the muscle.
D) contracts the thigh muscles.

Question 38

You arrive on the scene to help another crew with the extrication from an attic of a female patient who fell while retrieving holiday decorations. As a result of the fall, she has an open fracture to her left lower leg. The patient has been fully immobilized to a long board and has a rigid splint in place to her left leg. Which one of the following would indicate the extremity has been improperly splinted?

A) The splint has immobilized the ankle, knee, and hip regions.
B) Ice packs wrapped in towels have been applied to the skin between the splints.
C) The patient is able to flex her left ankle when directed to do so.
D) The skin of the foot is red and swollen with a weak pedal pulse noted.

Question 39

Which one of the following statements about traction splints is true?

A) "Once the traction splint has been positioned under the leg, and the ankle hitch is applied, manual traction can be released."
B) "Mechanical traction should be applied until the affected leg is approximately 1 to 2 inches longer than the unaffected leg."
C) "Mechanical traction should be applied until the mechanical traction is equal to the manual traction and the patient experiences a reduction in pain."
D) "Once the mechanical traction has been applied, the ischial strap must be released to promote circulation into the affected leg."

Question 40

A patient with a closed fracture to the forearm has been properly splinted when which of the following are immobilized?

A) Wrist and forearm
B) Wrist, forearm, and elbow
C) Elbow and forearm
D) Shoulder, elbow, and forearm

Question 41

A 67-year-old female complains of severe left lower leg pain. She states that she was walking across the room when she suddenly heard a "crack" and felt excruciating pain in her leg. Her left tibia appears to be deformed and ecchymotic, as well as tender on palpation. Her vital signs are: pulse 96, respirations 28, blood pressure 168/74, and SpO₂ 98%. Additionally, she states that her doctor told her that the steroids she takes can weaken her bones, placing her at greater risk for fractures. Appropriate care for this patient would include:

A) high-concentration oxygen by mask.
B) full immobilization to the long board.
C) direct pressure to the area of injury.
D) application of a splint to the leg.

Question 42

You have been called for a male worker complaining of arm pain. On scene the 31-year-old patient states that his arm was crushed between two heavy boxes. There was minimal pain at that time, but now his right forearm is swollen and painful, especially with movement. He also states that the arm and fingers feel like they are "asleep." You note decreased strength to the arm and a radial pulse that is weak when compared to the left. There is no deformity to the arm and the skin is intact, although hard on palpation. Vital signs are pulse 88, respiration 18, and blood pressure 134/76 mmHg. Given these assessment findings, the EMT should be suspicious of:

A) compartment syndrome.
B) fracture.
C) hemorrhagic shock.
D) stroke.

Question 43

A patient with diagnosed osteoporosis is more likely to sustain which of the following injuries?

A) Strain
B) Joint sprain
C) Nontraumatic dislocation
D) Fracture

Question 44

Which one of the following statements about compartment syndrome is true?

A) "It can be treated in the prehospital setting by applying warm packs and elevating the extremity."
B) "It is commonly associated with bone fractures and can result in hemorrhagic shock if not treated."
C) "It describes swelling in the tissues that can result in the loss of an extremity."
D) "It is a life-threatening condition that will lead to death if not recognized and treated."

Question 45

An elderly female patient has fallen and is complaining of right hip and right knee pain. When assessing her, what finding would you find most concerning?

A) Swelling on the right knee
B) Absent pedal pulse
C) Crepitus at the right hip
D) Ecchymosis of the right hip and knee