Deck 35: Abdominal and Genitourinary Trauma

Question 1

You have arrived on the scene of an assault involving a knife. Assessment of the unresponsive 21-year-old male reveals him to have sustained multiple lacerations to the arms and abdomen, with a section of his intestine protruding through a large laceration in the area around the umbilicus. He has lost a significant amount of blood. His airway is open and he is breathing poorly at a rate of 28 breaths per minute. His radial pulse is weak, and his skin is cool and pale. Which one of the following should the EMT do first?

A) Cover the intestine with saline-soaked gauze.
B) Immobilize to a long board.
C) Start positive pressure ventilation.
D) Check the blood pressure.

Answer 1

C

Question 2

A patient has been shot in the abdomen. Assessment reveals that the bullet entered the body in the right upper quadrant and exited the lower right back. Given this finding, the EMT should assume which of the following organs may have been injured?

A) Liver, gallbladder
B) Liver, gallbladder, right kidney
C) Liver, gallbladder, right kidney, small intestine
D) Liver, gallbladder, right kidney, small intestine, pancreas

Answer 2

D

Question 3

A patient has been assaulted and sustained blunt trauma to the abdomen. As you start the primary assessment, you note that he is vomiting blood and you begin to suction him immediately. After the airway has been suctioned, you should:

A) check the patient's respirations.
B) examine the abdomen for specific injuries.
C) obtain a full set of vital signs.
D) administer oxygen with a nonrebreather face mask.

Answer 3

A

Question 4

A patient has referred pain to her left shoulder. Which of the following should the EMT suspect?

A) Hemorrhage from the spleen
B) Rupture of the small intestine
C) Damage to the gallbladder
D) Trauma to the right kidney

Question 5

You have just arrived on the scene of a very serious motor vehicle collision. Emergency Medical Responders (EMRs) have rapidly extricated an unresponsive female from the driver's seat. The EMRs report that she was unrestrained and struck the steering wheel with her chest and abdomen. As you start the primary assessment, you note that she has snoring respirations and is breathing shallowly at a rate of 24 breaths per minute. Which one of the following should you do next?

A) Obtain her vital signs.
B) Immobilize her to the backboard.
C) Perform a jaw-thrust maneuver.
D) Start positive pressure ventilation.

Question 6

A 74-year-old female is complaining of abdominal pain after falling down five stairs and hitting her abdomen and left hand on a mailbox at the bottom. She also states pain to her left wrist and right ankle, both of which show obvious deformity. She is alert and oriented, and her abdomen is free of bruising but is tender to the left upper and lower quadrants. Her vital signs are: pulse 132, respirations 22, blood pressure 106/86, and SpO₂ at 93%. Oxygen has been applied, and she is fully immobilized. Advanced life support has been requested and is 12 minutes away. What is your next action?

A) Apply ice to the wrist and ankle.
B) Initiate immediate transport.
C) Monitor the patient and wait for ALS assistance.
D) Immobilize the wrist and ankle.

Question 7

You have been called for a 42-year-old male complaining of back pain. On scene, the man tells you that he was lying on the floor when his 5-year-old son unexpectedly jumped feet first onto his back. He gives a medical history of high blood pressure and asthma, for which he takes medications. As you assess the patient, which one of the following signs or symptoms provides the greatest indication that the patient has sustained an abdominal injury?

A) Bruise to his back
B) Mild nausea
C) Blood in his urine
D) Shortness of breath

Question 8

You have arrived on the scene for a patient assaulted with a baseball bat. As you approach, which one of the following positions would seemingly indicate that he has suffered an injury to the abdomen?

A) Supine with legs extended and toes pointed
B) Prone with hands on the back
C) Standing with restless movement and pacing
D) On his side with knees drawn to the chest

Question 9

You have arrived on the scene of a stabbing. As you approach the patient, you note that he has removed his shirt and has a single stab wound to the right lower quadrant of the abdomen. At the patient's side, your first action should be to:

A) cover the wound with a nonporous dressing.
B) examine the patient's airway.
C) quickly look for additional stab wounds.
D) provide oxygen via nonrebreather face mask.

Question 10

Which organ, if seriously injured, would cause the most rapid death?

A) Vena cava
B) Spleen
C) Stomach
D) Large intestine

Question 11

A patient suffering blunt trauma to the abdomen has a lacerated liver. Which of the following represents the most immediate threat to life?

A) Infection
B) Pain
C) Peritonitis
D) Hemorrhage

Question 12

Which one of the following injuries is most likely to cause peritonitis?

A) Contusion to the pancreas
B) Stab wound to the small intestine
C) Blunt trauma to the spleen
D) Bullet injury to the liver

Question 13

You have been called for a male patient who has been shot. Assessment reveals an entrance wound to the left upper quadrant of the abdomen. An exit wound to the left upper back is also located. Which of the following should you do immediately?

A) Cover the abdominal wound with saline-soaked gauze.
B) Auscultate the patient's breath sounds.
C) Cover the exit wound with a gloved hand.
D) Place a cervical collar on the patient.

Question 14

A patient has been stabbed in the right upper quadrant of the abdomen. Which organ or structure should the EMT be concerned with being injured?

A) Liver
B) Spleen
C) Small intestine
D) Pancreas

Question 15

A patient has suffered an abdominal evisceration. There is no evidence of spinal injury. How should you place the patient on the stretcher?

A) Prone, to maintain pressure on the abdomen
B) Semi-Fowler's, to promote adequate breathing
C) Lateral recumbent with legs extended
D) Supine, with knees flexed to his chest

Question 16

EMT care for an open chest wound and an abdominal evisceration are similar in that:

A) air must be periodically released from both wounds.
B) occlusive dressings are placed over both wounds.
C) moist dressings are placed over both wounds.
D) both wounds can cause the trapping of air in the body.

Question 17

An industrial worker has sustained a laceration to his abdomen. On closer inspection, you note what appears to be fat tissue and a portion of intestine protruding through the wound. Which one of the following is most appropriate for treating this injury?

A) One attempt at replacement using sterile gloves
B) Dry sterile dressing applied over the wound
C) Direct pressure using gloved palms to the injury
D) Occlusive dressing applied over saline-soaked gauze

Question 18

A 45-year-old female was at a family reunion and fell off a trampoline. She hit a picnic table with the left side of her lower rib cage and is now very anxious and confused. Her airway is open and her breathing adequate. Her radial pulse is rapid and weak and her skin is cool and diaphoretic. Vital signs are: pulse 132, respirations 20, blood pressure 102/78 mmHg, and SpO₂ 97%. She has ecchymosis to the left lower rib area as well as tenderness and instability. She also has a superficial abrasion to her forehead. Given these findings, you would suspect and treat her for what condition?

A) Hypovolemic shock
B) Hypoxia
C) Spinal shock
D) Closed head injury

Question 19

A confused unrestrained male struck the steering wheel with his abdomen. Currently, he is complaining of generalized abdominal pain and rates it a 6/10. Assessment indicates red marks across his lower abdomen caused by the steering wheel. His pulse is 140, respirations 18, blood pressure 108/88, and SpO₂ at 94%. He looks pale with moist skin. Which of the following is most appropriate when providing oxygen to this patient?

A) 2 liters per minute through a nasal cannula
B) 8 liters per minute through a simple face mask
C) 15 liters per minute through nonrebreather
D) Oxygen can be withheld due to the SpO₂ reading

Question 20

The EMT recognizes that the division between the thoracic and abdominal cavities lies approximately:

A) at the level of the umbilicus.
B) at the fifth intercostal space.
C) below the twelfth rib.
D) above the twelfth thoracic vertebra.

Question 21

While cleaning a window, the glass broke and a sharp piece sliced the groin of a 43-year-old man. Assessment shows him to have a large laceration to his left scrotum, with a testicle exposed and protruding through the sac. Blood is pouring from the laceration and the patient rates the pain as an 8/10. Which of the following should be done first?

A) Apply direct pressure to the injury.
B) Provide oxygen at 15 liters per minute.
C) Call for advanced life support assistance.
D) Cover the exposed testicle with moist dressing.

Question 22

On scene, you encounter a restless patient who has been stabbed in the right upper quadrant of the abdomen and complaining of abdominal pain and a dry mouth. Assessment reveals no immediate life threats to the airway or breathing. The radial pulse is rapid and weak and the skin cool and diaphoretic. Vital signs are: pulse 124, respirations 20, blood pressure 122/88, and SpO₂ 97%. The injury is isolated with no involvement of the head, neck, or back. In managing the scene and patient, what observation would cause you to immediately intervene?

A) EMR holding manual in-line spinal stabilization
B) Application of high-concentration oxygen with SpO₂ of 97%
C) EMR covering the stab wound with a nonsterile glove
D) Family giving the patient water to drink

Question 23

A female patient who suffered a straddle injury while trying to balance on top of a chain link fence continues to bleed from the vaginal area despite your initial attempt to control the hemorrhage. At this time, you would:

A) apply an ice pack wrapped in a towel to the genital area.
B) gently put sterile gauze dressings into the opening of the vaginal canal.
C) place another dressing over the first and maintain direct pressure.
D) clean the area with sterile saline and reapply direct pressure.

Question 24

You have been called for a deeply disturbed psychiatric patient who has cut off the tip of his penis with a steak knife. Assessment reveals the 31-year-old male to be crying, with blood noted to his hands and pants. The primary assessment reveals no life threats and Emergency Medical Responders are applying oxygen to the patient. At this time, your priority is to:

A) place the amputated penis in sterile water.
B) control the bleeding.
C) prevent the patient from urinating.
D) determine why the patient cut himself.

Question 25

You are transporting an alert and oriented male who sustained severe abdominal trauma in an assault. The primary survey indicates a patent airway with respirations between 22 to 24 a minute. He has a rapid and weak radial pulse of 144 beats per minute and his skin is pale and cool. The blood pressure is 106/84 and SpO₂ 94%. Best management of the respiratory and oxygenation parameters would include:

A) positive pressure ventilation.
B) high-concentration oxygen through a nonrebreather.
C) application of a nasal cannula at 4 liters per minute O₂.
D) encouraging the patient to slow his respirations.

Question 26

A middle-aged male has sustained blunt force trauma to the abdomen resulting in an isolated tear and perforation of the large intestine. When following up on the patient, which of the following should the EMT not suppose, given the organ that was injured?

A) The patient developed an infection.
B) The patient rapidly decompensated into shock.
C) The patient has profound hypoxia.
D) The patient suffered from severe internal bleeding.

Question 27

You are transporting a female patient who was sexually assaulted by having a foreign body inserted deep into her vagina. You are attempting to control hemorrhage by the appropriate means. As you reassess the patient, which one of the following is of most concern?

A) Pain increases from a 7/10 to 10/10.
B) Large blood clots are forming at the vaginal entrance.
C) Patient informs you she has a sexually transmitted disease.
D) Heart rate increases from 116 to 140 per minute.

Question 28

While returning from a call, you are flagged down by a frantic family member of a 12-year-old male patient who reports him as being shot in the abdomen and inside the house in which she is standing. She states that the shooter is another family member who has since left the scene. What is your best course of action?

A) Go to the porch and have the patient brought to you.
B) Carefully look for scene hazards and enter once you feel safe.
C) Move the ambulance and wait for law enforcement to arrive.
D) Cautiously enter the house and be ready to vacate if any hazards are found.

Question 29

A 16-year-old male has been struck in the genitalia by a baseball. Assessment indicates a tremendous amount of edema as well as hematoma formation and bruising to his scrotum. The primary assessment reveals no life-threatening conditions; however, he is crying and rates the pain as a 10/10. Which one of the following is most appropriate for this patient?

A) Rapid transport using lights and sirens
B) Application of warm packs to the scrotum
C) Apply direct pressure to the site of injury
D) Place cool compresses to the testicles

Question 30

On scene of a motor vehicle accident, a car has extensive front-end damage and a deformed steering wheel. The restrained driver, who was self-extricated, is in the care of EMRs, who have applied a cervical collar and continue to hold manual in-line spinal stabilization. The airway is patent and respirations adequate. His radial pulse is rapid and weak and skin is cool and diaphoretic. The EMRs report the following vital signs: pulse 136, respirations 20, blood pressure 100/68, and SpO₂ 98% with 15 liters of O₂ being administered through a nonrebreather mask. The right forearm is deformed, and the head, chest, and upper back are uninjured according to your assessment. Your next action would be to:

A) start positive pressure ventilation.
B) repeat the vital signs.
C) change the nonrebreather to a nasal cannula.
D) check the abdomen for injury.

Question 31

A patient with severe retroperitoneal bleeding from an organ located within this cavity, has most likely injured her:

A) stomach.
B) liver.
C) large intestine.
D) kidney.

Question 32

You are transporting a male patient with a deep stab wound to the groin, with damage also noted to the genitalia. The patient is alert and oriented, albeit restless. Vital signs on scene were pulse 136, respirations 20, blood pressure 106/64, and SpO₂ 9%. Oxygen is being administered through a nonrebreathing face mask. On reassessment, what sign would be most concerning to the EMT?

A) Patient's urge to void
B) Blood pressure 108/90 mmHg
C) SpO₂ remaining at 96% despite O₂ therapy
D) Heart rate of 124 beats per minute

Question 33

The EMT has fundamental understanding of abdominal trauma when he states:

A) "Evisceation injuries can be recognized by dark-colored bruising over the top of the injury site."
B) "Blunt trauma tends to be more lethal than penetrating trauma because of the large number of organs affected."
C) "Injury to the solid organs like the bladder tend to be more lethal than injury to of hollow organs."
D) "Injury to the hollow organs tends to be worse than the solid organs because of the increased potential for blood loss."

Question 34

You are assessing a young male patient who was assaulted with a baseball bat and struck once on the left upper quadrant of the abdomen. You would recognize the patient as having Kehr's sign when he makes what statement?

A) "I am having a hard time breathing!"
B) "My belly hurts really bad…"
C) "My left shoulder is killing me!"
D) "It really hurts for me to breathe…"