Chapter 32 Musculoskeletal Trauma MOD 5

1) Which of the following structures connect bone ends and allow for a stable range of motion?

A) Ligaments

B) Cartilage

C) Tendons

D) Periosteum

Ligaments

2) Which of the following allows for smooth movement of bone surfaces against one another at

joints?

A) Smooth muscle

B) Ligaments

C) Tendons

D) Cartilage

Cartilage

3) The sound or feeling of the ends of broken bones rubbing together is called:

A) crepitus.

B) deformity.

C) angulation.

D) paresthesia.

crepitus

4) Which one of the following definitions is not true?

A) A sprain is the stretching and tearing of ligaments.

B) Tendons connect muscles to ligaments.

C) Another name for manual traction is tension.

D) Joints are places where bones articulate.

Tendons connect muscles to ligaments.

5) The part of the skeleton that includes the skull and spinal column is called the:

A) appendicular skeleton.

B) boney skeleton.

C) axial skeleton.

D) torso.

axial skeleton.

6) Where could you find the phalange bones?

A) Arms

B) Legs

C) Skull and neck

D) Hands and feet

Hands and feet

7) Which of the following bones is found in the chest?

A) Tarsals

B) Ilium

C) Sternum

D) Metacarpals

Sternum

8) The strong white fibrous material called the periosteum:

A) covers the bones.

B) protects the perineum.

C) surrounds the heart.

D) surrounds the abdominal cavity.

covers the bones.

9) Which one of the following statements is not true?

A) Cartilage is connective tissue that covers the outside of the bone end and acts as a surface for

articulation.

B) Tendons are bands of connective tissue that bind the ligaments to muscles.

C) Ligaments are connective tissues that connect bone to bone.

D) Muscles are the tissues or fibers that cause movement of body parts or organs.

Tendons are bands of connective tissue that bind the ligaments to muscles.

10) Your patient is a 12-year-old female who fell onto her outstretched hands while

rollerblading. She has a deformity of her forearm, about 2 inches proximal to her wrist. This

injury is a result of which of the following mechanisms?

A) Direct force

B) Indirect force

C) Sudden acceleration

D) Twisting motion

Indirect force

11) Your patient is a 70-year-old male whose tractor rolled over onto him. Your assessment

makes you suspicious that the patient has a fractured pelvis. Which of the following signs and

symptoms should you anticipate?

A) Patient demonstrates signs of shock.

B) Patient cannot lift legs when lying supine.

C) Patient feels the need to empty his bladder.

D) All of the above.

All of the above.

12) Which of the following is not a mechanism of musculoskeletal injury?

A) Direct force

B) Indirect force

C) Twisting or rotational forces

D) Extensive force

Extensive force

13) Which of the following statements is not true?

A) A fracture is any break in a bone.

B) A comminuted break is when a bone is broken in only one place.

C) A greenstick break is an incomplete break in a bone.

D) An angulated break is when the broken bone segments are at an angle to one another.

A comminuted break is when a bone is broken in only one place.

14) Which one of the following statements is not true concerning a knee injury?

A) Fractures can occur to the proximal femur.

B) Fractures can occur to the proximal tibia and fibula.

C) Fractures can occur to the patella.

D) There could be pain and tenderness.

Fractures can occur to the proximal femur.

15) Which of the following is a muscle injury caused by overstretching or overexertion of the

muscle?

A) Luxation

B) Strain

C) Fracture

D) Sprain

Strain

16) Which of the following describes an open extremity injury?

A) A gunshot wound has penetrated the skin and then fractured the bone.

B) Bone ends have lacerated the soft tissues and skin from the inside.

C) The joint capsule has been torn open during a dislocation.

D) Both A and B

Both A and B

17) Although it can be difficult to definitively determine hip dislocation in the field, certain signs and symptoms are usually there. Which of the following statements is false?

A) An anterior hip dislocation would probably present with the entire lower limb rotated inward.

B) A posterior hip dislocation presents with a bent knee and the foot may hang loose.

C) The posterior hip dislocation is the most common.

D) Often there is lack of sensation in the limb.

An anterior hip dislocation would probably present with the entire lower limb rotated inward.

18) Distinguishing between a knee dislocation and a patella dislocation can sometimes be

difficult. Which of the following statements is not true?

A) In a patellar dislocation, the knee will be stuck in flexion but the knee cap will not be

displaced.

B) In a knee dislocation, the tibia is forced anteriorly or posteriorly in relation to the distal femur.

C) You should always check for a distal pulse.

D) The lack of a distal pulse could be a signal of a real emergency

In a patellar dislocation, the knee will be stuck in flexion but the knee cap will not be displaced.

19) Which of the following is a complication of bone fractures?

A) Nerve damage

B) Swelling

C) Hemorrhage

D) All of the above

All of the above

20) A traction splint may be used on which of the following musculoskeletal injuries?

A) Possible fracture of the cervical spine

B) Possible fracture of the femur

C) Suspected multiple fractures of the femur, tibia, and fibula

D) Possible fracture of the humerus

Possible fracture of the femur

21) Which of the following best describes the compartment syndrome?

A) A serious condition caused by the amount of equipment that must be carried in the ambulance compartments

B) A life-threatening condition caused by trapping the blood flow by a fracture when the bone

ends cut the blood vessels

C) A serious condition caused by the bleeding and swelling from a fracture or crush injury that becomes so strong that the body can no longer perfuse the tissues against that pressure

D) A non-life-threatening condition caused by orthopedic injuries in which blood flow is stopped when the bone ends compress the blood vessels

A serious condition caused by the bleeding and swelling from a fracture or crush injury that becomes so strong that the body can no longer perfuse the tissues against that pressure

22) Which of the following is appropriate in the examination of a painful, swollen extremity of a

conscious patient?

A) Gently attempting to flex the mid-portion of the bone to check for angulation

B) Asking the patient to see if he can bear weight on the extremity

C) Comparing the injured side to the uninjured side

D) Seeing if you can elicit crepitus on palpation

Comparing the injured side to the uninjured side

23) When the EMT is assessing compromise to an extremity, perhaps due to an orthopedic

injury, the EMT should initially check what "six Ps"?

A) Pain, pallor, position, pulses, placement, and pressure

B) Pain, pallor, paresthesia, pulses, placement, and pressure

C) Pain, pallor, position, pulses, placement, and pad

D) Pain, pallor, paresthesia, pulses, paralysis, and pressure

Pain, pallor, paresthesia, pulses, paralysis, and pressure

24) One of the more serious conditions that EMTs are confronted with would occur as follows: A

fracture or crush injury causes bleeding and swelling within the extremity. Pressure and swelling

caused by the bleeding within the muscle compartment become so great that the body can no

longer perfuse the tissues against the pressure. Cellular damage occurs and causes additional

swelling. Blood flow to the area is lost. The limb itself may be lost if the pressure is not relieved.

What is this condition called?

A) Compartment syndrome

B) Crushing syndrome

C) Perfusing syndrome

D) Fracture syndrome

Compartment syndrome

25) A method of assessing compromise to an extremity when a musculoskeletal injury is

suspected is to learn and follow the six Ps. Which of the items below is not one of the six Ps?

A) Pain

B) Pallor

C) Paresthesia

D) Parenthesis

Parenthesis

26) What is a primary problem when treating musculoskeletal injuries?

A) Many musculoskeletal injuries have a grotesque appearance, and the EMT cannot be

distracted from life-threatening conditions by a deformed limb.

B) All musculoskeletal injuries are life threatening due to the bone bleeding leading to

hypoperfusion.

C) Splints do not adequately fit the patient's extremities and must be modified with padding to

ensure immobilization.

D) Most musculoskeletal injuries are simply splinted and not a life threat to the patient.

Many musculoskeletal injuries have a grotesque appearance, and the EMT cannot be

distracted from life-threatening conditions by a deformed limb.

27) Your patient is a 60-year-old woman who stepped off a curb and injured her ankle. Your

exam shows that her left ankle is swollen and painful. Which of the following should you do?

A) Explain to the patient that her ankle is fractured, and you must splint her ankle to prevent

further injury and reduce pain.

B) Explain to the patient that you cannot tell if her ankle is sprained or fractured until she is Xrayed

at the emergency department, then splint the ankle.

C) Transport the patient immediately to a trauma center, applying high-concentration oxygen en

route.

D) Explain to the patient that her ankle is sprained and transport her with her ankle elevated on a

pillow and a cold pack applied to the injury.

Explain to the patient that you cannot tell if her ankle is sprained or fractured until she is Xrayed

at the emergency department, then splint the ankle.

28) Your patient is a 28-year-old male who was ejected from his motorcycle after striking a

parked vehicle. He has multiple deformities to his upper and lower extremities on both sides.

Which of the following would be the best way to immobilize this patient's extremities prior to

transport?

A) Use traction splints for the lower extremities and allow the upper extremities to be

immobilized by the long backboard.

B) Use padded board splints for the upper extremities and a PASG for the lower extremities.

C) Use moldable splints for the upper and lower extremities, padding any voids to fully stabilize

the fractures.

D) Immobilize the patient to a long backboard without splinting the extremities individually.

Immobilize the patient to a long backboard without splinting the extremities individuall

29) Which of the following is not a contraindication for the use of a traction splint?

A) Pelvis, hip, or knee injury

B) Avulsion or partial amputation where traction could separate the extremity

C) Injury to the lower third of the leg that would interfere with the ankle hitch

D) Severe swelling and redness at a midshaft femur

Severe swelling and redness at a midshaft femur

30) A painter falls from his ladder and tells you he has dislocated his shoulder again. When you

attempt to splint the shoulder, it "pops back into place." What should your next step be?

A) Contact medical control for input into the best treatment for this patient.

B) Check distal CSM, apply a sling and swathe, and transport the patient.

C) Check distal CSM, apply a traction splint, and transport the patient.

D) Report the popping sound to the receiving physician when you arrive at the hospital.

Check distal CSM, apply a sling and swathe, and transport the patient.

31) Which of the following is not a principle of splinting that must be considered by the EMT?

A) Immobilize the site of an extremity injury from the joint above it to the joint below it.

B) Splint an isolated extremity injury before moving the patient to the stretcher.

C) Check the distal neurovascular function before and after splinting.

D) Gently replace protruding bone ends back beneath the skin to prevent further contamination

Gently replace protruding bone ends back beneath the skin to prevent further contamination

32) There are general rules that apply to all types of splinting. Which of the following is not a

general rule of splinting?

A) In order to avoid loss of use of a limb, it is important to splint before moving, even if the patient is unstable.

B) Expose the injury.

C) Assess distal CSM.

D) Align long-bone injuries to anatomical position.

In order to avoid loss of use of a limb, it is important to splint before moving, even if the patient is unstable.

33) Which of the following is not a benefit of splinting an injury to bones and connective

tissues?

A) It prevents neurological damage due to movement of bone ends or fragments.

B) It may prevent a closed injury from becoming an open injury.

C) It restricts blood flow to the site of the injury to prevent swelling.

D) It reduces pain.

It restricts blood flow to the site of the injury to prevent swelling.

Your patient is a 20-year-old college student who has fallen from a third-level balcony onto a wooden deck below. The patient responds to verbal stimuli, is pale in color with moist skin, and has a very obvious deformity with protruding bone ends of his right forearm. Which of the

following is the best sequence of intervention for this patient?

A) Provide manual in-line stabilization of the cervical spine along with assessment of breathing,

pulse, and the presence of significant hemorrhage; apply high-concentration oxygen; perform a

rapid trauma exam; immobilize to a long backboard; transport; and splint the extremity en route

if time and resources allow.

3 multiple choice options

35) Your patient is an 11-year-old male who has a swollen, painful, and angulated right lower

arm after falling from his bicycle onto his hands. Which of the following should be considered in

the immobilization of his injured extremity?

A) Check pulse, movement, and sensation distal to the injury before and after splinting.

B) Immobilize from the shoulder to the wrist.

C) Use an upper extremity traction splint.

D) Do not attempt to realign the extremity before splinting.

Check pulse, movement, and sensation distal to the injury before and after splinting.

36) A new EMT who is treating a suspected femur injury asks his partner, "How much traction

should I pull?" The partner's best reply is which of the following?

A) No traction splint applied in the field pulls true traction; they must pull 20 pounds of

countertraction.

B) Pull enough traction to give the patient some relief from the pain.

C) The amount of traction applied should be roughly 10% of the patient's body weight and not

exceed 15 pounds.

D) The amount of traction applied should be 15 pounds.

The amount of traction applied should be roughly 10% of the patient's body weight and not

exceed 15 pounds.

37) You are treating a 16-year-old skateboarder who has fallen at the skate park. She has an

angulated left forearm that she has in a guarded position. When do you splint this injury?

A) En route to the hospital

B) Immediately

C) During the primary exam

D) During the secondary exam

During the secondary exam

38) Which of the following hazards may arise from properly splinting an injured extremity?

A) Converting a closed fracture to an open one

B) Compromising circulation to the extremity

C) Ignoring life-threatening problems while focusing on an extremity injury

D) All of the above

Ignoring life-threatening problems while focusing on an extremity injury

39) Your patient is a 3-year-old girl who is unable to move her elbow after her mother picked her up by the forearm. Proper splinting of this injury would be to immobilize from the to ______

the ______

A) wrist; elbow

B) wrist; shoulder

C) forearm; humerus

D) fingertips; shoulder

forearm; humerus

40) A suspected musculoskeletal injury of the shoulder is best managed by which of the

following techniques?

A) Placing the arm in a sling and using a triangular bandage to secure it to the body

B) Using an upper extremity traction splint

C) Placing two long padded board splints on either side of the extremity, extending from the

shoulder to the wrist

D) Using a long-arm air splint

Placing the arm in a sling and using a triangular bandage to secure it to the body

B) Using an upper extremity traction splint

41) The PASG may be used as a splinting device for patients with which of the following

suspected injuries?

A) Hip dislocation

B) Compression fracture of the lumbar or sacral spine

C) Fractured pelvis

D) None of the above

Fractured pelvis

42) Blood at the meatus of the penis (opening of the urethra) is a sign of:

A) spinal fracture or injury.

B) pelvic trauma/fracture.

C) pelvic dislocation syndrome.

D) priapism.

pelvic trauma/fracture.

43) Which of the following statements is not true concerning a pelvic wrap?

A) It can be used if the pelvis shows deformity.

B) It can be used if the pelvis shows instability.

C) It should not be used unless the patient shows signs of shock.

D) You can consider its use based on mechanism of injury (MOI).

It should not be used unless the patient shows signs of shock.

44) Your patient is a 37-year-old man who tripped while walking down a hill and now has a

painful, deformed right leg. Your assessment reveals that the foot is cold and mottled in

appearance. You cannot detect a pulse in the foot or ankle. Which of the following is the best

course of action?

A) Explain to the patient that, because you cannot detect circulation in his foot, his leg will most

likely have to be amputated above the site of the injury.

B) Gently attempt to straighten the leg to regain a pulse before splinting.

C) Splint the leg in the position in which it was found and transport without delay.

D) Transport rapidly to the nearest trauma center

Gently attempt to straighten the leg to regain a pulse before splinting.

45) A pillow is frequently used to splint an ankle or foot injury. It is effective, rapid, and can be

used for most patients. Its main weakness is:

A) it requires three people to apply.

B) you might not have a pillow on your ambulance.

C) you are not immobilizing the knee and the joint adjacent to the ankle.

D) it is hard to access distal pulses after application.

you are not immobilizing the knee and the joint adjacent to the ankle.