Chapter 29

An open fracture is MOST accurately defined as a fracture in which:
a) the overlying skin is no longer intact.
b) bone ends protrude through the skin.
c) a bullet shatters the underlying bone.
d) a large laceration overlies the fracture.

the overlying skin is no longer intact.

A "hip" fracture is actually a fracture of the:
a) pelvic girdle.
b) femoral shaft.
c) pubic symphysis.
d) proximal femur.

proximal femur.

Which of the following statements regarding compartment syndrome is correct?
a) Compartment syndrome occurs because of increased pressure within the bone cavity.
b) Compartment syndrome typically develops within 6 to 12 hours after an injury.
c) In most cases, compartment syndrome develops within a few minutes after an injury.
d) Most cases of compartment syndrome occur following a severe fracture of the pelvis.

Compartment syndrome typically develops within 6 to 12 hours after an injury.

Applying ice to and elevating an injured extremity are performed in order to:
a) reduce pain and swelling.
b) maintain extremity perfusion.
c) prevent further injury.
d) enhance tissue circulation.

reduce pain and swelling.

A fracture caused by minimal force that is associated with diseases such as cancer and osteoporosis is called a __________ fracture.
a) comminuted
b) transverse
c) greenstick
d) pathologic

pathologic

Which of the following musculoskeletal injuries would MOST likely result in deformity?
a) moderate sprain
b) severe strain
c) displaced fracture
d) hairline fracture

displaced fracture

Which of the following types of muscle is under direct voluntary control of the brain?
a) smooth
b) cardiac
c) skeletal
d) autonomic

skeletal

A fracture is MOST accurately defined as a(n):
a) abnormality in the structure of a bone.
b) disruption in the midshaft of a bone.
c) break in the continuity of the bone.
d) total loss of function in a bone.

break in the continuity of the bone.

Which of the following statements regarding shoulder dislocations is MOST correct?
a) Posterior dislocations are most common.
b) They are caused by forced arm adduction.
c) They involve the acromion process and humerus.
d) Most shoulder dislocations occur anteriorly.

Most shoulder dislocations occur anteriorly.

The musculoskeletal system refers to the:
a) nervous system’s control over the muscles.
b) bones and voluntary muscles of the body.
c) connective tissue that supports the skeleton.
d) involuntary muscles of the nervous system.

bones and voluntary muscles of the body.

A 21-year-old male was thrown over the handlebars of his motorcycle when he rear-ended a car that was stopped at a red light. He was wearing a helmet, which he removed prior to your arrival. He is conscious, but restless, and has closed deformities to both of his femurs. His skin is pale, his heart rate is rapid and weak, and his respirations are rapid and shallow. In addition to applying high-flow oxygen and protecting his spine, you should:
a) splint each of his deformed femurs with long board splints and transport immediately.
b) apply the PASG to stabilize his femurs and transport at once.
c) apply traction splints to both of his legs, keep him warm, and transport without delay.
d) bind his legs together on the backboard, keep him warm, and transport without delay.

bind his legs together on the backboard, keep him warm, and transport without delay.

Skeletal muscle is also referred to as __________ muscle.
a) striated
b) smooth
c) connective
d) involuntary

striated

Bone marrow produces:
a) electrolytes.
b) lymphocytes.
c) blood cells.
d) platelets.

blood cells.

Crepitus and false motion are:
a) most common with dislocations.
b) positive indicators of a fracture.
c) only seen with open fractures.
d) indicators of a severe sprain.

positive indicators of a fracture.

In moving joints, the ends of the bones are covered with:
a) gliding cartilage.
b) synovial tendons.
c) articular cartilage.
d) muscular fascia.

articular cartilage.

A(n) __________ fracture occurs in the growth section of a child’s bone and may lead to bone growth abnormalities.
a) diaphyseal
b) greenstick
c) epiphyseal
d) metaphyseal

epiphyseal

Bones are connected to other bones by bands of tough fibrous tissues called:
a) ligaments.
b) tendons.
c) bursa.
d) cartilage.

ligaments.

Femoral shaft fractures can result in up to _____ mL of internal blood loss.
a) 2,000
b) 1,500
c) 4,000
d) 1,000

1,000

Of the following musculoskeletal injuries, which is considered to be the LEAST severe?
a) open fractures of a long bone
b) nondisplaced pelvic fracture
c) an amputation of an extremity
d) multiple closed long bone fractures

nondisplaced pelvic fracture

A 31-year-old male fell and landed on his left elbow. Your assessment reveals that the elbow is grossly deformed, his forearm is cool and pale, and the distal pulse on the side of the injury is barely palpable. His vital signs are stable and he denies any other injuries. Your transport time to the closest appropriate hospital is approximately 15 minutes. You should:
a) gently straighten the elbow and apply an air splint.
b) splint the elbow in the position found and transport.
c) apply a heat pack to the elbow to reduce swelling.
d) gently manipulate the elbow to improve circulation.

splint the elbow in the position found and transport.

A subluxation occurs when:
a) a joint is incompletely dislocated.
b) a fracture and a dislocation exist.
c) a bone develops a hairline fracture.
d) ligaments are partially severed.

a joint is incompletely dislocated.

In general, musculoskeletal injuries should be splinted before moving the patient unless:
a) the patient is clinically unstable.
b) deformity and swelling are present.
c) the patient is in severe pain.
d) transport time is less than 15 minutes.

the patient is clinically unstable.

Which of the following musculoskeletal injuries would pose the greatest threat to a patient’s life?
a) an amputated extremity
b) pelvic fracture with hypotension
c) bilateral femur fractures
d) nondisplaced long bone fractures

pelvic fracture with hypotension

The MOST commonly fractured bone(s) in the body is the:
a) radius and ulna.
b) scapula.
c) clavicle.
d) midshaft femur.

clavicle.

Which of the following statements regarding striated muscle is correct?
a) It forms the major muscle mass of the body and usually crosses at least one joint.
b) Most of the body’s striated muscle is found within the walls of the blood vessels.
c) Striated muscle is involuntary because you have no conscious control over it.
d) Striated muscle tissue is attached directly to the bones by tough bands of cartilage.

It forms the major muscle mass of the body and usually crosses at least one joint.

If a dislocated shoulder has spontaneously reduced before your arrival, the only way to confirm the injury is by noting:
a) the patient history.
b) the presence of deformity.
c) distal circulation.
d) bruising to the shoulder.

the patient history.

What type of muscle contracts and relaxes to control the movement of the contents within its structures?
a) smooth
b) striated
c) cardiac
d) skeletal

smooth

In which of the following situations should the EMT splint an injured limb in the position of deformity?
a) if resistance is encountered or the patient experiences severe pain
b) if a traction splint will be used to immobilize the injured extremity
c) when distal circulation and neurological functions are absent
d) if transport time to the hospital is greater than 20 to 30 minutes

if resistance is encountered or the patient experiences severe pain

The MOST common and significant complication associated with fractures or dislocations of the knee is:
a) neurovascular compromise.
b) total depletion of synovial fluid.
c) ligament and cartilage damage.
d) internal bleeding and shock.

neurovascular compromise.

Skeletal muscle is attached to the bone by tough, ropelike fibrous structures called:
a) cartilage.
b) ligaments.
c) tendons.
d) fascia.

tendons.

A ____________ is a musculoskeletal injury in which there is partial or temporary separation of the bone ends as well as partial stretching or tearing of the supporting ligaments.
a) sprain
b) strain
c) dislocation
d) fracture

sprain

During your assessment of a 29-year-old female with significant deformity to her left elbow, you are unable to palpate a radial pulse. Your transport time to the hospital is approximately 40 minutes. You should:
a) splint the elbow in the position of deformity and transport immediately.
b) carefully straighten the injured arm and secure it with padded board splints.
c) apply gentle manual traction in line with the limb and reassess for a pulse.
d) make two or three attempts to restore distal circulation by manipulating the elbow.

apply gentle manual traction in line with the limb and reassess for a pulse.

When assessing a patient with a possible fracture of the leg, the EMT should:
a) assess proximal circulation.
b) ask the patient to move the injured leg.
c) carefully move it to elicit crepitus.
d) compare it to the uninjured leg.

compare it to the uninjured leg.

When splinting a possible fracture of the foot, it is MOST important for the EMT to:

A. leave the toes exposed
B. observe for tissues swelling
C. use a pillow as a splint
D. apply a pneumatic splint

A. leave the toes exposed

You have applied a zippered air splint to a patient’s left arm. During transport, the patient complains of increased numbness and tingling in his left hand. You reassess distal circulation and note that it remains present. Your MOST appropriate action should be to:

A. remove the air splint and reimmobolize with padded board splints
B. assess the amount of air in the splint and let air out as necessary
C. elevate the injured arms and reassess distal sensory function
D. inflate the splint with more air until the patient is comfortable

B. asses the amount of air in the splint and let air out as necessary

When splinting an injury of the wrist, the hand should be placed:

A. in an extended position
B. in a functional position
C. into a fist
D. in a straight position

B. in a functional position

The primary purpose for splinting a musculoskeletal injury is to:

A. maximize distal circulation
B. prevent further injury
C. facilitate ambulance transport
D. make the patient comfortable

B. prevent further injury

A 77 year old woman slipped and fell on a throw rug and landed on her left hip. She denies striking her head or losing consciousness. Assessment of her left leg reveals that it is shortened and externally rotated. Distal pulses, sensory and motor functions are intact. You should:

A. place her onto a scoop stretcher, pad around her left hip with pillows, and secure her to the scoop with straps.
B. manually stabilize her left leg, apply a traction splint, and then secure her to a long backboard or scoop
C. carefully slide a long backboard underneath her, keep her in a supine position, and apply a splint to her leg
D. bind both of her legs together with triangular bandages and carefully secure her onto the ambulance stretcher

A. place her onto a scoop stretcher, pad around her left hip with pillows, and secure her to the scoop with straps.

A Colles fracture involves a fracture of the:

A. distal radius
B. distal ulna
C. radius and ulna
D. proximal radium

A. distal radius

A 17 year old football player collided with another player and has pain to his left clavicular area. He is holding his arm against his chest and refuses to move it. Your assessment reveals obvious deformity to the midshaft clavicle. After assessing distal pulse, sensory and motor functions, you should:

A. place a pillow under his arm and apply a sling
B. perform a rapid secondary assessment
C. immobilize the injury with a sling and swathe
D. straighten his arm and apply a board splint

C. immobilize the injury with a sling and swathe

A 45 year old female was the unrestrained passenger of a small car that rear-ended another vehicle at a moderate rate of speed. She is conscious and alert, but complains of pain to both of her knees. There is visible damage to the dashboard on the passenger’s side of the vehicle. In addition to fractures or dislocations of the knees, you should be MOST suspicious for:

A. a thoracic spine fracture
B. anterior hip dislocation
C. fracture of the tibia or fibula
D. posterior hip dislocation

D. posterior hip dislocation

Atrophy is a condition that occurs when:
A) The tendons that attach muscle to bone become stretched or injured.
B) Muscle decreases in size and function because of disease or trauma.
C) Carbon dioxide, lactic acid, and other wastes accumulate in the muscle.
D) Increased use of skeletal muscle causes an increase in its strength.

B) Muscle decreases in size and function because of disease or trauma.

The disruption of a joint in which the bone ends are no longer in contact is called a:
A) Fracture.
B) Dislocation.
C) Sprain.
D) Strain.

B) Dislocation.

The MOST reliable indicator of an underlying fracture is:
A) Guarding.
B) Point tenderness.
C) Obvious bruising.
D) Severe swelling.

B) Point tenderness.

A 22-year-old female was ejected from her car after striking a tree head-on. As you approach her, you note obvious closed deformities to both of her femurs. She is not moving and does not appear to be conscious. You should:
A) Apply manual stabilization to both of her femurs.
B) Stabilize her head and perform a primary assessment.
C) Administer oxygen and perform a rapid assessment.
D) Assess for a carotid pulse and assist her ventilations.

B) Stabilize her head and perform a primary assessment.

The act of pulling on a body structure in the direction of its normal alignment is called:
A) Immobilization.
B) Reduction.
C) Stabilization.
D) Traction.

D) Traction.

A 76-year-old male experienced sudden pain to his left thigh when he was standing in line at the grocery store. Your assessment reveals ecchymosis and deformity to the distal aspect of his left femur, just above the knee. Distal circulation and sensory and motor functions are intact. The MOST appropriate method of splinting this injury involves:
A) Binding the legs together and elevating them 6" to 8".
B) Applying padded board splints to both sides of the leg.
C) Applying a traction splint to realign the deformity.
D) Applying and fully inflating the pneumatic antishock garment (PASG).

B) Applying padded board splints to both sides of the leg.

The MOST significant hazard associated with splinting is:
A) Aggravation of the injury or worsened pain.
B) Delaying transport of a critically injured patient.
C) Reduction in circulation distal to the injury site.
D) Compression of nerves, tissues, and vasculature.

B) Delaying transport of a critically injured patient.

Which of the following fractures has the greatest potential for internal blood loss and shock?
A) Hip.
B) Femur.
C) Pelvis.
D) Humerus.

C) Pelvis.

A person who experiences a calcaneus fracture after jumping and landing on his or her feet would MOST likely experience an accompanying fracture of the:
A) Lumbar spine.
B) Symphysis pubis.
C) Thoracic spine.
D) Coccygeal spine.

A) Lumbar spine.

Which of the following is not a type of muscle found in the body?
A) cardiac
B) skeletal
C) joint
D) smooth

C) joint

Approximately how many bones are in the human body?
A) 206
B) 210
C) 204
D) 208

A) 206

A _________ is any break in the bone surface.
A) dislocation
B) sprain
C) strain
D) fracture

D) fracture

A _________ fracture is a fracture where the bones are broken in more than two fragments.
A) greenstick
B) comminuted
C) pathologic
D) epiphyseal

B) comminuted

When ligaments are torn or stretched, it is called a:
A) strain.
B) sprain.
C) dislocation.
D) fracture.

B) sprain.

When the EMT encounters a probable fracture, what should be assessed below the injury?
A) pulse and capillary refill
B) sensation and motor function
C) respiratory rate
D) both a and b

D) both a and b

When a rigid splint is in use, the EMT should apply _________ to the splint to prevent local pressure and discomfort.
A) ice
B) padding
C) eat
D) traction

B) padding

What type of splint should the EMT use when dealing with a broken femur?
A) rigid
B) air
C) Hare traction
D) vacuum

C) Hare traction

How should the EMT take care of a dislocated shoulder?
A) Lift the arm straight out and splint it in place.
B) Put the arm in a sling.
C) Tie the arm against the chest with a triangle bandage.
D) Pad between the arm and the chest and sling the arm.

D) Pad between the arm and the chest and sling the arm.

When splinting a hip fracture, what should the EMT apply between the patient’s legs?
A) ice
B) a pad
C) a rigid board
D) heat

B) a pad

_________ is a grating or grinding sensation that can be felt and sometimes heard when fractured bone ends rub together.
A) Greenstick
B) Guarding
C) Crepitus
D) False movement

C) Crepitus

Orthopaedic injuries can lead to complications, including:
A) infection.
B) bleeding.
C) long-term disability.
D) all of the above

D) all of the above

What is the first step in caring for an open fracture?
A) Apply a rigid splint.
B) Control bleeding.
C) Attempt to realign the bone.
D) Assess distal pulse.

B) Control bleeding.

What is the first step when applying a Hare traction splint?
A) Expose the injured extremity.
B) Apply manual traction.
C) Assess distal pulse and motor function.
D) Attach the ischial strap.

A) Expose the injured extremity.

Which of the following is not a contraindication to the use of the pneumatic antishock garment (PASG)?
A) pregnancy
B) groin injury
C) pelvis fracture
D) pulmonary edema

C) pelvis fracture

During your rapid secondary assessment of a 19-year-old female with multiple trauma, you note bilateral humeral deformities and a deformity to the left midshaft femur. Her skin is diaphoretic and her pulse is rapid and weak. Your partner has appropriately managed her airway and is maintaining manual stabilization of her head. The MOST appropriate treatment for this patient includes:

immobilizing her to a backboard and rapidly transporting.

A 54-year-old male accidentally shot himself in the leg while cleaning his gun. Your assessment reveals a small entrance wound to the medial aspect of his right leg. The exit wound is on the opposite side of the leg and is actively bleeding. The patient complains of numbness and tingling in his right foot. You should:

control the bleeding and cover the wound with a sterile dressing.

Following direct trauma to the left upper back, a 44-year-old male presents with diaphoresis and restlessness. His blood pressure is 100/50 mm Hg, his pulse rate is 120 beats/min and weak, and his respirations are 24 breaths/min and labored. Your assessment reveals abrasions and contusions over the left scapula. You should:

apply high-flow oxygen, consider spinal precautions, and transport without delay.

With regard to musculoskeletal injuries, the zone of injury is defined as the:

area of soft-tissue damage surrounding the injury.

Which of the following joints allows no motion?

skull sutures

Common signs and symptoms of a sprain include all of the following, EXCEPT:

deformity.

Which of the following structures is regulated by smooth muscle?

blood vessels

Which of the following scenarios is an example of a direct injury?

A passenger fractures her patella after it strikes the dashboard.

The PASG is absolutely contraindicated in patients who have:

pulmonary edema.

The MOST common and significant complication associated with fractures or dislocations of the knee is:

ligament and cartilage damage.

Deformity caused by a fracture would MOST likely be masked by:

swelling.

Traction splints are used primarily to immobilize and secure fractures of the:

femur.

A supracondylar or intercondylar fracture is also known as a fracture of the:

distal humerus.

The pectoral girdle consists of the.

scapulae and clavicles.

When caring for a patient with a possible fracture of the scapula, the EMT should:

carefully assess the patient for breathing problems.

During your rapid secondary assessment of a 30-year-old male who fell 25′, you note crepitus when palpating his pelvis. Your partner advises you that the patient’s blood pressure is 80/50 mm Hg and his heart rate is 120 beats/min and weak. After completing your assessment, you should:

stabilize the pelvis with a pelvic binder and protect the spine.

Assessing a person’s neurovascular status following a musculoskeletal injury includes all of the following, EXCEPT:

evaluating proximal pulses.

You receive a call to a local gymnasium for a basketball player with a dislocated shoulder. Upon arrival, you find the patient, a 17-year-old male, sitting on the ground. He is holding his left arm in a fixed position away from his body. There is an obvious anterior bulge to the area of injury. You should

assess distal pulse, motor, and sensory functions.

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