Assessment of Soft-tissue Injuries Practice Questions

25 multiple-choice questions on Assessment of soft-tissue injuries for paramedic and EMT students, from Chapter 32 (Soft-Tissue Trauma). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. When approaching a patient with an obvious bloody soft-tissue wound, your first priority is:

   1. A. Scene safety and PPE
   2. B. Measuring the wound's length
   3. C. Cleaning the wound with saline
   4. D. Asking about tetanus status
   Show answer

   Answer: A. Scene safety and PPE

   Blood creates exposure risk, and the mechanism may involve ongoing hazards such as weapons or machinery. Wound details come later, after safety and the primary survey.

2. A 26-year-old has a dramatic scalp laceration from a bar fight and is talking loudly. During the primary survey you must remember that:

   1. A. Loud speech rules out a head injury
   2. B. The wound must be closed before transport
   3. C. Shock can be blamed on the scalp wound
   4. D. Wounds can distract from hidden threats
   Show answer

   Answer: D. Wounds can distract from hidden threats

   Gruesome soft-tissue wounds draw attention away from airway, breathing, and internal injuries. Talking loudly does not exclude a head injury or intoxication, and signs of shock should not be blamed on a scalp wound until other sources of bleeding are ruled out. Scalp wounds can bleed heavily, so control them with pressure; closure happens at the hospital.

3. In the primary survey of a soft-tissue trauma patient, a wound becomes a priority when it:

   1. A. Causes life-threatening bleeding or airway risk
   2. B. Is longer than 5 cm (2 in) in any direction
   3. C. Is located anywhere on the patient's face or scalp
   4. D. Contains visible dirt or other contamination
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   Answer: A. Causes life-threatening bleeding or airway risk

   The primary survey targets immediate threats to life: massive hemorrhage, airway, and breathing. A facial wound matters in the primary survey only when it threatens the airway or bleeds massively.

4. A patient has a stab wound to the upper back and is breathing 28 times per minute. Before addressing the wound dressing, you should check for:

   1. A. Radial pulse quality and skin signs
   2. B. Breath sounds and signs of pneumothorax
   3. C. Tenderness and step-offs along the thoracic spine
   4. D. Pupil size and reactivity to light
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   Answer: B. Breath sounds and signs of pneumothorax

   A penetrating wound over the chest can enter the pleural space, so assessing breathing and breath sounds is a primary survey priority in a patient breathing 28 times per minute. Circulation, spinal tenderness, and pupils are assessed in turn, but a possible pneumothorax comes first in the breathing step.

5. The best way to fully assess soft-tissue injuries in a trauma patient is to:

   1. A. Feel through the clothing for hidden wounds
   2. B. Ask the patient to point to where it hurts
   3. C. Expose the patient, then cover for warmth
   4. D. Look only in areas where blood is visible
   Show answer

   Answer: C. Expose the patient, then cover for warmth

   Wounds can hide under clothing or in skin folds, the axillae, and the back, so expose and inspect, then cover to keep the patient warm. Patients with distracting injuries or intoxication may not report all wounds.

6. A patient has a laceration on the palm. When you test light touch on his fingertips, the best way to detect a subtle nerve injury is to:

   1. A. Test only the thumb and the little fingertip
   2. B. Compare each fingertip with the other side
   3. C. Ask him if the whole hand feels normal
   4. D. Check only capillary refill in the nails
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   Answer: B. Compare each fingertip with the other side

   Partial nerve injuries may cause only reduced sensation, so comparing the matching fingertip on the uninjured hand reveals differences the patient might not notice. Testing only two fingers misses others, a global question is unreliable, and capillary refill tests circulation, not sensation.

7. Bright red blood spurting from a forearm wound in time with the pulse indicates:

   1. A. Venous bleeding
   2. B. Capillary bleeding
   3. C. Arterial bleeding
   4. D. Bleeding from a hematoma
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   Answer: C. Arterial bleeding

   Arterial blood is bright red and spurts with each heartbeat. Venous bleeding is darker and flows steadily, and it is the common wrong choice when the wound is large.

8. A dark red, steady flow of blood from a deep leg laceration most likely comes from a:

   1. A. Vein
   2. B. Artery
   3. C. Capillary bed
   4. D. Lymph vessel
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   Answer: A. Vein

   Venous blood is lower in oxygen and under less pressure, so it is darker and flows rather than spurts. Capillary bleeding is a slow ooze, not a steady flow.

9. When documenting a soft-tissue wound, which description is most useful?

   1. A. The patient's opinion of its seriousness
   2. B. A guess about how long it will take to heal
   3. C. Whether it will need stitches
   4. D. Location, length, depth, and type of wound
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   Answer: D. Location, length, depth, and type of wound

   Objective details such as location, size, depth, wound type, and contamination allow the receiving team to track changes. Predicting the need for sutures is a hospital decision.

10. SAMPLE history for a patient with a laceration should specifically include:

    1. A. Childhood vaccination record
    2. B. Tetanus immunization status
    3. C. Family history of cancer
    4. D. Last dental visit
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    Answer: B. Tetanus immunization status

    Tetanus status determines whether a booster or immune globulin is needed, and it should be recorded. Childhood vaccines are only relevant in that they include tetanus.

11. When reporting a deep hand laceration in a carpenter, which additional history is especially useful to the hand surgeon?

    1. A. The brand of the saw that cut him
    2. B. His height and his current body weight
    3. C. His dominant hand and his occupation
    4. D. His blood type and recent vaccines
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    Answer: C. His dominant hand and his occupation

    Hand dominance and occupation influence how a hand injury is repaired and how much function the patient needs, and they help the team set priorities. Blood type is determined at the hospital if needed, and the saw's brand or the patient's height and weight do not change how a hand surgeon plans the repair.

12. A 70-year-old woman on apixaban fell and has a large, expanding forearm hematoma. Vital signs are stable. The most important consideration is that:

    1. A. Bleeding may continue and be underestimated
    2. B. Stable vital signs rule out major blood loss
    3. C. Bruising this size is typical on apixaban
    4. D. Apixaban speeds clotting after trauma
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    Answer: A. Bleeding may continue and be underestimated

    Anticoagulated patients can lose significant blood into soft tissues; mark the borders and reassess for expansion. Apixaban inhibits factor Xa and impairs clotting rather than speeding it. Stable vital signs do not rule out significant loss in an older patient, and an expanding hematoma should not be dismissed as an expected drug effect.

13. Which wound characteristic should raise your suspicion of significant underlying injury?

    1. A. A shallow abrasion on the forearm
    2. B. A bruise on the lower leg
    3. C. A superficial scratch on the hand
    4. D. A small stab wound to the torso
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    Answer: D. A small stab wound to the torso

    Penetrating wounds to the chest, abdomen, or back may look small but injure vital organs. Torso wounds warrant trauma center transport despite benign appearance.

14. A 34-year-old has multiple superficial lacerations to both forearms. He is calm but reports that he is having thoughts of suicide. In addition to wound care, you should:

    1. A. Treat the wounds and let him refuse transport
    2. B. Give him the bandages to apply himself
    3. C. Ensure safety and arrange psychiatric care
    4. D. Lecture him about self-harm
    Show answer

    Answer: C. Ensure safety and arrange psychiatric care

    Self-inflicted wounds warrant a safety assessment and transport for mental health evaluation, and sharp objects should be secured. Letting him refuse transport ignores the risk of further self-harm.

15. During reassessment of a bandaged arm laceration, the fingers are cool and numb. You should first:

    1. A. Add more layers of gauze
    2. B. Loosen the bandage and recheck
    3. C. Elevate the arm and recheck in an hour
    4. D. Tighten the bandage to stop oozing
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    Answer: B. Loosen the bandage and recheck

    Cool, numb fingers suggest the bandage is restricting circulation. Adding layers makes the bandage tighter and is the most common error in this situation.

16. Signs of shock in a patient with only minor visible soft-tissue wounds should make you suspect:

    1. A. Pain from the minor wounds
    2. B. A normal stress response
    3. C. Anxiety about the ambulance ride
    4. D. Hidden internal bleeding
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    Answer: D. Hidden internal bleeding

    Minor wounds do not cause shock, so look for hidden blood loss in the chest, abdomen, pelvis, or long bones. Attributing tachycardia to anxiety is a dangerous anchoring error.

17. A 45-year-old construction worker has a laceration on the shin from a metal beam. During the secondary assessment you note gaping edges and visible fat. This tells you that the wound:

    1. A. Extends into the subcutaneous layer
    2. B. Is limited to the dermis
    3. C. Involves only the outer epidermis
    4. D. Is a partial-thickness wound of the skin
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    Answer: A. Extends into the subcutaneous layer

    Yellow fat in a wound means the dermis has been cut through to the subcutaneous layer, a deep laceration that likely needs closure. A wound limited to the epidermis or dermis, or a partial-thickness skin wound, would not expose fat.

18. Which description best documents a scalp laceration?

    1. A. Big, deep cut on the side of the patient's head
    2. B. Bleeding head wound sustained in a bar fight
    3. C. Bad laceration that will need a lot of stitches
    4. D. 4-cm linear laceration, right parietal scalp
    Show answer

    Answer: D. 4-cm linear laceration, right parietal scalp

    Precise size, shape, and anatomic location let others recognize change. Vague or judgmental descriptions are not useful clinical documentation.

19. When assessing for compartment syndrome, which finding is most important to reassess frequently?

    1. A. Distal pulse as the earliest warning sign
    2. B. Pain and its response to passive stretch
    3. C. Skin color over the swollen area
    4. D. Wound color and the shape of its edges
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    Answer: B. Pain and its response to passive stretch

    Increasing pain, especially on passive stretch, is the key early indicator that compartment pressure is rising. Wound appearance does not track compartment pressure. A distal pulse is usually lost late, and skin color over the compartment changes little until pressure is very high.

20. A patient with a laceration says he lost about a cup of blood. Which approach to estimating blood loss is most reliable?

    1. A. Rely on the patient's estimate
    2. B. Measure the stain on the clothing
    3. C. Assess vital signs and perfusion
    4. D. Count the soaked gauze pads
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    Answer: C. Assess vital signs and perfusion

    Visual estimates of blood loss are notoriously inaccurate, so perfusion status, heart rate, and blood pressure guide treatment. Counting soaked gauze is tempting because it seems objective, but it is still a rough estimate.

21. A wound that requires transport for evaluation includes one that:

    1. A. Shows tendon, bone, or muscle
    2. B. Is a small, clean abrasion
    3. C. Has stopped bleeding on its own
    4. D. Is a superficial paper cut
    Show answer

    Answer: A. Shows tendon, bone, or muscle

    Deep wounds exposing tendon, muscle, or bone need surgical evaluation and often repair. A wound that has stopped bleeding may still be deep, but that alone is not an indication.

22. A 23-year-old cut his forearm on broken glass. Which finding most suggests a retained glass fragment?

    1. A. Mild oozing from the edges of the wound
    2. B. Slight redness around the wound edges
    3. C. Sharp, localized pain on palpation
    4. D. Normal sensation in all of the fingers
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    Answer: C. Sharp, localized pain on palpation

    Point tenderness or a gritty feel when the wound is touched suggests a fragment left in the tissue, and glass may not be visible, so report it for imaging. Oozing and mild redness are expected with any fresh laceration.

23. A man has two gunshot wounds, one on the front of the thigh and one on the back. When documenting them, you should:

    1. A. Describe each wound without labeling it
    2. B. Label the larger one as the exit wound
    3. C. Label the front one as the entrance wound
    4. D. Document only the wound that is bleeding
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    Answer: A. Describe each wound without labeling it

    Entrance and exit wounds are often impossible to tell apart in the field, and incorrect labels can mislead forensic and legal review. Document location, size, and appearance of each wound objectively. Size and location do not reliably identify entrance versus exit, and every wound should be documented.

24. An older patient has a large bruise over the lower back after a fall but denies back pain. You should:

    1. A. Treat it as a simple surface bruise
    2. B. Apply ice and skip the spinal exam
    3. C. Massage the area firmly to reduce the bruise
    4. D. Consider underlying injury and assess it
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    Answer: D. Consider underlying injury and assess it

    Older adults may underreport pain and have fragile tissues, so a bruise over the back may hide fractures or kidney injury. Absence of pain does not exclude serious injury. The bruise should not be dismissed as superficial, cold therapy does not replace a spinal and flank assessment, and massage can worsen bleeding.

25. Which finding on assessment of a wound suggests that the wound is already infected?

    1. A. Clean edges and mild swelling
    2. B. Pus, spreading redness, warmth
    3. C. Clear fluid and minimal pain
    4. D. Bleeding that stops with pressure
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    Answer: B. Pus, spreading redness, warmth

    Purulent drainage with spreading erythema and warmth indicates infection, usually appearing 24 to 72 hours after injury. Mild early swelling is part of normal inflammation.