Assessment: Physical Exam Limits, Serial Reassessment, Distracting Injuries, and FAST/POCUS Practice Questions

25 multiple-choice questions on Assessment: physical exam limits, serial reassessment, distracting injuries, and FAST/POCUS for paramedic and EMT students, from Chapter 37 (Abdominal and Genitourinary Trauma). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. The most reliable early indicator of intra-abdominal bleeding is often:

   1. A. Shock without an obvious cause
   2. B. A visibly distended abdomen
   3. C. Loss of bowel sounds on auscultation
   4. D. Bruising around the umbilicus
   Show answer

   Answer: A. Shock without an obvious cause

   Tachycardia, pale skin, anxiety, and narrowing pulse pressure appear well before the abdomen distends or bruises. The abdomen can hold liters of blood with little visible change.

2. When palpating the abdomen of a trauma patient who reports pain, you should begin:

   1. A. Directly over the painful area
   2. B. With deep pressure over the umbilicus first
   3. C. By testing for rebound tenderness
   4. D. In the quadrant farthest from the pain
   Show answer

   Answer: D. In the quadrant farthest from the pain

   Starting away from the painful area keeps the patient relaxed and lets you compare quadrants before touching the injured one. Pressing the painful area first causes guarding that makes the rest of the exam unreliable.

3. Inspection of the abdomen in a trauma patient should look for:

   1. A. Rebound and deep tenderness
   2. B. Bowel sounds heard in each quadrant
   3. C. Bruises, wounds, and distension
   4. D. Abdominal girth with a tape
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   Answer: C. Bruises, wounds, and distension

   Inspection uses the DCAP-BTLS approach to find bruising, seat belt marks, penetrating wounds, eviscerations, and distension. Rebound and deep tenderness belong to palpation, bowel sounds to auscultation, and tape measurements of girth are unreliable and not part of inspection.

4. A 27-year-old crash victim has a GCS of 9 and a soft abdomen with no response to palpation. The best interpretation of this exam is:

   1. A. It rules out intra-abdominal injury
   2. B. It is unreliable for ruling out injury
   3. C. It proves the head injury is isolated
   4. D. It means the patient has no pain
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   Answer: B. It is unreliable for ruling out injury

   Altered mental status removes the patient's ability to report pain or guard, so a benign exam cannot exclude abdominal injury. Mechanism and signs of shock must guide your suspicion.

5. A 66-year-old who takes prednisone daily for lung disease was kicked in the abdomen. She has only mild tenderness. Her steroid use matters because it can:

   1. A. Make her abdomen more tender
   2. B. Thicken the abdominal muscles
   3. C. Make her injuries heal more quickly
   4. D. Blunt the signs of peritonitis
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   Answer: D. Blunt the signs of peritonitis

   Long-term corticosteroids suppress inflammation, so patients may have little tenderness, guarding, or fever despite a serious bowel injury, and they can also blunt the stress response. Rely on mechanism, vital sign trends, and serial exams rather than a reassuring abdomen. Steroids do not make the abdomen more tender, they thin rather than thicken muscle with long-term use, and they slow rather than speed wound healing.

6. Serial reassessment of the abdomen is important mainly because:

   1. A. The first exam is accurate and complete
   2. B. Repeated exams stop the bleeding from worsening
   3. C. Findings evolve as injuries progress
   4. D. Protocols require a set number of abdominal exams
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   Answer: C. Findings evolve as injuries progress

   Abdominal injuries often declare themselves over time as blood accumulates and the peritoneum becomes inflamed. A single normal exam early after injury cannot rule out serious injury.

7. A 70-year-old woman was a restrained passenger in a crash. She has mild abdominal tenderness. She takes metoprolol and warfarin. Your interpretation should be:

   1. A. She has a high risk of hidden, serious bleeding
   2. B. Her medicines lower her risk of internal bleeding
   3. C. Mild tenderness excludes intra-abdominal injury
   4. D. She can be evaluated later by her own physician
   Show answer

   Answer: A. She has a high risk of hidden, serious bleeding

   Warfarin impairs clotting, and metoprolol blunts the tachycardia that would warn you of shock. Older patients may also have diminished pain responses, so mild findings deserve a high index of suspicion.

8. FAST stands for:

   1. A. Fluid Analysis by Sonographic Scanning in Trauma
   2. B. Focused Assessment with Sonography for Trauma
   3. C. Field Assessment of Shock and Tamponade
   4. D. Fast Abdominal Screening Technique
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   Answer: B. Focused Assessment with Sonography for Trauma

   The FAST exam is a bedside ultrasound to detect free fluid, usually blood, in the abdomen and pericardium. The extended version (eFAST) adds views of the lungs to detect pneumothorax.

9. In a trauma patient, the FAST exam is designed mainly to detect:

   1. A. Fractures of the lumbar spine
   2. B. Bowel perforation and free air
   3. C. Free fluid in the abdomen or pericardium
   4. D. Injury to the pancreas in the retroperitoneum
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   Answer: C. Free fluid in the abdomen or pericardium

   FAST looks for free fluid, presumed to be blood, in the peritoneal cavity and pericardial sac. It is poor at detecting retroperitoneal, pancreatic, and hollow organ injuries.

10. A prehospital FAST exam on a very obese patient with extensive subcutaneous air gives poor images. This means:

    1. A. The scan is less reliable in this patient
    2. B. The scan is normal and rules out bleeding
    3. C. The images prove there is free fluid
    4. D. The scan should be repeated on scene
    Show answer

    Answer: A. The scan is less reliable in this patient

    Obesity, subcutaneous emphysema, and bowel gas limit ultrasound windows, so FAST is less sensitive in these patients and a poor or negative study does not exclude injury. Decisions should rest on mechanism, exam, and vital signs, and scanning must not delay transport.

11. On a FAST exam, free blood in the abdomen typically appears:

    1. A. Bright white around the liver
    2. B. Gray and identical to the liver
    3. C. As a shadow behind each rib
    4. D. Dark (black) between organs
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    Answer: D. Dark (black) between organs

    Fluid does not reflect ultrasound, so blood appears anechoic (black) in spaces such as the hepatorenal pouch. Bright white areas are highly reflective structures such as bone or the diaphragm.

12. The right upper quadrant view of the FAST exam looks for blood in the space between the liver and the right kidney, called:

    1. A. Douglas pouch
    2. B. Morison pouch
    3. C. The lesser sac
    4. D. The left paracolic gutter
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    Answer: B. Morison pouch

    The hepatorenal recess (Morison pouch) is the most dependent area of the upper abdomen in a supine patient, so blood collects there early. The pouch of Douglas is in the pelvis behind the uterus.

13. The four standard views of the FAST exam are:

    1. A. Right lower, left lower, aortic, and renal windows
    2. B. Lungs, liver, kidneys, and abdominal wall
    3. C. Epigastric, umbilical, and two flank views
    4. D. Right upper, left upper, pelvic, and pericardial
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    Answer: D. Right upper, left upper, pelvic, and pericardial

    FAST examines the hepatorenal space, the splenorenal space, the pelvis behind the bladder, and the subxiphoid pericardial view. eFAST adds the anterior lung windows.

14. A paramedic performs a prehospital FAST on a hypotensive crash victim and finds no free fluid. The best conclusion is:

    1. A. Injury is still possible; treat for shock
    2. B. Intra-abdominal bleeding has been ruled out
    3. C. The patient can go to a non-trauma hospital
    4. D. The hypotension must be from a head injury
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    Answer: A. Injury is still possible; treat for shock

    A negative FAST does not exclude small or early bleeding, retroperitoneal hemorrhage, or hollow organ injury. Clinical findings and mechanism still determine destination and treatment.

15. A crash victim is in shock, and a prehospital FAST shows free fluid in the right upper quadrant. This result is most useful for:

    1. A. Deciding to stay on scene for fluid boluses
    2. B. Alerting the trauma team before arrival
    3. C. Guiding a needle to drain the blood
    4. D. Excluding injury to the chest
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    Answer: B. Alerting the trauma team before arrival

    A positive FAST in an unstable patient points to hemoperitoneum and supports early activation of the trauma team, blood products, and the operating room. It never justifies longer scene time.

16. The most important rule for prehospital point-of-care ultrasound (POCUS) in trauma is that it:

    1. A. Must be done before any IV is started
    2. B. Replaces the physical exam on scene
    3. C. Must not delay transport to definitive care
    4. D. Is required before any pelvic binder is applied
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    Answer: C. Must not delay transport to definitive care

    Ultrasound can add information, but in a bleeding patient the time to the operating room matters most, so scans are done en route or not at all. It supplements, rather than replaces, the physical exam.

17. Which limitation of FAST is most important to remember?

    1. A. It cannot detect blood around the heart
    2. B. It cannot reliably detect bowel injury
    3. C. It requires the patient to be standing up
    4. D. It exposes the patient to radiation
    Show answer

    Answer: B. It cannot reliably detect bowel injury

    FAST detects free fluid, but bowel perforations often release little fluid early and the retroperitoneum is poorly imaged. Ultrasound uses sound waves, not ionizing radiation, which is one of its advantages.

18. During the secondary assessment of a patient with an abdominal stab wound, the wound should be:

    1. A. Probed with a gloved finger
    2. B. Explored with a sterile swab
    3. C. Inspected but not probed
    4. D. Irrigated to see the tract
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    Answer: C. Inspected but not probed

    Probing a wound can dislodge clots, push contaminants deeper, and injure organs, and it gives an unreliable estimate of depth. The wound is inspected, covered, and explored only by a surgeon.

19. Measuring abdominal girth with a tape to detect bleeding is unreliable in the field because:

    1. A. The tape cannot be used on adult patients
    2. B. Girth rises early with even minor bleeds
    3. C. Bleeding shrinks the abdomen within minutes
    4. D. Large blood loss changes girth very little
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    Answer: D. Large blood loss changes girth very little

    The adult abdomen can accommodate a large volume of blood before girth changes appreciably, so tape measurements give false reassurance. Vital signs and perfusion are better trend indicators.

20. When examining the pelvis in a hypotensive trauma patient, you should:

    1. A. Apply gentle pressure once, then stop
    2. B. Rock the pelvis firmly several times
    3. C. Have the patient stand to test stability
    4. D. Skip inspection of the perineum
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    Answer: A. Apply gentle pressure once, then stop

    If the pelvis is unstable or painful, a single gentle compression is enough, and repeated movement can disrupt clots and worsen bleeding. Many systems now apply a binder on mechanism and shock without testing at all.

21. A 29-year-old was ejected from a car and is intoxicated. He is combative and says nothing hurts. His pulse is 124/min. You should:

    1. A. Assume abdominal injury is present
    2. B. Trust his report that nothing is painful
    3. C. Delay transport until he is sober
    4. D. Wait for the alcohol to cause bradycardia
    Show answer

    Answer: A. Assume abdominal injury is present

    Alcohol blunts pain perception and judgment, and ejection with tachycardia indicates high-energy trauma with possible hidden bleeding. His statement that nothing hurts cannot be trusted.

22. Which finding during abdominal assessment should prompt the most immediate change in your plan?

    1. A. A small abrasion over the left iliac crest
    2. B. Mild tenderness in one quadrant
    3. C. Rising pulse with falling blood pressure
    4. D. Normal bowel sounds in each quadrant
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    Answer: C. Rising pulse with falling blood pressure

    Worsening vital signs mean decompensating shock and call for immediate rapid transport and trauma notification. A small abrasion or mild localized tenderness is important but less urgent.

23. Why is a thorough secondary exam of the back and flanks important in abdominal trauma?

    1. A. Back wounds are usually superficial
    2. B. Wounds there may reach the kidneys
    3. C. The ribs protect the organs in back
    4. D. Back wounds bleed more than front ones
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    Answer: B. Wounds there may reach the kidneys

    Posterior and flank wounds can reach the kidneys, pancreas, duodenum, and great vessels, and they are easily missed unless the patient is logrolled or inspected. Back wounds cannot be assumed to be superficial, the lower ribs cover the kidneys only partly, and the reason to look is the depth of injury, not the amount of external bleeding.

24. A 40-year-old has a gunshot wound to the abdomen. During the secondary assessment you find one wound only. You should:

    1. A. Assume the bullet is still in the abdomen
    2. B. Assume the bullet exited the same wound
    3. C. Stop the exam to avoid scene delay
    4. D. Search carefully for other wounds
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    Answer: D. Search carefully for other wounds

    Gunshot patients often have more than one wound, and an unseen exit or second entry wound may lie in the axilla, back, perineum, or skin folds. The number of wounds does not reliably tell you where a bullet is.

25. Most prehospital decisions about suspected abdominal injury are based mainly on:

    1. A. The exact diagnosis of the injured organ
    2. B. Mechanism, findings, and signs of shock
    3. C. The patient's bowel sounds and appetite
    4. D. The results of a prehospital urine test
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    Answer: B. Mechanism, findings, and signs of shock

    Paramedics do not need to identify which organ is injured; the mechanism, abdominal findings, and perfusion status determine urgency and destination. Pinpointing an organ wastes scene time.