Ear, Nose, and Dental Injuries Practice Questions

25 multiple-choice questions on Ear, nose, and dental injuries for paramedic and EMT students, from Chapter 34 (Face and Neck Trauma). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A patient with a midface fracture and clear fluid mixed with blood from the nose is bleeding steadily from the nose. Which nosebleed treatment should you avoid?

   1. A. Nasal packing or a nasal airway
   2. B. Gentle external pressure on the soft nose
   3. C. Allowing the blood to drain onto gauze
   4. D. Positioning him upright and leaning forward
   Show answer

   Answer: A. Nasal packing or a nasal airway

   With a possible cribriform plate fracture and CSF leak, anything inserted into the nose could enter the cranial vault and spread infection. Let the fluid drain, apply gentle pressure to the soft nose if needed, and position to protect the airway. Upright, leaning forward is fine if there is no spinal concern.

2. A 19-year-old was elbowed in the nose during a basketball game. He has a steady nosebleed but no other injuries and no neck pain. The best initial care is to:

   1. A. Lay him supine and tilt his head back
   2. B. Pack both nostrils tightly with dry gauze strips
   3. C. Sit him up, lean forward, and pinch the nose
   4. D. Place him supine with his legs raised
   Show answer

   Answer: C. Sit him up, lean forward, and pinch the nose

   Leaning forward keeps blood out of the airway and stomach, and firm pressure on the soft part of the nose controls most anterior bleeds. Tilting the head back sends blood down the throat, causing vomiting and aspiration.

3. A 25-year-old knocked out a permanent front tooth that fell onto dirt. Before placing it in milk, you should:

   1. A. Scrub the root clean with a gauze pad
   2. B. Rinse it briefly; do not scrub the root
   3. C. Wipe it dry so the dirt comes off
   4. D. Soak it in alcohol to kill the bacteria
   Show answer

   Answer: B. Rinse it briefly; do not scrub the root

   The cells on the root surface are needed for reattachment, so a dirty tooth is held by the crown and rinsed briefly (about 10 seconds) with milk, saline, or water, without scrubbing or drying, then stored in milk or a balanced salt solution. Scrubbing, drying, or alcohol kills the root cells.

4. A posterior nosebleed is more likely than an anterior one to:

   1. A. Stop with firm pinching of the soft nostrils alone
   2. B. Occur in children after nose picking
   3. C. Be caused by dry air without trauma
   4. D. Drain down the throat and resist direct pressure
   Show answer

   Answer: D. Drain down the throat and resist direct pressure

   Posterior bleeds come from larger vessels and run into the pharynx, so pinching the nose does not reach them, and the airway is at greater risk. Children with nose picking or dry air usually have anterior bleeds.

5. A 72-year-old woman taking warfarin fell and has heavy bleeding from the nose. She is pale and her heart rate is 118/min. In addition to controlling the bleeding, you should:

   1. A. Hold the warfarin and reassess her in about an hour
   2. B. Treat her for hypovolemia and transport promptly
   3. C. Have her blow her nose to clear the clots
   4. D. Transport with the head tilted back
   Show answer

   Answer: B. Treat her for hypovolemia and transport promptly

   Anticoagulated patients can lose significant volume from a nosebleed, and tachycardia with pallor suggests shock. Blowing the nose dislodges clots and restarts the bleeding.

6. A 40-year-old with a traumatic anterior nosebleed is sitting up and leaning forward, and you pinch the soft part of his nose. How long should you hold steady pressure before checking?

   1. A. For 30 seconds at a time
   2. B. Only about 1 to 2 minutes
   3. C. At least 10 to 15 minutes
   4. D. Until it slows, then let go to check
   Show answer

   Answer: C. At least 10 to 15 minutes

   Firm, continuous pressure on the soft lower nose squeezes the Kiesselbach plexus against the septum, and a stable clot needs several minutes to form. The AAO-HNSF nosebleed guideline calls for sustained compression for at least 5 minutes, and EMS teaching is commonly 10 to 15 minutes without peeking. Thirty-second holds and 1 to 2 minutes are far too short for a clot to form. Letting go to check as soon as the flow slows breaks the fresh clot and restarts the bleeding.

7. After a fall, a 9-year-old has a fractured front tooth and is in pain. You also see a cut lip with a hard lump inside it. You should suspect:

   1. A. A tooth fragment embedded in the lip
   2. B. A normal swelling from the bruise
   3. C. A cyst that was there before injury
   4. D. A blood clot that will dissolve alone
   Show answer

   Answer: A. A tooth fragment embedded in the lip

   When a tooth breaks and a fragment is missing, it may be in the lip, the airway, or the stomach. A firm lump in a lacerated lip suggests an embedded fragment that the hospital should find with imaging and remove. Report the missing fragment; aspiration must also be considered.

8. A man was struck in the mouth, and two lower teeth are loose and bleeding but still in their sockets. You should:

   1. A. Pull them out to prevent aspiration
   2. B. Push them firmly back into line
   3. C. Have him chew to test their strength
   4. D. Leave them in place and transport
   Show answer

   Answer: D. Leave them in place and transport

   Loosened (luxated) teeth that are still in the socket are left in place, since a dentist can often splint them. Have the patient bite gently on gauze to control bleeding. Pulling them sacrifices the teeth unless they are so loose they threaten the airway, and manipulation or chewing can worsen the injury.

9. A 16-year-old's permanent front tooth was knocked out 10 minutes ago. He is alert, but no milk, saline, or tooth-storage solution is available, and your protocol does not permit replantation. The best way to carry the tooth is:

   1. A. Wrapped in dry paper towel
   2. B. In a cup of tap water with ice
   3. C. Wrapped in an alcohol prep pad
   4. D. In a cup of his own saliva
   Show answer

   Answer: D. In a cup of his own saliva

   IADT 2020 lists the patient's saliva, spat into a container, as an acceptable short-term storage medium after balanced salt solution, milk, and saline; it keeps the root moist and is close enough to the body's own fluids to protect the ligament cells for a short time. A container is preferred over holding the tooth in the mouth, which risks swallowing or aspiration. A dry paper towel lets the root dehydrate, and after about 60 minutes of dry time the ligament cells are dead. Tap water is hypotonic and bursts the cells, and ice adds cold injury. Alcohol and other antiseptics are toxic to the root cells.

10. A man has a deep, bleeding laceration through the inside of his cheek after being struck. Bleeding into the mouth is steady. You should:

    1. A. Pack gauze far back toward the throat
    2. B. Lay him flat on his back for comfort
    3. C. Press inside and outside the cheek
    4. D. Rinse his mouth repeatedly with water
    Show answer

    Answer: C. Press inside and outside the cheek

    Bleeding from the cheek is best controlled by holding pressure with gauze inside the mouth and a dressing outside, while keeping the patient upright and leaning forward (if no spinal concern) to drain blood. Packing near the throat can obstruct the airway, lying flat lets blood run back, and rinsing washes away clot.

11. A patient struck in the face has a loose, broken dental bridge in his mouth and a decreasing level of consciousness. You should:

    1. A. Leave it, since it helps the mask seal
    2. B. Remove the loose bridge from his mouth
    3. C. Push it back into place on the teeth
    4. D. Glue it in place before transport
    Show answer

    Answer: B. Remove the loose bridge from his mouth

    Loose dental appliances can be aspirated or obstruct the airway, especially as consciousness falls, so they should be removed. Well-fitting dentures may be left to help a mask seal, but broken or loose ones must come out.

12. After a fall, a patient has a broken front tooth, and one fragment cannot be found. The most important concern is that the fragment may have been:

    1. A. Aspirated into the airway
    2. B. Swallowed into the stomach
    3. C. Embedded in the tongue
    4. D. Lost at the scene
    Show answer

    Answer: A. Aspirated into the airway

    An aspirated fragment can obstruct a bronchus and cause pneumonia, so look for coughing or wheezing and report the missing fragment. A swallowed fragment usually passes harmlessly.

13. Bleeding from a tooth socket after an avulsion is best controlled by:

    1. A. Rinsing the socket with hot water
    2. B. Having the patient bite on rolled gauze
    3. C. Packing the socket with loose cotton balls
    4. D. Applying a tourniquet to the face
    Show answer

    Answer: B. Having the patient bite on rolled gauze

    Folded gauze placed over the socket with gentle biting pressure controls most dental bleeding. Hot water dilates vessels and increases bleeding; loose cotton can be aspirated.

14. A 30-year-old was slapped hard across the ear and now has ear pain and decreased hearing on that side. You should suspect:

    1. A. A fracture of the mandibular condyle
    2. B. An avulsion of the pinna
    3. C. An inner ear infection
    4. D. A ruptured tympanic membrane
    Show answer

    Answer: D. A ruptured tympanic membrane

    A sudden pressure change from a slap, blast, or diving can tear the eardrum, causing pain, hearing loss, and sometimes bleeding. Infection is not caused by a blow and develops over days.

15. A 30-year-old diver has ear pain, decreased hearing, and a little blood in the ear canal after a rapid descent. You should:

    1. A. Not irrigate or pack the ear canal
    2. B. Irrigate the canal to remove blood
    3. C. Pack the canal firmly with gauze
    4. D. Instill antibiotic drops into the ear
    Show answer

    Answer: A. Not irrigate or pack the ear canal

    Fluids or packing can carry bacteria into the middle ear. Most ruptured eardrums heal on their own; cover the ear loosely and transport.

16. A 50-year-old man fell from a ladder onto his head and has blood-tinged fluid draining from his right ear. This most strongly suggests:

    1. A. A ruptured eardrum alone
    2. B. A laceration of the pinna
    3. C. A basilar skull fracture
    4. D. An ear canal abrasion
    Show answer

    Answer: C. A basilar skull fracture

    Blood or CSF from the ear after significant head trauma points to a fracture of the temporal bone at the skull base. Let it drain freely and cover loosely, and assess for brain injury.

17. After an explosion, a woman has ringing in her ears and cannot hear your questions. The best way to communicate with her is to:

    1. A. Use written notes and gestures
    2. B. Shout directly into her ear
    3. C. Assume she is confused instead
    4. D. Wait until her hearing returns
    Show answer

    Answer: A. Use written notes and gestures

    Blast-related hearing loss is common, so written questions, gestures, and facing her clearly are the best way to assess and reassure her. Shouting into a damaged ear adds harm, misreading deafness as confusion can lead to wrong conclusions about head injury, and waiting delays assessment.

18. A 17-year-old has had the upper part of his ear torn off in a dog bite. You should:

    1. A. Place the part directly on ice in water
    2. B. Discard the part because it cannot be saved
    3. C. Wrap the part in moist gauze and keep it cool
    4. D. Store the part in a dry plastic bag at room temperature
    Show answer

    Answer: C. Wrap the part in moist gauze and keep it cool

    Avulsed parts of the ear may be reattached, so wrap the part in sterile gauze moistened with saline, seal it in a bag, and keep it cool. Direct contact with ice causes freezing injury.

19. Ear lacerations are slow to heal and prone to infection mainly because the pinna:

    1. A. Contains the ossicles
    2. B. Has a poor blood supply
    3. C. Has thick, tightly bound skin
    4. D. Is mostly fat with few vessels
    Show answer

    Answer: B. Has a poor blood supply

    The cartilage of the pinna receives blood from its overlying skin, so injuries heal slowly. An untreated hematoma can deform the cartilage, producing cauliflower ear. The skin of the pinna is thin, the ear is built on cartilage rather than fat, and the ossicles lie deep in the middle ear.

20. A man's ear was bitten during a fight and the cartilage is exposed. Compared with a skin-only bite, this wound is at higher risk of:

    1. A. Faster healing without a scar
    2. B. Heavy arterial bleeding from the pinna
    3. C. Tetanus within the first day
    4. D. Cartilage infection, deformity
    Show answer

    Answer: D. Cartilage infection, deformity

    Ear cartilage has a poor blood supply, and human bites carry many bacteria, so exposed cartilage is prone to infection (chondritis) that can destroy it and deform the ear. Cover with a moist dressing and transport for irrigation, antibiotics, and repair. It heals more slowly, not faster, bleeding from the pinna is usually modest, and tetanus takes days to weeks to appear.

21. A man wearing a motorcycle helmet crashed and has blood coming from inside one ear canal, but no other injuries are visible. Besides a ruptured eardrum, you should consider:

    1. A. A basilar skull fracture
    2. B. Simple wax buildup in the ear
    3. C. An ear infection from before
    4. D. A nosebleed draining out the ear
    Show answer

    Answer: A. A basilar skull fracture

    Blood from the ear canal after head trauma may come from a canal laceration or eardrum rupture, but it may also signal a temporal bone (basilar skull) fracture. Cover the ear loosely, do not pack it, and monitor mental status. Wax, prior infection, or a nosebleed would not explain fresh blood after a crash.

22. A 35-year-old was struck in the mouth with a bat and has a deep laceration of the tongue that is bleeding heavily. The priority is to:

    1. A. Suture the laceration before moving him
    2. B. Keep the airway clear and control the bleeding
    3. C. Lay him supine with his head tilted well back
    4. D. Ask him to swallow the blood until arrival
    Show answer

    Answer: B. Keep the airway clear and control the bleeding

    Tongue lacerations bleed briskly and swelling can block the airway, so suction, position for drainage, and apply direct pressure with gauze. Supine positioning lets the blood flow into the airway.

23. When a patient has an object impaled through the cheek and it is obstructing the airway, you should:

    1. A. Leave it in place and transport him supine
    2. B. Push it through to the outside
    3. C. Cut it short and leave both ends
    4. D. Remove it and pack the inside of the cheek
    Show answer

    Answer: D. Remove it and pack the inside of the cheek

    Impaled objects are usually stabilized, but an object in the cheek that blocks the airway or prevents control of bleeding may be removed. Pack gauze between the teeth and the cheek and hold pressure on both sides.

24. After a fall, a 30-year-old has an upper front tooth that is loose and pushed slightly back but still in its socket. He is alert, with a clear airway and minor gum bleeding. You should:

    1. A. Pull it out to prevent aspiration
    2. B. Push it firmly back into alignment
    3. C. Leave it in place and transport him
    4. D. Have him bite down hard to reseat it
    Show answer

    Answer: C. Leave it in place and transport him

    A displaced tooth that is still in its socket keeps part of its ligament attachment and blood supply, and a dentist can often reposition and splint it, so leave it alone, control gum bleeding with gauze, and transport. In an alert patient with a clear airway the aspiration risk is low; only a tooth hanging free in an altered patient may need removal and storage per protocol. Pulling it out turns a luxation into an avulsion and destroys the ligament. Forcing it back by hand or by hard biting can fracture the root or the bony socket; repositioning is done by a dentist, usually with local anesthesia.

25. A 22-year-old with an avulsed permanent tooth is unresponsive after a fall. Field reimplantation of the tooth is inappropriate mainly because:

    1. A. The tooth will no longer survive
    2. B. The socket will already have closed
    3. C. The root must first be scrubbed
    4. D. The tooth could be aspirated
    Show answer

    Answer: D. The tooth could be aspirated

    Reimplantation in the field is considered only in an alert, cooperative patient who can protect the airway; in an unresponsive patient the tooth may be dislodged and aspirated. The tooth can still be saved if it is stored properly and brought with the patient.