Falls and Other Blunt Trauma, Including Geriatric Falls Practice Questions

25 multiple-choice questions on Falls and other blunt trauma, including geriatric falls for paramedic and EMT students, from Chapter 30 (Trauma Systems and Mechanism of Injury). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. The three main factors that determine injury severity in a fall are the height of the fall, the surface struck, and:

   1. A. The body part that strikes first
   2. B. The speed of the wind at the time
   3. C. Whether bystanders saw the fall
   4. D. The patient's level of fitness
   Show answer

   Answer: A. The body part that strikes first

   Landing on the feet, back, or head produces very different injury patterns from the same height. Witnesses help the history but do not change the injury.

2. A fall onto which surface is likely to cause the most injury from the same height?

   1. A. Loose sand
   2. B. Concrete
   3. C. Deep snow
   4. D. Grass lawn
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   Answer: B. Concrete

   Hard surfaces stop the body abruptly, so deceleration and force are greatest. Sand and snow deform and lengthen stopping time.

3. A 28-year-old man jumped from a second-floor balcony and landed on his feet. Which injury pattern should you suspect?

   1. A. Wrist, elbow, and shoulder fractures
   2. B. Facial fractures and cervical spine injury
   3. C. Calcaneus, leg, hip, and lumbar fractures
   4. D. Isolated injury to the abdominal organs
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   Answer: C. Calcaneus, leg, hip, and lumbar fractures

   Feet-first falls transmit energy up the skeleton, the pattern called Don Juan or lover's leap syndrome. Wrist and arm injuries suggest a forward fall onto outstretched hands.

4. A patient who fell and landed on his feet has bilateral heel fractures. You should also carefully assess his:

   1. A. Cervical spine
   2. B. Wrists and hands
   3. C. Ears and eyes
   4. D. Lumbar spine
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   Answer: D. Lumbar spine

   Axial load travels up from the heels to the lumbar spine, and compression fractures there are common. Cervical injury is more typical of head-first falls.

5. A person who falls forward onto outstretched hands commonly suffers:

   1. A. Wrist and forearm fractures
   2. B. Calcaneus fractures
   3. C. Lumbar compression fractures
   4. D. Posterior hip dislocation
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   Answer: A. Wrist and forearm fractures

   Arms extended to break a fall take the impact first, causing distal radius (Colles) fractures and elbow and shoulder injury. Calcaneus fractures are a feet-first pattern.

6. A diver struck his head on the bottom of a shallow pool. He is most at risk for:

   1. A. Lumbar spine flexion injury
   2. B. Cervical spine compression injury
   3. C. Bilateral calcaneus fractures
   4. D. Splenic laceration from the pool floor
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   Answer: B. Cervical spine compression injury

   Head-first impacts load the cervical spine axially. Shallow-water diving is a classic cause of cervical cord injury in young men.

7. Under the 2021 field triage guideline, a low-level fall with significant head impact is an EMS judgment criterion for:

   1. A. Adults 18 to 40 years old with no medical history
   2. B. Patients of any age who lose consciousness
   3. C. Children 5 and under and adults 65 and over
   4. D. Adults who take antiplatelet drugs
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   Answer: C. Children 5 and under and adults 65 and over

   Young children and older adults can have serious injuries from ground-level falls. Anticoagulant use is a separate yellow criterion at any age.

8. A 30-year-old slipped on ice and landed hard in a sitting position. He now has midback pain and tenderness over the spine. The injury you should suspect is:

   1. A. A posterior dislocation of the hip joint
   2. B. Fractures of the two heel bones
   3. C. An open-book pelvic fracture
   4. D. A thoracolumbar compression fracture
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   Answer: D. A thoracolumbar compression fracture

   Landing on the buttocks drives axial force up the spine, so compression or burst fractures of the thoracolumbar junction are the classic injury; assess motor and sensory function and use spinal motion restriction per protocol. Posterior hip dislocation comes from a knee striking a dashboard. Calcaneus fractures come from landing on the feet. Open-book pelvic fractures come from front-to-back compression.

9. An 82-year-old woman tripped on a rug and fell. She is now confused, and her family says she takes warfarin. You should be most concerned about:

   1. A. Intracranial hemorrhage
   2. B. Hypoglycemia from a skipped meal
   3. C. Delirium from a urinary infection
   4. D. A minor scalp abrasion
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   Answer: A. Intracranial hemorrhage

   Anticoagulants dramatically raise the risk of bleeding in the head after even minor trauma, and confusion suggests it is already present. Low blood sugar and infection can confuse an older adult and are worth checking, but new confusion after a fall on warfarin must be treated as a head bleed until proven otherwise.

10. A 78-year-old man was found on the floor after an unwitnessed fall. In addition to his injuries, you must consider:

    1. A. That the fall was simple clumsiness
    2. B. A medical cause such as syncope or stroke
    3. C. That the fall was faked to get attention or care
    4. D. A medical cause if he says he fainted
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    Answer: B. A medical cause such as syncope or stroke

    Many geriatric falls result from dysrhythmias, hypoglycemia, stroke, or medication effects. Waiting for the patient to report fainting misses causes he may not remember.

11. An elderly woman fell from standing. Her right leg is shortened and externally rotated. The most likely injury is:

    1. A. Posterior hip dislocation
    2. B. Ankle fracture with lateral swelling
    3. C. Tibial shaft fracture
    4. D. Hip (proximal femur) fracture
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    Answer: D. Hip (proximal femur) fracture

    Shortening and external rotation is the classic sign of a proximal femur fracture, common in osteoporotic older adults. Posterior dislocation causes internal rotation.

12. Older adults may hide signs of shock after a fall because:

    1. A. Their blood pressure rises with blood loss
    2. B. They have more blood volume than younger adults
    3. C. Beta-blockers can blunt a rise in heart rate
    4. D. Their skin becomes warm and flushed
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    Answer: C. Beta-blockers can blunt a rise in heart rate

    Medications and reduced physiological reserve mean tachycardia may not appear even with significant hemorrhage. A normal pulse in an older adult is not reassuring.

13. An 80-year-old man who fell from standing has a BP of 128/80 mmHg. His usual BP is 180/100 mmHg. You should interpret this as:

    1. A. Better blood pressure control after the fall
    2. B. Normal blood pressure for his age
    3. C. A sign that no injury occurred
    4. D. Possible relative hypotension and shock
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    Answer: D. Possible relative hypotension and shock

    A drop of more than 50 mmHg from baseline may represent significant hemorrhage in a chronically hypertensive patient. This is why the 2021 guideline uses an SBP under 110 for older adults.

14. A 3-year-old fell out of a second-story window. He is crying and moving all extremities. His injuries are more likely than an adult's to include:

    1. A. Head injury, since the head is heavy
    2. B. Feet-first calcaneus fractures
    3. C. Lumbar fractures from axial load
    4. D. Wrist fractures from outstretched arms
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    Answer: A. Head injury, since the head is heavy

    Young children have proportionally large, heavy heads and tend to fall head first. Calcaneus and lumbar fractures follow feet-first landings, more typical of adults.

15. A worker fell 14 feet from scaffolding onto concrete. He is alert with normal vital signs. Under the 2021 guideline you should:

    1. A. Release him with fall precautions
    2. B. Transport to a trauma center
    3. C. Take him to an urgent care clinic
    4. D. Transport if he develops back pain
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    Answer: B. Transport to a trauma center

    A fall of more than 10 feet is a yellow mechanism criterion at any age. Normal initial vital signs do not rule out spinal or internal injury.

16. A blow to the chest from a baseball in a 13-year-old causes sudden cardiac arrest. This is called:

    1. A. Cardiac tamponade
    2. B. Flail chest
    3. C. Commotio cordis
    4. D. Traumatic asphyxia
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    Answer: C. Commotio cordis

    A blow during the vulnerable part of repolarization triggers ventricular fibrillation, so early CPR and defibrillation are lifesaving. Tamponade causes progressive, not instant, collapse.

17. A football player was tackled and has pain in the knee after it bent sideways. This type of sports injury is most often due to:

    1. A. Twisting and lateral forces on the joint
    2. B. Penetrating force from the cleats of a player
    3. C. Axial loading from above the head
    4. D. Thermal energy from turf friction burns
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    Answer: A. Twisting and lateral forces on the joint

    Sports injuries often come from acceleration, deceleration, twisting, and compression forces on joints and the spine. Cleats can cause lacerations but are not the main mechanism of ligament injury.

18. A construction worker was pinned between a truck and a wall for 2 hours. When freed, he is at risk of:

    1. A. Tension pneumothorax on release
    2. B. Air embolism from the pressure
    3. C. Crush syndrome with hyperkalemia
    4. D. Isolated compartment syndrome of the hand
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    Answer: C. Crush syndrome with hyperkalemia

    Prolonged compression releases potassium, myoglobin, and acids when blood flow returns, causing dysrhythmias and kidney failure. Air embolism is a blast or diving injury.

19. Blunt trauma injuries are often more dangerous than they appear because:

    1. A. Bruising appears at once over injuries
    2. B. Blunt injuries usually bleed externally first
    3. C. Pain reliably marks the injured organ
    4. D. Damage may be hidden beneath intact skin
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    Answer: D. Damage may be hidden beneath intact skin

    Internal organ injury and bleeding may produce few outward signs at first. That is why mechanism and serial vital signs matter in blunt trauma. Bruising often takes hours to appear, and pain may be dull, referred, or masked, so neither reliably shows where the damage is.

20. During an assault, a man raised his forearm to block a swinging baseball bat. He now has pain and swelling over the middle of the forearm on the little-finger side. The most likely injury is:

    1. A. A distal radius (Colles) wrist fracture
    2. B. An ulnar shaft (nightstick) fracture
    3. C. A scaphoid fracture of the wrist
    4. D. A posterior elbow dislocation
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    Answer: B. An ulnar shaft (nightstick) fracture

    A direct blow to a raised forearm fractures the exposed ulnar shaft, the classic nightstick fracture, which also suggests a defensive injury. A Colles fracture and a scaphoid fracture come from falling on an outstretched hand. A posterior elbow dislocation also follows a fall on the outstretched arm, not a direct blow to the midforearm.

21. Shear injury from blunt trauma occurs when:

    1. A. An object penetrates the skin at high speed
    2. B. Mobile and fixed parts of an organ move differently
    3. C. A pressure wave passes through the air-filled organs
    4. D. Heat from friction damages tissue
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    Answer: B. Mobile and fixed parts of an organ move differently

    Tearing occurs at points of attachment, such as the aorta at the ligamentum arteriosum or the mesentery of the bowel. Pressure waves through air-filled organs describe primary blast injury.

22. A 40-year-old woman fell from a ladder and landed on her back across a railing. She cannot move her legs. You should suspect:

    1. A. A hip dislocation
    2. B. Bilateral calcaneus fractures
    3. C. Hysterical conversion paralysis
    4. D. Thoracolumbar spinal cord injury
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    Answer: D. Thoracolumbar spinal cord injury

    Landing across an object can hyperextend or fracture the thoracolumbar spine, injuring the cord. Conversion disorder is a diagnosis of exclusion and is never assumed in the field.

23. Older adults are more likely to be seriously injured in falls because of:

    1. A. More elastic ribs, joints, and blood vessels
    2. B. A stronger heart rate response to bleeding and pain
    3. C. Osteoporosis and reduced physiological reserve
    4. D. Denser bones from decades of weight bearing
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    Answer: C. Osteoporosis and reduced physiological reserve

    Brittle bones fracture at lower forces, and older organs compensate poorly for blood loss. With age, ribs and vessels stiffen rather than gain elasticity, bone density falls, and the heart rate response to blood loss is weaker, often blunted further by medications.

24. An 88-year-old nursing home resident is found on the floor in the morning with no memory of falling. Which complication of a long lie should you assess for?

    1. A. Rhabdomyolysis and pressure injury
    2. B. Fat embolism from lying still
    3. C. Hyperglycemia from overnight fasting
    4. D. Hypertensive crisis from stress
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    Answer: A. Rhabdomyolysis and pressure injury

    Lying on the floor for hours causes muscle breakdown, dehydration, hypothermia, and pressure injury. Fat embolism follows long-bone fractures rather than immobility, fasting tends to lower blood sugar rather than raise it, and stress is not the expected complication of a long lie.

25. A child fell from a height of 6 feet and the caregiver's story does not match the injuries. You should:

    1. A. Accept the story and leave the patient
    2. B. Confront the caregiver at the scene
    3. C. Consider abuse and report it per protocol
    4. D. Document the fall without further comment
    Show answer

    Answer: C. Consider abuse and report it per protocol

    Suspected child abuse is an EMS judgment criterion in the 2021 guideline, and paramedics are mandatory reporters. Confronting the caregiver can escalate the scene and endanger the child.