Neck Injuries: Penetrating Trauma, Vessels, Airway, and Strangulation Practice Questions

25 multiple-choice questions on Neck injuries: penetrating trauma, vessels, airway, and strangulation 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. Zone I of the neck extends from the:

   1. A. Clavicles to the cricoid cartilage
   2. B. Cricoid cartilage to the angle of the mandible
   3. C. Angle of the mandible to the base of the skull
   4. D. Sternal notch to the xiphoid process
   Show answer

   Answer: A. Clavicles to the cricoid cartilage

   Zone I contains the great vessels at the thoracic outlet, the lung apices, and the proximal trachea and esophagus, so injuries there often involve the chest. The cricoid to the mandible is zone II.

2. Zone II of the neck lies between the:

   1. A. Clavicles and the cricoid cartilage
   2. B. Mandible angle and the base of the skull
   3. C. Hyoid bone and the thyroid cartilage
   4. D. Cricoid and the angle of the mandible
   Show answer

   Answer: D. Cricoid and the angle of the mandible

   Zone II is the largest and most commonly injured zone, containing the carotids, jugular veins, larynx, and esophagus. Its injuries are the most visible and the easiest to control with direct pressure.

3. Penetrating injuries in zone III of the neck are especially difficult to manage because:

   1. A. The zone contains the lung apices
   2. B. The zone has no major vessels
   3. C. Its vessels lie hidden under the skull base
   4. D. The trachea is most exposed to injury in this zone
   Show answer

   Answer: C. Its vessels lie hidden under the skull base

   Zone III vessels, including the distal carotid and vertebral arteries, run up beneath the skull base, where pressure and surgical exposure are difficult. The lung apices are in zone I.

4. A 22-year-old man was stabbed in the left side of the neck. Which finding is a hard sign of vascular injury requiring immediate surgery?

   1. A. An expanding or pulsatile hematoma
   2. B. Mild pain on swallowing
   3. C. A small amount of dark venous oozing
   4. D. Tenderness over the wound
   Show answer

   Answer: A. An expanding or pulsatile hematoma

   Hard signs include pulsatile bleeding, an expanding hematoma, a bruit or thrill, and shock unexplained by other injuries. Painful swallowing suggests an esophageal injury but is not a hard sign of vascular injury.

5. A 24-year-old has a stab wound to the right side of the neck that is bleeding steadily. You should control the bleeding with:

   1. A. A circumferential pressure bandage
   2. B. Direct pressure with an occlusive dressing
   3. C. A tourniquet placed around the neck
   4. D. Packing the wound deeply with dry gauze alone
   Show answer

   Answer: B. Direct pressure with an occlusive dressing

   Direct pressure controls bleeding, and an occlusive dressing prevents air from entering an open vein. A circumferential bandage can obstruct the airway and cerebral blood flow.

6. When applying pressure to a bleeding carotid wound, you must avoid:

   1. A. Using an occlusive dressing
   2. B. Applying pressure for more than 10 minutes
   3. C. Using gloved fingers directly
   4. D. Pressing on both carotid arteries
   Show answer

   Answer: D. Pressing on both carotid arteries

   Compressing both carotids cuts off blood to the brain and can cause stroke or bradycardia. Pressure on one side, over the wound, is appropriate.

7. Large open neck veins are at risk of drawing in air during inspiration because:

   1. A. Their pressure can fall below atmospheric
   2. B. They carry oxygenated blood from the lungs
   3. C. Their walls are thicker than the arteries
   4. D. They are protected by the clavicles
   Show answer

   Answer: A. Their pressure can fall below atmospheric

   When the patient breathes in, negative intrathoracic pressure can suck air into an open jugular vein, causing an air embolism. This is why an occlusive dressing is applied.

8. A 30-year-old man with a lacerated jugular vein suddenly becomes short of breath, hypotensive, and cyanotic, and you hear a churning sound over his heart. You should suspect:

   1. A. A tension pneumothorax
   2. B. An anaphylactic reaction
   3. C. A venous air embolism
   4. D. A cardiac tamponade
   Show answer

   Answer: C. A venous air embolism

   Air entering the right heart froths with the blood, producing a mill-wheel murmur and obstructing outflow to the lungs. Tamponade causes muffled heart sounds, not a churning murmur.

9. A man was stabbed just above the left clavicle and is hypotensive. When starting IV access, it is best to use:

   1. A. The left arm, nearest the wound
   2. B. The left external jugular vein
   3. C. Only the left hand and wrist veins
   4. D. The arm on the uninjured side
   Show answer

   Answer: D. The arm on the uninjured side

   A wound low in the neck may injure the subclavian vein or artery on that side, so fluids given through the left arm could leak into the wound or chest. Start IV access in the opposite arm or a leg. The left external jugular is also near the injury.

10. A 40-year-old driver struck his throat on the steering wheel. Which finding most strongly suggests an injury to the larynx or trachea?

    1. A. Bruising over the medial clavicles
    2. B. Subcutaneous emphysema in the neck
    3. C. Pain when turning the neck
    4. D. Mild neck muscle tenderness
    Show answer

    Answer: B. Subcutaneous emphysema in the neck

    Air escaping from a torn airway collects under the skin, producing crackling on palpation. Other findings include hoarseness, stridor, and loss of the normal laryngeal prominence. Bruising near the clavicles and pain or tenderness in the neck muscles are common after a blow but do not show that the airway is torn.

11. A 19-year-old motorcyclist struck a wire across the road at neck level. He is hoarse, his neck is swollen, and he has stridor. This injury is known as a:

    1. A. Seat belt injury
    2. B. Whiplash injury
    3. C. Clothesline injury
    4. D. Hyperflexion injury
    Show answer

    Answer: C. Clothesline injury

    A wire or rope across the path strikes the anterior neck, crushing the larynx or separating the larynx from the trachea. Airway compromise can worsen rapidly as swelling increases.

12. A 30-year-old was stabbed just above the right clavicle. He has decreased breath sounds on the right, an SpO2 of 88%, and a BP of 84/50 mm Hg. Which associated injury should you suspect first?

    1. A. An isolated esophageal tear
    2. B. A pneumothorax or hemothorax
    3. C. A carotid dissection with stroke
    4. D. A fracture of the hyoid bone
    Show answer

    Answer: B. A pneumothorax or hemothorax

    A wound just above the clavicle is in zone I, which contains the lung apex and the subclavian vessels, so the knife often enters the chest. One-sided decreased breath sounds, hypoxia, and hypotension point to a pneumothorax, a hemothorax from a subclavian injury, or both; reassess for tension physiology, decompress if indicated, and transport rapidly to a trauma center. An esophageal tear causes painful swallowing and later infection, not one-sided breath-sound loss and early shock. A carotid dissection shows up as stroke signs, which he does not have. The hyoid is higher in the neck and is usually fractured by blunt force or strangulation.

13. A 32-year-old was stabbed in the neck and has painful swallowing and blood-streaked saliva. An esophageal injury is dangerous mainly because it can cause:

    1. A. Mediastinitis and sepsis
    2. B. Immediate airway obstruction
    3. C. Rapid hemorrhagic shock
    4. D. Bradycardia and hypotension
    Show answer

    Answer: A. Mediastinitis and sepsis

    Saliva and stomach contents leaking into the neck and mediastinum cause severe infection that may not appear for hours. Esophageal injuries are often missed initially because signs are subtle.

14. Which finding most suggests an esophageal injury after penetrating neck trauma?

    1. A. Stridor at rest
    2. B. Bright red, pulsatile bleeding from the wound
    3. C. Unequal pupils
    4. D. Pain or difficulty with swallowing
    Show answer

    Answer: D. Pain or difficulty with swallowing

    Painful or difficult swallowing, blood in the saliva, or subcutaneous air suggest esophageal perforation. Stridor points to the airway, and pulsatile bleeding points to an artery.

15. A patient with a penetrating neck wound has a dilated pupil, drooping eyelid, and weakness of one arm and leg. You should suspect:

    1. A. Injury to the carotid artery
    2. B. Injury to the esophageal wall
    3. C. Injury to the thyroid gland
    4. D. Injury to the jugular vein
    Show answer

    Answer: A. Injury to the carotid artery

    Carotid injury or dissection can cause a stroke, producing hemiparesis, and damage to the sympathetic chain alongside it can cause Horner syndrome. Jugular injuries cause bleeding but not stroke-like signs.

16. Blunt trauma to the neck from a seat belt or a hard blow can cause a delayed stroke because of:

    1. A. Internal jugular vein thrombosis
    2. B. Carotid artery dissection
    3. C. Thyroid gland rupture
    4. D. Vagus nerve contusion
    Show answer

    Answer: B. Carotid artery dissection

    A tear in the inner layer of the carotid can form a clot that later travels to the brain, producing symptoms hours to days after injury. A seat belt mark on the neck should raise this concern.

17. Penetrating neck trauma patients should not have an impaled object removed in the field because:

    1. A. It will be needed as legal evidence
    2. B. It helps to stabilize the cervical spine
    3. C. The object may be tamponading a vessel
    4. D. It prevents an air embolism
    Show answer

    Answer: C. The object may be tamponading a vessel

    Removing the object can release a tamponade and cause massive bleeding. Stabilize it with bulky dressings and transport.

18. For a patient with an isolated penetrating neck wound and no neurologic deficit, routine spinal motion restriction is:

    1. A. Required in all cases
    2. B. Required for zone I only
    3. C. Needed if the wound bleeds
    4. D. Not recommended
    Show answer

    Answer: D. Not recommended

    Isolated penetrating injury rarely causes an unstable spine without a deficit, and a collar can hide a hematoma and delay airway care. Current trauma guidance recommends against routine SMR in this situation.

19. The cervical spine fracture classically produced by a long-drop hanging is the:

    1. A. Jefferson fracture of C1
    2. B. Hangman fracture of C2
    3. C. Clay-shoveler fracture of C7
    4. D. Compression fracture of C6
    Show answer

    Answer: B. Hangman fracture of C2

    A long, judicial-style drop causes the hangman fracture, a bilateral fracture through the pedicles of C2 from hyperextension and distraction. A Jefferson fracture of C1 comes from axial loading, such as diving into shallow water.

20. In most suicidal hangings without a long drop, death results mainly from:

    1. A. Fracture of the upper cervical spine with cord transection
    2. B. Laceration of the trachea
    3. C. Obstruction of venous and arterial blood flow
    4. D. Penetrating injury to the larynx
    Show answer

    Answer: C. Obstruction of venous and arterial blood flow

    Pressure on the neck blocks venous return and then arterial flow to the brain, causing cerebral hypoxia within minutes; airway compression adds to it. Spinal fracture usually requires a long drop.

21. A 28-year-old woman says her partner choked her an hour ago. She has a hoarse voice and petechiae on her face but appears well. You should:

    1. A. Transport for evaluation of airway injury
    2. B. Release her on scene because she looks well
    3. C. Have her drink water to test swallowing
    4. D. Treat only the visible bruises
    Show answer

    Answer: A. Transport for evaluation of airway injury

    Strangulation can cause delayed airway swelling, carotid dissection, and stroke, and visible injury is often minimal. Hoarseness and petechiae are signs of significant pressure and warrant evaluation; also address safety.

22. A patient found after a hanging has a pulse but is not breathing. After cutting the rope, your priority is:

    1. A. Obtain a blood glucose level
    2. B. Apply a cervical collar before anything else
    3. C. Assess the pupil size and reactivity
    4. D. Open the airway and begin ventilation
    Show answer

    Answer: D. Open the airway and begin ventilation

    Restoring oxygenation is the immediate priority. Maintain manual in-line stabilization if the mechanism suggests spinal injury, but do not delay airway management to apply a collar.

23. Petechiae on the face and conjunctivae after strangulation are caused by:

    1. A. Low oxygen weakening the capillaries
    2. B. High arterial pressure bursting the capillaries
    3. C. Direct trauma to the eyes
    4. D. Raised venous pressure above the compression
    Show answer

    Answer: D. Raised venous pressure above the compression

    Blocked venous drainage with continued arterial inflow ruptures small capillaries in the head. Their presence indicates significant pressure on the neck. Low oxygen does not burst capillaries, and the pressure comes from blocked veins rather than an arterial surge; the petechiae appear on the face and eyes whether or not they were struck.

24. A 26-year-old stabbed in the neck coughs up bright red blood, and air bubbles from the wound with each breath. This suggests:

    1. A. A minor venous injury
    2. B. An injury to the esophagus only
    3. C. An injury to the trachea
    4. D. A superficial skin wound
    Show answer

    Answer: C. An injury to the trachea

    Air bubbling from a neck wound and hemoptysis indicate a breach of the airway. These patients need close airway monitoring and rapid transport to a trauma center.

25. Which statement about transporting patients with penetrating neck trauma is correct?

    1. A. They can safely wait for a full secondary survey
    2. B. They need a trauma center with surgical capability
    3. C. They should be taken to the nearest clinic or urgent care
    4. D. They need no care unless bleeding is pulsatile
    Show answer

    Answer: B. They need a trauma center with surgical capability

    Any penetration of the platysma muscle can mean deep structure injury requiring surgery, so these patients go to a trauma center with minimal scene time. Lack of pulsatile bleeding does not rule out serious injury.