Open Injuries: Abrasions, Lacerations, Avulsions, Amputations, Punctures, and Impaled Objects Practice Questions

25 multiple-choice questions on Open injuries: abrasions, lacerations, avulsions, amputations, punctures, and impaled objects 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. An abrasion is a wound in which:

   1. A. Outer skin is scraped away
   2. B. A flap of skin is torn loose
   3. C. A sharp object cuts a clean line
   4. D. A pointed object pierces deep tissue
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   Answer: A. Outer skin is scraped away

   Abrasions remove epidermis and sometimes upper dermis, producing oozing from capillaries and intense pain because nerve endings are exposed. A torn flap of skin is an avulsion.

2. A motorcyclist slid across asphalt without protective clothing and has a large, oozing road rash on his thigh. The main concern with this wound is:

   1. A. Rapid arterial bleeding
   2. B. Damage to the underlying femur
   3. C. Air entering the blood vessels
   4. D. Embedded debris
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   Answer: D. Embedded debris

   Abrasions bleed little but often contain dirt and gravel that raise infection risk and can cause traumatic tattooing. Arterial bleeding is unlikely because abrasions are superficial.

3. A laceration differs from an incision in that a laceration:

   1. A. Is caused by a scalpel or razor
   2. B. Has jagged, irregular edges
   3. C. Stays within the epidermis
   4. D. Has smooth, straight edges
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   Answer: B. Has jagged, irregular edges

   Lacerations are tears caused by blunt or irregular forces, producing ragged edges. Smooth, straight edges describe an incision from a sharp object such as a knife or glass.

4. A clean cut from a broken window that has smooth, straight edges is best classified as:

   1. A. An abrasion
   2. B. An avulsion
   3. C. A contusion
   4. D. An incision
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   Answer: D. An incision

   Incisions are made by sharp edges and tend to bleed freely because vessels are cut cleanly. Contusions are closed injuries with intact skin.

5. Why can a clean incision bleed more than a jagged laceration of similar size?

   1. A. Cleanly cut vessels do not retract well
   2. B. Sharp objects carry more bacteria into it
   3. C. Incisions usually reach a deeper artery
   4. D. Jagged wounds release more clotting factor
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   Answer: A. Cleanly cut vessels do not retract well

   Vessels cut cleanly across tend to stay open, while torn, stretched vessels constrict and retract more effectively. Incisions do not always reach an artery; depth and location determine that.

6. An avulsion is an injury in which:

   1. A. The skin is bruised but intact
   2. B. A pointed object pierces the skin
   3. C. Tissue is torn loose as a flap
   4. D. Only the epidermis is scraped off
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   Answer: C. Tissue is torn loose as a flap

   Avulsions may leave a flap attached or tear the tissue away completely. The flap's blood supply may be compromised, so careful handling matters.

7. You find a partially avulsed skin flap on a patient's forearm that is still attached by a broad base. You should:

   1. A. Lay the flap back in place and dress it
   2. B. Cut the flap off and discard it at the scene
   3. C. Leave the flap folded back so it can drain
   4. D. Pull the flap tight and secure it with tape
   Show answer

   Answer: A. Lay the flap back in place and dress it

   Returning the flap to its normal position, after gently cleaning gross debris, restores blood flow through the attached base. Leaving it folded back kinks the pedicle and starves the tissue of blood.

8. A complete amputation is often associated with less bleeding than a partial amputation because:

   1. A. Severed vessels clot faster in open air
   2. B. The stump is usually crushed closed
   3. C. Severed vessels retract and spasm
   4. D. Partially cut vessels clot instantly
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   Answer: C. Severed vessels retract and spasm

   Completely transected arteries spasm and pull back into tissue, limiting bleeding. Partially cut vessels are held open by the remaining wall and may bleed more heavily. Exposure to air does not speed clotting, and many amputations are cuts rather than crushed stumps; the difference lies in how the vessel wall behaves.

9. A 35-year-old man has a partial amputation of the ring finger hanging by a strip of skin. You should:

   1. A. Complete the amputation with sterile scissors
   2. B. Splint it in place without cutting the skin
   3. C. Pull the finger straight and tape it tight
   4. D. Soak the finger in a cup of ice water
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   Answer: B. Splint it in place without cutting the skin

   Never complete a partial amputation; even a small skin bridge may carry vessels that keep the part alive. Splinting it in normal alignment protects the tissue and remaining connection.

10. A puncture wound is dangerous because:

    1. A. It usually causes heavy external bleeding
    2. B. It seldom becomes infected
    3. C. It affects mainly the epidermis
    4. D. Deep damage may be hidden
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    Answer: D. Deep damage may be hidden

    A small entry site can hide deep injury to organs, vessels, or nerves, and bacteria carried deep into tissue thrive in a low-oxygen environment. External bleeding is often minimal, which leads students to underestimate these wounds.

11. A 19-year-old stepped on a rusty nail through her sneaker. The wound is small and not bleeding. The most important concern is:

    1. A. Infection, including tetanus
    2. B. A fracture of the heel bone
    3. C. Compartment syndrome of the foot
    4. D. Injury to the plantar nerves
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    Answer: A. Infection, including tetanus

    Puncture wounds through shoe material carry dirt and bacteria, including Clostridium tetani, deep into tissue. Because a nail can carry bacteria deep into the sole, ask about tetanus status and refer for evaluation. A small nail puncture seldom fractures bone, causes compartment syndrome, or injures nerves; infection is the main risk.

12. A fisherman has a large fishhook embedded in his finger with the barb buried under the skin. Bleeding is minimal. Unless your protocol allows removal, you should:

    1. A. Pull it back out the way it went in
    2. B. Cut the finger tissue around it
    3. C. Push it through with pliers
    4. D. Stabilize the hook, then transport
    Show answer

    Answer: D. Stabilize the hook, then transport

    Most protocols treat an embedded fishhook like any impaled object: pad and stabilize it, cover it, and transport for removal. Pulling it back out tears tissue on the barb. Advancing or cutting techniques are for providers specifically trained and authorized, and cutting tissue is never appropriate.

13. After you rinse away loose debris, a large road-rash abrasion on a motorcyclist's thigh should be covered with:

    1. A. Dry cotton balls pressed into the wound
    2. B. Adhesive tape applied directly to the skin
    3. C. A moist or nonadherent sterile dressing
    4. D. Nothing, so that a scab forms right away
    Show answer

    Answer: C. A moist or nonadherent sterile dressing

    A nonadherent (or saline-moistened) sterile dressing protects the wound and will not stick to the oozing surface, so removal will not tear the healing tissue. Cotton fibers stick and leave debris, adhesive tape on raw skin causes further injury, and leaving it open invites contamination.

14. A patient in cardiac arrest has a large screwdriver impaled in the center of the chest that prevents effective compressions. The appropriate action is to:

    1. A. Perform compressions around the object
    2. B. Remove the object so CPR can be performed
    3. C. Withhold CPR and transport rapidly
    4. D. Stabilize the object and give only ventilations
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    Answer: B. Remove the object so CPR can be performed

    When an impaled object makes effective CPR impossible, the object may be removed because the patient will die without compressions. Compressing around a large central object is ineffective and can drive it deeper.

15. An object impaled through the cheek should be removed by:

    1. A. Pushing it through into the mouth
    2. B. Twisting it while pulling outward
    3. C. Pulling it out the way it entered
    4. D. Cutting it flush with the skin
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    Answer: C. Pulling it out the way it entered

    Pull the object out in the direction it entered, retracing the existing tract. Pushing it farther in risks more injury to the mouth and airway, and twisting tears more tissue.

16. After removing an object impaled through the cheek, you should place gauze:

    1. A. Deep in the posterior pharynx to stop the bleeding
    2. B. Between the cheek and teeth, and dress the outside
    3. C. Only over the outer skin wound of the cheek
    4. D. Under the tongue to absorb blood from the wound
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    Answer: B. Between the cheek and teeth, and dress the outside

    Packing between the cheek and teeth controls internal bleeding while an outer dressing covers the skin wound. Gauze deep in the throat can cause an airway obstruction.

17. A very long impaled object, such as a fence post, must be shortened before transport. The best practice is to:

    1. A. Pull it out to make transport easier
    2. B. Cut it flush with the skin surface
    3. C. Have the patient hold it still during cutting
    4. D. Stabilize it, then cut with little motion
    Show answer

    Answer: D. Stabilize it, then cut with little motion

    Shortening is sometimes necessary, but the object must be firmly stabilized so vibration and motion are not transmitted to the tissue. Pulling it out is never done simply to make transport easier. Leave enough length to secure it, since cutting flush leaves nothing to stabilize, and a patient cannot hold the object steady enough to protect his own tissue.

18. A 32-year-old has a small entrance wound in the abdomen from a narrow wooden stake that has been removed by bystanders. The stake was 20 cm (8 in) long. You should assume:

    1. A. Deep internal injury is present
    2. B. The injury is likely superficial
    3. C. The wound can be safely closed
    4. D. There is no risk of infection
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    Answer: A. Deep internal injury is present

    The length of a penetrating object, not the size of the skin hole, predicts depth of injury. Assume internal organ damage and transport to a trauma center.

19. Which wound typically produces the most capillary oozing but the least risk of major bleeding?

    1. A. Abrasion
    2. B. Incision
    3. C. Laceration
    4. D. Amputation
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    Answer: A. Abrasion

    Abrasions involve only superficial capillaries and ooze slowly. Incisions and lacerations can cut larger vessels.

20. Which statement about lacerations is correct?

    1. A. They involve only the outer epidermis
    2. B. They seldom require any form of closure
    3. C. They may be linear or stellate in shape
    4. D. They are found mainly on the scalp
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    Answer: C. They may be linear or stellate in shape

    Lacerations can be linear or stellate (star-shaped), especially over bone from blunt impact, and may extend through all layers. Superficial-only injury describes an abrasion.

21. Which finding with a laceration over the back of the hand most suggests tendon injury?

    1. A. Mild bleeding from the edges
    2. B. Pain at the wound site
    3. C. A gaping wound edge
    4. D. Inability to extend a finger
    Show answer

    Answer: D. Inability to extend a finger

    Loss of finger extension after a dorsal hand laceration indicates an extensor tendon injury. Pain and bleeding occur with any laceration and do not specifically point to the tendon.

22. A 50-year-old has a laceration on the palm and cannot feel the tip of his index finger. This finding suggests injury to a:

    1. A. Flexor tendon
    2. B. Digital nerve
    3. C. Radial artery
    4. D. Metacarpal bone
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    Answer: B. Digital nerve

    Numbness distal to a wound indicates nerve damage, which needs surgical evaluation. A flexor tendon injury would cause loss of finger flexion, not loss of sensation.

23. A fracture is classified as open when:

    1. A. The limb is visibly deformed at the site
    2. B. A large bruise forms over the fracture
    3. C. A wound connects with the fracture
    4. D. The fracture line extends into a joint
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    Answer: C. A wound connects with the fracture

    Any wound that communicates with the fracture site, even a small puncture from a bone end that slipped back in, makes the fracture open and highly prone to infection. Deformity and bruising occur with closed fractures too.

24. A patient was impaled on a metal rod while falling, and the rod is still fixed in the ground. Firefighters must cut it. During cutting, you should:

    1. A. Pull the patient up and off the rod before cutting
    2. B. Steady the rod and shield the patient from heat
    3. C. Have the patient stand up so the rod can be cut
    4. D. Wait for the rod to cool before any cutting begins
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    Answer: B. Steady the rod and shield the patient from heat

    Stabilize the rod above and below the cut and shield the patient from sparks and heat transmitted along the metal. Pulling the patient off the rod risks uncontrolled bleeding.

25. A 7-year-old's foot was run over by a riding lawn mower. He has deep, ragged wounds containing grass and soil. Compared with a clean cut, this wound has:

    1. A. A risk equal to a clean cut once rinsed
    2. B. Mostly a bleeding risk, not infection
    3. C. Less tissue damage than its look suggests
    4. D. A much higher risk of serious infection
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    Answer: D. A much higher risk of serious infection

    Mower injuries combine crush, avulsion, and laceration with heavy soil and plant contamination, so they carry a high risk of serious infection and often involve tendon or bone. Control bleeding, cover with sterile dressings, and transport for surgical care. Rinsing does not bring the risk down to that of a clean cut, bleeding is not the only concern, and the damage is usually worse, not less, than it looks.