Trauma Practice Questions for Paramedics

2,000 free paramedic practice questions on trauma systems and mechanism of injury, bleeding, soft-tissue trauma, burns, face and neck trauma, head and spine trauma, chest trauma, abdominal and genitourinary trauma, orthopaedic trauma, and environmental emergencies. Every question has the answer and a short explanation.

25 sample questions

1. The first priority in caring for a patient whose clothing is still smoldering is to:

   1. A. Estimate the TBSA
   2. B. Stop the burning
   3. C. Start an IV line
   4. D. Apply sterile dressings
   Show answer

   Answer: B. Stop the burning

   Smoldering clothing and hot material keep injuring tissue. Assessment and IV access come after the burning is stopped and the scene is safe.

2. The extended FAST (eFAST) examination adds evaluation of the:

   1. A. Long bones for hidden fractures in the legs
   2. B. Aorta for a dissection flap in the chest
   3. C. Pleural spaces for pneumothorax and blood
   4. D. Kidneys for urinary obstruction or stones
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   Answer: C. Pleural spaces for pneumothorax and blood

   eFAST adds views of both hemithoraces to the standard abdominal and pericardial views, looking for pneumothorax and hemothorax. It is not designed to diagnose aortic dissection or fractures.

3. A 40-year-old man with 35% TBSA flame burns is pale, with a pulse of 136 and a BP of 78/50 mmHg, 15 minutes after the fire. The most likely explanation is:

   1. A. Burn shock from capillary leak
   2. B. Another injury causing bleeding
   3. C. Carbon monoxide causing vasodilation
   4. D. Pain-induced neurogenic shock
   Show answer

   Answer: B. Another injury causing bleeding

   Burn shock takes hours to develop. Early hypotension in a burned patient should prompt a search for trauma such as a fall, blast, or crash, rather than being blamed on the burn.

4. Frostbite injures tissue mainly through:

   1. A. Ice crystals and impaired blood flow
   2. B. Direct burns from touching freezing metals
   3. C. Bacterial infection of the skin
   4. D. Loss of sodium in cold sweat
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   Answer: A. Ice crystals and impaired blood flow

   Ice crystals form in tissue and draw water out of cells, while vasoconstriction, sludging, and microthrombi cut off blood flow. Damage worsens during thaw and refreezing.

5. A patient was burned on the face by a flash fire in an enclosed space. Which finding most strongly suggests an inhalation injury?

   1. A. Redness and pain of the forehead and cheeks
   2. B. A small blister on the chin
   3. C. Pain around the eyelids
   4. D. Carbonaceous sputum and singed nasal hair
   Show answer

   Answer: D. Carbonaceous sputum and singed nasal hair

   Soot in the sputum, singed nasal hair, and a hoarse voice suggest heat injury to the upper airway, which can swell rapidly. Superficial facial redness alone does not indicate airway involvement.

6. Peritonitis can lead to shock mainly by:

   1. A. Fluid shifting into the abdomen and sepsis
   2. B. Raising blood pressure from intense pain
   3. C. Causing direct bleeding from the bowel wall
   4. D. Paralyzing the diaphragm and the lungs
   Show answer

   Answer: A. Fluid shifting into the abdomen and sepsis

   Inflamed peritoneum leaks large volumes of fluid into the abdomen (third spacing), and bacterial infection progresses to septic shock. Pain may raise blood pressure briefly but does not cause shock.

7. Why should paramedics evaluate the mechanism of injury rather than rely only on the initial physical exam?

   1. A. The mechanism alone sets the triage level
   2. B. Physical findings are unreliable in adults
   3. C. Many serious injuries are hidden at first
   4. D. The mechanism predicts each exact injury
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   Answer: C. Many serious injuries are hidden at first

   Internal bleeding and organ injury may not produce signs until compensation fails. The mechanism complements the exam and vital signs but never replaces them. It raises suspicion without predicting exact injuries, and the 2021 field triage guideline weighs it alongside injury patterns, mental status, and vital signs rather than letting it set the triage level by itself.

8. Which finding on assessment of a wound suggests that the wound is already infected?

   1. A. Clean edges and mild swelling
   2. B. Pus, spreading redness, warmth
   3. C. Clear fluid and minimal pain
   4. D. Bleeding that stops with pressure
   Show answer

   Answer: B. Pus, spreading redness, warmth

   Purulent drainage with spreading erythema and warmth indicates infection, usually appearing 24 to 72 hours after injury. Mild early swelling is part of normal inflammation.

9. Ecchymosis refers to:

   1. A. A pool of blood that forms a lump
   2. B. Blood discoloring the tissues
   3. C. Swelling caused by lymph fluid
   4. D. Hardening of the skin after injury
   Show answer

   Answer: B. Blood discoloring the tissues

   Ecchymosis is the blue-black color of blood leaking into tissues, which later turns yellow-green as it breaks down. A distinct pool of blood forming a lump is a hematoma.

10. After a frontal crash, a belted driver has abrasions on his face and inner forearms, burning, irritated eyes, and a fine white powder on his clothing. The most likely cause of these findings is the:

    1. A. Driver's frontal airbag
    2. B. Shattered windshield glass
    3. C. Rim of the steering wheel
    4. D. Battery acid from the engine
    Show answer

    Answer: A. Driver's frontal airbag

    A deploying airbag strikes the face and the forearms held up on the wheel, causing abrasions, and the propellant and powder residue irritates the eyes and leaves a white dust that is not toxic smoke. Windshield glass causes lacerations, usually from the up-and-over pathway in unbelted occupants, not powder or eye burning in a belted driver. The steering wheel rim causes chest and upper abdominal injury, not facial abrasions with eye irritation. Battery acid rarely reaches the occupant compartment and does not explain the abrasion pattern. Irrigate the eyes and still assess for steering wheel and deceleration injuries.

11. Thirst is an unreliable guide to fluid needs during heavy work in heat because it:

    1. A. Overstates fluid loss
    2. B. Appears before sweating
    3. C. Rises with acclimatization
    4. D. Lags behind fluid loss
    Show answer

    Answer: D. Lags behind fluid loss

    Workers who drink only when thirsty during hours of heavy work in heat usually replace only part of their sweat loss (voluntary dehydration), so occupational guidance (NIOSH 2016) recommends drinking at regular intervals, about one cup (240 mL) every 15 to 20 minutes during moderate work, rather than waiting for thirst. Thirst understates, not overstates, the deficit. Thirst follows fluid loss; it does not appear before sweating. Acclimatization improves fluid balance and does not make thirst unreliable. The setting matters: for endurance athletes, the WMS exercise-associated hyponatremia guideline recommends drinking to thirst, because scheduled overdrinking causes hyponatremia. (NIOSH 2016 heat criteria document; WMS 2019 EAH update.)

12. After a minor crash, a woman at 31 weeks feels well but reports cramping that now comes every 5 minutes. The best interpretation is that:

    1. A. Cramping is from the seat belt bruise
    2. B. Contractions may signal an abruption
    3. C. These are Braxton Hicks contractions
    4. D. She can be released with no transport
    Show answer

    Answer: B. Contractions may signal an abruption

    Regular uterine contractions after trauma can be the first sign of placental abruption or preterm labor, even when the mother looks well. She needs transport for several hours of fetal and uterine monitoring. Regular contractions every 5 minutes should not be put down to Braxton Hicks contractions or a belt bruise, and dismissing them risks missing fetal compromise.

13. After an assault, a patient's penis has been amputated. The amputated part should be:

    1. A. Left at the scene for the police
    2. B. Placed directly into ice water
    3. C. Cleaned thoroughly with alcohol
    4. D. Wrapped, bagged, and kept cool
    Show answer

    Answer: D. Wrapped, bagged, and kept cool

    Handle it like any amputated part and transport it with the patient for possible reimplantation. Law enforcement may need evidence, but patient care and the part's viability come first, and direct ice damages tissue.

14. A tourniquet is tight enough when:

    1. A. The skin below it turns slightly pink and warm
    2. B. Bleeding stops and the distal pulse is absent
    3. C. The patient reports mild tightness
    4. D. The windlass has turned two times
    Show answer

    Answer: B. Bleeding stops and the distal pulse is absent

    The endpoint is cessation of bleeding and loss of the distal pulse. Stopping at a set number of turns or at mild discomfort risks a venous tourniquet that increases bleeding.

15. The posterior tibial pulse, used to check distal circulation after a lower leg injury, is palpated:

    1. A. On top of the midfoot
    2. B. Behind the lateral malleolus
    3. C. At the front of the ankle
    4. D. Behind the medial malleolus
    Show answer

    Answer: D. Behind the medial malleolus

    The posterior tibial artery runs behind the medial ankle bone. The dorsalis pedis pulse is felt on top of the foot, the other common distal pulse to check.

16. Traumatic asphyxia is caused by:

    1. A. A sudden chest crush that backs blood into the head
    2. B. Strangulation that blocks arterial blood flow to the brain
    3. C. Smoke inhalation that poisons the hemoglobin
    4. D. Aspiration of blood that obstructs the airway
    Show answer

    Answer: A. A sudden chest crush that backs blood into the head

    Sudden severe compression of the chest forces blood backward out of the heart and into the veins of the head and neck. Despite the name, it is not an airway obstruction or a strangulation injury.

17. A 2-year-old has burns of both feet and lower legs with a sharp line at mid-calf, uniform depth, and no splash marks. This pattern is most consistent with:

    1. A. Forced immersion in hot water
    2. B. Accidentally pulling a pot down
    3. C. Stepping on a hot surface once
    4. D. A flash burn from a stove
    Show answer

    Answer: A. Forced immersion in hot water

    Stocking-pattern burns with clear margins and no splashes suggest the child was held in hot water. Accidental spills cause irregular splash marks and varying depth.

18. A 130-kg man has signs of tension pneumothorax, and you are concerned an anterior needle will not reach the pleura. A reasonable approach is to:

    1. A. Use the lateral site, where the wall is often thinner
    2. B. Use the sternal border, where the wall is the thinnest
    3. C. Use a shorter needle to avoid hitting the lung
    4. D. Avoid decompression because of his body size
    Show answer

    Answer: A. Use the lateral site, where the wall is often thinner

    The 4th or 5th intercostal space at the anterior axillary line often has a thinner chest wall than the anterior site, especially in large patients. The sternal border risks the internal mammary vessels and heart.

19. For prehospital care, the difference between fresh water and salt water drowning:

    1. A. Determines which IV fluid is given
    2. B. Decides whether to start CPR
    3. C. Does not change the treatment
    4. D. Changes the compression depth
    Show answer

    Answer: C. Does not change the treatment

    Fluid type matters little clinically; care focuses on oxygenation, ventilation, and support of circulation in both. The older teaching about different electrolyte effects is not useful in the field.

20. A hypothermia wrap for a wilderness evacuation should include:

    1. A. Insulation, vapor barrier, and wind shell
    2. B. One cotton blanket wrapped loosely over the body
    3. C. Wet clothing left on beneath a tarp
    4. D. Heat packs placed directly on bare skin
    Show answer

    Answer: A. Insulation, vapor barrier, and wind shell

    A hypothermia wrap layers dry insulation (sleeping bags, pads underneath), a vapor barrier such as plastic or a foil sheet to stop evaporative loss, and an outer windproof and waterproof shell, so conduction, evaporation, convection, and radiation are all limited. A single loose cotton blanket gives little insulation and loses it when damp. Wet clothing left on keeps drawing heat out by evaporation and conduction; remove it or, if exposure is severe, wrap a vapor barrier over it. Heat packs belong on the chest, axillae, and back with a layer between pack and skin, because cold skin burns easily. (WMS 2019 hypothermia update.)

21. A 5-year-old fell from a bicycle and has a laceration under the chin and a swollen jaw. Which consideration is most important for children with facial trauma?

    1. A. Their facial bones break more easily
    2. B. Their airway obstructs more easily
    3. C. They seldom need airway management
    4. D. Their jaw cannot be dislocated
    Show answer

    Answer: B. Their airway obstructs more easily

    Children have a large tongue, a small mouth and jaw, and a narrow airway, so even modest bleeding or swelling can block it quickly; position for drainage, suction, and reassess often. Children's facial bones do not break more easily than adults', children with facial injuries often do need airway support, and a child's jaw can be injured or dislocated like an adult's.

22. When descent is impossible because of weather, a climber with HAPE can be treated with oxygen and:

    1. A. Furosemide to clear the fluid
    2. B. Acetazolamide by mouth
    3. C. A portable hyperbaric bag
    4. D. Large IV fluid boluses
    Show answer

    Answer: C. A portable hyperbaric bag

    A portable hyperbaric chamber pressurized by foot pump simulates a descent of about 1,500 to 2,000 m. It buys time but does not replace actual descent. Diuretics can worsen volume depletion and are not recommended, acetazolamide helps prevent AMS but does not treat HAPE, and large fluid boluses add to the lung edema.

23. After you splint a knee, the patient reports numbness on the top of his foot and cannot lift his toes. A splint pressing just below the outside of the knee may be compressing the:

    1. A. Peroneal (fibular) nerve
    2. B. Femoral nerve in the groin
    3. C. Radial nerve of the arm
    4. D. Sciatic nerve in the buttock
    Show answer

    Answer: A. Peroneal (fibular) nerve

    The peroneal nerve wraps around the head of the fibula just below the lateral knee, where it is easily compressed by splints, straps, or casts, causing foot drop and numbness on the top of the foot. Pad this area and loosen the device. The other nerves are not at this location.

24. Sensation of the face is carried mainly by which cranial nerve?

    1. A. Facial (CN VII)
    2. B. Glossopharyngeal (CN IX)
    3. C. Trigeminal (CN V)
    4. D. Hypoglossal (CN XII)
    Show answer

    Answer: C. Trigeminal (CN V)

    The three branches of the trigeminal nerve carry facial sensation and also supply the muscles of chewing. The facial nerve controls the muscles of facial expression, not sensation of the facial skin.

25. Class I hemorrhage is a loss of up to about:

    1. A. 5% of blood volume
    2. B. 30% of blood volume
    3. C. 40% of blood volume
    4. D. 15% of blood volume
    Show answer

    Answer: D. 15% of blood volume

    Class I (up to about 750 mL in an adult) causes little change in vital signs, similar to donating a unit of blood. Class II begins at about 15%, with tachycardia and a narrowing pulse pressure.