Soft-tissue Injuries of the Face and Scalp Practice Questions

25 multiple-choice questions on Soft-tissue injuries of the face and scalp 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. Scalp lacerations often bleed more than expected because the scalp:

   1. A. Lacks the connective tissue layers of other skin
   2. B. Has many vessels that do not constrict well
   3. C. Has no venous drainage of its own
   4. D. Contains mostly arterial blood
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   Answer: B. Has many vessels that do not constrict well

   Scalp vessels are held open by dense connective tissue, so they cannot retract and constrict after being cut. A large scalp wound can cause significant blood loss, especially in children.

2. A 45-year-old man has a large scalp laceration that is bleeding briskly. You feel no bony instability beneath it. You should:

   1. A. Apply a tourniquet around the head
   2. B. Leave it uncovered until arrival
   3. C. Apply firm direct pressure with a dressing
   4. D. Pack the wound tightly with dry gauze strips
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   Answer: C. Apply firm direct pressure with a dressing

   With no suspected skull fracture, firm direct pressure controls nearly all scalp bleeding. Leaving a bleeding scalp wound open can lead to substantial blood loss.

3. A teenager was shot in the cheek with a BB gun. There is a tiny wound with no exit and little bleeding, but the cheek is swollen. You should:

   1. A. Assume the pellet is deep and transport
   2. B. Squeeze the wound to push the pellet out
   3. C. Probe the wound with forceps to find it
   4. D. Send him home with a bandage only
   Show answer

   Answer: A. Assume the pellet is deep and transport

   Air-gun pellets can penetrate deeply despite small entry wounds and may lodge near the eye, nerves, vessels, or sinuses. Cover the wound and transport for imaging. Squeezing or probing can push the pellet deeper or start bleeding, and a small wound does not mean minor injury.

4. A 4-year-old has a large scalp laceration and is pale with a heart rate of 160/min. The most likely explanation is:

   1. A. Pain from the laceration alone
   2. B. A normal heart rate for this age
   3. C. Hypovolemia from scalp bleeding
   4. D. Fever from early infection
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   Answer: C. Hypovolemia from scalp bleeding

   Children have small blood volumes, and a scalp wound can bleed enough to cause shock. Pallor with marked tachycardia should not be blamed on pain; control the bleeding and search for other injuries.

5. In an adult with an isolated head injury, signs of hypovolemic shock should prompt you to:

   1. A. Assume an epidural hematoma is the cause
   2. B. Search for bleeding elsewhere in the body
   3. C. Assume the scalp wound is the only source
   4. D. Treat it as neurogenic shock right away
   Show answer

   Answer: B. Search for bleeding elsewhere in the body

   Except in infants and with large scalp wounds, intracranial bleeding cannot cause shock in adults because the skull has too little room. Look for blood loss into the chest, abdomen, pelvis, or long bones.

6. An avulsion of the scalp has left a flap of tissue hanging. The best care is to:

   1. A. Cut the flap off and save it on ice
   2. B. Leave the flap hanging to drain
   3. C. Fold the flap under a tight bandage
   4. D. Replace the flap and cover it
   Show answer

   Answer: D. Replace the flap and cover it

   Return the flap to its normal position to restore blood flow, cover it, and apply gentle pressure. Removing the flap destroys tissue that could survive.

7. A 26-year-old woman has a deep laceration across the cheek. Which complication is most important to look for?

   1. A. Facial nerve and parotid duct injury
   2. B. Lingual nerve and tongue injury
   3. C. Injury to the submandibular gland duct
   4. D. Fracture of the cervical spine
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   Answer: A. Facial nerve and parotid duct injury

   The facial nerve and parotid duct cross the cheek, and their injury causes facial weakness and saliva leaks. Document facial movement on both sides before transport. The lingual nerve and the submandibular duct lie under the tongue and jaw rather than in the cheek, and a cheek laceration is not a spinal mechanism.

8. Facial wounds rarely become infected compared with wounds elsewhere because the face:

   1. A. Is always kept clean by tears
   2. B. Has thicker skin than the limbs
   3. C. Has fewer bacteria on its skin
   4. D. Has an excellent blood supply
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   Answer: D. Has an excellent blood supply

   The rich blood supply of the face brings oxygen and immune cells, so wounds heal quickly and resist infection. The facial skin is generally thin, not thick.

9. Facial wounds should be dressed carefully and the patient transported because of the concern for:

   1. A. Tetanus that develops within hours
   2. B. Cosmetic outcome and nerve function
   3. C. Blood loss that cannot be controlled
   4. D. Spread of infection to the lungs
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   Answer: B. Cosmetic outcome and nerve function

   Even small facial wounds can leave visible scars, and early, careful repair gives the best result. Tetanus takes days to develop and is prevented with immunization at the hospital.

10. A dog has bitten a 7-year-old on the face, leaving several deep puncture wounds. Besides wound care, which concern should be addressed?

    1. A. Systemic allergic reaction
    2. B. Toxic venom absorption
    3. C. Rabies and infection risk
    4. D. Tetanus within the hour
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    Answer: C. Rabies and infection risk

    Animal bites carry a high infection risk, and the animal's vaccination status must be determined because of rabies. Report the bite to animal control per local requirements.

11. A 35-year-old was bitten on the lip by another person during a fight. Human bites are especially concerning because they:

    1. A. Carry a high risk of infection
    2. B. Seldom need medical care
    3. C. Usually transmit hepatitis C
    4. D. Cause more bleeding than dog bites
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    Answer: A. Carry a high risk of infection

    The human mouth contains many bacteria, and bites to the face or hands often become infected. Wounds should be cleaned and evaluated. Hepatitis C transmission by bite is rare, and human bites usually bleed less than the deeper crushing wounds of a dog bite.

12. 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
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    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.

13. A patient with lacerations from broken glass on the face has a small piece of glass embedded in the skin of the forehead. You should:

    1. A. Remove it with forceps in the field
    2. B. Leave it in place and stabilize it
    3. C. Push it in deeper to stop bleeding
    4. D. Rub the area with an alcohol pad
    Show answer

    Answer: B. Leave it in place and stabilize it

    Impaled objects are stabilized and removed at the hospital, where bleeding can be controlled. The exception is an object in the cheek that blocks the airway.

14. A cyclist slid along the road on his face and has a large abrasion embedded with grit. After protecting the airway and controlling bleeding, the best wound care is to:

    1. A. Scrub the grit out with a stiff brush
    2. B. Leave the wound open and dry to scab
    3. C. Rinse gently; apply a moist dressing
    4. D. Apply butter or ointment to soothe it
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    Answer: C. Rinse gently; apply a moist dressing

    Facial road rash should be gently irrigated and covered with a moist, nonadherent dressing; embedded grit is removed at the hospital under anesthesia to prevent traumatic tattooing. Scrubbing in the field is painful and incomplete, open drying delays healing, and greasy remedies contaminate the wound.

15. After a blow to the face, a patient's swelling around the eyes is so severe that he cannot open them. Before transport, the most important reason to try to check his eyes is to:

    1. A. Detect globe injury or vision loss
    2. B. Decide whether he needs stitches later
    3. C. Test whether he is faking the injury
    4. D. Check whether he wears contact lenses
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    Answer: A. Detect globe injury or vision loss

    Severe lid swelling can hide a ruptured globe, hyphema, or vision loss, which change management and urgency. If it can be done without pressing on the globe, gently open the lids to check vision and pupils; if not, shield the eye and report it. Stitches, malingering, and contacts are lesser concerns.

16. A 50-year-old man has severe facial swelling after a beating, and his eyes are swollen shut. You should:

    1. A. Assume the pupils are equal
    2. B. Press on the lids to reduce swelling
    3. C. Gently open the lids to check the pupils
    4. D. Defer any eye assessment to the hospital
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    Answer: C. Gently open the lids to check the pupils

    Pupil assessment matters in head trauma, and swollen lids can often be parted gently with no pressure on the globe. Pressing on the lids or forcing them open risks injuring an open globe beneath.

17. Which finding in a patient with facial soft-tissue injuries requires the most urgent intervention?

    1. A. Bleeding into the airway with gurgling
    2. B. A large laceration across the forehead
    3. C. Swelling and bruising of the cheeks
    4. D. A partly avulsed earlobe
    Show answer

    Answer: A. Bleeding into the airway with gurgling

    Gurgling means blood is in the airway and needs immediate suction and positioning. A large forehead laceration may bleed but is controlled with pressure.

18. A cold pack applied to a facial contusion helps by:

    1. A. Restoring sensation to the area
    2. B. Removing bacteria from the wound
    3. C. Improving lymphatic drainage
    4. D. Reducing swelling and bleeding
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    Answer: D. Reducing swelling and bleeding

    Cold constricts vessels and limits the swelling that can distort the face and threaten the airway. It does not sterilize wounds.

19. A patient has a bleeding forehead laceration, a deformed nose, and a small chest wound, and his BP is falling. Which injury should you treat first?

    1. A. The forehead laceration
    2. B. The chest wound
    3. C. The nasal deformity
    4. D. The facial bleeding
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    Answer: B. The chest wound

    Facial wounds are dramatic but rarely cause shock in adults, so the wound threatening life comes first. Forehead bleeding is controlled with pressure once the chest is addressed.

20. A patient was struck in the face with a sharp machete and has a deep laceration exposing the bones of the cheek. Which complication should you anticipate?

    1. A. Air embolism through facial veins
    2. B. Compartment syndrome of the cheek
    3. C. Heavy bleeding and airway swelling
    4. D. Loss of hearing in the ear on that side
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    Answer: C. Heavy bleeding and airway swelling

    Deep facial wounds can bleed heavily from the rich vascular supply and can swell, threatening the airway. Facial veins do not draw in air the way large open neck veins can, and the cheek has no closed compartment like a limb.

21. The use of a pressure dressing over a laceration near the eye is limited by the need to:

    1. A. Keep the patient able to see
    2. B. Avoid pressure on the globe
    3. C. Prevent drying of the wound
    4. D. Allow tears to drain freely
    Show answer

    Answer: B. Avoid pressure on the globe

    A possible globe injury beneath a periorbital wound means pressure must stay off the eye. Use light pressure on the surrounding bone and cover the eye with a shield if needed.

22. A 20-year-old has a laceration through the full thickness of his lip. Which care is appropriate?

    1. A. Apply pressure on both sides of the lip
    2. B. Close it with adhesive strips in the field
    3. C. Irrigate it with alcohol
    4. D. Leave it open to drain
    Show answer

    Answer: A. Apply pressure on both sides of the lip

    Holding gauze on both the inner and outer surface controls bleeding from a through-and-through lip wound. Repair of the lip margin is done at the hospital for cosmetic alignment.

23. A patient whose face hit a windshield has many small embedded glass fragments. The main field priorities are:

    1. A. Removing every glass fragment before transport
    2. B. Scrubbing the face with antiseptic
    3. C. Applying ointment to all the wounds
    4. D. Airway, bleeding control, and eye protection
    Show answer

    Answer: D. Airway, bleeding control, and eye protection

    Small fragments are removed at the hospital; in the field, protect the airway and eyes and control bleeding. Scrubbing pushes glass deeper and causes more injury.

24. When documenting facial soft-tissue injuries, you should:

    1. A. Record only injuries that are bleeding
    2. B. Describe the size, location, and appearance
    3. C. Estimate the likelihood of permanent scarring
    4. D. Defer description to the physician
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    Answer: B. Describe the size, location, and appearance

    A clear description supports clinical care and, in assault or abuse cases, possible legal proceedings. Paramedics document findings rather than predicting cosmetic outcomes.

25. A 28-year-old woman has facial bruises of different ages and says she walked into a door. Her partner answers questions for her. You should:

    1. A. Accept the history without concern
    2. B. Confront the partner directly
    3. C. Suspect intimate partner violence
    4. D. Record the injuries as accidental
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    Answer: C. Suspect intimate partner violence

    Facial injuries are among the most common in intimate partner violence, and injuries of different ages with an implausible history are red flags. Ensure scene safety, speak with her privately if possible, and report per local law.