Special Areas and Populations: Face, Neck, Chest, Abdomen, Genitals, and Age Practice Questions

25 multiple-choice questions on Special areas and populations: face, neck, chest, abdomen, genitals, and age 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. A scalp laceration often bleeds heavily because the scalp vessels:

   1. A. Lie directly on top of the skull bone
   2. B. Are held open by dense connective tissue
   3. C. Carry blood at a higher arterial pressure
   4. D. Have no smooth muscle in their walls
   Show answer

   Answer: B. Are held open by dense connective tissue

   Dense scalp connective tissue keeps cut vessels from retracting and constricting, so even small scalp wounds bleed briskly. The vessels do have smooth muscle and normal pressure; they simply cannot clamp down.

2. A patient with a facial laceration and heavy bleeding into the mouth is at greatest immediate risk of:

   1. A. Airway obstruction
   2. B. Hypovolemic shock
   3. C. Compartment syndrome
   4. D. Wound infection
   Show answer

   Answer: A. Airway obstruction

   Blood, broken teeth, and swelling can block the airway, so suction and positioning come first. Shock is possible with heavy facial bleeding, but the airway is the faster threat.

3. A 27-year-old was stabbed in the front of the neck. There is little external bleeding, but a hematoma is expanding and his voice is becoming hoarse. The greatest immediate threat is:

   1. A. Hypovolemic shock from the hematoma
   2. B. Spinal cord injury from the knife blade
   3. C. Infection spreading into the deep neck
   4. D. Airway compromise from the swelling
   Show answer

   Answer: D. Airway compromise from the swelling

   An expanding neck hematoma with voice change is a hard sign of vascular and airway injury: blood trapped in the neck can compress and distort the larynx and trachea within minutes, so prepare for a difficult airway, seal the wound with an occlusive dressing, and transport rapidly to a trauma center. Shock is possible, but a confined neck hematoma obstructs the airway long before its volume is fatal. Cord injury from an anterior stab is uncommon and would cause motor or sensory deficits, which he does not have. Deep neck infection is a complication that develops over days.

4. A man stabbed in the side of the neck has a wound that has stopped bleeding with a firm clot over it. He is alert with stable vital signs. You should:

   1. A. Remove the clot to look at the vessel
   2. B. Probe the wound gently to find its depth
   3. C. Leave the clot; cover it without probing
   4. D. Rinse it hard with saline to clean it
   Show answer

   Answer: C. Leave the clot; cover it without probing

   Probing a neck wound, removing the clot, or forceful irrigation can restart massive bleeding or allow air into an injured vein. Cover it with an occlusive dressing, monitor the airway for an expanding hematoma, and transport. Wound exploration belongs in the operating room.

5. When holding pressure on a bleeding neck wound, you must avoid:

   1. A. Using a gloved hand over the dressing
   2. B. Pressing on both sides of the neck at once
   3. C. Covering the wound with an occlusive layer
   4. D. Keeping the patient in a supine position
   Show answer

   Answer: B. Pressing on both sides of the neck at once

   Pressure on both carotid arteries can cut off blood flow to the brain, so press only on the injured side. A gloved hand over an occlusive dressing is the correct technique.

6. A patient with an open neck laceration suddenly becomes short of breath, has chest pain, and loses consciousness. The most likely cause is:

   1. A. Simple vasovagal syncope
   2. B. Air embolism from the neck vein
   3. C. Anxiety-related hyperventilation
   4. D. Low blood glucose level
   Show answer

   Answer: B. Air embolism from the neck vein

   Sudden cardiopulmonary collapse after an open neck vein wound suggests air embolism; seal the wound, give high-flow oxygen, and position per protocol (left side down with the head lowered is traditional, though the evidence for it is weak and mostly from animal studies). Vasovagal syncope does not cause chest pain and respiratory distress of this kind.

7. A finger was crushed in a car door an hour ago. The nail is intact, but a dark purple collection under it causes throbbing pain. This is a:

   1. A. Fungal nail infection
   2. B. Skin abrasion
   3. C. Subungual hematoma
   4. D. Ingrown nail
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   Answer: C. Subungual hematoma

   Blood trapped under the nail after a crush injury is a subungual hematoma; pressure under the rigid nail causes throbbing pain, and an underlying fracture or nail bed laceration is common. Apply a cold pack, elevate, splint if needed, and recommend evaluation, since the hospital may drain it. Infections and ingrown nails develop over days and do not follow acute crush.

8. After an unvented occlusive dressing is placed on a sucking chest wound, the patient becomes more short of breath and hypotensive. You should first:

   1. A. Lift one edge of the dressing
   2. B. Add a second dressing on top
   3. C. Increase the oxygen flow rate
   4. D. Apply a firm pressure bandage
   Show answer

   Answer: A. Lift one edge of the dressing

   Worsening distress suggests tension pneumothorax from air trapped under the seal; lifting an edge lets it escape. Adding another dressing traps even more air.

9. During a 45-minute rural transport of a patient with an abdominal evisceration, you notice the moist dressing over the bowel is starting to dry. You should:

   1. A. Replace it with dry gauze so it will not stick
   2. B. Gently push the bowel back in to keep it moist
   3. C. Remove the outer cover so air can reach the bowel
   4. D. Moisten the dressing again with sterile saline
   Show answer

   Answer: D. Moisten the dressing again with sterile saline

   Exposed bowel must stay moist and warm, so add sterile saline to the existing dressing and keep the occlusive layer and blankets over it. Dry gauze adheres to the serosa and tears it when removed. Pushing the bowel back adds contamination and can injure it; replacement is done in the operating room. Removing the outer occlusive cover lets the bowel dry and lose heat faster; exposure to air is harmful, not helpful.

10. A patient with an abdominal evisceration and no suspected spinal injury should be positioned:

    1. A. Prone with the legs extended
    2. B. Sitting with the legs straight
    3. C. Supine with the knees flexed
    4. D. On the side with legs straight
    Show answer

    Answer: C. Supine with the knees flexed

    Flexing the knees relaxes the abdominal muscles and reduces tension on the wound. Prone positioning presses directly on the exposed organs.

11. A 28-year-old man has an avulsion of the scrotal skin from a machinery accident. You should:

    1. A. Save the skin under a moist dressing
    2. B. Trim away the loose skin at the scene
    3. C. Apply ice directly against the area
    4. D. Leave the area uncovered for air
    Show answer

    Answer: A. Save the skin under a moist dressing

    Avulsed scrotal tissue is saved and covered with moist sterile dressings because it may be used in reconstruction. Trimming loose skin destroys tissue the surgeon needs.

12. A laceration over the front of the knee is leaking clear, slightly sticky, yellow fluid. This suggests:

    1. A. Normal serum from a shallow cut
    2. B. The wound has entered the joint
    3. C. Lymph from a cut lymphatic vessel
    4. D. Plasma leaking from a deep bruise
    Show answer

    Answer: B. The wound has entered the joint

    Clear, viscous fluid from a wound over a joint suggests synovial fluid and an open joint injury, which carries a high risk of septic arthritis and needs surgical washout. Cover with a sterile dressing, splint, and transport. Serum, lymph, and plasma from a bruise are thin and watery rather than sticky, so a sticky leak over the knee should be treated as synovial fluid.

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. When caring for a patient with a genital injury, it is most important to:

    1. A. Delay the exam until the hospital
    2. B. Allow a bystander to stay close
    3. C. Protect privacy while examining
    4. D. Leave the clothing fully in place
    Show answer

    Answer: C. Protect privacy while examining

    Expose and examine only as needed and shield the patient from onlookers, because genital injuries are embarrassing and may involve assault. Delaying the exam entirely can miss serious bleeding.

15. A patient has a laceration of the eyelid and a possible injury to the eyeball. You should:

    1. A. Hold firm pressure on the eyelid
    2. B. Irrigate the eye with sterile water
    3. C. Remove any visible debris from the eye
    4. D. Cover the eye without pressing on it
    Show answer

    Answer: D. Cover the eye without pressing on it

    Pressure on an injured globe can push eye contents out, so cover the eye with a loose dressing or shield. Firm pressure is the usual bleeding control step, which is why it is tempting here.

16. A man has a bleeding laceration through his eyebrow. When cleaning around the wound, you should:

    1. A. Leave the eyebrow intact
    2. B. Shave the eyebrow off
    3. C. Pluck hairs at the edges
    4. D. Trim it short
    Show answer

    Answer: A. Leave the eyebrow intact

    Eyebrows are an important landmark for aligning the wound edges during repair and may not grow back normally if shaved, so they are left intact. Plucking or trimming them also removes the landmark. Clean gently, control bleeding, and dress the wound.

17. A 75-year-old woman has a skin tear on the forearm under an old adhesive dressing. To remove the dressing, you should:

    1. A. Pull it off quickly in one motion
    2. B. Moisten it and peel it off slowly
    3. C. Cut through it and the skin flap
    4. D. Leave it and tape over the top
    Show answer

    Answer: B. Moisten it and peel it off slowly

    Fragile older skin tears again easily, so moisten adhesive and remove it gently in the direction of the flap. Ripping it off quickly reduces pain briefly but can tear the skin further.

18. An 82-year-old has a skin tear on the forearm with a thin flap still attached. Bleeding has stopped. The best field care is to:

    1. A. Secure the flap with strips of adhesive tape placed directly on skin
    2. B. Trim off the flap so the wound edges are clean and even
    3. C. Ease the flap back into place and apply a nonadherent dressing
    4. D. Leave the flap rolled back and cover the wound with dry gauze
    Show answer

    Answer: C. Ease the flap back into place and apply a nonadherent dressing

    Skin tear guidance (ISTAP) is to gently realign the viable flap over the wound bed, cover it with a nonadherent dressing such as silicone or petrolatum gauze, and hold it with a roller or tubular bandage rather than tape; an arrow on the dressing shows which way to remove it. Adhesive tape on fragile skin causes new tears when it comes off. Trimming discards living tissue that can heal as a natural graft. A rolled-back flap dies, and dry gauze sticks to the wound bed and tears it again at the next dressing change.

19. An older patient on apixaban has a growing bruise on her thigh after a fall. To help the hospital judge whether it is still expanding, you should:

    1. A. Massage the bruise to spread the blood
    2. B. Apply heat to speed up healing of the area
    3. C. Photograph only her face for identification
    4. D. Outline its edges with a pen and the time
    Show answer

    Answer: D. Outline its edges with a pen and the time

    Marking the borders of a hematoma with the time lets you and the receiving team see whether it is enlarging, which signals ongoing bleeding in an anticoagulated patient. Massage and heat can worsen bleeding; a cold pack and pressure are appropriate. A photo of her face does nothing to track the bruise.

20. Children with large open wounds lose body heat faster than adults mainly because children have:

    1. A. Thicker skin over the trunk
    2. B. More surface area per kilogram
    3. C. More subcutaneous fat stores
    4. D. Slower metabolic heat output
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    Answer: B. More surface area per kilogram

    A larger surface-to-mass ratio speeds heat loss through exposed skin and wounds, so keep injured children covered. Children actually have higher, not slower, metabolic rates.

21. Which pattern of bruising in a 3-year-old most strongly suggests abuse?

    1. A. Bruises on the back and ears
    2. B. Bruises on the shins and knees
    3. C. A bruise on the forehead
    4. D. Scrapes on both palms
    Show answer

    Answer: A. Bruises on the back and ears

    Bruises on protected areas such as the back, buttocks, and ears, or bruises in patterns, are red flags for nonaccidental trauma. Shin, knee, and forehead bruises are typical of toddler falls and play.

22. A child has a bruise in the shape of a hand on the cheek, and the caregiver's story is inconsistent. You should:

    1. A. Confront the caregiver directly
    2. B. Ask the child to explain in front of the caregiver
    3. C. Accept the story to keep rapport
    4. D. Document objectively and report
    Show answer

    Answer: D. Document objectively and report

    Record findings and statements objectively and report suspected abuse as required by law. Confronting the caregiver may escalate danger to the child and the crew.

23. A 2-year-old has a bleeding forehead laceration. Compared with an adult with the same wound, the child:

    1. A. Heals more slowly than an adult
    2. B. Has a lower risk of going into shock
    3. C. Tolerates less total blood loss
    4. D. Needs no dressing over the wound
    Show answer

    Answer: C. Tolerates less total blood loss

    Children have a small total blood volume, so a given loss is a larger share of circulation. They actually heal faster than adults, which makes that distractor a common confusion.

24. A patient reports a sexual assault and has minor genital bleeding. To preserve evidence, you should:

    1. A. Wash the area with saline
    2. B. Avoid cleaning the area
    3. C. Discard the torn clothing
    4. D. Encourage her to shower
    Show answer

    Answer: B. Avoid cleaning the area

    Do not wash the area unless needed for bleeding control, and place clothing in paper bags. Washing seems like good wound care but destroys forensic evidence.

25. A facial laceration that crosses the border of the lip needs careful repair mainly because:

    1. A. Precise alignment prevents a visible scar
    2. B. Lip wounds will not heal unless they are closed
    3. C. Lip wounds are usually caused by a jaw fracture
    4. D. Lip wounds carry a high risk of tetanus
    Show answer

    Answer: A. Precise alignment prevents a visible scar

    Even a small mismatch at the vermilion border leaves an obvious scar, so these wounds are referred for precise closure. Lip wounds heal well because the face is very vascular; closure is about appearance, not healing.