Special Wounds: Bites, High-pressure Injection, Degloving, and Amputated Parts Practice Questions

25 multiple-choice questions on Special wounds: bites, high-pressure injection, degloving, and amputated parts 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. The proper care of an amputated part is to:

   1. A. Wrap in moist gauze, seal in a bag, and cool it
   2. B. Place it directly on ice so it cools quickly
   3. C. Soak it unwrapped in a cup of sterile saline
   4. D. Pack it in dry ice to keep it frozen in transport
   Show answer

   Answer: A. Wrap in moist gauze, seal in a bag, and cool it

   The part is wrapped in sterile gauze moistened with saline (or per local protocol), sealed in a plastic bag, and the bag is kept cool on ice or in ice water. Placing the part directly on ice or in dry ice causes cold injury that can prevent reimplantation, and soaking it unwrapped leaves tissue waterlogged.

2. An amputated part should be transported:

   1. A. Separately by law enforcement
   2. B. Only after the patient is stable
   3. C. Along with the patient
   4. D. To the nearest pathology lab
   Show answer

   Answer: C. Along with the patient

   The part goes with the patient so the surgical team can evaluate reimplantation immediately. Separating them wastes the limited time before the tissue dies.

3. Cooling an amputated part improves the chance of reimplantation because cooling:

   1. A. Kills bacteria in the tissue
   2. B. Slows cellular metabolism
   3. C. Stops the blood from clotting
   4. D. Reconnects nerve fibers
   Show answer

   Answer: B. Slows cellular metabolism

   Lower temperature reduces oxygen demand and extends viability. Cooling does not sterilize tissue; that is a common misconception.

4. A 42-year-old carpenter amputated his thumb with a table saw. Bleeding is controlled. Which statement about the thumb is correct?

   1. A. Thumbs are a top priority for replantation
   2. B. Thumbs are rarely reimplanted
   3. C. The thumb is less vital than the index finger
   4. D. The thumb should be cleaned with alcohol
   Show answer

   Answer: A. Thumbs are a top priority for replantation

   The thumb provides much of hand function, so reimplantation is attempted whenever possible. Alcohol damages tissue and should never be used on the part.

5. When preparing an amputated finger for transport, you should first:

   1. A. Scrub it vigorously with soap and water
   2. B. Gently rinse off debris with saline
   3. C. Trim off the ragged edges of the tissue
   4. D. Soak it in povidone-iodine solution
   Show answer

   Answer: B. Gently rinse off debris with saline

   Gently rinsing gross contamination with saline is acceptable; scrubbing or trimming damages tissue the surgeon may need. Antiseptics harm the delicate tissue.

6. A degloving injury occurs when:

   1. A. A bone protrudes through the skin
   2. B. Fingers are crushed in a door
   3. C. A glove is removed after a burn
   4. D. Skin is peeled off deeper tissue
   Show answer

   Answer: D. Skin is peeled off deeper tissue

   Degloving, often from rings caught on objects or limbs pulled into machinery, strips skin and subcutaneous tissue off like a glove. It is a severe avulsion with major damage to blood supply.

7. A 31-year-old's hand was pulled into a roller press, and the skin of the hand has been peeled back like a glove. You should:

   1. A. Cut away the loose skin and discard it at the scene
   2. B. Leave the skin flipped back so it can drain
   3. C. Return the skin to its position and dress it
   4. D. Soak the whole hand in a basin of cold water
   Show answer

   Answer: C. Return the skin to its position and dress it

   Lay the skin back in normal position and cover with a moist or dry sterile dressing per protocol, then splint. Cutting away tissue destroys potential reconstructive material.

8. A high-pressure injection injury is serious because:

   1. A. It usually causes heavy external bleeding
   2. B. The damage is limited to the outer skin
   3. C. It heals quickly without any treatment
   4. D. Small entry hides deep damage
   Show answer

   Answer: D. Small entry hides deep damage

   Paint, grease, or hydraulic fluid is forced along tissue planes, causing chemical damage, swelling, and ischemia that may require amputation. The tiny entry wound often makes the injury look minor.

9. A 36-year-old painter accidentally injected paint into his index finger with a high-pressure sprayer. The finger looks only slightly swollen with a pinhole wound. You should:

   1. A. Transport for surgical evaluation
   2. B. Apply a bandage and advise follow-up
   3. C. Squeeze the finger to remove paint
   4. D. Apply heat to prevent swelling
   Show answer

   Answer: A. Transport for surgical evaluation

   These injuries are surgical emergencies that need early debridement despite a benign appearance. Squeezing the finger can spread the material further.

10. Which statement about dog bites is correct?

    1. A. They seldom need any medical evaluation
    2. B. They rarely bleed enough to matter
    3. C. They can crush and tear tissue
    4. D. They do not transmit rabies to humans
    Show answer

    Answer: C. They can crush and tear tissue

    Large dogs generate strong jaw pressure, causing crushing, tearing, and deep punctures. Dog bites may transmit rabies and need evaluation, especially on the hands and face.

11. Cat bites carry a higher infection risk than dog bites mainly because:

    1. A. Cats carry more rabies than dogs
    2. B. Their teeth make deep punctures
    3. C. Cats' bites bleed more heavily
    4. D. Cat saliva is acidic
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    Answer: B. Their teeth make deep punctures

    Cat teeth create narrow, deep punctures that seal over and trap bacteria such as Pasteurella multocida. Infection risk is related to wound depth, not saliva acidity.

12. A 48-year-old woman was bitten on the hand by her cat 18 hours ago. The hand is now red, swollen, and painful. The most likely organism is:

    1. A. Clostridium tetani
    2. B. Streptococcus pneumoniae
    3. C. Pasteurella multocida
    4. D. Eikenella corrodens
    Show answer

    Answer: C. Pasteurella multocida

    Pasteurella multocida causes rapid infection, often within 24 hours, after cat and dog bites. Eikenella is the most tempting wrong choice, but it is a human-mouth organism, not an animal one; Clostridium tetani causes tetanus, and S. pneumoniae is a respiratory pathogen.

13. Human bites are considered high risk because:

    1. A. Human teeth are very sharp
    2. B. They commonly transmit rabies
    3. C. They cause severe bleeding
    4. D. Mouths carry many bacteria
    Show answer

    Answer: D. Mouths carry many bacteria

    Human saliva contains a large number of aerobic and anaerobic bacteria, so these wounds often become infected. Humans do not transmit rabies by biting in practice.

14. A 25-year-old has a small laceration over the knuckle after punching someone in the mouth. You should be concerned about:

    1. A. A simple, low-risk abrasion of the knuckle
    2. B. A fight bite with high infection risk
    3. C. A clean cut that can be glued shut
    4. D. A minor bruise needing ice and rest
    Show answer

    Answer: B. A fight bite with high infection risk

    Fight bites drive oral bacteria into the joint capsule and tendon sheath, and the tendon retracts when the hand opens, hiding damage. They need prompt surgical evaluation and antibiotics. They should not be glued or closed, or treated as a simple abrasion or bruise, because sealing in oral bacteria raises the risk of joint infection.

15. When treating a patient with an animal bite, which information is most important to report?

    1. A. The animal type and its vaccination status
    2. B. The animal's age, breed, and color
    3. C. Whether the patient owns other pets at home
    4. D. The exact time of day of the bite
    Show answer

    Answer: A. The animal type and its vaccination status

    Knowing the species and whether it is vaccinated and available for observation guides rabies decisions. The animal's color has no clinical relevance.

16. A child was bitten on the finger by a pet hamster that has lived indoors in a cage for a year. Regarding rabies, you should explain that:

    1. A. Rabies shots must start today
    2. B. Small rodents rarely carry rabies
    3. C. The hamster must be tested
    4. D. All mammal bites carry the same risk
    Show answer

    Answer: B. Small rodents rarely carry rabies

    Small rodents such as hamsters, mice, rats, and squirrels are almost never found to have rabies and are not known to transmit it to humans, so a caged pet hamster bite rarely needs rabies prophylaxis. The wound still needs cleaning and evaluation for infection. Bites from bats, raccoons, skunks, foxes, and unvaccinated dogs or cats carry much higher risk.

17. A patient was bitten by a raccoon behaving aggressively. Which action is most important after wound care?

    1. A. Advise the patient to watch for fever at home
    2. B. Release the patient with a simple bandage
    3. C. Report it and transport for rabies evaluation
    4. D. Recommend antibiotic ointment and home care
    Show answer

    Answer: C. Report it and transport for rabies evaluation

    Raccoons are a common rabies reservoir, and post-exposure prophylaxis must begin promptly. Waiting for fever is too late; rabies is nearly always fatal once symptoms develop.

18. Wound care for an animal bite should include:

    1. A. Sealing the wound with tape strips
    2. B. Applying a tourniquet above the bite
    3. C. Packing the wound tightly with gauze
    4. D. Irrigation and a sterile dressing
    Show answer

    Answer: D. Irrigation and a sterile dressing

    Irrigation reduces bacterial load, and a dressing protects the wound; closure decisions are made at the hospital. Sealing the wound traps bacteria and increases infection risk.

19. An infected human bite wound is classically associated with which organism?

    1. A. Eikenella corrodens
    2. B. Pasteurella multocida
    3. C. Clostridium tetani
    4. D. Bartonella henselae
    Show answer

    Answer: A. Eikenella corrodens

    Eikenella corrodens is part of normal human mouth flora and is the classic organism in human bite and fight-bite infections. Pasteurella is the tempting choice, but it is linked to cat and dog bites, and Bartonella causes cat-scratch disease.

20. Which feature of a bite wound increases the risk of infection the most?

    1. A. Location on the scalp
    2. B. Shallow depth
    3. C. Minimal tissue damage
    4. D. Location on the hand
    Show answer

    Answer: D. Location on the hand

    The hand has many tendon sheaths and compartments and relatively poor blood flow in some areas, so infections spread easily. The scalp's rich blood supply lowers infection risk.

21. A 9-year-old was bitten on the face by a neighbor's dog. The wound is gaping and bleeding moderately. Your priorities include:

    1. A. Airway, bleeding control, and transport
    2. B. Cleaning the wound and releasing the child
    3. C. Waiting for animal control first
    4. D. Closing the wound with tape strips
    Show answer

    Answer: A. Airway, bleeding control, and transport

    Facial dog bites in children can involve the airway and need surgical repair. Animal control should be notified, but patient care comes first.

22. A tourniquet has stopped the bleeding from a traumatic below-knee amputation. Transport will take 50 minutes, and his vital signs are improving. You should:

    1. A. Loosen it every 15 minutes to let blood reach the stump
    2. B. Leave it in place and record the time it went on
    3. C. Remove it once bleeding stops and use a pressure dressing
    4. D. Cover it with a blanket so it cannot be bumped or moved
    Show answer

    Answer: B. Leave it in place and record the time it went on

    Once a tourniquet controls life-threatening bleeding, it stays on, stays visible, and the application time is written on the tourniquet or patient so the hospital knows the ischemic time; transport times of an hour or two are well tolerated. Periodic loosening is outdated: each release causes new blood loss and reperfusion of ischemic tissue without saving the limb. Removing it in the field invites rebleeding, and TCCC specifically excludes amputations from field tourniquet conversion. Covering it with a blanket hides it from the receiving team and lets slow rebleeding go unnoticed.

23. A 27-year-old has a ring avulsion injury of the finger after his ring caught on a fence. The finger is pale and cold. This suggests:

    1. A. A simple superficial abrasion
    2. B. Brief vasospasm that warming will fix
    3. C. Loss of blood supply to the finger
    4. D. A nerve injury that numbs the finger
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    Answer: C. Loss of blood supply to the finger

    Ring avulsions can strip skin, vessels, and nerves, leaving the finger ischemic. These need urgent hand surgery. Nerve injury causes numbness but not a pale, cold finger, and pallor after an avulsion should not be dismissed as vasospasm that will pass.

24. Which patient with a traumatic amputation is the strongest candidate for transport to a center with replantation capability?

    1. A. A stable adult with a mangled, crushed forearm
    2. B. A stable adult with one amputated small toe
    3. C. A stable child with a clean finger amputation
    4. D. An adult with multiple life threats and a lost finger
    Show answer

    Answer: C. A stable child with a clean finger amputation

    Replantation is most strongly indicated for the thumb, multiple digits, partial hand, wrist or forearm levels, and nearly any amputated part in a child, because children regain function well. A clean, sharp cut in a stable child is an ideal candidate. A mangled, crushed forearm has destroyed vessels and muscle over a long segment and usually cannot be replanted. A single lesser toe is rarely replanted because its loss causes little disability. A patient with multiple life threats goes to the nearest appropriate trauma center for resuscitation; saving life comes before saving a part.

25. A 44-year-old has an amputated hand. Which action should be performed first?

    1. A. Control stump bleeding
    2. B. Search for and wrap the hand
    3. C. Place the hand on ice
    4. D. Call the hand surgeon
    Show answer

    Answer: A. Control stump bleeding

    The patient's life comes before the part; control hemorrhage from the stump first, then care for the amputated part. Searching for the part first is the most common priority error.