NREMT-PTE : NREMT Paramedic Trauma Exam

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NREMT-PTE
NREMT Paramedic Trauma Exam
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Question: 41
Which of the following most accurately describes the finding of jugular venous
distension in pneumothorax?
A. It is an early finding of even minor pneumothoraxes
B. It indicates relative hypovolemia in the thorax due to hemorrhage
C. It is indicative of high intrathoracic pressure
D. Pneumothorax is more likely to cause jugular vein flattening
Answer: C
JVD is typically a sign of increased intrathoracic pressure, but can be a very late
finding. It presents when increased pressure on the great vessels in the thorax
cause a backup of blood returning from the head. This typically presents in
serious tension pneumothoraxes and does not appear in minor cases.
Question: 42
Beck’s triad is a combination of increased JVD, hypotension and muffled heart
tones and occurs in which of the following?
A. Hemothorax
B. Cardiac tamponade
C. Aortic dissection
D. Traumatic brain injury
Answer: B
Beck’s triad is observed in cases of cardiac tamponade and is caused by the
increase in pressure in the pericardial sac, which, in turn, causes the inability of
the ventricles to expand fully. This results in hypotension systemically and a
backup of blood in the jugular veins.
Question: 43
Upon arrival to the scene of a stabbing, you find a patient with a stab wound to
the left chest, midclavicular, 4th intercostal space. The patient is in peri-arrest,
hypotensive, with a rapid, thready pulse and jugular venous distension. The
patient’s GCS score is 3. You perform bilateral needle decompression, but there is
no rush of air or improvement in patient’s condition. The patient no longer has a
pulse and now presents in PEA. Which of the following is suspected in assessing
the patient?
A. Cardiac rupture
B. Diaphragmatic rupture
C. Hemopneumothorax
D. Pericardial tamponade
Answer: D -Hypotension presenting with JVD and clear mechanism of
traumatic injury is highly suspect for pericardial tamponade. Consideration for a
hemothorax, pneumothorax, or hemopneumothorax should be made and can be
differentiated by considering location of penetrating trauma, presence of Beck’s
triad and clinical suspicion. Cardiac rupture is almost entirely caused by blunt
force trauma, particularly in MVAs.
Question: 44
Other than rapid transport to a trauma center, which of the following is most
helpful for a patient suffering from pericardial tamponade?
A. Needle thoracostomy
B. Positive pressure ventilation therapy
C. Aggressive IV fluid administration
D. Remote ischemic conditioning
Answer: C
The best prehospital treatment for patients with pericardial tamponade is to
maintain vital signs and keep perfusion up. Oxygenation is typically not a
problem for these patients, but the increase in pressure around the heart requires
that adequate preload be maintained.
Question: 45
Which type of mechanism of injury is not likely in patients with posterior rib
fractures of the second and third ribs?
A. Frontal strike
B. Compression of the ribcage from the side
C. Relatively high force impact
D. All of the above.
Answer: A
Frontal impacts are more likely to cause lateral fractures, not posterior fractures.
Posterior second and third rib fractures are usually a result of high velocity side
impact to the chest. The first, second, and third ribs in healthy adults are strong
and require a high degree of force to fracture. When posterior fractures do occur,
it is usually from side impact.
Question: 46
You are called to the scene of an elderly patient female who slipped and fell,
landing on her chest. She complains of dyspnea and chest pain that increases with
inspiration and palpation. She states that her symptoms are much better when she
holds pressure on her left side. What is the most likely cause of her symptoms?
A. Hypovolemia from hip fracture
B. Tension pneumothorax
C. Rib fracture
D. Traumatic asphyxiation
Answer: C
This patient likely has a fractured rib. Elderly patients are more vulnerable to rib
fractures due to their bones becoming more brittle with age. The presentation of
mild dyspnea with improvement in symptoms when being held is very typical of
rib fractures.
Question: 47
You are called to the scene of an elderly patient female who is displaying classic
symptoms of a fractured rib. The patient’s GCS level is 15, oxygen saturation on
room air is 93%. Heart rate is 112, blood pressure is 142/102. What is the most
appropriate course of treatment for this patient?
A. Use rib binders for comfort, apply high flow O2, transport to a trauma center
B. Apply supplemental O2 via nasal cannula, monitor for ventilatory changes,
transport to a trauma center
C. Bind the ribs for comfort, apply nebulized albuterol for dyspnea, give 324mg
aspirin for chest pain, transport to a trauma center
D. Give nitroglycerine 0.4mg sublingual for chest pain, apply high flow O2,
transport to a cardiac center
Answer: B
The optimal treatment for patients with broken ribs includes supplemental O2 as
needed and monitor for changes during transport to trauma center. C-spine
precautions should be considered per protocol. The use of chest binders is
contraindicated as it can result in hypoventilation. This patient should receive an
assessment for cardiac chest pain, but this etiology is unlikely given the
mechanism of injury and nature of complaints.
Question: 48
Flail chest occurs when a segment of the rib cage is broken and detached
following trauma. This typically presents as a section of the rib cage moving out
of sync and independent of from breathing motions. What is this phenomenon
called?
A. Pulsus paradoxus
B. Rib contusion
C. Paradoxic chest wall movement
D. Traumatic pneumonia
Answer: C
This pattern of chest wall movement is called paradoxic chest wall movement.
This paradoxical movement causes significant pain and dyspnea and is usually
accompanied by a pulmonary contusion, the latter of which and can lead to
respiratory compromise.
Question: 49
What is the best management for a patient with flail chest who is deteriorating
and developing severe respiratory distress?
A. Analgesia to reduce the pain of respiration
B. Needle thoracostomy to reduce internal pressure
C. Encouragement to hold their breath to increase the internal pressure
D. CPAP or positive pressure by BVM to internally splint the injury
Answer: D
Patients that are starting to develop severe respiratory distress require ventilation
assistance in order to avoid complete respiratory compromise. By applying
positive airway pressure carefully, the flail segment can become splinted
internally, allowing for better ventilation. Analgesics would have been more
applicable before a patient reaches this point. Needle thoracostomy would not
help this patient.

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