EMT TRAUMA EXAM LATEST UPDATED VERSION
QUESTIONS AND ANSWERS
Questions 1–50
1. A 22-year-old male sustained a gunshot wound to the right upper chest. He is
tachypneic, and you note diminished breath sounds on the right side. Which of
the following is the most immediate life-threatening condition you should
suspect?
A) Hemothorax
B) Tension pneumothorax
C) Simple pneumothorax
D) Pulmonary contusion
Answer: B) Tension pneumothorax
Rationale: A gunshot wound to the chest can create a one-way valve effect,
trapping air in the pleural space. The combination of penetrating trauma,
tachypnea, and diminished breath sounds points to a tension pneumothorax,
which causes hemodynamic compromise by shifting the mediastinum and
collapsing the vena cava. This is immediately life-threatening and requires needle
decompression.
2. During the primary survey of a trauma patient, you note jugular venous
distention (JVD), tracheal deviation to the left, and absent breath sounds on the
right. What is your immediate action?
,A) Apply high-flow oxygen via non-rebreather
B) Perform a needle thoracostomy on the right side
C) Intubate the patient immediately
D) Insert a nasal airway
Answer: B) Perform a needle thoracostomy on the right side
Rationale: JVD, tracheal deviation away from the affected side (right), and absent
breath sounds are the classic triad of a tension pneumothorax. Needle
decompression (14-gauge catheter in the 2nd intercostal space, midclavicular line)
is the immediate, life-saving intervention before chest tube placement.
3. A 45-year-old restrained driver involved in a high-speed MVC has a "steering
wheel" contusion on his chest. He is complaining of chest pain that worsens with
inspiration. You hear muffled heart sounds on auscultation. What is the most likely
diagnosis?
A) Myocardial contusion
B) Pericardial tamponade
C) Flail chest
D) Aortic dissection
Answer: B) Pericardial tamponade
Rationale: Muffled heart sounds (often described as distant), hypotension, and
JVD (Beck's Triad) indicate pericardial tamponade. Blood in the pericardial sac
restricts cardiac filling. While myocardial contusion is possible, the muffled sounds
and mechanism point directly to tamponade.
4. Which of the following findings is an indication for immediate decompression of
a tension pneumothorax in a pediatric trauma patient?
,A) Respiratory rate of 30
B) Pulse oximetry of 94%
C) Hypotension and decreased breath sounds
D) Crying and agitation
Answer: C) Hypotension and decreased breath sounds
Rationale: In children, hypotension is a late and ominous sign of decompensated
shock. When combined with unilateral decreased breath sounds and mechanisms
suggesting chest trauma, it indicates tension pneumothorax requiring immediate
needle decompression.
5. A 30-year-old male fell 20 feet from a ladder. He is conscious but confused. His
blood pressure is 88/62, heart rate 120, and respiratory rate 24. Which of the
following is the priority intervention?
A) Obtain a detailed history
B) Perform a rapid trauma assessment
C) Apply a cervical collar and immobilize on a long spine board
D) Initiate two large-bore IVs and fluid resuscitation
Answer: D) Initiate two large-bore IVs and fluid resuscitation
Rationale: The patient is in compensated shock (tachycardia, narrowing pulse
pressure). While spinal precautions are important (C), the immediate threat to life
is hypoperfusion. Establishing vascular access and fluid resuscitation are the
priorities alongside managing the ABCs.
6. You are treating a patient with a stab wound to the left lower chest. You note an
open, sucking wound. What is the appropriate initial management?
A) Place an occlusive dressing taped on three sides
, B) Pack the wound tightly with gauze
C) Apply a bulky dressing taped on all four sides
D) Insert a chest tube at the 5th intercostal space
Answer: A) Place an occlusive dressing taped on three sides
Rationale: An occlusive dressing taped on three sides creates a flutter-valve effect,
allowing trapped air to escape during exhalation but preventing air from entering
during inhalation, converting an open pneumothorax into a simple pneumothorax.
7. A 19-year-old athlete was struck in the chest by a baseball. He is in cardiac
arrest with pulseless electrical activity (PEA) on the monitor. What is the most
likely cause?
A) Tension pneumothorax
B) Commotio cordis
C) Massive hemothorax
D) Cardiac tamponade
Answer: B) Commotio cordis
Rationale: Commotio cordis occurs when a blunt, non-penetrating blow to the
chest (often during sports) strikes the chest wall directly over the heart during the
vulnerable repolarization phase of the cardiac cycle, causing ventricular fibrillation
or PEA/asystole.
8. When assessing a trauma patient with suspected spinal injury, which of the
following is a contraindication to the use of a rigid cervical collar?
A) Patient is combative
B) Patient has penetrating trauma to the neck
C) Patient is vomiting
QUESTIONS AND ANSWERS
Questions 1–50
1. A 22-year-old male sustained a gunshot wound to the right upper chest. He is
tachypneic, and you note diminished breath sounds on the right side. Which of
the following is the most immediate life-threatening condition you should
suspect?
A) Hemothorax
B) Tension pneumothorax
C) Simple pneumothorax
D) Pulmonary contusion
Answer: B) Tension pneumothorax
Rationale: A gunshot wound to the chest can create a one-way valve effect,
trapping air in the pleural space. The combination of penetrating trauma,
tachypnea, and diminished breath sounds points to a tension pneumothorax,
which causes hemodynamic compromise by shifting the mediastinum and
collapsing the vena cava. This is immediately life-threatening and requires needle
decompression.
2. During the primary survey of a trauma patient, you note jugular venous
distention (JVD), tracheal deviation to the left, and absent breath sounds on the
right. What is your immediate action?
,A) Apply high-flow oxygen via non-rebreather
B) Perform a needle thoracostomy on the right side
C) Intubate the patient immediately
D) Insert a nasal airway
Answer: B) Perform a needle thoracostomy on the right side
Rationale: JVD, tracheal deviation away from the affected side (right), and absent
breath sounds are the classic triad of a tension pneumothorax. Needle
decompression (14-gauge catheter in the 2nd intercostal space, midclavicular line)
is the immediate, life-saving intervention before chest tube placement.
3. A 45-year-old restrained driver involved in a high-speed MVC has a "steering
wheel" contusion on his chest. He is complaining of chest pain that worsens with
inspiration. You hear muffled heart sounds on auscultation. What is the most likely
diagnosis?
A) Myocardial contusion
B) Pericardial tamponade
C) Flail chest
D) Aortic dissection
Answer: B) Pericardial tamponade
Rationale: Muffled heart sounds (often described as distant), hypotension, and
JVD (Beck's Triad) indicate pericardial tamponade. Blood in the pericardial sac
restricts cardiac filling. While myocardial contusion is possible, the muffled sounds
and mechanism point directly to tamponade.
4. Which of the following findings is an indication for immediate decompression of
a tension pneumothorax in a pediatric trauma patient?
,A) Respiratory rate of 30
B) Pulse oximetry of 94%
C) Hypotension and decreased breath sounds
D) Crying and agitation
Answer: C) Hypotension and decreased breath sounds
Rationale: In children, hypotension is a late and ominous sign of decompensated
shock. When combined with unilateral decreased breath sounds and mechanisms
suggesting chest trauma, it indicates tension pneumothorax requiring immediate
needle decompression.
5. A 30-year-old male fell 20 feet from a ladder. He is conscious but confused. His
blood pressure is 88/62, heart rate 120, and respiratory rate 24. Which of the
following is the priority intervention?
A) Obtain a detailed history
B) Perform a rapid trauma assessment
C) Apply a cervical collar and immobilize on a long spine board
D) Initiate two large-bore IVs and fluid resuscitation
Answer: D) Initiate two large-bore IVs and fluid resuscitation
Rationale: The patient is in compensated shock (tachycardia, narrowing pulse
pressure). While spinal precautions are important (C), the immediate threat to life
is hypoperfusion. Establishing vascular access and fluid resuscitation are the
priorities alongside managing the ABCs.
6. You are treating a patient with a stab wound to the left lower chest. You note an
open, sucking wound. What is the appropriate initial management?
A) Place an occlusive dressing taped on three sides
, B) Pack the wound tightly with gauze
C) Apply a bulky dressing taped on all four sides
D) Insert a chest tube at the 5th intercostal space
Answer: A) Place an occlusive dressing taped on three sides
Rationale: An occlusive dressing taped on three sides creates a flutter-valve effect,
allowing trapped air to escape during exhalation but preventing air from entering
during inhalation, converting an open pneumothorax into a simple pneumothorax.
7. A 19-year-old athlete was struck in the chest by a baseball. He is in cardiac
arrest with pulseless electrical activity (PEA) on the monitor. What is the most
likely cause?
A) Tension pneumothorax
B) Commotio cordis
C) Massive hemothorax
D) Cardiac tamponade
Answer: B) Commotio cordis
Rationale: Commotio cordis occurs when a blunt, non-penetrating blow to the
chest (often during sports) strikes the chest wall directly over the heart during the
vulnerable repolarization phase of the cardiac cycle, causing ventricular fibrillation
or PEA/asystole.
8. When assessing a trauma patient with suspected spinal injury, which of the
following is a contraindication to the use of a rigid cervical collar?
A) Patient is combative
B) Patient has penetrating trauma to the neck
C) Patient is vomiting
