FISDAP TRAUMA 2026 ACTUAL EXAM TEST
WITH QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES
GRADED A+
A patient has an open chest wound, which has been covered with
an occlusive dressing. He is receiving oxygen at 12 L/min by
nonrebreathing mask. During transport, the patient's heart rate
increases, he becomes pale and diaphoretic, and his oxygen
saturation falls.
What should you do?
A) Remove the occlusive dressing.
B) Ventilate with a bag-mask device.
C) Increase the oxygen to 15 L/min.
D) Encourage him to take deep breaths. Correct Answer A)
Remove the occlusive dressing.
When placing an occlusive dressing over a sucking chest
wound (open pneumothorax), it is important to remember
that you have converted the injury to a
closed pneumothorax. With no way for the air in the pleural
space to escape, and depending on the size of the
pneumothorax, the patient could develop
,excessive pleural tension that interferes with circulation
(tension pneumothorax). You should suspect that this is what
is happening to the patient in this
scenario. Your most immediate action should be to remove
the occlusive dressing and allow air to escape from the
pleural space. Positive pressure
ventilation {ie, bag-mask ventilation) in a patient whose open
chest injury has been covered with an occlusive dressing
may rapidly lead to a tension
pneumothorax; therefore, if the patient must be ventilated,
the occlusive dressing should be removed.
A patient with a chest injury has a BP of 100/70 mm Hg and a
heart rate of 100 beats/min. Reassessment reveals a BP of 90/74
mm Hg, a
pulse of 120 beats/min, and the development of jugular venous
distention. What should you suspect?
A) Massive hemothorax
B) Simple pneumothorax
C) Pericardia! tamponade
D) Traumatic aortic rupture Correct Answer C) Pericardia!
tamponade
The EMT should suspect pericardia! tamponade. Signs of
pericardia! tamponade include a narrowing pulse pressure
and jugular venous distention (JVD). The
,first pulse pressure recorded was 30 mm Hg; however, it
narrowed to 16 mm Hg during reassessment. The pulse
pressure narrows in pericardia! tamponade
because pressure against the heart prevents full relaxation
and filling; as a result, the diastolic BP increases. Because of
inadequate ventricular filling, cardiac
output decreases; this causes a decrease in the systolic BP.
JVD occurs because blood backs up into the systemic
venous system. Massive hemothorax and
traumatic aortic rupture would not be expected to cause JVD
because there is simply not enough blood in the venous
system to distend the jugular veins.
Simple pneumothorax typically does not present with signs
of shock; the patient usually complains of pleuritic chest
pain and shortness of breath. However,
in some cases, a simple pneumothorax can progress to a
tension pneumothorax and cause hemodynamic
compromise.
A hiker fell 25 feet from a ledge. There is obvious deformity to his
thoracic spine and he has a large laceration on his forehead. His
BP is
60/40 mm Hg, pulse is 50 beats/min, and respirations are 26
breaths/min. His face and chest are pale and cool, but his
abdomen and lower extremities are pink and warm. Which of the
following BEST describes the pathophysiology of these findings?
A) Loss of nervous system control over the systemic vasculature
, B) Severe bleeding into the thoracic cavity from a ruptured aorta
C) Systemic vasoconstriction due to nervous system hyperactivity
D) Increased intracranial pressure due to bleeding within the brain
Correct Answer A) Loss of nervous system control over the
systemic vasculature
On the basis of the mechanism of injury and assessment
findings, the EMT should suspect that the patient is
experiencing neurogenic shock. Neurogenic
shock occurs when an injury or condition (in this case, a
spinal injury) interrupts the nervous system's control over
the diameter of the blood vessels. As a
result, the blood vessels dilate and the patient's blood
pressure falls. The nervous system releases epinephrine and
norepinephrine when a patient is in shock,
which results in tachycardia and vasoconstriction. However,
if the nervous system is impaired, as with neurogenic shock,
these catecholamines do not get
released. Therefore, the patient with neurogenic shock is
bradycardic, not tachycardic as you would expect with other
types of shock that do not involve
nervous system impairment (ie, hypovolemic, septic,
anaphylactic). The blood vessels above the level of the injury
are still able to constrict, so the skin is pale
WITH QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES
GRADED A+
A patient has an open chest wound, which has been covered with
an occlusive dressing. He is receiving oxygen at 12 L/min by
nonrebreathing mask. During transport, the patient's heart rate
increases, he becomes pale and diaphoretic, and his oxygen
saturation falls.
What should you do?
A) Remove the occlusive dressing.
B) Ventilate with a bag-mask device.
C) Increase the oxygen to 15 L/min.
D) Encourage him to take deep breaths. Correct Answer A)
Remove the occlusive dressing.
When placing an occlusive dressing over a sucking chest
wound (open pneumothorax), it is important to remember
that you have converted the injury to a
closed pneumothorax. With no way for the air in the pleural
space to escape, and depending on the size of the
pneumothorax, the patient could develop
,excessive pleural tension that interferes with circulation
(tension pneumothorax). You should suspect that this is what
is happening to the patient in this
scenario. Your most immediate action should be to remove
the occlusive dressing and allow air to escape from the
pleural space. Positive pressure
ventilation {ie, bag-mask ventilation) in a patient whose open
chest injury has been covered with an occlusive dressing
may rapidly lead to a tension
pneumothorax; therefore, if the patient must be ventilated,
the occlusive dressing should be removed.
A patient with a chest injury has a BP of 100/70 mm Hg and a
heart rate of 100 beats/min. Reassessment reveals a BP of 90/74
mm Hg, a
pulse of 120 beats/min, and the development of jugular venous
distention. What should you suspect?
A) Massive hemothorax
B) Simple pneumothorax
C) Pericardia! tamponade
D) Traumatic aortic rupture Correct Answer C) Pericardia!
tamponade
The EMT should suspect pericardia! tamponade. Signs of
pericardia! tamponade include a narrowing pulse pressure
and jugular venous distention (JVD). The
,first pulse pressure recorded was 30 mm Hg; however, it
narrowed to 16 mm Hg during reassessment. The pulse
pressure narrows in pericardia! tamponade
because pressure against the heart prevents full relaxation
and filling; as a result, the diastolic BP increases. Because of
inadequate ventricular filling, cardiac
output decreases; this causes a decrease in the systolic BP.
JVD occurs because blood backs up into the systemic
venous system. Massive hemothorax and
traumatic aortic rupture would not be expected to cause JVD
because there is simply not enough blood in the venous
system to distend the jugular veins.
Simple pneumothorax typically does not present with signs
of shock; the patient usually complains of pleuritic chest
pain and shortness of breath. However,
in some cases, a simple pneumothorax can progress to a
tension pneumothorax and cause hemodynamic
compromise.
A hiker fell 25 feet from a ledge. There is obvious deformity to his
thoracic spine and he has a large laceration on his forehead. His
BP is
60/40 mm Hg, pulse is 50 beats/min, and respirations are 26
breaths/min. His face and chest are pale and cool, but his
abdomen and lower extremities are pink and warm. Which of the
following BEST describes the pathophysiology of these findings?
A) Loss of nervous system control over the systemic vasculature
, B) Severe bleeding into the thoracic cavity from a ruptured aorta
C) Systemic vasoconstriction due to nervous system hyperactivity
D) Increased intracranial pressure due to bleeding within the brain
Correct Answer A) Loss of nervous system control over the
systemic vasculature
On the basis of the mechanism of injury and assessment
findings, the EMT should suspect that the patient is
experiencing neurogenic shock. Neurogenic
shock occurs when an injury or condition (in this case, a
spinal injury) interrupts the nervous system's control over
the diameter of the blood vessels. As a
result, the blood vessels dilate and the patient's blood
pressure falls. The nervous system releases epinephrine and
norepinephrine when a patient is in shock,
which results in tachycardia and vasoconstriction. However,
if the nervous system is impaired, as with neurogenic shock,
these catecholamines do not get
released. Therefore, the patient with neurogenic shock is
bradycardic, not tachycardic as you would expect with other
types of shock that do not involve
nervous system impairment (ie, hypovolemic, septic,
anaphylactic). The blood vessels above the level of the injury
are still able to constrict, so the skin is pale
