Deck 32: Spinal Column and Spinal Cord Trauma

Question 1

Which one of the following signs or symptoms best indicates the patient has suffered an injury to the thoracic spine?

A) Bruising to the back
B) Paralysis of the arms
C) Tingling in the legs
D) Cool and diaphoretic skin

Answer 1

C

Question 2

A patient injured in a motor vehicle collision is suffering from the separation of the rib and its associated spinal vertebrae. Based on the anatomy of the spine, where has this injury occurred?

A) Lumbar spine
B) Cervical spine
C) Middle spine
D) Thoracic spine

Answer 2

D

Question 3

For a person to make a fist, which one of the following must occur?

A) The central nervous system must send a message through the spinal cord and then to the peripheral nerves.
B) The central nervous system must send a message through the spinal cord and then to the autonomic nervous system.
C) The peripheral nervous system must send a message to the brain and then back through the peripheral nervous system.
D) The muscles must signal the brain to send a message through the autonomic nervous system.

Answer 3

A

Question 4

You have been called for a patient with severe back pain. When obtaining a medical history, he tells you that he has a history of damaged disks in his vertebrae. As a knowledgeable EMT, you should recognize that the:

A) ligaments on the side of the spinal column were overstretched.
B) vertebrae making up the spinal column were fractured.
C) nerves making up the spinal cord have been damaged.
D) fluid-filled structures between the vertebrae have been injured.

Question 5

You arrive on the scene of a two-car motor vehicle collision. The patient was the unrestrained driver of a car that struck another from behind at 25 mph. In the course of the collision, the patient flew forward and struck the windshield with his head. No air bags were deployed. The patient extricated himself and denies head, neck, or back pain; however, you do note a small cut on his hand, which occurred as he was getting out of the car. When asked about preexisting medical problems he tells you that he did have herniated disks in his lumbar spine that were surgically repaired several years ago. Based on this, your strongest reason to fully immobilize this patient would be:

A) history of back surgery.
B) laceration to the hand.
C) self-extrication of the patient.
D) mechanism of injury.

Question 6

A young female driver, involved in a motor vehicle collision, complains of cervical pain resulting from a lateral-type mechanism of neck injury. Based on this information, what type of collision most likely took place?

A) The patient's car was struck from behind.
B) The patient's car was struck from the side.
C) The patient's car struck a utility pole head on.
D) The patient's car rear-ended another car.

Question 7

As you approach a motorcyclist who was thrown from his bike, you hear him saying that he cannot feel or move his legs. You note obvious deformity to both femurs as well as his left wrist and forearm. Emergency Medical Responders are holding manual in-line spinal stabilization. Of the following, which should be done first?

A) Check for motor function and sensation in the feet.
B) Expose the legs and look for bleeding.
C) Check his rate and effort of breathing.
D) Place a cervical collar and administer oxygen.

Question 8

You have arrived on a shooting where a middle-aged male has suffered a single gunshot wound to the abdomen. As you approach the patient, you note that he is sitting up and talking with the police officer holding a blood-soaked towel over the left upper quadrant of his abdomen. Your initial action in caring for this patient is to:

A) take manual in-line spinal stabilization.
B) determine the need for airway management.
C) expose the abdomen to assess the gunshot wound.
D) obtain a pulse rate, respiratory rate, blood pressure, and SpO₂.

Question 9

A 42-year-old man has called 911 because of severe back pain. He informs you that his back pain is related to a recent fracture of his coccyx. Based on this information, where should the EMT expect the patient to be complaining of pain?

A) Neck
B) Upper back
C) Pelvic area
D) Lower back

Question 10

Assessment of a young girl who was hit while riding her bike reveals her to be responsive to painful stimuli with flexion of the extremities and in respiratory distress. There is marked deformity to her thoracic spine and bruising noted to her anterior chest and abdomen. She does not move her legs when a noxious stimulus is applied to the lower extremities. Manual in-line spinal stabilization is being held and a cervical collar has been applied. Given the critical nature of this patient, which one of the following is most appropriate for her care?

A) Rapidly transfer her to the stretcher with immobilization to the long board done en route to the hospital.
B) Transfer her to the long board already placed on the stretcher and secure with straps en route to the hospital.
C) Take time to completely immobilize her to the long board on scene prior to rapid transport to the hospital.
D) Wait for family members to arrive and give consent for treatment prior to moving her to the stretcher for immediate transport.

Question 11

An Emergency Medical Responder reports that a male patient, injured while playing football, has bruising to the lumbar area of the back. Based on this statement, the EMT should expect to find bruising in which area?

A) Upper back
B) Neck
C) Lower back
D) Buttocks

Question 12

A young intoxicated male patient cannot move his left arm and leg after diving into the shallow end of a pool and hitting the bottom head first. The EMT would recognize which of the following mechanisms as most likely responsible for this injury?

A) Compression
B) Rotation
C) Distraction
D) Penetration

Question 13

While performing the primary assessment on a patient with an isolated spinal cord injury, you note that he is in severe respiratory distress and struggling to breathe. Where should you suspect the spinal cord injury has occurred?

A) Diaphragm
B) Cervical spine
C) Thoracic spine
D) Lumbar spine

Question 14

Which one of the following shows that the EMT is correctly assessing motor function in the arms of a patient with potential spine injuries?

A) "Can you tell me what finger I am touching?"
B) "I need you to flex both arms across your chest."
C) "I am going to move your arm; tell me if it hurts."
D) "I am going to feel for a pulse in your wrist."

Question 15

An elderly patient has fallen down a flight of stairs and is complaining of neck and back pain as well as weakness to both legs. The primary assessment reveals no life threats to the airway, breathing, or circulation. Manual in-line spinal stabilization is being maintained. Which of the following would the EMT do next?

A) Apply high-concentration oxygen and move to the stretcher for transport.
B) Complete the secondary assessment looking for injuries.
C) Place an oral airway and begin positive pressure ventilation.
D) Place a cervical collar and immobilize to the long spine board.

Question 16

Which injury is possible based on the anatomy of the spine?

A) Fracture to the ninth cervical vertebra
B) Dislocation of lumbar vertebra number 6
C) Disk injury between thoracic vertebrae 11 and 12
D) Compression fracture to lumbar vertebra 12

Question 17

The EMT is caring for a patient who has a problem with the autonomic component of his nervous system. Which sign or symptom would most likely be caused by this condition?

A) Difficulty walking
B) Elevated heart rate
C) Inability to move facial muscles
D) Trouble remembering his name

Question 18

What area of the spinal cord is most commonly injured?

A) Cervical spine
B) Thoracic spine
C) Lumbar spine
D) Sacral spine

Question 19

Based on the structure of the nervous system, which of the following is true?

A) A stroke represents an injury to the peripheral nervous system.
B) A gunshot wound to the spinal cord will directly damage the peripheral nerves.
C) A deep laceration to the arm can sever peripheral nerves.
D) Numbness in a fractured leg indicates damage to the autonomic nervous system.

Question 20

You arrive on the scene of a motor vehicle collision. Walking toward you is the unrestrained driver of the vehicle that sustained moderate front-end damage. The patient complains of some back pain, but is walking around after the crash and does not appear to be suffering from any neurological deficits. What is your initial action in caring for this patient?

A) Perform the primary assessment.
B) Obtain the patient's vital signs.
C) Look for injuries to the patient's back.
D) Take manual in-line spinal stabilization.

Question 21

Assessment of the cervical spine of a patient, complaining of lower back pain after falling down five stairs, reveals no displacement, tenderness, or instability. Accordingly, the EMT should:

A) release manual in-line spinal stabilization.
B) apply a properly sized cervical collar.
C) immobilize to a backboard without a cervical collar.
D) inform the team that immobilization is not needed.

Question 22

For which of the following patients involved in a motor vehicle collision is the use of a vest-type short immobilization device indicated?

A) 41-year-old male who was ejected and is lying supine in the roadway complaining of back pain
B) 25-year-old restrained driver who is unresponsive and has a history of diabetes and cardiac problems
C) 15-year-old female complaining of neck and back pain who was self-extricated and is standing next to the car
D) 33-year-old female in the backseat who states that her neck hurts and she has a headache

Question 23

A patient has been struck in the back by a heavy piece of wood that was being bent to make a form for a concrete arch. He is responsive, but cannot feel or move his legs. He has bruising to his back and is incontinent of urine. The skin below the injury site is red and warm. As a knowledgeable EMT, you should realize that:

A) the paralysis is permanent.
B) the ability to feel will return.
C) a cervical collar is unnecessary.
D) the paralysis may resolve.

Question 24

A patient involved in a diving accident has his head positioned so that his left cheek is touching his left shoulder. He states that he has severe pain in his neck and it hurts to move his head. He denies numbness, tingling, or decreased strength in his arms or legs. Which one of the following is the EMT's best course of action?

A) Carefully straighten the head and neck so that a cervical collar can be placed.
B) Stabilize and maintain the head in the position in which the patient is holding it.
C) Avoid use of a cervical collar or backboard and transport in the patient's current position.
D) Avoid palpation of the cervical spine and apply a vest-type spinal immobilization device.

Question 25

A patient is complaining of back pain and numbness to both legs after being thrown from a bicycle. When should the EMT first check the motor function, sensory function, and pulses in this patient?

A) Immediately after taking manual in-line spinal immobilization
B) Immediately after application of a cervical collar
C) During the primary assessment
D) As the secondary assessment is performed

Question 26

A patient is lying under a tree after being involved in a motor vehicle collision. She states that immediately after the crash, she felt okay, but now her legs are numb and tingling. She also has lower back discomfort. What question is it most important for the EMT to ask first?

A) "Do you think that you had a seizure?"
B) "Are you allergic to any medications?"
C) "How did you get out of the car?"
D) "Do you have a history of back problems?"

Question 27

While transporting a 38-year-old female who fell from a second-story window, you note that she is becoming confused and her pulse rate is increasing. Additionally, her blood pressure has dropped and her skin is now cool and clammy. Based on these assessment findings you would recognize:

A) spinal shock.
B) hypovolemic shock.
C) neurogenic shock.
D) head injury.

Question 28

A patient dove into a shallow pool and struck his head on the bottom. Your assessment findings indicate that he has no motor or sensation ability in his legs, but he can move his arms. The EMT should recognize which of the following conditions?

A) Paraplegia
B) Quadriplegia
C) Hemiplegia
D) Tetraplegia

Question 29

When performing the secondary assessment, what sign is most suggestive of a spinal cord injury?

A) Pain in the right leg
B) Headache and nausea
C) Bruising on the back
D) Persistent penile erection

Question 30

A 25-year-old male jail inmate was pushed over the railing of a walkway 20 feet above the ground. He is unresponsive and has an open fracture of the left upper arm. How would you determine if the patient has sensation in his legs?

A) Ask him if he can feel you touching his foot.
B) Check for the presence and strength of a pedal pulse.
C) Pinch his foot and look for movement on the leg.
D) Lift his leg and look for a facial grimace.

Question 31

What instruction would you provide to your team immediately after securing a patient with head, neck, and back pain to the long backboard?

A) "Loosen the collar so you can palpate the back of the neck."
B) "Maintain manual in-line spinal stabilization until he is on the stretcher."
C) "Check for pedal pulses before we move him to the stretcher."
D) "Remove the chest strap so he can breathe easier now that his head and legs are secured."

Question 32

You are securing a patient to the long backboard. The appropriate order for securing the straps would be:

A) chest, head, pelvis, legs.
B) head, chest, pelvis, legs.
C) head, legs, chest, pelvis.
D) legs, head, chest, pelvis.

Question 33

Which one of the following statements about the care and treatment of a patient with a spinal injury in the prehospital setting is true?

A) "Prehospital care for the patient with a spine injury involves immobilization and the identification of life-threatening conditions."
B) "It is important to identify the site of spinal injury so the proper prehospital care can be rendered."
C) "Before transporting the critically injured patient with a spinal injury, the EMT must perform a detailed neurological assessment from head to toe."
D) "If a patient has a possible spine injury but is in shock, it is permissible to forego immobilization since this takes time from definitive care in the hospital."

Question 34

When applying a cervical spine immobilization collar (CSIC) to a young boy who fell out of a tree, the EMT realizes the collar benefits the patient by:

A) preventing the head and neck from moving.
B) maintaining manual in-line stabilization.
C) immobilizing the cervical spine.
D) decreasing downward compression on the cervical spine.

Question 35

A restrained driver of a car, that struck another car from behind at a low rate of speed, has a bruise to her forehead and complains of tingling in her left leg. She is lying on the side of the road and another EMT has taken manual in-line spinal stabilization. A quick scan of her as you approach indicates that she is in little to no distress. Which one of the following should you do first?

A) Check her breathing and radial pulse.
B) Perform a secondary assessment.
C) Palpate her cervical spine and apply a cervical collar.
D) Administer high-concentration oxygen.

Question 36

A patient is being extricated from a car using a vest-type short immobilization device. After the patient has been extricated, the EMT should:

A) remove the vest-type short immobilization device and secure the patient to a long backboard.
B) immobilize the patient with the vest-type short immobilization device to a long backboard.
C) place the patient in a semi-Fowler's position on the stretcher for transport to the hospital.
D) secure the patient and vest device in a supine position on the stretcher with the legs flexed.

Question 37

A male driver was ejected from his vehicle after it rolled several times at a high rate of speed. As you approach the patient you note that he is unresponsive and struggling to breathe. He also has a laceration to the left side of his face and multiple contusions to his legs. After assigning another EMT to take manual in-line spinal stabilization, what should you do?

A) Start positive pressure ventilation.
B) Insert an oropharyngeal airway.
C) Apply a properly sized cervical collar.
D) Open the airway using the jaw-thrust maneuver.

Question 38

You have been called for an 87-year-old male who fell in his kitchen while making breakfast. He states that he did hit his forehead but managed to catch himself on the way down and did not hit the ground hard. Your assessment reveals him to have kyphosis of the thoracic and cervical spine, but no neurological deficits. Which action is appropriate given these assessment findings?

A) Avoid application of a rigid collar due to the natural deformity of the cervical spine.
B) Disregard application of a rigid collar since the patient has no neurological deficits.
C) Apply a rigid collar and prepare the patient for any discomfort that the collar may cause.
D) Place a soft cervical collar instead of the rigid cervical spine immobilization collar.

Question 39

A teenage boy was found by friends as he attempted to hang himself in a garage using chains suspended from the ceiling. As you approach, you note that the patient is conscious, struggling to breathe, and has contusions that encircle his neck from the chains. After taking manual in-line spinal stabilization and opening the airway, your next action would be to:

A) start positive pressure ventilation.
B) size and apply a cervical collar.
C) perform a secondary assessment.
D) log roll him onto a long board.

Question 40

Which one of the following instructions from one EMT to another shows the correct application of a cervical spine immobilization collar?

A) "Carefully flex his head forward a little so I can pass the collar underneath his neck."
B) "Let's log roll the patient to one side so I can apply the cervical spine immobilization collar."
C) "Keep his head in neutral position while I apply the cervical spine immobilization collar."
D) "I need you to extend the patient's chin backward a little so I can fit the collar under his chin."

Question 41

A 43-year-old male has fallen from a roof and cannot move or feel his arms or legs. When assessing the patient, which one of the following signs would lead the EMT to suspect the patient is suffering from spinal shock?

A) Cool and moist skin
B) Heart rate of 68 beats per minute
C) Cyanosis to the fingertips
D) Seizure activity

Question 42

You have been called to a public building for a 32-year-old male patient who fell down a flight of stairs. As you pull up, he walks to the ambulance and states that he would like to be looked at because his shoulder and lower back hurt. You immediately take in-line manual spinal stabilization and examine his back, which reveals no sign of injury. How should you immobilize this patient?

A) Place a long board behind the patient and immobilize in a standing position.
B) Have the patient lie on the ground and immobilize in the usual fashion.
C) Place the long board on the stretcher and carefully assist the patient onto the long board.
D) Place a cervical collar on the patient and transfer him to the stretcher.

Question 43

The EMT should recognize a possible spinal column injury with no spinal cord involvement when he discovers what assessment finding?

A) Tenderness to the thoracic spine with intact motor and sensory to each extremity
B) Intact motor ability to all four extremities with loss of sensation to the legs
C) Pain to the cervical spine with loss of sensation to the right arm and leg
D) Intact sensation to all four extremities with loss of motor ability to the arms

Question 44

A minivan has struck a utility pole and is on fire. The driver is unresponsive and has life-threatening injuries. Which one of the following would be most appropriate when extricating the patient from the vehicle?

A) Vest-type short spine immobilization device
B) Rapid extrication with cervical collar applied
C) Pull the patient from the car and immobilize away from the vehicle
D) Remove the patient and immobilize in the ambulance during rapid transport

Question 45

Which one of the following shows that the EMTs are correctly using a vest-type short spine immobilization device?

A) The cervical collar is applied after the torso has been secured to the device.
B) The head is secured first followed by the torso and legs.
C) The head is secured to the device immediately after the cervical collar is placed.
D) The head is secured to the device after the torso has been secured.

Question 46

You and your partner are preparing to extricate a patient from a car using a vest-type short spine immobilization device. After ensuring that in-line manual spinal stabilization is being maintained, your next instruction should be:

A) "Let's get the cervical collar applied before we place the vest."
B) "Let's turn the patient toward the door of the car before applying the vest."
C) "Let's check his motor, sensory, and pulses in the arms and legs."
D) "Let's place the vest on the backboard and carefully move him from the car onto it."

Question 47

The EMT is properly assessing for a spinal cord injury when she:

A) asks the patient if he has pain anywhere along his spinal column.
B) palpates the entire spinal column for tenderness.
C) asks the patient to spread his fingers apart on both hands.
D) checks for distal pulses in all four extremities.

Question 48

An EMT is rapidly extricating a critically injured patient from a severely damaged vehicle. Which one of the following would the EMT recognize as acceptable given this patient's condition?

A) A vest-type or other short spine immobilization device can be omitted, but a cervical collar and manual in-line spinal stabilization are still required.
B) Manual in-line spinal stabilization can be omitted in the vehicle, but should be taken once the patient has been extricated and is on the long backboard.
C) A vest-type or other short spine immobilization device still needs to be used to extricate the patient from the vehicle.
D) The long backboard can be omitted and the patient can be placed directly onto the stretcher as long as a cervical collar has been applied.

Question 49

A football player was struck in the head and is complaining of a headache and nausea. He also states that he has pain to his upper back and tingling in his left hand. The EMT is providing proper care for the patient when he:

A) removes the helmet to better assess the airway and head.
B) leaves the helmet in place but removes the face mask.
C) removes the shoulder pads to apply a cervical collar.
D) does not place the patient on a long board due to the presence of shoulder pads.

Question 50

A male patient fell 20 feet from a cliff to a trail below. The primary assessment shows him to be confused, with an open airway and shallow breathing. His pulse is 72 beats per minute and his blood pressure is 78/50 mmHg. The skin is warm and flushed. The patient has no motor ability or sensation in his legs. Which one of the following is the most likely cause of this patient's presentation?

A) Internal bleeding
B) Spinal injury
C) Hemorrhagic shock
D) Hypoglycemia

Question 51

A window washer has fallen 20 feet from scaffolding while washing the windows on an office building. He is alert and oriented, but states that he cannot move or feel his legs. Additionally, because his blood pressure is 82/48 mmHg, you suspect spinal shock. What other assessment finding reinforces your suspicion of spinal shock?

A) Cool and clammy skin
B) Heart rate of 144
C) Flushed and dry skin
D) SpO₂ at 92%

Question 52

A patient has just been log rolled and positioned onto the long backboard. Which one of the following care measures should be performed next?

A) Apply a properly sized cervical collar.
B) Secure the patient's head.
C) Secure the patient's chest with straps.
D) Release manual in-line stabilization.

Question 53

You pull up to the scene of a single-car motor vehicle collision. Emergency Medical Responders (EMRs) are maintaining in-line manual spinal stabilization of the 56-year-old driver who was unrestrained when she struck a tree at a high rate of speed. As you approach the vehicle, you note that she appears unresponsive with blood coming from her nose and ears. Which one of the following instructions to the EMRs is most appropriate?

A) "Let me conduct the primary assessment and place a cervical collar on her, and then let's quickly move her to the long board."
B) "Let me conduct the primary assessment, and then we can place a vest-type extrication device on her to get her to the backboard."
C) "After I do the primary and secondary assessment, we will need to get her onto the stretcher for immediate transport."
D) "Let's put a cervical collar on her, and then move her out of the car onto the ground where we will immobilize her to the long backboard."

Question 54

A motorcyclist wearing a full helmet was thrown from his motorcycle after hitting a patch of oil. The bike had been traveling at a high rate of speed. Manual in-line spinal stabilization is being held by an off-duty EMT. The primary assessment reveals the patient to be responsive to painful stimuli and breathing rapidly. His radial pulse is weak and fast. As you quickly scan his body, you note deformity to the left femur and lower leg. Your immediate action should be to:

A) apply a cervical collar.
B) place a nonrebreather face mask.
C) remove his helmet.
D) expose his left lower extremity.

Question 55

A male patient has suffered an injury that severed his spinal cord in the thoracic spine. What presentation would be associated with this injury?

A) He will have no sensation in his arms.
B) He will feel pain below the injury in his legs.
C) He will have decreased motor ability above the injury.
D) He will experience paralysis to the legs.

Question 56

You are maintaining manual in-line stabilization of the cervical spine for a patient being log rolled, transferred, and secured to a long backboard. At what point will you release the manual in-line spinal stabilization?

A) Once the patient has been log rolled onto the long backboard
B) After the head, chest, and knees have been secured with straps
C) After the patient has been secured to the backboard and transferred to the stretcher
D) After the chest has been secured with a head immobilization device

Question 57

Which one of the following statements about removing a helmet in the prehospital setting is true?

A) "Helmets should only be removed if they are too tight or spinal immobilization will be required."
B) "It is acceptable to leave the helmet on a patient if the patient has no airway or breathing problems."
C) "Any patient wearing a helmet should have it removed so the airway and breathing can be properly assessed."
D) "Since helmets should never be removed, the EMT must be creative in providing care around the obstacle of a helmet."

Question 58

A 2-year-old boy fell down a flight of stairs. Which instruction would you provide to other EMTs who are immobilizing the patient?

A) "After he is on the board, place a towel behind his head to keep the airway open."
B) "It is better if the collar is a little too big; that is more comfortable for him."
C) "Let's place a folded towel under his shoulders to help maintain head alignment."
D) "Just apply a cervical collar and then place him directly on the stretcher."

Question 59

A high school football player was hit from behind and is complaining of severe back pain and numbness to his right leg. Manual in-line spinal stabilization is being maintained by an assistant coach. Once at the patient's side, what should you do next?

A) Disconnect the face mask from the helmet.
B) Carefully remove the helmet.
C) Apply a cervical spine immobilization collar.
D) Assess the airway and breathing.