10 free EMT practice questions: Focused Physical Exam

Simple rib fracture: A simple rib fracture leaves the rib attached to the rib cage, so the chest wall still moves as one piece. Paradoxical movement needs a free-floating segment. A free-floating segment takes multiple ribs broken in multiple places.

Open chest wound: An open chest wound lets air move through a hole in the chest wall. You would hear sucking or see bubbling at the wound. Nothing here describes a hole, only a segment of chest wall moving opposite the rest of the chest.

Pulmonary contusion: A pulmonary contusion is a bruise to the lung tissue. A bruised lung by itself does not make the chest wall move the wrong way. Paradoxical movement tells you a piece of the chest wall has broken loose from the rest of the rib cage.

The mild respiratory distress rules out a serious lung injury: An early or simple pneumothorax can cause only mild shortness of breath. Mild distress does not rule out a serious lung injury. The absent breath sounds on the left are what matter here, no matter how mild the distress looks.

The patient's age means pneumothorax is unlikely and can be observed at home: Young age does not protect anyone from a pneumothorax. A pneumothorax can happen at any age. A patient with this crash and absent breath sounds on one side needs urgent transport, not observation at home.

The intact skin perfusion rules out any involvement of the circulatory system: Skin perfusion tells you how the circulation is doing right now, not whether the lung is injured. A patient can have normal perfusion with a simple pneumothorax. If the pneumothorax turns into a tension pneumothorax, the perfusion will get worse.

Palpate directly over the bruise to check for rib instability: An obvious injury seems like the place to put your hands. Pressing over an obvious bruise or fracture is avoided. You can check the ribs around the bruise for tenderness without adding pain or moving broken bone ends.

Palpate over the bruise firmly enough to elicit crepitus: Crepitus is a sign of a rib fracture. Crepitus is felt as the patient breathes, not made by pushing hard. Firm pressure on a bruised chest wall can make the injury worse.

Palpate the bruise first and then the rest of the chest wall: Starting at the visible injury sounds like an organized way to do the exam. The visible injury is the one place you do not palpate. Doing the bruise first still means pressing on the bruise.

Record it as crepitus and continue the head-to-toe exam: A grating sensation is what crepitus describes. Crepitus also says the grating comes from broken bone or joint surfaces rubbing. Some joints grate at baseline, so you cannot record crepitus until you have checked the other side.

Palpate the left elbow again using firmer pressure: Pressing harder can seem like a way to settle a doubtful finding. Firmer pressure only makes the same grating stronger. A stronger grating still cannot tell you an injury from a joint that grates normally.

Palpate the left shoulder and wrist for the same sensation: Checking the shoulder and wrist is still a comparison, just along the same arm. The comparison has to be with the matching joint on the other side of the body. The shoulder and wrist are different joints and tell you nothing about whether this elbow is normal for this patient.

Local nerve injury in each limb: Feeling and movement are gone in all four limbs at once. Four separate nerve injuries do not explain that pattern, and one injury in the spinal cord explains every limb.

Fractures of both wrists and both ankles: No extremity here is deformed or swollen. Fractures also would not take away the feeling of a pinch in all four limbs.

Impaired circulation to all four extremities: If the distal pulses are strong in all four extremities, blood is getting to the limbs, and circulation is not the cause.

Grip strength compared between the two hands: Grip strength is a normal part of the extremity exam. The patient has to squeeze your hands when you ask. An unresponsive patient cannot squeeze on request, so you get no finding.

Sensation reported after a gentle pinch of a toe: You do the pinch yourself, so this test looks like something you can still do. The finding is the patient telling you what you did and to which finger or toe. An unresponsive patient cannot report anything.

Movement of the fingers and toes on command: Moving the fingers and toes is the simplest motor test. The patient still has to follow your command for the result to mean anything. This patient is unresponsive and cannot follow commands.

Record faint breath sounds over both sides of the chest: You record what you hear when you listen the right way. These sounds came through a sweatshirt and are mostly the stethoscope head sliding on the fabric. Faint breath sounds heard through clothing do not describe how this patient is moving air.

Press the stethoscope harder onto the sweatshirt: More pressure usually means a better seal. On fabric, more pressure makes more rubbing noise instead of less. The diaphragm has to be against the skin.

Move the patient to the ambulance and listen there: A noisy scene can make breath sounds hard to hear. The question says the room is quiet, so noise is not the problem. Moving the patient only delays a finding you can get right where the patient is sitting.

The fingertips for temperature and the back of the hand for the swelling: Both jobs are switched here. The fingertips are for texture and firmness, not temperature. The back of the hand is for temperature, not for telling firm swelling from soft.

The fingertips for both the temperature and the swelling: Temperature is judged with the back of the hand, not the fingertips. B uses the fingertips for both jobs, so the temperature half is done with the wrong part of the hand.

The back of the hand for both the temperature and the swelling: The back of the hand cannot tell you whether the calf swelling is firm or soft. You need your fingertips for texture and firmness.

Cyanosis: blue skin from poor oxygenation. You do check for cyanosis, but cyanosis goes with your skin color and perfusion checks. Cyanosis is not one of the letters in DCAP-BTLS.

Crepitus: the grating you feel when broken bone ends rub together. Crepitus starts with C too. You note crepitus separately, along with DCAP-BTLS, not as one of its letters.

Crackles: a lung sound you hear with a stethoscope. DCAP-BTLS is for looking at and feeling injury sites, not for listening to breath sounds.

A full head-to-toe exam, since any trauma patient requires one: A full head-to-toe exam is for a patient with a significant mechanism of injury, an altered mental status, or multi-system trauma. This patient has one injury, the wrist, with a clear mechanism.

A repeat of the primary assessment in its entirety: The primary assessment looks for immediate life threats. You do not repeat the whole primary assessment as your secondary assessment. The secondary assessment is its own step, and here it is focused on the wrist.

Vital signs only, with no physical exam of the injury: Vital signs alone skip the exam of the injured wrist. You still need to check the wrist for deformity, the distal pulse, and sensation.