Focused Physical Examination (Medical and Trauma)
Help Questions
NREMT: EMT Level › Focused Physical Examination (Medical and Trauma)
You responded to a parking lot where a 47-year-old man was struck by a vehicle while jogging. He was found sitting against a wall and appeared confused. Bystanders reported he stumbled after impact and then sat down. MOI included possible head strike and rapid deceleration. SAMPLE: Signs/symptoms headache, confusion; Allergies none known; Medications none; Past history unknown; Last oral intake unknown; Events vehicle hit left side, he fell. He answered questions slowly and did not recall the event. Vitals were BP 150/90 mmHg, pulse 88/min, respirations 16/min, SpO₂ 99% on room air. Focused head and neck exam revealed a small ear laceration, clear fluid in the ear canal, and unequal pupils with the left pupil larger. Which abnormal finding would indicate a need for rapid transport?
Patient sat against a wall after the collision occurred
Small ear laceration with minor bleeding controlled by dressing
Pulse of 88/min with normal rate and regular rhythm
Unequal pupils with left pupil larger and slow reaction
Explanation
This question tests EMT level skills in performing a focused physical examination and identifying abnormal findings. The focused physical exam involves a thorough assessment of the patient's complaint area and the identification of any life-threatening conditions or red flags. In this scenario, the patient's symptoms such as confusion, headache, and amnesia require the EMT to prioritize specific examination steps. Choice B is correct because it aligns with the primary focus of the examination and addresses the most critical finding of unequal pupils, indicating possible brain injury needing rapid transport. Choice D is incorrect because it reflects a misunderstanding of the symptom's priority, leading to an ineffective examination focus as the patient's position is not an abnormal finding. To help students: Teach them to prioritize examination based on life threats and patient presentation. Practice scenarios that require identifying critical symptoms quickly and accurately.
You arrived at a crosswalk where a 34-year-old pedestrian was struck by a sedan at low speed. The scene was controlled by police, and the patient lay supine near the curb. Bystanders reported he was briefly unconscious. MOI included head impact on the pavement. He responded to voice but seemed confused and kept repeating questions. SAMPLE: Signs/symptoms headache, dizziness, nausea; Allergies unknown; Medications none reported; Past history none known; Last oral intake lunch 1 hour earlier; Events walking, struck, fell, head hit ground. You performed OPQRST for headache: Onset after impact; Provocation worse with movement; Quality throbbing; Region right forehead; Severity 7/10; Time constant. Vitals were BP 142/88 mmHg, pulse 96/min, respirations 18/min, SpO₂ 98% on room air. During a focused head and neck exam, you noted a scalp hematoma, midline neck tenderness, and pupils that were unequal with sluggish reaction on the right. Based on the scenario, what abnormal finding should the EMT prioritize?
Lunch eaten about 1 hour before the incident occurred
Unequal pupils with sluggish right-sided reaction to light
Scalp hematoma over the right forehead without active bleeding
Pulse of 96/min with regular rhythm on assessment
Explanation
This question tests EMT level skills in performing a focused physical examination and identifying abnormal findings. The focused physical exam involves a thorough assessment of the patient's complaint area and the identification of any life-threatening conditions or red flags. In this scenario, the patient's symptoms such as confusion, headache, and nausea require the EMT to prioritize specific examination steps. Choice A is correct because it aligns with the primary focus of the examination and addresses the most critical finding of unequal pupils with sluggish reaction, indicating possible increased intracranial pressure. Choice B is incorrect because it reflects a misunderstanding of the symptom's priority, leading to an ineffective examination focus as a scalp hematoma is less immediately life-threatening without neurological signs. To help students: Teach them to prioritize examination based on life threats and patient presentation. Practice scenarios that require identifying critical symptoms quickly and accurately.
You responded to a 22-year-old woman at a dorm room who complained of severe shortness of breath (NOI). She sat upright, used accessory muscles, and spoke only one to two words at a time. OPQRST for breathing difficulty: Onset 30 minutes earlier; Provocation worse after exposure to a roommate’s cat; Quality “tight chest”; Region chest; Severity 9/10; Time worsening. SAMPLE: Signs/symptoms wheezing, cough, chest tightness; Allergies cats and pollen; Medications albuterol inhaler, used twice with little relief; Past history asthma with prior ED visits; Last oral intake water 1 hour earlier; Events cat exposure then symptoms. Vitals were BP 128/76 mmHg, pulse 124/min, respirations 32/min, SpO₂ 89% on room air. Focused respiratory exam showed loud wheezes, prolonged expiratory phase, and intercostal retractions. Which symptom indicates the need for immediate intervention?
History of asthma with prior emergency department visits
Water intake about 1 hour before symptom onset
Cat exposure reported as a trigger for her symptoms
SpO₂ of 89% with severe work of breathing
Explanation
This question tests EMT level skills in performing a focused physical examination and identifying abnormal findings. The focused physical exam involves a thorough assessment of the patient's complaint area and the identification of any life-threatening conditions or red flags. In this scenario, the patient's symptoms such as severe shortness of breath, wheezing, and chest tightness require the EMT to prioritize specific examination steps. Choice B is correct because it aligns with the primary focus of the examination and addresses the most critical finding of low SpO₂ with severe work of breathing, indicating respiratory distress needing immediate intervention. Choice D is incorrect because it reflects a misunderstanding of the symptom's priority, leading to an ineffective examination focus as last oral intake is not a critical symptom. To help students: Teach them to prioritize examination based on life threats and patient presentation. Practice scenarios that require identifying critical symptoms quickly and accurately.
You evaluated a 33-year-old woman at home who complained of severe abdominal pain (NOI). She lay still with knees drawn up. OPQRST: Onset 6 hours earlier; Provocation worse with movement; Quality sharp; Region right lower abdomen; Severity 10/10; Time worsening. She reported nausea, feverish feeling, and no appetite. SAMPLE: Signs/symptoms RLQ pain, nausea; Allergies none; Medications acetaminophen; Past history appendicitis diagnosed previously without surgery; Last oral intake crackers 8 hours earlier; Events pain began near belly button then moved to RLQ. Vitals were BP 98/60 mmHg, pulse 122/min, respirations 22/min, SpO₂ 98% on room air. Focused abdominal exam found guarding and rebound tenderness in the RLQ. Which symptom indicates the need for immediate intervention?
Crackers eaten about 8 hours before the abdominal pain
Acetaminophen taken earlier for discomfort and feverish feeling
Pain began near the belly button before moving right
Rebound tenderness with guarding in the right lower quadrant
Explanation
This question tests EMT level skills in performing a focused physical examination and identifying abnormal findings. The focused physical exam involves a thorough assessment of the patient's complaint area and the identification of any life-threatening conditions or red flags. In this scenario, the patient's symptoms such as severe abdominal pain, nausea, and feverish feeling require the EMT to prioritize specific examination steps. Choice A is correct because it aligns with the primary focus of the examination and addresses the most critical finding of rebound tenderness with guarding, suggesting appendicitis. Choice B is incorrect because it reflects a misunderstanding of the symptom's priority, leading to an ineffective examination focus as last oral intake is not a critical indicator. To help students: Teach them to prioritize examination based on life threats and patient presentation. Practice scenarios that require identifying critical symptoms quickly and accurately.
You arrived for a 39-year-old pedestrian struck by a car in a parking garage. He was found supine and slow to respond. MOI included head impact and possible cervical injury. He opened eyes to voice but seemed confused. SAMPLE: Signs/symptoms headache, nausea; Allergies none; Medications none; Past history none; Last oral intake unknown; Events struck, fell, head hit concrete. Vitals were BP 148/92 mmHg, pulse 90/min, respirations 14/min, SpO₂ 98% on room air. Focused head and neck exam showed midline neck tenderness and unequal pupils, with the right sluggish. Based on the scenario, what abnormal finding should the EMT prioritize?
Headache reported after the fall in the parking garage
Unequal pupils with sluggish right reaction after head trauma
Unknown last oral intake reported by bystanders on scene
Pulse of 90/min with normal rhythm during initial assessment
Explanation
This question tests EMT level skills in performing a focused physical examination and identifying abnormal findings. The focused physical exam involves a thorough assessment of the patient's complaint area and the identification of any life-threatening conditions or red flags. In this scenario, the patient's symptoms such as confusion, headache, and nausea require the EMT to prioritize specific examination steps. Choice A is correct because it aligns with the primary focus of the examination and addresses the most critical finding of unequal pupils with sluggish reaction, indicating head trauma priority. Choice D is incorrect because it reflects a misunderstanding of the symptom's priority, leading to an ineffective examination focus as unknown last intake is not abnormal. To help students: Teach them to prioritize examination based on life threats and patient presentation. Practice scenarios that require identifying critical symptoms quickly and accurately.
You arrived for a 45-year-old pedestrian struck by a pickup truck. He was found supine, groaning, and not following commands. MOI included head impact and possible cervical spine injury. A witness reported he was unconscious for about 1 minute. SAMPLE: Signs/symptoms confusion and headache; Allergies none known; Medications none; Past history unknown; Last oral intake unknown; Events struck, thrown, head hit road. Vitals were BP 156/88 mmHg, pulse 92/min, respirations 10/min, SpO₂ 95% on room air. Focused head and neck exam showed unequal pupils, shallow breathing, and midline neck tenderness. Which abnormal finding would indicate a need for rapid transport?
Midline neck tenderness reported when he was palpated gently
Pulse of 92/min recorded during the first set of vitals
Unconscious period reported as about 1 minute by a witness
Respirations of 10/min with shallow breathing after head trauma
Explanation
This question tests EMT level skills in performing a focused physical examination and identifying abnormal findings. The focused physical exam involves a thorough assessment of the patient's complaint area and the identification of any life-threatening conditions or red flags. In this scenario, the patient's symptoms such as altered mental status, groaning, and shallow breathing require the EMT to prioritize specific examination steps. Choice A is correct because it aligns with the primary focus of the examination and addresses the most critical finding of low respirations with shallow breathing, indicating need for rapid transport. Choice B is incorrect because it reflects a misunderstanding of the symptom's priority, leading to an ineffective examination focus as pulse rate is not the most abnormal. To help students: Teach them to prioritize examination based on life threats and patient presentation. Practice scenarios that require identifying critical symptoms quickly and accurately.
You arrived at a busy intersection for a 41-year-old pedestrian struck by a car. He was found sitting, confused, and bleeding from the scalp. MOI included head strike and possible neck injury. He answered incorrectly when asked the date. SAMPLE: Signs/symptoms headache, confusion; Allergies none known; Medications none; Past history unknown; Last oral intake unknown; Events struck, fell, hit head. Vitals were BP 146/86 mmHg, pulse 102/min, respirations 18/min, SpO₂ 97% on room air. Focused head and neck exam showed midline cervical tenderness, unequal pupils, and vomit on his shirt. Which symptom indicates the need for immediate intervention?
Incorrect date given when asked orientation questions on scene
Unequal pupils with altered mental status after a vehicle strike
Vomit noted on clothing without active vomiting during exam
Scalp bleeding that slowed after direct pressure was applied
Explanation
This question tests EMT level skills in performing a focused physical examination and identifying abnormal findings. The focused physical exam involves a thorough assessment of the patient's complaint area and the identification of any life-threatening conditions or red flags. In this scenario, the patient's symptoms such as confusion, headache, and disorientation require the EMT to prioritize specific examination steps. Choice D is correct because it aligns with the primary focus of the examination and addresses the most critical finding of unequal pupils with altered mental status, indicating severe head injury. Choice B is incorrect because it reflects a misunderstanding of the symptom's priority, leading to an ineffective examination focus as controlled scalp bleeding is less urgent. To help students: Teach them to prioritize examination based on life threats and patient presentation. Practice scenarios that require identifying critical symptoms quickly and accurately.
You responded to a 32-year-old man with abdominal pain at a workplace (NOI). He sat still and guarded his right lower abdomen. OPQRST: Onset 8 hours earlier; Provocation worse with walking; Quality sharp; Region RLQ; Severity 8/10; Time worsening. He reported nausea and one episode of vomiting. SAMPLE: Signs/symptoms RLQ pain, vomiting; Allergies none; Medications none; Past history appendicitis diagnosis in the past; Last oral intake sandwich 6 hours earlier; Events pain started then localized. Vitals were BP 108/70 mmHg, pulse 112/min, respirations 18/min, SpO₂ 99% on room air. Focused abdominal exam showed rebound tenderness and rigidity in the RLQ. What abnormal finding would indicate a need for rapid transport?
Rigidity and rebound tenderness in the right lower quadrant
Pain rated 8/10 and worsened when he walked at work
One episode of vomiting reported earlier in the day
Sandwich eaten about 6 hours before the abdominal pain worsened
Explanation
This question tests EMT level skills in performing a focused physical examination and identifying abnormal findings. The focused physical exam involves a thorough assessment of the patient's complaint area and the identification of any life-threatening conditions or red flags. In this scenario, the patient's symptoms such as abdominal pain, nausea, and vomiting require the EMT to prioritize specific examination steps. Choice D is correct because it aligns with the primary focus of the examination and addresses the most critical finding of rigidity and rebound tenderness, indicating need for rapid transport. Choice B is incorrect because it reflects a misunderstanding of the symptom's priority, leading to an ineffective examination focus as last intake is not abnormal. To help students: Teach them to prioritize examination based on life threats and patient presentation. Practice scenarios that require identifying critical symptoms quickly and accurately.
You responded to a 27-year-old man with abdominal pain at an apartment (NOI). He lay still and guarded his abdomen. OPQRST: Onset 9 hours earlier; Provocation worse with movement; Quality sharp; Region right lower abdomen; Severity 9/10; Time worsening. He reported nausea and had not eaten since morning. SAMPLE: Signs/symptoms RLQ pain, nausea; Allergies none; Medications none; Past history appendicitis diagnosed previously; Last oral intake breakfast 10 hours earlier; Events pain started then localized to RLQ. Vitals were BP 102/64 mmHg, pulse 120/min, respirations 20/min, SpO₂ 98% on room air. Focused abdominal exam found rebound tenderness in the RLQ. Based on the scenario, what abnormal finding should the EMT prioritize?
No food intake since breakfast earlier in the day
Pain rated 9/10 and worsened with movement at home
Rebound tenderness in the right lower quadrant with guarding
Past history of appendicitis reported without surgical removal
Explanation
This question tests EMT level skills in performing a focused physical examination and identifying abnormal findings. The focused physical exam involves a thorough assessment of the patient's complaint area and the identification of any life-threatening conditions or red flags. In this scenario, the patient's symptoms such as abdominal pain, nausea, and guarding require the EMT to prioritize specific examination steps. Choice D is correct because it aligns with the primary focus of the examination and addresses the most critical finding of rebound tenderness with guarding, indicating priority for appendicitis. Choice B is incorrect because it reflects a misunderstanding of the symptom's priority, leading to an ineffective examination focus as no food intake is not abnormal. To help students: Teach them to prioritize examination based on life threats and patient presentation. Practice scenarios that require identifying critical symptoms quickly and accurately.
You assessed a 36-year-old man at home for abdominal pain (NOI). He reported the pain became severe over several hours. OPQRST: Onset gradual; Provocation worse with movement; Quality sharp; Region right lower abdomen; Severity 8/10; Time worsening. He reported nausea and chills. SAMPLE: Signs/symptoms RLQ pain, nausea; Allergies none; Medications none; Past history appendicitis diagnosis in the past; Last oral intake cereal 7 hours earlier; Events pain started, then localized to RLQ. Vitals were BP 106/66 mmHg, pulse 114/min, respirations 20/min, SpO₂ 98% on room air. Focused abdominal exam showed guarding and rebound tenderness. What is the most likely cause of the patient's symptoms based on the examination results?
Likely asthma flare suggested by chills and abdominal discomfort
Likely anxiety attack suggested by nausea and rapid pulse
Likely acute appendicitis suggested by RLQ rebound tenderness and guarding
Likely rib fracture suggested by pain worsening with movement
Explanation
This question tests EMT level skills in performing a focused physical examination and identifying abnormal findings. The focused physical exam involves a thorough assessment of the patient's complaint area and the identification of any life-threatening conditions or red flags. In this scenario, the patient's symptoms such as abdominal pain, nausea, and chills require the EMT to prioritize specific examination steps. Choice D is correct because it aligns with the primary focus of the examination and addresses the most critical finding of likely acute appendicitis based on RLQ rebound and guarding. Choice B is incorrect because it reflects a misunderstanding of the symptom's priority, leading to an ineffective examination focus as anxiety does not match the physical findings. To help students: Teach them to prioritize examination based on life threats and patient presentation. Practice scenarios that require identifying critical symptoms quickly and accurately.