Focused Physical Examination (Medical and Trauma) Practice Test

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?

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?