15 free questions from the CinnaEMS trauma bank (286 in the app). Tap an answer to check it. The rationale opens right away.
A restrained driver from a high-speed frontal collision complains of tearing pain between the shoulder blades. The injury you should suspect is:
Answer: A. A shearing tear of the aorta where it is anchored
Sudden deceleration lets the mobile arch keep moving while the descending aorta stays fixed at the ligamentum arteriosum, and the vessel shears at that anchor point — which is why the pain is felt between the scapulae. A strain or a wall contusion would not follow this mechanism, and treating it as musculoskeletal delays the gentle handling and blood pressure control the tear demands.
A four-month-old who is not yet crawling or walking is brought to you with a fractured femur. The most important feature of this presentation is that:
Answer: A. The child could not generate that injury alone
Matching the injury against what the child is developmentally able to do is the central test, and a femur fracture takes force an immobile infant cannot produce — so the history and the injury do not fit, which is documented objectively and reported as required. Blood loss is a genuine concern but it is not what makes this presentation significant.
A patient with a severe traumatic brain injury desaturates for two minutes during airway management. The significance of that episode is that:
Answer: A. Even a brief hypoxic period adds measurable secondary injury
The injured brain has lost its ability to autoregulate, so it depends entirely on the oxygen and pressure you deliver, and even one short desaturation measurably worsens outcome. Treating brief hypoxia as tolerable is why preoxygenation and attention to the clock matter more in this patient than the elegance of the airway technique itself.
A 6-year-old hit by a car has a heart rate of 150, delayed capillary refill and a normal blood pressure. The most accurate interpretation is:
Answer: A. Compensated shock; hypotension would be a late and ominous sign
Children compensate with tachycardia and vasoconstriction until a large share of blood volume is lost, then decompensate abruptly, so a normal pressure with a fast rate and poor refill is compensated shock. Attributing the tachycardia to fear misses the refill finding, and neurogenic shock would produce warm skin with a relatively slow heart rate.
An unrestrained driver slid down and under the steering wheel in a frontal crash. Injuries you should specifically anticipate include:
Answer: A. Knee, femur and posterior hip dislocation
In the down-and-under pathway the knees strike the dash, driving force up the femur into the hip, which can dislocate posteriorly. The windshield pattern of head, neck and chest belongs to the up-and-over pathway, and lateral pelvic and splenic injury belongs to side impacts.
A patient with massive midface trauma cannot be intubated and cannot be oxygenated by any other route. The concept this situation invokes is:
Answer: A. Access to the airway through the cricothyroid membrane
When the airway can neither be intubated nor oxygenated, the remaining route is through the neck at the cricothyroid membrane, and the decision is recognized rather than delayed because the clock is hypoxic time. Repeating a failed attempt and continuing a bag-mask seal that is already not working both spend that time, and facial swelling worsens rather than settles.
An unresponsive assault victim has an obvious fracture of both sides of the lower jaw, with the jaw sagging freely. The main airway danger in this patient is that:
Answer: A. The tongue loses its front anchor and falls back to block the airway
The tongue is attached to the front of the mandible, so a double fracture removes its support and it drops back into the pharynx, with blood and teeth adding to the obstruction. Constant suction and positioning are needed, and a supraglottic airway may be difficult to seat. The trachea is not usually injured by jaw fragments.
A closed-space fire victim has altered mentation, hypotension and suspected cyanide toxicity. What is the mechanism of the preferred antidote class?
Answer: A. It binds cyanide to form a compound excreted by the kidneys
Hydroxocobalamin, a form of vitamin B12, combines with cyanide to form cyanocobalamin, which is excreted in the urine, restoring cellular use of oxygen. Displacing carbon monoxide is what high-concentration oxygen does. Blocking muscarinic receptors describes atropine for organophosphates, and opioid reversal is irrelevant to smoke-related cyanide.
A woman at 32 weeks is restrained in a moderate collision. Her uterus is now constantly firm and tender and there is some vaginal bleeding. The likely injury is:
Answer: A. Separation of the placenta from the uterine wall
Deceleration shears the relatively inelastic placenta off the elastic uterine wall, and a firm, tender uterus with bleeding is the classic presentation — while much of the blood loss can stay concealed behind the placenta. A wall tear or a bruised bladder would not make the uterus rigid, and the tenderness and constant firmness separate this from ordinary contractions.
A 71-year-old who takes a beta-blocker fell down a flight of stairs. Heart rate is 72, blood pressure 108/70, and the skin is pale and cool. The most accurate interpretation is:
Answer: A. The normal heart rate may be masking significant shock
A beta-blocker blunts the tachycardic response, and a pressure of 108 may be well below this patient's usual baseline, so pale cool skin is the honest clue. Treating a normal heart rate as reassurance is the classic trap in older trauma patients; for patients 65 and older the 2021 field triage guideline flags a systolic pressure below 110 or a heart rate above it.
A patient with midface trauma has clear fluid draining from the nose and bruising around both eyes. A nasopharyngeal airway is avoided here because:
Answer: A. A skull base fracture may let it enter the cranial vault
Clear drainage and periorbital bruising suggest the floor of the skull is broken, and a tube passed blindly along that route can follow the fracture instead of the nasopharynx. Bleeding and discomfort are real but minor objections, and correct sizing does nothing to protect a patient whose skull base is no longer intact.
A patient in a crash is intoxicated and has an obviously fractured femur, but denies neck pain. Regarding spinal motion restriction, you should:
Answer: A. Treat the examination as unreliable and restrict motion
Selective spinal motion restriction depends on a patient who can be examined, and intoxication plus a painful distracting injury both destroy the reliability of a denial of neck pain. Waiting for sobriety is not an option in the field, and vehicle damage is a mechanism clue rather than a substitute for an assessment you cannot perform.
An intubated patient with a severe head injury develops a newly dilated, nonreactive pupil and extensor posturing. What is the most appropriate change in ventilation?
Answer: A. Briefly increase the rate toward mild hyperventilation guided by capnography
Routine hyperventilation is harmful because low carbon dioxide constricts cerebral vessels and starves the brain, but active signs of herniation are the exception: a brief, capnography-guided increase to mild hypocapnia can buy time. Saying it is never indicated misses that exception; letting CO2 rise raises cerebral blood volume and intracranial pressure further.
A patient with a tibial fracture has severe, escalating pain and a tense calf, but a strong dorsalis pedis pulse. Why does the pulse not rule out compartment syndrome?
Answer: A. Compartment pressure blocks capillary flow well below arterial pressure
Tissue dies when compartment pressure exceeds capillary perfusion pressure, which is far lower than the arterial pressure needed to obliterate a pulse. Pulselessness is therefore a late sign; pain out of proportion and pain on passive stretch come first. The other options misstate the physiology.
Ten minutes after intubation, a head-injured patient with equal, reactive pupils and no posturing has an EtCO2 of 27 mmHg. What is the best action?
Answer: A. Slow the ventilation rate and titrate toward normal EtCO2 values
An EtCO2 of 27 without signs of herniation means inadvertent hyperventilation; low CO2 constricts cerebral vessels and reduces blood flow to injured brain. The goal is normal ventilation (EtCO2 35–45). A present, low waveform indicates tracheal placement with overventilation, not an esophageal tube, which would show no sustained waveform.
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