10 free EMT practice questions: Focused Physical Exam

Simple rib fracture: A simple rib fracture doesn't produce paradoxical chest wall movement. That specific finding requires a free-floating segment, which needs multiple ribs broken in multiple places.

Open chest wound: An open chest wound would show air moving through a hole in the chest wall with a sucking or bubbling sound, not a segment of chest wall moving opposite the rest of the chest.

Pulmonary contusion: A pulmonary contusion is a lung tissue injury that doesn't by itself cause the chest wall to move paradoxically. That finding specifically indicates the chest wall has lost its normal bony connection to the rib cage.

The mild respiratory distress rules out a serious lung injury: Mild respiratory distress doesn't rule out a serious lung injury. Early or simple pneumothorax can present with minimal symptoms, and the absent breath sounds on one side are the definitive finding here regardless of how mild the distress looks.

The patient's age means pneumothorax is unlikely and can be observed at home: The patient's young age doesn't make pneumothorax unlikely, and this mechanism plus this specific finding requires urgent transport with advanced life support available, not observation at home.

The intact skin perfusion rules out any involvement of the circulatory system: Intact skin perfusion reflects the current hemodynamic state, not the integrity of the lung itself. A patient can have completely normal perfusion with a simple pneumothorax that could still progress to tension physiology.

Record it as crepitus and continue the head-to-toe exam: A student picks this because grating and crepitus sound like the same thing. Crepitus means fractured bone ends or joint surfaces rubbing, which is a conclusion about the cause; some joints grate at baseline, and the finding is not established until the other side has been checked.

Palpate the left elbow again using firmer pressure: A student picks this because they think a doubtful finding is settled by pressing harder. More pressure produces the same sensation more strongly and still cannot separate an injury from a joint that grates normally.

Palpate the left shoulder and wrist for the same sensation: A student picks this because they know to compare but compare along the same limb. Comparison is made with the matching site on the opposite side of the body; the shoulder and wrist are different joints and tell the EMT nothing about whether this elbow is normal for this patient.

Local nerve injury in each limb: A student picks this because they read each limb on its own and a single limb that cannot feel or move does suggest a local nerve injury. Four limbs failing at once is not four separate local injuries; loss of sensation and movement in several extremities points to the spinal cord, where one lesion accounts for all of them.

Fractures of both wrists and both ankles: A student picks this because they attribute an inability to move to broken bones. The question states that no extremity is deformed or swollen, and fractures would not explain loss of sensation to pinch in all four limbs.

Impaired circulation to all four extremities: A student picks this because pale or poorly perfused limbs can lose feeling. Strong distal pulses in all four extremities are stated, so circulation to the limbs is intact and cannot be the explanation.

Grip strength compared between the two hands: A student picks this because grip strength is part of the extremity exam they have practiced. Comparing grip strength requires the patient to squeeze on request, so an unresponsive patient cannot produce the finding.

Sensation reported after a gentle pinch of a toe: A student picks this because the pinch is something the EMT does and therefore feels available. The finding is the patient's report of what was done to which finger or toe, and that report cannot come from an unresponsive patient.

Movement of the fingers and toes on command: A student picks this because moving the fingers and toes seems like the simplest test in the set. It is a command, and the patient has to follow it for the result to mean anything.

Record faint breath sounds over both sides of the chest: A student picks this because a reading was obtained and they document what they heard. Breath sounds are muted by clothing, and what the stethoscope picked up over the sweatshirt is largely the sound of the head sliding on the fabric, so the finding does not describe this patient's air movement.

Press the stethoscope harder onto the sweatshirt: A student picks this because more pressure usually means a better seal. Pressing harder on fabric increases the rubbing noise rather than removing it; the diaphragm has to be against the skin.

Move the patient to the ambulance and listen there: A student picks this because they attribute unclear breath sounds to a noisy scene. The question states the room is quiet, so ambient noise is not the problem, and moving the patient delays a finding that can be obtained where the patient is sitting.

The fingertips for temperature and the back of the hand for the swelling: A student picks this because they remember that the two surfaces have different jobs but invert which is which. The fingertips are the sensitive surface for texture and consistency, and the back of the hand is the surface used to judge temperature, so this reverses both halves.

The fingertips for both the temperature and the swelling: A student picks this because the fingertips are the part of the hand used for almost everything else in the exam. Fingertips are correct for the swelling, but the back of the hand is the surface suited to noting temperature, so half of this pairing is wrong.

The back of the hand for both the temperature and the swelling: A student picks this because they learned the back of the hand as the skin-assessment surface and apply it to the whole skin exam. The back of the hand is correct for temperature but cannot resolve texture and consistency, which is what the swollen calf question requires.

Cyanosis: describes bluish skin from poor oxygenation, a real finding you watch for, but it belongs to skin assessment, not to this particular mnemonic.

Crepitus: a genuine finding you palpate for, a grating sensation from broken bone ends, and it's close because it's also a physical-exam term for trauma, but it still isn't one of the letters spelled out in DCAP-BTLS.

Crackles: a lung sound heard on auscultation, a real finding you're trained to listen for, but DCAP-BTLS is a mnemonic for inspecting and palpating injury sites, not an auscultation checklist, so crackles doesn't fit it either.

Move to a quieter area before auscultating a blood pressure: Relocating sounds reasonable, but this patient shows signs of poor perfusion and needs a blood pressure reading now to guide care; a validated field alternative exists and should be used immediately instead of moving the patient first.

Estimate blood pressure from the radial pulse's strength and rate, without a cuff: Pulse strength and rate can suggest perfusion is poor, but this is not the palpation method, which specifically uses the cuff to identify the actual systolic pressure at which the pulse returns, rather than a subjective impression of the pulse.

Estimate the systolic pressure using capillary refill time instead of a cuff: Capillary refill reflects peripheral perfusion, not a numeric systolic pressure, and it is not the recognized substitute for auscultation when Korotkoff sounds cannot be heard.

A full head-to-toe exam, since any trauma patient requires one: Incorrect. A full head-to-toe exam is reserved for patients with a significant mechanism of injury, an altered mental status, or multi-system trauma, not an isolated, non-significant injury with a clear mechanism.

A repeat of the primary assessment in its entirety: Incorrect. The primary assessment addresses immediate life threats and is not repeated as the secondary assessment; the secondary assessment is a distinct, focused step.

Vital signs only, with no physical exam of the injury: Incorrect. Vital signs alone skip the physical exam of the injured area, which is needed to assess for deformity, distal pulse, and sensation.