10 free EMT practice questions: Head, Spinal & Nervous System Trauma

Apply restriction, since any collision mechanism requires it: Applying restriction to any collision mechanism regardless of exam is the older mechanism-based standard EMTs trained under before selective criteria replaced it. This patient's full negative exam, no tenderness, no deficits, alert and sober, already answers what that mechanism concern is for, so mechanism alone can't override it. It treats a step contained inside the broader exam as a separate rule.

Apply a cervical collar for comfort only: A cervical collar for comfort fits a patient who reports neck pain and finds the support soothing. This patient has no neck complaint and no midline tenderness on exam, so there's no pain for the collar to relieve. It applies a device to a symptom the question says isn't present.

Withhold restriction only if neck range of motion is also pain-free: Testing pain-free neck range of motion is a real step in some clearance rules, like the Canadian C-Spine Rule. This patient meets every item of the prehospital criteria already: alert, sober, no distracting injury, no midline tenderness, normal strength and sensation. Requiring an extra step those criteria never contain keeps a cleared patient restricted for nothing.

Have the patient tilt the head back and apply pressure to the bridge of the nose: Head back with pressure on the bridge is the folk version of nosebleed care, and half of it is right: pressure is correct. Two things are wrong: the pressure belongs on the soft cartilage below the bony bridge, where the bleeding vessels actually are, and tilting the head back drains blood straight into the posterior pharynx. In a patient who already has blood running down his throat, that turns a controllable bleed into an airway problem.

Have the patient lie flat and apply ice to the forehead: Lying flat with ice fits a different injury: a facial contusion without active bleeding, where cold limits swelling. Supine is the worst position for an actively bleeding nose in an alert patient, because gravity now carries the blood toward the airway rather than out of it, and ice on the forehead addresses neither the bleeding site nor the aspiration risk.

Pack the nostrils tightly with gauze to stop the bleeding before transport: Nasal packing is real definitive care. It is what the ED does for bleeding that direct pressure will not control and for posterior bleeds. It is not an EMT skill, and packing a nose after a blow to the face risks forcing material where it does not belong if there is an underlying facial or skull fracture. Right treatment, wrong provider and wrong setting.

Immobilize the jaw with a tight circumferential bandage to prevent any movement: A circumferential bandage under the jaw and over the head is a real technique for supporting a fractured mandible in a fully alert patient with an intact airway and no active bleeding. Applied tightly in the field it becomes a hazard: it holds the mouth shut in a patient who is already drooling and finds swallowing painful, so if that patient vomits, common after facial trauma with swallowed blood. You have bound the airway closed and have to cut the bandage off before you can suction. Support the jaw with something you can remove instantly.

Position the patient upright and encourage speaking to ensure the airway is open: Sitting a facial-trauma patient upright is often good thinking, because it lets blood and saliva drain forward instead of down the throat. The error is the second half. Encouraging the patient to keep speaking makes a painful, unstable jaw move repeatedly, risks aspirating pooled secretions mid-sentence, and confirms nothing you cannot learn by watching the patient breathe. Assess the airway; do not exercise it.

Apply ice packs to reduce swelling, then transport without additional jaw support: Ice is a reasonable adjunct for facial swelling and would fit an isolated, stable jaw injury with no airway concern: a straightforward mandibular contusion. It fails here on two counts: it treats swelling over the next hour while the threat is instability over the next few minutes, and the option explicitly transports without jaw support, which means nothing at all is holding the tongue forward if this patient's mental status drops en route.

Hands placed under the patient's chin and supporting the jaw: This grip belongs to opening an airway with a jaw-thrust, the correct airway maneuver in suspected spinal injury. The question asks specifically about blocking rotation and lateral movement, and hands on the mandible alone cannot resist a turning force at the skull; pressure under the chin can also push soft tissue into the airway in facial trauma. Airway control and head stabilization are separate tasks.

Hands grasping the patient's shoulders while using the arms to immobilize the head: Squeezing the head between the forearms while gripping the shoulders is the bracing technique used during a standing takedown or seated rapid extrication, not a general answer to what stops rotation. The head can still rotate inside the forearms while the hands stay fixed on the shoulders, since the hold controls the torso, not the skull directly.

One hand on the forehead, one hand on the occiput, applying gentle traction: A hand on the forehead and one on the occiput controls flexion and extension, so this option can look right at first, but it leaves rotation and lateral bending unopposed, the motions this question asks about. Adding traction compounds it: axial pull can distract an unstable spine, and current teaching calls for neutral stabilization with no pulling force.

Stop the log-roll immediately and turn the patient's head to the side to allow vomit to drain: Turning the head to the side is the correct reflex for a supine patient who vomits and has no suspected spine injury, since gravity alone clears the mouth. Here the torso is being manually held in-line during an active roll, so rotating the head independently against that held torso is the exact motion in-line stabilization exists to prevent; the roll to the recovery position already achieves the same drainage without that risk.

Pause the roll, apply a cervical collar to secure the airway, and then resume movement: Applying a cervical collar is normal log-roll sequencing and belongs later in this same maneuver, but a collar limits flexion and extension only, it does not clear an airway or suction vomit. Stopping mid-roll to fasten one while the patient is actively vomiting delays the airway management the moment actually requires.

Call for paramedics to intubate the patient before continuing care: Advanced airway placement is correct once suctioning and positioning fail to protect the airway, but intubation is beyond EMT scope and paramedics aren't present yet. Waiting on another crew while vomit sits in the airway is not immediate care; suction and the roll already underway are the EMT's own tools right now.

The patient has a corneal abrasion that can be managed with a protective eye covering during routine transport: A corneal abrasion produces pain, tearing, and a foreign-body sensation; it does not dilate the pupil or slow its reaction to light. Attributing a new pupil asymmetry after head trauma to a surface eye injury misses the intracranial process the finding is warning about.

The pupil difference reflects physiologic anisocoria, which occurs naturally in a portion of the population: Physiologic anisocoria does occur in a portion of the healthy population, but it is not a call the field can make in a patient with acute head trauma: a newly unequal, sluggishly reactive pupil in this context must be treated as serious intracranial pathology until proven otherwise.

The patient needs serial pupil checks, with transport upgraded only if both pupils become fixed and dilated: Serial pupil checks are appropriate, but reserving the upgrade for bilaterally fixed and dilated pupils means waiting for a late sign of herniation. The unilateral change already present is the early warning, and it calls for expedited transport now, not a higher threshold for concern.

Flat on the stretcher with the head supported by a pillow: Flat positioning is what you'd default to for spinal immobilization concerns, but it removes the gravity assist on venous drainage, so the worsening mental status in this patient keeps climbing instead of stabilizing.

Trendelenburg position (head lower than feet) to maintain cerebral perfusion: Trendelenburg gets pulled in for shock states where you need blood returning to the core, but head-down here pools venous blood in the cranium and drives ICP up, the opposite of what a head injury with altered mental status needs.

Right lateral recumbent to improve venous drainage: Right lateral recumbent is the correct move for an unprotected airway at risk of aspiration, and this patient's airway is already secured, so that concern is handled; this position doesn't address the venous drainage problem the falling mental status is telling you about.

The Glasgow Coma Score measures an infant's mental capacity across eye opening, verbal response, and motor response, and below 10 is severe.: This describes a pediatric-specific tool that grades mental capacity, but the GCS applies to any patient regardless of age and grades level of consciousness, not mental capacity; the severe cutoff is 8 or below, not below 10, and the tool is the Glasgow Coma Scale, not Score.

The Glasgow Coma Scale measures an infant's mental capacity across eye opening, verbal response, and motor response, and below 8 is severe.: This one gets the name right, Scale, and lands close to the true cutoff, but it still limits the tool to an infant's mental capacity instead of level of consciousness in any patient. It also draws the line at "below 8" rather than "8 or below," which would wrongly place a score of exactly 8 in the moderate range instead of severe.

The Glasgow Coma Score measures a patient's level of consciousness across eye opening, verbal response, and motor response, and 10 or below is severe.: This one keeps level of consciousness and the three components correct but drifts the cutoff to 10 or below, which actually spans the moderate range of 9 to 12; severe starts at 8 and counts down, and the tool's proper name is the Glasgow Coma Scale, not Score.

Place both hands on the sides of the head, pressing firmly against the face: Hands on the sides of the head is right. That half of the option describes the correct technique. The failure is in the second half, "pressing firmly against the face," because pressure across the face covers the mouth and nose and loads the mandible, which is the one structure you cannot afford to compromise in a patient whose airway you may need. The key beats it because C describes the same hand placement doing the correct job: holding the head still rather than compressing it.

Support the neck from underneath, lifting slightly to align the airway: Supporting the neck from underneath and lifting to align the airway is a real maneuver in the right patient, a medical patient with no suspected spinal injury, where repositioning the head to open the airway carries no spinal cost. This question states a suspected cervical spine injury, which makes lifting the neck the exact movement spinal motion restriction exists to prevent. The key beats it because neutral alignment already is an airway-open position, so C gets the airway without moving the spine.

Place one hand under the neck and one on the forehead: One hand under the neck and one on the forehead is the head-tilt/chin-lift family of positioning, correct for opening the airway of an unresponsive patient with no trauma. Here the patient is a trauma patient with a suspected cervical injury lying supine, and a hand under the neck both extends the head and creates a fulcrum the spine can pivot over. The key beats it because two hands on the sides of the head apply force symmetrically, which holds the spine still instead of levering it.

Apply the collar, then establish manual stabilization afterward: The collar alone sounds like what stops spinal movement, so applying it fast would matter most. The patient already has manual stabilization holding neutral alignment, and releasing that before the collar is fully seated risks shifting an unstable fracture.

Apply the collar after the patient is secured to the stretcher: This matches the full sequence where the collar goes on before the log roll and the patient is strapped to a backboard or stretcher. Waiting until after that strapping to place the collar leaves an alert patient's neck unsupported during every move in between.

Release manual stabilization to place the collar, then resume it: The collar wraps around the neck, and it seems like the hands holding the head must come off to make room. That's backward: stabilization stays on the head the whole time, chin piece first, then the back piece slides in behind the neck, releasing only once the patient is secured to a board.