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

Apply restriction, since any collision mechanism requires it: Restricting every collision patient was in fact the old standard, which is why this option still reads as the safe, familiar answer. National guidance replaced blanket mechanism-based immobilization with the selective criteria precisely because routine immobilization produced measurable harm without a demonstrated benefit. The key applies the criteria this patient fully meets; this option ignores an assessment that has already answered the question.

Apply a cervical collar for comfort only: A collar for comfort is a reasonable thing to offer a patient who is complaining of neck pain and finds the support relieving. This patient has no neck complaint at all: no pain and no midline tenderness, so there is nothing for the collar to relieve. The key withholds a device with no indication; this option applies partial restriction for a symptom the question explicitly says is absent.

Withhold restriction only if neck range of motion is also pain-free: Testing pain-free neck rotation is a real step in some clearance rules, so the instinct behind this option is not invented. The criteria being applied in this question are the standard prehospital selective set, and this patient satisfies all of them; adding a requirement those criteria do not contain would keep a fully clearable patient in a collar. The key clears the patient on the criteria that actually govern the decision.

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: Hands under the chin supporting the jaw is the grip for a chin-lift or jaw-thrust, and the jaw-thrust is in fact the airway maneuver of choice in suspected spinal injury, so the hand position is right for a different task. As stabilization it fails twice: hands on the mandible alone cannot stop the skull from rotating, and pressure under the chin in a patient with facial trauma can push soft tissue into the airway. Airway management is a separate job from holding the head still.

Hands grasping the patient's shoulders while using the arms to immobilize the head: Grasping the shoulders and squeezing the head between your forearms is a legitimate technique for a specific moment, such as a seated rapid extrication or a standing takedown where you brace from behind. As the answer to which placement best prevents rotation and lateral movement it falls short, because the head can still turn between your arms while you control the torso and hope the head follows. The key puts the hands directly on the structure being stabilized.

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 well, which is why it feels correct, but it leaves rotation and lateral bending unopposed. The larger problem is the traction: axial pull can distract an unstable cervical spine and worsen a cord injury, which is why current practice is neutral in-line stabilization with no pulling force at all.

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 reflex airway move for a supine patient who vomits, and it works: gravity clears the mouth. It is the one thing you cannot do with a suspected cord injury, because rotating the head against a held torso is precisely the motion in-line stabilization exists to prevent. The key gets the same drainage by turning the whole patient instead of just the head, which is why it beats this rather than contradicting the instinct behind it.

Pause the roll, apply a cervical collar to secure the airway, and then resume movement: A cervical collar is a reasonable adjunct and the log-roll is usually when it goes on, so the timing instinct is not crazy. It does nothing for the problem in front of you, though: a collar does not protect an airway, does not remove vomit, and does not replace the hands at the head. It limits flexion and extension and that is all. Stopping mid-roll to fasten straps leaves vomit sitting in the airway.

Call for paramedics to intubate the patient before continuing care: An advanced airway is the answer when positioning and suction have failed and the patient still cannot protect his airway, and yes, intubation sits above the EMT level. The larger error is the delay: waiting on another crew while a patient is actively vomiting is not airway management. Positioning and suction are immediate, they are yours, and they solve this one.

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 does not promote venous drainage and may allow intracranial pressure to increase.

Trendelenburg position (head lower than feet) to maintain cerebral perfusion: Trendelenburg (head down) increases intracranial pressure by promoting venous congestion in the head and should be avoided in head injury.

Right lateral recumbent to improve venous drainage: Lateral positioning is not standard for reducing intracranial pressure management; it is used for airway protection in altered consciousness to prevent aspiration.

The Glasgow Coma Score measures an infant's mental capacity across eye opening, verbal response, and motor response, and below 10 is severe.: Two separate things are wrong here. The GCS is not an infant tool that grades mental capacity, and the severe cutoff is 8, not 10. It is also the Glasgow Coma Scale, not the Glasgow Coma Score.

The Glasgow Coma Scale measures an infant's mental capacity across eye opening, verbal response, and motor response, and below 8 is severe.: The cutoff of 8 is right, but the rest is not. The GCS is scored on any patient, and what it grades is level of consciousness, not an infant's mental capacity.

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 gets what the scale measures right and the number wrong. A GCS of 10 sits in the moderate range, 9 to 12. Severe starts at 8 and counts down from there.

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: Incorrect. Manual stabilization should be maintained throughout collar application. Releasing the head before the collar is fully applied risks loss of neutral alignment and secondary injury.

Apply the collar after the patient is secured to the stretcher: Incorrect. The cervical collar should be applied as soon as spinal injury is suspected, not delayed until the patient is on the stretcher.

Release manual stabilization to place the collar, then resume it: Incorrect. Releasing manual stabilization to apply the collar creates a gap in protection. Stabilization is maintained throughout the process.