Viristar 5-Day Pre-Course Exam - Wilderness Medical Associates International

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. As you approach the scene of a climbing accident, you observe an injured climber hanging just above the ground. The belay rope disappears over the top of the cliff 20 meters (65 feet) above. Your first action should be to:

a. Survey the scene for dangers, numbers of patients, and available resources.

b. Conduct a secondary assessment.

c. Stand under the climber in case she falls when the belay rope is cut.

d. Check the climber for circulation, breathing, and spine injury.

Question 1 of 60

2. The technical team has relieved the belayer and lowered an injured climber to the ground. Your primary assessment reveals a rapid pulse and easy but rapid breathing. Possible causes include:

a. Acute stress reaction.

b. Respiratory distress.

c. Volume shock.

d. Both a & c.

Question 2 of 60

3. What actions would be appropriate in the treatment of a climber with a fractured femur following a 10 meter (32 foot) fall?

a. Request a paramedic for IV fluids and pain control.

b. Spine protection unless the spine can be cleared.

c. Packaging to prevent hypothermia.

d. All of the above.

Question 3 of 60

4. The assessment Traumatic Brain Injury (TBI) carries the anticipated problem of:

a. Volume shock.

b. Spine injury.

c. Increased intracranial pressure.

d. Skull fracture.

Question 4 of 60

5. Your team is called to recover the body of a lost skier. On arrival, you discover that the “body” is still pliable and has a core temperature of 28 degrees C (82 F). You cannot detect respiration but you do feel a slow pulse. The most appropriate course of action would be to:

a. Perform CPR and external warming for 30 minutes before transporting.

b. Request that an AED be brought to the scene to confirm the pulse and shock the patient if necessary.

c. Package the patient in a hypothermia wrap, provide PPV, and evacuate gently but urgently to medical care.

d. Immerse the patient in a nearby hot spring until normal body core temperature is reached.

Question 5 of 60

6. One of your crew members lacerates her shin on a sail track on an offshore passage. The wound exposes bone and muscle, and is about 5 cm (2 inches) long. Bleeding is minimal. You are not expecting to make port for three more days. The best way to reduce the chance of infection would be:

a. Immediately cover the wound with a pressure dressing and leave it in place until port is reached.

b. Clean the wound with hydrogen peroxide and close it with butterfly bandages.

c. Close the wound with surgical staples to prevent drainage of blood and fluid.

d. Clean and irrigate the wound, and dress it open with wet to dry dressings.

Question 6 of 60

7. Which cause of upper airway obstruction would be most difficult to manage without medication and advanced techniques?

a. Forward flexion of the neck.

b. Swelling from anaphylaxis.

c. A bolus (small mass) of food lodged in the trachea.

d. Vomiting.

Question 7 of 60

8. One of your rescue team members dislocates his thumb when it becomes caught in a belay device. His symptoms include an elevated pulse, elevated respiratory rate and mental status changes. This is most likely due to:

a. Acute stress reaction.

b. Shock caused by pain.

c. Central nervous system injury.

d. Blood loss in the thumb.

Question 8 of 60

9. On a camping trip you are called to evaluate a 10 year old girl who has just been stung by hornets. Exam reveals an awake but very upset patient with 3 obvious stings on her left leg. She is known to have an allergy to bee stings. Vital signs are: P: 120, R: 24 and easy, without wheezing or stridor. Skin: warm and pink with slight swelling and redness at three sites on the left leg. No hives or facial swelling. C: Awake and anxious. This is most likely:

a. Systemic infection.

b. Parasympathetic acute stress reaction.

c. Sympathetic acute stress reaction.

d. Anaphylactic shock

Question 9 of 60

10. Your secondary assessment on a climber injured by a 10 meter (32 foot) fall reveals a deformed, tender, and very swollen left thigh. In addition to fracture, this finding also suggests a mechanism for:

a. Significant blood loss.

b. Volume shock.

c. A critical body system injury.

d. All of the above.

Question 10 of 60

11. You are manning an aid station for a back country ski race in Colorado. Your hut is at an elevation of 3600 meters (11,800 feet)12 kilometers (7.5 miles) from the trailhead and accessible only by ski or snowshoe. A competitor enters the hut and removes his boot to reveal several frozen toes with frostbite extending into the forefoot. The area is completely numb, frosted, and very firm to the touch. The competitor is otherwise healthy. The most appropriate plan is to:

a. Have him immediately ski back to the trailhead for a ride to the hospital.

b. Rewarm the foot in 39 degrees C (102 F) water and allow him to continue the race.

c. Rewarm the foot in 39 degrees C (102 F) water and keep him at the hut until the frostbite has healed.

d. Rub the area vigorously with snow until rewarmed.

Question 11 of 60

12. One of your crew members on an offshore boat delivery stuck a fish hook through his hand. He comes to you two days later complaining of swelling and pain. You see a scabbed over puncture wound through the web space of the thumb and 2nd finger. The area is swollen, red, and warm to the touch. Which signs would indicate that the infection is becoming systemic?

a. Swelling and redness at the wound site.

b. Thick, yellow exudate coming from the wound site.

c. Fever and swollen lymph nodes in the armpit.

d. Numbness and tingling of the fingers and pain in the hand.

Question 12 of 60

13. As a ski patroller, you are called to evaluate a young man behaving abnormally. He is carrying a snowboard and wandering around the base area. He seems confused and is unable to tell you what he is doing or how he came to be there. The problem could be:

a. Drug use (intoxication).

b. Low blood sugar.

c. Traumatic brain injury.

d. Any of the above.

Question 13 of 60

14. Vital signs on a climber with a fractured pelvis from a fall measure as follows: First set of vitals: P – 128, R – 20, BP – 110/72, Skin – pale, C – awake with normal metal status. Second set of Vitals: P – 136, R – 24, BP – 110/72, Skin – cool and pale, C – Awake with normal mental status. This pattern fits the assessment of:

a. Decompensated volume shock.

b. Compensated volume shock.

c. Systemic infection from open wounds.

d. Traumatic brain injury with increased ICP.

Question 14 of 60

15. What is the appropriate dose of injectable epinephrine in the emergency treatment of anaphylaxis?

a. 3.0 mg.

b. 0.3 mg.

c. 0.3 mg per kilogram of body weight.

d. 1 mg per kilogram of body weight.

Question 15 of 60

16. Lightning strikes a ridge line near you injuring a hiker. You arrive on scene two minutes later to find several people standing back and afraid to approach the victim. You should:

a. Use a wooden stick to push the patient out of the danger area.

b. Wait until the charge has dissipated to avoid getting a shock from the patient.

c. Immediately begin CPR.

d. Extricate the patient to a safe location and perform a primary assessment.

Question 16 of 60

17. The hasty team has just located the subject of a 36 hour search in wet and cold conditions. You are called to the scene to perform a medical evaluation. Your patient is curled up under a spruce tree and is awake but mumbling and confused. He is shivering and feels cold to the touch. You find no evidence of trauma. The most likely case for his altered mental status is:

a. Traumatic brain injury.

b. Severe hypothermia.

c. Mild hypothermia.

d. Volume shock.

Question 17 of 60

18. What is the most appropriate field treatment for a mildly hypothermic hiker located after a 36 hour search? You are on a steep hillside 4.8 km (3 miles) from the trailhead in fog and rain.

a. Wait for a litter team with equipment for a scree evac.

b. Get him up and immediately start hiking out.

c. Strip off his wet clothes and wrap him in a tarp with the hasty team.

d. Wrap him in a sleeping bag and tarp and feed him sugar and electrolyte drink.

Question 18 of 60

19. You arrive on scene 30 minutes after a dirt bike accident to find the injured person up and walking around. You can safely conclude that:

a. The patient does not have a traumatic brain injury.

b. There are no serious fractures.

c. There is no spine injury.

d. The patient can walk.

Question 19 of 60

20. You are treating a patient following a mountain bike accident. What finding leads you to include traumatic brain injury on your problem list?

a. The swelling of the scalp and the bloody nose.

b. The patient cannot remember the accident.

c. The patient was not wearing a helmet.

d. The large scalp laceration.

Question 20 of 60

21. You are providing medical support to an adventure race and are called to the scene of a runner down. You find a young man staggering, confused and combative. He is hot to the touch. VS: P 140, R irregular and rapid. Skin: hot, red, moist. The most appropriate immediate treatment is:

a. Aggressive re-hydration.

b. Food, fluids, rest.

c. Radical cooling with a water sprayer.

d. Salt tablets.

Question 21 of 60

22. You are near the end of a long hike with friends on a warm summer day when one of your party lags behind the rest. You backtrack a kilometer ( ½ mile) to find him sitting by the trail. Your exam reveals an ill appearing man with the following vital signs: P: 122, R: 22, Skin: pale and moist, C: Awake and oriented but subdued. SAMPLE history reveals that he has not produced urine for the past 8 hours, and has not been drinking because he forgot his water bottle. The most likely explanation for his vital sign pattern is:

a. Compensated volume shock from sweating.

b. Heat stroke.

c. Exertional hyponatremia.

d. Altitude illness.

Question 22 of 60

23. The most appropriate treatment for heat exhaustion is:

a. Immediate descent.

b. Radical cooling.

c. Rest and hydration.

d. Salt tablets.

Question 23 of 60

24. One of your backcountry skiing clients is having difficulty keeping up with the rest of the group. When questioned he describes a fall earlier in the day where he felt a pop and brief pain, after which his left knee “gave out” on him several times. He reports no numbness or tingling or other symptoms. He is able to ski only by bearing most of his weight on this right leg. Which statement is true about this case?

a. This is an unstable injury that requires emergent evacuation.

b. This is a stable injury and can be managed with RICE and pain free activity.

c. This is definitely a fracture and requires a traction splint and emergency evacuation.

d. This is an unstable injury that should be splinted and referred to medical care on a non-emergent basis.

Question 24 of 60

25. It is best to avoid:

a. Any use of helicopters.

b. Letting the weather influence your evacuation decisions.

c. High risk evacuations for low risk problems.

d. Low risk evacuations for high risk problems.

Question 25 of 60

26. Persistent ischemia is a high-risk problem because it will ultimately result in:

a. Severe pain.

b. Loss of sensation.

c. Infarction (tissue death).

d. Pitting edema (severe swelling).

Question 26 of 60

27. Why might blunt injury to the chest and abdomen be a mechanism for volume shock?

a. Rib fracture can cause problems with breathing.

b. Parasympathetic acute stress reactions are common.

c. Solid organs like the spleen and liver can rupture and bleed profusely.

d. The pain can cause the patient to go into shock.

Question 27 of 60

28. A sailor struck by the main boom is A on AVPU with normal mental status and is able to describe the accident in detail. For field purposes, this finding confirms that there is no:

a. Spine injury.

b. Volume shock.

c. Traumatic brain injury.

d. Skull fracture.

Question 28 of 60

29. You are providing medical support to an adventure race. A competitor presents to the aid tent feeling weak and dizzy. She has made every water stop along the way, and reports that she has stopped to urinate several times in the last five miles of running. VS: P 100, R 20, Skin: warm and moist. T 37.5C. The most appropriate treatment is:

a. Radical cooling with a water sprayer.

b. Rest, fluid restriction, and food.

c. Continued hydration.

d. Antibiotics for urinary tract infection.

Question 29 of 60

30. Under what circumstances would you apply traction into position for a dislocated elbow?

a. The patient asks you to straighten it.

b. The splint is straight and the elbow is bent.

c. There is persistent ischemia and you are more than two hours from medical care.

d. It is very painful and you are more than two hours from medical care.

Question 30 of 60

Multiple Response

Identify the 1 or 2 choices that best answer the question.

31. The terms ischemia and infarction refer to:

a. A problem that can be life-threatening.

b. Swelling and airway obstruction.

c. Loss of local perfusion leading to tissue death.

d. The types of toxins found in North American pit vipers.

Question 31 of 60

32. You are evaluating a sick refugee with a persistent cough at a remote base camp. What elements of the history, signs, or symptoms would motivate a high priority for evacuation?

a. The patient has lost interest in eating and drinking.

b. The patient cannot speak more than two or three words between breaths.

c. You can hear wheezing in the lungs with your stethoscope.

d. The patient coughs up green sputum.

Question 32 of 60

33. An angulated forearm fracture should be restored to normal anatomic position before splinting unless:

a. The bone ends are sticking out.

b. You are within two hours of the hospital.

c. The patient refuses to allow the procedure.

d. Significant pain or resistance develops.

Question 33 of 60

34. Which presentations of abdominal pain are the most worrisome?

a. Localized and aggravated by movement, worsening slowly over the past several hours.

b. Diffuse, crampy, with hyperactive bowel sounds.

c. All over abdominal pain that is relieved temporarily by a bout of diarrhea or flatulence.

d. Persistent and spreading following a hard blow to the abdomen and chest.

Question 34 of 60

35. Your patient with a deformed fracture of the wrist has an elevated pulse and respiratory rate, pale skin, and mildly altered mental status. The cause of these vital signs could be:

a. shock from the pain of the fracture.

b. Volume shock from another injury that you missed on your exam.

c. Volume shock from the swelling of the wrist.

d. Acute stress reaction.

Question 35 of 60

36. Immediately following a jellyfish sting, your mate begins to develop hives, itching, respiratory distress and facial swelling. This is most likely:

a. An anaphylactic reaction.

b. An asthma attack.

c. A condition requiring emergency treatment.

d. Acute stress reaction.

Question 36 of 60

37. The purpose of traction into position to realign a deformed fracture of the lower leg is:

a. To make the patient conform to the splint.

b. To preserve perfusion of the distal extremity.

c. To prevent injury to adjacent nerves and other soft tissue.

d. To allow the patient to walk out.

Question 37 of 60

38. Bone ends protruding from the skin at a fracture site should be:

a. Considered a high-risk wound and evacuated urgently.

b. Irrigated and restored to normal position within the soft tissue.

c. Soaked with full strength Betadine and left exposed.

d. Splinted in the position found.

Question 38 of 60

39. What mechanisms for shoulder dislocation are examples of indirect force?

a. Impact with a tree while skiing.

b. Falling 10 meters while bouldering.

c. Barn-door swing on one arm while climbing.

d. High bracing with a kayak paddle.

Question 39 of 60

40. Which statements are true about a dislocated shoulder?

a. It should be reduced as soon as possible.

b. It is usually caused by a direct impact.

c. The pain can cause shock.

d. The primary concern is ischemia to infarction.

Question 40 of 60

41. The wind suddenly shifts and your hot-shot crew is forced to run from a rapidly advancing wildland fire. One of your crew members tumbles over a 3 meter (10 foot) high ledge. He is able to walk but complains of neck pain. An appropriate plan includes:

a. Pronounce his spine “clear” and keep running.

b. Maintain hands-on spine stabilization and wait for a medical team to bring a backboard and litter.

c. Assist the crew member in running from the fire and evaluate the spine when a safe zone is reached.

d. Quickly fashion a short backboard from a tree branch and urge the crew member to run with it in place.

Question 41 of 60

42. Which presentation fits the assessment Mild Hypothermia?

a. Not shivering, cold, U on AVPU.

b. Not shivering, cold, P on AVPU.

c. Shivering, cold, awake, normal mental status.

d. Shivering, cold, awake, altered mental status.

Question 42 of 60

43. You have tried several times to reduce a dislocated shoulder but have not been successful. What should be done now?

a. Enlist the aid of several more rescuers so more force can be applied.

b. Treat as a stable injury and evacuate when convenient.

c. Treat as an unstable injury.

d. Plan an urgent evacuation.

Question 43 of 60

44. With which musculoskeletal problems would you also anticipate critical system problems?

a. Unstable pelvis injury.

b. Dislocated shoulder.

c. Skull fracture.

d. Unstable wrist injury.

Question 44 of 60

45. Which type of respiratory system problem typically produces wheezing?

a. Pulmonary edema.

b. Asthma

c. Lower airway constriction.

d. Pneumothorax.

Question 45 of 60

46. Which findings support the assessment Stable Injury?

a. The extremity is numb, but circulation is intact.

b. The patient was able to walk on the ankle for several miles after the injury.

c. Swelling developed slowly over 12 hours.

d. The deformity is not too severe.

Question 46 of 60

47. One of your clients on a winter trip presents with a white fingertip. The tissue is numb and cold but soft to the touch. Appropriate field treatment includes:

a. Immediate rewarming inside a warm glove or pocket.

b. Keeping the finger frozen until tomorrow when the patient can be evacuated.

c. Hydration and calories to warm the patient up.

d. Rubbing snow on the finger.

Question 47 of 60

48. An angulated wrist fracture is not considered a primary assessment problem because:

a. It can be addressed after the secondary assessment is completed.

b. It is not a life-threatening injury.

c. The patient still has one good arm.

d. It does not prevent walking.

Question 48 of 60

49. Which history and exam findings would prompt you to include traumatic brain injury (TBI) on the problem list for a patient that was involved in a lightning strike?

a. The patient was unconscious for 90 seconds following the strike, but has normal mental status now.

b. The patient was knocked to the deck and chipped a tooth.

c. The patient has singed hair and a bloody nose.

d. The patient cannot remember the event.

Question 49 of 60

50. A client complains of a sore throat for the past few days. What symptoms might indicate an impending emergency?

a. He is refusing to eat or drink anything.

b. You notice that the glands in his neck are swollen.

c. You see white patches on the tonsils.

d. He has a persistent fever of 41 degrees C (105 F) and altered mental status.

Question 50 of 60

51. Which signs and symptoms would indicate that an ankle injury is definitely unstable?

a. Obvious deformity.

b. Pain.

c. The joint “gives out” when the patient tries to walk.

d. Swelling.

Question 51 of 60

52. The immediate care of a stable ankle injury would include:

a. Rest, ice, compression, and elevation.

b. Walking off the pain.

c. Rest, hot packs, and deep tissue massage.

d. Splinting for comfort as needed.

Question 52 of 60

53. What symptoms would indicate the development of increased intracranial pressure in an awake patient with traumatic brain injury?

a. Worsening headache and the onset of vomiting.

b. Photophobia and the desire to sleep.

c. The inability to retain new memory.

d. He points out that one pupil is larger than the other.

Question 53 of 60

54. A crew member on your yacht delivery complains of chest pain for the past hour. What elements of history would make you more likely to insist on an emergency evacuation?

a. He is a 2 pack per day smoker for the past 25 years.

b. She celebrated her 21st birthday by learning to windsurf.

c. She raised the anchor and 75 feet of 3/8” chain by hand yesterday.

d. He has a history of hypertension and high blood cholesterol.

Question 54 of 60

55. Which two of the following techniques are the most effective in controlling severe bleeding from an extremity?

a. Arterial pressure points.

b. Powdered clot enhancers.

c. Tourniquet.

d. Direct pressure.

Question 55 of 60

56. You are evaluating a student in your Wilderness Trip Leader training program who has been complaining of persistent abdominal pain for the past 16 hours. Which of these presentations would motivate you to perform an urgent evacuation?

a. The pain is most severe in the right lower quadrant of the abdomen and is exacerbated by palpation and movement.

b. Her vital signs include a pulse of 120, a temperature of 39 degrees C (102 F), and a respiratory rate of 24.

c. She reveals that she might be pregnant.

d. The pain is crampy and relieved by passing gas.

Question 56 of 60

57. A helicopter evacuation at sea or in mountainous terrain is a high-risk operation. Which situations might justify it?

a. A traumatic brain injury with persistent vomiting.

b. Volume shock from internal bleeding.

c. A rib fracture with pain on deep inspiration.

d. A 10 cm (4 inch) scalp laceration.

Question 57 of 60

58. You are evaluating a 14 y.o. boy on a wilderness adventure trip. He has been complaining of severe pain in his lower leg for the past 24 hours. The leg seems extremely tender to palpation but there is only a small area of redness and swelling. He has lost interest in food and water and exhibits mildly altered mental status. He feels warm to the touch. This is most likely:

a. An emergency.

b. A faked illness to prompt a trip home.

c. Acute stress reaction to a minor injury.

d. A spreading infection.

Question 58 of 60

59. You were able to clear the spine two hours ago after a crew member suffered a fall from the rigging of a sail training vessel. But now she complaints of neck pain and stiffness. You should:

a. Repeat your spine assessment exam and treat accordingly.

b. Give ibuprofen and advise pain free activity.

c. Reassure her that her symptoms are a normal response to minor trauma.

d. Stabilize her spine until x-rays can be obtained.

Question 59 of 60

60. A female crew member complains of a urinary tract infection. What symptoms would lead you to believe that it is more serious than a simple UTI?

a. Pain on urination.

b. Persistent fever.

c. Cloudy urine.

d. Back pain.

Question 60 of 60