Wilderness Medic WALS Pre-Course Test

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 above. Your first action should be to:

Question 1 of 60

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

Question 2 of 60

3. The patient is A on AVPU and able to describe the accident in detail. This finding confirms that there is no:

Question 3 of 60

4. Your focused physical exam reveals a deformed, tender, and very swollen left thigh. In addition to fracture, this finding also suggests a mechanism for:

Question 4 of 60

5. Vital signs on your injured climber measure as follows: P – 136, R – 24, BP – 110/72, Skin – cool and pale, C – Awake with normal mental status. This pattern fits the assessment of:

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6. Which actions would be appropriate in the treatment of the injured climber?

Question 6 of 60

7. A week after rescuing the climber, you are hiking with friends on a fine summer day. One of your party is lagging behind. You return to find him sitting by the trail. There has been no trauma. Your exam reveals an ill appearing man with the following vital signs: P: 122, R: 22, Skin: flushed and sweaty, C: Awake and oriented but subdued. He reveals that he has not produced urine for the past 5 hours, and has been drinking little because he forgot his water bottle. The most likely explanation for these signs and symptoms is:

Question 7 of 60

8. The most appropriate treatment for the patient in the previous question is:

Question 8 of 60

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

Question 9 of 60

10. Under what circumstances would manipulation of a complicated elbow dislocation be appropriate in the field?

Question 10 of 60

11. 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 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:

Question 11 of 60

12. Your team is called to recover the body of a lost skier. On scene you discover that the “body” is still pliable and has a core temperature of 29 degrees C. You cannot detect respiration but you do feel a slow pulse. The ideal course of action would be to:

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13. It is best to avoid:

Question 13 of 60

14. 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:

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15. Which cause of upper airway obstruction would be most difficult to manage without medication or surgical intervention?

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

Question 16 of 60

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

Question 17 of 60

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

Question 18 of 60

19. One of your ski patrollers calls to report a young man behaving abnormally. He is carrying a snowboard and wandering around the base area. He seems confused and is unable to explain what he is doing or how he came to be there. The problem could be:

Question 19 of 60

20. 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: 112, R: 22 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:

Question 20 of 60

21. You have administered epinephrine to a patient experiencing a severe asthma attack. She is improving. You will be caring for her for at least the next 24 hours. Which would be the most appropriate course of therapy?

Question 21 of 60

22. Lightning strikes a ridge line near you injuring a hiker. You arrive on scene five minutes later to find CPR in progress. The storm continues and lightning is striking nearby. You should:

Question 22 of 60

23. 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:

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?

Question 24 of 60

25. 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?

Question 25 of 60

26. 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 weakly. He feels cold to the touch. You find no evidence of trauma. The most likely case for his altered mental status is:

Question 26 of 60

27. What is the most appropriate field treatment for the patient in the previous question? You are on a steep hillside 3 miles from the trailhead in fog and rain.

Question 27 of 60

28. 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:

Question 28 of 60

29. During this same race, you 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:

Question 29 of 60

30. You are manning an aid station for a back country ski race in Colorado. Your hut is at an elevation of 3600 meters 12 kilometers 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:

Question 30 of 60

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

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

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

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34. Which findings support the assessment Stable Injury?

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

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36. 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:

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

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38. An angulated wrist fracture is not considered an Initial Assessment problem because:

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

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

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

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42. The administration of morphine or demerol to a patient on a long backcountry evacuation increases the risk of:

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43. Which presentation fits the assessment Mild Hypothermia?

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

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45. 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?

Question 45 of 60

46. Which statements are true about a dislocated shoulder?

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

Question 47 of 60

48. Which history and exam findings would prompt you to include traumatic brain injury (TBI) in the problem list for a patient that has been struck by the boom during an accidental jibe?

Question 48 of 60

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

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50. 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?

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

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

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53. Which two of the following techniques are the most effective in controlling severe bleeding?

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

Question 54 of 60

55. 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 high ledge. He is able to walk but complains of neck pain. An appropriate plan includes:

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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?

Question 56 of 60

57. 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:

Question 57 of 60

58. 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?

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 complains of neck pain and stiffness. You should:

Question 59 of 60

60. 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 seems to have mildly altered mental status. He feels warm to the touch. This is most likely:

Question 60 of 60