CH 33 Trauma to the Head, Neck and Spine Flashcards
H-1) The process by which the brain is compressed toward and through the foramen magnum is known as: A. herniation. B. subdural hematoma. C. concussion. D. cerebral contusion.
A. herniation.
Pushing a portion of the brain downward toward the foramen magnum is called herniation.
H-2) The purpose of spinal motion restriction is to prevent movement of individual: A. muscles. B. joints. C. vertebrae. D. tendons.
C. vertebrae
H-3) he 12 vertebrae in the upper back are known as the: A. coccyx. B. sacral spine. C. thoracic spine. D. lumbar spine.
C. thoracic spine
The thoracic spine is the region of vertebrae named as such because of the attachment of the ribcage that provides the external borders of the thoracic cavity.
H-4) Which of the following structures is the only movable part of the face? A. Maxilla B. Mastoid C. Mandible D. Zygoma
C. Mandible
The mandible, or jaw, is the only movable part of the face. It is hinged at its posterior aspect, and the movement allows for functions such as talking and chewing.
H-5) Skull injuries divide into two general categories, which are: A. traumatic and nontraumatic. B. subdural and epidural. C. open and closed. D. direct and indirect.
C. open and closed.
H-6) Which of the following statements about an epidural hematoma is true?
A. Patients with epidural hematomas may present similarly to those with subdural hematomas.
B. Unlike subdural hematomas, which occur rapidly, epidural hematomas take hours or days to develop.
C. Epidural hematomas do not carry the threat to life that subdural hematomas do.
D. The bleeding site is between the brain and the dura mater.
A. Patients with epidural hematomas may present similarly to those with subdural hematomas
Patients with epidural hematomas may present similarly to those with subdural hematomas, although numerous factors such as size, location, and concurrent injuries play a role in how a patient presents. In a subdural hematoma, presentation of symptoms may be delayed by as long as a day or more.
H-7) Which of the following findings is least likely in a patient with nontraumatic brain injury? A. Unequal pupils B. Battle sign C. Altered level of consciousness D. Slurred speech
B. Battle sign
Battle sign is an indication of possible basal skull fracture, and is unlikely in a patient with nontraumatic brain injury.
H-8) Which of the following intracranial physiological events is most likely to occur in a patient with traumatic brain injury but not in a patient with nontraumatic brain injury? A. Cerebral edema B. Cerebral contusion C. Increased intracranial pressure D. Cerebral hemorrhage
B. Cerebral contusion
H-9) Which of the following is a component of Cushing reflex? A. Increased cerebral perfusion B. Decreased heart rate C. Decreased intracranial pressure D. Decreased blood pressure
B. Decreased heart rate
Increased blood pressure and decreased heart rate are known as the Cushing reflex, and indicate rising intracranial pressure.
H-10) In a patient who sustained massive impact trauma to the face during a motor vehicle crash, the presence of facial fractures and a fractured mandible should lead you to suspect:
A. that a compromised airway is not very likely.
B. that the patient is not likely to have a brain injury, because the facial fractures absorbed all of the energy at impact.
C. that the patient was unrestrained.
D. that the energy involved might have caused skull or brain injury.
D. that the energy involved might have caused skull or brain injury.
H-11) Your patient responds to painful stimulus with decorticate posturing (arms bent to his chest, fists clenched, and legs straight out), his eyes do not open to pain, and he makes incomprehensible sounds when you pinch him. What score would you give him on the Glasgow Coma Scale? A. 4 B. 6 C. 5 D. 3
B. 6
His score would be eye = 1 (no eye opening), verbal = 2 (incomprehensible sounds), and motor = 3 (flexion to pain).
H-12) What is your first priority for a patient with massive facial trauma? A. Preventing permanent scarring B. Keeping the airway open C. Protecting the patient's privacy D. Bandaging all open injuries
B. Keeping the airway open
Top priorities include securing the airway and controlling bleeding, with cervical spine precautions if indicated.
H-13) Which of the following indicates a possible mandible injury? A. Unequal pupils B. Memory loss C. Improperly aligned teeth D. Bruising around the eyes
C. Improperly aligned teeth
Improperly aligned teeth and difficulty speaking are indications of possible mandible injury.
H-14) If a standard medically approved occlusive dressing is not available, what material might be effective in treating an open neck wound?
A. Elastic wrap (e.g., an Ace bandage)
B. Aluminum foil
C. A piece of heavy plastic that is at least 2 inches larger in diameter than the wound site
D. A water- or saline-soaked 4 x 4 gauze pad
C. A piece of heavy plastic that is at least 2 inches larger in diameter than the wound site
A sheet of heavy plastic of an appropriate size will most effectively occlude the neck from air entry. (secured with medical tape)
H-15) You arrive on scene to an assault victim who is grabbing the side of her neck. You notice hemorrhage on the left side of her neck. How should you manage this patient’s neck wound once you arrive at her side?
A. Locate an occlusive dressing and place it on the wound in a timely fashion
B. Apply firm, direct pressure bilaterally to the neck
C. Immediately wrap a bandage around the neck
D. Immediately cover the wound with a gloved hand
D. Immediately cover the wound with a gloved hand
H-16) Your patient attempted suicide by hanging. What type of spinal injury is most likely? A. Extension injury B. Compression injury C. Distraction injury D. Flexion injury
C. Distraction injury
The spine is pulled excessively (hanging is an example of this)
H-17) A diver struck his head on the bottom of the swimming pool and now complains of neck pain and numbness in his lower extremities. You suspect: A. compression injury. B. rotational injury. C. crush injury. D. distraction injury.
A. compression injury.
H-18) In neurogenic shock, the pulse rate may be: A. normal. B. lower than the blood pressure. C. undetectable. D. erratic.
A. normal
In neurogenic shock, the heart rate may continue to be normal, or even slow, because the neural messages for the heart to speed up its pumping action are blocked by spinal injury.
H-19) Paralysis of the extremities is probably the most reliable sign of spinal cord injury: A. if accompanied by paresthesia. B. in patients who are conscious. C. in pediatric patients. D. if verbal response is also impaired.
B. in patients who are conscious.
H-20) You are the second unit on the scene of a multiple-vehicle crash. You and your partner are caring for a middle-aged woman who is sitting in the passenger seat of a vehicle that seems undamaged. You see no signs of injury in this patient. When you ask her about pain, she replies in a foreign language. What should you do?
A. Take full spinal precautions, because you cannot determine the extent of the patient’s injuries.
B. Although communication is important, given the fact that there are no MOIs and no signs of injury, you can safely choose not to immobilize the patient.
C. The patient’s language has no bearing on how you treat here. She does not require immobilization.
D. Examine the patient more closely, and look for physical signs of pain when you palpate her back.
A. Take full spinal precautions, because you cannot determine the extent of the patient’s injuries.
The language barrier creates an inability to communicate. The patient should be immobilized as a precaution, because the patient cannot relay information about her injuries.
H-21) The police call you for a 50-year-old male patient who has a history of intoxication and belligerence. You find him sitting on the curb with a small abrasion, minimal bleeding to his forehead, and his hands cuffed behind his back. He is exhibiting tremors, and his speech is slurred. He denies any pain, denies any consumption of alcohol, and says that he sustained the abrasion 3 days earlier. You should:
A. transport him without spinal precautions.
B. ask law enforcement for permission to immobilize the patient.
C. immobilize him, because the history seems unreliable.
D. explain the risks to the patient and let him choose whether or not to be immobilized.
C. immobilize him, because the history seems unreliable.
The history is inconsistent with your physical findings, and the patient is probably intoxicated. The patient should be immobilized. You should identify the potential for spinal injury while also identifying secondary causes to the patient’s condition.
PT-1) The catcher at a baseball game is struck on the front of his head by a thrown bat. He sustains a cerebral bruise on the front of his brain but also has a contusion on the back of his brain. The bruise on the back of his brain is called a(n): A. unilateral injury. B. contrecoup injury. C. coup injury. D. anterior cerebral contusion.
B. contrecoup injury.
PT-2) You are assessing a patient who is unconscious but who responds to painful stimuli by attempting to push away the painful stimulus (for instance, a pinch on the leg) with his hand. How would you score his motor response according to the Glasgow Coma Scale? A. 4 B. 3 C. 5 D. 6
C. 5
PT-3) You respond to the scene of an explosion to treat a victim with a penetrating injury to the occipital area from shrapnel. For which of the following additional injuries should you have a high level of suspicion? A. Spinal injury B. Transection of the trachea C. Penetrating thoracic injury D. Carotid artery involvement
A. Spinal injury
PT-4) Which of the following describes shock following spinal injury?
A. Dilation of the blood vessels, resulting in reduction of perfusion to tissues
B. Paralysis of the respiratory muscles occurring with injury to the thoracic spine
C. Paralysis to only one side of the body that does not resolve
D. Inadequate circulation indicated by a rapid pulse and cool, clammy skin
A. Dilation of the blood vessels, resulting in reduction of perfusion to tissues
PT-5) The region where the jaw articulates with the remainder of the head is termed the: A. temporomandibular joint. B. frontomandibular joint. C. parietomandibular joint. D. angle of the mandible.
A. temporomandibular joint.
PT-6) You are assessing a victim of a gunshot wound to the head. Her eyes are open, but she does not follow or track any movement. There is no eye blink, and her pupils are fixed and dilated. Her motor response score is a 1, and her verbal response is a 1 as well. What is her eye-opening score? A. 4 B. 1 C. 2 D. 3
B. 1
PT-7) In treating a patient with suspected head or spine injury, manual stabilization of the head and neck can be released:
A. only after the cervical spine has been cleared by an X-ray.
B. when you find a good pulse, motor function, and sensation in the distal extremities.
C. after the patient has been secured to a backboard.
D. after the cervical collar has been applied.
C. after the patient has been secured to a backboard.
PT-8) You are treating a 22-year-old male who was stabbed in the neck during a bar fight. What is an important part of the treatment of this injury?
A. Sealing the wound with an occlusive dressing
B. Laying the patient down
C. Checking for subcutaneous emphysema
D. Listening to the lung sounds right away
A. Sealing the wound with an occlusive dressing
PT-9) You are caring for a 19-year-old female patient who was involved in a motor vehicle crash. She sustained blunt-force trauma to her face with contusions, swelling, and minor bleeding throughout her facial region. Which of the following findings most strongly suggests a fractured mandible?
A. Tenderness to palpation of her zygomatic bone
B. Inability to close her mouth from a wide-open position
C. Bleeding from the nose
D. Lower teeth that are out of alignment in the front
D. Lower teeth that are out of alignment in the front
PT-10) When you are stabilizing an impaled object in the head, always:
A. use a pressure-type dressing such as elastic wrap to hold the object in place.
B. avoid wrapping the dressing around the head, as this may increase pressure in the head.
C. cover both the patient’s eyes as well.
D. use bulky and rigid support.
D. use bulky and rigid support.
PT-11) How many vertebrae make up the cervical spine? A. Nine B. Five C. Seven D. Three
C. Seven
7 - 12 - 5 - 5 - 4
PT-12) Your patient is unable to move his lower jaw or speak. You should suspect an injury to the: A. temporal region. B. maxilla. C. orbit. D. mandible.
D. mandible.
PT-13) A brain injury is classified as nontraumatic if it is:
A. not serious.
B. not permanent.
C. not attributable to an external cause.
D. not assessable on the Glasgow Coma Scale.
C. not attributable to an external cause
PT-14) You are treating a 6-year-old car crash victim, and have decided to immobilize him. You should refrain from doing which of the following?
A. Using a coordinated long axis move onto the backboard
B. Securing the patient on an adult long spine board
C. Securing the patient in his child safety seat
D. Padding the patient’s shoulders
C. Securing the patient in his child safety seat
PT-15) The regions on the surface of the body that individually are innervated by a single spinal nerve are called: A. myotomes. B. nerve tracts. C. dermatomes. D. vertebral branches.
C. dermatomes
PT-16) If an individual sustains a head injury, and blood has accumulated on top of the brain but beneath the dura, this type of injury is termed a(n): A. subarachnoid hemorrhage. B. epidural hematoma. C. intracerebral laceration. D. subdural hematoma.
D. subdural hematoma
PT-17) You just arrived at the scene of a motor vehicle crash involving two cars. The passenger of one car is sitting in the front seat, unconscious, with her chin to her chest. She is having snoring respirations, so you carefully position her head in a neutral position to clear her airway. In doing so, you notice that her nose is bleeding, there is a reddened area on her forehead at the hairline, and the windshield is starred, with some hair stuck in the fractured glass. What type of cervical injury should you suspect?
A. Extension or flexion injury
B. Flexion or rotational injury
C. Axial loading or rotational injury
D. Axial loading or hyperextension injury
A. Extension or flexion injury
PT-18) Manual cervical stabilization should be provided to all patients with a significant mechanism of injury until:
A. completion of a sensory examination.
B. completion of a neuromotor examination.
C. establishment of spinal tenderness.
D. completion of the assessment.
D. completion of the assessment.
PT-19) Which of the following is a common cause of nontraumatic brain injury? A. Syncope B. Tinnitus C. Blood clot D. TIA
C. Blood clot
PT-20) You find out that one of your patients from an earlier car wreck suffered bleeding that caused the blood to collect and pool within the patient's skull. Based on this information, you know that the patient most likely suffered which type of brain injury? A. Concussion B. Contusion C. Laceration D. Hematoma
D. Hematoma
PT-21) You have established manual in-line cervical spine stabilization of an unconscious trauma patient. You may release manual stabilization:
A. once a cervical collar has been applied.
B. when immobilization has begun.
C. when the patient is fully immobilized and secured to the backboard.
D. when the patient arrives at the hospital emergency department.
C. when the patient is fully immobilized and secured to the backboard.
PT-22) A 22-year-old male patient was involved in a physical altercation at a bar. He has no evidence of head trauma, and reportedly did not fall or lose consciousness at any time. His only complaint is pain upon deep inspiration along the front of his left rib cage. Given the mechanism of injury and his presentation, should this patient be immobilized?
A. Probably so, because he was at a bar and was likely drinking
B. Probably not, because evidence of spinal injury would be obvious
C. Probably so, because he has pain in his chest
D. Probably not, because he does not have the mechanism of injury or the symptoms to suggest the need
D. Probably not, because he does not have the mechanism of injury or the symptoms to suggest the need
