Ch. 37

Question 1

As you are examining a victim involved in a motor vehicle collision, you see that the patient has an injury involving the entire midfacial region, and you note the presence of a clear fluid draining from the nose. You suspect this is a:

A) Le Fort III fracture.
B) Le Fort I fracture.
C) basilar fracture.
D) linear fracture.

Answer 1

A) Le Fort III fracture.

Page Ref: 855-856
Objective: 37.1 Define key terms introduced in the chapter; 37.3 Discuss special considerations in the assessment and management of patients with injuries to the head, face, and neck, including airway compromise, profuse bleeding, potential that injuries may be self-inflicted or the result of violence, and patient fears associated with the injuries; 37.5 Demonstrate the assessment and management of specific injuries of the eye, scalp, face, and neck.

Question 2

A patient was forcefully struck on the forehead with a baseball bat, causing the patient’s brain to bounce backward to strike the back of his skull. This is a(n):

A) vascular lesion.
B) comminuted injury.
C) open brain injury.
D) coup-contrecoup injury.

Answer 2

D) coup-contrecoup injury.

Page Ref: 853
Objective: 37.1 Define key terms introduced in the chapter.

Question 3

An injury that occurs as a result of bleeding intracranially is:

A) a subdural hematoma.
B) a spinal cord transaction.
C) a comminuted fracture.
D) hypovolemia.

Answer 3

A) a subdural hematoma.

Page Ref: 853-854
Objective: 37.1 Define key terms introduced in the chapter; 37.7 Explain the pathophysiology and significance of the following with respect to traumatic brain injury: scalp lacerations and avulsions, open and closed skull fractures, cerebral concussion and diffuse axonal injury, cerebral contusion, coup-contrecoup injury, cerebral and intracranial hematomas, and cerebral hemorrhage.

Question 4

The initial signs of Cushing’s triad include:

A) tachycardia, hypotension, and decreased respirations.
B) tachycardia, hypertension and increased respirations.
C) bradycardia, hypertension, and irregular respirations.
D) bradycardia, hypotension, and decreased respirations.

Answer 4

C) bradycardia, hypertension, and irregular respirations.

Page Ref: 851
Objective: 37.1 Define key terms introduced in the chapter; 37.10 Describe the pathophysiology and key signs of increased intracranial pressure and brain herniation.

Question 5

A male soccer player was struck in the head with a soccer ball. Players state that he was dazed for several seconds following the impact and then asked the same questions over and over. Presently, he is conscious and oriented to person but confused to place and time. He also has a reddened area to the side of his head and face. As you proceed with your assessment, his memory continues to improve. Based on these findings, the AEMT should suspect which one of the following injuries?

A) Cerebral contusion
B) Open head injury
C) Epidural hematoma
D) Concussion

Answer 5

D) Concussion

Page Ref: 852-853
Objective: 37.1 Define key terms introduced in the chapter; 37.7 Explain the pathophysiology and significance of the following with respect to traumatic brain injury: scalp lacerations and avulsions, open and closed skull fractures, cerebral concussion and diffuse axonal injury, cerebral contusion, coup-contrecoup injury, cerebral and intracranial hematomas, and cerebral hemorrhage.

Question 6

You have been called by family members for their mother who is “not acting right.” On scene the family informs you that they are concerned because their 68-year-old mother has been complaining of a headache and is very confused. Assessment reveals a bruise to the right side of the head that the family states occurred one week ago when she fell in church. Because all other aspects of the assessment are normal, you suspect a head injury. Which condition would make the MOST sense given these findings and history?

A) Occult subdural hematoma
B) Cerebral contusion
C) Scalp laceration
D) Concussion

Answer 6

A) Occult subdural hematoma

Page Ref: 854
Objective: 37.1 Define key terms introduced in the chapter; 37.7 Explain the pathophysiology and significance of the following with respect to traumatic brain injury: scalp lacerations and avulsions, open and closed skull fractures, cerebral concussion and diffuse axonal injury, cerebral contusion, coup-contrecoup injury, cerebral and intracranial hematomas, and cerebral hemorrhage; 37.12 Document information relevant to the assessment and management of patients with injuries to the head.

Question 7

In a closed skull fracture, the scalp:

A) is avulsed.
B) remains intact.
C) receives minor lacerations.
D) suffers severe ecchymosis.

Answer 7

B) remains intact.

Page Ref: 850
Objective: 37.1 Define key terms introduced in the chapter.

Question 8

The blunt force trauma that causes a concussion causes no:

A) disruption of neurons.
B) structural damage to the brain.
C) loss of consciousness.
D) brain injury.

Answer 8

B) structural damage to the brain.

Page Ref: 852
Objective: 37.1 Define key terms introduced in the chapter; 37.3 Discuss special considerations in the assessment and management of patients with injuries to the head, face, and neck, including airway compromise, profuse bleeding, potential that injuries may be self-inflicted or the result of violence, and patient fears associated with the injuries.

Question 9

The ongoing assessment in the critically injured trauma patient should be done:

A) at least every five minutes.
B) every 15 minutes.
C) every minute.
D) once on the way to the hospital.

Answer 9

A) at least every five minutes.

Page Ref: 849
Objective: 37.4 Given a variety of scenarios, demonstrate the assessment-based management of patients with injuries to the brain, skull, scalp, face, eye, and neck; 37.12 Document information relevant to the assessment and management of patients with injuries to the head.

Question 10

A patient in a lateral-impact MVC displays decreased responsiveness without localized neurologic dysfunction. Based on the mechanism of injury and the presentation of the patient, you suspect:

A) cerebral contusion.
B) diffuse axonal injury.
C) coup-contrecoup injury.
D) concussion.

Answer 10

B) diffuse axonal injury.

Page Ref: 853-854
Objective: 37.5 Demonstrate the assessment and management of specific injuries of the eye, scalp, face, and neck.

Question 11

A patient has a partially avulsed scalp and is bleeding profusely. You anticipate the possibility of:

A) hypovolemia.
B) cerebral concussion.
C) herniation of brain tissue.
D) cerebral contusion.

Answer 11

A) hypovolemia.

Page Ref: 849
Objective: 37.5 Demonstrate the assessment and management of specific injuries of the eye, scalp, face, and neck.

Question 12

You are assessing a patient who had a previous head injury in which a portion of the cerebellum was destroyed. Which one of the following signs and symptoms would the AEMT expect to find in relation to this injury?

A) Inability to move or feel sensations in one side of his body
B) Inability to remember information such as a past medical history
C) Problems with the regulation of heart rate and blood pressure
D) Poor coordination when signing his name to the prehospital care report

Answer 12

D) Poor coordination when signing his name to the prehospital care report

Page Ref: 846
Objective: 37.5 Demonstrate the assessment and management of specific injuries of the eye, scalp, face, and neck; 37.7 Explain the pathophysiology and significance of the following with respect to traumatic brain injury: scalp lacerations and avulsions, open and closed skull fractures, cerebral concussion and diffuse axonal injury, cerebral contusion, coup-contrecoup injury, cerebral and intracranial hematomas, and cerebral hemorrhage; 37.12 Document information relevant to the assessment and management of patients with injuries to the head.

Question 13

Blood loss from a scalp wound:

A) is severe enough to cause shock.
B) requires vasopressor agents to control.
C) is easy to control with pressure.
D) is usually only minor.

Answer 13

A) is severe enough to cause shock.

Page Ref: 849
Objective: 37.7 Explain the pathophysiology and significance of the following with respect to traumatic brain injury: scalp lacerations and avulsions, open and closed skull fractures, cerebral concussion and diffuse axonal injury, cerebral contusion, coup-contrecoup injury, cerebral and intracranial hematomas, and cerebral hemorrhage.

Question 14

A patient with a severe scalp injury and a decreased level of responsiveness is bleeding significantly, and the patient’s head and face are covered with blood. You must:

A) focus exclusively on controlling the bleeding.
B) control the bleeding while completing your assessment.
C) ignore the bleeding while attempting to ascertain the extent of the patient’s injuries.
D) package the patient for immediate transport.

Answer 14

B) control the bleeding while completing your assessment.

Page Ref: 849-850
Objective: 37.3 Discuss special considerations in the assessment and management of patients with injuries to the head, face, and neck, including airway compromise, profuse bleeding, potential that injuries may be self-inflicted or the result of violence, and patient fears associated with the injuries.

Question 15

A 14-year-old boy fell 10 feet from a retaining wall and hit his head on a metal post. He is responsive to verbal stimuli with incomprehensible speech. The secondary assessment indicates blood and fluid coming from inside the patient’s left ear. You should do which one of the following?

A) Suction the blood from the ear so that you can determine the cause of bleeding.
B) Tilt the backboard to the left to allow the ear to drain freely.
C) Place a folded piece of gauze in the ear canal to stop the drainage.
D) Place a piece of sterile gauze over the ear.

Answer 15

D) Place a piece of sterile gauze over the ear.

Page Ref: 850
Objective: 37.5 Demonstrate the assessment and management of specific injuries of the eye, scalp, face, and neck.

Question 16

Hyperglycemia will:

A) worsen cerebral edema and ischemia.
B) decrease intracranial pressure.
C) counteract the effects of Cushing’s triad.
D) reverse the herniation of brain tissue.

Answer 16

A) worsen cerebral edema and ischemia.

Page Ref: 851
Objective: 37.9 Explain the limitations of the compensatory mechanisms for increased intracranial pressure; 37.11 Identify and, where possible, manage factors that can worsen traumatic brain injuries, including hyperglycemia, hypoglycemia, hyperthermia, hypotension, hypoxia, hypercarbia, and hypocarbia.

Question 17

A construction worker fell and sustained a traumatic brain injury. Which of the following findings with this patient would be of concern to you?

A) SpO2 90
B) Systolic BP 90 mmHg
C) ETCO2 32
D) Ventilations 12

Answer 17

A) SpO2 90

Page Ref: 852
Objective: 37.11 Identify and, where possible, manage factors that can worsen traumatic brain injuries, including hyperglycemia, hypoglycemia, hyperthermia, hypotension, hypoxia, hypercarbia, and hypocarbia.

Question 18

You are assessing the pupils of a patient who hit his head after falling from the top of a tractor trailer. Which one of the following findings would suggest a closed head injury?

A) The left pupil constricts to light but the right pupil does not.
B) The left pupil dilates in reaction to light while the right does not.
C) Both the left and right pupils are constricted and do not react to light.
D) The right pupil constricts when light is shined into the left pupil.

Answer 18

A) The left pupil constricts to light but the right pupil does not.

Page Ref: 855
Objective: 37.10 Describe the pathophysiology and key signs of increased intracranial pressure and brain herniation; 37.12 Document information relevant to the assessment and management of patients with injuries to the head.

Question 19

A sign of basal skull fracture in the trauma patient would be the presence of:

A) bilateral periorbital ecchymosis.
B) tachycardia.
C) confusion.
D) hypotension.

Answer 19

A) bilateral periorbital ecchymosis.

Page Ref: 850
Objective: 37.7 Explain the pathophysiology and significance of the following with respect to traumatic brain injury: scalp lacerations and avulsions, open and closed skull fractures, cerebral concussion and diffuse axonal injury, cerebral contusion, coup-contrecoup injury, cerebral and intracranial hematomas, and cerebral hemorrhage.

Question 20

The presence of a basilar skull fracture indicates each of the following EXCEPT:

A) the necessity of rapid transport.
B) a significant mechanism of injury.
C) the need for specialized care.
D) Le Fort criteria.

Answer 20

D) Le Fort criteria.

Page Ref: 850
Objective: 37.7 Explain the pathophysiology and significance of the following with respect to traumatic brain injury: scalp lacerations and avulsions, open and closed skull fractures, cerebral concussion and diffuse axonal injury, cerebral contusion, coup-contrecoup injury, cerebral and intracranial hematomas, and cerebral hemorrhage.

Question 21

Starting an IV for a patient with a traumatic brain injury assists in managing:

A) ETCO2.
B) systolic BP.
C) BGL.
D) SpO2.

Answer 21

B) systolic BP.

Page Ref: 852
Objective: 37.11 Identify and, where possible, manage factors that can worsen traumatic brain injuries, including hyperglycemia, hypoglycemia, hyperthermia, hypotension, hypoxia, hypercarbia, and hypocarbia.

Question 22

A patient has sustained a traumatic brain injury and presents with anterograde amnesia following a brief loss of consciousness. This patient’s injury is likely a:

A) concussion.
B) epidural hematoma.
C) subdural hematoma.
D) diffuse axonal injury.

Answer 22

A) concussion.

Page Ref: 852-853
Objective: 37.7 Explain the pathophysiology and significance of the following with respect to traumatic brain injury: scalp lacerations and avulsions, open and closed skull fractures, cerebral concussion and diffuse axonal injury, cerebral contusion, coup-contrecoup injury, cerebral and intracranial hematomas, and cerebral hemorrhage.

Question 23

When ventilating a patient with a traumatic brain injury, the tidal volume should be:

A) 15 to 17 mL/kg.
B) 1.5 to 1.7 L/kg.
C) 5 to 7 mL/kg.
D) 500 to 700 mL/g.

Answer 23

C) 5 to 7 mL/kg.

Page Ref: 852
Objective: 37.11 Identify and, where possible, manage factors that can worsen traumatic brain injuries, including hyperglycemia, hypoglycemia, hyperthermia, hypotension, hypoxia, hypercarbia, and hypocarbia.

Question 24

A car strikes a tree, causing the passenger to strike his forehead against the dashboard. After the impact, the brain bounces back and forth within the skull. Based on the anatomy and physiology of the skull, which one of the following is TRUE?

A) The frontal bone is the thinnest portion of the skull and most easily fractured.
B) The brain will not be injured because the flexibility of the skull will absorb the force of the impact.
C) The brain will not be injured unless an object on the dashboard penetrates the skull.
D) The ridges of the basilar skull can injure the brain as it moves back and forth.

Answer 24

D) The ridges of the basilar skull can injure the brain as it moves back and forth.

Page Ref: 853
Objective: 37.7 Explain the pathophysiology and significance of the following with respect to traumatic brain injury: scalp lacerations and avulsions, open and closed skull fractures, cerebral concussion and diffuse axonal injury, cerebral contusion, coup-contrecoup injury, cerebral and intracranial hematomas, and cerebral hemorrhage.

Question 25

A patient with an open head injury is bleeding profusely. Controlling this patient’s bleeding helps to preserve the:

A) oxygen-carrying capacity of the blood.
B) ETCO2 level.
C) normal body temperature.
D) blood glucose level.

Answer 25

A) oxygen-carrying capacity of the blood.

Page Ref: 852
Objective: 37.11 Identify and, where possible, manage factors that can worsen traumatic brain injuries, including hyperglycemia, hypoglycemia, hyperthermia, hypotension, hypoxia, hypercarbia, and hypocarbia.

Question 26

Hyperventilating a posturing brain injury patient:

A) assures good cerebral oxygenation.
B) may aggravate cerebral edema by causing cerebral vasodilation.
C) may aggravate the head injury by significantly reducing cerebral blood flow.
D) reduces the PaCO2, thus promoting cerebral oxygenation.

Answer 26

C) may aggravate the head injury by significantly reducing cerebral blood flow.

Page Ref: 852
Objective: 37.11 Identify and, where possible, manage factors that can worsen traumatic brain injuries, including hyperglycemia, hypoglycemia, hyperthermia, hypotension, hypoxia, hypercarbia, and hypocarbia.

Question 27

An unresponsive patient has been ejected from a car as it rolled at a high rate of speed. The patient has a significant deformity to the right side of his head, and his pupils are unequal. The patient’s ventilations are 10 but the breathing pattern is irregular, and the patient is bradycardic with decorticate posturing. Ventilations for this patient should be:

A) decreased to 8.
B) increased to 24.
C) decreased to 6 to 9.
D) increased to 12 to 20.

Answer 27

D) increased to 12 to 20.

Page Ref: 852, 855
Objective: 37.11 Identify and, where possible, manage factors that can worsen traumatic brain injuries, including hyperglycemia, hypoglycemia, hyperthermia, hypotension, hypoxia, hypercarbia, and hypocarbia; 37.12 Document information relevant to the assessment and management of patients with injuries to the head.

Question 28

You are at the scene of a gunshot victim who has been shot in the head at close range with a 38-caliber pistol. The patient is unconscious with irregular gasping respirations and bradycardia. The gunshot wound is just above the forehead and inside the hairline. You see no exit wound. The mechanism of injury is consistent with a(n):

A) open skull fracture.
B) basilar skull fracture.
C) concussion.
D) diffuse axonal injury.

Answer 28

A) open skull fracture.

Page Ref: 850
Objective: 37.4 Given a variety of scenarios, demonstrate the assessment-based management of patients with injuries to the brain, skull, scalp, face, eye, and neck; 37.5 Demonstrate the assessment and management of specific injuries of the eye, scalp, face, and neck.

Question 29

When transporting an unresponsive patient with a traumatic brain injury, you note a higher-than-normal PaO2. What does this indicate is happening in this patient’s brain?

A) Vasoconstriction, increasing blood volume
B) Vasodilation, decreasing tissue perfusion
C) Vasoconstriction, decreasing tissue perfusion
D) Vasodilation, increasing blood volume

Answer 29

C) Vasoconstriction, decreasing tissue perfusion

Page Ref: 852
Objective: 37.11 Identify and, where possible, manage factors that can worsen traumatic brain injuries, including hyperglycemia, hypoglycemia, hyperthermia, hypotension, hypoxia, hypercarbia, and hypocarbia; 37.12 Document information relevant to the assessment and management of patients with injuries to the head.

Question 30

You have been called to a residence of a diabetic patient who is confused. A family member states she could not reach the patient by telephone, so she came over and found the patient awake but confused. The patient can remember his name and address but cannot remember the day or year. He refuses to go to the hospital but consents to an assessment. Of the following physical exam findings, which one is MOST concerning?

A) Blood glucose level of 77 mg/dL
B) Bruise to the left temple
C) Heart rate of 62 beats per minute
D) SpO2 at 96 percent

Answer 30

B) Bruise to the left temple

Page Ref: 850
Objective: 37.11 Identify and, where possible, manage factors that can worsen traumatic brain injuries, including hyperglycemia, hypoglycemia, hyperthermia, hypotension, hypoxia, hypercarbia, and hypocarbia; 37.12 Document information relevant to the assessment and management of patients with injuries to the head.

Question 31

A 57-year-old man fell on the sidewalk, hitting his head on the concrete. According to witnesses, the patient was unresponsive for several minutes following the fall. The man’s scalp sustained a severe laceration in the fall, which is bleeding and has already caused a significant amount of blood loss. People at the scene are attempting to control the bleeding. The patient appears to be responsive now and is sitting up and speaking to the people attempting to stop the bleeding. Which one of the following would be MOST critical to manage to ensure this patient has adequate perfusion?

A) Open and maintain the airway.
B) Check the blood glucose level.
C) Keep the patient warm.
D) Ensure the bleeding is controlled.

Answer 31

D) Ensure the bleeding is controlled.

Page Ref: 852
Objective: 37.11 Identify and, where possible, manage factors that can worsen traumatic brain injuries, including hyperglycemia, hypoglycemia, hyperthermia, hypotension, hypoxia, hypercarbia, and hypocarbia.

Question 32

You are treating a patient injured from a metal filing striking his eye. What injury is MOST likely given the mechanism of injury?

A) Laceration of the cornea or conjunctiva
B) Detached retina
C) Penetrating damage to the anterior tissues
D) Avulsion of the sclera

Answer 32

A) Laceration of the cornea or conjunctiva

Page Ref: 856
Objective: 37.4 Given a variety of scenarios, demonstrate the assessment-based management of patients with injuries to the brain, skull, scalp, face, eye, and neck; 37.5 Demonstrate the assessment and management of specific injuries of the eye, scalp, face, and neck; 37.12 Document information relevant to the assessment and management of patients with injuries to the head.

Question 33

In a patient with a head injury, which finding is of LEAST concern?

A) ETCO2 36
B) Ventilations 8
C) Systolic BP 89 mmHg
D) ETCO2 29

Answer 33

B) Ventilations 8

Page Ref: 852
Objective: 37.11 Identify and, where possible, manage factors that can worsen traumatic brain injuries, including hyperglycemia, hypoglycemia, hyperthermia, hypotension, hypoxia, hypercarbia, and hypocarbia.

Question 34

During transport of a patient with a suspected head injury showing signs of herniation, the AEMT may:

A) hyperventilate the patient.
B) conduct the primary assessment.
C) administer dextrose.
D) perform a focused exam.

Answer 34

D) perform a focused exam.

Page Ref: 849, 852
Objective: 37.4 Given a variety of scenarios, demonstrate the assessment-based management of patients with injuries to the brain, skull, scalp, face, eye, and neck; 37.5 Demonstrate the assessment and management of specific injuries of the eye, scalp, face, and neck.

Question 35

When treating cerebral edema, it is important to know that a high PaCO2 causes:

A) vasoconstriction.
B) tissue perfusion.
C) permissive hypotension.
D) vasodilation.

Answer 35

D) vasodilation.

Page Ref: 852
Objective: 37.10 Describe the pathophysiology and key signs of increased intracranial pressure and brain herniation; 37.11 Identify and, where possible, manage factors that can worsen traumatic brain injuries, including hyperglycemia, hypoglycemia, hyperthermia, hypotension, hypoxia, hypercarbia, and hypocarbia.

Question 36

Which of the following injuries puts the patient at the HIGHEST risk for airway compromise because of bleeding?

A) Linear skull fractures
B) Concussions
C) Le Fort I fractures
D) Le Fort II fractures

Answer 36

D) Le Fort II fractures

Page Ref: 856
Objective: 37.5 Demonstrate the assessment and management of specific injuries of the eye, scalp, face, and neck; 37.11 Identify and, where possible, manage factors that can worsen traumatic brain injuries, including hyperglycemia, hypoglycemia, hyperthermia, hypotension, hypoxia, hypercarbia, and hypocarbia.

Question 37

When treating a patient with injury due to the eye coming in contact with a chemical, the eye should be irrigated for at least ________ minutes.

A) 5
B) 10
C) 15
D) 20

Answer 37

D) 20

Page Ref: 857
Objective: 37.4 Given a variety of scenarios, demonstrate the assessment-based management of patients with injuries to the brain, skull, scalp, face, eye, and neck; 37.5 Demonstrate the assessment and management of specific injuries of the eye, scalp, face, and neck.