Head & Neck Trauma

Question 1

Presentation of epidural hematoma

Answer 1

LOC -> lucid interval -> sudden deterioration

Lenticular deformity on head CT

Middle Meningeal artery most common

Question 2

Indications to operate on epidural hematoma

Answer 2

Significant neurological degeneration

Significant mass effect (shift >5 mm)

Question 3

Presentation of subdural hematoma

Answer 3

Crescent-shaped deformity in CT

Tearing of bridging veins

Question 4

Management of traumatic intraventricular hemorrhage

Answer 4

Ventriculostomy if causing hydrocephalus

Question 5

Treatment for elevated ICP

>20 needs treatment

Answer 5

Cerebral perfusion pressure >60
Sedation and paralysis 
Elevate HOB
Relative hyperventilation (CO2 30-35)
Serum Na 140-150
Mannitol 1g/kg loading + 0.25mg/kg q4hr
Seizure ppx (keppra)

Question 6

Jefferson fracture

Answer 6

C1 burst fracture

Question 7

Hangman’s fracture

Answer 7

C2 fracture

Question 8

Type I C-2 odontoid fracture

Answer 8

Above the base

Stable

Question 9

Type II C-2 odontoid fracture

Answer 9

At the base
Unstable
Requires fusion or halo

Question 10

Type III C-2 odontoid fracture

Answer 10

Extends into vertebral body

Requires fusion or halo

Question 11

Presentation of orbital blowout fractures and indications for surgery

Answer 11

Impaired upward gaze

Diplopia with upward vision

Question 12

Presentation of mandibular fracture

Answer 12

Malocclusion (misalignment)

TMJ misalignment/dislocation

Question 13

Le Fort I fracture

Answer 13

Lower maxillary fracture straight across

Reduction, stabilization, fixation

Question 14

Le Fort II fracture

Answer 14

Lateral to nasal bone, inferior to eyes, diagonal toward maxilla

Reduction, stabilization, fixation

Question 15

Le Fort III fracture

Answer 15

Lateral orbital walls

Wiring and external fixation

Question 16

Neck zone 1 boundaries

Answer 16

Cricoid cartilage

Sternal notch

Question 17

Neck zone 2 boundaries

Answer 17

Angle of mandible

Cricoid cartilage

Question 18

Neck zone 3 boundaries

Answer 18

Base of skull

Angle of mandible

Question 19

Management of neck zone 1 injury

Answer 19

Angiography
Bronchoscopy
Esophagoscopy
Barium swallow
Pericardial window
Median sternotomy

Question 20

Management of neck zone 2 injury

Answer 20

Exploration in OR

Question 21

Management of neck zone 3 injury

Answer 21

Angiography

Laryngoscopy

Question 22

Presentation of diffuse axonal injury

Answer 22

Cerebral contusions causing LOC
Result of shearing forces (rotational accel)
Multiple focal lesions at grey-white junction
Elevated ICP

Question 23

Imaging for diffuse axonal injury

Answer 23

MRI is modality of choice

CT not as sensitive

Question 24

Treatment of diffuse axonal injury

Answer 24

Minimize secondary damage from cerebral edema and hypoxia

Question 25

Vital signs in elevated ICP

Answer 25

Hypertension
Bradycardia

Decreased ventricular size
Loss of sulci and cisterns

Question 26

Cerebral perfusion pressure equation

Answer 26

CPP = MAP - ICP (normal > 60)

Increased ICP results in reflexive increase in MAP in order to lower CPP

Increased MAP causes reflexive drop in HR due to baroreceptor stimulation

Question 27

Treatment of elevated ICP

Answer 27

Sedation and paralysis
HOB raised
Hyperventilation   (CO2 30-35)
Hypertonic Saline   (Na 140-150)
Mannitol   (Sosm 295-310)
External ventricular drain 
Fosphenytoin or Keppra

Question 28

Battle’s Sign (mastoid ecchymosis)

Answer 28

Middle fossa fracture
Possible Facial nerve injury
Look for CSF leak