TCCC Final Review - CMS Quiz 4 Flashcards
A patient is found down after being hit in the head with a baseball bat; he has limited
responsiveness and the on-site EMS team tells you he has been having DECEREBRATE
posturing. On exam, you would expect him to be exhibiting?
A. Flexion of upper extremities
B. Weak upper extremities but strong lower
extremities
C. Focal seizure activity of one extremity
D. Extension of upper extremities
D. Extension of upper extremities
Pg 225
The leading cause of traumatic brain injury (TBI) in those under 65 years old is \_\_\_\_\_; in the elderly, the leading cause is \_\_\_\_\_. A. MVC; Falls B. Falls; MVC C. MVC; MVC D. Gunshot wounds; Gunshot wounds E. Falls;Falls
A. MVC; Falls
Pg 218
You are caring for an aviator who was playing baseball and was hit in the head by a line
drive. Bystanders noted that he did NOT lose consciousness, but was reported to have been
“dazed”. On examination, the pilot tells you he cannot recall any of the events from the
accident and doesn’t even remember coming to the hospital. His squadron commander
wants to know if he has had a concussion. You inform him that the HALLMARK finding for
the diagnosis of concussion is?
A. Loss of consciousness
B. Disorientation
C. Post-traumatic amnesia
D. Confusion
C. Post-traumatic amnesia
Pg 233
A patient must have a loss of consciousness to be diagnosed with a concussion?
True
False
False
Pg 233
You are a GMO physician caring for a 22 year-old soldier injured by an IED blast. The
helicopters are en route to transfer the patient from your Battalion Aid Station to a level III
facility in theater. You suspect severe traumatic brain injury. He begins having changes to his
physical exam. Which of the following physical findings are associated with herniation (check
all that apply):
A. Cheyne-Stokes ventilation
B. Consistently rapid, deep breaths
C. Decorticate posturing
D. A unilateral enlarged pupil
E. Increased verbalizations
F. Greatly increased blood pressure with
bradycardia
A,B,C,D,F
Pg 225
How does hyperventilating a patient reduce intracranial pressure?
A. Decreases arterial O2 levels: reducing free
radical production and apoptosis
B. Decreases arterial CO2 levels; leading to
cerebral artery vasoconstriction
C. Decreases arterial CO2; leading to
cerebral artery vasodilatation
D. Increases arterial O2 levels; leading to
increased oxygen supply to the brain
B. Decreases arterial CO2 levels; leading to
cerebral artery vasoconstriction
Pg 222-223
According to the national Traumatic Brain Injury (TBI) database, the two most significant
predictors of poor outcome from TBI are the amount of time spent with an ICP greater than
20mmHg, and hypotension. A single episode of a Systolic Blood Pressure (SBP) less than
________ mmHg significantly increases the likelihood of a poor outcome in a TBI patient.
A. 110 mmHg
B. 90 mmHg
C. 80 mmHg
D. 100 mmHg
B. 90 mmHg
Pg 226
A bicycle rider cutting through a neighbor’s back yard ran into a clothes line, which struck him in the neck. The patient arrives complaining of dyspnea and difficulty speaking (and a lower tone of his voice). On exam you note prominent neck contusion and subcutaneous emphysema. The patient now begins to have further deterioration in their respiratory status.
True/False: The most appropriate airway intervention at this time would be immediate endotracheal intubation; you want to definitively secure the airway before they develop frank respiratory failure.
True
False
False
Pg 32
Which of the following are neurologic changes associated with concussion? (check all that apply) A. delayed verbal and motor responses B. slurred or incoherent speech C. disorientation D. Vomiting E. inability to memorize and recall F. post-traumatic amnesia
A,B,C,D,E,F
Pg 233
You are dispatched to the scene of an accident. A teenager fell out of a second story
townhouse window; he had been drinking (alcohol) and lost his balance. He landed on a
concrete sidewalk. Bystanders noted a 10-minute loss of consciousness, but he was awake by the time you arrived and had a GCS of 14 (some confusion as he attempts to answer
questions). His heart rate is 120 bpm, vital signs otherwise normal. He has a 10-cm laceration to the right side of his scalp; bleeding is controlled with direct pressure. He follows commands, but does not recall the events leading up to the fall. You place him in spinal immobilization (C-collar and backboard). En-route to the ER, he has a decline in his mental status and level of responsiveness – now he is only speaking incomprehensible words, opens his eyes spontaneously, and withdraws from pain. What injury is most likely given the casualty’s presenting signs?
A. cerebral concussion
B. acute alcohol intoxication
C. cervical spine fracture
D. epidural hematoma
E. brain death
F. subdural hematoma
D. epidural hematoma
Pg 218, 233-241
An intubated TBI casualty has a blood pressure of 100/50, HR 110, oxygen saturation of 100%, and temperature of 96.9. They withdraw from pain and have no eye opening. How would you report their GCS score? A. 5 B. 5T C. 6 D. 6T E. 7 F. 7T G. 8 H. 8T
B. 5T
Pg 228
You are dispatched to the scene of an accident. A teenager fell out of a second story
townhouse window; he had been drinking and lost his balance. He landed on a concrete
sidewalk. Bystanders noted a 10-minute loss of consciousness, but he was awake by the
time you arrived and had a GCS of 14 (some confusion as he attempts to answer questions).
His heart rate is 120 bpm, vital signs otherwise normal. He has a 10-cm laceration to the right
side of his scalp; bleeding is controlled with direct pressure. He follows commands, but does
not recall the events leading up to the fall. You place him in spinal immobilization (C-collar
and backboard). En-route to the ER, he has a decline in his mental status and level of
responsiveness – now he is only making incomprehensible noises, opens his eyes only to
painful stimuli, and withdraws from pain. What is his current GCS?
A. 3
B. 4
C. 5
D. 6
E. 7
F. 8
G. 9
H. 10
I. 11
J. 12
K. 13
L. 14
M. 15
F. 8
Pg 228
Possible interventions that may help acutely control/manage increased intracranial pressure include the following: (check all that apply) A. chemical paralysis B. sedation C. controlled hyperventilation D. controlled hypoglycemia E. application of PASG/MAST trousers F. osmotherapy (such as mannitol)
A,B,C,F
Pg 238
In the casualty with traumatic brain injury, which of the following can contribute to secondary brain injury? (check all that apply) A. hematoma B. hypoxia C. hypotension D. cerebral edema E. hypoglycemia
A,B,C,D,E
Pg 223-27
Which of the following is NOT considered to increase risk for secondary brain injury? A. Hypothermia B. Hypotension C. Hematoma D. Hypoxia
A. Hypothermia
Pg 223
A patient’s blood pressure is 150/90. Their intracranial pressure is elevated at 30 mmHg.
Their cerebral perfusion pressure (CPP) is ____.
80
Pg 222
BP 150/90, so MAP is 110.
CPP = MAP - ICP = 110 - 30 = 80
According to the Trauma Coma Data Bank, the presence of which of the following types of
intracranial hemorrhage DOUBLES the incidence of death in Traumatic Brain Injury patients?
A. Intracerebral hemorrhage
B. Subarachnoid hemorrhage
C. Subdural hemorrhage
D. Epidural hemorrhage
B. Subarachnoid hemorrhage
Pg 235
Use of Positive End Expiratory Pressure (PEEP) valves on patients with Traumatic Brain
Injury (TBI) has been proven to be helpful in maintaining oxygenation. However, PEEP
greater than ________ can cause a dangerous raise in intracranial pressure.
A. 20 cmH20
B. 15 cmH20
C. 5 cmH20
D. 10 cmH20
B. 15 cmH20
Pg 236
Intubation should be considered in TBI casualties with a GCS of 8 or less.
True
False
True
Pg 236
You are examining a 22-year-old man who just had a serious fall onto his face. While
examining
him, it is difficult to palpate his jaw secondary to his severe pain and swelling. Which of the
following is the most common complaint of patient’s with a mandibular fracture?
A. Epistaxis (nose bleed)
B. Dyspnea (difficulty breathing)
C. Malocclusion of the teeth
D. Lost teeth
C. Malocclusion of the teeth
Pg 232
An 82 y.o male presents to your clinic with his wife because she fears he has had a stroke.
On history you note that he complains of a worsening headache and blurred vision; on exam his is lethargic and has weakness on his right side. In discussion with his wife, you find he had a fall 10 days ago and hit his head. She says he did not lose consciousness and was
“OK” after the fall. Which of the following is the MOST likely diagnosis?
A. Epidural hemorrhage
B. Subdural hemorrhage
C. Intracerebral hemorrhage
D. Subarachnoid hemorrhage
B. Subdural hemorrhage
Pg 234-5
Match the area of the brain with its function:
- Frontal
- Parietal
- Temporal
- Occipital
- Brainstem
- Cerebellum F. vision
A. sensory function and spatial orientation
B. coordination and balance
C. cardiorespiratory; reticular activating system
D. certain memory functions; speech reception and integration
E. emotions, motor function, expression of
speech on the dominant side
1:E, 2:A, 3:D, 4:F, 5:C, 6:B
Pg 220
You are caring for a sailor who was playing baseball and was hit in the head by a line
drive. Bystanders noted helost consciousness for a few minutes. On your arrival he is alert
and lucid, and simply reports to “feeling dazed.” During transport, he becomes less
responsive and his Glasgow Coma Scale score is dropping. You suspect the underlying
pathology is a pure space-occupying lesion. When you radio theEmergency Department,
the receiving nurse asks which injury you think he has. While the patient’s exact diagnosis
cannot be known without imaging, what is most likely based on this classic history.
A. Subdural hemorrhage
B. Epidural hemorrhage
C. Subarachnoid hemorrhage
D. Intracerebral hemorrhage
B. Epidural hemorrhage
Pg 233-34
While transporting a patient who was involved in an aircraft crash, you notice he is beginning
to develop stridorous respirations and respiratory distress. A quick re-examination reveals he
has a neck contusion, loss of the prominence of the thyroid cartilage, and subcutaneous
emphysema (air under the skin) in his neck. Fearing your patient is near respiratory arrest,
which of the following would be the BEST way to secure and protect his airway?
A. Cricothyrotomy
B. oropharyngeal airway
C. Allow the patient to sit in the position of
comfort
D. Endotracheal intubation
A. Cricothyrotomy
Pg 232
While rounding on the Trauma Service as a fourth year medical student, the surgery resident attempts to throw you off by stating “this patient has a craniofacial dysjunction injury”. Being a superior USUHS student, you astutely inform him the eponym is a \_\_\_\_\_? A. Salter-Harris III fracture B. LeFort III fracture C. Jeffersonian fracture D. Lis-Franc fracture
B. LeFort III fracture
Pg 231-2
You are taking care of a patient who fell from wing of a C-130 to the tarmac below. He was
not wearing a helmet and has signs of a head injury. You visit the patient a few hours later in
the hospital. Which of the following physical findings indicate he suffered a basilar skull
fracture? (check all that apply)
A. Periorbital eccymosis
B. A palpable depression at his R frontal skull
C. Nasal fracture
D. Bruising to his mastoid areas
E. CSF draining from his ear canals
A. Periorbital eccymosis
D. Bruising to his mastoid areas
E. CSF draining from his ear canals
Pg 230
What type of posturing does this drawing demonstrate? A. demobilized B. demotion C. decorticate D. decerebrate
C. decorticate
Pg 225
You are caring for a 23-year-old woman who was struck in the orbit by a line-drive at a
squadron softball game. Her left eye is injured. You consider a differential of possible eye
injuries. While you should always treat eye injuries gently, which of the following injury
descriptions mandates that you do NOT apply any pressure to the globe?
A. She has a disruption of the corneal epithelium that is very painful
B. She has blood in the anterior chamber of
her globe between her iris and cornea
C. She has a scleral defect with expulsion of
a small amount of intraocular contents
D. She has a laceration through the tarsal
plate of her left upper eyelid
C. She has a scleral defect with expulsion of
a small amount of intraocular contents
Pg 230-1
