Chapter 28 - Head and Spine

Which of the following skull fractures would be the LEAST likely to present with palpable deformity or other outward signs? A. Linear B. Basilar C. Open D. Depressed

A. Linear

Which of the following statements regarding motor nerves is correct? A. They carry information from the CNS to the muscles. B. They perform special functions such as sight, smell, and hearing. C. They transmit information from the body to the brain via the spinal cord. D. They are part of the CNS and control reflexes.

A. They carry information from the CNS to the muscles.

An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is: A. a rapid deterioration of neurologic signs. B. a progressively lowering blood pressure. C. an acute increase in the patient's pulse rate. D. acute unilateral paralysis following the injury.

A. a rapid deterioration of neurologic signs.

Common signs and symptoms of a serious head injury include all of the following, EXCEPT: A. a rapid, thready pulse. B. widening pulse pressure. C. CSF leakage from the ears. D. decerebrate posturing.

A. a rapid, thready pulse.

An epidural hematoma is MOST accurately defined as: A. bleeding between the skull and dura mater. B. bleeding between the dura mater and brain. C. venous lacerations that occur within the brain. D. an injury caused by a damaged cerebral artery.

A. bleeding between the skull and dura mater.

The _________ is the best-protected part of the CNS and controls the functions of the cardiac and respiratory systems. A. brainstem B. cerebellum C. spinal cord D. cerebral cortex

A. brainstem

The _________ contain(s) about 75% of the brain's total volume. A. cerebrum B. cerebellum C. brain stem D. meninges

A. cerebrum

When assessing a conscious patient with an MOI that suggests spinal injury, you should: A. determine if the strength in all extremities is equal. B. rule out a spinal injury if the patient denies neck pain. C. defer spinal immobilization if the patient is ambulatory. D. ask the patient to move his or her head to assess for pain.

A. determine if the strength in all extremities is equal.

It would be MOST appropriate to perform a focused secondary assessment on a patient who: A. fainted and fell to the ground from a standing position. B. was restrained during a high-speed motor vehicle crash. C. has blood draining from the ears following a head injury. D. struck his or her head and is experiencing nausea or vomiting.

A. fainted and fell to the ground from a standing position.

When placing a patient onto a long backboard, the EMT at the patient's _________ is in charge of all patient movements. A. head B. chest C. waist D. lower extremities

A. head

The effectiveness of positive-pressure ventilations when treating a head-injured patient can ONLY be determined by: A. immediate reassessment following the intervention. B. a neurosurgeon or emergency department physician. C. reassessing the patient's blood pressure after 10 minutes. D. noting a decrease in the heart rate during ventilations.

A. immediate reassessment following the intervention.

A tight-fitting motorcycle helmet should be left in place unless: A. it interferes with your assessment of the airway. B. the patient must be placed onto a long backboard. C. the patient complains of severe neck or back pain. D. the helmet is equipped with a full face shield or visor.

A. it interferes with your assessment of the airway.

When activated, the sympathetic nervous system produces all of the following effects, EXCEPT: A. pupillary constriction. B. increase in heart rate. C. shunting of blood to vital organs. D. dilation of the bronchiole smooth muscle.

A. pupillary constriction.

A patient who cannot remember the events that preceded his or her head injury is experiencing: A. retrograde amnesia. B. anterograde amnesia. C. prograde amnesia. D. posttraumatic amnesia.

A. retrograde amnesia.

You should be MOST suspicious that a patient has experienced a significant head injury if his or her pulse is: A. slow. B. weak. C. rapid. D. irregular.

A. slow.

The spinal cord is encased in and protected by the: A. spinal canal. B. vertebral body. C. vertebral arch. D. intervertebral disc.

A. spinal canal.

If you do not have the appropriate-size cervical collar, you should: A. use rolled towels to immobilize the patient's head. B. place sandbags on either side of the patient's head. C. ask the patient to keep his or her head in a neutral position. D. defer cervical immobilization and apply lateral head blocks.

A. use rolled towels to immobilize the patient's head.

A patient with a head injury presents with abnormal flexion of his extremities. What numeric value should you assign to him for motor response? A. 2 B. 3 C. 4 D. 5

B. 3

Which of the following nerves allow sensory and motor impulses to be sent from one nerve directly to another? A. Somatic B. Connecting C. Peripheral D. Autonomic

B. Connecting

Which of the following breathing patterns is MOST indicative of increased intracranial pressure? A. Increased rate with a normal inspiratory time and a prolonged expiratory time B. Irregular rate, pattern, and volume of breathing with intermittent periods of apnea C. Increased rate and depth with the distinct odor of acetone on the patient's breath D. Slow, shallow occasional gasps that progress to prolonged periods of apnea

B. Irregular rate, pattern, and volume of breathing with intermittent periods of apnea

In which of the following situations would the EMT be the LEAST likely to immobilize a patient's spine? A. No spinal pain, but tingling in the extremities B. No distracting injuries or evidence of intoxication C. Unresponsive, but moving all extremities equally D. Pain to the c-spine, but no numbness or tingling.

B. No distracting injuries or evidence of intoxication

The MOST reliable sign of a head injury is: A. a pulse that is rapid and thready. B. a decreased level of consciousness. C. an abnormally low blood pressure. D. decreased sensation in the extremities.

B. a decreased level of consciousness.

The meninges, along with the cerebrospinal fluid (CSF) that circulates in between each meningeal layer, function by: A. regenerating brain cells after they have been damaged. B. acting as a shock absorber for the brain and spinal cord. C. delivering oxygen directly to the CNS. D. producing leukocytes that protect the brain from infection.

B. acting as a shock absorber for the brain and spinal cord.

After your partner assumes manual in-line stabilization of the patient's head, you should: A. apply an appropriately sized rigid cervical collar. B. assess distal neurovascular status in the extremities. C. thoroughly palpate the patient's head for deformities. D. use four people to log roll the patient onto a backboard.

B. assess distal neurovascular status in the extremities.

A man jumped from the roof of his house and landed on his feet. He complains of pain to his heels, knees, and lower back. This mechanism of injury is an example of: A. distraction. B. axial loading. C. hyperextension. D. hyperflexion.

B. axial loading.

The central nervous system (CNS) is composed of the: A. cerebellum and brain. B. brain and spinal cord. C. cerebrum and meninges. D. meninges and spinal cord.

B. brain and spinal cord.

A temporary loss or alteration of part or all of the brain's abilities to function without physical damage to the brain MOST accurately describes a(n): A. cerebral contusion. B. cerebral concussion. C. intracranial hemorrhage. D. intracerebral hematoma.

B. cerebral concussion.

The MOST common and serious complication of a significant head injury is: A. a skull fracture. B. cerebral edema. C. a hypoxic seizure. D. acute hypotension.

B. cerebral edema.

The five sections of the spinal column, in descending order, are the: A. thoracic, cervical, lumbar, coccygeal, and sacral. B. cervical, thoracic, lumbar, sacral, and coccygeal. C. coccygeal, sacral, lumbar, thoracic, and cervical. D. cervical, coccygeal, thoracic, sacral, and lumbar.

B. cervical, thoracic, lumbar, sacral, and coccygeal.

The frontal and parietal bones of the skull are especially susceptible to: A. basilar skull fractures. B. depressed skull fractures. C. linear skull fractures. D. nondisplaced skull fractures.

B. depressed skull fractures.

A 45-year-old male was working on his roof when he fell approximately 12 feet, landing on his feet. He is conscious and alert and complains of an ache in his lower back. He is breathing adequately and has stable vital signs. You should: A. obtain a Glasgow Coma Score value and give him oxygen. B. immobilize his spine and perform a focused secondary exam. C. allow him to refuse transport if his vital signs remain stable. D. perform a rapid head-to-toe exam and immobilize his spine.

B. immobilize his spine and perform a focused secondary exam.

During your primary assessment of a semiconscious 30-year-old female with closed head trauma, you note that she has slow, irregular breathing and a slow, bounding pulse. As your partner maintains manual in-line stabilization of her head, you should: A. perform a focused secondary assessment of the patient's head and neck. B. instruct him to assist her ventilations while you perform a rapid assessment. C. apply 100% oxygen via a nonrebreathing mask and obtain baseline vital signs. D. immediately place her on a long backboard and prepare for rapid transport.

B. instruct him to assist her ventilations while you perform a rapid assessment.

Bleeding within the brain tissue itself is called a(n): A. epidural hematoma. B. intracerebral hematoma. C. subdural hematoma. D. subarachnoid hemorrhage.

B. intracerebral hematoma.

A high school football player was injured during a tackle and complains of neck and upper back pain. He is conscious and alert and is breathing without difficulty. The EMT should: A. remove his helmet and shoulder pads. B. leave his helmet and shoulder pads in place. C. remove his helmet, but leave his shoulder pads in place. D. leave his helmet in place, but remove his shoulder pads.

B. leave his helmet and shoulder pads in place.

When a patient experiences a severe spinal injury, he or she: A. will likely be paralyzed from the neck down. B. may lose sensation below the level of the injury. C. most commonly has a palpable spinal deformity. D. often loses motor function on one side of the body.

B. may lose sensation below the level of the injury.

During your primary assessment of a 19-year-old unconscious male who experienced severe head trauma, you note that his respirations are rapid, irregular, and shallow. He has bloody secretions draining from his mouth and nose. You should: A. assist his ventilations with a BVM. B. suction his oropharynx for up to 15 seconds. C. immobilize his spine and transport immediately. D. pack his nostrils to stop the drainage of blood.

B. suction his oropharynx for up to 15 seconds.

The ideal procedure for moving an injured patient from the ground to a backboard is: A. the clothes drag. B. the four-person log roll. C. the use of a scoop stretcher. D. the direct patient carry.

B. the four-person log roll.

When the parasympathetic nervous system is activated: A. blood is shunted away from the digestive organs. B. the heart rate decreases and the blood vessels dilate. C. hormones are released that prepare the body for stress. D. heart rate and blood pressure increase.

B. the heart rate decreases and the blood vessels dilate.

Following a head injury, a 20-year-old female opens her eyes spontaneously, is confused, and obeys your commands to move her extremities. You should assign her a GCS score of: A. 12. B. 13. C. 14. D. 15.

C. 14.

Which of the following interventions may be used to help reduce intracranial pressure? A. Supine with the legs elevated B. Maintaining the SpO2 at 90% C. 30-degree elevation of the head D. Increasing the patient's body temperature

C. 30-degree elevation of the head

The cervical spine is composed of _____ vertebrae. A. 5 B. 6 C. 7 D. 8

C. 7

Which of the following statements regarding secondary brain injury is correct? A. It results from direct brain trauma following an impact to the head. B. Because cerebral edema develops quickly, it is considered to be a primary brain injury. C. Hypoxia and hypotension are the two most common causes of secondary brain injury. D. Signs are often present immediately after an impact to the head.

C. Hypoxia and hypotension are the two most common causes of secondary brain injury.

What part of the nervous system controls the body's voluntary activities? A. Central B. Sensory C. Somatic D. Autonomic

C. Somatic

Which of the following statements regarding a basilar skull fracture is correct? A. Bloody CSF commonly leaks from the nose. B. In most cases, mastoid bruising occurs. C. The absence of raccoon eyes or Battle's sign does not rule it out. D. They are typically the result of local, low-energy trauma to the head.

C. The absence of raccoon eyes or Battle's sign does not rule it out.

When immobilizing a seated patient with a short backboard or vest-style immobilization device, you should apply a cervical collar: A. after the torso has been adequately secured. B. after moving the patient to a long backboard. C. after assessing distal neurovascular functions. D. before manually stabilizing the patient's head.

C. after assessing distal neurovascular functions.

The body's functions that occur without conscious effort are regulated by the _________ nervous system. A. sensory B. somatic C. autonomic D. voluntary

C. autonomic

When controlling bleeding from a scalp laceration with a suspected underlying skull fracture, you should: A. elevate the patient's head and apply an ice pack. B. apply manual pressure and avoid applying a bandage. C. avoid excessive pressure when applying the bandage. D. apply firm compression for no longer than 5 minutes.

C. avoid excessive pressure when applying the bandage.

Coordination of balance and body movement is controlled by the: A. medulla. B. cerebrum. C. cerebellum. D. brain stem.

C. cerebellum.

The hormone responsible for the actions of the sympathetic nervous system is: A. insulin. B. thyroxine. C. epinephrine. D. aldosterone.

C. epinephrine.

The MOST important immediate treatment for patients with a head injury, regardless of severity, is to: A. immobilize the entire spine. B. administer high-flow oxygen. C. establish an adequate airway. D. transport to a trauma center.

C. establish an adequate airway.

Hyperextension injuries of the spine are MOST commonly the result of: A. falls. B. diving. C. hangings. D. compression.

C. hangings.

In contrast to a cerebral concussion, a cerebral contusion: A. does not cause pressure within the skull. B. results from a laceration to the brain tissue. C. involves physical injury to the brain tissue. D. usually does not cause a loss of consciousness.

C. involves physical injury to the brain tissue.

Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed unless: A. the patient adamantly denies neck pain. B. lateral immobilization has been applied. C. it causes a problem managing the airway. D. sensory and motor functions remain intact.

C. it causes a problem managing the airway.

Lacerations to the scalp: A. bleed minimally because the scalp has few vessels. B. uncommonly cause hypovolemic shock in children. C. may be an indicator of deeper, more serious injuries. D. are most commonly associated with skull fractures.

C. may be an indicator of deeper, more serious injuries.

Which of the following sets of vital signs depicts Cushing's triad? A. Blood pressure, 190/110 mm Hg; pulse, 55 beats/min; respirations, 30 breaths/min B. Blood pressure, 90/50 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min C. Blood pressure, 200/100 mm Hg; pulse, 140 beats/min; respirations, 28 breaths/min D. Blood pressure, 80/40 mm Hg; pulse, 30 beats/min; respirations, 32 breaths/min

D. Blood pressure, 80/40 mm Hg; pulse, 30 beats/min; respirations, 32 breaths/min

Which of the following head injuries would cause the patient's condition to deteriorate MOST rapidly? A. Cerebral contusion B. Subdural hematoma C. Cerebral concussion D. Epidural hematoma

D. Epidural hematoma

Which of the following nerves carry information from the body to the brain via the spinal cord? A. Motor B. Central C. Somatic D. Sensory

D. Sensory

A reflex arc occurs when: A. the motor nerves function automatically without receiving a message from the CNS. B. a sensory nerve sends a message to the brain but the motor nerve fails to send the appropriate response to the body. C. the brain interprets sensory information that it receives from peripheral and cranial nerves and sends a signal to the muscles. D. a sensory nerve detects an irritating stimulus and bypasses the brain by sending a direct message to the motor nerve.

D. a sensory nerve detects an irritating stimulus and bypasses the brain by sending a direct message to the motor nerve.

Rapid deceleration of the head, such as when it impacts the windshield, causes: A. compression injuries and contusions to the anterior, posterior, and lateral aspects of the brain. B. primary impact to the posterior aspect of the brain, resulting in compression injuries, bruising, or torn blood vessels. C. stretching or tearing of the anterior aspect of the brain and compression injuries or bruising to the posterior aspect of the brain. D. compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain.

D. compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain.

The tough, fibrous outer meningeal layer is called the: A. pia mater. B. arachnoid mater. C. gray mater. D. dura mater.

D. dura mater.

When immobilizing a patient on a long backboard, you should: A. have the patient exhale before fastening the torso straps. B. secure the torso and then center the patient on the board. C. follow the commands of the person at the patient's torso. D. ensure that you secure the torso before securing the head.

D. ensure that you secure the torso before securing the head.

The Glasgow Coma Scale (GCS) is used to assess: A. mental status, eye opening, and respiratory rate. B. sensory response, pupil reaction, and heart rate. C. verbal response, eye opening, and mental status. D. eye opening, verbal response, and motor response.

D. eye opening, verbal response, and motor response.

In the setting of a head injury, hypertension, bradycardia, and Biot respirations indicate: A. decreased cerebral blood flow. B. internal bleeding in the chest. C. an underlying skull fracture. D. herniation of the brain stem.

D. herniation of the brain stem.

When opening the airway of a patient with a suspected spinal injury, you should use the: A. tongue-jaw lift maneuver. B. head tilt-neck lift maneuver. C. head tilt-chin lift maneuver. D. jaw-thrust maneuver.

D. jaw-thrust maneuver.

When caring for a patient with a possible head injury, it is MOST important to monitor the patient's: A. pupil size. B. blood pressure. C. pulse regularity. D. level of consciousness.

D. level of consciousness.

The _________ nervous system consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves. A. central B. somatic C. autonomic D. peripheral

D. peripheral

When immobilizing a child on a long backboard, you should: A. secure the head prior to securing the torso and legs. B. defer cervical collar placement to avoid discomfort. C. place the child's head in a slightly extended position. D. place padding under the child's shoulders as needed.

D. place padding under the child's shoulders as needed.

When assessing a patient with a head injury, you note the presence of thin, bloody fluid draining from his right ear. This indicates: A. fractures to the internal structures of the ear following direct trauma. B. a linear skull fracture and a significant increase in intracranial pressure. C. significant pressure and bleeding in between the skull and dura mater. D. rupture of the tympanic membrane following diffuse impact to the head.

D. rupture of the tympanic membrane following diffuse impact to the head.

Common signs of a skull fracture include all of the following, EXCEPT: A. mastoid process bruising. B. ecchymosis around the eyes. C. noted deformity to the skull. D. superficial scalp lacerations.

D. superficial scalp lacerations.

When immobilizing a trauma patient's spine, the EMT manually stabilizing the head should not let go until: A. an appropriately sized cervical collar has been applied. B. the patient has been secured to the ambulance stretcher. C. the head has been stabilized with lateral immobilization. D. the patient has been completely secured to the backboard.

D. the patient has been completely secured to the backboard.

A female patient with a suspected head injury has slow, shallow breathing. The MOST appropriate treatment for her includes: A. hyperventilating her at 30 breaths/min. B. administering oxygen via a nonrebreathing mask. C. ventilation assistance to maintain an oxygen saturation of 90%. D. ventilation assistance to maintain an ETCO2 of 30 to 35 mm Hg.

D. ventilation assistance to maintain an ETCO2 of 30 to 35 mm Hg.