Quiz 6-9 Brain Trauma

Which of the following signs of a basilar skull fracture would MOST likely be observed in the prehospital setting? Ecchymosis around the eyes Battle's sign Bruising over the mastoid process Cerebrospinal fluid drainage from the ear

Cerebrospinal fluid drainage from the ear

What portion of the brainstem is responsible for maintenance of consciousness? Diencephalon Basal ganglia Limbic system Reticular activating system

Reticular activating system

What portion of the brain is a relay center that filters important signals from routine signals? Thalamus Prefrontal area Hypothalamus Temporal lobe

Thalamus

Autoregulation is defined as: reflex bradycardia that occurs secondary to systemic hypertension. a decrease in cerebral perfusion pressure that reduces intracranial pressure. the forcing of cerebrospinal fluid into the spinal cord as ICP increases. an increase in mean arterial pressure to maintain cerebral blood flow.

an increase in mean arterial pressure to maintain cerebral blood flow.

Decerebrate posturing is characterized by: extension of the arms and extension of the legs. flexion of the arms and extension of the legs. inward flexion of the wrists and flexed knees. pulling in of the arms toward the core of the body.

extension of the arms and extension of the legs.

Paralysis of the extremities would MOST likely result from injury to the: hypothalamus. cerebellum. diencephalon. cerebral cortex.

cerebral cortex.

When assessing the severity of a traumatic brain injury, the MOST important assessment parameter is the patient's: response to verbal stimuli. level of consciousness. blood pressure. initial Glasgow Coma Scale score.

level of consciousness.

Prehospital treatment of the patient with a traumatic brain injury must focus primarily on: taking measures to decrease intracranial pressure. hyperventilating the patient at 20 breaths/min. maintaining a systolic BP of at least 120 mm Hg. maintaining cerebral perfusion pressure.

maintaining cerebral perfusion pressure.

Common clinical findings associated with a subdural hematoma include all of the following, EXCEPT: a fluctuating level of consciousness. an underlying skull fracture. unilateral hemiparesis or slurred speech. rapidly increasing intracranial pressure.

rapidly increasing intracranial pressure.

An epidural hematoma typically causes rapid deterioration in the patient's condition because: it is associated with brisk arterial bleedingconcomitant spinal cord injury is often present. numerous axons are severely damaged. the meningeal veins are often disrupted.

it is associated with brisk arterial bleeding

The innermost meningeal layer that rests directly on the brain and spinal cord is the: cortex. arachnoid. dura mater. pia mater.

pia mater.

Which of the following statements regarding the brainstem is correct? The brainstem provides protection to the cerebellum. The brainstem connects the spinal cord to the brain. The brainstem is responsible for muscle coordination. All but 4 of the 12 cranial nerves exit the brainstem.

The brainstem connects the spinal cord to the brain.

The MOST disastrous consequence of a severe traumatic brain injury is: an increase in intracranial pressure. an increase in mean arterial pressure. a decrease in cerebral perfusion pressure. severe hypertension and bradycardia.

a decrease in cerebral perfusion pressure.

Open fractures of the cranial vault: typically cause lethal atrial cardiac dysrhythmias. are associated with a high risk of bacterial meningitis. are uncommonly associated with multisystem trauma. cause death due to increased intracranial pressure.

are associated with a high risk of bacterial meningitis.

Unlike a cerebral concussion, a cerebral contusion is: typically not associated with retrograde amnesia or focal neurologic deficits. associated with physical brain damage and more pronounced neurologic deficits. a type of diffuse axonal injury that often leads to permanent neurologic damage. a diffuse brain injury that results in severe intracranial hemorrhage and pressure.

associated with physical brain damage and more pronounced neurologic deficits.

Secondary brain injuries include all of the following, EXCEPT: cerebral edema. axonal injury. intracranial hemorrhage. cerebral ischemia.

axonal injury.

When an unrestrained passenger's head strikes the windshield of a motor vehicle following rapid deceleration: the anterior portion of the brain sustains stretching or tearing injuries, and the posterior portion of the brain sustains compression injuries. compression injuries occur to the anterior portion of the brain, and stretching or tearing injuries occur to the posterior portion of the brain. the brain initially strikes the rear of the skull, resulting in direct bruising, and then rebounds and strikes the front part of the skull. the head falls back against the headrest or seat and the brain collides with the rear of the skull, resulting in direct injury to the occipital lobe.

compression injuries occur to the anterior portion of the brain, and stretching or tearing injuries occur to the posterior portion of the brain.

Beginning with the outermost layer, the three meningeal layers of the central nervous system are the: dura mater, arachnoid, and pia mater. pia mater, dura mater, and arachnoid. arachnoid, pia mater, and dura mater. dura mater, pia mater, and arachnoid.

dura mater, arachnoid, and pia mater.

The dura mater: is the middle meningeal layer and is comprised of a delicate transparent membrane that is damaged easily by trauma. anatomically separates the cerebellum and the brainstem and contains vasculature that resembles a spider web. folds in to form the tentorium, a structure that separates the cerebral hemispheres from the cerebellum and brainstem. is the inner meningeal layer and is comprised of a thin, translucent, highly vascular membrane that adheres firmly directly to the surface of the brain.

folds in to form the tentorium, a structure that separates the cerebral hemispheres from the cerebellum and brainstem.

Chronic subdural hematomas are MOST commonly seen in patients who: have high cholesterol. have alcoholism. are less than 2 years of age. are prone to hypoglycemia.

have alcoholism.

Early signs and symptoms of increased intracranial pressure include: hypertension and bradycardia. widening of the pulse pressure. headache and vomiting. arm flexion and leg extension.

headache and vomiting.

A 19-year-old woman fell from a second story window and landed on her head. She is unconscious with a blood pressure of 168/104 mm Hg, heart rate of 56 beats/min, and irregular respirations of 8 breaths/min. Further assessment reveals blood draining from her nose and bilaterally dilated pupils that are slow to react. In addition to employing full spinal precautions, the MOST appropriate treatment for this patient involves: preoxygenating her with a bag-mask device and 100% oxygen for 2 to 3 minutes, performing nasotracheal intubation, transporting at once, starting at least one large-bore IV line en route, and obtaining her Glasgow Coma Scale score. intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments. applying oxygen via nonrebreathing mask, covering her with blankets, starting an IV of normal saline set to keep the vein open, applying a cardiac monitor, initiating transport, and monitoring her pupils while en route to the hospital. hyperventilating her with a bag-mask device at a rate of 20 breaths/min, starting two large-bore IV lines, applying a cardiac monitor, administering 5 mg of Valium to prevent seizures, and transporting to a trauma center.

intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments.

A diffuse axonal injury: is a specific, grossly observable brain injury that can easily be diagnosed with a computer tomography scan of the head. results in severe stretching or tearing of the portion of the nerve cell that receives sensory messages from the rest of the body. is generally associated with better neurologic outcomes than a cerebral concussion because permanent brain damage does not occur. involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body.

involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body.

The Broca region of the left frontal lobe is responsible for the muscular actions that are associated with: sight. speech eye movement. reflexes

speech

Nuchal rigidity is MOST commonly seen in patients with a(n): subdural hematoma. epidural hematoma. subarachnoid hemorrhage. intracerebral hematoma.

subarachnoid hemorrhage.