34-39 module exam

Following a spinal injury, a patient presents with abdominal breathing and use of the accessory muscles in the neck. This suggests injury at or above:

C3-C4.

Wrist extension is controlled at the level of:

C6

Which of the following is a type of secondary brain injury?

Cerebral edema

Which of the following factors would likely result in secondary spinal cord injury?

Hypoglycemia

Which of the following statements regarding a closed head injury is correct?

In a closed head injury, the dura mater remains intact.

What type of intracranial hemorrhage would MOST likely be caused by a penetrating head injury?

Intracerebral hematoma

Which of the following statements regarding the hangman's fracture is correct?

It is a fracture of C2 that is secondary to significant distraction of the neck.

increased central; venous pressure commonly manifests as:

Jugular venous pressure

What spinal nerve tract carries information regarding pain and temperature?

Lateral spinothalamic

Which of the following types of skull fracture would be the LEAST likely to present with gross physical signs?

Linear fracture

Which of the following organs lies within the retroperitoneal space?

Pancreas

which of the following interventions would most likely convert a simple pneumothorax to a tension pneumothorax?

Positive-pressure ventilation

What portion of the brainstem is responsible for maintenance of consciousness?

Reticular activating system

Which of the following conditions that can cause an airway obstruction is unique to patients with an injury to the upper cervical spine?

Retropharyngeal hematoma

Which of the following is a function of the pancreas?

Secretion of insulin

A patient with a possible spinal cord injury is acutely agitated. What type of medication, if any, should they receive after hypoxia has been ruled out?

Short-acting reversible sedative

A patient with diaphragmatic breathing without intercostal muscle use has MOST likely experienced a spinal injury above the level of:

T2

Which of the following statements regarding the brainstem is correct?

The brainstem connects the spinal cord to the brain.

Common clinical findings associated with a subdural hematoma include

a slow progression of symptoms

Treatment for a patient with neurogenic shock may include

a vasopressor medication.

During the third collision in a motor vehicle crash:

abdominal organs shear from their points of attachment.

A pulmonary contusion following blunt chest trauma results in:

alveolar and capillary damage with intraparenchymal lung hemorrhage.

Autoregulation is defined as:

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

A spinal cord concussion is:

caused by a short-duration shock or pressure wave within the cord.

Following a traumatic brain injury, initial swelling of the brain occurs due to:

cerebral vasodilation.

The phrenic nerve arises from which plexus?

cervical

The middle ear consists of the:

inner portion of the tympanic membrane and the ossicles.

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:

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

Fractures of the lower rib cage should make you MOST suspicious for injuries to the:

liver or spleen.

As the body ages, the intervertebral discs:

lose water content and become thinner.

Hypotension that is associated with neurogenic shock is the result of:

loss of alpha receptor stimulation

Disruption of the lower parasympathetic nerves in the sacrum results in:

loss of bowel/bladder tone

Decerebrate posturing is characterized by:

extension of the arms and extension of the legs.

If a trauma patient cannot be assessed properly in his or her vehicle, you should:

maintain manual stabilization of the head, apply a cervical collar, and move the patient from the vehicle onto a long backboard.

A 45-year-old unrestrained man was ejected from his small truck when it struck a tree. The patient is found approximately 20 feet from the wreckage. Your primary assessment reveals that he is unresponsive and has sonorous respirations and a rapid pulse. Your initial actions should include:

manually stabilizing his head and opening his airway with the jaw-thrust maneuver.

A moderate diffuse axonal injury:

produces an immediate loss of consciousness and residual neurologic deficits when the patient wakes up.

When assessing a patient with maxillofacial trauma, it is MOST important to:

protect the cervical spine and monitor the patient's neurologic status.

Upon arriving at the scene of a motor vehicle crash, you find the driver of the car still seated in her two-door vehicle. The passenger side of the vehicle has sustained severe damage and is inaccessible. The driver is conscious and alert and complains only of lower back pain. The backseat passenger, a young child who was unrestrained, is bleeding from the head and appears to be unconscious. You should:

rapidly extricate the driver so you can gain quick access to the child in the backseat.

You have just completed spinal immobilization of a hemodynamically stable patient with a possible spinal injury. Prior to moving the patient to the ambulance, it is MOST important to:

reassess pulse, motor, and sensory functions in all extremities.

A motorcycle or football helmet should be removed if:

the patient is breathing shallowly and access to the airway is difficult.

Isolated rib fractures may result in inadequate ventilation because:

the patient often purposely limits chest wall movement.

Vagal tone remains intact following a spine injury because:

the vagus nerve originates outside the medulla and regulates the heart via the carotid arteries.

An injured patient's head should be secured to the long backboard only after:

their torso has been secured adequately.

A positive Babinski reflex is observed when the:

toes move upward in response to stimulation of the sole of the foot.

A 24-year-old male intentionally placed a commercially manufactured constricting object around the base of his penis. He complains of moderate pain, and assessment of his penis reveals that it is cyanotic. You should:

transport him to the hospital and provide emotional support en route

When moving an injured patient from the ground onto a long backboard, it is preferred that you:

use the four-person log roll technique.

You have intubated an unresponsive, apneic patient with a suspected spinal injury. After confirming proper ET tube placement and securing the tube, you should:

ventilate at 10 to 12 breaths/min and monitor end-tidal CO2.

A complete spinal cord injury to the upper cervical spine:

will result in permanent loss of all cord-mediated functions below the level of the injury.

A subdural hematoma is classified as acute if clinical signs and symptoms develop:

within 48 hours following the injury.

with the exception of the aorta, great vessel injury is most likely to occur following:

penetrating trauma

When caring for a patient with a seemingly isolated ear injury, you should:

perform a careful assessment to detect or rule out more serious injuries.

The major complication associated with hollow organ injury is:

peritonitis caused by rupture and spillage of toxins.

The leading cause of death in spinal cord injury patients who are discharged from the hospital is:

pneumonia

which of the following is a sign of neurogenic shock?

Bradycardia

What spinal cord injury is characterized by motor loss on the same side as the injury, but below the lesion?

Brown-Séquard syndrome

What type of skull fracture is MOST common following high-energy direct trauma to a small surface area of the head with a blunt object?

Depressed fracture

Which of the following statements regarding central cord syndrome is correct?

The patient typically presents with greater loss of function in the upper extremities than in the lower extremities.

Which of the following factors can decrease the potential damage caused by trauma to the abdomen?

Toned abdominal muscles and an empty bladder

Which of the following factors contributes to the extent of injury from a gunshot wound to the abdomen?

Trajectory of the bullet

Which of the following is a sign of a moderate elevation in intracranial pressure?

Widened pulse pressure

If a knife is impaled in the neck:

a cricothyrotomy may be required to establish a patent airway.

a subluxation is defined as:

a partially severed spinal cord

When assessing a patient with abdominal trauma for distention, you must recall that:

a significant amount of blood volume in the abdominal cavity is required to produce distention.

A compression or burst fracture of the cervical spine would MOST likely occur following:

a significant fall in which the patient lands head first.

A 17-year-old high school football player was struck in the abdomen by another player during a tackle. Your assessment reveals signs of shock and pain to the patient's left shoulder, which is unremarkable for trauma. Examination of the patient's abdomen is also unremarkable for obvious injury. Based on your assessment findings and the patient's clinical presentation, you should be MOST suspicious of:

an injury to the spleen.

Displacement of bony fragments into the front portion of the spinal cord results in:

anterior cord syndrome.

A 17-year-old man jumped from a second-story balcony and landed on his feet. He complains of pain to both of his heels and knees. Your assessment reveals swelling and ecchymosis to both of his feet. His vital signs are stable and he is breathing without difficulty. In addition to caring for his lower-extremity injuries, it is MOST important that you:

apply spinal motion restriction precautions.

The periumbilical area refers to the:

area around the umbilicus

When assigning a Glasgow Coma Scale (GCS) score to a patient who has limb paralysis due to a spinal cord injury, you should:

ask the patient to blink or move a facial muscle.

When immobilizing a sitting patient with a vest-type extrication device or short backboard, you should manually stabilize his or her head and then:

assess distal pulse and sensory and motor functions.

When caring for a patient with fractured or avulsed teeth following an assault, you should:

assess the knuckles of the person who assaulted the patient.

A 39-year-old woman sustained an abdominal evisceration after she was cut in the abdomen with a machete. The patient is semiconscious and is breathing shallowly. You should:

assist ventilations with a bag-mask device; cover the exposed bowel with moist, sterile dressings and protect them from injury; transport at once; and initiate IV therapy en route

Tracheobronchial injuries have a high mortality due to:

associated airway obstruction.

If the mechanism of injury indicates that your patient may have sustained a spinal cord injury:

assume that a spine injury exists, regardless of the neurologic findings.

In contrast to secondary spinal cord injury, primary spinal cord injury occurs:

at the moment of impact.

A 39-year-old man crashed his vehicle into a wooded area and was not found for approximately 8 hours. When you arrive at the scene and assess him, you note that he is conscious but anxious. He is unable to feel or move below his mid-thoracic area and complains of a severe headache. His blood pressure is 210/130 mm Hg, heart rate is 44 beats/min, and respirations are 22 breaths/min. This patient's clinical presentation is MOST consistent with:

autonomic dysreflexia.

Gross hematuria and suprapubic pain following a pelvic injury is MOST indicative of injury to the:

bladder.

Hyphema is defined as:

blood in the anterior chamber of the eye.

Loss of function of the lower arms and hands following trauma to the anterior neck is indicative of damage to the:

brachial plexus.

Dysrhythmias following a myocardial contusion are usually secondary to:

damage to myocardial tissue at the cellular level.

As air accumulates in the pleural space, the FIRST thing to occur is:

decreased pulmonary function.

when performing your neurologic assessment of a patient, you should first:

determine the patient's level of consciousness

General treatment for a man with a significant head injury and signs of Cushing triad includes:

elevating the head 15 to 30 degrees

When immobilizing a patient to a long backboard, you should first:

ensure that the patient's head is stabilized manually.

You are assessing a patient who sustained blunt trauma to the center of his back. He is conscious, but is unable to feel or move his lower extremities. His blood pressure is 80/50 mm Hg, pulse is 40 beats/min and weak, and respirations are 24 breaths/min and shallow. If IV fluids do not adequately improve perfusion, you should:

give 0.5 mg of atropine and consider a dopamine infusion.

Horner syndrome is identified when a patient with a spinal injury:

has a drooping upper eyelid and small pupil

Early signs and symptoms of increased intracranial pressure include:

headache and vomiting.

Hyperacute pain to touch is called:

hyperesthesia

A skier wiped out while skiing down a large hill. He is conscious and alert and complains of being very cold; he also complains of neck stiffness and numbness and tingling in all of his extremities. A quick assessment reveals that his airway is patent and his breathing is adequate. You should:

immobilize his spine and quickly move him to a warmer environment.

A diffuse axonal injury:

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

According to the National Spinal Cord Injury Database, MOST spinal cord injuries are caused by:

motor vehicle crashes.

An open pneumothorax causes ventilatory inadequacy when:

negative pressure created by inspiration draws air into the pleural space.

When applying a vest-type extrication device or short backboard to a seated patient, his or her head should be secured to the device:

only after the torso is fastened securely.

If a patient is unable to follow your finger above the midline following blunt trauma to the face, you should be MOST suspicious for a(n):

orbital skull fracture.

Because of its anatomic position in the retroperitoneum, it typically takes high-energy force to damage the:

pancreas.

Bradycardia that occurs shortly after you have dressed and bandaged an open neck wound is MOST likely the result of:

parasympathetic nervous system stimulation due to excessive pressure on the carotid artery.

The upper peritoneal cavity includes the:

spleen

A 19-year-old man experienced direct trauma to his left elbow. Your assessment reveals gross deformity and ecchymosis. His arm is pink and warm, and he has a strong radial pulse. Your transport time to the hospital will be delayed. You should:

splint the elbow in the position found and reassess distal circulation

Following a traumatic injury, a 19-year-old woman presents with confusion, tachycardia, and significant hypotension. Her skin is cool, clammy, and pale. Further assessment reveals abdominal rigidity and deformity with severe pain over her thoracic vertebrae. In addition to administering high-flow oxygen and immobilizing her spine, you should:

start at least one large-bore IV line and give crystalloid boluses as needed to maintain adequate perfusion.

A blood pressure of 110/68 mm Hg in the presence of clinical signs of a tension pneumothorax:

suggests adequate cardiac compensation for the diminished venous return.