Chapter 33 Face and neck

A flattened appearance to the face and loss of sensation over the cheek following blunt facial trauma is MOST indicative of a(n): A) zygomatic fracture. B) orbital skull fracture. C) Le Fort I fracture. D) temporomandibular joint dislocation.

A) zygomatic fracture.

When caring for a patient with a seemingly isolated ear injury, you should: A) carefully assess the external ear canal and inner ear for blood or CSF. B) perform a careful assessment to detect or rule out more serious injuries. C) recall that the pinna of the ear is highly vascular and bleeds profusely. D) consider direct transport of the patient to an audiologist for evaluation.

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

When assessing a patient with maxillofacial trauma, it is MOST important to: A) gently palpate the maxilla, mandible, and zygoma to elicit crepitus. B) protect the cervical spine and monitor the patient's neurologic status. C) apply a cervical collar and determine if the patient has visual disturbances. D) have the patient open his or her mouth and assess for dental malocclusion.

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

Proper treatment for an open wound to the neck includes: A) administering 2 L of IV crystalloid solution. B) sealing the wound with an occlusive dressing. C) prompt transportation to a hyperbaric chamber. D) applying a circumferential pressure dressing.

B) sealing the wound with an occlusive dressing.

Which of the following statements regarding anisocoria is correct? A) Anisocoria is a condition in which the pupils are unequal. B) Anisocoria is a normal finding in the majority of the population C) Physiologic anisocoria indicates significant intracranial pressure. D) Anisocoria is a condition characterized by bilateral pupillary dilation.

A) Anisocoria is a condition in which the pupils are unequal.

Which of the following statements regarding the nasal septum is correct? A) The nasal septum may be slightly deviated to one side or the other. B) The nasal septum is comprised mainly of cartilage. C) Inflammation of the nasal septum is common during infection. D) The nasal septum separates the oropharynx and nasopharynx

A) The nasal septum may be slightly deviated to one side or the other.

A patient with a loss of peripheral vision MOST likely has damage to the: A) retina. B) pupil. C) cornea. D) lens.

A) retina.

Which of the following statements regarding vitreous humor is correct? A) Vitreous humor is a jelly-like substance that is replenished if lost. B) Vitreous humor fills the posterior chamber and maintains the shape of the globe. C) Vitreous humor is a clear watery fluid that fills the anterior chamber. D) The most significant risk caused by a loss of vitreous humor is infection

B) Vitreous humor fills the posterior chamber and maintains the shape of the globe.

If you are unable to orotracheally intubate a patient due to massive maxillofacial trauma and severe oropharyngeal and nasopharyngeal bleeding, you would MOST likely have to perform: A) nasotracheal intubation. B) a needle or surgical cricothyrotomy. C) pharmacologically assisted intubation. D) digital (tactile) intubation.

B) a needle or surgical cricothyrotomy.

Following blunt trauma to the face, a 30-year-old man presents with epistaxis, double vision, and an inability to look upward. You should be MOST suspicious of: A) traumatic conjunctivitis. B) an orbital blowout fracture. C) traumatic retinal detachment. D) fracture of the cribriform plate.

B) an orbital blowout fracture.

Hyphema is defined as: A) severe ecchymosis to the orbital region. B) blood in the anterior chamber of the eye. C) marked swelling of the globe of the eye. D) double vision following blunt eye trauma.

B) 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: A) carotid artery. B) brachial plexus. C) vagus nerves. D) parathyroid glands.

B) brachial plexus.

During an explosion, a 42-year-old construction worker sustained a large laceration to the lateral aspect of his neck when he was struck by a piece of flying debris. The patient is conscious, but complains of difficulty hearing. In addition to protecting his spine, you should be MOST concerned with: A) administering high-flow oxygen via nonrebreathing mask as soon as possible. B) covering the laceration with an occlusive dressing and controlling the bleeding. C) carefully examining his ear to determine if his tympanic membrane is ruptured. D) applying a bulky dressing to the laceration and securing it firmly with a bandage.

B) covering the laceration with an occlusive dressing and controlling the bleeding.

Because significant force is required to fracture the mandible: A) most mandibular fractures are associated with a spinal fracture. B) it is often fractured in more than one place and is unstable to palpation. C) patients with a possible mandibular fracture should be intubated routinely. D) a mandibular fracture can be ruled out in cases of minor blunt facial trauma.

B) it is often fractured in more than one place and is unstable to palpation.

You are transporting a conscious middle-aged man with anterior neck trauma. He is on high-flow oxygen, has spinal precautions in place, and has a large-bore IV line of normal saline in place. When you reassess his vital signs, you note that his blood pressure is 90/64 mm Hg, his pulse rate is 120 beats/min, and his respirations are 22 breaths/min with adequate depth. You should: A) begin assisting his ventilations with a bag-mask device, rapidly infuse 2 L of IV fluid, and reassess. B) keep the patient warm and infuse enough isotonic crystalloid solution to maintain adequate perfusion. C) elevate his legs, apply a blanket, and administer IV fluid boluses until his heart rate is within a normal range. D) start a second IV line and administer crystalloid IV fluids until his systolic blood pressure is at least 100 mm Hg.

B) keep the patient warm and infuse enough isotonic crystalloid solution to maintain adequate perfusion.

The __________ is a cone-shaped fossa that encloses and protects the eye. A) zygoma B) orbit C) condyle D) crista galli

B) orbit

Which of the following is the MOST significant complication associated with a fractured nasal bone? A) Facial swelling B) Lateral displacement C) Damage to the septum D) Posterior epistaxis

D) Posterior epistaxis

The primary risk associated with oral and dental injuries is: A) malocclusion. B) intraoral infection. C) permanent tooth loss. D) airway compromise.

D) airway compromise

When managing the airway of an unresponsive patient with serious anterior neck trauma and shallow breathing, you should: A) apply a cervical collar and perform intubation immediately. B) ventilate the patient with an oxygen-powered ventilation device. C) give oxygen via nonrebreathing mask and apply a pulse oximeter. D) assist ventilations with a bag-mask device and prepare to intubate.

D) assist ventilations with a bag-mask device and prepare to intubate.

In addition to massive bleeding, injury to a carotid or vertebral artery would MOST likely cause: A) hemiparalysis. B) an air embolism. C) severe bradycardia. D) cerebral hypoxia.

D) cerebral hypoxia.

A 51-year-old woman sustained a large laceration to her cheek when she was cut by a knife during a robbery attempt. The patient is conscious and alert and has severe oral bleeding. She denies any other trauma. Your FIRST action should be to: A) suction her oropharynx for up to 15 seconds. B) manually stabilize her head in a neutral position. C) control the intraoral bleeding with sterile gauze. D) ensure that she is sitting up and leaning forward.

D) ensure that she is sitting up and leaning forward.

Blood supply to the face is provided primarily through the: A) temporal artery. B) vertebral artery. C) internal carotid artery. D) external carotid artery.

D) external carotid artery.

A ruptured tympanic membrane: A) commonly results in permanent hearing loss. B) is characterized by CSF leakage from the ears. C) commonly leads to an infection of the middle ear. D) is extremely painful but typically heals spontaneously.

D) is extremely painful but typically heals spontaneously.

The anterior chamber is the portion of the globe between the _____ and the _____, and is filled with _____ humor. A) iris, lens, vitreous B) cornea, iris, aqueous C) lens, iris, vitreous D) lens, cornea, aqueous

D) lens, cornea, aqueous

If a knife is impaled in the neck: A) a cricothyrotomy may be required to establish a patent airway. B) it should be removed in case the airway becomes compromised. C) you should stabilize the object in place, regardless of its location. D) it should be shortened to facilitate proper airway management.

A) a cricothyrotomy may be required to establish a patent airway.

Significant blunt injuries to the larynx or trachea pose an IMMEDIATE risk of: A) airway compromise. B) hypovolemic shock. C) mediastinal inflammation. D) aspiration of gastric contents.

A) airway compromise.

You are caring for a man with a chemical burn to both eyes. The patient, who has contact lenses in place, is in severe pain and tells you that he can't see. Proper care for this patient includes: A) carefully removing his contact lenses, flushing both eyes for at least 20 minutes, and transporting with continuous eye irrigation. B) leaving his contact lenses in place to avoid further injury and transporting at once with irrigation of both eyes performed en route. C) removing his contact lenses, covering both eyes with moist, sterile dressings, administering a narcotic analgesic, and transporting. D) asking the patient to remove his contact lenses, irrigating both eyes for no more than 10 minutes, covering both eyes with sterile dressings, and transporting.

A) carefully removing his contact lenses, flushing both eyes for at least 20 minutes, and transporting with continuous eye irrigation.

The ONLY indication for removing contact lenses in the prehospital setting is: A) chemical eye burns. B) acute conjunctivitis. C) cardiopulmonary arrest. D) a foreign body in the eye.

A) chemical eye burns.

Signs and symptoms of retinal detachment include: A) flashing lights, specks, or floaters in the field of vision. B) double vision and partial or complete loss of peripheral vision. C) immediate pain and total loss of vision following blunt eye trauma. D) paralysis of upward gaze and greater than 50% loss of central vision.

A) flashing lights, specks, or floaters in the field of vision.

Motor function to the muscles of the tongue is provided by the ___________ nerve. A) hypoglossal B) trigeminal C) mandibular D) glossopharyngeal

A) hypoglossal

A fracture of all midfacial bones, separating the entire midface from the cranium: A) is commonly associated with facial elongation and dental malocclusion. B) should be stabilized by placing bulky dressings across the fractured area. C) is almost always accompanied by multiple severe fractures of the mandible. D) is referred to as a Le Fort I fracture and most commonly results from a fall

A) is commonly associated with facial elongation and dental malocclusion.

Appropriate management for a patient with severe epistaxis, tachycardia, and diaphoresis following an injury to the face includes: A) positioning the patient supine and elevating his or her legs 12 to 18 inches. B) administering enough IV crystalloid fluids to maintain adequate perfusion. C) pinching the patient's nares together and instructing him or her to lean back. D) applying direct pressure to the bridge of the nose and keeping the patient calm.

B) administering enough IV crystalloid fluids to maintain adequate perfusion.

_________ forms the principal mass of the tooth and is much denser and stronger than bone. A) Pulp B) Dentin C) Enamel D) Gingiva

B) Dentin

When treating a patient with an ocular injury, what should you do to avoid an increase in intraocular pressure? A) Apply light pressure to both eyes. B) Discourage the patient from coughing. C) Administer prophylactic atropine sulfate. D) Ensure that the patient remains supine.

B) Discourage the patient from coughing.

What two major nerves provide sensory and motor control to the face? A) Facial and maxillary B) Facial and trigeminal C) Ophthalmic and vagus D) Maxillary and mandibular

B) Facial and trigeminal

What portion of the eye may become icteric in patients with hepatitis? A) Iris B) Sclera C) Cornea D) Conjunctiva

B) Sclera

Alkali or strong acid burns to the eye should be irrigated continuously for at least ___ minutes. A) 10 B) 15 C) 20 D) 30

C) 20

Which of the following cranial nerves innervates the muscles that cause motion of the eyeballs and upper eyelids? A) Optic B) Ophthalmic C) Oculomotor D) Trigeminal

C) Oculomotor

When caring for a patient with fractured or avulsed teeth following an assault, you should: A) handle any avulsed teeth by the root only, not the crown. B) flush the patient's mouth with sterile water for 20 minutes. C) assess the knuckles of the person who assaulted the patient. D) remove any partially avulsed teeth and immerse them in water.

C) assess the knuckles of the person who assaulted the patient.

The large cartilaginous external portion of the ear is called the: A) ossicle. B) cochlea. C) auricle. D) oval window.

C) auricle.

General care for an eye injury involves: A) applying direct pressure to the globe. B) irrigating the eye with sterile saline solution. C) covering both eyes to minimize further injury. D) applying a cold compress to the eyeball.

C) covering both eyes to minimize further injury.

The hyoid bone: A) articulates with the temporal bone at the temporomandibular joint. B) is anatomically attached to the skull and supports the vocal cords. C) floats in the superior aspect of the neck just below the mandible. D) is a hollowed section of bone that provides resonance for the voice

C) floats in the superior aspect of the neck just below the mandible.

The middle ear consists of the: A) cochlea and semicircular canals. B) organ of Corti and the external auditory canal. C) inner portion of the tympanic membrane and the ossicles. D) pinna and the exterior portion of the tympanic membrane.

C) inner portion of the tympanic membrane and the ossicles.

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): A) Le Fort II fracture. B) nasal bone fracture. C) orbital skull fracture. D) basilar skull fracture.

C) orbital skull fracture.

Vascular injury following trauma to the anterior neck would MOST likely present with: A) hemoptysis. B) parasthesia. C) pulse deficits. D) dysphagia.

C) pulse deficits.

Open soft-tissue facial trauma following a significant mechanism of injury: A) often requires removal of foreign bodies that are impaled in the face. B) is of most concern due to the possibility of permanent disfigurement. C) suggests that the patient may have a closed head injury or spinal injury. D) dictates the need for immediate intubation to protect the patient's airway.

C) suggests that the patient may have a closed head injury or spinal injury.

Which of the following bones is part of the cranial vault AND the face? A) Vomer B) Palatine C) Lacrimal D) Ethmoid

D) Ethmoid

What part of the eye is MOST commonly injured following a thermal burn? A) Globe B) Retina C) Cornea D) Eyelid

D) Eyelid

A young man was assaulted and has extensive maxillofacial injuries. Your primary assessment reveals that he is semiconscious, has shallow breathing, and has blood draining from the corner of his mouth. Initial management for this patient involves: A) inserting an oropharyngeal airway, preoxygenating him with a bag-mask device for 2 minutes, and then intubating his trachea. B) applying a cervical collar, performing a blind finger sweep to clear his airway, and providing ventilatory assistance with a bag-mask device. C) fully immobilizing his spine, inserting a nasopharyngeal airway, and hyperventilating him with a bag-mask device at a rate of 20 breaths/min. D) manually stabilizing his head in a neutral position, suctioning his oropharynx, and assisting ventilations with a bag-mask device and 100% oxygen.

D) manually stabilizing his head in a neutral position, suctioning his oropharynx, and assisting ventilations with a bag-mask device and 100% oxygen.

Bradycardia that occurs shortly after you have dressed and bandaged an open neck wound is MOST likely the result of: A) decreased vagal tone secondary to direct injury to the vagus nerve. B) decreased venous return from the brain and an increase in intracranial pressure. C) an acute pulmonary embolism due to the entrainment of air into one of the jugular veins. D) parasympathetic nervous system stimulation due to excessive pressure on the carotid artery.

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

The ________ conducts signals to the brain via the optic nerve and interprets them as vision. A) iris B) lens C) pupil D) retina

D) retina

A conscious but combative patient with severe facial trauma is fully immobilized on a backboard. During your assessment, the patient begins coughing up large amounts of blood. You suction his oropharynx, but his mouth quickly refills with blood. You should: A) preoxygenate the patient with a bag-mask for 2 minutes and then perform nasotracheal intubation. B) roll the backboard on its side, suction his oropharynx, and prepare to perform pharmacologically assisted intubation. C) alternate suctioning of his oropharynx for 15 seconds and assisting ventilations for 2 minutes until his airway is clear of blood. D) continually suction his oropharynx until it is clear of blood, apply oxygen via nonrebreathing mask, and administer a sedative drug.

B) roll the backboard on its side, suction his oropharynx, and prepare to perform pharmacologically assisted intubation.

Movement of both of the eyes in unison is called: A) dysconjugate gaze. B) sympathetic eye movement. C) extraocular movement. D) physiologic anisocoria.

B) sympathetic eye movement.

You are dispatched to a high school where a 16-year-old male was stabbed in the eye with a pencil. The patient is conscious and in severe pain. A classmate removed the pencil prior to your arrival. The MOST appropriate care for this patient's injury includes: A) irrigating the injured eye with sterile saline, covering both eyes with a protective eye shield, and transporting immediately. B) applying an icepack to the affected eye, administering 1 µg/kg of fentanyl IM, elevating the patient's legs, and transporting. C) covering the affected eye with a sterile dressing and protective eye shield, covering the unaffected eye, and transporting promptly. D) covering the affected eye with a moist, sterile dressing, applying gently pressure to reduce intraocular pressure, and transporting at once.

C) covering the affected eye with a sterile dressing and protective eye shield, covering the unaffected eye, and transporting promptly.

A patient with a dysconjugate gaze following an ocular injury: A) most likely has a concomitant basilar skull fracture. B) should have ice applied to the eyes to prevent blindness. C) has discoordination between the movements of both eyes. D) should be treated by irrigating both eyes for 20 minutes.

C) has discoordination between the movements of both eyes.