Chapter 35

A subluxation is defined as:

A partial or incomplete dislocation

Common clinical findings associated with a subdural hematoma include:

A slow progression of symptoms

Wrist extension is controlled at the level of:

C6

In which of the following situations would it be most appropriate to apply a vest-type extrication device to a patient who is seated in their crashed motor vehicle?

Conscious with neck pain and stable vital signs

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

Determine the patient's level of consciousness.

The dura mater:

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

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.

In which of the following situations would spinal restriction precautions likely be necessary?

Isolated head injury without gross signs or symptoms of a spinal injury

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

When applying a vest-type extrication device to a seated patient, their head should be secured to the device:

Only after the torso is fastened securely

The most significant complication associated with prolonged immobilization of a patient on a long board is:

Pressure lesion development

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 important to:

Reassess pulse, motor, and sensory functions in all extremities

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

As patient with a possible spinal injury is acutely agitated. What type of medication, if any, should they receive after hypoxia has been rules 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.

Injury to the temporal lobe on the left side would MOST likely cause:

abnormal speech

Autoregulation is defined as:

an increase in mean arterial pressure to maintain cerebral blood flow

Medications administered in the prehospital setting for a patient with a head injury would most likely be used to:

facilitate intubation or terminate seizures

The crescent-shaped fold that divides the cerebrum into left and right hemispheres is called the:

falx cerebelli

Spinal cord injuries that cause neurogenic shock generally produce:

flaccid paralysis and complete loss of sensation distal to the injury.

A spinal cord concussion is:

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

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

cerebral edema

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

cerebral vasodilation

The phrenic nerves arise from which plexus?

cervical

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

intracerebral hematoma

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.

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

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

Decerebrate posturing is characterized by:

extension of the arms and extension of the legs

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

loss of bowel/bladder tone

If a trauma patient cannot be assessed properly in their vehicle, you should:

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

Prior to immobilizing an anxious patient with a suspected spinal injury on a backboard, it is important to:

make note of any neurologic deficits or gross injuries up to that point.

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 neuorologic deficits when the patient wakes up

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

The cervical collar is designed to:

reduce flexion and extension of the head and place the weight of the head on the shoulders.

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

reticular activating systematic

Proprioception is defined as:

the ability to perceive the position and movement of one's body

A motorcycle or football helmet should be removed if:

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

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.

Spinal cord injury without radiographic abnormalities can occur in children because:

their vertebrae lie flatter on top of each other.

A positive Babinski reflex is observed when the:

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

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 endotracheal (ET) tube placement and securing the tube, you should:

ventilate at 10 to 12 breaths/min and monitor end-tidal carbon dioxide

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.

Regardless of the method of spinal immobilization used, you must:

keep the head, neck, and trunk in alignment.

The innermost meningeal layer that rests directly on the brain and spinal cord is the:

pia mater

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

pneumonia

The only area of the spine that allows for significant rotation is:

C1-C2

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

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

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

Brown-Sequard syndrome

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

Treatment for a patient with neurogenic shock may include:

Vasopressor medication

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

Widened pulse pressure

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

a significant fall in which the patient lands head first

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

anterior cord syndrome

Pupils that are slow (sluggish) to react to light:

are a sign of cerebral hypoxia

Open fractures of the cranial vault:

are associated with a high risk of bacterial meningitis

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, you should manually stabilize their head and then:

assess distal pulse, sensory, and motor functions.

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

assume that a spine injury exists, regardless of neurologic findings

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

at the moment of impact.

Which of the following is a sign of neurogenic shock?

bradycardia

The parietal lobe of the brain:

controls the body's ability to perceive body limb movement.

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

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

elevating the head 15 to 30 degrees.

You are assessing a patient who sustained blunt trauma to the center of her back. She is conscious, but is unable to feel or move her lower extremities. Her 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.

Spinal shock is a condition that:

is usually temporary and results from swelling of the spinal cord.

Modification of your physical examination of a patient with a suspected spinal cord injury following a two-car motor vehicle crash is based on:

mechanism of injury

According to the National Spinal Cord Injury Statistical Center, most spinal cord injuries are caused by:

motor vehicle crashes

Following a traumatic injury, a 19-year-old woman presents with confusion, tachycardia, and 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.