Sectional Exam 6 - Head & Spine Trauma

A male patient with a closed head injury opens his eyes in response to pain, makes incomprehensible sounds, and responds to pain with flexion of his arms. His Glasgow Coma Scale score is ___, and the MOST appropriate treatment for him involves:

7; intubation, ventilations performed at a rate of 12 breaths/min, IV fluids as needed to maintain a systolic blood pressure of at least 90 mm Hg, and maintaining his oxygen saturation at greater than 90%.

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 signs of a basilar skull fracture would MOST likely be observed in the prehospital setting?

Cerebrospinal fluid drainage from the ear

Which of the following statements regarding a cerebral concussion is correct?

Concussions are usually not associated with structural brain injury.

In which of the following situations would it be MOST appropriate to apply a vest-type extrication device or a short backboard to a patient who is seated in his or her crashed motor vehicle?

Conscious with neck pain and stable vital signs

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 factors would be the LEAST likely to result in secondary spinal cord injury?

Hyperglycemia

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.

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

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

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

Short-acting, reversible sedative

In which of the following situations would spinal motion restriction precautions likely NOT be necessary?

Syncopal episode in which the patient was already seated or supine

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.

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

a significant fall in which the patient lands head first.

Cerebrospinal fluid drainage from the ears is MOST indicative of:

a skull fracture.

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

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.

The dura mater:

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

A spinal cord concussion is:

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

Paralysis of the extremities would MOST likely result from injury to the:

cerebral cortex.

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

cerebral vasodilation.

The phrenic nerve arises from the _________ plexus and innervates the _______.

cervical, diaphragm

Patients with evidence of trauma above the _________ should be considered at risk for an associated spine injury.

clavicles

The main disadvantage of using a scoop stretcher to transfer a patient to a long backboard is:

inability to conduct a visual exam of the back for injuries.

The cerebellum is located in the ____________ part of the brain and is responsible for _______________.

inferoposterior, posture and equilibrium

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

injuries to patients in the other vehicle.

You would MOST likely have to place several blankets or pillows under a patient's upper back prior to immobilization if he or she has:

kyphosis.

When assessing the severity of a traumatic brain injury, the MOST important assessment parameter is the patient's:

level of consciousness.

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.

When an unrestrained passenger's head strikes the windshield of a motor vehicle following rapid deceleration:

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

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.

Prehospital treatment of the patient with a traumatic brain injury must focus primarily on:

maintaining cerebral perfusion pressure.

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.

The MOST significant complication associated with prolonged immobilization of a patient on a long backboard is:

pressure lesion development.

Treatment for a patient with neurogenic shock may include all of the following, EXCEPT:

prevention of hyperthermia.

A moderate diffuse axonal injury:

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

The MOST effective method for decreasing morbidity and mortality associated with spinal cord injury is:

public education and prevention strategies.

Flexion injuries to the spine would MOST likely result from:

rapid deceleration forces

Common clinical findings associated with a subdural hematoma include all of the following, EXCEPT:

rapidly increasing intracranial pressure.

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.

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.

Death following a head injury is MOST often the result of:

trauma to the brain.

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

use the four-person log roll technique.

Beta receptor stimulation results in all of the following effects, EXCEPT:

vascular smooth muscle contraction.

The anterior weight-bearing structure of the vertebra is the:

vertebral body.

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.

Spinal shock is a condition that:

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

An epidural hematoma typically causes rapid deterioration in the patient's condition because:

it is associated with brisk arterial bleeding.

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.

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

C1-C2.

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

Brown-Séquard 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.

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

Widened pulse pressure

The MOST disastrous consequence of a severe traumatic brain injury is:

a decrease in cerebral perfusion pressure.

Displacement of bony fragments into the anterior 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 or short backboard, you should manually stabilize his or her head and then:

assess distal pulse and sensory and motor functions.

Unlike a cerebral concussion, a cerebral contusion is:

associated with physical brain damage and more pronounced neurologic deficits.

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.

Secondary brain injuries include all of the following, EXCEPT:

axonal injury.

The __________ is the largest component of the central nervous system and contains billions of neurons that serve a variety of functions.

brain

The parietal lobe of the brain:

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

The ______________ consists of eight bones that encase and protect the brain.

cranial vault

The FIRST step in any neurologic assessment involves:

determining the patient's level of consciousness.

Signs of neurogenic shock include all of the following, EXCEPT: -diaphoresis -bradycardia -hypothermia -flushed skin

diaphoresis.

When immobilizing a patient to a long backboard, you should take standard precautions and then:

ensure that the patient's head is stabilized manually.

The brain connects to the spinal cord through a large opening at the base of the skull called the:

foramen magnum.

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

has a drooping upper eyelid and small pupil.

Chronic subdural hematomas are MOST commonly seen in patients who:

have alcoholism.

Early signs and symptoms of increased intracranial pressure include:

headache and vomiting.

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

his or her torso has been secured adequately.

Hyperacute pain to touch is called:

hyperesthesia.

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.

A diffuse axonal injury:

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

A scalp laceration that occurs in conjunction with a nondisplaced skull fracture:

is considered to be an open skull fracture.

Bleeding from a scalp laceration with an underlying skull deformity:

may contribute to hypovolemia in adults.

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

motor vehicle crashes.

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

muscular atrophy.

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.

Hyperventilation of the brain-injured patient:

shunts oxygen away from the brain and may result in decreased cerebral perfusion pressure.

The MOST effective way for the paramedic to minimize further injury in a patient with a spinal injury is:

spinal motion restriction and prevention of heat loss.

Nuchal rigidity is MOST commonly seen in patients with a(n):

subarachnoid hemorrhage.