Ch. 34 - Head and Spine Trauma
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: A) C1-C2 B) C3-C4 C) T1-T4 D) T2-T5
B) C3-C4
A compression or burst fracture of the c-spine would MOST likely occur following: A) a direct blow to the occipital region of the skull B) a significant fall in which the patient lands head first C) rapid acceleration following an MVC D) axial loading after a patient falls and lands feet first
B) a significant fall in which the patient lands head first
As the body ages, the intervertebral discs: A) lose water content and become thinner B) enlarge and result in increased height C) are not able to protect the spinal cord D) calcify and become more rigid
A) lose water content and become thinner
A patient that is immediately unresponsive as a result of a TBI most likely has sustained a DAI. A) true B) false
A) true
A short backboard or vest-type immobilization device is indicated for which of the following? A) a patient in a sitting position who is clinically stable B) an unstable patient in need of rapid extrication C) a supine patient who is clinically stable D) an unconscious patient in the water
A) a patient in a sitting position who is clinically stable
Injury to the temporal lobe on the left side would MOST likely cause: A) abnormal speech B) visual disturbances C) sleep abnormalities D) lack of coordination
A) abnormal speech
Pupils that are sluggish to react to light: A) are a sign of cerebral hypoxia B) indicate impending brain herniation C) suggest significant intracranial pressure D) indicate compression of an oculomotor nerve
A) are a sign of cerebral hypoxia
A rise of 20 mmHg above the patient's normal resting BP along with a history of SCI and associated signs and symptoms indicate that the patient is experiencing: A) autonomic dysreflexia B) cauda equina syndrome C) spinal stenosis D) hypotensive shock
A) autonomic dysreflexia
What is the most reliable sign of a head injury? A) decreasing LOC B) dizziness C) Cushing triad D) sluggish/nonreactive pupils
A) decreasing LOC
A hangman's fracture is an example of a ____ force. A) distraction B) flexion C) hyperextension D) vertical compression
A) distraction
You are providing care for a 29 y/o male who was assaulted with a baseball bat and appears to have sustained a linear skull fracture to the right parietal area. Bystanders report that the patient initially lost consciousness but got up quickly. As you begin your assessment, he becomes unresponsive rapidly with signs of increasing ICP. Based on this information, the patient most likely has sustained a(n): A) epidural hematoma B) subdural hematoma C) cerebral contusion D) intracranial hemorrhage
A) epidural hematoma
Medications administered in the prehospital setting for a patient with a head injury would MOST likely be used to: A) facilitate intubation or terminate seizures B) reduce body temperature and promote diuresis C) reduce cerebral edema and prevent shivering D) prevent cardiac dysrhythmias or increase HR
A) facilitate intubation or terminate seizures
You are providing care for a 24 y/o female patient who was driving her car when she lost control and struck a telephone pole. The patient was wearing her seatbelt at the time, but the impact did throw her head forward. Based on this information, the patient most likely sustained a: A) flexion injury B) rotation with flexion injury C) distraction injury D) hyperextension injury
A) flexion injury
The dura mater: A) folds in to form the tentorium B) is the inner meningeal layer and is comprised of a thin, translucent, highly vascular membrane that adheres firmly to the surface of the brain C) is the middle meningeal layer and is comprised of a delicate transparent membrane that is damaged easily by trauma D) anatomically separates the cerebellum and brainstem and contains vasculature that resembles a spider web
A) folds in to form the tentorium
Which of the following statements regarding a closed head injury is correct? A) in a closed head injury, the dura mater remains intact B) diffuse brain injury occurs with all closed head injuries C) closed head injuries are less common than open head injuries D) intracranial pressure is usually minimal in a closed head injury
A) in a closed head injury, the dura mater remains intact
What spinal nerve tract carries information regarding pain and temperature? A) lateral spinothalamic B) corticospinal C) reticulospinal D) spinocerebellar
A) lateral spinothalamic
Upon arriving at the scene of an MVC, 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: A) rapidly extricate the driver so you can gain quick access to the child in the backseat B) apply a vest-type extrication device to the driver and quickly remove her from the car C) ask the driver to step out of the vehicle so you can access the backseat passenger D) carefully assess the driver for occult injuries before removing her from the vehicle
A) rapidly extricate the driver so you can gain quick access to the child in the backseat
Common clinical findings associated with SDH include all of the following EXCEPT: A) rapidly increasing ICP B) unilateral hemiparesis or slurred speech C) a fluctuating level of consciousness D) an underlying skull fracture
A) rapidly increasing ICP
What portion of the brainstem is responsible for maintenance of consciousness? A) reticular activating system B) limbic system C) diencephalon D) basal ganglia
A) reticular activating system
A motorcycle or football helmet should be removed if: A) the patient is breathing shallowly and access to the airway is difficult B) you are properly trained in the technique, even if you are by yourself C) the patient complains of severe neck pain and the helmet fits snugly D) you are going to transport the patient to a hospital
A) the patient is breathing shallowly and access to the airway is difficult
An injured patient's head should be secured to a backboard only after: A) their torso has been secured B) both of the legs are secured C) a vest-style immobilization device has been applied D) you have placed padding under the shoulders
A) their torso has been secured
Secondary spinal cord injuries are the result of inflammation. A) true B) false
A) true
Seizures in head injuries must be stopped, justifying the use of benzodiazepines. A) true B) false
A) true
The posterior spinal tracts carry the nerves involved in proprioception. A) true B) false
A) true
Treating skull fractures should not take priority over primary management. A) true B) false
A) true
Beta receptor stimulation results in all of the following effects EXCEPT: A) vascular smooth muscle contraction B) relaxation of bronchiolar smooth muscle C) positive cardiac inotropy D) positive cardiac chronotropy
A) vascular smooth muscle contraction
A SDH is classified as acute if clinical signs and symptoms develop: A) within 48 hours following injury B) immediately following injury C) within 24 hours following injury D) within 36 hours following injury
A) within 48 hours following injury
The crescent-shaped fold that divides the cerebrum into the left and right hemispheres is the: A) diencephalon B) mesencephalon C) tentorium D) fall cerebelli
C) tentorium
Which of the following indications would you see in a patient with moderate ICP elevation? A) blown pupils B) decerebrate posturing C) widened pulse pressure and bradycardia D) Cheyne-Stokes respirations
B and C
The only area of the spine that allows for significant rotation is: A) T1-T2 B) C1-C2 C) C2-C4 D) C6-C7
B) C1-C2
Which of the following is the correct method for rapid extrication of a patient from a motor vehicle? A) apply an extrication collar and remove the patient from the car using the direct carry method B) apply an extrication collar, slide a long spine board under the patient's buttocks, and remove the patient from the car C) apply a c-collar, insert a short backboard between the patient's back and the seat, and slide the patient out of the car onto a long spine board for full immobilization D) maintain support of the head, grasp the patient by the clothing, and rapidly remove the patient from the car
B) apply an extrication collar, slide a long spine board under the patient's buttocks, and remove the patient from the car
You are providing care for a 34 y/o female patient who fell down a flight of stairs, striking her head. The patient is complaining of pain on the right side of her head. On closer inspection, you can see blood mixed with a clear fluid draining from her right ear and there is bruising in the area behind the ear. Based on this information, the patient has most likely sustained a(n): A) linear skull fracture B) basilar skull fracture C) depressed skull fracture D) open skull fracture
B) basilar skull fracture
A spinal cord concussion is: A) the result of direct trauma and is associated with spinal cord edema B) caused by a short duration shock or pressure wave within the cord C) characterized by temporary dysfunction that lasts for up to 1 week D) a condition that results in a permanent loss of neurologic function
B) caused by a short duration shock or pressure wave within the cord
You are responding to an older woman who slipped and struck her forehead on the bathtub. She is complaining of having trouble "making her arms work". Which syndrome is this patient exhibiting? A) anterior cord syndrome B) central cord syndrome C) posterior cord syndrome D) Brown-Sequard syndrome
B) central cord syndrome
The parietal lobe of the brain: A) is where the optic nerve originates and processes vision B) controls the body's ability to perceive body limb movement C) is important for voluntary motor action and personality traits D) controls functions such as long-term memory, taste, and smell
B) controls the body's ability to perceive body limb movement
You are providing care for a 34 y/o patient with a head injury. Your management should include all of the following EXCEPT: A) maintaining oxygen saturation above 90% B) covering the patient with warm blankets C) elevating the head of the backboard 15-30 degrees D) establishing vascular access while en route
B) covering the patient with warm blankets
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? A) basilar fracture B) depressed fracture C) nondisplaced fracture D) open fracture
B) depressed fracture
A normal neurologic exam generally rules out the possibility of a spinal cord injury. A) true B) false
B) false
Patients with low back spasms should be allowed to walk as much as possible. A) true B) false
B) false
SDH are more common in younger, previously healthy patients. A) true B) false
B) false
The brain connects to the spinal cord through a large opening at the base of the skull called the: A) cribriform plate B) foramen magnum C) occipital condyle D) palatine bone
B) foramen magnum
Which of the following are indicators for Cushing triad? A) tachycardia, hypertension, and decorticate posturing B) hypertension, bradycardia, and irregular respirations C) abnormal behavior, pupillary abnormalities, and a period of unresponsiveness D) hypotension, focal neurologic deficits, and disorientation
B) hypertension, bradycardia, and irregular respirations
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: A) perform a detailed neurologic exam and carefully palpate his neck B) immobilize his spine and quickly move him to a warmer environment C) apply a cervical collar and start an IV line with warm NS D) administer oxygen and perform a detailed secondary assessment
B) immobilize his spine and quickly move him to a warmer environment
All of the following statements are true of disk herniation EXCEPT: A) typically affects men aged 30-50 years B) most often occurs from S2-S3 and S3-S4 C) patients present with pain and limited ROM D) generally caused by some degree of trauma in patients with pre-existing disk degeneration
B) most often occurs from S2-S3 and S3-S4
You are treating a 20 y/o patient who was kicked in the head during a soccer game. When you arrive, he is unconscious. His coach reports that after the incident, the patient "seemed a little stunned" but got up to rejoin the game before he suddenly collapsed. A teammate reports that the patient had a prior injury due to a car accident a few weeks ago. What condition does this indicate? A) moderate DAI B) second impact syndrome C) post-concussion syndrome D) cerebral contusion
B) second impact syndrome
A patient with a possible spinal injury is acutely agitated. What type of medication, if any, should be given after hypoxia has been ruled out? A) dissociative anesthetic B) short-acting, reversible sedative C) neuromuscular blocker D) corticosteroid
B) short-acting, reversible sedative
A positive Babinski reflex is observed when: A) patient's reflexes are hyperactive in response to an external stimulus B) toes move upward in response to stimulation of the sole of the foot C) toes curve or move downward when the sole of the foot is touched D) patient responds to pain by flexing the arms and extending the legs
B) toes move upward in response to stimulation of the sole of the foot
When applying a short spine board, what part of the body do you need to secure first? A) chest B) torso C) shoulders D) head
B) torso
What SCI is characterized by motor loss on the same side as the injury, but below the lesion? A) anterior cord syndrome B) central cord syndrome C) Brown-Sequard syndrome D) posterior cord syndrome
C) Brown-Sequard syndrome
Autoregulation is defined as: A) the forcing of CSF into the spinal cord as ICP increases B) a decrease in cerebral perfusion pressure that reduces ICP C) an increase in MAP to maintain cerebral blood flow D) reflex bradycardia that occurs secondary to systemic hypertension
C) an increase in MAP to maintain cerebral blood flow
A 39 y/o male crashed his vehicle into a wooded area and was not found for about 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 BP is 210/130, HR is 44 bpm, and respirations are 22/min. The patient's clinical presentation is MOST consistent with: A) symptomatic bradycardia B) neurogenic shock C) autonomic dysreflexia D) intracranial pressure
C) autonomic dysreflexia
Following a TBI, initial swelling of the brain occurs due to: A) severe ischemia B) acute hypertension C) cerebral vasodilation D) an increase in cerebral water
C) cerebral vasodilation
A diffuse axonal injury: A) is a specific, grossly observable brain injury that can be easily diagnosed with a CT scan B) results in severe stretching or tearing or the portion of the nerve cell that receives sensory messages from the rest of the body C) involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the body D) is generally associated with better neurologic outcomes that a cerebral concussion because permanent brain damage does not occur
C) involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the body
All of the following statements are true of concussion EXCEPT: A) may be caused by a direct or indirect blow to the head or face or an impulsive force that is transmitted to the head B) typically results in rapid onset of short-lived impairment of neurologic impairment that resolves spontaneously C) may result in long-term structural damage D) results in a range of signs and symptoms
C) may result in long-term structural damage
The LEAST common cause of death in spinal cord injury patients who are discharged from the hospital is: A) pneumonia B) pulmonary embolism C) muscular atrophy D) septicemia
C) muscular atrophy
The ____ lobe governs the perception of pain, temperature, and vibration. A) frontal B) occipital C) parietal D) temporal
C) parietal
The c-collar is designed to: A) maintain a neutral position and eliminate all flexion, extension, and lateral movement of the head B) simply remind the patient not to move their head in any direction until lateral stabilization is applied C) reduce flexion and extension of the head and place the weight of the head on the shoulders D) realign potentially unstable vertebral injuries and prevent movement of the head in all directions
C) reduce flexion and extension of the head and place the weight of the head on the shoulders
You are assessing a young woman who fell and hit her head. She is conscious but can't remember the circumstances that led up to the injury. What is the patient experiencing? A) anterograde amnesia B) transient global amnesia C) retrograde amnesia D) systematized amnesia
C) retrograde amnesia
The speech center is located in the: A) frontal lobe B) parietal lobe C) temporal lobe D) occipital lobe
C) temporal lobe
Vagal tone remains intact following a spine injury because: A) the nerve fibers of the PSNS do not originate from the brainstem or spinal cord B) PSNS nerve fibers are largely under control of the involuntary nervous system C) the vagus nerve originates outside the medulla and regulates the heart via the carotid arteries D) the thoracolumbar system provides parasympathetic stimulation to the periphery via alpha and beta receptors
C) the vagus nerve originates outside the medulla and regulates the heart via the carotid arteries
You are managing a 36 y/o male patient who sustained a head injury during an MVC. The patient is unresponsive and breathing 4-6 breaths per minute. His pupils are asymmetric. Based on this presentation, you should: A) ventilate the patient to an EtCO2 of 20-25 mmHg B) ventilate the patient to an EtCO2 of 25-30 mmHg C) ventilate the patient to an EtCO2 of 30-35 mmHg D) ventilate the patient to an EtCO2 of 35-40 mmHg
C) ventilate the patient to an EtCO2 of 30-35 mmHg
According to the National Spinal Cord Injury Statistical Center, MOST spinal cord injuries are caused by: A) acts of violence B) athletic activities C) falls in the elderly D) MVCs
D) MVCs
A patient with diaphragmatic breathing without intercostal muscle use has MOST likely experienced a spinal injury above the level of: A) C5 B) C7 C) C2 D) T2
D) T2
When immobilizing a child younger than the age of 6 on a long backboard, where do you need to place padding? A) behind the occiput B) under the knees C) under the L-spine D) between the shoulder blades
D) between the shoulder blades
The phrenic nerve arises from the _____ plexus and innervates the _____. A) lumbar, abdominal wall B) sacral, lower limbs C) brachial, upper extremities D) cervical, diaphragm
D) cervical, diaphragm
The FIRST step in any neurologic assessment involves: A) assessing pupils for size, equality, and reactivity B) obtaining an initial GCS score C) asking the patient if they can feel or move D) determining the patient's level of consciousness
D) determining the patient's level of consciousness
How should you move an injured patient from the ground to a backboard? A) hammock carry B) clothes drag C) firefighter's lift D) four-person log roll
D) four-person log roll
What type of ICH would MOST likely be caused by a penetrating head injury? A) SAH B) epidural hematoma C) SDH D) intracerebral hematoma
D) intracerebral hematoma
A 19 y/o woman fell from a second story window and landed on her head. She is unconscious with BP of 168/104, HR of 56 bpm, and irregular respirations at 8/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: A) preoxygenating her with a BVM at 100% oxygen for 2-3 minutes, performing nasotracheal intubation, transporting at once, starting at least one large-bore IV line en route, and obtaining her GCS score B) applying oxygen via NRB, covering her with blankets, starting an IV of NS to keep the vein open, applying a cardiac monitor, initiating transport, and monitoring her pupils while en route to the hospital C) hyperventilating her with a BVM at 20/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 D) intubating her after preoxygenating with a BVM and 100% oxygen for 2-3 minutes, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments
D) intubating her after preoxygenating with a BVM and 100% oxygen for 2-3 minutes, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments
Spinal shock is a condition that: A) generally affects the sensory nerves but spares the motor nerves B) typically manifests within 24-36 hours following a spinal injury C) results in permanent neurologic deficits in the majority of patients D) is usually temporary and results from swelling of the spinal cord
D) is usually temporary and results from swelling of the spinal cord
Which of the following types of skull fracture would be the LEAST likely to present with gross physical signs? A) open fracture B) depressed fracture C) basilar fracture D) linear fracture
D) linear fracture
A 45 y/o 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: A) applying a c-collar and assisting his ventilations with a BVM B) rolling the patient onto his side as a unit and suctioning his mouth for 15 seconds C) performing a tongue-jaw lift and looking in his mouth for any obvious obstructions D) manually stabilizing his head and opening his airway with the jaw-thrust maneuver
D) manually stabilizing his head and opening his airway with the jaw-thrust maneuver
The MOST significant complication associated with prolonged immobilization on a long backboard is: A) patient discomfort and frustration B) compression of the vena cava C) increased ICP D) pressure lesion development
D) pressure lesion development
Treatment for a patient with neurogenic shock may include all of the following EXCEPT: A) a vagolytic medication B) a vasopressor medication C) fluid volume to maintain perfusion D) prevention of hyperthermia
D) prevention of hyperthermia
A moderate DAI: A) is generally characterized by a brief LOC, with or without retrograde amnesia B) causes a prolonged LOC and affects axons in both cerebral hemispheres C) is the most common result of blunt head trauma and is associated with temporary neuronal dysfunction D) produces an immediate LOC and residual neurological deficits when the patient wakes up
D) produces an immediate LOC and residual neurological deficits when the patient wakes up
SCI without radiographic abnormalities can occur in children because: A) their spinal cord is more compressed than an adult's B) unlike adults, their vertebrae are more curved C) they have excessive mobility of C1 and C2 D) their vertebrae lie flatter on top of each other
D) their vertebrae lie flatter on top of each other
A complete SCI to the upper cervical spine: A) results in quadriplegia but the patient usually retains their ability to breathe spontaneously B) results in neurologic dysfunction that is considered to be permanent if it lasts longer than 24 hours C) is not compatible with life and results in immediate death due to cardiopulmonary failure D) will result in permanent loss of all cord-mediated functions below the level of the injury
D) will result in permanent loss of all cord-mediated functions below the level of the injury