Chapter 26: Head and Spine Injuries (Questions)
A 44-year-old male sustained a laceration to his left ear during a minor car accident. Your assessment reveals minimal bleeding. Appropriate care for this injury includes: A. padding between the ear and the scalp. B. covering the wound with a moist dressing. C. applying a tight pressure dressing. D. packing the ear with sterile gauze pads.
A
A patient who cannot remember the events that preceded his or her head injury is experiencing: A. retrograde amnesia. B. anterograde amnesia. C. perigrade amnesia. D. post-traumatic amnesia.
A
A tight-fitting motorcycle helmet should be left in place unless: A. it interferes with your assessment of the airway. B. the patient must be placed onto a long backboard. C. the patient complains of severe neck or back pain. D. the helmet is equipped with a full face shield or visor.
A
A young female experienced a laceration to her left eyeball from flying glass when her boyfriend broke a soda bottle against a wall. There is moderate bleeding and the patient states that she cannot see out of the injured eye. You should: A. avoid applying pressure to the globe when you are covering her eye. B. apply firm direct pressure to the injured eye and cover the opposite eye. C. carefully examine her eye and remove any foreign objects if needed. D. ask her to move the injured eye to assess the integrity of the optic nerve.
A
An epidural hematoma is MOST accurately defined as: A. bleeding between the skull and dura mater. B. bleeding between the dura mater and brain. C. venous lacerations that occur within the brain. D. an injury caused by a damaged cerebral artery.
A
An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is: A. a rapid deterioration of neurologic signs. B. a progressively lowering blood pressure. C. an acute increase in the patient's pulse rate. D. acute unilateral paralysis following the injury.
A
Any unresponsive trauma patient should be assumed to have: a) an accompanying spinal injury. b) a history of diabetes mellitus. c) a severe intracranial hemorrhage. d) internal bleeding in the abdomen.
A
Common SxS of a serious head injury include all of the following, EXCEPT: A. constricted pupils. B. combative behavior. C. CSF leakage from the ears. D. decreased sensory function.
A
Following blunt trauma to the face, a 21-year-old male complains of a severe headache and decreased ability to move his eyes. This patient's clinical presentation is MOST consistent with: A. a blowout fracture. B. acute hyphema. C. conjunctivitis. D. a detached retina.
A
Frequent reassessments of the patient with face or neck injuries are MOST important because: A. such injuries can affect the respiratory system. B. hospital staff require frequent patient updates. C. rapid facial swelling may mask hidden injuries. D. they lend credibility to your documentation.
A
If you do not have the appropriate size cervical collar, you should: A. use rolled towels to immobilize the patient's head. B. place sandbags on either side of the patient's head. C. ask the patient to keep his or her head in a neutral position. D. defer cervical immobilization and apply lateral head blocks.
A
It would be MOST appropriate to perform a focused secondary assessment on a patient who: A. fainted and fell to the ground from a standing position. B. was restrained during a high-speed motor vehicle crash. C. has blood draining from the ears following a head injury. D. struck his or her head and is experiencing nausea or vomiting.
A
Retinal injuries that are caused by exposure to extremely bright light: A. are typically not painful, but may result in permanent damage to vision. B. are intensely painful, but usually only result in temporary blindness. C. usually do not immediate medical attention unless vision is impaired. D. damage the motor cells of the eye, resulting in reduced eye movement.
A
The Adam's apple is: A. the upper part of the larynx that is formed by the thyroid cartilage. B. the lower part of the larynx that is formed by the cricoid cartilage. C. the small indentation in between the thyroid and cricoid cartilages. D. below the thyroid cartilage and forms the upper part of the trachea.
A
The _________ contain(s) about 75% of the brain's total volume. A. cerebrum B. cerebellum C. brain stem D. meninges
A
The _________ is the best-protected part of the CNS and controls the functions of the cardiac and respiratory systems. A. brain stem B. cerebellum C. spinal cord D. cerebral cortex
A
The cricoid cartilage: A. is the only complete circular cartilage of the trachea. B. is easier to see and palpate than the thyroid cartilage. C. lies superior to the thyroid cartilage in the neck. D. lies superior to the cricothyroid membrane in the neck.
A
The effectiveness of positive-pressure ventilations when treating a head-injured patient can ONLY be determined by: A. immediate reassessment following the intervention. B. a neurosurgeon or emergency department physician. C. reassessing the patient's blood pressure after at least 10 minutes. D. noting a decrease in the heart rate during ventilations.
A
The eyeball itself is called the: A. globe. B. sclera. C. orbit. D. cornea.
A
The skin and underlying tissues of the face: A. have a rich blood supply and bleed heavily. B. swell minimally when exposed to blunt trauma. C. contain a relatively small number of nerve fibers. D. are well protected by the maxillae and mandible.
A
The small, rounded, fleshy bulge immediately anterior to the ear canal is called the: A. tragus. B. stapes. C. pinna. D. incus.
A
The spinal cord is encased in and protected by the: A. spinal canal. B. vertebral body. C. vertebral arch. D. intervertebral disc.
A
The superficial temporal artery can be palpated: A. just anterior to the tragus. B. at the angle of the jaw. C. slightly above the ear. D. over the mastoid process.
A
What is the function of the sternocleidomastoid muscle? A. Allows movement of the head B. Allows flexion of the neck C. Connects the scapulae together D. Facilitates chest movement
A
When activated, the sympathetic nervous system produces all of the following effects, EXCEPT: A. pupillary constriction. B. increase in heart rate. C. shunting of blood to vital organs. D. dilation of the bronchiole smooth muscle.
A
When assessing a conscious patient with an MOI that suggests spinal injury, you should: A. determine if the strength in all extremities is equal. B. rule out a spinal injury if the patient denies neck pain. C. defer spinal immobilization if the patient is ambulatory. D. ask the patient to move his or her head to assess for pain.
A
When placing a patient onto a long backboard, the EMT at the patient's _________ is in charge of all patient movements. A. head B. chest C. waist D. lower extremities
A
Which of the following skull fractures would be the LEAST likely to present with palpable deformity or other outward signs? A. linear B. basilar C. open D. compressed
A
A 22-year-old male was walking on the beach and had sand blown into his eyes. He complains of pain and decreased vision to his right eye. Treatment should include: A. covering both eyes and transporting. B. irrigating his right eye laterally. C. irrigating both eyes simultaneously. D. flushing his eye starting laterally.
B
A 45-year-old male was working on his roof when he fell approximately 12′,landing on his feet. He is conscious and alert and complains of an ache in his lower back. He is breathing adequately and has stable vital signs. You should: A. obtain a Glasgow Coma Score value and give him oxygen. B. immobilize his spine and perform a focused secondary exam. C. allow him to refuse transport if his vital signs remain stable. D. perform a rapid head-to-toe exam and immobilize his spine.
B
A 50-year-old male was splashed in the eyes with radiator fluid when he was working on his car. During your assessment, he tells you that he wears soft contact lenses. You should: A. leave the contact lenses in place and cover both eyes with a dry dressing. B. carefully remove the contact lenses and then irrigate his eyes with saline. C. leave the contact lenses in place and flush his eyes with sterile water. D. remove the contact lenses and cover his eyes with a dry, sterile dressing.
B
A 6-year-old female was riding her bicycle and struck a clothesline with her throat. She is breathing, but with obvious difficulty. Your assessment reveals a crackling sensation in the soft tissues of her neck and facial cyanosis. In addition to the appropriate airway management, the intervention that will MOST likely improve her chance of survival is: A. requesting a paramedic ambulance. B. rapidly transporting her to the hospital. C. quickly immobilizing her spinal column. D. careful monitoring of her vital signs.
B
A fracture involving the nasal bone and inferior maxilla, which separates the nasal bone and lower maxilla from the facial skull and remainder of the cranial bones describes: A. a Le Fort III fracture. B. a Le Fort II fracture. C. a Le Fort I fracture. D. craniofacial disjunction.
B
A patient with a head injury presents with abnormal flexion of his extremities. What numeric value should you assign to him for motor response? A. 2 B. 3 C. 4 D. 5
B
A short backboard or vest-style immobilization device is indicated for patients who: A. are found supine and have stable vital signs. B. are in a sitting position and are clinically stable. C. require prompt extrication from an automobile. D. are sitting in their car and are clinically unstable.
B
A temporary loss or alteration of part/ or all of the brain's abilities to function without physical damage to the brain MOST accurately describes a(n): A. cerebral contusion. B. cerebral concussion. C. intracranial hemorrhage. D. intracerebral hematoma.
B
After your partner assumes manual in-line stabilization of the patient's head, you should: A. apply an appropriately sized rigid cervical collar. B. assess distal neurovascular status in the extremities. C. thoroughly palpate the patient's head for deformities. D. use four people to log roll the patient onto a backboard.
B
Bleeding within the brain tissue itself is called a(n): A. epidural hematoma. B. intracerebral hematoma. C. subdural hematoma. D. intracranial hematoma.
B
During your primary assessment of a 19-year-old unconscious male who experienced severe head trauma, you note that his respirations are rapid, irregular, and shallow. He has bloody secretions draining from his mouth and nose. You should: A. assist his ventilations with a bag-mask device. B. suction his oropharynx for up to 15 seconds. C. immobilize his spine and transport immediately. D. pack his nostrils to stop the drainage of blood.
B
During your primary assessment of a semiconscious 30-year-old female with closed head trauma, you note that she has slow, shallow breathing and a slow, bounding pulse. As your partner maintains manual in-line stabilization of her head, you should: A. perform a focused secondary assessment of the patient's head and neck. B. instruct him to assist her ventilations while you perform a rapid assessment. C. apply 100% oxygen via a nonrebreathing mask and obtain baseline vital signs. D. immediately place her on a long backboard and prepare for rapid transport.
B
Moderate elevation in intracranial pressure with middle brain stem involvement is characterized by: A. increased blood pressure, bradycardia, reactive pupils, and rapid respirations. B. sluggishly reactive pupils, widened pulse pressure, bradycardia, and posturing. C. ataxic respirations, unequal pupils, no response to pain, and an irregular pulse. D. fixed and dilated pupils, decreased blood pressure, and irregular respirations.
B
The AEMT should be MOST suspicious of a Le Fort fracture if a patient who experienced massive blunt force trauma to the face presents with: A. misalignment of the teeth. B. mobility of the facial bones. C. numbness of the chin. D. flattening of the cheekbones.
B
The MOST common and serious complication of a significant head injury is: a) a hypoxic seizure. b) cerebral edema. c) a skull fracture. d) acute hypotension.
B
The MOST reliable sign of a head injury is: A. a pulse that is rapid and thready. B. a decreased LOC C. an abnormally low BP. D. decreased sensation in the extremities.
B
The central nervous system (CNS) is composed of the: A. cerebellum and brain. B. brain and spinal cord. C. cerebrum and meninges. D. meninges and spinal cord.
B
The five sections of the spinal column, in descending order, are the: A. thoracic, cervical, lumbar, coccygeal, and sacral. B. cervical, thoracic, lumbar, sacral, and coccygeal. C. coccygeal, sacral, lumbar, thoracic, and cervical. D. cervical, coccygeal, thoracic, sacral, and lumbar.
B
The ideal procedure for moving an injured patient from the ground to a backboard is: A. the clothes drag. B. the four-person log roll. C. to use a scoop stretcher. D. the direct patient carry.
B
The meninges, along with the CSF that circulates in between each meningeal layer, function by: A. regenerating brain cells after they have been damaged. B. acting as a shock absorber for the brain and spinal cord. C. delivering oxygen directly to the CNS. D. producing leukocytes that protect the brain from infection.
B
The opening in the center of the iris, which allows light to move to the back of the eye, is called the: A. sclera. B. pupil. C. cornea. D. conjunctiva.
B
The optic nerve endings are located within the: A. cornea. B. retina. C. pupil. D. sclera.
B
When a patient experiences a severe spinal injury, he or she: A. will likely be paralyzed from the neck down. B. may lose sensation below the level of the injury. C. most commonly has a palpable spinal deformity. D. often loses motor function on one side of the body.
B
When assessing a patient with a head injury, you note the presence of thin, bloody fluid draining from his right ear. This indicates: a) fractures to the internal structures of the ear following direct trauma. b) rupture of the tympanic membrane following diffuse impact to the head. c) a linear skull fracture and a significant increase in intracranial pressure. d) significant pressure and bleeding in between the skull and dura mater.
B
When assessing a patient with a mandibular fracture, you would MOST likely encounter: A. pain directly over the chin. B. misalignment of the teeth. C. impaired ocular movement. D. lateral bulging of the jaw.
B
When controlling bleeding from a scalp laceration with a suspected underlying skull fracture, you should: a) elevate the patient's head and apply an ice pack. b) avoid excessive pressure when applying the bandage. c) apply firm compression for no longer than 5 minutes. d) apply manual pressure and avoid applying a bandage.
B
Which of the following nerves allow sensory and motor impulses to be sent from one nerve directly to another? A. somatic B. connecting C. peripheral D. autonomic
B
Which of the following statements regarding anterior nosebleeds is correct? A. They are usually caused by a fracture of the basilar skull. B. They usually originate from the septum area and bleed slowly. C. They are usually severe and require aggressive treatment to control. D. They cause blood to drain into the posterior pharynx.
B
Which of the following statements regarding cervical collars is correct? A. Once a cervical collar is applied, you can cease manual head stabilization. B. A cervical collar is used in addition to, not instead of, manual immobilization. C. Cervical collars are contraindicated in patients with numbness to the extremities. D. The patient's head should be forced into a neutral position to apply a cervical collar.
B
A young female was involved in a MVC. She complains of pain to her left eye, which appears to have a piece of glass impaled in it. Further assessment reveals a large laceration to her left forearm with heavy bleeding. As your partner manually stabilizes the patient's head, you should: A. administer 100% supplemental oxygen. B. stabilize the impaled glass in her eye. C. apply direct pressure to her arm wound. D. carefully remove the glass from her eye.
C
Coordination of balance and body movement is controlled by the: A. medulla. B. cerebrum. C. cerebellum. D. brain stem.
C
Distraction injuries of the spine are MOST commonly the result of: A. falls. B. diving. C. hangings. D. compression.
C
Lacerations to the scalp: A. bleed minimally because the scalp has few vessels. B. uncommonly cause hypovolemic shock in children. C. may be an indicator of deeper, more serious injuries. D. are most commonly associated with skull fractures.
C
Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed unless: A. the patient adamantly denies neck pain. B. lateral immobilization has been applied. C. it causes a problem managing the ABCs. D. sensory and motor functions remain intact.
C
Rapid deceleration of the head, such as when it impacts the windshield, causes: a) primary impact to the posterior aspect of the brain, resulting in compression injuries, bruising, or torn blood vessels. b) stretching or tearing of the anterior aspect of the brain and compression injuries or bruising to the posterior aspect of the brain. c) compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain. d) compression injuries and contusions to the anterior, posterior, and lateral aspects of the brain.
C
The body's functions that occur without conscious effort are regulated by the _________ nervous system. A. sensory B. somatic C. autonomic D. voluntary
C
The cervical spine is composed of _____ vertebrae. A. 5 B. 6 C. 7 D. 8
C
The conjunctiva are kept moist by fluid produced by the: A. posterior orbit. B. corneal ducts. C. lacrimal glands. D. optic chiasma.
C
The hormone responsible for the actions of the sympathetic nervous system is: A. insulin. B. thyroxine. C. epinephrine. D. aldosterone.
C
The inner surface of the eyelids and the exposed surface of the eye itself are covered by a delicate membrane called the: A. retina. B. cornea. C. conjunctiva. D. sclera.
C
The mastoid process is located approximately: A. ½" anterior to the external opening of the ear. B. 1" inferior to the external opening of the ear. C. 1" posterior to the external opening of the ear. D. 1" posterior to the angle of the mandible.
C
The tough, fibrous outer meningeal layer is called the: A. pia mater. B. arachnoid. C. gray mater. D. dura mater.
C
The upper jawbones are called the: A. mastoid. B. mandible. C. maxillae. D. zygoma.
C
What part of the nervous system controls the body's voluntary activities? A. central B. sensory C. somatic D. autonomic
C
When immobilizing a seated patient with a short backboard or vest-style immobilization device, you should apply a cervical collar: A. after the torso has been adequately secured. B. after moving the patient to a long backboard. C. after assessing distal neurovascular functions. D. before manually stabilizing the patient's head.
C
When the parasympathetic nervous system is activated: a) hormones are released that prepare the body for stress. b) heart rate and blood pressure increase. c) the heart rate decreases and the blood vessels dilate d) blood is shunted away from the digestive organs.
C
When transporting a patient with a facial injury, it is MOST important to be as descriptive as possible with the hospital regarding the patient's injury because: A. it saves time on repeat assessments at the hospital. B. most patients with facial trauma will need surgery. C. a specialist may be needed to manage the injury. D. they must make arrangements for an ICU bed.
C
Which of the following statements regarding a basilar skull fracture is correct? A. Bloody CSF commonly leaks from the nose. B. In most cases, mastoid bruising occurs. C. The absence of raccoon eyes or Battle's sign does not rule it out. D. They are typically the result of local, low-energy trauma to the head.
C
Which of the following statements regarding secondary brain injury is correct? A. It results from direct brain trauma following an impact to the head. B. Because cerebral edema develops quickly, it is considered to be a primary brain injury. C. Hypoxia and hypotension are the two most common causes of secondary brain injury. D. Signs are often present immediately after an impact to the head.
C
You are dispatched to a convenience store, where the clerk sustained a laceration to the side of his neck during a robbery attempt. During your assessment, you note bright red blood spurting from the laceration. You should: A. circumferentially wrap a dressing around his neck. B. apply direct pressure below the lacerated vessel. C. apply direct pressure above and below the wound. D. apply pressure to the closest arterial pressure point.
C
The frontal and parietal bones of the skull are especially susceptible to:
Compressed skull fractures
A 29-year-old male has an anterior nosebleed after he was accidentally elbowed in the nose. His is conscious and alert with adequate breathing. The MOST appropriate care for this patient includes: A. applying a gauze pad in between his lower lip and gum. B. packing the nasopharynx with moist, sterile dressings. C. placing him supine and pinching his nostrils together. D. leaning him forward and pinching his nostrils together.
D
A 30-year-old female was assaulted by a gang as she was leaving a nightclub. She has massive facial trauma and slow, gurgling respirations. As your partner manually stabilizes her head, you should: A. apply oxygen via a nonrebreathing mask. B. visualize her mouth for obvious wounds. C. begin immediate ventilatory assistance. D. suction her oropharynx for 15 seconds.
D
A 39-year-old female experienced a severe closed head injury. She is unconscious with her eyes slightly open; her pupils are bilaterally dilated and slow to react. In addition to managing problems with airway, breathing, and circulation, you should: A. secure her eyes open so you can reassess her pupils. B. inspect her eyes and gently remove impaled objects. C. irrigate her eyes with water to prevent mucosal drying. D. close her eyes and cover them with a moist dressing.
D
A 4-year-old female has a peanut lodged in the external auditory canal of her right ear. You should: A. thoroughly flush her ear with sterile saline. B. remove the peanut with a cotton-tipped swab. C. use tweezers to try to remove the object. D. transport her to the emergency department.
D
A female patient with a suspected spinal injury is breathing with a marked reduction in tidal volume. The MOST appropriate airway management for her includes: A. hyperventilating her at 30 breaths/min. B. administering oxygen via a nonrebreathing mask. C. ventilation assistance to maintain an oxygen saturation of 90%. D. assisting ventilations at an age-appropriate rate.
D
A reflex arc occurs when: A) The motor nerves function automatically without receiving a message from the CNS B) a sensory nerve sends a message to the brain but the motor nerve fails to send the appropriate response to the body C) the brain interprets sensory information that it receives from peripheral and cranial nerves and sends a signal to the muscles D) a sensory nerve detects an irritating stimulus and bypasses the brain by sending a direct message to the motor nerve
D
Abnormal variations in pupil size and reaction would MOST likely be observed in a patient with: A. conjunctivitis. B. contact lenses. C. retinitis. D. a brain injury.
D
Bleeding from soft-tissue injuries to the face is MOST effectively controlled with: A. digital pressure to an adjacent pulse point. B. ice packs and elevation of the patient's head. C. pressure dressings and chemical ice packs. D. direct pressure using dry, sterile dressings.
D
Clinical findings associated with a laryngeal injury include: A. hematemesis, bulging eyes, and jugular venous distention. B. pallor, a mediastinal shift, and tracheal deviation. C. posterior neck deformity, Battle's sign, and a dry cough. D. hemoptysis, subcutaneous emphysema, and cyanosis.
D
Common signs of a skull fracture include all of the following, EXCEPT: A. mastoid process bruising. B. ecchymosis around the eyes. C. noted deformity to the skull. D. superficial scalp lacerations.
D
Facial injuries must be identified and treated as soon as possible because: A. bleeding must be controlled early. B. swelling may mask hidden injuries. C. the spine may be injured as well. D. of the risk for airway problems.
D
Significant trauma to the face should increase the AEMT's index of suspicion for a/an: A. displaced mandible. B. airway obstruction. C. basilar skull fracture. D. spinal cord injury.
D
The Glasgow Coma Scale (GCS) is used to assess: A. mental status, eye opening, and respiratory rate. B. sensory response, pupil reaction, and heart rate. C. verbal response, eye opening, and mental status. D. eye opening, verbal response, and motor response.
D
The _________ nervous system consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves. A. central B. somatic C. autonomic D. peripheral
D
The term "hyphema" is defined as: A. an acute rupture of the globe of the eye. B. inflammation of the iris, cornea, and lens. C. compression of one or both optic nerves. D. blood in the anterior chamber of the eye.
D
When immobilizing a child on a long backboard, you should: A. secure the head prior to securing the torso and legs. B. defer cervical collar placement to avoid discomfort. C. place the child's head in a slightly extended position. D. place padding under the child's shoulders as needed.
D
When immobilizing a patient on a long backboard, you should: A. have the patient exhale before fastening the torso straps. B. secure the torso and then center the patient on the board. C. follow the commands of the person at the patient's torso. D. ensure that you secure the torso before securing the head.
D
When immobilizing a trauma patient's spine, the EMT manually stabilizing the head should not let go until: A. an appropriately sized cervical collar has been applied. B. the patient has been secured to the ambulance stretcher. C. the head has been stabilized with lateral immobilization. D. the patient has been completely secured to the backboard.
D
Which of the following head injuries would cause the patient's condition to deteriorate MOST rapidly? A. cerebral contusion B. subdural hematoma C. cerebral concussion D. epidural hematoma
D
Which of the following nerves carry information from the body to the brain via the spinal cord? A. motor B. central C. somatic D. sensory
D
Which of the following sets of vital signs depicts Cushing's triad? A. blood pressure, 190/110 mm Hg pulse, 55 beats/min respirations, 30 breaths/min B. blood pressure, 90/50 mm Hg pulse, 120 beats/min respirations, 10 breaths/min C. blood pressure, 200/100 mm Hg pulse, 140 beats/min pulse, 140 beats/min respirations, 28 breaths/min D. blood pressure, 80/40 mm Hg pulse, pulse 30 beats/min respirations, 32 breaths/min
D
Which of the following statements regarding motor nerves is correct? a) They perform special functions such as sight, smell, and hearing. b) They are part of the CNS and control reflexes. c) They transmit information from the body to the brain via the spinal cord. d) They carry information from the CNS to the muscles.
D
Which of the following statements regarding scalp lacerations is correct? A. Because the scalp is highly vascular, you should always apply a tight pressure dressing to control bleeding B. Patients who take antihypertensive medications bleed more severely from scalp lacerations C. Although deep scalp lacerations bleed profusely, they are rarely associated with skull fractures D. Blood loss from a scalp laceration may result in hypovolemic shock, especially in children
D
Which of the following statements regarding the cranium is correct? A. The skull is a subdivision of the cranium. B. Thirty percent of the cranium is occupied by blood. C. The cranium protects the structures of the face. D. Eighty percent of the cranium is occupied by brain tissue.
D