EMT Chapter 28 - Head and Spine Injuries

In supine patients with a head injury, the head should be elevated _____ to help reduce intracranial pressure.

30 degrees

Which of the following statements regarding motor nerves is correct? A. They carry information from the CNS to the muscles. B. They perform special functions such as sight, smell, and hearing. C. They transmit information from the body to the brain via the spinal cord. D. They are part of the CNS and control reflexes.

A. They carry information from the CNS to the muscles.

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. a rapid deterioration of neurologic signs.

In a patient with a head injury, hypertension, bradycardia, and Biot respirations indicate: A. herniation of the brain stem. B. internal bleeding in the chest. C. an underlying skull fracture. D. decreased cerebral blood flow.

A. herniation of the brain stem.

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. use rolled towels to immobilize the patient's head.

Which of the following skull fractures would be the LEAST likely to present with palpable deformity or other outward signs? A. Depressed B. Linear C. Open D. Basilar

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. Connecting

Which of the following breathing patterns is MOST indicative of increased intracranial pressure? A. Increased rate with a normal inspiratory time and a prolonged expiratory time B. Irregular rate, pattern, and volume of breathing with intermittent periods of apnea C. Increased rate and depth with the distinct odor of acetone on the patient's breath D. Slow, shallow, occasional gasps that progress to prolonged periods of apnea

B. Irregular rate, pattern, and volume of breathing with intermittent periods of apnea

The MOST reliable sign of a head injury is: A. a pulse that is rapid and thready. B. a decreased level of consciousness. C. an abnormally low blood pressure. D. decreased sensation in the extremities.

B. a decreased level of consciousness.

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. are in a sitting position and are clinically stable

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. assess distal neurovascular status in the extremities.

A 44-year-old man was struck in the back of the head and was reportedly unconscious for approximately 30 seconds. He complains of a severe headache and "seeing stars," and states that he regained his memory shortly before your arrival. His presentation is MOST consistent with a(n): A. contusion. B. concussion. C. subdural hematoma. D. intracerebral hemorrhage.

B. concussion.

yperextension injuries of the spine are MOST commonly the result of: Select one: A. diving. B. hangings. C. compression. D. falls.

B. hangings

Bleeding within the brain tissue itself is called a(n): A. epidural hematoma. B. intracerebral hematoma. C. subdural hematoma. D. intracranial hematoma.

B. intracerebral hematoma.

When placing a patient onto a long backboard, the EMT at the patient's _________ is in charge of all patient movements. A. lower extremities B. chest C. head D. waist

C

What part of the nervous system controls the body's voluntary activities? A. Central B. Sensory C. Somatic D. Autonomic

C. Somatic

The hormone responsible for the actions of the sympathetic nervous system is: A. insulin. B. thyroxine. C. epinephrine. D. aldosterone.

C. epinephrine.

Rapid deceleration of the head, such as when it impacts the windshield, causes: A. compression injuries and contusions to the anterior, posterior, and lateral aspects of the brain. B. primary impact to the posterior aspect of the brain, resulting in compression injuries, bruising, or torn blood vessels. C. stretching or tearing of the anterior aspect of the brain and compression injuries or bruising to the posterior aspect of the brain. D. 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 or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain.

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 concussion. B. cerebral contusion. C. intracerebral hematoma. D. intracranial hemorrhage.

A

Common signs and symptoms of a serious head injury include all of the following, EXCEPT: A. a rapid, thready pulse. B. widening pulse pressure. C. CSF leakage from the ears. D. decerebrate posturing.

A. a rapid, thready pulse.

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. bleeding between the skull and dura mater.

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. brain stem

The _________ contain(s) about 75% of the brain's total volume. A. cerebrum B. cerebellum C. brain stem D. meninges

A. cerebrum

The brain, a part of the central nervous system (CNS), is divided into the: A. cerebrum, cerebellum, and brain stem. B. cerebrum, brain stem, and spinal cord. C.cerebellum, cerebrum, and spinal cord. D. spinal cord, cerebrum, and cerebral cortex.

A. cerebrum, cerebellum, and brain stem.

A patient who experiences an immediate loss of consciousness followed by a lucid interval has a(n): A. epidural hematoma. B. subdural hematoma. C. concussion. D. contusion.

A. epidural hematoma.

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. fainted and fell to the ground from a standing position.

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. immediate reassessment following the intervention.

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. it interferes with your assessment of the airway.

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. pupillary constriction.

You should be MOST suspicious that a patient has experienced a significant head injury if his or her pulse is: A. slow. B. weak. C. rapid. D. irregular.

A. slow.

The spinal cord is encased in and protected by the: A. spinal canal. B. vertebral body. C. vertebral arch. D. intervertebral disc.

A. spinal canal.

The meninges, along with the cerebrospinal fluid (CSF) that circulates in between each meningeal layer, function by: A. delivering oxygen directly to the CNS. B. acting as a shock absorber for the brain and spinal cord. C. regenerating brain cells after they have been damaged. D. producing leukocytes that protect the brain from infection.

B

When caring for a patient with a possible head injury, it is MOST important to monitor the patient's: A. pupil size. B. level of consciousness. C. pulse regularity. D. blood pressure.

B

The cerebrospinal fluid (CSF) that circulates in between each meningeal layer: 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. acting as a shock absorber for the brain and spinal cord.

A man jumped from the roof of his house and landed on his feet. He complains of pain to his heels, knees, and lower back. This mechanism of injury is an example of: A. distraction. B. axial loading. C. hyperextension. D. hyperflexion.

B. axial loading.

As you are assessing a 24-year-old man with a large laceration to the top of his head, you should recall that: A. the scalp, unlike other parts of the body, has relatively fewer blood vessels. B. blood loss from a scalp laceration may contribute to hypovolemic shock in adults. C. any avulsed portions of the scalp should be carefully cut away to facilitate bandaging. D. most scalp injuries are superficial and are rarely associated with more serious injuries.

B. blood loss from a scalp laceration may contribute to hypovolemic shock in adults.

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. brain and spinal cord.

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. cerebral concussion.

The MOST common and serious complication of a significant head injury is: A. a skull fracture. B. cerebral edema. C. a hypoxic seizure. D. acute hypotension.

B. cerebral edema.

The frontal and parietal bones of the skull are especially susceptible to: A. basilar skull fractures. B. compressed skull fractures. C. linear skull fractures. D. nondisplaced skull fractures.

B. compressed skull fractures.

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 BVM. 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. suction his oropharynx for up to 15 seconds.

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. the use of a scoop stretcher. D. the direct patient carry.

B. the four-person log roll.

When the parasympathetic nervous system is activated: A. blood is shunted away from the digestive organs. B. the heart rate decreases and the blood vessels dilate. C. hormones are released that prepare the body for stress. D. heart rate and blood pressure increase.

B. the heart rate decreases and the blood vessels dilate.

During immobilization of a patient with a possible spinal injury, manual stabilization of the head must be maintained until: A. an appropriate-size extrication collar has been placed. B. the patient is fully immobilized on a long backboard. C. a range of motion test of the neck has been completed. D. pulse, motor, and sensory functions are found to be intact.

B. the patient is fully immobilized on a long backboard.

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. 4 B. 2 C. 3 D. 5

C. 3

Which of the following sets of vital signs depicts Cushing triad? A. Blood pressure, 200/100 mm Hg; pulse, 140 beats/min; respirations, 28 breaths/min B. Blood pressure, 90/50 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min C. Blood pressure, 190/110 mm Hg; pulse, 55 beats/min; respirations, 30 breaths/min D. Blood pressure, 80/40 mm Hg; pulse, 30 beats/min; respirations, 32 breaths/min

C. Blood pressure, 190/110 mm Hg; pulse, 55 beats/min; respirations, 30 breaths/min

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. Hypoxia and hypotension are the two most common causes of secondary brain injury.

A young male was involved in a motor vehicle accident and experienced a closed head injury. He has no memory of the events leading up to the accident, but remembers that he was going to a birthday party. What is the correct term to use when documenting his memory loss? A. Concussion B. Cerebral contusion C. Retrograde amnesia D. Anterograde amnesia

C. Retrograde amnesia

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. The absence of raccoon eyes or Battle sign does not rule it out.

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. after assessing distal neurovascular functions.

Hyperextension injuries of the spine are MOST commonly the result of: A. falls. B. diving. C. hangings. D. compression.

C. hangings.

In contrast to a cerebral concussion, a cerebral contusion: A. does not cause pressure within the skull. B. results from a laceration to the brain tissue. C. involves physical injury to the brain tissue. D. usually does not cause a loss of consciousness.

C. involves physical injury to the brain tissue.

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 airway. D. sensory and motor functions remain intact.

C. it causes a problem managing the airway.

Your patient is a 21-year-old male who has massive face and head trauma after being assaulted. He is lying supine, is semiconscious, and has blood in his mouth. You should: A. insert a nasal airway, assess his respirations, and give 100% oxygen. B. suction his airway and apply high-flow oxygen via a nonrebreathing mask. C. manually stabilize his head, log roll him onto his side, and suction his mouth. D. apply a cervical collar, suction his airway, and begin assisting his ventilations.

C. manually stabilize his head, log roll him onto his side, and suction his mouth.

When immobilizing a child on a long backboard, you should: A. place the child's head in a slightly extended position. B. secure the head prior to securing the torso and legs. C. defer cervical collar placement to avoid discomfort. D. place padding under the child's shoulders as needed.

D

Which of the following interventions may be used to help reduce intracranial pressure? A. Supine with the legs elevated B. Increasing the patient's body temperature C. Maintaining SpO2 at 90% D. 30-degree elevation of the head

D. 30-degree elevation of the head

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. Epidural hematoma

In which of the following situations would the EMT be the LEAST likely to immobilize a patient's spine? A. No spinal pain, but tingling in the extremities B. Unresponsive, but moving all extremities equally C. Pain to the c-spine, but no numbness or tingling. D. No distracting injuries or evidence of intoxication

D. No distracting injuries or evidence of intoxication

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. Sensory

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. a sensory nerve detects an irritating stimulus and bypasses the brain by sending a direct message to the motor nerve.

The five sections of the spinal column, in descending order, are the: Select one: A. coccygeal, sacral, lumbar, thoracic, and cervical. B. cervical, coccygeal, thoracic, sacral, and lumbar. C. thoracic, cervical, lumbar, coccygeal, and sacral. D. cervical, thoracic, lumbar, sacral, and coccygeal.

D. cervical, thoracic, lumbar, sacral, and coccygeal.

The tough, fibrous outer meningeal layer is called the: A. pia mater. B. arachnoid. C. gray mater. D. dura mater.

D. dura mater.

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. ensure that you secure the torso before securing the head.

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. eye opening, verbal response, and motor response.

A distraction injury to the cervical spine would MOST likely occur following: A. a diving accident. B. blunt neck trauma. C. hyperextension of the neck. D. hanging-type mechanisms.

D. hanging-type mechanisms.

A man is found slumped over the steering wheel, unconscious and making snoring sounds, after an automobile accident. His head is turned to the side and his neck is flexed. You should: A. gently rotate his head to correct the deformity. B. carefully hyperextend his neck to open his airway. C. apply an extrication collar with his head in the position found. D. manually stabilize his head and move it to a neutral, in-line position.

D. manually stabilize his head and move it to a neutral, in-line position.

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. a linear skull fracture and a significant increase in intracranial pressure. C. significant pressure and bleeding in between the skull and dura mater. D. rupture of the tympanic membrane following diffuse impact to the head.

D. rupture of the tympanic membrane following diffuse impact to the head.

You should NOT remove an injured football player's helmet if: A. a cervical spine injury is suspected, even if the helmet fits loosely. B. the patient has a patent airway, even if he has breathing difficulty. C. he has broken teeth, but only if the helmet does not fit snugly in place. D. the face guard can easily be removed and there is no airway compromise.

D. the face guard can easily be removed and there is no airway compromise.

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. the patient has been completely secured to the backboard.

Which of the following is NOT a symptom of a concussion?

Muscle tremors

Neck rigidity, bloody cerebrospinal fluid, and headache are associated with what kind of bleeding in the brain?

Subarachnoid hemorrhage

Injury to the head and neck may indicate injury to the:

cervical spine.

A 45-year-old male was working on his roof when he fell approximately 12 feet, 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:

immobilize his spine and perform a focused secondary exam.

You respond to a 38-year-old man who fell while rock climbing. He is unconscious with an open airway. The respiration and pulse rates are within normal limits. His distal pulses are intact. You check his pupils and find that they are unequal. You know this could be a sign of:

increased intracranial pressure.

The nervous system is divided into the central nervous system and the:

peripheral nervous system.

A female patient with a suspected head injury has slow, shallow breathing. The MOST appropriate treatment for her includes:

ventilation assistance to maintain an ETCO2 of 30 to 35 mm Hg.

Helmets must be removed in all of the following cases, EXCEPT:

when there are no impending airway or breathing problems.