Chapter 28 EMT

Following a head injury, a 20-year-old female opens her eyes spontaneously, is confused, and obeys your commands to move her extremities. You should assign her a GCS score of: A. 14. B. 15. C. 12. D. 13.

A. 14.

Which of the following statements regarding secondary brain injury is correct? A. Hypoxia and hypotension are the two most common causes of secondary brain injury. B. It results from direct brain trauma following an impact to the head. C. Because cerebral edema develops quickly, it is considered to be a primary brain injury. D. Signs are often present immediately after an impact to the head.

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

Which of the following statements regarding a basilar skull fracture is correct? A. The absence of raccoon eyes or Battle's sign does not rule it out. B. They are typically the result of local, low-energy trauma to the head. C. Bloody CSF commonly leaks from the nose. D. In most cases, mastoid bruising occurs.

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

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

A. a decreased level of consciousness.

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. assisting ventilations at an age-appropriate rate. B. hyperventilating her at 30 breaths/min. C. administering oxygen via a nonrebreathing mask. D. ventilation assistance to maintain an oxygen saturation of 90%.

A. assisting ventilations at an age-appropriate rate.

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, 200/100 mm Hg; pulse, 140 beats/min; respirations, 28 breaths/min C. blood pressure, 80/40 mm Hg; pulse, 30 beats/min; respirations, 32 breaths/min D. blood pressure, 90/50 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min

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

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

A. cerebrum

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

A. hangings.

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

A. intracerebral hematoma.

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

A. level of consciousness.

Lacerations to the scalp: A. may be an indicator of deeper, more serious injuries. B. bleed minimally because the scalp has few vessels. C. uncommonly cause hypovolemic shock in children. D. are most commonly associated with skull fractures.

A. may be an indicator of deeper, more serious injuries.

A patient who cannot remember the events that preceded his or her head injury is experiencing: A. retrograde amnesia. B. posttraumatic amnesia. C. perigrade amnesia. D. anterograde amnesia.

A. retrograde amnesia.

If you do not have the appropriate size cervical collar, you should: A. use rolled towels to immobilize the patient's head. B. defer cervical immobilization and apply lateral head blocks. C. place sandbags on either side of the patient's head. D. ask the patient to keep his or her head in a neutral position.

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

A reflex arc occurs when: A. the brain interprets sensory information that it receives from peripheral and cranial nerves and sends a signal to the muscles. B. a sensory nerve detects an irritating stimulus and bypasses the brain by sending a direct message to the motor nerve. C. a sensory nerve sends a message to the brain but the motor nerve fails to send the appropriate response to the body. D. the motor nerves function automatically without receiving a message from the CNS.

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

The central nervous system (CNS) is composed of the: A. cerebrum and meninges. B. brain and spinal cord. C. cerebellum and brain. D. meninges and spinal cord.

B. brain and spinal cord.

Common signs and symptoms of a serious head injury include all of the following, EXCEPT: A. combative behavior. B. constricted pupils. C. decreased sensory function. D. CSF leakage from the ears.

B. constricted pupils.

When assessing a conscious patient with an MOI that suggests spinal injury, you should: A. rule out a spinal injury if the patient denies neck pain. B. determine if the strength in all extremities is equal. C. ask the patient to move his or her head to assess for pain. D. defer spinal immobilization if the patient is ambulatory.

B. determine if the strength in all extremities is equal.

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. allow him to refuse transport if his vital signs remain stable. B. immobilize his spine and perform a focused secondary exam. C. perform a rapid head-to-toe exam and immobilize his spine. D. obtain a Glasgow Coma Score value and give him oxygen.

B. immobilize his spine and perform a focused secondary exam.

A tight-fitting motorcycle helmet should be left in place unless: A. the helmet is equipped with a full face shield or visor. B. it interferes with your assessment of the airway. C. the patient complains of severe neck or back pain. D. the patient must be placed onto a long backboard.

B. it interferes with your assessment of the airway.

When activated, the sympathetic nervous system produces all of the following effects, EXCEPT: A. shunting of blood to vital organs. B. pupillary constriction. C. dilation of the bronchiole smooth muscle. D. increase in heart rate.

B. pupillary constriction.

Moderate elevation in intracranial pressure with middle brain stem involvement is characterized by: A. ataxic respirations, unequal pupils, no response to pain, and an irregular pulse. B. sluggishly reactive pupils, widened pulse pressure, bradycardia, and posturing. C. increased blood pressure, bradycardia, reactive pupils, and rapid respirations. D. fixed and dilated pupils, decreased blood pressure, and irregular respirations.

B. sluggishly reactive pupils, widened pulse pressure, bradycardia, and posturing.

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

B. spinal canal.

Common signs of a skull fracture include all of the following, EXCEPT: A. noted deformity to the skull. B. superficial scalp lacerations. C. mastoid process bruising. D. ecchymosis around the eyes.

B. superficial scalp lacerations.

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

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

When immobilizing a trauma patient's spine, the EMT manually stabilizing the head should not let go until: A. the head has been stabilized with lateral immobilization. B. the patient has been completely secured to the backboard. C. the patient has been secured to the ambulance stretcher. D. an appropriately sized cervical collar has been applied.

B. the patient has been completely secured to the 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. 2 B. 5 C. 3 D. 4

C. 3

An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is: A. a progressively lowering blood pressure. B. an acute increase in the patient's pulse rate. C. a rapid deterioration of neurologic signs. D. acute unilateral paralysis following the injury.

C. a rapid deterioration of neurologic signs.

After your partner assumes manual in-line stabilization of the patient's head, you should: A. apply an appropriately sized rigid cervical collar. B. use four people to log roll the patient onto a backboard. C. assess distal neurovascular status in the extremities. D. thoroughly palpate the patient's head for deformities.

C. assess distal neurovascular status in the extremities.

An epidural hematoma is MOST accurately defined as: A. venous lacerations that occur within the brain. B. bleeding between the dura mater and brain. C. bleeding between the skull and dura mater. D. an injury caused by a damaged cerebral artery.

C. bleeding between the skull and dura mater.

Coordination of balance and body movement is controlled by the: A. cerebrum. B. brain stem. C. cerebellum. D. medulla.

C. cerebellum.

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

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

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. 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. primary impact to the posterior aspect of the brain, resulting in compression injuries, bruising, or torn blood vessels.

C. compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain.

It would be MOST appropriate to perform a focused secondary assessment on a patient who: A. has blood draining from the ears following a head injury. B. struck his or her head and is experiencing nausea or vomiting. C. fainted and fell to the ground from a standing position. D. was restrained during a high-speed motor vehicle crash.

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

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. immediately place her on a long backboard and prepare for rapid transport. B. perform a focused secondary assessment of the patient's head and neck. C. instruct him to assist her ventilations while you perform a rapid assessment. D. apply 100% oxygen via a nonrebreathing mask and obtain baseline vital signs.

C. instruct him to assist her ventilations while you perform a rapid assessment.

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

C. place padding under the child's shoulders as needed.

When assessing a patient with a head injury, you note the presence of thin, bloody fluid draining from his right ear. This indicates: A. significant pressure and bleeding in between the skull and dura mater. B. a linear skull fracture and a significant increase in intracranial pressure. C. rupture of the tympanic membrane following diffuse impact to the head. D. fractures to the internal structures of the ear following direct trauma.

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

Which of the following nerves carry information from the body to the brain via the spinal cord? A. central B. somatic C. sensory D. motor

C. sensory

What part of the nervous system controls the body's voluntary activities? A. central B. sensory C. somatic D. autonomic

C. somatic

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. immobilize his spine and transport immediately. C. suction his oropharynx for up to 15 seconds. D. pack his nostrils to stop the drainage of blood.

C. suction his oropharynx for up to 15 seconds.

Any unresponsive trauma patient should be assumed to have: A. a severe intracranial hemorrhage. B. internal bleeding in the abdomen. C. a history of diabetes mellitus. D. an accompanying spinal injury.

D. an accompanying spinal injury.

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

D. cerebral concussion.

Which of the following head injuries would cause the patient's condition to deteriorate MOST rapidly? A. cerebral concussion B. cerebral contusion C. subdural hematoma D. epidural hematoma

D. epidural hematoma

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

D. epinephrine.

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

D. involves physical injury to the brain tissue.

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

D. slow.