Chapter 28: Head and Spine Injuries

In a(n) ________, CSF flows freely from the patient's ear; this type of injury can be difficult to diagnose with a radiograph. (a) Basilar skull fracture (b) Intracerebral hematoma (c) Linear skull fracture (d) Subdural hematoma

(a) Basilar skull fracture In a basilar skull fracture, CSF flows freely from the patient's ear; this type of injury can be difficult to diagnose with a radiograph.

You are treating a patient who went face-first through a windshield. She has extensive head injuries and is displaying hypertension, bradycardia, and Cheyne-Stokes respirations. Which of the following should you suspect? (a) Cushing triad (b) C6 herniation (c) Concussion (d) Cerebral edema

(a) Cushing triad

When securing a patient to a backboard, what area of the body should you secure last? (a) Head (b) Upper torso (c) Pelvis (d) Upper legs

(a) Head

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) Depressed

(a) Linear

You are assessing a man who has a head injury and note that cerebrospinal fluid is leaking from his ear. You should recognize that this patient is at risk for: (a) bacterial meningitis. (b) hypovolemic shock. (c) sudden hypotension. (d) permanent hearing loss.

(a) bacterial meningitis.

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) determine if the strength in all extremities is equal.

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) head

A patient who cannot remember the events that preceded his or her head injury is experiencing: (a) retrograde amnesia. (b) anterograde amnesia. (c) prograde amnesia. (d) posttraumatic amnesia.

(a) retrograde amnesia.

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 cervical collar is used in addition to, not instead of, manual immobilization.

Which of the following acts as a shock absorber for the CNS? (a) Dura mater (b) Cerebrospinal fluid (c) Fascia (d) Pia mater

(b) Cerebrospinal fluid

During your primary assessment of a semiconscious 30-year-old female with closed head trauma, you note that she has slow, irregular 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) instruct him to assist her ventilations while you perform a rapid assessment.

A high school football player was injured during a tackle and complains of neck and upper back pain. He is conscious and alert and is breathing without difficulty. The EMT should: (a) remove his helmet and shoulder pads (b) leave his helmet and shoulder pads in place. (c) remove his helmet, but leave his shoulder pads in place. (d) leave his helmet in place, but remove his shoulder pads.

(b) leave his helmet and shoulder pads in place.

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) 12. (b) 13. (c) 14. (d) 15.

(c) 14.

The cervical spine is composed of _____ vertebrae. (a) 5 (b) 6 (c) 7 (d) 8

(c) 7

You are reassessing a patient and you find that her left pupil is dilated and fixed. What does this indicate? (a) Decreased blood pressure (b) Increased blood pressure (c) Increased intracranial pressure (d) Drug abuse

(c) Increased intracranial pressure

Cushing triad in a patient is a sign of which of the following? (a) Spinal cord damage (b) Concussion (c) Intracranial pressure (d) Blood clot in the brain

(c) Intracranial pressure

Accounting for approximately 80% of all skull fractures, which of the following often present with no physical signs? (a) Basilar skull fractures (b) Depressed skull fractures (c) Linear skull fractures (d) Open skull fractures

(c) Linear skull fractures

The time between an initial period of unconsciousness and a subsequent loss of consciousness is referred to as what? (a) Coherent stage (b) Danger zone (c) Lucid interval (d) Recognition period

(c) Lucid interval

You are treating a patient who might have a skull fracture. What should you do if a dressing you have applied to a head wound becomes soaked? (a) Replace the dressing with a fresh one. (b) Remove the dressing and apply an occlusive dressing. (c) Place a clean dressing over the bloody one. (d) Apply direct pressure and add a compression dressing.

(c) Place a clean dressing over the bloody one.

Battle sign is an indication of which of the following? (a) Concussion (b) Contusion (c) Skull fracture (d) Secondary injury

(c) Skull fracture

The body's functions that occur without conscious effort are regulated by the _________ nervous system. (a) sensory (b) somatic (c) autonomic (d) voluntary

(c) autonomic

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) apply manual pressure and avoid applying a bandage. (c) avoid excessive pressure when applying the bandage. (d) apply firm compression for no longer than 5 minutes.

(c) avoid excessive pressure when applying the bandage.

Coordination of balance and body movement is controlled by the: (a) medulla. (b) cerebrum. (c) cerebellum. (d) brain stem.

(c) cerebellum.

The MOST important immediate treatment for patients with a head injury, regardless of severity, is to: (a) immobilize the entire spine. (b) administer high-flow oxygen. (c) establish an adequate airway. (d) transport to a trauma center.

(c) establish an adequate airway.

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

While performing a secondary assessment of a patient who was hit with a tire iron on the side of the head, you find a depressed area above the patient's left ear. This indicates that the patient could have which of the following? (a) An intracerebral hematoma (b) A subdural hematoma (c) A subarachnoid hemorrhage (d) An epidural hematoma

(d) An epidural hematoma

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) Eighty percent of the cranium is occupied by brain tissue.

When opening the airway of a patient with a suspected spinal injury, you should use the: (a) tongue-jaw lift maneuver. (b) head tilt-neck lift maneuver. (c) head tilt-chin lift maneuver. (d) jaw-thrust maneuver.

(d) jaw-thrust maneuver.

When caring for a patient with a possible head injury, it is MOST important to monitor the patient's: (a) pupil size. (b) blood pressure. (c) pulse regularity. (d) level of consciousness.

(d) level of consciousness.

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) peripheral

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

When assessing a patient with a suspected head or spine injury, which of the following should you do? - Administer high-flow oxygen. - Hyperventilate the patient. - Remove the cervical collar during secondary assessment to facilitate reassessment of vital signs. - Assess the patient in the position found.

- Assess the patient in the position found - Administer high-flow oxygen

Which of the following are signs of Cushing triad? - loss of sensation - hypertension - irregular respirations - bradycardia

- irregular respirations - hypertension - bradycardia

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: Select one: A. axial loading. B. hyperflexion. C. distraction. D. hyperextension

A. axial loading.

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

B. a rapid, thready pulse.

Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed unless: Select one: A. lateral immobilization has been applied. B. it causes a problem managing the airway. C. sensory and motor functions remain intact. D. the patient adamantly denies neck pain.

B. it causes a problem managing the airway.

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

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

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

D. hangings.

True or false: Central nervous system structures are very strong even though they are not well protected.

False. Central nervous system structures, whose bony enclosures protect them quite well, are also very fragile.

True or false: The structure of the skull and the presence of the meninges in effect reduce the likelihood of problems in closed head injuries.

False. The closed bony structure of the skull (which is similar to a vault) and the meninges may lead to serious problems in closed head injuries. Severe injury may cause bleeding within the skull. Such bleeding causes increased pressure inside the skull and compresses softer brain tissue. In many cases, only prompt surgery can prevent permanent brain damage.

True or false: The most prominent and most easily palpable spinous process is at the seventh cervical vertebra at the base of the neck.

True.