CHAPTER 34

Patients with evidence of trauma above the _________ should be considered at risk for an associated spine injury.

clavicles

The occipital condyles are the:

points of articulation between the skull and vertebral column.

At what age do the sutures of the skull solidify and the fontanelles close?

18 months

The MOST significant complication associated with prolonged immobilization of a patient on a long backboard is

pressure lesion development.

Treatment for a patient with neurogenic shock may include all of the following, EXCEPT:

prevention of hyperthermia.

A moderate diffuse axonal injury:

produces an immediate loss of consciousness and residual neuorologic deficits when the patient wakes up

The MOST effective method for decreasing morbidity and mortality associated with spinal cord injury is:

public education and prevention strategies

Flexion injuries to the spine would MOST likely result from:

rapid deceleration forces.

Upon arriving at the scene of a motor vehicle crash, 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:

rapidly extricate the driver so you can gain quick access to the child in the backseat

When an unrestrained passenger's head strikes the windshield of a motor vehicle following rapid deceleration:

compression injuries occur to the anterior portion of the brain, and stretching or tearing injuries occur to the posterior portion of the brain.

The crista galli:

is the anatomic point of attachment of the meninges.

Regardless of the method of spinal immobilization used, you must:

keep the head, neck, and trunk in alignment.

If a trauma patient cannot be assessed properly in his or her vehicle, you should:

maintain manual stabilization of the head, apply a cervical collar, and move the patient from the vehicle onto a long backboard.

Prior to immobilizing an anxious patient with a suspected spinal injury on a backboard, it is important to:

make note of any neurologic deficits or gross injuries up to that point.

When performing a cranial nerve assessment of a patient with a suspected spinal injury, you note that the patient's pupil is constricted and the upper eyelid droops. This indicates an injury to:

C3

Which of the following statements regarding a cerebral concussion is correct?

Concussions are usually not associated with structural brain injury.

Which of the following types of skull fracture would be the LEAST likely to present with gross physical signs?

Linear fracture

Which of the following conditions that can cause an airway obstruction is unique to patients with an injury to the upper cervical spine?

Retropharyngeal hematoma

A patient with diaphragmatic breathing without intercostal muscle use has MOST likely experienced a spinal injury above the level of:

T-2

Inability to feel or move below the level of the nipple line indicates injury to which spinal nerve root?

T4

Which of the following statements regarding the brainstem is correct?

The brainstem connects the spinal cord to the brain.

Which of the following statements regarding the hypothalamus is correct?

The hypothalamus is the most inferior portion of the diencephalon and controls functions such as hunger, sleep, and vomiting.

Which of the following statements regarding central cord syndrome is correct?

The patient typically presents with greater loss of function in the upper extremities than in the lower extremities

When performing the standing takedown technique to immobilize a patient's spine, the patient is secured to the long backboard with straps:

after he or she is lowered to the ground

In contrast to secondary spinal cord injury, primary spinal cord injury occurs:

at the moment of impact.

A spinal cord concussion is:

caused by a short-duration shock or pressure wave within the cord

The FIRST step in any neurologic assessment involves:

determining the patient's level of consciousness.

Signs of neurogenic shock include all of the following, EXCEPT:

diaphoresis

When immobilizing a patient to a long backboard, you should take standard precautions and then:

ensure that the patient's head is stabilized manually.

The dura mater:

folds in to form the tentorium, a structure that separates the cerebral hemispheres from the cerebellum and brainstem.

A diffuse axonal injury:

involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body.

A scalp laceration that occurs in conjunction with a nondisplaced skull fracture:

is considered to be an open skull fracture

Hyperventilation of the brain-injured patient:

shunts oxygen away from the brain and may result in decreased cerebral perfusion pressure.

Cerebrospinal fluid drainage from the ears is MOST indicative of:

skull fracture

The __________ is a continuation of the central nervous system and exits the skull through the _______.

spinal cord, foramen magnum

The cervical spine:

supports the weight of the head and permits a high degree of mobility in multiple planes.

A motorcycle or football helmet should be removed if:

the patient is breathing shallowly and access to the airway is difficult.

Spinal cord injury without radiographic abnormalities (SCIWORA. can occur in children because:

their vertebrae lie flatter on top of each other.