Chapter 34 Head and Spine
Which of the following types of skull fracture would be the LEAST likely to present with gross physical signs? A) Open fracture B) Depressed fracture C) Basilar fracture D) Linear fracture
D) Linear fracture
Which of the following statements regarding the brainstem is correct? A) The brainstem provides protection to the cerebellum. B) The brainstem is responsible for muscle coordination. C) All but 4 of the 12 cranial nerves exit the brainstem. D) The brainstem connects the spinal cord to the brain.
D) The brainstem connects the spinal cord to the brain.
What spinal cord injury is characterized by motor loss on the same side as the injury, but below the lesion? A) Central cord syndrome B) Brown-Séquard syndrome C) Anterior cord syndrome D) Posterior cord syndrome
B) Brown-Séquard syndrome
Most head injuries are the result of: A) assault or abuse. B) motor vehicle crashes. C) sports-related incidents. D) falls from a significant height.
B) motor vehicle crashes.
The respiratory centers of the brainstem lie within the: A) basal ganglia. B) pons and medulla. C) diencephalon. D) midbrain.
B) pons and medulla.
The parietal lobe of the brain: A) is where the optic nerve originates and processes vision. B) is important for voluntary motor action and personality traits. C) controls somatic functions for the contralateral side of the body. D) controls functions such as long-term memory, taste, and smell.
C) controls somatic functions for the contralateral side of the body.
The ______________ consists of eight bones that encase and protect the brain. A) skull B) cerebrum C) cranial vault D) cribriform plate
C) cranial vault
Patients with evidence of trauma above the _________ should be considered at risk for an associated spine injury. A) diaphragm B) pelvis C) umbilicus D) clavicles
D) clavicles
Which of the following conditions that can cause an airway obstruction is unique to patients with an injury to the upper cervical spine? A) Retropharyngeal hematoma B) Blood or secretions in the mouth C) Oropharyngeal occlusion by the tongue D) Improperly inserted oropharyngeal airway
A) Retropharyngeal hematoma
In which of the following situations would spinal motion restriction precautions likely NOT be necessary? A) Syncopal episode in which the patient was already seated or supine B) Unrestrained occupant of moderate- to high-speed motor vehicle crash C) Isolated head injury without gross signs or symptoms of a spinal injury D) Vehicular damage with compartmental intrusion of greater than 12 inches
A) Syncopal episode in which the patient was already seated or supine
Pupils that are slow (sluggish) to react to light: A) are a sign of cerebral hypoxia. B) indicate impending brain herniation. C) suggest significant intracranial pressure. D) indicate compression of an oculomotor nerve.
A) are a sign of cerebral hypoxia.
Secondary brain injuries include all of the following, EXCEPT: A) axonal injury. B) cerebral edema. C) cerebral ischemia. D) intracranial hemorrhage.
A) axonal injury.
The __________ is the largest component of the central nervous system and contains billions of neurons that serve a variety of functions. A) brain B) medulla C) cerebellum D) spinal cord
A) brain
Hyperventilation of the brain-injured patient: A) shunts oxygen away from the brain and may result in decreased cerebral perfusion pressure. B) has clearly demonstrated decreased mortality and morbidity in patients with a severe head injury. C) causes cerebral vasodilation with increased intracranial pressure and should be avoided. D) is only appropriate if the patient is unresponsive and has bilaterally dilated and sluggishly reactive pupils.
A) shunts oxygen away from the brain and may result in decreased cerebral perfusion pressure.
A subdural hematoma is classified as acute if clinical signs and symptoms develop: A) immediately following the injury. B) within 24 hours following the injury. C) within 36 hours following the injury. D) within 48 hours following the injury.
B) within 24 hours following the injury.
At what age do the sutures of the skull solidify and the fontanelles close? A) 18 months B) 2 years C) 36 months D) 4 years
A) 18 months
Prehospital treatment of the patient with a traumatic brain injury must focus primarily on: A) maintaining cerebral perfusion pressure. B) hyperventilating the patient at 20 breaths/min. C) maintaining a systolic blood pressure of at least 120 mm Hg. D) taking measures to decrease intracranial pressure.
A) maintaining cerebral perfusion pressure.
Bleeding from a scalp laceration with an underlying skull deformity: A) may contribute to hypovolemia in adults. B) commonly causes severe shock in adults. C) should be controlled with firm direct pressure. D) is limited due to the scalp's minimal vasculature.
A) may contribute to hypovolemia in adults.
The MOST significant complication associated with prolonged immobilization of a patient on a long backboard is: A) pressure lesion development. B) compression of the vena cava. C) increased intracranial pressure. D) patient discomfort and frustration.
A) pressure lesion development.
Unlike a cerebral concussion, a cerebral contusion is: A) typically not associated with retrograde amnesia or focal neurologic deficits. B) a type of diffuse axonal injury that often leads to permanent neurologic damage. C) a diffuse brain injury that results in severe intracranial hemorrhage and pressure. D) associated with physical brain damage and more pronounced neurologic deficits.
D) associated with physical brain damage and more pronounced neurologic deficits.
Common clinical findings associated with a subdural hematoma include all of the following, EXCEPT: A) rapidly increasing intracranial pressure. B) an underlying skull fracture. C) a fluctuating level of consciousness. D) unilateral hemiparesis or slurred speech.
A) rapidly increasing intracranial pressure.
Vagal tone remains intact following a spine injury because: A) the vagus nerve originates outside the medulla and regulates the heart via the carotid arteries. B) parasympathetic nerve fibers are largely under the control of the involuntary nervous system. C) the nerve fibers of the parasympathetic nervous system do not originate from the brainstem or spinal cord. D) the thoracolumbar system provides parasympathetic stimulation to the periphery via alpha and beta receptors.
A) the vagus nerve originates outside the medulla and regulates the heart via the carotid arteries.
What type of skull fracture is MOST common following high-energy direct trauma to a small surface area of the head with a blunt object? A) Depressed fracture B) Open fracture C) Basilar fracture D) Nondisplaced fracture
A) Depressed fracture
Which of the following statements regarding the brain is correct? A) The brain uses 45 to 50 L/min of oxygen. B) The brain occupies approximately 60% of the cranium. C) The brain metabolizes minimal amounts of glucose. D) The brain has the ability to store oxygen and glucose.
A) The brain uses 45 to 50 L/min of oxygen.
Which of the following statements regarding central cord syndrome is correct? A) The patient typically presents with greater loss of function in the upper extremities than in the lower extremities. B) Central cord syndrome is almost always associated with a vertebral fracture and has an overall poor prognosis. C) Patients with cervical spondylosis or stenosis are at a lower risk for central cord syndrome following an injury. D) Central cord syndrome typically causes complete paralysis of the lower extremities and decreased proprioception.
A) The patient typically presents with greater loss of function in the upper extremities than in the lower extremities.
Early signs and symptoms of increased intracranial pressure include: A) headache and vomiting. B) hypertension and bradycardia. C) widening of the pulse pressure. D) arm flexion and leg extension.
A) headache and vomiting.
The main disadvantage of using a scoop stretcher to transfer a patient to a long backboard is: A) inability to conduct a visual exam of the back for injuries. B) patient discomfort due the cold metal frame of the scoop. C) unnecessary patient movement and the risk for further harm. D) inability to palpate the spinal vertebrae for gross deformities.
A) inability to conduct a visual exam of the back for injuries.
The upper thoracic spinal nerves: A) innervate the muscles of the chest that help in breathing and coughing. B) regulate the parasympathetic nervous system and inhibit inspiration. C) are the only pair of spinal nerves that do not truly exit the spinal cord. D) provide abdominal muscle control and contain sympathetic nerve fibers.
A) innervate the muscles of the chest that help in breathing and coughing.
Cerebrospinal fluid drainage from the ears is MOST indicative of: A) a nasal fracture. B) intracerebral bleeding. C) an epidural hematoma. D) a skull fracture.
D) a skull fracture.
An epidural hematoma typically causes rapid deterioration in the head-injured patient's condition because: A) numerous axons are severely damaged. B) the meningeal veins are often disrupted. C) it is associated with brisk arterial bleeding. D) concomitant spinal cord injury is often present.
C) it is associated with brisk arterial bleeding.
When assessing the severity of a traumatic brain injury, the MOST important assessment parameter is the patient's: A) initial Glasgow Coma Scale score. B) blood pressure. C) level of consciousness. D) response to verbal stimuli.
C) level of consciousness.
What type of intracranial hemorrhage would MOST likely be caused by a penetrating head injury? A) Subdural hematoma B) Intracerebral hematoma C) Epidural hematoma D) Subarachnoid hemorrhage
B) Intracerebral hematoma
Autoregulation is defined as: A) reflex bradycardia that occurs secondary to systemic hypertension. B) an increase in mean arterial pressure to maintain cerebral blood flow. C) the forcing of cerebrospinal fluid into the spinal cord as intracranial pressure increases. D) a decrease in cerebral perfusion pressure that reduces intracranial pressure.
B) an increase in mean arterial pressure to maintain cerebral blood flow.
As the body ages, the intervertebral discs: A) calcify and become more rigid. B) enlarge and result in increased height. C) are not able to protect the spinal cord. D) lose water content and become thinner.
D) lose water content and become thinner.
Which of the following statements regarding a closed head injury is correct? A) In a closed head injury, the dura mater remains intact. B) Diffuse brain injury occurs with all open head injuries. C) Closed head injuries are less common than open head injuries. D) Intracranial pressure is usually minimal in a closed head injury.
A) In a closed head injury, the dura mater remains intact.
The only area of the spine that allows for significant rotation is: A) C1-C2. B) C2-C4. C) C6-C7. D) T1-T2.
A) C1-C2.
Which of the following factors would be the LEAST likely to result in secondary spinal cord injury? A) Inflammation B) Hypothermia C) Hyperglycemia D) Hypoxemia
C) Hyperglycemia
Any motor or sensory deficits noted during the neurologic examination of a patient with a possible spinal cord injury: A) indicate a complete spinal cord injury. B) require you to repeat the primary assessment. C) should be documented and monitored. D) must be reported to the hospital at once.
C) should be documented and monitored.
Following a spinal injury, a patient presents with abdominal breathing and use of the accessory muscles in the neck. This suggests injury at or above: A) C1-C2. B) C3-C4. C) T1-T4. D) T2-T5.
B) C3-C4.
Which of the following statements regarding a cerebral concussion is correct? A) A cerebral concussion is a moderate focal brain injury. B) Concussions are usually not associated with structural brain injury. C) Prolonged loss of consciousness is common with a cerebral concussion. D) A concussion results in permanent dysfunction of the cerebral cortex.
B) Concussions are usually not associated with structural brain injury.
A diffuse axonal injury: A) is a specific, grossly observable brain injury that can easily be diagnosed with a computer tomography scan of the head. B) involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body. C) results in severe stretching or tearing of the portion of the nerve cell that receives sensory messages from the rest of the body. D) is generally associated with better neurologic outcomes than a cerebral concussion because permanent brain damage does not occur.
B) involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body.
Spinal shock is a condition that: A) generally affects the sensory nerves but spares the motor nerves. B) is usually temporary and results from swelling of the spinal cord. C) typically manifests within 24 to 36 hours following a spinal injury. D) results in permanent neurologic deficits in the majority of patients.
B) is usually temporary and results from swelling of the spinal cord.
Prior to immobilizing an anxious patient with a suspected spinal injury on a backboard, it is important to: A) ask the patient to pull against your hands with his or her feet. B) make note of any neurologic deficits or gross injuries up to that point. C) administer the appropriate dose of a sedative to facilitate patient compliance. D) apply a cervical collar to free up the medic that is holding the patient's head.
B) make note of any neurologic deficits or gross injuries up to that point.
A complete spinal cord injury to the upper cervical spine: A) results in quadriplegia but the patient usually retains his or her ability to breathe spontaneously. B) is not compatible with life and results in immediate death due to cardiopulmonary failure. C) will result in permanent loss of all cord-mediated functions below the level of the injury. D) results in neurologic dysfunction that is considered to be permanent if it lasts longer than 24 hours.
C) will result in permanent loss of all cord-mediated functions below the level of the injury.
The galea aponeurotica is: A) the dense fibrous membrane covering the surface of the cranium. B) a loose connective tissue that is easily damaged during "scalping" injuries. C) the subcutaneous layer of the scalp that contains easily damaged major veins. D) a tendon expansion that connects the frontal and occipital muscles of the cranium.
D) a tendon expansion that connects the frontal and occipital muscles of the cranium.
A male patient with a closed head injury opens his eyes in response to pain, makes incomprehensible sounds, and responds to pain with flexion of his arms. His Glasgow Coma Scale score is ___, and the MOST appropriate treatment for him involves: A) 6; intubation, hyperventilation at a rate of 20 breaths/min, two large-bore IV lines running wide open, keeping him warm, and maintaining his oxygen saturation at greater than 90%. B) 7; intubation, ventilations performed at a rate of 10 breaths/min, IV fluids as needed to maintain a systolic blood pressure of at least 90 mm Hg, and maintaining his oxygen saturation at greater than 95%. C) 8; ventilation assistance with a bag-mask device, a 2-L bolus of normal saline or lactated Ringer's solution, elevating his head 12 inches, and hyperventilating him if his heart rate falls below 60 beats/min. D) 9; high-flow oxygen via nonrebreathing mask, IV fluids as needed to maintain a systolic blood pressure of at least 100 mm Hg, monitoring his oxygen saturation, and administering 1.5 mg/kg of lidocaine to decrease intracranial pressure.
D) 9; high-flow oxygen via nonrebreathing mask, IV fluids as needed to maintain a systolic blood pressure of at least 100 mm Hg, monitoring his oxygen saturation, and administering 1.5 mg/kg of lidocaine to decrease intracranial pressure.
What spinal nerve tract carries information regarding pain and temperature? A) Corticospinal B) Spinocerebellar C) Reticulospinal D) Lateral spinothalamic
D) Lateral spinothalamic
Displacement of bony fragments into the anterior portion of the spinal cord results in: A) central cord syndrome. B) anterior cord syndrome. C) Brown-Séquard syndrome. D) complete spinal cord injury.
B) anterior cord syndrome.
Open fractures of the cranial vault: A) cause death due to increased intracranial pressure. B) are associated with a high risk of bacterial meningitis. C) typically cause lethal atrial cardiac dysrhythmias. D) are uncommonly associated with multisystem trauma.
B) are associated with a high risk of bacterial meningitis.
Injury to the temporal lobe on the left side would MOST likely cause: A) abnormal speech. B) visual disturbances. C) sleep abnormalities. D) lack of coordination.
A) abnormal speech
A spinal cord concussion is: A) caused by a short-duration shock or pressure wave within the cord. B) a condition that results in a permanent loss of neurologic function. C) characterized by temporary dysfunction that lasts for up to 1 week. D) the result of direct trauma and is associated with spinal cord edema.
A) caused by a short-duration shock or pressure wave within the cord.
The crista galli: A) is the anatomic point of attachment of the meninges. B) is divided into the anterior, middle, and posterior fossae. C) is a horizontal bone perforated with numerous foramina. D) allows the passage of the olfactory nerves from the nasal cavity.
A) is the anatomic point of attachment of the meninges.
Because of its weight-bearing capacity, the ________ spine is especially susceptible to injury. A) cervical B) thoracic C) lumbar D) coccygeal
C) lumbar
The LEAST common cause of death in spinal cord injury patients who are discharged from the hospital is: A) pneumonia. B) septicemia. C) muscular atrophy. D) pulmonary embolism.
C) muscular atrophy.
The innermost meningeal layer that rests directly on the brain and spinal cord is the: A) cortex. B) arachnoid. C) pia mater. D) dura mater.
C) pia mater.
The occipital condyles are the: A) key anatomic structures to which the meninges are attached. B) passageways for the olfactory nerves to exit the nasal cavity. C) points of articulation between the skull and vertebral column. D) horizontal bones of the cribriform plate that contain foramina.
C) points of articulation between the skull and vertebral column.
Treatment for a patient with neurogenic shock may include all of the following, EXCEPT: A) a vagolytic medication. B) a vasopressor medication. C) prevention of hyperthermia. D) fluid volume to maintain perfusion.
C) prevention of hyperthermia.
In addition to the supporting muscles and ligaments found in the vertebral column, the thoracic spine is further stabilized by the: A) diaphragm. B) upper sternum. C) rib attachments. D) large spinous processes.
C) rib attachments.
Beta receptor stimulation results in all of the following effects, EXCEPT: A) positive cardiac inotropy. B) positive cardiac chronotropy. C) vascular smooth muscle contraction. D) relaxation of bronchiole smooth muscle
C) vascular smooth muscle contraction.
Cerebrospinal fluid is manufactured in the __________ of the brain and serves to ______________. A) subdural space, prevent infection B) cortex, protect the brain from injury C) ventricles, cushion and protect the brain D) subarachnoid space, oxygenate the brain
C) ventricles, cushion and protect the brain
What portion of the brainstem is responsible for maintenance of consciousness, specifically one's level of arousal? A) Diencephalon B) Limbic system C) Basal ganglia D) Reticular activating system
D) Reticular activating system
A patient with diaphragmatic breathing without intercostal muscle use has MOST likely experienced a spinal injury above the level of: A) C2. B) C5. C) C7. D) T2.
D) T2.
The dura mater: A) folds in to form the tentorium, a structure that separates the cerebral hemispheres from the cerebellum and brainstem. B) is the middle meningeal layer and is comprised of a delicate transparent membrane that is damaged easily by trauma. C) anatomically separates the cerebellum and the brainstem and contains vasculature that resembles a spider web. D) is the inner meningeal layer and is comprised of a thin, translucent, highly vascular membrane that adheres firmly directly to the surface of the brain.
A) folds in to form the tentorium, a structure that separates the cerebral hemispheres from the cerebellum and brainstem.
The spine: A) is the major structural component of the axial skeleton. B) is comprised of irregular bones that are all fused together. C) consists of 23 bones articulating to form the spinal column. D) provides support and strength for the appendicular skeleton.
A) is the major structural component of the axial skeleton.
Hypotension that is associated with neurogenic shock is the result of: A) loss of alpha receptor stimulation. B) concomitant internal hemorrhage. C) increased peripheral vascular tone. D) profound peripheral vasoconstriction.
A) loss of alpha receptor stimulation.
Herniation of an intervertebral disc occurs when: A) stress on the vertebral column forces a disc into the spinal canal. B) the spinal column sustains flexion or extension of more than 50%. C) the spinous process fractures and puts pressure on one or more discs. D) significant blunt trauma displaces the disc away from the spinal cord.
A) stress on the vertebral column forces a disc into the spinal canal.
Modification of your physical examination of a patient with a suspected spinal cord injury following a two-car motor vehicle crash is based on all of the following factors, EXCEPT: A) the mechanism of injury. B) injuries to patients in the other vehicle. C) the patient's level of consciousness. D) reliability of the patient as a historian.
B) injuries to patients in the other vehicle.
If the mechanism of injury indicates that your patient may have sustained a spinal cord injury: A) contact medical control to determine if spinal immobilization is needed. B) assume that a spine injury exists, regardless of the neurologic findings. C) apply a cervical collar and transport the patient in a position of comfort. D) fully immobilize the spine only if gross neurologic deficits are present.
B) assume that a spine injury exists, regardless of the neurologic findings.
In contrast to secondary spinal cord injury, primary spinal cord injury occurs: A) from progressive swelling. B) at the moment of impact. C) from penetrating mechanisms. D) within 24 hours of the injury.
B) at the moment of impact.
Which of the following signs of a basilar skull fracture would MOST likely be observed in the prehospital setting? A) Battle's sign B) cerebrospinal fluid drainage from the ear C) Ecchymosis around the eyes D) Bruising over the mastoid process
B) cerebrospinal fluid drainage from the ear
The phrenic nerve arises from the _________ plexus and innervates the _______. A) sacral, lower limbs B) cervical, diaphragm C) lumbar, abdominal wall D) brachial, upper extremities
B) cervical, diaphragm
Although extremely painful, injuries to the ________ spine are typically neurologically insignificant. A) lumbar B) coccygeal C) thoracic D) cervical
B) coccygeal
The brain connects to the spinal cord through a large opening at the base of the skull called the: A) cribriform plate. B) foramen magnum. C) occipital condyle. D) palatine bone.
B) foramen magnum.
Chronic subdural hematomas are MOST commonly seen in patients who: A) are less than 2 years of age. B) have alcoholism. C) are prone to hypoglycemia. D) have high cholesterol.
B) have alcoholism.
The cerebellum is located in the ____________ part of the brain and is responsible for _______________. A) anteromedial, voluntary motor functions B) inferoposterior, posture and equilibrium C) anterolateral, short- and long-term memory D) inferolateral, involuntary motor functions
B) inferoposterior, posture and equilibrium
The cone-shaped section of bone located at the base of each temporal bone is called the: A) lamboid suture. B) mastoid process. C) cribriform plate. D) ethmoid bone.
B) mastoid process.
The MOST effective method for decreasing morbidity and mortality associated with spinal cord injury is: A) rapid transportation to a trauma center. B) public education and prevention strategies. C) minimizing scene time to 10 minutes or less. D) routine use of spinal motion restriction precautions.
B) public education and prevention strategies.
Flexion injuries to the spine would MOST likely result from: A) rapid acceleration forces. B) rapid deceleration forces. C) a rear-end motor vehicle crash. D) a direct blow to the frontal lobe
B) rapid deceleration forces.
The __________ is a continuation of the central nervous system and exits the skull through the _______. A) vagus nerve, spinal cord B) spinal cord, foramen magnum C) brainstem, vertebral foramen D) medulla, cauda equina
B) spinal cord, foramen magnum
Death following a head injury is MOST often the result of: A) an epidural hematoma. B) trauma to the brain. C) airway compromise. D) spinal cord transection.
B) trauma to the brain.
The anterior weight-bearing structure of the vertebra is the: A) pedicle. B) vertebral body. C) lamina. D) spinous process.
B) vertebral body.
Which of the following statements regarding the hangman's fracture is correct? A) Hangman's fractures occur when the patient's skull rapidly accelerates. B) Most hangman's fractures occur during a fall from greater than 10 feet. C) It is a fracture of C2 that is secondary to significant distraction of the neck. D) Severe hyperflexion of the neck commonly results in a hangman's fracture.
C) It is a fracture of C2 that is secondary to significant distraction of the neck.
The afferent and efferent nerves: A) are regulated by the sympathetic nervous system. B) are receptors stimulated by the sympathetic nervous system. C) are responsible for the somatic functions of the spinal cord. D) originate from the hypothalamus and regulate temperature.
C) are responsible for the somatic functions of the spinal cord.
Paralysis of the extremities would MOST likely result from injury to the: A) cerebellum. B) diencephalon. C) cerebral cortex. D) hypothalamus.
C) cerebral cortex.
Following a traumatic brain injury, initial swelling of the brain occurs due to: A) severe ischemia. B) acute hypertension. C) cerebral vasodilation. D) an increase in cerebral water.
C) cerebral vasodilation.
Signs of neurogenic shock include all of the following, EXCEPT: A) bradycardia. B) flushed skin. C) diaphoresis. D) hypothermia.
C) diaphoresis.
Decerebrate posturing is characterized by: A) flexion of the arms and extension of the legs. B) inward flexion of the wrists and flexed knees. C) extension of the arms and extension of the legs. D) pulling in of the arms toward the core of the body.
C) extension of the arms and extension of the legs.
A 19-year-old woman fell from a second story window and landed on her head. She is unconscious with a blood pressure of 148/94 mm Hg, heart rate of 58 beats/min, and irregular respirations of 8 breaths/min. Further assessment reveals blood draining from her nose and bilaterally dilated pupils that are slow to react. In addition to employing full spinal precautions, the MOST appropriate treatment for this patient involves: A) hyperventilating her with a bag-mask device at a rate of 20 breaths/min, starting two large-bore IV lines, applying a cardiac monitor, administering 5 mg of Valium to prevent seizures, and transporting to a trauma center. B) preoxygenating her with a bag-mask device and 100% oxygen for 2 to 3 minutes, performing nasotracheal intubation, transporting at once, starting at least one large-bore IV line en route, and obtaining her Glasgow Coma Scale score. C) intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments. D) applying oxygen via nonrebreathing mask, covering her with blankets, starting an IV of normal saline set to keep the vein open, applying a cardiac monitor, initiating transport, and monitoring her pupils while en route to the hospital
C) intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments
A scalp laceration that occurs in conjunction with a nondisplaced skull fracture: A) typically causes significant hypertension. B) should be treated with firm direct pressure. C) is considered to be an open skull fracture. D) often causes an infection that progresses rapidly.
C) is considered to be an open skull fracture.
Which of the following statements regarding the hypothalamus is correct? A) The hypothalamus works in conjunction with the subthalamus and regulates motor functions of the body. B) The hypothalamus is located in the inferior portion of the diencephalon and influences body movement in response to fear. C) The hypothalamus is located between the brainstem and cerebrum and is solely responsible for maintaining body temperature. D) The hypothalamus is the most inferior portion of the diencephalon and controls functions such as hunger, sleep, and vomiting.
D) The hypothalamus is the most inferior portion of the diencephalon and controls functions such as hunger, sleep, and vomiting.
The MOST disastrous consequence of a severe traumatic brain injury is: A) an increase in intracranial pressure. B) an increase in mean arterial pressure. C) severe hypertension and bradycardia. D) a decrease in cerebral perfusion pressure.
D) a decrease in cerebral perfusion pressure.
A compression or burst fracture of the cervical spine would MOST likely occur following: A) a direct blow to the occipital region of the skull. B) rapid acceleration following a motor vehicle crash. C) axial loading after a patient falls and lands feet first. D) a significant fall in which the patient lands head first.
D) a significant fall in which the patient lands head first.
When an unrestrained passenger's head strikes the windshield of a motor vehicle following rapid deceleration: A) the anterior portion of the brain sustains stretching or tearing injuries, and the posterior portion of the brain sustains compression injuries. B) the head falls back against the headrest or seat and the brain collides with the rear of the skull, resulting in direct injury to the occipital lobe. C) the brain initially strikes the rear of the skull, resulting in direct bruising, and then rebounds and strikes the front part of the skull. D) compression injuries occur to the anterior portion of the brain, and stretching or tearing injuries occur to the posterior portion of the brain.
D) compression injuries occur to the anterior portion of the brain, and stretching or tearing injuries occur to the posterior portion of the brain.
According to the National Spinal Cord Injury Database, MOST spinal cord injuries are caused by: A) acts of violence. B) athletic activities. C) falls in the elderly. D) motor vehicle crashes.
D) motor vehicle crashes.
A moderate diffuse axonal injury: A) is generally characterized by a brief loss of consciousness, with or without retrograde amnesia. B) causes a prolonged loss of consciousness and affects axons in both cerebral hemispheres. C) is the most common result of blunt head trauma and is associated with temporary neuronal dysfunction. D) produces an immediate loss of consciousness and residual neurologic deficits when the patient wakes up.
D) produces an immediate loss of consciousness and residual neurologic deficits when the patient wakes up.
A full-body exam for a trauma patient with a significant mechanism of injury and signs of a spinal cord injury: A) is performed at least every 5 to 10 minutes. B) should focus specifically on the spinal region. C) is usually not practical in the prehospital setting. D) should be performed en route to the hospital.
D) should be performed en route to the hospital.
The MOST effective way for the paramedic to minimize further injury in a patient with a spinal injury is: A) prompt transport of the patient to a trauma center. B) rapid administration of corticosteroid medications. C) aggressive administration of IV crystalloid solutions. D) spinal motion restriction and prevention of heat loss.
D) spinal motion restriction and prevention of heat loss.
Signs of meningeal irritation, such as nuchal rigidity, are MOST commonly seen in patients with a(n): A) subdural hematoma. B) epidural hematoma. C) intracerebral hematoma. D) subarachnoid hemorrhage.
D) subarachnoid hemorrhage.
The cervical spine: A) is the weakest part of the spinal column, yet is generally the least injured part of the spine. B) includes the first seven bones of the vertebral column that indirectly protect the spinal cord. C) consists of vertebrae that are slightly larger than those of the less powerful thoracic spine. D) supports the weight of the head and permits a high degree of mobility in multiple planes.
D) supports the weight of the head and permits a high degree of mobility in multiple planes.
Proprioception is defined as: A) a person's ability to sense light touch. B) the loss of thermoregulatory function distal to an injury. C) a person's awareness of pain and the ability to localize it. D) the ability to perceive the position and movement of one's body.
D) the ability to perceive the position and movement of one's body.
