Chapter 29: Head and Spine Injuries Practice Multiple Choice Questions
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. 3 C. 4 D. 5
3
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.
A cervical collar is used in addition to, not instead of, manual immobilization.
What is the BEST definition of a step-off?
A deformity of the spine, where the spinous process may be palpable.
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, 90/50 mm Hg pulse, 120 beats/min respirations, 10 breaths/min C.blood pressure, 200/100 mm Hg pulse, 140 beats/min pulse, 140 beats/min respirations, 28 breaths/min D.blood pressure, 80/40 mm Hg pulse, pulse 30 beats/min respirations, 32 breaths/min
A. blood pressure, 190/110 mm Hg pulse, 55 beats/min respirations, 30 breaths/min (high bp, low pulse)
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. cerebrospinal fluid 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
Coordination of balance and body movement is controlled by the: A. medulla. B. cerebrum. C. cerebellum. D. brain stem.
A. cerebellum.
The _________ contain(s) about 75% of the brain's total volume. A. cerebrum B. cerebellum C. brain stem D. meninges
A. cerebrum
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.
In contrast to a cerebral concussion, a cerebral contusion: Select one: A. involves physical injury to the brain tissue. B. does not cause pressure within the skull. C. results from a laceration to the brain tissue. D. usually does not cause a loss of consciousness.
A. involves physical injury to the brain tissue.
Signs and symptoms that might be found in a patient who has experienced a concussion include: A. nausea and ringing in the ears. B. anxiety and restlessness. C. hypotension and nosebleed. D. tachycardia and diaphoresis.
A. nausea and ringing in the ears.
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.
A female patient with a suspected head injury has slow, shallow breathing. The most appropriate treatment for her includes: A. ventilation assistance to maintain an ETCO2 of 30 to 35 mm Hg. B. hyperventilating her at 30 breaths/min. C. ventilation assistance to maintain an oxygen saturation of 90%. D. administering oxygen via a nonrebreathing mask.
A. ventilation assistance to maintain an ETCO2 of 30 to 35 mm Hg.
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 meninges, along with the cerebrospinal fluid (CSF) that circulates in between each meningeal layer, function by: 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. hyperflexion. B. axial loading. C. distraction. D. hyperextension.
B. axial loading
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. sudden hypotension. B. bacterial meningitis. C. hypovolemic shock. D. permanent hearing loss.
B. bacterial meningitis.
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. obtain a Glasgow Coma Score value and give him oxygen. B. immobilize his spine and perform a focused secondary exam. C. allow him to refuse transport if his vital signs remain stable. D. perform a rapid head-to-toe exam and immobilize his spine.
B. immobilize his spine and perform a focused secondary exam.
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. 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.
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 ABCs. D. sensory and motor functions remain intact.
B. it causes a problem managing the airway/ABCs.
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.
When a patient experiences a severe spinal injury, he or she: A. will likely be paralyzed from the neck down. B. may lose sensation below the level of the injury. C. most commonly has a palpable spinal deformity. D. often loses motor function on one side of the body.
B. may lose sensation below the level of the injury.
An injured brain begins to swell initially due to: A.intracranial pressure. B.cerebral edema. C.an epidural hematoma. D.a coup-contrecoup injury.
B.cerebral edema.
A motor vehicle crash is most likely to result in which kind of skull fracture?
Basilar skull fracture g
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: Select one: 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
The most important immediate treatment for patients with a head injury, regardless of severity, is to: A. administer high-flow oxygen. B. immobilize the entire spine. C. establish an adequate airway. D. transport to a trauma center.
C. establish an adequate airway.
In the setting of a head injury, hypertension, bradycardia, and Biot respirations indicate: A. internal bleeding in the chest. B. an underlying skull fracture. C. herniation of the brain stem. D. decreased cerebral blood flow.
C. herniation of the brain stem.
When opening the airway of a patient with a suspected spinal injury, you should use the: A. head tilt-neck lift maneuver. B. head tilt-chin lift maneuver. C. jaw-thrust maneuver. D. tongue-jaw lift maneuver.
C. jaw-thrust maneuver.
What part of the nervous system controls the body's voluntary activities (actions that we consciously perform, in which sensory input or conscious thought determines a specific muscular activity.) A. central B. sensory C. somatic D. autonomic
C. somatic
When the parasympathetic nervous system is activated: a) hormones are released that prepare the body for stress. b) heart rate and blood pressure increase. c) the heart rate decreases and the blood vessels dilate d) blood is shunted away from the digestive organs.
C. the heart rate decreases and the blood vessels dilate
Rotation-flexion injuries of the spine that are the result of rapid acceleration forces are more likely to happen at which two cervical vertebrae?
C1 and C2
Which of the following interventions may be used to help reduce intracranial pressure? A. Increasing the patient's body temperature B. Maintaining the SpO2 at 90% C. Supine with the legs elevated D. 30-degree elevation of the head
D. 30-degree elevation of the head
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
The hormone responsible for the actions of the sympathetic nervous system is: A. insulin. B. thyroxine. C. aldosterone. D. epinephrine.
D. epinephrine.
Bleeding within the brain tissue itself is called a(n): A. epidural hematoma. B. intracerebral hematoma. C. subdural hematoma. D. intracranial hematoma.
D. intracerebral hematoma.
Common signs of a skull fracture include all of the following, EXCEPT: A. mastoid process bruising. B. ecchymosis around the eyes. C. noted deformity to the skull. D. superficial scalp lacerations.
D. superficial scalp lacerations.
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.
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.
Eighty percent of the cranium is occupied by brain tissue.
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.
Hypoxia and hypotension are the two most common causes of secondary brain injury.
What breathing patterns are MOST indicative of increased intracranial pressure?
Irregular rate, pattern, and volume of breathing with intermittent periods of apnea
Which kind of fractures account for approximately 80% of all fractures to the skull?
Linear skull fractures
All of the following are indications that the patient's head cannot be moved any farther, EXCEPT:
Numbness, tingling, or weakness in the neck area.
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?
Retrograde amnesia
What is the most prominent and most easily palpable spinous process?
Seventh cervical vertebra
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.
The absence of raccoon eyes or Battle's sign does not rule it out.
Which of the following statements regarding motor nerves is correct? a) They perform special functions such as sight, smell, and hearing. b) They are part of the CNS and control reflexes. c) They transmit information from the body to the brain via the spinal cord. d) They carry information from the CNS to the muscles.
They carry information from the CNS to the muscles.
If you are unable to provide a patent and open airway using the jaw-thrust maneuver, what is acceptable for you to do next, even if this might cause further injury to the spine?
Use the head tilt-chin lift maneuver.
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.
a decreased level of consciousness.
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 rapid deterioration of neurologic signs.
A rapid and prolonged loss of consciousness is MOST common in patients with a(n): a) epidural hematoma. b) subdural hematoma. c) concussion. d) contusion.
a) epidural hematoma.
You are treating a 35-year-old female who failed to wear a helmet and struck her head when she fell off her bike. In most EMS systems, she would be taken to a trauma center if her Glasgow Coma Scale (GCS) score was less than: a. 14 b. 10 c. 12 d. 15
a. 14
Your patient has a suspected air bubble that may have been sucked into a large vein in his neck. This is called a(n): a. air embolus b. blood clot c. occlusion d. case of the "bends"
a. air embolus
You are treating a 52-year-old man who was involved in a serious high-speed collision. If the patient is up and walking around at the scene, you should: a. assess for potential spinal injury. b. check with medical direction for orders. c. check with bystanders about the patient's mental status. d. assume that the patient is uninjured.
a. assess for potential spinal injury.
If a responsive patient has the mechanism of injury for a spinal injury, the EMT should do all of the following except: a. assess for spinal pain by asking the patient to move. b. keep the patient still while asking him or her questions. c. assess for equality of strength in the extremities. d. assess for tingling in the extremities.
a. assess for spinal pain by asking the patient to move.
You suspect your patient may have a traumatic brain injury. His signs and symptoms may include: a. blood or fluid flowing from the ears and/or nose. b. yellow discoloration in the eyes. c. bruising around the base of the nose. d. pain at the base of the neck.
a. blood or fluid flowing from the ears and/or nose.
After performing the primary assessment and rapid trauma exam on a spine-injured patient, your next step is to: a. determine the patient's priority b. administer high-concentration oxygen. c. immobilize the patient on a long spine board. d. determine the mechanism of injury.
a. determine the patient's priority
When immobilizing a 6-year-old or younger child on a long backboard: a. provide padding beneath the shoulder blades. b. it is unnecessary to apply a cervical collar. c. place a chin cup or chin strap on the patient. d. secure the head first and then secure the torso.
a. provide padding beneath the shoulder blades.
When assessing a suspected spine-injured patient, you note a reversal of the normal breathing pattern. This is likely a result of damage to the nerves that control the: a. rib cage. b. diaphragm. c. abdomen. d. lungs.
a. rib cage.
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.
after assessing distal neurovascular functions.
Any unresponsive trauma patient should be assumed to have: a) an accompanying spinal injury. b) a history of diabetes mellitus. c) a severe intracranial hemorrhage. d) internal bleeding in the abdomen.
an accompanying spinal injury.
Inability to remember events after an injury.
anterograde amnesia
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.
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.
assess distal neurovascular status in the extremities.
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. hyperventilating her at 30 breaths/min. B. administering oxygen via a nonrebreathing mask. C. ventilation assistance to maintain an oxygen saturation of 90%. D. assisting ventilations at an age-appropriate rate.
assisting ventilations at an age-appropriate rate.
The body's functions that occur without conscious effort are regulated by the _________ nervous system. A. sensory B. somatic C. autonomic D. voluntary
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) avoid excessive pressure when applying the bandage. c) apply firm compression for no longer than 5 minutes. d) apply manual pressure and avoid applying a bandage.
avoid excessive pressure when applying the bandage.
Injuries in which load is applied along the vertical or longitudinal axis of the spine, which results in load being transmitted along the entire length of the vertebral column; for example, falling from a height and landing on the feet in an upright position.
axial loading injuries
What is the significance of an increase in carbon dioxide in the injured brain? a. it increases the blood pressure. b. It causes brain tissue swelling. c. It raises the heart rate. d. It causes brain tissue shrinkage.
b. It causes brain tissue swelling.
You are treating a 45-year-old male who was involved in a high-speed car crash. You have decided to use the rapid extrication technique, which is typically used in all of the following situations except when: a. moving a patient rapidly from an unsafe scene. b. a stable, low-priority patient must be immobilized. c. more seriously injured patients must be accessed. d. moving a high-priority patient.
b. a stable, low-priority patient must be immobilized.
Skull or traumatic brain injury may result in: a. airway swelling and dizziness. b. altered mental status and unequal pupils. c. difficulty moving below the waist. d. nausea and hypoperfusion.
b. altered mental status and unequal pupils.
Your patient is a 19-year-old male who was involved in a motorcycle crash. You should consider keeping the helmet on the patient: a. if it interferes with breathing management. b. if it has a snug fit that allows no head movement. c. by using a two-rescuer procedure. d. if it hinders immobilization.
b. if it has a snug fit that allows no head movement.
The patient does not complain of any spinal pain. It is important to remember that a lack of spinal pain does not rule out the possibility of spinal-cord injury because: a. spinal injuries seldom cause pain. b. other painful injuries may mask it. c. spinal injuries are not painful until shock sets in. d. a patient may feel the pain but cannot verbalize it.
b. other painful injuries may mask it.
You are assessing a 22-year-old male who was involved in a bar fight earlier this evening. It is now 4 a.m. and the family called the ambulance because he has been vomiting. Further examination reveals that he also has discoloration of the soft tissues under both eyes. This finding is called: a. Cushing's syndrome. b. raccoon eyes. c. Battle's sign. d. posturing syndrome.
b. raccoon eyes.
You are assessing a 27-year-old male who you suspect has a spine injury. If he complains of pain when you attempt to place his head in a neutral in-line position, you should: a. pad the neck before immobilizing. b. steady the head in the position found. c. continue with the stabilization procedure. d. contact medical direction immediately.
b. steady the head in the position found.
Fractures that usually occur following diffuse impact to the head (eg, falls, motor vehicle crashes); generally result from extension of a linear fracture to the base of the skull and can be difficult to diagnose with a radiograph.
basilar skull fractures
Bruising behind an ear over the mastoid process that may indicate a skull fracture.
battle sign
As you are assessing a 24-year-old man with a large laceration to the top of his head, you should recall that:
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.
brain and spinal cord.
You are assessing a 22-year-old male who was involved in a bar fight earlier this evening. It is now 4 a.m. and the family called the ambulance because he has been vomiting. You notice he has a bruise behind the ear. This is called: a. Cushing's syndrome. b. raccoon eyes. c. Battle's sign. d. posturing syndrome.
c. Battle's sign.
You are treating a 22-year-old male who was assaulted with a knife. The attacker slashed the patient's throat. Initially there was considerable blood, but you were able to control it and bandage the wound. The patient went into sudden cardiac arrest. what is the most likely cause? a. a stroke b. a heart attack c. an air embolism d. infection from the wound
c. an air embolism
Your patient fell down the stairs and may have injured his spine. Examples of findings that may lead you to consider a spine injury include all of the following except: a. the presence of priapism. b. the loss of bladder control. c. an increased pulse rate. d. nerve impairment to the extremities.
c. an increased pulse rate.
When a patient has a scalp injury: a. expect minimal bleeding. b. determine the wound depth. c. expect profuse bleeding. d. palpate the site with the fingertips.
c. expect profuse bleeding.
If a stable 22-year-old male patient is found in a sitting position on the ground and is complaining of back pain, the EMT Should: a. apply a cervical collar and rapidly transport the patient. b. ask the patient to lie down, then immobilize. c. immobilize with a short spine board or extrication vest. d. perform a rapid take-down procedure with a long spine board.
c. immobilize with a short spine board or extrication vest.
An abnormal breathing pattern associated with increased intracranial pressure that is characterized by deep, rapid breathing; this pattern is similar to Kussmaul respirations, but without an acetone breath odor.
central neurogenic hyperventilation
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.
cerebral concussion.
Swelling of the brain
cerebral edema
Swelling of the brain.
cerebral edema
The MOST common and serious complication of a significant head injury is: a) a hypoxic seizure. b) cerebral edema. c) a skull fracture. d) acute hypotension.
cerebral edema.
The brain, a part of the central nervous system (CNS), is divided into the:
cerebrum, cerebellum, and brainstem
The five sections of the spinal column, in descending order, are the: A. thoracic, cervical, lumbar, coccygeal, and sacral. B. cervical, thoracic, lumbar, sacral, and coccygeal. C. coccygeal, sacral, lumbar, thoracic, and cervical. D. cervical, coccygeal, thoracic, sacral, and lumbar.
cervical, thoracic, lumbar, sacral, and coccygeal.
Injury in which the brain has been injured but the skin has not been broken and there is no obvious bleeding.
closed head injury
Forces that compress the patient's vertebral body can cause herniation of disks
compression injuries
Rapid deceleration of the head, such as when it impacts the windshield, causes: a) primary impact to the posterior aspect of the brain, resulting in compression injuries, bruising, or torn blood vessels. 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) compression injuries and contusions to the anterior, posterior, and lateral aspects of the brain.
compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain.
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):
concussion
A temporary loss or alteration of part or all of the brain's abilities to function without actual physical damage to the brain.
concussion
Hyperextension of the spine can cause all of the following injuries, EXCEPT:
concussions
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
connecting
Common signs and symptoms of a serious head injury include all of the following, EXCEPT: A. constricted pupils. B. combative behavior. C. CSF leakage from the ears. D. decreased sensory function.
constricted pupils.
A brain injury that occurs when force is applied to the head and energy transmission through brain tissue causes injury on the opposite side of original impact.
coup-contrecoup brain injury
the symptom triad of increased systolic blood pressure, decreased pulse rate, and irregular respirations
cushing reflex
Which of the following would NOT create a high index of suspicion of a spine injury? a. Motor vehicle or motorcycle collisions b. Falls that cause open fractures to the ankles c. Trauma patients who are found unconscious d. A fall from 1.5 times the patient's height.
d. A fall from 1.5 times the patient's height.
The practice of supine spinal immobilization has recently been on the decline in many services due to possible harmful side effects. These include which of the following? a. hypothermia b. pressure sores c. worsening lung injuries d. all of the above are possible side effects
d. all of the above are possible side effects
You are treating a patient who fell backward and struck his head. You suspect that he is developing increased ICP. The time it takes to develop the symptoms from a increased ICP depend on: a. the rate of bleeding into the head. b. the location of the bleed. c. the age of the patient. d. all of these are important factors.
d. all of these are important factors.
If a patient is found on her back with arms extended above the head, this may indicate a _________ spine injury. a. thoracic b. lumbar c. sacral d. cervical
d. cervical
You are treating a 35-year-old female who has an injury to one of her spinal vertebrae. Based on the frequency of injury, it is most likely one of the: a. lumbar and sacral. b. thoracic and cervical. c. coccygeal and thoracic. d. cervical and lumbar.
d. cervical and lumbar.
You are treating a patient who has a steel rod penetrating the skull. You should: a. shorten lengthy objects, using any available tools. b. elevate the patient's legs immediately. c. remove the object and quickly control the bleeding. d. stabilize the object with bulky dressings, provided it is a length that can be transported with the patient.
d. stabilize the object with bulky dressings, provided it is a length that can be transported with the patient.
The tough, fibrous outer meningeal layer is called the: A. pia mater. B. arachnoid. C. gray mater. D. dura mater.
dura mater.
EMS providers can use an assessment tool that physicians use to decide if full spinal immobilization on a long spine board is needed for a possible spinal injury. The key parts of it are: a. conscious and truthful patient to answer questions b. pain along the spinal midline c. pain upon palpation anywhere on the spine d. intact sensory and motor functions in extremities e. all of the above are key parts of the assessment for spinal integrity
e. all of the above are key parts of the assessment for spinal integrity
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.
ensure that you secure the torso before securing the head.
A patient who experiences an immediate loss of consciousness followed by a lucid interval has a(n):
epidural hematoma
An accumulation of blood between the skull and the dura mater.
epidural hematoma
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
epidural hematoma
The hormone responsible for the actions of the sympathetic nervous system is: A. insulin. B. thyroxine. C. epinephrine. D. aldosterone.
epinephrine.
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.
eye opening, verbal response, and motor response.
A head position in which the patient's eyes are looking straight ahead and the head and torso are in line.
eyes forward position
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.
fainted and fell to the ground from a standing position.
The recommended procedure for moving a patient with a suspected spinal injury from the ground to a long backboard or other spinal precaution device.
four-person log roll
Distraction injuries of the spine are MOST commonly the result of: A. falls. B. diving. C. hangings. D. compression.
hangings.
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
head
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.
immediate reassessment following the intervention.
Tough, elastic structures between adjoining vertebrae that act as shock absorbers.
intervertebral disks
Bleeding within the brain tissue (parenchyma) itself; also referred to as an intraparenchymal hematoma.
intracerebral hematoma
The pressure within the cranial vault.
intracranial pressure
Actions of the body that are not under a person's conscious control.
involuntary activities
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.
it interferes with your assessment of the airway.
When caring for a patient with a possible head injury, it is MOST important to monitor the patient's:
level of consciousness
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. compressed
linear
Fractures that commonly occur in the temporoparietal region of the skull and that are not associated with deformities to the skull; account for 80% of skull fractures; also referred to as nondisplaced skull fractures.
linear skull fractures
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:
manually stabilize his head and move it to a neutral, in-line position
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:
manually stabilize his head, log roll him onto his side, and suction his mouth
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.
may be an indicator of deeper, more serious injuries.
Three distinct layers of tissue that surround and protect the brain and the spinal cord within the skull and the spinal canal.
meninges
Injury to the head often caused by a penetrating object in which there may be bleeding and exposed brain tissue.
open head injury
The _________ nervous system consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves. A. central B. somatic C. autonomic D. peripheral
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.
place padding under the child's shoulders as needed.
What should you do to minimize the risk of injury when a patient is on a backboard?
place padding under the pt
An injury to the brain and its associated structures that is a direct result of impact to the head.
primary injury
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.
pupillary constriction.
Bruising under the eyes that may indicate a skull fracture.
racoon eyes
The inability to remember events leading up to a head injury.
retrograde amnesia
A patient who cannot remember the events that preceded his or her head injury is experiencing: A. retrograde amnesia. B. anterograde amnesia. C. perigrade amnesia. D. posttraumatic amnesia.
retrograde amnesia.
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) rupture of the tympanic membrane following diffuse impact to the head. c) a linear skull fracture and a significant increase in intracranial pressure. d) significant pressure and bleeding in between the skull and dura mater.
rupture of the tympanic membrane following diffuse impact to the head.
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) rupture of the tympanic membrane following diffuse impact to the head. c) fractures to the internal structures of the ear following direct trauma. d) a linear skull fracture and a significant increase in intracranial pressure.
rupture of the tympanic membrane following diffuse impact to the head.
The aftereffects of the primary injury; includes abnormal processes such as cerebral edema, increased intracranial pressure, cerebral ischemia and hypoxia, and infection; onset is often delayed following the primary brain injury.
secondary injury
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
sensory
Moderate elevation in intracranial pressure with middle brain stem involvement is characterized by: A. increased blood pressure, bradycardia, reactive pupils, and rapid respirations. B. sluggishly reactive pupils, widened pulse pressure, bradycardia, and posturing. C. ataxic respirations, unequal pupils, no response to pain, and an irregular pulse. D. fixed and dilated pupils, decreased blood pressure, and irregular respirations.
sluggishly reactive pupils, widened pulse pressure, bradycardia, and posturing.
Bleeding into the subarachnoid space, where the cerebrospinal fluid circulates.
subarachnoid hemorrhage
Neck rigidity, bloody cerebrospinal fluid, and headache are associated with what kind of bleeding in the brain? A. Epidural hematoma B. Subdural hematoma C. Intracerebral hematoma D. Subarachnoid hemorrhage
subarachnoid hemorrhage
An accumulation of blood beneath the dura mater but outside the brain.
subdural hematoma
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. 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.
suction his oropharynx for up to 15 seconds.
You should NOT remove an injured football player's helmet if:
the face guard can easily be removed and there is no airway compromise
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. to use a scoop stretcher. D. the direct patient carry.
the four-person log roll.
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.
the patient has been completely secured to the backboard.
During immobilization of a patient with a possible spinal injury, manual stabilization of the head must be maintained until:
the patient is fully immobilized on a long backboard
A traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes.
traumatic brain injury
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.
use rolled towels to immobilize the patient's head.
Actions that we consciously perform, in which sensory input or conscious thought determines a specific muscular activity.
voluntary activities
