Head and Spine Injuries

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. hyperflexion. B. hyperextension. C. distraction. D. axial loading.

axial loading.

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

retrograde amnesia.

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

slow.

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. 13. B. 14. C. 12. D. 15.

14

A patient with a head injury presents with abnormal flexion of his extremities. What numeric value should you assign to him for motor response? Select one: A. 3 B. 2 C. 4 D. 5

3

Which of the following interventions may be used to help reduce intracranial pressure? Select one: A. Supine with the legs elevated B. Increasing the patient's body temperature C. Maintaining the SpO2 at 90% D. 30-degree elevation of the head

30-degree elevation of the head

The cervical spine is composed of _____ vertebrae. Select one: A. 5 B. 7 C. 8 D. 6

7

Which of the following head injuries would cause the patient's condition to deteriorate most rapidly? Select one: A. Intracerebral hematoma B. Cerebral contusion C. Cerebral concussion D. Subdural hematoma

?

Which of the following statements regarding cervical collars is correct? Select one: A. A cervical collar is used in addition to, not instead of, manual immobilization. B. The patient's head should be forced into a neutral position to apply a cervical collar. C. Cervical collars are contraindicated in patients with numbness to the extremities. D. Once a cervical collar is applied, you can cease manual head stabilization.

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

Which of the following sets of vital signs depicts Cushing triad? Select one: A. Blood pressure, 200/100 mm Hg; pulse, 140 beats/min; respirations, 28 breaths/min B. Blood pressure, 80/40 mm Hg; pulse, 30 beats/min; respirations, 32 breaths/min C. Blood pressure, 90/50 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min D. Blood pressure, 190/110 mm Hg; pulse, 55 beats/min; respirations, 30 breaths/min

Blood pressure, 190/110 mm Hg; pulse, 55 beats/min; respirations, 30 breaths/min

Which of the following nerves allow sensory and motor impulses to be sent from one nerve directly to another? Select one: A. Somatic B. Connecting C. Autonomic D. Peripheral

Connecting

Which of the following statements regarding the cranium is correct? Select one: A. Eighty percent of the cranium is occupied by brain tissue. B. Thirty percent of the cranium is occupied by blood. C. The cranium protects the structures of the face. D. The skull is a subdivision of the cranium.

Eighty percent of the cranium is occupied by brain tissue.

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

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

Which of the following breathing patterns is most indicative of increased intracranial pressure? Select one: 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

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

Which of the following skull fractures would be the least likely to present with palpable deformity or other outward signs? Select one: A. Basilar B. Depressed C. Linear D. Open

Linear

In which of the following situations would the EMT be the least likely to immobilize a patient's spine? Select one: A. Unresponsive, but moving all extremities equally B. No distracting injuries or evidence of intoxication C. No spinal pain, but tingling in the extremities D. Pain to the c-spine, but no numbness or tingling.

No distracting injuries or evidence of intoxication

Which of the following nerves carries information from the body to the brain via the spinal cord? Select one: A. Sensory B. Motor C. Somatic D. Central

Sensory

What part of the nervous system controls the body's voluntary activities? Select one: A. Sensory B. Autonomic C. Central D. Somatic

Somatic

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

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

Which of the following statements regarding motor nerves is correct? Select one: A. They are part of the CNS and control reflexes. B. They carry information from the CNS to the muscles. C. They transmit information from the body to the brain via the spinal cord. D. They perform special functions such as sight, smell, and hearing.

They carry information from the CNS to the muscles.

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

a decreased level of consciousness.

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

a rapid, thready pulse.

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

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

The meninges, along with the cerebrospinal fluid (CSF) that circulates in between each meningeal layer, function by: Select one: A. delivering oxygen directly to the CNS. B. regenerating brain cells after they have been damaged. C. acting as a shock absorber for the brain and spinal cord. D. producing leukocytes that protect the brain from infection.

acting as a shock absorber for the brain and spinal cord.

When immobilizing a seated patient with a short backboard or vest-style immobilization device, you should apply a cervical collar: Select one: A. after moving the patient to a long backboard. B. after the torso has been adequately secured. C. after assessing distal neurovascular functions. D. before manually stabilizing the patient's head.

after assessing distal neurovascular functions.

A short backboard or vest-style immobilization device is indicated for patients who: Select one: A. are sitting in their car and are clinically unstable. B. are in a sitting position and are clinically stable. C. are found supine and have stable vital signs. D. require prompt extrication from an automobile.

are in a sitting position and are clinically stable.

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

assess distal neurovascular status in the extremities.

The body's functions that occur without conscious effort are regulated by the _________ nervous system. Select one: A. sensory B. voluntary C. autonomic D. somatic

autonomic

When controlling bleeding from a scalp laceration with a suspected underlying skull fracture, you should: Select one: A. apply manual pressure and avoid applying a bandage. B. elevate the patient's head and apply an ice pack. C. avoid excessive pressure when applying the bandage. D. apply firm compression for no longer than five minutes.

avoid excessive pressure when applying the bandage.

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: Select one: A. permanent hearing loss. B. hypovolemic shock. C. sudden hypotension. D. bacterial meningitis.

bacterial meningitis.

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

bleeding between the skull and dura mater.

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

brain and spinal cord.

The _________ is the best-protected part of the CNS and controls the functions of the cardiac and respiratory systems. Select one: A. cerebellum B. brain stem C. cerebral cortex D. spinal cord

brain stem

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

cerebellum

An injured brain begins to swell initially due to: Select one: A. an epidural hematoma. B. intracranial pressure. C. cerebral edema. D. a coup-contrecoup injury.

cerebral edema

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

cerebrum

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

cervical, thoracic, lumbar, sacral, and coccygeal.

Rapid deceleration of the head, such as when it impacts the windshield, causes: Select one: A. stretching or tearing of the anterior aspect of the brain and compression injuries or bruising to the posterior aspect of the brain. B. compression injuries and contusions to the anterior, posterior, and lateral aspects of the brain. C. primary impact to the posterior aspect of the brain, resulting in compression injuries, bruising, or torn blood vessels. D. compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion 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.

The frontal and parietal bones of the skull are especially susceptible to: Select one: A. depressed skull fractures. B. basilar skull fractures. C. nondisplaced skull fractures. D. linear skull fractures.

depressed skull fractures.

When assessing a conscious patient with a mechanism of injury that suggests spinal injury, you should: Select one: 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.

determine if the strength in all extremities is equal.

The tough, fibrous outer meningeal layer is called the: Select one: A. arachnoid mater. B. dura mater. C. gray mater. D. pia mater.

dura mater.

When immobilizing a patient on a long backboard, you should: Select one: A. follow the commands of the person at the patient's torso. B. secure the torso and then center the patient on the board. C. have the patient exhale before fastening the torso straps. D. ensure that you secure the torso before securing the head.

ensure that you secure the torso before securing the head.

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

epinephrine

The most important immediate treatment for patients with a head injury, regardless of severity, is to: Select one: A. establish an adequate airway. B. administer high-flow oxygen. C. immobilize the entire spine. D. transport to a trauma center.

establish an adequate airway.

The Glasgow Coma Scale (GCS) is used to assess: Select one: A. mental status, eye opening, and respiratory rate. B. verbal response, eye opening, and mental status. C. eye opening, verbal response, and motor response. D. sensory response, pupil reaction, and heart rate.

eye opening, verbal response, and motor response.

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

fainted and fell to the ground from a standing position.

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

hangings.

When placing a patient onto a long backboard, the EMT at the patient's _________ is in charge of all patient movements. Select one: A. lower extremities B. waist C. chest D. head

head

In the setting of a head injury, hypertension, bradycardia, and Biot respirations indicate: Select one: A. an underlying skull fracture. B. herniation of the brain stem. C. internal bleeding in the chest. D. decreased cerebral blood flow.

herniation of the brain stem.

The effectiveness of positive pressure ventilations when treating a head-injured patient can only be determined by: Select one: A. noting a decrease in the heart rate during ventilations. B. reassessing the patient's blood pressure after 10 minutes. C. immediate reassessment after the intervention. D. a neurosurgeon or emergency department physician.

immediate reassessment after the intervention.

A 45-year-old male was working on his roof when he fell approximately 12 feet, 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: Select one: A. obtain a Glasgow Coma Score value and give him oxygen. B. allow him to refuse transport if his vital signs remain stable. C. perform a rapid head-to-toe exam and immobilize his spine. D. immobilize his spine and perform a focused secondary exam.

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, irregular breathing and a slow, bounding pulse. As your partner maintains manual in-line stabilization of her head, you should: Select one: A. instruct him to assist her ventilations while you perform a rapid assessment. B. perform a focused secondary assessment of the patient's head and neck. 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.

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

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

intracerebral hematoma.

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

involves physical injury to the brain tissue.

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. sensory and motor functions remain intact. C. it causes a problem managing the airway. D. the patient adamantly denies neck pain.

it causes a problem managing the airway.

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

it interferes with your assessment of the airway.

When opening the airway of a patient with a suspected spinal injury, you should use the: Select one: A. tongue-jaw lift maneuver. B. head tilt-chin lift maneuver. C. jaw-thrust maneuver. D. head tilt-neck lift maneuver.

jaw-thrust maneuver.

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: Select one: A. remove his helmet, but leave his shoulder pads in place. B. remove his helmet and shoulder pads. C. leave his helmet and shoulder pads in place. D. leave his helmet in place, but remove his shoulder pads.

leave his helmet and shoulder pads in place.

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

level of consciousness.

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

might be an indicator of deeper, more serious injuries.

When a patient experiences a severe spinal injury, he or she: Select one: A. might lose sensation below the level of the injury. B. will likely be paralyzed from the neck down. C. most commonly has a palpable spinal deformity. D. often loses motor function on one side of the body.

might lose sensation below the level of the injury.

Signs and symptoms that might be found in a patient who has experienced a concussion include: Select one: A. anxiety and restlessness. B. nausea and ringing in the ears. C. hypotension and nosebleed. D. tachycardia and diaphoresis.

nausea and ringing in the ears.

The _________ nervous system consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves. Select one: A. central B. autonomic C. somatic D. peripheral

peripheral

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

place padding under the child's shoulders as needed.

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

pupillary constriction.

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

rapid deterioration of neurologic signs.

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

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

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

spinal canal.

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: Select one: A. immobilize his spine and transport immediately. B. pack his nostrils to stop the drainage of blood. C. assist his ventilations with a bag valve mask. D. suction his oropharynx for up to 15 seconds.

suction his oropharynx for up to 15 seconds.

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

superficial scalp lacerations.

The ideal procedure for moving an injured patient from the ground to a backboard is: Select one: A. the use of a scoop stretcher. B. the four-person log roll. C. the clothes drag. D. the direct patient carry.

the four-person log roll.

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

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: Select one: A. the head has been stabilized with lateral immobilization. B. the patient has been secured to the ambulance stretcher. C. an appropriately sized cervical collar has been applied. D. the patient has been completely secured to the backboard.

the patient has been completely secured to the backboard.

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

use rolled towels to immobilize the patient's head.

A female patient with a suspected head injury has slow, shallow breathing. The most appropriate treatment for her includes: Select one: A. hyperventilating her at 30 breaths/min. B. ventilation assistance to maintain an oxygen saturation of 90%. C. administering oxygen via a nonrebreathing mask. D. ventilation assistance to maintain an ETCO2 of 30 to 35 mm Hg.

ventilation assistance to maintain an ETCO2 of 30 to 35 mm Hg.