Deck 6: Head, Neck, and Spinal Trauma

Question 1

Your patient is a 7-year-old male pedestrian who was struck by a vehicle. Your assessment reveals bleeding from the right auditory canal. Which of the following describes the most appropriate way to manage this?

A) Determining the presence or absence of cerebrospinal fluid is a low priority. Pack the auditory canal with sterile gauze to control bleeding.
B) Use a "halo" test to determine whether cerebrospinal fluid is in the blood. If it is, loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. If cerebrospinal fluid is not present, pack the ear canal with sterile gauze to control bleeding.
C) Determining the presence or absence of cerebrospinal fluid in the blood is a low priority. Loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear.
D) Check the glucose level in the blood draining from the ear. If it is less than the patient's blood glucose level, there is cerebrospinal fluid present. Cover the ear loosely with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. If the glucose level of the blood from the ear is the same as the patient's blood glucose level, pack the auditory canal with sterile gauze to control bleeding.

Answer 1

Determining the presence or absence of cerebrospinal fluid in the blood is a low priority. Loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear.

Question 2

Which of the following groups is NOT among those with the highest incidence of serious head trauma?

A) The elderly
B) Young men
C) Middle-aged men
D) Infants

Answer 2

Middle-aged men

Question 3

Which of the following correctly describes the impact of motorcycle helmet use?

A) Helmet usage is associated with a 10 percent reduction in serious head injuries.
B) There have been no reported fatalities from motorcycle collisions in which the riders were wearing helmets.
C) Helmet usage decreases the risk of serious head injuries but increases the risk of cervical-spine injuries.
D) Helmet usage results in a more than 50 percent reduction in serious head injuries.

Answer 3

Helmet usage results in a more than 50 percent reduction in serious head injuries.

Question 4

Your patient has received blunt facial trauma due to an assault. For which of the following injuries should you maintain a high index of suspicion?

A) Airway obstruction
B) Hypoxia due to aspiration of blood
C) Basilar skull fracture
D) Lumbar spine trauma

Question 5

Your patient is a 22-year-old female assault victim. She has blunt trauma to the face with swelling around the right eye and zygomatic area. Upon assessing her eye movement, you note that the right eye cannot follow your finger and does not move. Which of the following MOST likely explains this finding?

A) She has a fracture of the orbit that has trapped the optic nerve, thereby paralyzing her gaze.
B) She has direct trauma to the eyeball that has damaged the intrinsic muscles of the eye.
C) She has a fracture of the orbit that has trapped the extrinsic eye muscles.
D) She has direct trauma to the eyeball that has damaged the optic nerve, thereby paralyzing her gaze.

Question 6

Regarding the primary assessment of the patient with suspected traumatic brain injury, which of the following describes the best approach to assessing the patient's neurological functioning?

A) The use of AVPU
B) Assessing the patient for level of consciousness and orientation to person, place, and time
C) Assessing a revised trauma score
D) Assessing a Champion trauma scale score

Question 7

Which of the following best describes the percentage of mortality from penetrating gunshot wounds to the cranium?

A) 35 to 50
B) 75 to 80
C) 90 to 95
D) 10 to 15

Question 8

Your patient is a 45-year-old man with extensive blunt trauma to the face. He has decorticate posturing in response to pain; weak, irregular respiratory effort at 6 per minute; and a heart rate of 50 with a good radial pulse. The patient appears to have nasal and mandibular fractures, and an oropharyngeal airway is insufficient to keep the tongue from the posterior pharynx. Which of the following has the most potential to negatively impact the patient?

A) Retrograde intubation
B) Oral intubation under direct laryngoscopy
C) Nasotracheal intubation
D) A non-visualized dual-lumen airway

Question 9

You are caring for a 22-year-old amateur boxer who complained of a sudden obstruction of part of his visual field. This complaint is most consistent with which of the following conditions?

A) Extrusion of the eyeball
B) Subconjunctival hemorrhage
C) Hyphema
D) Retinal detachment

Question 10

Which of the following parameters should be used to guide the oxygenation and ventilation of the patient with a traumatic brain injury?

A) Maintain an oxygen saturation level of at least 96 percent and a capnography reading between 35 and 40 mmHg.
B) Maintain an oxygen saturation level of at least 90 percent and a capnography level < 45 mmHg.
C) Maintain an oxygen saturation level of at least 98 percent and a capnography reading > 45 mmHg.
D) Maintain an oxygen saturation level of at least 90 percent and a capnography reading < 35 mmHg.

Question 11

For the head injury patient without signs of herniation, adjust ventilation rates to maintain a capnography reading of between:

A) 15 and 20 mmHg.
B) 25 and 30 mmHg.
C) 45 and 50 mmHg.
D) 35 and 40 mmHg.

Question 12

Which of the following medications may be indicated in the prehospital management of the patient with traumatic brain injury?

A) Methylprednisolone
B) Diazoxide
C) Mannitol
D) Furosemide

Question 13

Which of the following features of the cranium exacerbates the severity of intracranial trauma?

A) It is rigid.
B) It is formed of dense, heavy bone.
C) It is relatively thin in the frontal region.
D) The sutures allow for separation of the bones.

Question 14

During the early care for a patient with a basilar skull fracture in the prehospital setting, which of the following would be an unexpected finding?

A) Periorbital ecchymoses or "raccoon eyes"
B) CSF otorrhea
C) Blood mixed with cerebral spinal fluid flowing from the mouth
D) CSF rhinorrhea

Question 15

Which of the following patients fit the criteria for application of spinal precautions in the prehospital setting?

A) An 85-year-old man who has fallen down three steps and has a large laceration to the occipital region of the skull, but no complaints of pain
B) A 21-year-old man who was diving into a pool and states he hit his head, but is out of the pool and ambulatory upon your arrival with no complaint of neck or back pain
C) A 36-year-old woman who was involved in a minor motor vehicle crash with an obvious closed tibia fracture
D) None of the above

Question 16

Circulation to the face is provided by the ________ artery.

A) external carotid
B) internal carotid
C) midfacial
D) mandibular

Question 17

Which of the following best describes the effect of hyperventilation in the brain-injured patient?

A) It is beneficial, because vasodilation results in increased cerebral blood flow.
B) It is detrimental, because vasodilation causes an increase in tissue edema.
C) It is beneficial, because vasoconstriction results in decreased tissue edema.
D) It is detrimental, because vasoconstriction results in decreased cerebral perfusion.

Question 18

The ________ is one of the thinnest and most frequently fractured cranial bones.

A) temporal
B) ethmoid
C) parietal
D) occipital

Question 19

Which of the following skull fractures is most common?

A) Linear
B) Basilar
C) Depressed
D) Comminuted

Question 20

When developing a spinal clearance policy, age:

A) should never be considered, as age does not matter.
B) should be considered only when the patient is a man between the ages of 21 and 35.
C) should be considered, as the very old may not be able to describe their symptoms accurately.
D) should be considered only if the patient is a minor.

Question 21

Which of the following best describes the goals of manual cervical spine stabilization?

A) Preventing movement of the head in any direction; prevent any flexion/extension, rotation, or lateral bending
B) Keeping the head in an "eyes forward" position; applying enough traction to cause axial unloading, which is 18 to 22 pounds in the average adult
C) Preventing rotation of the head; avoiding any upward lifting or downward pressure on the cervical spine
D) Preventing movement of the head in any direction; applying gentle axial pressure to stabilize the vertebral column

Question 22

Which of the following is a common mechanism of injury associated with spinal cord injuries?

A) Falls greater than 20 feet
B) Bungee jumping
C) Shallow water diving
D) All of the above

Question 23

A concussion is best described as which of the following types of brain injuries?

A) Indirect, diffuse
B) Indirect, focal
C) Direct, focal
D) Direct, diffuse

Question 24

The shearing, stretching, and tearing associated with rapid acceleration/deceleration forces acting on the brain result in which of the following types of brain injury?

A) Direct, diffuse
B) Indirect, diffuse
C) Indirect, focal
D) Direct, focal

Question 25

The cerebral perfusion pressure is represented by which of the following equations?

A) CPP = MAP - CVP
B) CPP = CVP - ICP
C) CPP = MAP - ICP
D) CPP = ICP - MAP

Question 26

Your patient is a 12-year-old boy who was struck in the right temporal area of the head with a baseball. He had a brief loss of consciousness and is alert on your arrival. You note that he is becoming drowsy and has a strong radial pulse of 60, a blood pressure of 140/70, and a respiratory rate of 12. Which of the following best describes this patient's condition?

A) He is stable, and he most likely has a subarachnoid hemorrhage with no increase in intracranial pressure.
B) He is critical, and he most likely has an epidural hematoma with rapidly increasing intracranial pressure.
C) He is stable, and he most likely has a mild diffuse axonal injury with no increase in intracranial pressure.
D) He is serious, and he most likely has a subdural hematoma with an increase in intracranial pressure.

Question 27

Which of the following is the largest element of the nervous system?

A) Cerebellum
B) Pons
C) Medulla oblongata
D) Cerebrum

Question 28

You are caring for a 20-year-old skateboarder who crashed into a brick retaining wall at the bottom of a steep hill. He has blunt trauma to his face with nose deformity, loose teeth, and bleeding from the nose and mouth. Although you have answered him several times, he keeps repeating to you, "What happened? It seems like I'm having a bad day." This is most indicative of which of the following?

A) Aphasia
B) Retrograde amnesia
C) Decorticate disorientation
D) Anterograde amnesia

Question 29

Your patient is a 37-year-old male unrestrained driver of a vehicle. You find him with his upper body across the console and his head hanging down into the passenger's side floorboard area. You note pooled blood from a scalp wound. After immobilizing him and loading him into the ambulance, where you have more light for your examination, you note that he has a large, full-thickness avulsion of the scalp. The patient's heart rate is 112, respirations are 20, and blood pressure is 82/50. Which of the following statements about this patient are TRUE?
1) The scalp wound itself cannot account for the patient's vital signs.
2) The scalp wound itself may account for the patient's vital signs.
3) The patient's vital signs are consistent with increasing intracranial pressure.
4) Nothing about the vital signs indicates increased intracranial pressure.

A) 1 and 4
B) 2 and 3
C) 1 and 3
D) 2 and 4

Question 30

Which of the following is NOT a component of the Glasgow Coma Scale?

A) Eye opening
B) Motor ability
C) Pupillary reaction
D) Verbal response

Question 31

Which of the following best describes consensual reactivity of the pupils?

A) It is a pathological phenomenon. When a penlight is shone into one eye, both pupils constrict.
B) It is a normal phenomenon. When a penlight is shone into one eye, only that pupil will constrict, while the other pupil is unaffected.
C) It is a normal phenomenon. When a penlight is shone into one eye, both pupils constrict.
D) It is a pathological phenomenon. When a penlight is shone into one eye, only that pupil constricts, while the other pupil is unaffected.

Question 32

For the patient with suspected traumatic brain injury, the ideal positioning of the patient for transport is:

A) in a left lateral recumbent position on the backboard.
B) on a long backboard with the foot of the backboard in a 15-degree Trendelenburg position.
C) on a long backboard with the patient's feet elevated on pillows to achieve a 15-degree angle.
D) on a long backboard with the head of the backboard elevated 15 to 30 degrees.

Question 33

When palpating the spine of a patient during your assessment, you are feeling the:

A) spinous processes.
B) vertebral bodies.
C) transverse vertebral processes.
D) vertebral pedicles.

Question 34

Which of the following statements about the administration of dextrose to the patient with a traumatic brain injury is TRUE?

A) Hypoglycemia is associated with a poorer neurologic outcome; if the blood glucose level is less than 60 mg/dL, administer 25 grams of dextrose.
B) Hypoglycemia is inconsequential to neurologic outcome; assessing the blood glucose level is not a priority.
C) Hyperglycemia is associated with a poorer neurologic outcome; never administer dextrose to a patient with traumatic brain injury.
D) Hypoglycemia is associated with a poorer neurologic outcome. All patients with suspected traumatic brain injury who have an altered mental status should receive 25 grams of dextrose intravenously.

Question 35

Recent research has provided evidence of which of the following regarding spinal injury assessment?

A) Only trauma patients with signs and symptoms of neurological deficit need to receive spinal immobilization.
B) Paramedics cannot reliably identify patients who are likely to have spinal injuries.
C) All trauma patients should be assumed to have spinal injuries.
D) There are reliable criteria for determining the likelihood of spinal injury.

Question 36

Your patient states that he had a traumatic brain injury from a motorcycle collision three years ago. You notice that his gait is unsteady and his movements are a bit jerky. You suspect that he has damage to which of the following structures?

A) Falx cerebri
B) Reticular activating system
C) Third cranial nerve
D) Cerebellum

Question 37

Which of the following Glasgow Coma Scale scores indicates serious brain injury?

A) < 3
B) Between 12 and 15
C) < 8
D) < 15

Question 38

Which of the following mechanisms causes indirect brain injury?

A) Coup/contrecoup injuries
B) Systemic hypotension combined with increasing intracranial pressure
C) Cushing's reflex
D) Acceleration/deceleration forces without a direct blow to the cranium

Question 39

Which of the following are the two most important prehospital considerations for head injury patients?

A) Cervical spine immobilization and ventilation
B) ICP monitoring and administering corticosteroids
C) Ventilation and administering corticosteroids
D) Ventilation and maintaining adequate blood pressure

Question 40

A patient who has dived into a shallow pool and hit his head on the bottom is MOST likely to have which of the following types of injuries?

A) Cervical hyperextension
B) Cervical hyperflexion
C) Axial distraction
D) Axial loading

Question 41

All the following are seen in Cushing's triad, EXCEPT:

A) increased blood pressure.
B) irregular respirations.
C) tachycardia.
D) All of the above are seen in Cushing's triad.

Question 42

Anterior cord syndrome is caused by which of the following mechanisms?

A) Tearing of the anterior cord due to hyperextension mechanisms
B) Disruption of arterial blood supply to the anterior cord
C) Laceration of the anterior cord caused by bone fragments
D) Contusion of the anterior cord caused by blunt trauma

Question 43

The diaphragm is controlled by peripheral nerve roots ________ through ________.

A) C-3; C-7
B) C-3; C-5
C) C-1; C-7
D) C-1; C-5

Question 44

The spinal cord is continuous from the brain to the level of:

A) T-12 or T-13.
B) L-5 or L-6.
C) the coccyx.
D) L-1 or L-2.

Question 45

Which of the following about the use of prehospital fluid resuscitation in the patient with a traumatic brain injury is TRUE?

A) Administer fluids aggressively regardless of the patient's blood pressure.
B) Do not administer fluids unless the patient's blood pressure drops below 60 mmHg, because the administration of fluids leads to increased cerebral edema.
C) Administer fluids as needed to maintain a systolic blood pressure above 90 mmHg.
D) The use of hypertonic fluids is indicated to maintain vascular volume while reducing tissue edema.

Question 46

A patient unable to extend the leg or flex the hip is MOST likely to have incurred an injury in which nerve plexus?

A) Cervical
B) Lumbar
C) Brachial
D) Sacral

Question 47

You are treating a 16-year-old male patient who fell while practicing a new move on his skateboard. Bystanders relate that the patient was not wearing a helmet. The bystanders also relate that the patient was alert and oriented following the fall; however, while waiting for you to arrive, the patient became unconscious. While performing your physical exam, you note that the patient has a hematoma to the right temporal area. Your assessment leads you to believe that your patient has an epidural hematoma. You know that an epidural hematoma is caused by what type of bleeding?

A) Venous bleeding
B) Capillary bleeding
C) Arterial bleeding
D) Venous and capillary bleeding

Question 48

A spinal cord lesion may result in paralysis of both lower extremities. This condition is known as:

A) hemiplegia.
B) hemiparesis.
C) quadriplegia.
D) paraplegia.

Question 49

All of the following are used in the sedation of patients for rapid sequence intubation, EXCEPT:

A) Valium.
B) Romazicon.
C) etomidate.
D) ketamine.

Question 50

Which of the following spinal cord injuries is LEAST likely to result in residual neurologic deficit?

A) Compression
B) Transection
C) Contusion
D) Laceration

Question 51

Pediatric patients are ________ likely to become hypovolemic from head injuries than adult patients.

A) more
B) less
C) equally
D) Pediatric patients always become hypovolemic due to the movable fontanels.

Question 52

Which of the following is a function of the sympathetic nervous system?

A) Digestion
B) Sexual functioning
C) Constriction of the pupils
D) Increased heart rate

Question 53

You have intubated a 5-year-old girl with a suspected head injury. You note that the patient is exhibiting signs of herniation. What is the desired range for this patient's end-tidal CO₂?

A) 35 to 40
B) 30 to 35
C) 25 to 30
D) 40 to 45

Question 54

When CPP falls below the critical level of 50 mmHG, autoregulation does which of the following to maintain CPP and cerebral perfusion?

A) Decreases blood pressure
B) Increases blood pressure
C) Decreases intracranial pressure
D) Increases intracranial pressure

Question 55

The phrenic nerve consists of peripheral nerve roots ________ through ________.

A) C-1; C-3
B) C-5; C-8
C) C-3; C-5
D) C-1; C-8

Question 56

Coup injuries commonly occur in which region of the brain?

A) Frontal region
B) Occipital region
C) Temporal region
D) Neuronal region

Question 57

Which of the following best describes the role of rapid sequence intubation (RSI) in the prehospital management of patients with traumatic brain injury?

A) It is beneficial and should be used for all patients with traumatic brain injury who are experiencing trismus or who have an intact gag reflex.
B) It is supported by anecdotal evidence, but no studies have been done to determine its feasibility or usefulness.
C) It is controversial because of conflicting study results.
D) It is detrimental, resulting in poorer neurological outcomes than in patients who received standard airway management.

Question 58

Which of the following statements about the patient in neurogenic shock is NOT true?

A) The patient's heart rate may be slow.
B) The patient's blood pressure is decreasing.
C) Signs of hypovolemic shock may be masked.
D) Unopposed sympathetic nervous system stimulation results in generalized pallor and diaphoresis.

Question 59

When assessing an individual who has lost sensation below the umbilicus, at what level do you suspect injury?

A) T-10
B) T-4
C) L-1
D) T-8

Question 60

Your patient is a 17-year-old female who fell from a horse. She is complaining of being unable to move. During your assessment, you have placed her arms at her sides, but her arms keeping returning to a "stick-up" or "hold-up" position. Based on this, which of the following is MOST likely?

A) The patient has a spinal-cord injury at T-1.
B) The patient has Brown-Séquard syndrome.
C) The patient is feigning the injury.
D) The patient has a spinal cord injury in the midcervical region.

Question 61

Concussion is a(n) ________ injury.

A) direct.
B) indirect.
C) diffuse.
D) delayed.

Question 62

A patient who had a spinal cord T4 injury two years ago calls 911 for a pounding headache, blurred vision, and flushing. On your arrival, her vital signs include a blood pressure of 240/120 and pulse of 58. What is this condition called?

A) Autonomic hyperreflexia syndrome
B) Spinal shock
C) Malignant hypertension
D) Brown-Séquard syndrome

Question 63

When providing fluid resuscitation for a 1-year-old child with hypovolemia from a head injury, the goal is to maintain a systolic blood pressure of:

A) 90 mmHg.
B) 85 mmHg.
C) 75 mmHg.
D) 65 mmHg.

Question 64

Intracranial Volume = Brain Volume + CSF Volume + Blood Volume is the basis behind which of the following?

A) Cerebral perfusion pressure
B) Monroe-Kellie doctrine
C) Mean arterial pressure
D) Traumatic brain injury

Question 65

You are on the scene of a domestic assault in which the female victim defended herself against further attack by stabbing her attacker. Your patient is a 36-year-old man who has been stabbed in the posterior thorax about 1 centimeter to the right of the spinous process of T6. Your assessment reveals loss of motor and sensory function on the right side distal to T6 but intact motor function with some loss of sensation on the left side distal to T6. Which of the following best explains this patient's presentation?

A) "Pseudoneurologic" deficit to avoid being arrested
B) Brown-Séquard syndrome
C) Central cord syndrome
D) Autonomic hyperreflexia

Question 66

Which of the following trauma patients is MOST likely to have SCIWORA when examined in the hospital?

A) 5-year-old male
B) 80-year-old female
C) 21-year-old male
D) 45-year-old female

Question 67

A ________ fracture characteristically involves the entire facial region below the brow ridge, including the zygoma, nasal bone, and maxilla.

A) Le Fort I
B) Le Fort II
C) Le Fort III
D) Le Fort IV

Question 68

When assessing the eyes of a patient with head trauma, you can tell the function of all the following cranial nerves, EXCEPT:

A) II.
B) VII.
C) IV.
D) VI.

Question 69

Which of the cervical vertebrae is quite pronounced and can be felt as the first bony prominence along the spine and just above the shoulders?

A) C3
B) C1
C) C6
D) C7

Question 70

Which of the following mechanisms are involved in neurogenic shock?
1) Unopposed vasodilation
2) Loss of innervation to the adrenal medulla
3) Decreased preload
4) Unopposed sympathetic tone

A) 1, 2, 3
B) 1, 3, 4
C) 1, 2, 3, 4
D) 1, 3

Question 71

Your patient has sustained trauma to the eye. Upon examination, you see blood pooling in the anterior chamber and in front of the iris and pupil. What is this condition called?

A) Mediastinitis
B) Otorrhea
C) Icterus
D) Hyphema

Question 72

Which syndrome causes motor weakness that affects the upper extremities and usually occurs in patients older than 50 years of age?

A) Central cord
B) Anterior cord
C) Brown-Séquard
D) Cauda equina

Question 73

In a subdural hematoma, the vessel most commonly involved is the:

A) superior sagittal sinus.
B) inferior sagittal sinus.
C) middle meningeal artery.
D) superior meningeal artery.

Question 74

The cerebrum, cerebellum, and brainstem account for what percentage of the cranial volume?

A) 60 percent
B) 80 percent
C) 50 percent
D) 75 percent

Question 75

Which of the following is noted in the patient with a positive Babinski's sign?

A) Fanning of the toes with plantar flexion of the great toe
B) Dorsiflexion of the second to fifth toes with plantar flexion of the great toe
C) Fanning of the toes with dorsiflexion of the great toe
D) Plantar flexion of the second to fifth toes with dorsiflexion of the great toe