Chapter 34 Head and Spine Trauma

Question 1

1. 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.

Answer 1

Ans: D Page: 1644

Question 2

2. The ______________ consists of eight bones that encase and protect the brain. A) skull B) cerebrum C) cranial vault D) cribriform plate

Answer 2

Ans: C Page: 1644

Question 3

3. 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.

Answer 3

Ans: B Page: 1644

Question 4

4. 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

Answer 4

Ans: A Page: 1644

Question 5

5. 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.

Answer 5

Ans: B Page: 1644

Question 6

6. 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.

Answer 6

Ans: A Page: 1644

Question 7

7. 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.

Answer 7

Ans: C Page: 1645

Question 8

8. 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.

Answer 8

Ans: A Page: 1645

Question 9

9. Paralysis of the extremities would MOST likely result from injury to the: A) cerebellum. B) diencephalon. C) cerebral cortex. D) hypothalamus.

Answer 9

Ans: C Page: 1645

Question 10

10. 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.

Answer 10

Ans: C Page: 1646

Question 11

11. 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.

Answer 11

Ans: A Page: 1646

Question 12

12. 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.

Answer 12

Ans: D Page: 1646-1647

Question 13

13. 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

Answer 13

Ans: B Page: 1647

Question 14

14. 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

Answer 14

Ans: D Page: 1647

Question 15

15. The respiratory centers of the brainstem lie within the: A) basal ganglia. B) pons and medulla. C) diencephalon. D) midbrain.

Answer 15

Ans: B Page: 1647

Question 16

16. 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.

Answer 16

Ans: A Page: 1648

Question 17

17. 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

Answer 17

Ans: C Page: 1648

Question 18

18. 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.

Answer 18

Ans: D Page: 1663

Question 19

19. 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.

Answer 19

Ans: B Page: 1662

Question 20

20. 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.

Answer 20

Ans: B Page: 1662

Question 21

21. 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.

Answer 21

Ans: A Page: 1662

Question 22

22. 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.

Answer 22

Ans: A Page: 1669

Question 23

23. 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

Answer 23

Ans: D Page: 1663

Question 24

24. 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.

Answer 24

Ans: C Page: 1663

Question 25

25. 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

Answer 25

Ans: A Page: 1663

Question 26

26. 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

Answer 26

Ans: B Page: 1663

Question 27

27. 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.

Answer 27

Ans: B Page: 1663-1664

Question 28

28. Secondary brain injuries include all of the following, EXCEPT: A) axonal injury. B) cerebral edema. C) cerebral ischemia. D) intracranial hemorrhage.

Answer 28

Ans: A Page: 1664

Question 29

29. 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.

Answer 29

Ans: D Page: 1664

Question 30

30. 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.

Answer 30

Ans: C Page: 1664

Question 31

31. 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.

Answer 31

Ans: D Page: 1664-1665

Question 32

32. 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.

Answer 32

Ans: B Page: 1665

Question 33

33. 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.

Answer 33

Ans: A Page: 1665

Question 34

34. 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.

Answer 34

Ans: A Page: 1665

Question 35

35. 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.

Answer 35

Ans: C Page: 1665

Question 36

36. 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.

Answer 36

Ans: B Page: 1665

Question 37

37. 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.

Answer 37

Ans: B Page: 1666

Question 38

38. 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.

Answer 38

Ans: D Page: 1666

Question 39

39. 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.

Answer 39

Ans: D Page: 1667

Question 40

40. 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.

Answer 40

Ans: C Page: 1666-1667

Question 41

41. 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.

Answer 41

Ans: A Page: 1667-1668

Question 42

42. 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.

Answer 42

Ans: B Page: 1668

Question 43

43. 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.

Answer 43

Ans: B Page: 1668

Question 44

44. 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

Answer 44

Ans: B Page: 1668

Question 45

45. 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.

Answer 45

Ans: D Page: 1668

Question 46

46. 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.

Answer 46

Ans: C Page: 1658, 1668

Question 47

47. 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.

Answer 47

Ans: A Page: 1658-1659

Question 48

48. 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.

Answer 48

Ans: A Page: 1654

Question 49

49. 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.

Answer 49

Ans: C Page: 1653-1655

Question 50

50. 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.

Answer 50

Ans: B Page: 1653-1655, 1658

Question 51

51. 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.

Answer 51

Ans: B Page: 1670

Question 52

52. 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.

Answer 52

Ans: D Page: 1670

Question 53

53. 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.

Answer 53

Ans: C Page: 1670

Question 54

54. 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.

Answer 54

Ans: A Page: 1648

Question 55

55. The anterior weight-bearing structure of the vertebra is the: A) pedicle. B) vertebral body. C) lamina. D) spinous process.

Answer 55

Ans: B Page: 1648-1649

Question 56

56. 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.

Answer 56

Ans: D Page: 1649

Question 57

57. 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.

Answer 57

Ans: C Page: 1649

Question 58

58. Because of its weight-bearing capacity, the ________ spine is especially susceptible to injury. A) cervical B) thoracic C) lumbar D) coccygeal

Answer 58

Ans: C Page: 1649

Question 59

59. Although extremely painful, injuries to the ________ spine are typically neurologically insignificant. A) lumbar B) coccygeal C) thoracic D) cervical

Answer 59

Ans: B Page: 1650

Question 60

60. 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.

Answer 60

Ans: D Page: 1650

Question 61

61. 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.

Answer 61

Ans: A Page: 1650

Question 62

62. 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

Answer 62

Ans: A Page: 1645

Question 63

63. 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.

Answer 63

Ans: D Page: 1647

Question 64

64. 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.

Answer 64

Ans: C Page: 1648

Question 65

65. 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

Answer 65

Ans: B Page: 1644, 1650

Question 66

66. 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.

Answer 66

Ans: A Page: 1650

Question 67

67. 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

Answer 67

Ans: B Page: 1650, 1652

Question 68

68. What spinal nerve tract carries information regarding pain and temperature? A) Corticospinal B) Spinocerebellar C) Reticulospinal D) Lateral spinothalamic

Answer 68

Ans: D Page: 1651

Question 69

69. 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.

Answer 69

Ans: C Page: 1650-1651

Question 70

70. 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.

Answer 70

Ans: C Page: 1651

Question 71

71. 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.

Answer 71

Ans: A Page: 1651

Question 72

72. 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.

Answer 72

Ans: B Page: 1670

Question 73

73. The only area of the spine that allows for significant rotation is: A) C1-C2. B) C2-C4. C) C6-C7. D) T1-T2.

Answer 73

Ans: A Page: 1670

Question 74

74. 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.

Answer 74

Ans: D Page: 1671

Question 75

75. 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.

Answer 75

Ans: C Page: 1671

Question 76

76. 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.

Answer 76

Ans: B Page: 1671

Question 77

77. 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.

Answer 77

Ans: A Page: 1671

Question 78

78. 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

Answer 78

Ans: C Page: 1672

Question 79

79. 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.

Answer 79

Ans: D Page: 1672

Question 80

80. 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.

Answer 80

Ans: C Page: 1672

Question 81

81. 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.

Answer 81

Ans: B Page: 1672

Question 82

82. 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.

Answer 82

Ans: A Page: 1672

Question 83

83. 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.

Answer 83

Ans: D Page: 1672

Question 84

84. 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

Answer 84

Ans: B Page: 1672

Question 85

85. 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.

Answer 85

Ans: B Page: 1672

Question 86

86. Signs of neurogenic shock include all of the following, EXCEPT: A) bradycardia. B) flushed skin. C) diaphoresis. D) hypothermia.

Answer 86

Ans: C Page: 1673

Question 87

87. 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.

Answer 87

Ans: A Page: 1673

Question 88

88. 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

Answer 88

Ans: D Page: 1656

Question 89

89. 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

Answer 89

Ans: A Page: 1652

Question 90

90. 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.

Answer 90

Ans: B Page: 1656

Question 91

91. 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

Answer 91

Ans: A Page: 1653

Question 92

92. 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.

Answer 92

Ans: B Page: 1654

Question 93

93. 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.

Answer 93

Ans: D Page: 1654

Question 94

94. 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.

Answer 94

Ans: C Page: 1655

Question 95

95. 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.

Answer 95

Ans: C Page: 1656

Question 96

96. 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.

Answer 96

Ans: B Page: 1656

Question 97

97. 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.

Answer 97

Ans: A Page: 1656-1657

Question 98

98. 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.

Answer 98

Ans: A Page: 1657

Question 99

99. 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.

Answer 99

Ans: D Page: 1657

Question 100

100. 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.

Answer 100

Ans: B Page: 1659-1660

Question 101

101. The FIRST step in any neurologic assessment involves: A) obtaining an initial Glasgow Coma Scale score. B) asking the patient if he or she can feel or move. C) determining the patient’s level of consciousness. D) assessing the pupils for size, equality, and reactivity.

Answer 101

Ans: C Page: 1660

Question 102

102. When assigning a Glasgow Coma Scale (GCS) score to a patient who has limb paralysis due to a spinal cord injury, you should: A) score the patient as having no motor response. B) ask the patient to blink or move a facial muscle. C) exclude the motor response portion of the GCS. D) use another method for assessing neurologic function.

Answer 102

Ans: B Page: 1660

Question 103

103. When performing a cranial nerve assessment of a patient with a suspected spinal injury, you note that the patient’s pupil is constricted and the upper eyelid droops. This indicates an injury to: A) C3. B) C4. C) C5. D) C6.

Answer 103

Ans: A Page: 1660

Question 104

104. Inability to feel or move below the level of the nipple line indicates injury to which spinal nerve root? A) C7 B) T1 C) T4 D) L1

Answer 104

Ans: C Page: 1662

Question 105

105. Hyperacute pain to touch is called: A) parasthesia. B) anesthesia. C) hyperesthesia. D) akathisia.

Answer 105

Ans: C Page: 1660

Question 106

106. A positive Babinski reflex is observed when the: A) toes curve or move downward when the sole of the foot is touched. B) patient responds to pain by flexing the arms and extending the legs. C) patient’s reflexes are hyperactive in response to an external stimulus. D) toes move upward in response to stimulation of the sole of the foot.

Answer 106

Ans: D Page: 1661

Question 107

107. Spinal cord injuries that cause neurogenic shock generally produce: A) cool, clammy skin distal to the site of the spinal cord injury. B) reflex tachycardia due to sympathetic nervous system stimulation. C) flaccid paralysis and complete loss of sensation distal to the injury. D) signs and symptoms that are identical to those of hypovolemic shock.

Answer 107

Ans: C Page: 1661

Question 108

108. When moving an injured patient from the ground onto a long backboard, it is preferred that you: A) slide the patient onto the backboard. B) use the four-person log roll technique. C) log roll the patient away from you. D) use a scoop stretcher to move the patient.

Answer 108

Ans: B Page: 1674

Question 109

109. When immobilizing a patient to a long backboard, you should take standard precautions and then: A) ensure that the patient’s head is stabilized manually. B) assess distal pulse, sensory, and motor functions. C) log roll the patient as a unit and assess his or her back. D) apply the appropriately sized cervical collar to the patient.

Answer 109

Ans: A Page: 1674

Question 110

110. An injured patient’s head should be secured to the long backboard only after: A) you have placed padding under the shoulders. B) his or her torso has been secured adequately. C) both of the legs are secured to the board properly. D) a vest-style immobilization device has been applied.

Answer 110

Ans: B Page: 1674

Question 111

111. Spinal cord injury without radiographic abnormalities (SCIWORA. can occur in children because: A) their vertebrae lie flatter on top of each other. B) they have excessive mobility of C1 and C2. C) unlike adults, their vertebrae are more curved. D) their spinal cord is more compressed than an adult’s.

Answer 111

Ans: A Page: 1673

Question 112

112. In which of the following situations would it be MOST appropriate to apply a vest-type extrication device or a short backboard to a patient who is seated in his or her crashed motor vehicle? A) Conscious with bilateral femur fractures B) Unconscious with obvious spinal deformity C) Confused with lower back pain and tachycardia D) Conscious with neck pain and stable vital signs

Answer 112

Ans: D Page: 1676

Question 113

113. When immobilizing a sitting patient with a vest-type extrication device or short backboard, you should manually stabilize his or her head and then: A) apply an appropriately sized cervical collar. B) perform a rapid assessment to detect life threats. C) assess distal pulse and sensory and motor functions. D) carefully place the vest device behind the patient.

Answer 113

Ans: C Page: 1676

Question 114

114. When applying a vest-type extrication device or short backboard to a seated patient, his or her head should be secured to the device: A) after you apply a cervical collar. B) only after the torso is fastened securely. C) before you secure his or her torso. D) after he or she is moved to a long backboard.

Answer 114

Ans: B Page: 1676

Question 115

115. If a trauma patient cannot be assessed properly in his or her vehicle, you should: A) apply a rigid cervical collar, perform a rapid assessment only, and then remove the patient with the two-person lift technique. B) maintain manual stabilization of the head, apply a cervical collar, and move the patient from the vehicle onto a long backboard. C) apply a vest-type extrication device and then rapidly remove him or her from the vehicle using at least three people. D) grasp the patient behind the shoulders, cradle his or her head in your arms to protect the spine, and rapidly extricate him or her from the car.

Answer 115

Ans: B Page: 1677-1678

Question 116

116. You would MOST likely have to place several blankets or pillows under a patient’s upper back prior to immobilization if he or she has: A) kyphosis. B) osteoarthritis. C) spondylosis. D) osteoporosis.

Answer 116

Ans: A Page: 1678

Question 117

117. When performing the standing takedown technique to immobilize a patient’s spine, the patient is secured to the long backboard with straps: A) while still in the standing position. B) after the board is placed on the stretcher. C) after a cervical collar has been applied. D) after he or she is lowered to the ground.

Answer 117

Ans: D Page: 1679-1680

Question 118

118. Regardless of the method of spinal immobilization used, you must: A) always secure the head before the torso. B) secure the patient in the position found. C) keep the head, neck, and trunk in alignment. D) stabilize the head using slight manual traction.

Answer 118

Ans: C Page: 1680

Question 119

119. A motorcycle or football helmet should be removed if: A) the patient complains of severe neck pain and the helmet fits snugly. B) you are going to transport the patient to a medical treatment facility. C) the patient is breathing shallowly and access to the airway is difficult. D) you are properly trained in the technique, even if you are by yourself.

Answer 119

Ans: C Page: 1680-1681

Question 120

120. Corticosteroid use for a spinal cord injury may lead to significant complications, particularly if: A) the patient is younger than 45 years of age. B) it is initiated less than 3 hours after the injury. C) the patient is also taking beta-blocker medications. D) the injury is accompanied by penetrating trauma.

Answer 120

Ans: D Page: 1682

Question 121

121. You are dispatched to a senior citizen’s center where an elderly woman fainted. When you arrive, you find the patient sitting in a chair. An employee of the center tells you that he caught the patient before she fell to the ground. Your primary assessment reveals that the patient is conscious and alert and is breathing adequately. You should: A) forego spinal immobilization and transport only. B) obtain vital signs and assess her blood glucose level. C) apply oxygen at 15 L/min via nonrebreathing mask. D) perform a rapid head-to-toe assessment to detect injuries.

Answer 121

Ans: B Page: 1652, 1656

Question 122

122. A 45-year-old unrestrained man was ejected from his small truck when it struck a tree. The patient is found approximately 20 feet from the wreckage. Your primary assessment reveals that he is unresponsive and has sonorous respirations and a rapid pulse. Your initial actions should include: A) applying a cervical collar and assisting his ventilations with a bag-mask device. B) rolling the patient onto his side as a unit and suctioning his mouth for 15 seconds. C) performing a tongue-jaw lift and looking in his mouth for any obvious obstructions. D) manually stabilizing his head and opening his airway with the jaw-thrust maneuver.

Answer 122

Ans: D Page: 1653

Question 123

123. You have intubated an unresponsive, apneic patient with a suspected spinal injury. After confirming proper ET tube placement and securing the tube, you should: A) request medical control authorization to give Solu-Medrol. B) ventilate at 10 to 12 breaths/min and monitor end-tidal CO2. C) maintain an end-tidal CO2 reading of greater than 45 mm Hg. D) provide mild hyperventilation in case a head injury is present.

Answer 123

Ans: B Page: 1654

Question 124

124. You are assessing a patient who sustained blunt trauma to the center of his back. He is conscious, but is unable to feel or move his lower extremities. His blood pressure is 80/50 mm Hg, pulse is 40 beats/min and weak, and respirations are 24 breaths/min and shallow. If IV fluids do not adequately improve perfusion, you should: A) give 0.5 mg of atropine and consider a dopamine infusion. B) administer 1 mg of epinephrine 1:10,000 via rapid IV push. C) apply the pneumatic antishock garment and inflate all sections. D) administer a corticosteroid to reduce spinal cord inflammation.

Answer 124

Ans: A Page: 1655

Question 125

125. A skier wiped out while skiing down a large hill. He is conscious and alert and complains of being very cold; he also complains of neck stiffness and numbness and tingling in all of his extremities. A quick assessment reveals that his airway is patent and his breathing is adequate. You should: A) perform a detailed neurologic exam and carefully palpate his neck. B) apply a cervical collar and start an IV line with warm normal saline. C) immobilize his spine and quickly move him to a warmer environment. D) administer oxygen and perform a detailed secondary assessment.

Answer 125

Ans: C Page: 1656

Question 126

126. Following a traumatic injury, a 19-year-old woman presents with confusion, tachycardia, and significant hypotension. Her skin is cool, clammy, and pale. Further assessment reveals abdominal rigidity and deformity with severe pain over her thoracic vertebrae. In addition to administering high-flow oxygen and immobilizing her spine, you should: A) start at least one large-bore IV line and give crystalloid boluses as needed to maintain adequate perfusion. B) conclude that she is in neurogenic shock, start an IV line of normal saline, and initiate a dopamine infusion. C) start at least one large-bore IV of normal saline and administer a narcotic analgesic to treat her severe pain. D) perform a focused history and physical exam, start an IV of normal saline, and administer a corticosteroid.

Answer 126

Ans: A Page: 1655, 1661-1662

Question 127

127. You have just completed spinal immobilization of a hemodynamically stable patient with a possible spinal injury. Prior to moving the patient to the ambulance, it is MOST important to: A) start an IV of normal saline in case the patient deteriorates. B) apply a cardiac monitor and obtain a full set of vital signs. C) perform a detailed secondary assessment to detect other injuries. D) reassess pulse, motor, and sensory functions in all extremities.

Answer 127

Ans: D Page: 1674-1675

Question 128

128. A 21-year-old woman was thrown from a horse and landed on her head. Upon arrival at the scene, you find the patient lying supine. She is conscious and has her head turned to the side. As you attempt to move her head to a neutral in-line position, she screams in pain. You should: A) gently continue to move her head until it is in a neutral in-line position. B) maintain her head in the position found and continue with your assessment. C) perform a quick neurologic exam prior to attempting further movement of her head. D) administer an analgesic to relieve the pain so you can move her head to a neutral position.

Answer 128

Ans: B Page: 1675

Question 129

129. Upon arriving at the scene of a motor vehicle crash, you find the driver of the car still seated in her two-door vehicle. The passenger side of the vehicle has sustained severe damage and is inaccessible. The driver is conscious and alert and complains only of lower back pain. The backseat passenger, a young child who was unrestrained, is bleeding from the head and appears to be unconscious. You should: A) ask the driver to step out of the vehicle so you can access the backseat passenger. B) rapidly extricate the driver so you can gain quick access to the child in the backseat. C) carefully assess the driver for occult injuries before removing her from the vehicle. D) apply a vest-type extrication device to the driver and quickly remove her from the car.

Answer 129

Ans: B Page: 1677

Question 130

130. A 39-year-old man crashed his vehicle into a wooded area and was not found for approximately 8 hours. When you arrive at the scene and assess him, you note that he is conscious but anxious. He is unable to feel or move below his mid-thoracic area and complains of a severe headache. His blood pressure is 210/130 mm Hg, heart rate is 44 beats/min, and respirations are 22 breaths/min. This patient’s clinical presentation is MOST consistent with: A) neurogenic shock. B) intracranial pressure. C) autonomic dysreflexia. D) symptomatic bradycardia.

Answer 130

Ans: C Page: 1683