Which of the following places the layers of the meninges in the correct order as they occur
from the cerebrum to the skull?
pg 285
Pia mater, arachnoid, dura mater
The layer of the meninges that is strong and lines the interior of the cranium is the
pg 285
dura mater
The structure that divides the cerebrum into left and right halves is the
pg 286
falx cerebri.
T/F - The cerebellum is the center of conscious thought and perception
pg 286
False
What is a function of the hypothalamus?
pg 286
Body temperature control
What is a function of the thalamus?
pg 150
Control of the ascending reticular activating system
Which of the following is a function of the medulla oblongata?
pg 286
Control of respiration
T/F - While the brain accounts for only 2 percent of the total body weight, it requires 15 percent of
the cardiac output and 20 percent of the body’s oxygen supply.
pg 287
True
T/F - The capillaries serving the brain are thicker and less permeable than those in the rest of the
body.
pg 287
True
The normal intracranial pressure is
pg 287
less than 10 mmHg.
Perfusion through the cerebrum is a factor of intracranial pressure and
pg 287
mean arterial pressure
The reflex that increases the systemic blood pressure to maintain cerebral blood flow is called
pg 287
autoregulation.
Which nerve is responsible for slowing the heart rate?
pg 288
CN-X
Which nerve is responsible for voluntary movement of the tongue
pg 288
CN-XII
Which nerve control eye movement?
pg 288
CN 3/4/6
The region of the vertebral column in which the spinal cord ends is the
pg 289
lumbar.
The nerve tissue(s) responsible for communicating sensory impulses to the brain is (are) the
pg 289
ascending tracts.
The nerve tissue(s) consisting of nerve cell axons and making up the exterior portion of the
spinal cord is (are) the
pg 289
white matter.
T/F - The structure of the meninges of the spinal column is similar to the structure of the meninges
of the cranium.
pg 290
True
The region of the spine with the closest tolerance between the spinal cord and the interior of
the spinal foramen is the
pg 291
thoracic spine.
The region of the spine that has one more pair of nerve roots than it does vertebrae is the
pg 292
Cervical Spine.
The S-1 nerve root controls the
pg 292
small toe.
The T-10 nerve root controls the
pg 292
umbilicus
During your assessment of a patient, you find sensation is lost as you move from the lower
extremities all the way up to the level of the collar. This is probably due to an injury at which
spinal level?
pg 292
C-3
The type of injury that causes damage to the brain on the side opposite the impact is called
pg 294
contrecoup.
Which of the following is considered a focal injury
A. Cerebral contusion
B. Epidural hematoma
C. Subdural hematoma
D. Intracerebral hemorrhage
E. All of the above
pg 294
E. All of the above
Which of the following injuries is most likely to cause the patient to deteriorate rapidly?
pg 294
Epidural hematoma
Which of the following is an injury with venous bleeding into the arachnoid space?
pg 294
Subdural hematoma
What type head injury would you NOT expect to get worse with time?
pg 295
Concussion.
The injury that classically presents with unconsciousness immediately after an accident
followed by a lucid interval and then a decreasing level of consciousness is most likely a(n)
pg 295
concussion & epidural hematoma
T/F - Indirect brain injury occurs as a result of, but after, initial injury.
pg 295
True
All of the following result in indirect injury to the brain, EXCEPT
A. diminishing circulation to brain tissue.
B. hypertension.
C. hypoxia.
D. hypercarbia.
E. displacement of brain tissue.
pg 296
B. hypertension.
As intracranial hemorrhage begins, it first displaces which occupant of the cranium
pg 296
Venous blood
High levels of carbon dioxide in the blood will cause which of the following
pg 296
Cerebral artery dilation
Vomiting, changes in the level of consciousness, and pupillary dilation result from herniation
of the upper brainstem through the
Pg 297
tentorium incisura.
Cushing’s triad includes
pg 298
Erratic Respirations
Increasing BP
Slowing Heart Rate
Which of the following respiratory patterns is NOT indicative of brain injury?
Eupnea
Cheyne-Stokes respirations
Ataxic respirations
Agonal respirations
Central neurogenic hyperventilation
pg 298
Eupnea
In the presence of increased intracranial pressure, the fontanelles of the infant will
pg 298
bulge.
T/F - A spinal cord concussion is likely to produce residual deficit.
pg 298
False
A patient who presents with quadriplegia, incontinence, and respiratory paralysis has most
likely sustained which type of spinal cord injury?
pg 299
transection.
A spinal cord injury more commonly occurring in patients older than 50 years of age is
pg 299
central cord syndrome.
A penetrating spinal cord injury affecting one side of the cord is known as
pg 299
Brown-Sequard syndrome.
T/F - Spinal shock is a temporary form of neurogenic shock
pg 300
True
What are signs sign associated with neurogenic shock?
pg 301
Priapism
Decreased heart rate
Decreased peripheral vascular resistance
Warm skin below the injury
Which of the following is associated with the resolution of shock due to cord injury and results
in hypertension?
pg 301
Autonomic hyperreflexia syndrome
An episode of transient quadriplegia usually lasts less than
pg 154
15 minutes.
Pediatric patients display different spinal injury patterns than adults for all of the following
reasons, EXCEPT
A. underdeveloped neck muscles.
B. calcified, wedge-shaped vertebrae.
C. shallow, horizontally oriented facet joints.
D. proportionately larger head.
E. increased spinal elasticity and mobility.
pg 301
B. calcified, wedge-shaped vertebrae.
Capnography-guided ventilations for the patient without suspected cerebral herniation should
keep the end-tidal CO2 readings at
pg 303
35 to 40 mmHg.
Endotracheal intubation is indicated in patients with a Simplified Motor Score of
pg 303
Zero
Oxygenation of the head injury patient, who is breathing adequately, should be guided by
oximetry to maintain a saturation of at least
pg 303
96%
The approximate rate of ventilation for the infant head injury patient is
pg 303
25 breaths per minute.
What are signs indicative of cerebral herniation?
pg 304
Increasing blood pressure
Erratic respirations
Decreasing heart rate
Dilated and fixed pupil
Which of the following is a probable sign of increasing intracranial pressure?
pg 304
Slowing pulse rate & Increasing pulse strength
When light intensity changes in one eye and both respond, this response is called
pg 304
consensual reactivity.
When assessing limb sensation in the spine-injured patient, you should check for
pg 305
paralysis.
paresthesia.
paraparesis
anesthesia
T/F - A wide pulse pressure is a sign of cardiovascular compensation and decreasing intracranial
pressure.
pg 306
False
The Glasgow Coma Scale measures a patient’s level of consciousness by assessing
pg 306
eye opening, verbal response, and motor response.
During your assessment you determine that the patient exhibits confused speech, follows
simple commands, and opens his eyes on his own. What Glasgow Coma Scale value would
you assign?
pg 306
GCS of 14
The highest Glasgow Coma Scale score is
pg 306
GCS 15
A patient who responds only to pain by withdrawing, mutters incomprehensible words when
shouted at loudly, and opens his eyes only to pain is given what Glasgow Coma Scale score?
pg 306
GCS of 8
Priapism secondary to spinal injury is the result of
pg 308
unopposed parasympathetic stimulation.
When a patient reports sensitivity to light, this is an example of
pg 308
photophobia.
If the head injury patient is found without any other suspected injuries, what positioning would
be best for him?
pg 309
Recovery position with the head of the stretcher raised 30 degrees
If the patient has sustained an open neck injury with danger of air embolism, what positioning
would be best for him?
pg 309
With the head of the spine board elevated 30 degrees
All of the following are indications for rapid-sequence intubation EXCEPT for a patient who
A. is experiencing trismus.
B. is at risk of rapid airway swelling.
C. is completely unresponsive.
D. none of the above.
E. has serious oral trauma.
pg 309
is completely unresponsive.
T/F - Care for the patient with increasing intracranial pressure must NOT include aggressive fluid
resuscitation, even if the patient’s blood pressure drops below 80 mmHg.
pg 309
False
The minimum blood pressure necessary to maintain cerebral perfusion in the adult patient with
serious head injury is
Pg 308
90 mmHg
Which paralytic increases intracranial pressure and should be used with
caution, if at all, in head injury patients?
pg 310
Succinylcholine
T/F - Diazepam is used to premedicate patients prior to inserting a supraglottic airway.
pg 310
False
Which of the following drugs will reverse the effects of diazepam and midazolam?
pg 310
Flumazenil
Which of the following actions of atropine make it a desirable adjunct to rapid-sequence
intubation?
A. It reduces vagal stimulation.
B. It reduces airway secretions.
C. It reduces fasciculations.
D. It helps maintain heart rate during intubation.
E. All of the above.
pg 310
E. All of the above.
Which of the following is used in the prehospital setting for the treatment of spine injuries?
Mannitol
Furosemide
Methylprednisolone
Dexamethasone
None of the above
pg 311
None of the above
To address bradycardia in the suspected spinally injured patient, which drug would you
consider?
pg 310
Atropine
Dextrose is administered to the head injury patient
pg 311
for hypoglycemia only.
If a suspected spinally injured patient does not respond to fluid resuscitation, which drug
would you consider?
pg 311
Dopamine
