Head

Question 1

skull “base” comprises of:

Answer 1

frontal
occiput
occipital condyles
clivus
carotid canals
petrous portion of temporal bones
posterior sphenoid wall

Question 2

basically a linear fracture of the skull base

Answer 2

basilar skull fracture

Question 3

Trauma resulting in fractures to this area typically does not have localizing symptoms.

Answer 3

basilar skull fracture

Question 4

basilar skull fracture

Indirect signs of the injury

Answer 4

Battle sign or “raccoon eyes.”
Hemotympanum
blood in the sphenoid sinus
Clear or pink rhinorrhea - dextrose stick test (+), filter paper (halo or double ring)

Question 5

visible evidence of bleeding from the basilar fracture into surrounding soft tissue

Answer 5

Battle sign or “raccoon eyes.”

Question 6

Bleeding into other structures from basilar fracture—includes

Answer 6

hemotympanum

blood in the sphenoid sinus

Question 7

seen as an air-fluid level on computed tomography (CT)

Answer 7

hemotympanum

blood in the sphenoid sinus

Question 8

clear or pink rhinorrhea

can indicate

Answer 8

Cerebrospinal fluid (CSF) leaks

Question 9

how to confirm that
clear or pink rhinorrhea
is associated with CSF leaks

Answer 9

dextrose stick test (+)

filter paper - halo or double ring

Question 10

Identify underlying brain injury, which is best accomplished by

Answer 10

CT

Question 11

also the best diagnostic tool for identifying the fracture site, but fractures may not always be evident.

Answer 11

CT

Question 12

Evidence of open communication, such as a CSF leak, mandates

Answer 12

neurosurgical consultation and admission

Question 13

are antibiotics recommended in CSF leak

Answer 13

controversial because of the possibility of selecting resistant organisms.

Question 14

Clinical manifestations of basilar skull fracture may take_______ to fully develop.

Answer 14

several hours

Question 15

indications for head CT

and threshold

Answer 15

low threshold for head CT in any patient with head trauma, loss of consciousness, change in mental status, severe headache, visual changes, or nausea or vomiting.

Question 16

The use of filter paper or a dextrose stick test to determine if CSF is present in rhinorrhea is______% reliable.

Answer 16

not 100% reliable

Question 17

Acute periorbital ecchymosis seen in this patient with a basilar skull fracture. These findings may also be caused by facial fractures

Answer 17

Raccoon Eyes

Question 18

Subtle periorbital ecchymosis manifests 1 hour after a blast injury

Answer 18

early raccoon eyes

Question 19

Seen in a basilar skull fracture when the fracture line communicates with the auditory canal, resulting in bleeding into the middle ear

Answer 19

hemotympanum

Blood can be seen behind the tympanic membrane

Question 20

Depressed skull fractures typically occur when

Answer 20

a large force is applied over a small area.

Question 21

when are Depressed skull fractures classified as open

Answer 21

skin above them is lacerated

Question 22

sx that may also be present over the fracture site

Depressed skull fractures

Answer 22

Abrasions, contusions, and hematomas
mental status changes - dependent upon the degree of underlying brain injury
evidence of basilar fracture, facial fractures, or cervical spinal injuries

Question 23

how to manage depressed skull fractures

Answer 23

1. Explore all scalp lacerations to exclude a depressed fracture
2. CT - determine the extent of underlying brain injury
3. immediate neurosurgical consultation
4. Open fractures -antibiotics and tetanus prophylaxis as indicated
5. decision to observe or operate - made by neurosurgeon

Question 24

Children below 2 years of age with skull fractures can develop

Answer 24

leptomeningeal cysts, which are extrusion of CSF or brain through dural defects

-> children below age 2 with skull fractures require close follow-up or admission

Question 25

Examine all scalp injuries including lacerations for evidence of fractures or depression. When fragments are depressed _____ mm below the inner table, penetration of the dura and injury to the cortex are more likely.

Answer 25

5 mm

Question 26

Children with depressed skull fractures are more likely to develop

Answer 26

epilepsy

Question 27

Ping pong ball skull fractures can occur from a

Answer 27

forceps delivery or from compression by mother’s sacral promontory during delivery.

Question 28

Patients with head injuries must be evaluated for

Answer 28

cervical spine injuries.

Question 29

Akin to the greenstick fracture, occurs when a newborn or infant’s relatively soft skull is indented by the corner of a table or similar object without causing a frank break in the bone

Answer 29

Ping pong ball skull fractures

Question 30

Scalp lacerations should undergo

Answer 30

sterile exploration for skull fracture

Question 31

Clinically significant nasal fractures are almost always evident with

Answer 31

deformity, swelling, and ecchymosis

Question 32

Epistaxis in nasal fractures may be due to

Answer 32

septal or turbinate laceration but can also be seen with fractures of adjacent bones, including the cribriform plate

Question 33

is a rare but important complication that, if untreated, may result in necrosis of the septal cartilage

Answer 33

Septal hematoma

Question 34

Septal hematoma may lead to this deformity

Answer 34

saddle-nose” deformity.

Question 35

has nasal or frontal crepitus and may have telecanthus or obstruction of the nasolacrimal duct.

Answer 35

frontonasoethmoid fracture

Question 36

Management nasal fractures

Answer 36

1. Look for more serious injuries first. 2. CT to rule out facial fractures. 3. Refer obvious deformities within 2 to 5 days for reduction, after the swelling has subsided 4. Simple nasal fracture - vigorously irrigate + suture lacerations + antibiotic coverage

Question 37

Nasal fractures with mild angulation and without displacement may be reduced in the

Answer 37

emergency department (ED)

Question 38

Nasal injuries without deformity

Answer 38

need only conservative therapy with an analgesic and possibly a nasal decongestant

Question 39

septal hematomas on nasal fractures

Answer 39

Immediately drain | with packing placed to prevent reaccumulation

Question 40

Uncontrolled epistaxis on nasal fractures | intervention

Answer 40

require nasal packing

Question 41

for nasal fractures | to perform a good intranasal examination

Answer 41

control epistaxis

Question 42

If obvious deformity is present, including a new septal deviation or deformity, treat with

Answer 42

ice and analgesics and provide ENT referral in 2 to 5 days for reduction.

Question 43

patients discharged with nasal packing should be placed on

Answer 43

antistaphylococcal antibiotics and referred to ENT in 2 to 3 days Although the effectiveness of prophylactic antibiotics to prevent toxic shock syndrome is unproven

Question 44

Consider cribriform plate fractures in patients after nasal injury if they present with

Answer 44

clear rhinorrhea

Question 45

Patients with facial trauma should be examined for a

Answer 45

septal hematoma

Question 46

bluish, grapelike mass on the nasal septum

Answer 46

septal hematoma

Question 47

septal hematoma | tx

Answer 47

incision, drainage, and packing

Question 48

The zygoma bone has two major components

Answer 48

zygomatic arch and the body.

Question 49

forms the inferior and lateral orbit

Answer 49

arch

Question 50

forms the malar eminence of the face

Answer 50

body

Question 51

Direct blows to the arch can result in

Answer 51

isolated arch fractures

Question 52

isolated arch fractures | manifestations

Answer 52

pain on opening the mouth secondary to the insertion of the temporalis muscle at the arch or impingement on the coronoid process

Question 53

More extensive trauma to the zygomatic arch can result in the

Answer 53

tripod fracture

Question 54

tripod fracture

Answer 54

consists of fractures through three structures: the frontozygomatic suture; the maxillary process of the zygoma including the inferior orbital floor, inferior orbital rim, and lateral wall of the maxillary sinus; and the zygomatic arch

Question 55

tripod fracture | present with

Answer 55

flattened malar eminence and edema and ecchymosis to the area, with a palpable step-off on examination infraorbital paresthesia gaze disturbances Subcutaneous emphysema

Question 56

What other structures that can be affected by zygomatic fracture

Answer 56

Injury to the infraorbital nerve may result in infraorbital paresthesia disturbances may result from injury to orbital contents

Question 57

imaging that best identifies zygoma fractures

Answer 57

Maxillofacial CT

Question 58

Treat simple zygomatic arch or tripod fractures without eye injury with

Answer 58

ice and analgesics and refer for delayed operative consideration in 5 to 7 days.

Question 59

when should you urgently refer zygoma fractured

Answer 59

extensive tripod fractures or those with eye injuries

Question 60

intervention

Answer 60

refer urgently | Decongestants and broad-spectrum antibiotics - since the fracture crosses into the maxillary sinus

Question 61

Zygoma Fractures with blood in the sinus should also be treated with

Answer 61

antibiotics