Quiz 9 - Head and Spine Trauma & Chest Trauma Flashcards Preview

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Flashcards in Quiz 9 - Head and Spine Trauma & Chest Trauma Deck (40):
1

Dysrhythmias following a myocardial contusion are usually secondary to:

A. direct damage to the vasculature of the epicardium.

B. excess tachycardia that accompanies the injury.

C. aneurysm formation caused by vascular damage.

D. damage to myocardial tissue at the cellular level.

D. damage to myocardial tissue at the cellular level.

2

Commotio cordis is a phenomenon in which:

A. excessive pressure within the pericardial sac impairs cardiac contractility as well as venous return to the heart.

B. penetrating thoracic trauma perforates the atria or ventricles, causing acute rupture and massive hemorrhage.

C. myocardial tissue at the cellular level is damaged by blunt or penetrating trauma, resulting in cardiac arrest.

D. ventricular fibrillation is induced following blunt trauma to the chest during the heart's repolarization period.

D. ventricular fibrillation is induced following blunt trauma to the chest during the heart's repolarization period.

3

An open pneumothorax causes ventilatory inadequacy when:

A. the glottic opening is much larger than the open wound on the chest wall.

B. the heart stops perfusing the lung on the side of the open chest injury.

C. positive pressure created by expiration forces air into the pleural space.

D. negative pressure created by inspiration draws air into the pleural space.

D. negative pressure created by inspiration draws air into the pleural space.

4

Signs of neurogenic shock include all of the following, EXCEPT:

A. hypothermia.

B. diaphoresis.

C. bradycardia.

D. flushed skin.

B. diaphoresis.

5

When performing the standing takedown technique to immobilize a patient's spine, the patient is secured to the long backboard with straps:

A. after he or she is lowered to the ground.

B. while still in the standing position.

C. after the board is placed on the stretcher.

D. after a cervical collar has been applied.

A. after he or she is lowered to the ground.

6

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. horizontal bones of the cribriform plate that contain foramina.

D. points of articulation between the skull and vertebral column.

D. points of articulation between the skull and vertebral column.

7

A 16-year-old man collapsed after being struck in the center of the chest by a line drive during a high school baseball game. Your assessment reveals that he is pulseless and apneic. As your partner initiates one-rescuer CPR, your MOST important action should be to:

A. attach the ECG leads and be prepared to defibrillate.

B. perform intubation to secure the patient's airway.

C. start an IV line and administer an antiarrhythmic drug.

D. rapidly assess the chest for signs of a sternal fracture.

A. attach the ECG leads and be prepared to defibrillate.

8

A robbery suspect was shot once in the left anterior chest by law enforcement personnel when he pulled a gun on them. The patient is exhibiting obvious signs of shock, is in significant respiratory distress, and is coughing up blood. Further assessment reveals collapsed jugular veins and absent breath sounds over the left hemithorax. After covering the gunshot wound with the appropriate dressing, you should:

A. administer 100% oxygen, administer 1 to 2 L of normal saline, and transport to a trauma center for an emergency pericardiocentesis.

B. perform a needle thoracentesis to the left side of the chest, initiate rapid transport, and administer 20-mL/kg fluid boluses en route.

C. ventilate the patient with a demand valve, transport to a trauma center, and run two large-bore IV lines wide open while en route to the hospital.

D. provide oxygenation and ventilation support, transport at once, and maintain adequate perfusion with IV fluids while en route to a trauma center.

D. provide oxygenation and ventilation support, transport at once, and maintain adequate perfusion with IV fluids while en route to a trauma center.

9

A patient with diaphragmatic breathing without intercostal muscle use has MOST likely experienced a spinal injury above the level of:

A. C2.

B. C7.

C. T2.

D. C5.

C. T2.

10

A subdural hematoma is classified as acute if clinical signs and symptoms develop:

A. within 36 hours following the injury.

B. within 48 hours following the injury.

C. immediately following the injury.

D. within 24 hours following the injury.

D. within 24 hours following the injury.

11

Signs of meningeal irritation, such as nuchal rigidity, are MOST commonly seen in patients with a(n):

A. subarachnoid hemorrhage.

B. epidural hematoma.

C. subdural hematoma.

D. intracerebral hematoma.

A. subarachnoid hemorrhage.

12

Any patient with a presumptive diagnosis of a pneumothorax should:

A. be transported to a trauma center via air medical transport.

B. be considered unstable and reassessed every 5 minutes.

C. be intubated and ventilated at a rate of 15 breaths/min.

D. receive a prophylactic needle thoracentesis.

B. be considered unstable and reassessed every 5 minutes

13

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. Unconscious with obvious spinal deformity

B. Conscious with neck pain and stable vital signs

C. Conscious with bilateral femur fractures

D. Confused with lower back pain and tachycardia

B. Conscious with neck pain and stable vital signs

14

You are transporting a conscious and alert man who experienced an isolated blunt injury to the right anterolateral chest. His vital signs are stable, but he is dyspneic and his breath sounds are diminished over the apex of his right lung. In addition to administering high-flow oxygen, the MOST critical intervention for this patient involves:

A. administering a 500-mL normal saline bolus to maintain perfusion.

B. frequently reassessing him for signs of clinical deterioration.

C. positioning him on his right side to facilitate effective breathing.

D. performing a needle thoracentesis to release intrapleural tension.

B. frequently reassessing him for signs of clinical deterioration.

15

Injury to the temporal lobe on the left side would MOST likely cause:

A. visual disturbances.

B. sleep abnormalities.

C. abnormal speech.

D. lack of coordination.

C. abnormal speech.

16

Inability to feel or move below the level of the nipple line indicates injury to which spinal nerve root?

A. T4

B. L1

C. C7

D. T1

A. T4

17

The innermost meningeal layer that rests directly on the brain and spinal cord is the:

A. pia mater.

B. arachnoid.

C. cortex.

D. dura mater.

A. pia mater.

18

Secondary brain injuries include all of the following, EXCEPT:

A. cerebral edema.

B. axonal injury.

C. intracranial hemorrhage.

D. cerebral ischemia.

B. axonal injury.

19

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. spondylosis.

B. kyphosis.

C. osteoarthritis.

D. osteoporosis.

B. kyphosis.

20

Hyperventilation of the brain-injured patient:

A. shunts oxygen away from the brain and may result in decreased cerebral perfusion pressure.

B. is only appropriate if the patient is unresponsive and has bilaterally dilated and sluggishly reactive pupils.

C. has clearly demonstrated decreased mortality and morbidity in patients with a severe head injury.

D. causes cerebral vasodilation with increased intracranial pressure and should be avoided.

A. shunts oxygen away from the brain and may result in decreased cerebral perfusion pressure.

21

Chronic subdural hematomas are MOST commonly seen in patients who:

A. have high cholesterol.

B. have alcoholism.

C. are less than 2 years of age.

D. are prone to hypoglycemia.

B. have alcoholism.

22

Which of the following clinical findings is MOST suggestive of inadequate oxygenation?

A. Altered mental status

B. Irregular tachycardia

C. Accessory muscle use

D. Blood pressure of 90/50 mm Hg

A. Altered mental status

23

Increased intravenous pressure commonly manifests as:

A. a widened pulse pressure.

B. bounding peripheral pulses.

C. jugular venous distention.

D. a pulsating abdominal mass.

C. jugular venous distention.

24

The cone-shaped section of bone located at the base of each temporal bone is called the:

A. lamboid suture.

B. mastoid process.

C. ethmoid bone.

D. cribriform plate.

B. mastoid process.

25

Which of the following statements regarding the brain is correct?

A. The brain has the ability to store oxygen and glucose.

B. The brain uses 45 to 50 L/min of oxygen.

C. The brain occupies approximately 60% of the cranium.

D. The brain metabolizes minimal amounts of glucose.

B. The brain uses 45 to 50 L/min of oxygen

26

Early signs and symptoms of increased intracranial pressure include:

A. hypertension and bradycardia.

B. headache and vomiting.

C. arm flexion and leg extension.

D. widening of the pulse pressure.

B. headache and vomiting.

27

Beta receptor stimulation results in all of the following effects, EXCEPT:

A. positive cardiac chronotropy.

B. relaxation of bronchiole smooth muscle.

C. vascular smooth muscle contraction.

D. positive cardiac inotropy.

C. vascular smooth muscle contraction.

28

The preferred site for performing a needle thoracentesis is:

A. just above to the fifth rib into the intercostal space at the midaxillary line.

B. just below the second rib into the intercostal space at the midaxillary line.

C. inferior to the third rib into the intercostal space at the midclavicular line.

D. superior to the third rib into the intercostal space at the midclavicular line.

D. superior to the third rib into the intercostal space at the midclavicular line.

29

Traumatic injuries to the aorta are MOST commonly the result of:

A. motorcycle crashes.

B. penetrating trauma.

C. shearing forces.

D. rear-end collisions.

C. shearing forces.

30

Common clinical findings associated with a traumatic asphyxia include all of the following, EXCEPT:

A. facial cyanosis.

B. exopthalmos.

C. tongue swelling.

D. hyphema.

D. hyphema.

31

Flexion injuries to the spine would MOST likely result from:

A. a direct blow to the frontal lobe.

B. rapid acceleration forces.

C. a rear-end motor vehicle crash.

D. rapid deceleration forces.

D. rapid deceleration forces.

32

The self-splinting effect observed in patients with chest wall trauma:

A. may cause atelectasis, hypoxemia, or pneumonia.

B. allows the body to compensate for the injury.

C. is often accompanied by subcutaneous emphysema.

D. is characterized by a markedly increased tidal volume.

A. may cause atelectasis, hypoxemia, or pneumonia.

33

The MOST disastrous consequence of a severe traumatic brain injury is:

A. an increase in mean arterial pressure.

B. severe hypertension and bradycardia.

C. an increase in intracranial pressure.

D. a decrease in cerebral perfusion pressure

D. a decrease in cerebral perfusion pressure

34

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. C6.

B. C4.

C. C5.

D. C3.

D. C3.

35

Which of the following thoracic injuries would you LEAST likely discover in the primary assessment?

A. Open pneumothorax

B. Bronchial disruption

C. Myocardial contusion

D. Flail chest

C. Myocardial contusion

36

Which of the following statements regarding a pericardial tamponade is correct?

A. In a pericardial tamponade, blood collects between the visceral and parietal pericardium.

B. The parietal pericardium stretches easily, so significant blood accumulation is required before signs appear.

C. Pericardial tamponade is characterized by a marked increase in preload and flat jugular veins.

D. Most pericardial tamponades are caused by blunt chest trauma during an automobile crash.

A. In a pericardial tamponade, blood collects between the visceral and parietal pericardium.

37

Which of the following signs of a basilar skull fracture would MOST likely be observed in the prehospital setting?

A. Bruising over the mastoid process

B. Battle's sign

C. cerebrospinal fluid drainage from the ear

D. Ecchymosis around the eyes

C. cerebrospinal fluid drainage from the ear

38

Pneumothoraces create a ventilation-perfusion mismatch when:

A. concomitant myocardial injury prevents adequate pulmonary perfusion and the lung collapses.

B. the affected lung continues to expand adequately despite a decrease in pulmonary perfusion.

C. the vasculature of the affected lung is not intact and intrapulmonary gas exchange is impaired.

D. perfusion of the involved lung continues while the pneumothorax prevents adequate ventilation.

D. perfusion of the involved lung continues while the pneumothorax prevents adequate ventilation.

39

A positive Babinski reflex is observed when the:

A. toes move upward in response to stimulation of the sole of the foot.

B. patient's reflexes are hyperactive in response to an external stimulus.

C. patient responds to pain by flexing the arms and extending the legs.

D. toes curve or move downward when the sole of the foot is touched.

A. toes move upward in response to stimulation of the sole of the foot.

40

Corticosteroid use for a spinal cord injury may lead to significant complications, particularly if:

A. the patient is also taking beta-blocker medications.

B. the injury is accompanied by penetrating trauma.

C. it is initiated less than 3 hours after the injury.

D. the patient is younger than 45 years of age.

B. the injury is accompanied by penetrating trauma.