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Emergency Medicine: Head Trauma

Instructions:
  • Answer 36 questions in 20 minutes. 2 minutes extra for reading the instructions.
  • If you are not ready to take this test, you can study here.
  • Match each statement with the correct term.
  • Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. Carefully ventilated to maintain PaCO2 levels 35-40 mm Hg - Adequate sedation -> keeps patients relaxed & inhibits gag reflex - Elevate head of bed to 30 degrees -> increases outflow of CSF from skull base - Give mannitol






2. Neurologic or neurophysiologic dysfunction w/o overt hemorrhages or other gross lesions






3. CBF is maintained when the CPP is ______






4. Increased ICP -> Poor brain perfusion - Bilateral uncal herniation - drug effects - severe hypoxia






5. Skull fracture causes - Immediate LOC with a 'lucid' period prior to deterioration (in 20%)






6. Most common type of brain injury - Head injury with a temporary loss of brain function - aka: mild brain injury - mild traumatic brain injury (MTBI) - mild head injury (MHI) - and minor head trauma






7. The major caUse of brain herniations






8. The major caUse of Brian's herniations






9. Intracranial hematoma with uncal herniation - requires rapid operative decompression






10. Net pressure gradient causing blood flow to the brain - Too little -> Ischemia - Too much -> Raised ICP






11. Blunt trauma - acceleration-decelleration injury - Traumatic disruption parenchyma and ____ vessels - blood in CSF - Symptoms of HA - photophobia - meningeal signs - Traumatic ____ common in moderate-severe TBI - Early signs = higher mortality rate






12. Occurs @ side opposite to the area that was impacted






13. GCS - Verbal (1-5)






14. 1. Prevent further secondary injury (managing hypoxemia - hypotension - anemia - hyperglycemia - hyperthermia - evacuating intracranial masses) 2. Identify treatable mass lesions 3. Identify other life-threatening injuries






15. Blunt trauma - Usually anterior temopral or posterior frontal lobe - CT may be initially normal - delayed bleed - Symptoms range from normal -> LOC






16. GCS score of 3-8






17. Occurs @ site of impact with an object






18. GCS score of 14-15






19. Caused by contusions - hematomas - diffuse axonal injury - direct cellular damage - tearing/shearing of tissues - loss of BBB - disruption of neurochemical homeostasis - loss of electrochemical function






20. Battle's sign (mastoid ecchymosis) - Raccoon eyes (periorbital ecchymosis) - CSF otorrhea / rhinorrhea - hemotympanum - vertigo - decreased hearing - 7th nerve palsy






21. Uncal transtentorial herniation -> compression of parasympathetic fibers running with CN-III (Oculomotor) -> ________






22. An ICP level of _____ increases subsequent morbidity and mortality






23. The blood supply to the brain in a given time - Typically 15% of cardiac output - CBF = CPP / CVR






24. Blunt trauma - shaken baby syndrome - CT normal -> puncuate hemorrhagic injury along grey-white junction of cerebral cortex






25. Set of symptoms a patient may experience for up to a year or more after a concussion - Causes: HA - difficulty concentrating - emotional/behavioral problems (irritability)






26. GCS - Eye opening (1-4)






27. Osmotic agent that can reduce ICP - Expands plasma volume (reduces hypotension) - Can improve oxygen-carrying capacity






28. Blunt trauma - acceleration- deceleration - Brains with extensive atrophy (elderly and alcoholics) more susceptible to this - Acute: rapid LOC - lucid period possible - Chronic: Behavioral / AMS - gradual LOC






29. The most common site of brain herniation






30. Athletes at highest risk - Recurrent concussions more likely after 1st






31. The pressure inside the skull and thus in the brain tissue and CSF






32. GCS Motor (1-6)






33. GCS score of 9-13






34. Any alteration in the mental state at the time of the event or subsequent to the event - 'Getting your bell rung' or 'Seeing stars' - Subtle impairment of cognitive function






35. Patients with ______ should be given immediate antibiotics (ceftriaxone 2 gm IV)






36. A - Allergies M - Medications P - Past medical history L - time of Last meal E - Events leading up to injury