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Test your basic knowledge |
Emergency Medicine: Head Trauma
Start Test
Study First
Subjects
:
health-sciences
,
emergency-medicine
Instructions:
Answer 36 questions in 15 minutes.
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. A - Allergies M - Medications P - Past medical history L - time of Last meal E - Events leading up to injury
AMPLE Acronym for HI hx
Severe TBI
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
1 - None 2 - Incomprehensible 3 - Inappropriate words 4 - Confused speech 5 - Oriented
2. CBF is maintained when the CPP is ______
Bilateral fixed and dilated pupils
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
Pharmacology
> 60 mm Hg
3. Blunt trauma - Usually anterior temopral or posterior frontal lobe - CT may be initially normal - delayed bleed - Symptoms range from normal -> LOC
Pharmacology
Mild TBI
Intraparenchymal Hemorrhage
Uncal Herniation
4. The blood supply to the brain in a given time - Typically 15% of cardiac output - CBF = CPP / CVR
Cerebral Blood Flow
Epidural Hematoma
Mild TBI causes
Contra-coup Injury
5. 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
Diffuse Axonal injury
Primary treatment/management priorities of TBIs
ED steps to lower ICP
Penetrating wounds
6. The pressure inside the skull and thus in the brain tissue and CSF
Moderate TBI
AMPLE Acronym for HI hx
Intracranial Pressure
Mild TBI causes
7. Occurs @ site of impact with an object
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
Coup Injury
Single fixed and dilated pupil
Concussion
8. Uncal transtentorial herniation -> compression of parasympathetic fibers running with CN-III (Oculomotor) -> ________
Severe TBI
Subarachnoid hemorrhage
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
Ipsilateral fixed and dilated pupil
9. Skull fracture causes - Immediate LOC with a 'lucid' period prior to deterioration (in 20%)
Coup Injury
Epidural Hematoma
Bilateral fixed and dilated pupils
Ipsilateral fixed and dilated pupil
10. Athletes at highest risk - Recurrent concussions more likely after 1st
Cerebral Perfusion Pressure
Primary treatment/management priorities of TBIs
Increased risk of brain injury
AMPLE Acronym for HI hx
11. Blunt trauma - shaken baby syndrome - CT normal -> puncuate hemorrhagic injury along grey-white junction of cerebral cortex
Mild TBI injury
Basilar skull fracture
Diffuse Axonal injury
ED steps to lower ICP
12. The major caUse of Brian's herniations
Mild TBI injury
Uncal Herniation
Bilateral fixed and dilated pupils
Pharmacology
13. GCS - Verbal (1-5)
ED steps to lower ICP
Epidural Hematoma
Expanding lesions
1 - None 2 - Incomprehensible 3 - Inappropriate words 4 - Confused speech 5 - Oriented
14. 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
Mild TBI causes
Concussion
Subarachnoid hemorrhage
Moderate TBI
15. The major caUse of brain herniations
Mannitol
Contra-coup Injury
Moderate - Severe TBI Causes
Expanding lesions
16. Occurs @ side opposite to the area that was impacted
Contra-coup Injury
Subdural hematoma
Mild TBI injury
> 60 mm Hg
17. GCS - Eye opening (1-4)
Single fixed and dilated pupil
Diffuse Axonal injury
Mild TBI injury
1 - None 2 - To pain 3 - To command 4 - Spontaneous
18. Increased ICP -> Poor brain perfusion - Bilateral uncal herniation - drug effects - severe hypoxia
Cerebral Perfusion Pressure
Bilateral fixed and dilated pupils
Intracranial Pressure
Single fixed and dilated pupil
19. Battle's sign (mastoid ecchymosis) - Raccoon eyes (periorbital ecchymosis) - CSF otorrhea / rhinorrhea - hemotympanum - vertigo - decreased hearing - 7th nerve palsy
AMPLE Acronym for HI hx
Moderate - Severe TBI Causes
> 20 mm Hg
Basilar skull fracture
20. 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)
Post-Concussive syndrome
Single fixed and dilated pupil
Expanding lesions
Subarachnoid hemorrhage
21. GCS score of 3-8
Epidural Hematoma
Severe TBI
Contra-coup Injury
Intracranial Pressure
22. The most common site of brain herniation
Penetrating wounds
Uncal Herniation
1 - None 2 - To pain 3 - To command 4 - Spontaneous
> 20 mm Hg
23. Osmotic agent that can reduce ICP - Expands plasma volume (reduces hypotension) - Can improve oxygen-carrying capacity
Mannitol
Primary treatment/management priorities of TBIs
Concussion
ED steps to lower ICP
24. GCS score of 9-13
Mild TBI
Moderate TBI
1 - None 2 - Incomprehensible 3 - Inappropriate words 4 - Confused speech 5 - Oriented
Intraparenchymal Hemorrhage
25. GCS Motor (1-6)
Contra-coup Injury
Coup Injury
Moderate TBI
1 - None 2 - Extension 3 - Flexion 4 - Withdraws to pain 5 - Localizes pain 6 - Follows commands
26. 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
1 - None 2 - To pain 3 - To command 4 - Spontaneous
Mild TBI injury
Subarachnoid hemorrhage
Uncal Herniation
27. Intracranial hematoma with uncal herniation - requires rapid operative decompression
Mild TBI
Pharmacology
Single fixed and dilated pupil
Basilar skull fracture
28. GCS score of 14-15
Diffuse Axonal injury
Basilar skull fracture
Moderate - Severe TBI Causes
Mild TBI
29. 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
Contra-coup Injury
Subarachnoid hemorrhage
Moderate - Severe TBI Causes
Subdural hematoma
30. Patients with ______ should be given immediate antibiotics (ceftriaxone 2 gm IV)
Mild TBI injury
Single fixed and dilated pupil
Penetrating wounds
Increased risk of brain injury
31. 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
Primary treatment/management priorities of TBIs
Moderate - Severe TBI Causes
ED steps to lower ICP
Expanding lesions
32. Net pressure gradient causing blood flow to the brain - Too little -> Ischemia - Too much -> Raised ICP
Expanding lesions
Cerebral Perfusion Pressure
Cerebral Blood Flow
Post-Concussive syndrome
33. 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
Uncal Herniation
Ipsilateral fixed and dilated pupil
Mild TBI injury
Subdural hematoma
34. 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
ED steps to lower ICP
Primary treatment/management priorities of TBIs
Increased risk of brain injury
Contra-coup Injury
35. An ICP level of _____ increases subsequent morbidity and mortality
1 - None 2 - To pain 3 - To command 4 - Spontaneous
Single fixed and dilated pupil
> 20 mm Hg
Basilar skull fracture
36. Neurologic or neurophysiologic dysfunction w/o overt hemorrhages or other gross lesions
> 20 mm Hg
Moderate - Severe TBI Causes
Mild TBI causes
Cerebral Perfusion Pressure