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Emergency Medicine: Head Trauma

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. 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






2. 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






3. 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






4. Occurs @ site of impact with an object






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






6. The major caUse of Brian's herniations






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






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






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






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






11. GCS score of 14-15






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






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






14. The most common site of brain herniation






15. CBF is maintained when the CPP is ______






16. 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






17. 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






18. GCS score of 9-13






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






20. GCS - Verbal (1-5)






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






22. GCS Motor (1-6)






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






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






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






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






27. 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)






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






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






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






31. 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






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






33. GCS - Eye opening (1-4)






34. 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






35. The major caUse of brain herniations






36. GCS score of 3-8