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