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