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