Deck 31: Head Trauma

Question 1

A construction worker was accidentally shot with a nail gun. The nail penetrated the skull approximately ½ inch through the temporal region. Before your arrival, coworkers pulled the nail free. Based on the mechanism of injury, which sign provides the strongest evidence that the meningeal layers have been broken?

A) Blood draining from the puncture wound
B) Crepitus of the skull at the injury site
C) Deformity and depression at the injury site
D) Cerebrospinal fluid oozing from the puncture wound

Answer 1

D

Question 2

Which one of the following patients has an isolated head injury that should be considered the most serious?

A) 31-year-old male who is nonverbal and extends his arms and legs when you pinch the muscles on his shoulder
B) 62-year-old female who fell and hit her head and is becoming more confused and combative
C) 53-year-old female who fell and has a large laceration that is bleeding heavily on the back of her head
D) 21-year-old male wearing a deformed motorcycle helmet who does not respond to verbal or painful stimuli

Answer 2

D

Question 3

A 21-year-old male has suffered a gunshot wound to the head. As you assess him, what finding would you recognize as a nonpurposeful response to pain?

A) Garbled and incomprehensible speech when you call his name
B) Flexing his arms across his chest when you pinch his shoulder
C) Attempting to move his hand away from you as you pinch it
D) Exhibiting no response to any and all stimuli

Answer 3

B

Question 4

A woman strikes her forehead against the dashboard of her car as it strikes a tree. Immediately following the impact, her brain bounces back and forth within her skull. Based on the anatomy and physiology of the skull, which of the following is true?

A) The ridges of the basilar skull can damage the brain as it shifts back and forth.
B) The frontal bone is the thinnest portion of the skull and will most likely be fractured.
C) Her brain will not be injured unless an object from the dashboard penetrates her skull.
D) Her brain will most likely not be damaged since the skull's flexibility is designed to absorb the force of the impact.

Question 5

An unresponsive patient was ejected from a car as it rolled at a high rate of speed. The primary assessment is complete and you are providing positive pressure ventilation with high-concentration oxygen. The patient has a significant deformity to the right side of his head, and both pupils are equal but slow to react to light. He also has deformity to the forearms. Vital signs are: pulse 144, respirations 24 and inadequate, blood pressure 90/50 mmHg, and SpO₂ 97%. Based on this presentation, the EMT should:

A) look for evidence of bleeding in an area of the body other than the brain.
B) reassess the pupils and treat the patient for a severe head injury.
C) splint both arms and reassess the vital signs prior to departing the scene.
D) apply a nonrebreather face mask and prepare for possible seizure activity.

Question 6

A 61-year-old male has fallen off a roof. Your primary assessment findings include unresponsiveness, agonal breathing, and a slow and weak radial pulse. His skin is cool and dry. Emergency Medical Responders are maintaining manual in-line spinal stabilization. Which one of the following would you do immediately?

A) Size and apply a cervical collar.
B) Place the patient in the shock position.
C) Start positive pressure ventilation.
D) Transfer to the stretcher for rapid transport.

Question 7

A 68-year-old female patient is complaining of a headache and generalized weakness. Her husband informs you that she was with a friend yesterday and was involved in a motor vehicle collision. She did strike her face on the dashboard, but refused treatment on scene. Her past medical history includes a stroke with right arm weakness and high blood pressure for which she takes medications. When assessing this patient, what finding should concern the EMT most?

A) Contusion to her left cheek area
B) Weakness to the right-hand grip
C) Bruising behind her left ear
D) Complaint of pain when she moves her jaw

Question 8

Your assessment of a patient involved in a motor vehicle collision reveals a deformity to the left side of the head underneath the hair. On further inspection you note that the skin overlying the deformity is still intact. Based on these assessment findings, which one of the following is the EMT's greatest concern?

A) Possible brain injury
B) Fracture of the skull
C) Potential for infection of the brain
D) Soft tissue trauma to the scalp

Question 9

You are assessing the pupils of a patient who hit his head after falling from the top of a tractor trailer. What pupillary finding suggests a closed head injury?

A) The right pupil constricts when light is shined into the left pupil.
B) The left pupil dilates in reaction to light while the right does not.
C) Both the left and right pupils are constricted and do not react to light.
D) The left pupil constricts to light but the right pupil does not.

Question 10

You suspect that an unhelmeted male patient who was ejected from a motorcycle may have a basilar skull fracture. As you perform the secondary assessment, which finding would reinforce this suspicion?

A) Blood coming from the canals of both ear and nose
B) Dilation and sluggish response of the right pupil to light
C) Clear fluid coming from the right ear and left nostril
D) Paralysis of the left arm and leg

Question 11

You are assessing a patient who had a previous head injury in which a portion of the cerebellum was destroyed. In relation to this specific injury, which of the following would the EMT expect?

A) Inability to remember information such as a past medical history
B) Poor coordination when signing his name to the prehospital care report
C) Problems with the regulation of heart rate and blood pressure
D) Inability to move or feel sensations in one side of his body

Question 12

A middle-aged male immediately died following a self-inflicted gunshot wound to the head. Which portion of the central nervous system was most likely damaged in order to cause such a rapid death?

A) Cerebrum
B) Brainstem
C) Cerebellum
D) Meninges

Question 13

A patient involved in an altercation has been struck on the side of the head with a baseball bat, in addition to suffering several blows to the arms and legs. When assessing this patient, which of the following signs or symptoms best indicates the patient has suffered a brain injury?

A) Confusion and combativeness
B) Complaint of a headache
C) Ecchymosis to the side of the face
D) Weakness to both arms

Question 14

When assessing a head-injured patient, what finding is most indicative of increasing pressure within the skull?

A) Blood pressure of 192/106 mmHg
B) Heart rate of 132 beats per minute
C) Respirations of 24 to 28 per minute
D) Constriction of the right pupil to light

Question 15

A woman has fallen from a second-story window onto the concrete sidewalk below. She is unresponsive and has a large depression to the back and top of her skull. Additional findings include abdominal bruising and an angulated left ankle. Your partner reports that the patient's vital signs are: pulse 68, respirations 14 and irregular, blood pressure 198/110 mmHg, and SpO₂ 91%. Based on these assessment findings, which one of the following should the EMT recognize?

A) Shock caused by bleeding within the head
B) Shock caused by bleeding, most likely in the abdomen
C) Severe head injury with increasing pressure within the skull
D) Past medical history of untreated hypertension

Question 16

A young female was thrown from a horse and is now confused. Assessment findings include an open airway, adequate breathing, and a strong radial pulse. Her vital signs are normal. Which one of the following questions would be the most important to immediately ask her mother, who was riding with her?

A) "Does she have any medical problems?"
B) "Are all of her immunizations up to date?"
C) "Is she allergic to anything?"
D) "Did she lose consciousness?"

Question 17

A patient who fell out of a tree has an open skull injury. Which of the following inquiry descriptions would fit this description?

A) Instability to the temporal region of the skull with no break in the overlying scalp
B) Crepitus to the back of the skull with a hematoma overlying the unstable area
C) Laceration to the top of the scalp with pain to the skull when palpated
D) Obvious deformity to the right side of the skull with a laceration to the overlying scalp

Question 18

The EMT is properly assessing for sensory function in the hands when he tells or asks the patient to:

A) "Squeeze my fingers with both hands."
B) "Can you tell me what finger I am touching?"
C) "Do you feel me touching your right hand?"
D) "Can you wiggle your fingers?"

Question 19

A 41-year-old male patient has been struck in the head with a metal pipe. As you approach the patient, you note that he is combative and has blood on the left side of his face and head and on his shirt. His breathing appears to be labored and he is incontinent of urine. Which one of the following would you perform immediately?

A) Check his pupils for equality and reactivity.
B) Apply oxygen at 15 lpm via nonrebreather mask.
C) Take manual in-line spinal stabilization.
D) Expose the chest to look for possible bleeding.

Question 20

A 52-year-old male is unresponsive and has bruises and lacerations to the head, chest, and abdomen. Bystanders state that the patient was intoxicated and got into a fight with several patrons of a bar. They state that he was beaten with their fists, and not other objects or weapons. The patient has snoring respirations, shallow breathing, and a strong radial pulse. His skin is warm and dry. After taking manual in-line spinal stabilization, which one of the following should be your next action?

A) Insert a nasal or oral airway.
B) Perform the jaw-thrust maneuver.
C) Start positive pressure ventilation.
D) Apply a cervical collar.

Question 21

A 57-year-old man fell on the sidewalk, hitting his head on the concrete. According to witnesses, the patient was unresponsive for several minutes following the fall. Which one of the following would be most critical to relay to the physician in the emergency department?

A) Knee replacement two years ago
B) History of alcoholism
C) Position in which the patient was found
D) History of depression

Question 22

Which finding is most consistent with a basilar skull fracture?

A) Bruising behind the ear
B) Bilateral constricted pupils
C) A hematoma over the occipital region
D) Altered mental status

Question 23

Your patient is a young adult female who was struck by a vehicle while she was riding her bicycle. She was not wearing a helmet. She is unresponsive and has a deformity with a deep depression to the temporal area of the head. You note no bleeding and the scalp is intact. Which one of the following is the greatest threat associated with this injury?

A) Fracture of the temporal bone
B) Damage to the brain
C) Potential for infection
D) Loss of cerebrospinal fluid

Question 24

Which one of the following best describes the purpose of determining a Glasgow Coma Scale score (GCS) in a patient with a head injury?

A) The score gives information about the type of injury to the brain.
B) It allows the EMT to predict the patient's likelihood of recovery.
C) The score is important in guiding the EMT's treatment of the patient.
D) It helps determine whether a patient's mental status is improving or deteriorating.

Question 25

A young male patient was running through a park and struck his head on a low-lying branch of a tree. Emergency Medical Responders have already immobilized the patient to a long board and are providing supplemental oxygen through a nonrebreather face mask. During transport, which one of the following assessment findings obtained during your reassessment would best indicate that the patient has suffered a concussion?

A) Unequal grip strength
B) Persistent confusion
C) Improving memory
D) Elevated blood pressure

Question 26

A male soccer player was struck in the head with a soccer ball. Players state that he was dazed for several seconds following the impact and then asked the same questions over and over. Presently, he is conscious and oriented to person, but confused to place and time. He also has a reddened area to the side of his head and face. As you proceed with your assessment, his memory continues to improve. Based on these findings, the EMT should suspect which of the following injuries?

A) Concussion
B) Open head injury
C) Epidural hematoma
D) Cerebral contusion

Question 27

An intoxicated teenage male with a diabetic history fell down five stairs and is now responding to a shoulder pinch with garbled speech. Manual stabilization of the cervical spine is being maintained. The primary assessment reveals an open airway, adequate breathing, and strong radial pulse. Vital signs are pulse 122, respirations 18, blood pressure 108/60, and SpO₂ 97%. His skin is warm and dry. Which action would be performed next?

A) Obtain another set of vital signs.
B) Administer oral glucose.
C) Start hyperventilation.
D) Perform a secondary exam.

Question 28

An unhelmeted patient who was thrown from a motorcycle has a large scalp avulsion with obvious depression to the top of his head. These findings suggest which of the following injuries?

A) Intracranial hematoma
B) Linear skull fracture
C) Open head injury
D) Basilar skull fracture

Question 29

An unrestrained middle-aged female was thrown from her car as it rolled in the median of an interstate. She is supine, appears unresponsive, has blood on her face, and has snoring respirations. Your first action on reaching her side should be to:

A) determine the Glasgow Coma Scale score.
B) perform the jaw-thrust maneuver.
C) insert an oropharyngeal airway.
D) find the source of bleeding and apply direct pressure.

Question 30

Which one of the following is considered a normal finding when assessing a patient suffering from a head injury?

A) The left pupil dilates when light is shown onto the right pupil.
B) The right pupil constricts when light is shown into it.
C) Both the left and right pupils dilate when light is shown into them.
D) The right pupil dilates and the left pupil constricts when light is shown into the left eye.

Question 31

Your patient is a young adult male in police custody after he crashed his car into a utility pole. There is minor front-end damage to the vehicle, and the air bags deployed. The patient was not wearing a seat belt and has an abrasion on his forehead. He is awake and oriented to person, time, and place. His speech is slurred and he has an odor of alcohol on his breath. The arresting officer states that he just wants you to check the patient out before he transports him to jail. Which one of the following is most appropriate?

A) Contact medical command.
B) Have the patient sign a refusal-of-care form.
C) Release the patient to the police.
D) Have the officer sign a refusal-of-care form.

Question 32

You have been called by family members for their mother who is "not acting right." On scene the family informs you that they are concerned because their 68-year-old mother has been complaining of a headache for two days and is now very confused. When asking about a bruise on the right side of her forehead, the family states she fell in church a week ago and hit her head. Since all other aspects of the assessment are unremarkable, you suspect a head injury. What condition would you suspect given the findings and history?

A) Subdural hematoma
B) Battle's sign
C) Concussion
D) Cerebral contusion

Question 33

You have been called to a residence of a diabetic patient with altered mental status. A family member states she could not reach the patient by telephone, so she came over and found the patient awake but confused. The patient can remember his name and address, but cannot remember the day or year. He refuses to go to the hospital, but consents to an assessment. Of the following physical exam findings, which one is most concerning?

A) Bruise to the left temple
B) Blood glucose level of 77 mg/dL
C) SpO₂ at 95%
D) Heart rate of 62 beats per minute

Question 34

A patient complaining of a headache states that he fell and struck the back of his head. Which of the following patient statements should be of most concern to the EMT?

A) "I lost my balance after stumbling on the rug."
B) "I take the blood thinner for my heart."
C) "I had a mini-stroke (TIA) five years ago."
D) "I had my appendix out two weeks ago."

Question 35

A trauma surgeon informs you that the patient you transported to the emergency department earlier was diagnosed with an epidural hematoma. The patient was taken into surgery and the hematoma was removed. Right now the patient is in critical condition. Based on this information, the EMT should recognize that the patient suffered from:

A) blood from a ruptured vein that collected between the dura mater and brain tissue.
B) cerebrospinal fluid that accumulated in a pocket on top of the brain tissue.
C) blood from a ruptured artery that formed a hematoma within a section of brain tissue.
D) a pocket of arterial blood that collected between the skull and dura mater.

Question 36

A young female patient involved in a motor vehicle collision responds to painful stimuli by extending her arms and legs. Her airway is open and breathing shallow and irregular. A radial pulse that is moderate in strength is palpated. Her pulse is 64 beats per minute, respirations are 8, and blood pressure is 210/110 mmHg with an SpO₂ 90%. She has noted deformity to her forehead and a left pupil that is dilated and does not respond to light. Manual in-line stabilization is being held by Emergency Medial Responders (EMR). At this time, the EMT's priority action is to:

A) apply a nonrebreather face mask with high-concentration oxygen.
B) start positive pressure ventilation at 20 breaths per minute.
C) perform the secondary assessment to identify additional injuries.
D) apply a cervical collar and transfer to the stretcher for immediate transport.

Question 37

Which finding indicates that a patient who received a blow to the head is suffering from something other than a concussion?

A) He cannot remember what happened.
B) He asks the same questions over and over.
C) His heart rate is 92 and his blood pressure is 144/86.
D) His pupils are noticeably unequal.

Question 38

You have been called to the local community hospital for a 48-year-old male involved in a motor vehicle collision 2 hours prior. He has been diagnosed with a cerebral contusion and must be transported to a trauma center for specialty care. As a knowledgeable EMT, you recognize that a cerebral contusion is:

A) an open skull fracture with increased pressure in the skull.
B) the formation of a pocket of blood within the brain tissue.
C) bruising and swelling of the brain tissue.
D) active bleeding between the brain and the skull.

Question 39

At a construction site, an 18-year-old male was struck in the head by a pallet of concrete blocks as it was being moved by a crane. He has a large laceration to the left side of his head with noted instability to the skull beneath the wound. Moderate bleeding from the injury site is also noted. His airway is open, his breathing is adequate, and his pulse is strong and regular. Proper care for this patient should include:

A) hyperventilation with high-concentration oxygen.
B) direct pressure to control bleeding from injury.
C) rapid transport in an upright position.
D) loose dressing over the top of the laceration.

Question 40

A young female pedestrian was hit by a car and thrown 15 feet, striking her head against a metal guardrail. You start your secondary assessment and note a deep depression to the right parietal area of her head with intact skin overlying the area. You should:

A) note the injury and continue assessing the patient.
B) apply an ice pack to the injured area.
C) gently palpate the depression to determine the possibility of a skull fracture.
D) instruct your partner to hyperventilate the patient with a bag-valve mask.

Question 41

Your patient is a 40-year-old male who fell 20 feet from a ledge while hiking. The park ranger is maintaining manual in-line spinal stabilization. The patient is combative and confused, but the airway is open and breathing is adequate. The patient has a radial pulse of 112, blood pressure of 96/76, and SpO₂ 91%. Which one of the following should you do first?

A) Check the patient's blood glucose level.
B) Immobilize the patient to a long board.
C) Begin administering supplemental oxygen.
D) Perform a jaw-thrust maneuver.

Question 42

The cerebellum is described as an area of the brain that:

A) is responsible for most conscious and sensory functions.
B) consists of two hemispheres each containing five distinct lobes.
C) controls reflexes and assists in maintaining body posture.
D) controls the body functions most essential and vital to life.

Question 43

A 14-year-old male fell 10 feet from a retaining wall and hit his head on a metal post. He is responsive to verbal stimuli with incomprehensible speech. The secondary assessment indicates blood and fluid coming from inside the patient's left ear. You should do which one of the following?

A) Tilt the backboard to the left to allow the ear to drain freely.
B) Place a folded piece of gauze in the ear canal to stop the drainage.
C) Suction the blood from the ear so you can determine the source of bleeding.
D) Place a piece of sterile gauze over the ear.

Question 44

A male patient in his thirties fell 10 feet off of a loading dock, landing on his head. He has deformity and depression to the back of his head and is unresponsive with snoring respirations. Vital signs are pulse 132, respirations are agonal, blood pressure 136/64, and SpO₂ 89%. He responds to painful stimuli with purposeful activity. What instruction would you provide other caregivers at the scene?

A) "I need someone to start positive pressure ventilation at 12 breaths a minute."
B) "The patient is herniating, start hyperventilation of the patient immediately."
C) "Let's try a nonrebreather with high-concentration O₂ to increase his oxygen saturation."
D) "The airway must be manually opened with a head-tilt, chin-lift immediately!"

Question 45

You are assessing a patient who has sustained blunt trauma to the head. Which would be most indicative of the loss of cerebrospinal fluid (CSF)?

A) Red-tinged fluid in the ear canal
B) Light bruising around both eyes
C) Clear fluid coming from the nose
D) Dark bruising on the forehead

Question 46

You are transporting a patient with a right-sided head injury after a large refrigerator fell and pinned his head between the appliance and the floor. On scene, the patient was responsive to verbal stimuli with the following vital signs: pulse 96, respirations 16, blood pressure 134/66, and SpO₂ 95%. During transport, as you reassess the patient, what would be the most indicative sign that the head injury is worsening?

A) Increasing edema to right side of head
B) Current blood pressure 108/68 mmHg
C) Responding to painful stimuli
D) Heart rate of 112 beats per minute

Question 47

A patient exhibits retrograde amnesia when she:

A) cannot remember falling and hitting her head.
B) responds purposely to painful stimuli.
C) is foggy to events occurring after the injury.
D) is nonverbal following a head injury.

Question 48

Which statement is true regarding linear skull fractures?

A) Linear skull fractures are rare and infrequently encountered.
B) Linear skull fractures are identifiable by a mild depression in the skull.
C) Linear skull fractures place the patient at risk for blood loss.
D) Linear skull fractures cannot be identified with palpation.

Question 49

The EMT recognizes the parameters of the Glasgow Coma Score (GCS) as:

A) eyes, motor, and verbal response.
B) vital signs and mental status.
C) mental status, vital signs, and verbal response.
D) verbal and motor response.

Question 50

When using the Glasgow Coma Score (GCS) , the EMT understands that:

A) the score identifies the type of head injury.
B) the higher score the better.
C) the score must be combined with vital signs.
D) a low score indicates less severity.

Question 51

At an industrial complex, a young male was struck in the head by a large piece of steel thrown from a grinding machine. Assessment reveals a soft, painful depression underlying a tear in his scalp, which is covered with dried blood. There is also clear fluid coming from his right ear. He is conscious but confused and exhibits the following vital signs: pulse 84, respirations 16, blood pressure 142/76, and SpO₂ 92%. Emergency Medical Responders are on scene and are maintaining in-line manual stabilization of the cervical spine. What instruction would indicate the next step needed in this patient's care?

A) "Let's pack his right ear with gauze to stop the loss of fluid."
B) "Place manual, direct pressure over the injury to control bleeding."
C) "I need someone to check the clear fluid for glucose."
D) "Will someone administer supplemental oxygen to the patient?

Question 52

A patient with Cushing reflex is most likely incurring what pathophysiology?

A) Concussion
B) Hypovolemia
C) Brain herniation
D) Shock

Question 53

As brain herniation occurs, the body responds by:

A) increasing blood pressure to perfuse the brain.
B) increasing the heart rate to circulate oxygen-rich blood faster.
C) decreasing blood pressure to decrease pressure within the skull.
D) discharging cerebrospinal fluid to decrease pressure within the skull.

Question 54

Which one of the following statements best describes the technique to be used when hyperventilating a head-injured patient with signs that the brain is herniating?

A) Provide 1 ventilation every 3 seconds.
B) Ventilate 30 times per minute.
C) Provide 1 ventilation every 5 seconds.
D) Ventilate 16 times per minute.

Question 55

You are transporting a patient with a past medical history of a meningeal tumor (tumor on the meninges). You would recognize the tumor as being located:

A) within the cerebrum.
B) in tissue surrounding the brain.
C) within the bones of the skull.
D) in tissue composing the brainstem.

Question 56

Your patient is a young adult male with a gunshot wound to the left side of his head. He is unresponsive with snoring respirations. He is breathing 6 times per minute with a pulse rate of 52 and a blood pressure of 192/104 mmHg. His radial pulse is strong and his skin is cool, but not diaphoretic. In addition to in-line manual stabilization of the cervical spine, the first intervention for this patient would be:

A) high-concentration oxygen via nonrebreather mask.
B) inserting an oropharyngeal airway.
C) performing a jaw-thrust maneuver.
D) administering positive pressure ventilation.

Question 57

The normal response of the pupils while examined with a penlight is described as:

A) dilative.
B) diploplia.
C) dysconjugate.
D) consensual.