Chapt 21 Head and Facial Injuries

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The Galea aponeurotic a is:

A tendon expansion that frontal and occipital muscles of the cranium.

The ____________ consist of the eight bones that encase and protect the brain.

cranial vault


foramen magnum

At what age do the sutures of the skull solidify and the fontanelles close?

18 months

The cone-shaped section of bone located at the base of each temporal bone is called the:

mastoid process

The crista galli:

is the anatomic point of attachment of the meninges.

The occipital condyles are the:

points of articulation between the skull and vertebral column.

Which of the following bones is the part of the cranial vault AND the face?


What two major nerves provide sensory and motor control to the face?

Facial and trigeminal

Blood supply to the face is provided PRIMARILY through the:

external carotid artery

The _______ are coned-shaped fossae that enclose and protect the eyes.


Which of the following statements regarding the septum is MOST correct?

It may be slightly deviated to one side or the other.

The HYOID bone:

floats in the superior aspect of the neck just below the mandible.

Which cranial nerve innervates the muscles that cause motion of the eyeballs and upper lids?


Which portion of the eye may become icteric in patients with hepatitis?


The_______ conducts signals to the brain via the optical nerve and interprets them as vision.


The anterior chamber is the portion of the globe between the ________ and the _________, and is filled with_______ humor.

lens, cornea, aqueous..

Which of the following statements regarding vitreous humor is MOST correct?

It fills the posterior chambers and maintains the shape of the globe.

A patient with a loss of peripheral vision MOST likely has damage to the:


The large cartilaginous external portion of the ear is called the:


The middle ear consists of the :

inner portion of the tympanic membrane and the ossicles.

__________ forms the principal mass of the tooth and is much denser and sronger than bone.


Motor functions to the muscles of the tongue is provided by the ________ nerve.


In addition to massive bleeding, injury to a carotid or vertebral artery would MOST likely cause:

cerebral hypoxia

Loss of function of the lower arms and hands following trauma to the anterior neck is MOST indicative of damage to the:

brachial plexus

Which of the following statements regarding the brain is MOST correct?

The brain uses 45/50 L/min of oxygen per minute

Paralysis of the extremities would MOST likely results from injury to the:

Cerebral cortex

The parental lobe of the brain:

controls somatic functions for the contralateral side of the body.

Injury to the temporal lobe on the left side would MOST likely cause:

abnormal speech

Which of the following statements regarding the hypothalamus is MOST correct?

The hypothalamus is the most inferior portion of the diencephalon and controls functions such as hunger, sleep, and vomiting.

The cerebellum is located in the _______ part of the brain and is responsible for _________.

inferoposterior, posture and equilibrium

What portion of the brain stem is responsible for the maintenance of consciousness , specially one's level of arousal?

Reticular activating system

The respiratory centers of the brain stem lie within the:

pons and medula

The Dura matter:

folds in to form the tentorium, a structure that separates the cerebral hemispheres from the cerebellum and the brain stem.

Cerebrospinal fluid (CSF) is manufactured in the _______ of the brain and serves to ________.

ventricles, cushions and protect the brain

Open soft-tissue facial trauma following a significant mechanism of injury:

suggests that the patient may have closed head injury or spinal injury.

When assessing the patient with the maxillofacial trauma, it is MOST important to:

protect the cervical spine and monitor the patient's neurological status.

The MOST significant complication associated with a fractured nasal bone is:

posterior epistaxis

Because significant force is required to fracture the mandible:

it is often fractured in more than one place and is unstable to palpation.

A fracture of all mid facial bones, separating the entire mid face from the cranium.

is commonly associated with facial elongation and dental malocclusion.

If a patient is unable to follow your fingers above the midline following blunt trauma to the face, you should be MOST suspicious for a/an:

orbital skull fracture.

A flattened appearance to the face and loss of sensation over the check following blunt facial trauma is MOST indicative of a/an:

zygomatic fracture.

cerebrospinal rhinorrhea is MOST

a skull fracture.

if you are unable to orotracheally intubate a patient due to massive maxillofacial trauma and severe oropharyngeal and nasopharyngeal bleeding, you would MOST likely have to perform:

a needle or surgical cricothyrotomy

Appropriate management for a patient with severe epistaxis, tachycardia, and diaphoresis following an injury to the face includes:

administering enough IV crystoaloid fluids to maintain adequate perfusion.

General care for an eye injury involves:

covering both eyes to minimize further injury.

Hyphema is MOST accurately defined as:

blood in the anterior chamber of the eye.

Signs and symptoms of retinal detachment includes:

flashing lights, specks, or floaters in the field of vision.

What part of the eye is MOST commonly injured following a thermal burn?


Which of the following statements regarding anisocoria is MOST correct?

Anisocoria is a condition in which the pupils are equal

A patient with a dysconjugate gaze following an ocular injury:

has discoordination between the movements of both eyes.

When treating a patient with an ocular injury, what should you do to avoid an increase in intraocular pressure(IOP)?

Discourage the patient from coughing

Movement of both of the eyes in unison is called:

sympathetic eye movement

Alkali or strong acid burns to the eyes should be irrigated for an absolute minimum of _________ minutes.

20 minutes

The Only indication for removing contact lenses in the prehospital setting is:

Chemical eye burns.

A rupture tympanic membrane:

is extremely painful but typically heals spontaneously.

When caring fore a patient with a seemingly isolated ear injury, you should:

perform a careful assessment to detect or rule out more serious injuries.

The primary risk associated with oral and dental injuries is:

airway compromise.

When caring for a patient with fracture or avulsed teeth following an assault, you should:

assesss the knuckles of the person who assaulted the patient.

Proper treatment for an open wound to the neck includes:

sealing the wound with an occlusive dressing.

If a knife is impaled in the neck:

a cricothyrotomy may be established a patient airway.

Significant blunt injuries to the larynx or trachea pose an IMMEDIATE risk of:

airway compromise

When managing the airway of an unresponsive patient with serious anterior neck trauma and inadequate breathing, you should:

assist ventilations with a bag-mask device and prepare to intubate.

Bradycardia that occurs shortly after you have dressed and bandaged an open neck wound is MOST likely the result of:

parasympathetic nervous system stimulation due to excessive pressure on the carotid artery.

Vascular injury following trauma to the anterior neck MOST likely present with:

pulse deficits.

Death following a head injury is almost always the result of:

trauma to the brain.

Most head injuries are the result of:

motor vehicle crashes.

Which of the following statements regarding a closed head injury is MOST correct?

In a closed head injury, the dura mater remains intact.

Bleeding from the scalp laceration with an underlying skull deformity:

may contribute to hypovolemia in adults.

Which of the following types of skulls fractures would be the LEAST likely to present with gross physical signs?

Linear fracture

A scalp laceration that occurs in conjunction with a non displaced skull fracture:

is considered to be an open skull fracture

What type of skull fracture is MOST common following high-energy direct trauma to a small surface area of the head with a blunt object?

Depressed fracture

Which of the following signs of a basilar skull fracture would MOST likely be observed in the prehospital setting?

CSF drainage from the ear

Open fractures of the cranial vault:

are associated with a high risk of bacterial meningitis.

Secondary brain injuries include all of the following, EXCEPT:

Axonal injury.

When an unrestrained passenger's head strikes the windshield of a motor vehicle following rapid deceleration:

compression injuries occur to

Following a traumatic brain injury, initial swelling of the brain occurs due to:

cerebral vasodilation.

The MOST disastrous consequence of a severe traumatic brain injury is:

a decrease in cerebral perfusion pressure.

Autoregulation is MOST accurately defined as:

an increase in mean arterial pressure to maintain cerebral blood flow

Prehospital treatment of the patient with a traumatic brain injury must focus primarily on

maintaining cerebral perfusion presssure

Early signs and symptoms of increased intracranial pressure include

headache and vomiting

Decerebrate posturing is characterized by

extension of the arms and extension of the legs

Which of the following statements regarding a cerebral concussion is MOST correct

Concussions are usually not associated with structural brain injury

A diffuse axonal injury (DAI)

involves stretching,shearing or tearing of the extension of the neuron that conducts electrical impulses away from the cell body

Unlike a cerebral concussion a cerebral contusion is:

associated with physical brain damage and more pronounced neurologic deficits

A moderate diffuse axonal injury:

produces an immediate loss of consciousness and residual neurologic deficits when the patient wakes up

An epidural hematoma typically causes rapid deterioration in the head-injured patient's condition because:

it is associated with brisk arterial bleeding

Common clinical findings associated with a subdural hematoma include all of the following, EXCEPT:

rapidly increasing ICP

A subdural hematoma is classified as being acute if clinical signs and symptoms develop:

within 24 hours following the injury

Chronic subdural hematomas are MOST commonly seen in patients who:

have alcoholism

What type of intracranial hemorrhage would MOST likely be caused by a penetrating head injury

Intracranial hematoma

Signs of meningeal irritation, such as nuchal rigidity, are most commonly seen in patients with a/an:

subarachnoid hemorrhage

When assessing the severity of a traumatic brain injury, the single most important assessment parameter is the patients:

level of consciousness

Pupils that are slow(sluggish) to react to light:

are a sign of cerebral hypoxia

Hyperventilation of the brain-injured patient:

shunts oxygen away from the brain and may result in a decreased cerebral perfusion pressure

A young man was assaulted and has extensive maxillofacial injuries. Your initial assessment reveals that he is semiconscious, has poor respitory effort, and has blood draining from the corner of his mouth. Initial management for this patient involves:

manually stabilizing his head in a neutral position, suctioning his oropharynx, and assisting ventilations with a bag mask device and 100% oxygen

A conscious but combative patient with severe facial trauma is fully immobalized on a backboard. During your assessment , the patient begins coughing up large amounts of blood. You suction his oropharynx, but his mouth quickly refills with blood. You should:

roll the backboard on its side ,suction his oropharynx, and prepare to perform pharmacologically assisted intubation

Following blunt trauma to the face, a 30 year old man presents with epistaxis, double vision, and inability to look upward. You should be MOST suspicious of:

an orbital blowout fracture

You are dispatched to a high school where a 16 yr old man was stabbed in the eye with a pencil. Upon your arrival, you find the patient to be conscious and in severe pain. A classmate removed the pencil prior to your arrival. The MOST appropriate care for this patient's injury includes:

covering the affected eye with a sterile dressing and protective eye shield , covering the unaffected eye, and transporting prompt.

You are are caring for a man with a chemical burn to both eyes. The patient, who has contact lenses in place, is in severe pain and tells you that he can't see. Proper care for this patient includes:

carefully removing his contact lenses, flushing both eyes for at least 20 minutes, and transporting with continuous eye irrigation

A 51 yr old woman sustained a large laceration to her cheek when she was cut by a knife during a robbery attempt. The patient is conscious and alert and has several oral bleeding. She denies any other trauma. Your FIRST action should be to :

ensure that she is sitting up and leaning forward

During an explosion, a 42 yr old construction worker sustained a large laceration to the lateral aspect of his neck when he was struck by a piece of flying debris. The patient is conscious , but complains of difficulty hearing. In addition to protecting his spine,you should be MOST concerned with:

covering the laceration with an occlusive dressing and controlling the bleeding

You are in route to the hospital with a conscious middle aged man who experienced trauma to the anterior neck during an assault. He is on supplemental oxygen, has spinal precautions in place, and has a large-bore IV line of normal saline in place. When you obtain a repeat set of vital signs, you note that his blood pressure is 90/64mm Hg, his pulse rate is 120 beats/min, and his respirations are 22 breaths/min with adequate depth. You should:

Keep the patient warm & infuse enough isotonic crystalloid solution to maintain adequate perfusion.

A 19 yr old woman fell from second story window and landed on her head. She is unconscious with a blood pressure of 148/94mm,Hg, heart rate of 58 beats/min, and irregular respirations 8 breaths/mi. Further assessment reveals blood draining from her nose and bilaterally dilated pupils that are slow to react. In addition to employing full spinal precautions, the MOST appropriate treatment for this patient involves:

intubating her trachea after pre oxygenating her for 2 to 3 minuets with a bag-mask device,transporting immediately , starting at least one large-bore IV en route, applying a cardiac monitor and performing frequent neurologic assessments.

A Male patient with a closed head injury opens his eyes in response to pain,makes incomprehensible sounds, and responds ro pain with flexion of his arms. His Glasgow Coma Scale (GCS) score is ______,and the MOST appropriate treatment for him involves:

7; intubation,ventilations performed at a rate of 10 breaths/min, IV fluids as needed to maintain a systolic BP of at least 90mm Hg, and minting his oxygen saturation at greater than 95%.

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