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Adult Health Exam 2: Neuro (Chs 56, & 60) Questions and Answers 100% Solved 2024/2025
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Adult Health Exam 2: Neuro (Chs 56, & 60) Questions and Answers 100% Solved 2024/2025
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Adult Health Exam 2: Neuro (Chs 56, & 60)S. B. is a 28-year-old female. She is married and has a PMH of seizure disorder controlled with
Tegretol. Her last seizure was 5 years ago. She was involved in a motor vehicle crash (MVC).
S.B. was ejected form the car and found unconscious by the emergency medical service. She
was placed on a spinal board and a cervical collar was applied. She was immobilized on a long
backboard.
S.B. was transported to the nearest ER where the neurosurgeon is available on call.
Assessment findings: B/P 160/90, HR 100, R 4/min and stertorous, temperature is 36.7 C.
Pupils are reactive with L> R. Glasgow Coma Scale is 7.
1. What is the test of choice to determine the type of injury S.B. has sustained?
CT scan (with or without contrast)
Why is a MRI not the test of choice for a suspected spinal injury patient?
It takes too long
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For a suspected spinal injury patient:
Get a CT of the spinal cord and (BLANK) of the thoracic area. Apply a (BLANK-BLANK) and
(BLANK-BLANK) patient until spinal cord injuries are ruled out.
X-ray
C collar
,log-roll
S. B. is a 28-year-old female. She is married and has a PMH of seizure disorder controlled with
Tegretol. Her last seizure was 5 years ago. She was involved in a motor vehicle crash (MVC).
S.B. was ejected form the car and found unconscious by the emergency medical service. She
was placed on a spinal board and a cervical collar was applied. She was immobilized on a long
backboard.
S.B. was transported to the nearest ER where the neurosurgeon is available on call.
Assessment findings: B/P 160/90, HR 100, R 4/min and stertorous, temperature is 36.7 C.
Pupils are reactive with L> R. Glasgow Coma Scale is 7.
What are the expected findings?
Bleeding, midline of the brain (BLANK). Contusion. Hematoma. Cerebral (BLANK). (BLANK)
sided brain injury (the clue is Left pupil is bigger than the right).
shift
edema
Left
The brain is a closed circuit. There are two openings. The (BLANK-BLANK) (super small) and
the (BLANK-BLANK) (big opening) *will result in brain death if herniation goes through the
(BLANK-BLANK). *The higher the ICP, the more the brain herniates (BLANK) through the
midbrain, pons and medulla oblongata through the foramen magnum and this =
(BLANK-BLANK).
tentorial notch
Foramen Magnum; forman magnum
downward
brain death
Ratios in skull:
Brain = (BLANK)%
Blood = (BLANK)%
CSF = (BLANK)%
80
10
10
,Because you always have trouble remembering the layers of the brain and different hematomas,
you look up these before S.B. arrives. List and define the 3 major types of hematomas:
(BLANK) (above the dura): 99% of the time is an (BLANK) bleed. S/S seen very quickly.
S/S: unconscious, rapid decrease in (BLANK), headache, nausea, vomiting (projectile), pupils
(BLANK-BLANK), pupils bigger in size 7, 8, 10 mm. Won’t follow commands. Not able to talk.
Epidural
arterial
LOC
non-reactive
Epidural hematoma:
Treatment:
Priority is (BLANK). May need a (BLANK) (where you take the bone flap out to allow brain to
swell to reduce brain cell death). Can also do a (BLANK) (gold standard) aka (BLANK-BLANK)
((BLANK-BLANK-BLANK)). They drill a hole in the skull, will help you monitor ICP. It’s a drain,
so if the ICP goes up, you can open the drain a little bit, let some of it flow out, then close it.
Regulate ICP.
surgery
craniotomy
ventriculostomy; EVD drain (external ventricular drain)
Because you always have trouble remembering the layers of the brain and different hematomas,
you look up these before S.B. arrives. List and define the 3 major types of hematomas:
(BLANK) (below the dura)
Three categories. (BLANK) (look the same as epidural bleeds) 48 hours, (BLANK) (2-14 days),
and (BLANK) (over months, weeks). *(BLANK and BLANK), same symptoms, different time
rates.
Subdural
Acute; subacute; chronic
Acute and subacute
Subdural Hematoma
, Treatment:
Evacuation of hematoma, so (BLANK). If its small, body can absorb it. But if its acute, usually
(BLANK).
surgery; surgery
Because you always have trouble remembering the layers of the brain and different hematomas,
you look up these before S.B. arrives. List and define the 3 major types of hematomas:
(BLANK)
Bleeding into the tissues. WORST prognosis of all head injuries. Severity depends on site, size,
and how big the bleeding is. Also arterial vs venous. (BLANK), worst prognosis.
Intracerebral
Arterial
There are several types of skull fracture associated with head trauma. Give the clinical
presentations and pathophysiology pertinent in linear skull fracture, depressed skull fracture and
a basilar skull fracture.
1. (BLANK): A break in the continuity of the bone, ex hairline fracture, fracture.
2. (BLANK): Inward indentation. Can lacerate arteries, tissues. ICP, bleeding, infection,
hematoma.
3. (BLANK): Fractures at the base of the skull. Show distinct s/s. Worst outcome.
Linear
Depressed
Basilar
The risk of skull fractures is that they can (BLANK) the artery. Can lead to increased ICP from
bleeding, hematoma. Can lead to infection, and (BLANK).
lacerate
meningitis
Basilar: Fractures at the base of the skull. Show distinct s/s. Worst outcome.
1. (BLANK) (bleeding from the nose)
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