ATLS Written Review Latest 2021 Graded A+
What is the primary goal of treating TBI? How is this done? Correct ans
- preventing secondary brain injury. This is done by maintaining blood
pressure and providing adequate profusion.
After managing ABCDEs of TBI what MUST be identified if present? How is
this done? Correct ans - mass lesion that requires surgical evacuation
is critical! this is done with CT. NOTE: obtaining a CT should not delay patient
transfer to trauma center.
Which brain lobes do the following hold:
1. anterior fossa:
2. middle fossa:
3. posterior fossa: Correct ans - 1. anterior fossa: frontal lobes
2. middle fossa: temporal lobes
3. posterior fossa: lower brainstem and cerebellum
What are the 3 layers of the meninges? Correct ans - dura mater,
arachnoid mater, pia mater
What does the dura mater adhere firmly to? Correct ans - the skull. it
is tough and fibrous
What layer of the meninges splits into two leaves as specific sites to enclose
large venous sinuses? What do these sinuses do? Correct ans - dura
mater.
these sinuses provide major venous drainage from the brain.
What is the midline sinus of of the brain that splits into two sinuses: bilateral
transverse and sigmoid sinus? What side are these bigger on? Correct
ans - The main sinus enclosed by the dura major is the midline superior
sagital sinus. This splits into the sigmoid and bilateral transverse sinuses
which are larger on the right side.
What are the arteries that lie between the skull and the dura mater (epidural
space)? Correct ans - meningeal arteries.
What is the most commonly injured meningeal artery and where is it
located? Correct ans - middle meningeal artery.
Located over the temporal fossa
T/F: the arachnoid mater is fused to the dura mater? Correct ans -
FALSE: not attached. This produces a potential space for a subdural
hematoma
, In a subdural hematoma, what is the cause? Correct ans - injury to
bridging veins that extend from brain surface to the sinuses within the dura.
_______ fills the space between the arachnoid and pia mater? Correct
ans - CSF. this cushions the brain and spinal cord.
What location of brain hemorrhage is frequently seen in brain contusion or
injury to major blood vessels at base of brain? Correct ans -
subarachnoid.
The ____ and _____ contain the reticular activating system which is
responsible for ____. Correct ans - midbrain and upper pons
state of alertness
What important function resides in the medulla? Correct ans -
cardiorespiratory centers.
What important functions are in the following brain segments:
1. left hemisphere:
2. frontal lobe:
3. parietal lobe:
4. temporal: Correct ans - 1. left hemisphere: language center
2. frontal lobe: executive function, emotions, motor
3. parietal lobe: sensory function/spatial orientation
4. temporal: memory functions
What divides the brain into supratentorial and infratentorial compartments?
Correct ans - tentorium cerebelli. (tent over cerebellum)
What is the physiology behind a blown pupil? Correct ans - blown
pupil: dilation of pupil
-CN III runs along the tentorium cerebelli. parasympathetic fibers that
constrict the pupil run along CN III (oculomotor). When temporal lobe is
herniated, it can compress these fibers. Unapposed sympathetic activity
causes pupillary dilation.
What is the tentorial notch/hiatus Correct ans - this is where the
midbrain passes through into the infratentorial compartment.
what part of the brain most commonly herniates through the tentorial notch?
Correct ans - Uncus (medial part of temporal lobe)
does weakness occur on the same or opposite side of the uncal herniation?
Correct ans - OPPOSITE. the corticospinal tract of the midbrain is
compressed and then crosses at the foramen magnum.
What is the primary goal of treating TBI? How is this done? Correct ans
- preventing secondary brain injury. This is done by maintaining blood
pressure and providing adequate profusion.
After managing ABCDEs of TBI what MUST be identified if present? How is
this done? Correct ans - mass lesion that requires surgical evacuation
is critical! this is done with CT. NOTE: obtaining a CT should not delay patient
transfer to trauma center.
Which brain lobes do the following hold:
1. anterior fossa:
2. middle fossa:
3. posterior fossa: Correct ans - 1. anterior fossa: frontal lobes
2. middle fossa: temporal lobes
3. posterior fossa: lower brainstem and cerebellum
What are the 3 layers of the meninges? Correct ans - dura mater,
arachnoid mater, pia mater
What does the dura mater adhere firmly to? Correct ans - the skull. it
is tough and fibrous
What layer of the meninges splits into two leaves as specific sites to enclose
large venous sinuses? What do these sinuses do? Correct ans - dura
mater.
these sinuses provide major venous drainage from the brain.
What is the midline sinus of of the brain that splits into two sinuses: bilateral
transverse and sigmoid sinus? What side are these bigger on? Correct
ans - The main sinus enclosed by the dura major is the midline superior
sagital sinus. This splits into the sigmoid and bilateral transverse sinuses
which are larger on the right side.
What are the arteries that lie between the skull and the dura mater (epidural
space)? Correct ans - meningeal arteries.
What is the most commonly injured meningeal artery and where is it
located? Correct ans - middle meningeal artery.
Located over the temporal fossa
T/F: the arachnoid mater is fused to the dura mater? Correct ans -
FALSE: not attached. This produces a potential space for a subdural
hematoma
, In a subdural hematoma, what is the cause? Correct ans - injury to
bridging veins that extend from brain surface to the sinuses within the dura.
_______ fills the space between the arachnoid and pia mater? Correct
ans - CSF. this cushions the brain and spinal cord.
What location of brain hemorrhage is frequently seen in brain contusion or
injury to major blood vessels at base of brain? Correct ans -
subarachnoid.
The ____ and _____ contain the reticular activating system which is
responsible for ____. Correct ans - midbrain and upper pons
state of alertness
What important function resides in the medulla? Correct ans -
cardiorespiratory centers.
What important functions are in the following brain segments:
1. left hemisphere:
2. frontal lobe:
3. parietal lobe:
4. temporal: Correct ans - 1. left hemisphere: language center
2. frontal lobe: executive function, emotions, motor
3. parietal lobe: sensory function/spatial orientation
4. temporal: memory functions
What divides the brain into supratentorial and infratentorial compartments?
Correct ans - tentorium cerebelli. (tent over cerebellum)
What is the physiology behind a blown pupil? Correct ans - blown
pupil: dilation of pupil
-CN III runs along the tentorium cerebelli. parasympathetic fibers that
constrict the pupil run along CN III (oculomotor). When temporal lobe is
herniated, it can compress these fibers. Unapposed sympathetic activity
causes pupillary dilation.
What is the tentorial notch/hiatus Correct ans - this is where the
midbrain passes through into the infratentorial compartment.
what part of the brain most commonly herniates through the tentorial notch?
Correct ans - Uncus (medial part of temporal lobe)
does weakness occur on the same or opposite side of the uncal herniation?
Correct ans - OPPOSITE. the corticospinal tract of the midbrain is
compressed and then crosses at the foramen magnum.
