TRAUMA

Question 1

5 layers of the scalp

Answer 1

• Skin
• Connective tissue
• Aponeurotic galea
• Loose areolar tissue
• Pericranium

Question 2

How many bones in the skull

Answer 2

22 bones
8 cranial bones
14 facial bones

Question 3

Sutures
what are they
4 types

Answer 3

immovable joints that hold the skull together

• Coronal (frontal and parietal)
• Sagittal (two parietal)
• Lambdoidal (parietal to occipital)
• Squamous (parietal to temporal)

Question 4

What are fontanells

Answer 4

soft spots between cranial bones

Question 5

4 major parts of the brain

Answer 5

brain stem, diencephalon, cerebrum, cerebellum

Question 6

brain stem parts

Answer 6

• Continuous with spinal cord
• Pons
• Midbrain
• Medulla

Question 7

diencephalon

Answer 7

• Located above the brain stem
• Thalamus
• Hypothalamus
• Pineal gland

Question 8

cerebrum

Answer 8

• Supported on top of diencephalon and brain stem
• Surface is a thin layer of gray matter

Question 9

BBB function, what crosses easily

Answer 9

• Protection
• Prevents passage of substances
• Consists of tightly sealed blood capillaries
• O2, CO2, ETOH and most anaesthetic agents cross easily
• Lipid soluble or carrier mediated to cross BBB

Question 10

Difference between BBB and normal cells

Answer 10

BBB has tight junctions

Question 11

CSF purpose, produced where, normal volume, circulates where

Answer 11

• Another protective mechanism
• Carries O2, glucose and other required chemicals from blood to neurons to neuroglia
• Removes wastes and toxic substances
• Circulates through the subarachnoid space, around the brain and spinal cord and through the ventricles
• Produced at the choroid plexus (each ventricle of the brain)
• Reabsorbed through the arachnoid villi
• Volume is 80-150ml

Question 12

Medulla oblongata

Answer 12

Continuation of spinal cord
* White matter contains sensory and motor tracts
* Several nuclei (masses of grey matter)  two major are cardiovascular centre and rhythmicity centre, touch, vibration, swallowing, vomiting, coughing, hiccupping and sneezing

Question 13

Pons

Answer 13

• Consists of both nuclei and tracts
• Bridge that connects parts of the brain with one another
• Helps control breathing
• Cranial nerve (V,VI,VII and VIII) involvement

Question 14

midbrain

Answer 14

• Connects pons to diencephalon
• Contains motor neurons and conduct nerve impulses
• Co-ordinate muscle movements
• Cranial nerve (III and IV)

Question 15

thalamus

Answer 15

Contributes to regulation of autonomic activities and maintenance of consciousness

Question 16

Hypothalamus

Answer 16

Controls ANS
* Controls pituitary gland and production of hormones
* Regulates emotional and behavioural patterns
* Regulates eating and drinking
* Controls body temp
* Regulates circadian rhythm and state of consciousness

Question 17

pineal gland

Answer 17

produces melatonin

Question 18

cerebellum

Answer 18

Consists of two hemispheres
* Surface is called the cerebella cortex (grey matter)
* White matter
Functions
* Receives sensory input
* Coordinates complex sequence of skeletal muscle contractions
* Regulates posture and balance
* Essential for skilled motor activities

Question 19

Spinal column - hyoid bone

Answer 19

• Does not attach to any other bone
• Located between mandible and larynx
• Supports the tongue

Question 20

vertebral column structure

Answer 20

The vertebral column  33 vertebrae
* 7 Cervical
* 12 thoracic
* 5 lumbar
* 5 sacral
* 4 coccyx

Question 21

Spinal cord occupies the vertebral column from which landmarks

Answer 21

C1-L2

Question 22

spinal cord ascending pathways vs descending pathways

Answer 22

• Ascending pathways are sensory tracts
• Descending pathways are motor tracts

Question 23

how does the motor pathway causes movement in brain and spinal cord

Answer 23

Voluntary movement originates from the frontal lobe of the cerebral cortex
* Cross to opposite side of the medulla
* Descend down the corticospinal tract
* Lower motor neurons innervate skeletal muscle
* Cervical nerve fibres innervate upper extremities
* Sacral fibres innervate lower extremities

Question 24

affarent vs efferant nerves

Answer 24

aff –> towards spine
eff –> away

Question 25

spinal nerves how many pairs and where do they innervate

Answer 25

* 8 cervical * 12 thoracic (innervate thorax, buttocks and part of upper arm) * 5 lumbar (innervate groin and lower extremities) * 5 sacral (perianal nerves and voluntary contraction of anal and bladder sphincter) * 1 coccygeal

Question 26

spinal nerves posterior and anterior roots

Answer 26

posterior (dorsal)= sensory impulses anterior (ventral) = motor impulses

Question 27

cervical plexus

Answer 27

* First 4 cervical nerves * Innervate muscles of the neck * Phrenic nerve innervates the diaphragm

Question 28

brachial plexus

Answer 28

* C5 to C8 and T1 * Supplies motor control and sensation to upper extremities * Includes ulnar and radial nerves

Question 29

sacral plexus

Answer 29

sciatic nerve

Question 30

LIVER solid or hollow description

Answer 30

solid organ extremely vascular - 30% of total CO 3 major roles - metabolism, secretes bile, filters and stores blood

Question 31

Spleen

Answer 31

solid organ LUQ blood filter and resovoir up to 200ml

Question 32

kidneys

Answer 32

found in retroperitoneal space of T12-L3 moves with inspiration and expiration

Question 33

pancreas

Answer 33

solid organ exocrine and endocrine organ produces fluid containing enzymes, electrolytes and bicarbonate located behind the stomach L) side

Question 34

small bowel

Answer 34

divided into 3 sections--> duodenum, jejnum, ileum 7m long

Question 35

large bowel

Answer 35

1.2m long 4 sections, cecum, colon, rectum and anal canal

Question 36

3 major components of bones

Answer 36

matrix of collagen (35%) mineral matrix and calcium and phosphate bone cells

Question 37

types of bone cells osteoblasts, osteocytes, osteoclasts

Answer 37

Osteoblasts * Present on all bone surfaces * Synthesis and secretion of collagen and protein * Helps with the healing process Osteocytes * Forms from osteoblasts trapped in the matrix * Control of calcium release * Continues process of remodelling Osteoclasts * Near bone surface * Destroy dead bone * Reabsorption of bone

Question 38

what is compact cortical bone

Answer 38

* Outer parts of all bone * Forms shaft of long bones * Encloses marrow cavities

Question 39

what is the haversian system

Answer 39

about distribution of nutrients consist of canals, blood vessels, connective tissue, nerve fibres and lymphatic vessels

Question 40

which type of bones produce RBC what about as we get older?

Answer 40

long bones flat bones as we age

Question 41

cancellous (spongey bone) located contains

Answer 41

Located * End of long bones * Vertebrae * Flat bones Organised in lattice system Contains * Haversian canals * Red blood cells (RBC production) * Converted to yellow bone marrow

Question 42

classification of bones

Answer 42

Long short - tarsals flat- skull irregular - verterbrae

Question 43

define compartment syndrome

Answer 43

increased pressure within a restricted space

Question 44

what is fat embolism syndrome

Answer 44

* Results from  long bone fractures, intramedullary manipulation, blunt trauma * Fat emboli escapes and enters venous circulation * Defined as a triad of hypoxia, petechia and neurological impairment * Sx present within 12-60 hours * Major petechial rash, respiratory and cardiac symptoms, neurological changes * Minor SIRS

Question 45

what is occult haemorrhage

Answer 45

* Non traumatic, more associated with chronic health conditions * Often sub clinical  no obvious major external haemorrhage, nil major symptoms or diagnostic signs * Can present with other s/s such as SOB secondary to anaemia, lethargy * Consider anticoagulation effects * Days rather than minutes

Question 46

haemostatic response to bleeding 3 stages

Answer 46

vasoconstriction -platelet activation and coagulation cascade

Question 47

shock index equation

Answer 47

=HR/SBP once you have a HR above SBP you should be concerned anything above 0.9 = bad