ATLS Written Review UPDATED ACTUAL
Exam Questions and CORRECT Answers
What is the primary goal of treating TBI? How is this done? - CORRECT ANSWER -
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 ANSWER -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 ANSWER -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 ANSWER -dura mater, arachnoid
mater, pia mater
What does the dura mater adhere firmly to? - CORRECT ANSWER -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 ANSWER -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 ANSWER -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
ANSWER -meningeal arteries.
What is the most commonly injured meningeal artery and where is it located? - CORRECT
ANSWER -middle meningeal artery.
Located over the temporal fossa
T/F: the arachnoid mater is fused to the dura mater? - CORRECT ANSWER -FALSE: not
attached. This produces a potential space for a subdural hematoma
In a subdural hematoma, what is the cause? - CORRECT ANSWER -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 ANSWER -
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 ANSWER -subarachnoid.
The ____ and _____ contain the reticular activating system which is responsible for ____. -
CORRECT ANSWER -midbrain and upper pons
state of alertness
What important function resides in the medulla? - CORRECT ANSWER -
cardiorespiratory centers.
What important functions are in the following brain segments:
1. left hemisphere:
, 2. frontal lobe:
3. parietal lobe:
4. temporal: - CORRECT ANSWER -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
ANSWER -tentorium cerebelli. (tent over cerebellum)
What is the physiology behind a blown pupil? - CORRECT ANSWER -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 ANSWER -this is where the midbrain
passes through into the infratentorial compartment.
what part of the brain most commonly herniates through the tentorial notch? - CORRECT
ANSWER -Uncus (medial part of temporal lobe)
does weakness occur on the same or opposite side of the uncal herniation? - CORRECT
ANSWER -OPPOSITE. the corticospinal tract of the midbrain is compressed and then
crosses at the foramen magnum.
state: Ipsilateral/contralateral
____ pupillary dilation associated with _____ hemiparesis is the classic sign of uncial herniation.
- CORRECT ANSWER -ipsi
Exam Questions and CORRECT Answers
What is the primary goal of treating TBI? How is this done? - CORRECT ANSWER -
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 ANSWER -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 ANSWER -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 ANSWER -dura mater, arachnoid
mater, pia mater
What does the dura mater adhere firmly to? - CORRECT ANSWER -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 ANSWER -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 ANSWER -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
ANSWER -meningeal arteries.
What is the most commonly injured meningeal artery and where is it located? - CORRECT
ANSWER -middle meningeal artery.
Located over the temporal fossa
T/F: the arachnoid mater is fused to the dura mater? - CORRECT ANSWER -FALSE: not
attached. This produces a potential space for a subdural hematoma
In a subdural hematoma, what is the cause? - CORRECT ANSWER -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 ANSWER -
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 ANSWER -subarachnoid.
The ____ and _____ contain the reticular activating system which is responsible for ____. -
CORRECT ANSWER -midbrain and upper pons
state of alertness
What important function resides in the medulla? - CORRECT ANSWER -
cardiorespiratory centers.
What important functions are in the following brain segments:
1. left hemisphere:
, 2. frontal lobe:
3. parietal lobe:
4. temporal: - CORRECT ANSWER -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
ANSWER -tentorium cerebelli. (tent over cerebellum)
What is the physiology behind a blown pupil? - CORRECT ANSWER -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 ANSWER -this is where the midbrain
passes through into the infratentorial compartment.
what part of the brain most commonly herniates through the tentorial notch? - CORRECT
ANSWER -Uncus (medial part of temporal lobe)
does weakness occur on the same or opposite side of the uncal herniation? - CORRECT
ANSWER -OPPOSITE. the corticospinal tract of the midbrain is compressed and then
crosses at the foramen magnum.
state: Ipsilateral/contralateral
____ pupillary dilation associated with _____ hemiparesis is the classic sign of uncial herniation.
- CORRECT ANSWER -ipsi
