TNCC Notes for Written Exam Brainstorming
Questions and Their Correct Solutions Graded 100%
Pass
Define central or transtentorial herniation. - CORRECT ANSWER ✔✔ -A downward movement
of the cerebral hemispheres with herniation of the diencephalon and midbrain through the
elongated gap of the tentorium.
Define Hemothorax. - CORRECT ANSWER ✔✔ -Accumulation of blood in the pleural space.
Define Minor Head Trauma. - CORRECT ANSWER ✔✔ -GCS 13-15
Define Moderate Head Trauma - CORRECT ANSWER ✔✔ -Postresuscitative state with GCS 9-
13.
Define Pneumothorax. - CORRECT ANSWER ✔✔ -Results when an injury to lung leads to
accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial
or total collapse of lung may ensue.
An open pneumothorax results from wound through chest wall. Air enters pleural space both
through the wound and trachea.
Define Severe Head Trauma. - CORRECT ANSWER ✔✔ -Postresuscitative state with GCS
score of 8 or less.
,Define tension pneumothorax. - CORRECT ANSWER ✔✔ -Life-threatening injury. Air enters
pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure
collapses lung on side of injury causing a mediastinal shift that compresses the heart, great
vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension
results.
Immediate decompression should be performed. Treatment should not be delayed.
Define uncal herniation. - CORRECT ANSWER ✔✔ -The uncus (medial aspect of the temporal
lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more
common of the two types of herniation syndromes.
Disruptions of the bony structures of the skull can result in what? - CORRECT ANSWER ✔✔ -
Displaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a
passage for CSF.
CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading
bacteria.
Also: meningitis or encephalitis or brain abscess
Explain adrenal gland response. - CORRECT ANSWER ✔✔ -When adrenal glands are
stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal
medulla will increase.
,Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and
increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion.
Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates
pituitary to release ACTH that stimulates adrenal gland to release cortisol.
Effect of cortisol release is elevation in blood sugar and increased insulin resistance and
gluconeogenesis, hepatic process to produce more sugar.
Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve
body water.
Explain Cardiogenic Shock. - CORRECT ANSWER ✔✔ -Syndrome that results from
ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of
cardiac muscle.
Some causes:
- MI
- Blunt cardiac injury
- Mitral valve insufficiency
, - dysrhythmias
- Cardiac Failure
Explain Distributive Shock. - CORRECT ANSWER ✔✔ -Results from disruption in SNS
control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood
volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to
spinal cord in cervical or upper thoracic region.
Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in
complete cord injuries; reflexes return with resolution of spinal shock.
Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory
mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion
abnormalities.
Explain Hepatic Response. - CORRECT ANSWER ✔✔ -Liver can store excess glucose as
glycogen.
As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose.
In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other
vital areas.
Questions and Their Correct Solutions Graded 100%
Pass
Define central or transtentorial herniation. - CORRECT ANSWER ✔✔ -A downward movement
of the cerebral hemispheres with herniation of the diencephalon and midbrain through the
elongated gap of the tentorium.
Define Hemothorax. - CORRECT ANSWER ✔✔ -Accumulation of blood in the pleural space.
Define Minor Head Trauma. - CORRECT ANSWER ✔✔ -GCS 13-15
Define Moderate Head Trauma - CORRECT ANSWER ✔✔ -Postresuscitative state with GCS 9-
13.
Define Pneumothorax. - CORRECT ANSWER ✔✔ -Results when an injury to lung leads to
accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial
or total collapse of lung may ensue.
An open pneumothorax results from wound through chest wall. Air enters pleural space both
through the wound and trachea.
Define Severe Head Trauma. - CORRECT ANSWER ✔✔ -Postresuscitative state with GCS
score of 8 or less.
,Define tension pneumothorax. - CORRECT ANSWER ✔✔ -Life-threatening injury. Air enters
pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure
collapses lung on side of injury causing a mediastinal shift that compresses the heart, great
vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension
results.
Immediate decompression should be performed. Treatment should not be delayed.
Define uncal herniation. - CORRECT ANSWER ✔✔ -The uncus (medial aspect of the temporal
lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more
common of the two types of herniation syndromes.
Disruptions of the bony structures of the skull can result in what? - CORRECT ANSWER ✔✔ -
Displaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a
passage for CSF.
CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading
bacteria.
Also: meningitis or encephalitis or brain abscess
Explain adrenal gland response. - CORRECT ANSWER ✔✔ -When adrenal glands are
stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal
medulla will increase.
,Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and
increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion.
Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates
pituitary to release ACTH that stimulates adrenal gland to release cortisol.
Effect of cortisol release is elevation in blood sugar and increased insulin resistance and
gluconeogenesis, hepatic process to produce more sugar.
Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve
body water.
Explain Cardiogenic Shock. - CORRECT ANSWER ✔✔ -Syndrome that results from
ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of
cardiac muscle.
Some causes:
- MI
- Blunt cardiac injury
- Mitral valve insufficiency
, - dysrhythmias
- Cardiac Failure
Explain Distributive Shock. - CORRECT ANSWER ✔✔ -Results from disruption in SNS
control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood
volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to
spinal cord in cervical or upper thoracic region.
Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in
complete cord injuries; reflexes return with resolution of spinal shock.
Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory
mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion
abnormalities.
Explain Hepatic Response. - CORRECT ANSWER ✔✔ -Liver can store excess glucose as
glycogen.
As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose.
In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other
vital areas.
