CAISS Head and Neck Injuries Practice Questions — Questions and Answers
Question 1: In the AIS, a cerebral contusion with loss of consciousness lasting 31–60 minutes is coded at which severity level?
- AIS 2
- AIS 3 (Correct answer)
- AIS 4
- AIS 5
Correct answer: AIS 3
A cerebral contusion with LOC of 31–60 minutes corresponds to AIS 3 (Serious).
Question 2: Which cervical spine injury descriptor is used in AIS when there is fracture of C1 (atlas) without evidence of spinal cord involvement?
- Cervical cord injury NFS
- Atlas fracture without cord injury (Correct answer)
- Cervical dislocation AIS 4
- Atlanto-axial subluxation AIS 5
Correct answer: Atlas fracture without cord injury
A C1 fracture without cord involvement is coded as 'Atlas fracture without cord injury' to distinguish it from cord-level injuries.
Question 3: When coding a penetrating skull injury with retained foreign body but no documented brain laceration, which AIS code category applies?
- Skull fracture only
- Penetrating skull injury without brain injury (Correct answer)
- Intracranial injury NFS
- AIS 5 critical brain injury
Correct answer: Penetrating skull injury without brain injury
A penetrating skull injury with retained foreign body but no confirmed brain laceration is coded as penetrating skull injury without brain injury.
Question 4: A patient has bilateral frontal lobe contusions on CT with GCS of 9. What AIS severity is most appropriate?
- AIS 2
- AIS 3
- AIS 4 (Correct answer)
- AIS 5
Correct answer: AIS 4
Bilateral frontal lobe contusions with moderate neurological impairment (GCS 9) typically code to AIS 4 (Severe).
Question 5: Under AIS rules, which of the following neck soft-tissue injuries would receive AIS 1 (Minor)?
- Carotid artery laceration
- Laryngeal fracture
- Cervical muscle strain without fracture (Correct answer)
- Tracheal transection
Correct answer: Cervical muscle strain without fracture
Cervical muscle strain without fracture or vascular injury is coded AIS 1 because it poses minimal threat to life.
Question 6: What is the AIS coding principle when both a skull fracture and an intracranial hematoma are present in the same patient?
- Only the skull fracture is coded
- Only the hematoma is coded
- Both injuries are coded separately (Correct answer)
- A single combined code is assigned
Correct answer: Both injuries are coded separately
AIS codes both the skull fracture and the intracranial hematoma separately, as each represents a distinct injury.
Question 7: Which AIS body region contains injuries to the external ear and scalp?
- Body Region 1 – Head (Correct answer)
- Body Region 2 – Face
- Body Region 3 – Neck
- Body Region 9 – External
Correct answer: Body Region 1 – Head
The scalp and external ear are classified within AIS Body Region 1 (Head).
Question 8: A motorcyclist sustains a subdural hematoma with midline shift >5 mm on CT. What is the minimum expected AIS severity?
- AIS 3
- AIS 4 (Correct answer)
- AIS 5
- AIS 6
Correct answer: AIS 4
An acute subdural hematoma with significant midline shift is coded AIS 4 (Severe) or higher depending on clinical status.
Question 9: In the AIS dictionary, 'diffuse axonal injury' (DAI) with coma lasting more than 6 hours is coded at which level?
- AIS 3
- AIS 4
- AIS 5 (Correct answer)
- AIS 6
Correct answer: AIS 5
DAI with coma exceeding 6 hours represents a life-threatening brain injury coded at AIS 5 (Critical).
Question 10: Which of the following is an AIS 6 (Maximum/Untreatable) head injury?
- Cerebral contusion
- Epidural hematoma requiring surgery
- Complete brainstem destruction (Correct answer)
- Basilar skull fracture
Correct answer: Complete brainstem destruction
Complete brainstem destruction is virtually unsurvivable and is coded AIS 6.
Question 11: When a patient has a C3 fracture with complete motor and sensory loss below that level, what AIS code applies?
- AIS 2
- AIS 3
- AIS 4
- AIS 5 (Correct answer)
Correct answer: AIS 5
A high cervical cord injury (C3) with complete neurological deficit is coded AIS 5 (Critical) due to the threat to respiratory function.
Question 12: An intracerebral hemorrhage is found in the temporal lobe measuring 15 mL with GCS 14. Which AIS severity is most appropriate?
- AIS 2
- AIS 3 (Correct answer)
- AIS 4
- AIS 5
Correct answer: AIS 3
A small temporal intracerebral hemorrhage with near-normal GCS is coded AIS 3 (Serious).
Question 13: In AIS, where is a fracture of the hyoid bone classified?
- Head – face
- Neck region (Correct answer)
- Thorax
- Spine
Correct answer: Neck region
The hyoid bone is an anatomical structure of the neck and its fracture is coded under the AIS Neck body region.
Question 14: A patient presents with post-traumatic amnesia lasting 3 days without structural CT finding. How does AIS classify this?
- AIS 1 – Minor
- AIS 2 – Moderate (Correct answer)
- AIS 3 – Serious
- AIS 4 – Severe
Correct answer: AIS 2 – Moderate
Post-traumatic amnesia of several days without structural injury is coded AIS 2 because it reflects a moderate concussion.
Question 15: For AIS coding purposes, which criterion distinguishes an epidural hematoma (EDH) coded AIS 4 from one coded AIS 5?
- Hematoma location (temporal vs. parietal)
- Volume of hematoma and associated brain shift (Correct answer)
- Patient age
- Time to surgical evacuation
Correct answer: Volume of hematoma and associated brain shift
AIS severity for EDH escalates with larger hematoma volume and significant midline shift indicating greater mass effect.
Question 16: Under the AIS 2015 update, subarachnoid hemorrhage (SAH) is primarily coded based on which factor?
- Fisher grade
- Hunt-Hess scale
- Traumatic vs. spontaneous origin (Correct answer)
- Location relative to the Sylvian fissure
Correct answer: Traumatic vs. spontaneous origin
AIS distinguishes traumatic SAH from spontaneous SAH because the AIS dictionary covers only traumatic injuries.
Question 17: A pedestrian struck by a car has a depressed skull fracture with underlying dural laceration but no parenchymal injury on MRI. What AIS severity applies?
- AIS 2
- AIS 3
- AIS 4 (Correct answer)
- AIS 5
Correct answer: AIS 4
A depressed skull fracture with dural disruption but no brain parenchymal injury codes to AIS 4 due to the structural significance.
Question 18: Which structure, when lacerated in a neck injury, most likely elevates the AIS severity to 4 or 5?
- Sternocleidomastoid muscle
- External jugular vein
- Common carotid artery (Correct answer)
- Platysma muscle
Correct answer: Common carotid artery
Laceration of the common carotid artery is a major vascular injury that elevates AIS neck injury severity to 4 or 5.
Question 19: In AIS, the 'masked injury' rule states that if a more severe brain injury is identified later, the coder should:
- Keep the original code
- Add a supplemental code
- Revise the AIS code to the higher severity injury (Correct answer)
- Code both with equal weight
Correct answer: Revise the AIS code to the higher severity injury
AIS coding is updated to reflect the most accurate diagnosis; the code is revised upward when a more severe injury is subsequently identified.
Question 20: A cyclist falls and sustains loss of consciousness of 15 minutes with a GCS on arrival of 14. No CT abnormality is found. What is the AIS code?
- AIS 1
- AIS 2 (Correct answer)
- AIS 3
- AIS 4
Correct answer: AIS 2
LOC of 1–30 minutes with GCS ≥14 and no structural finding is coded AIS 2 (Moderate concussion).
Question 21: An AIS code ending in '.4' as the final digit represents which component of the 7-digit AIS predot code system?
- Body region
- Anatomical structure
- Specific injury level (Correct answer)
- Severity qualifier
Correct answer: Specific injury level
In the AIS 7-digit predot coding system, the sixth digit represents the specific injury level or type, refining the injury within the anatomical structure.
