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Soal Ujian Neurotrauma

1. Metabolic responses to trauma include each of the following except


A. hypoglycemia
B. increased rate of lipolysis
C. increased Na+ reabsorption
D. increased water reabsorption
E. metabolic'alkalosis
Proteolysis, gluconeogenesis, lipolysis, insulin resistance. Semua
menimbulkan auto-cannibalism (loss of fat and lean body mass).

2. An 18-year-old girl riding on the back of her boyfriends motorcycle


without a helmet is brought in with a left frontal skull fracture and cortical
contusion. GCS is 10. She is admitted to the intensive care unit. She has
had no seizures. Anticonvulsant therapy is
a. Contraindicated due to risk of rash
b. Best achieved using phenobarbital
c. Likely to cause increased cerebral edema
d. Indicated to reduce the incidence of late posttraumatic epilepsy
e. Indicated to reduce the incidence of early posttraumatic
seizures
E. fenitoin, levefiracetam, carbamazepin.

For questions 3-6


A 16-year-old boy is struck on the side of the head by a bottle thrownby a
friend involved in a prank. He appears dazed for about 30 s, but
isapparently lucid for several minutes before he abruptly becomes
stuporous. His limbs on the side opposite the site of the blow are more
flaccidthan those on the same side as the injury. On arrival in the
emergency room25 min after the accident, he is unresponsive to painful
stimuli. His pulseis 40/min, with an ECG revealing no arrhythmias. His
blood pressure inboth arms is 170/110 mmHg. Although papilledema is
not evident in hisfundi, he has venous distention and absent pulsations of
the retinal vasculature.

3. The best explanation for this young mans evolving clinical signs is
a. A seizure disorder
b. A cardiac conduction defect
c. Increased intracranial pressure
d. Sick sinus syndrome
e. Communicating hydrocephalus
2

Increased ICP: behavioral changes, decrease consciousness, headache,


lethargy, neurological symptoms (weakness, numbness, eye movement
problem, double vision), seizure, vomiting.

4. The wisest management over the next 4 h for this patient is


a. Craniotomy
b. Antihypertensive medication
c. Transvenous pacemaker placement
d. Ventriculoperitoneal shunt
e. Antiepileptic medication
A

5. Magnetic resonance imaging (MRI) of the patients head within thefirst


few hours of injury should reveal
a. A normal brain
b. Intracerebral hematoma
c. Temporal lobe contusion
d. Subarachnoid hemorrhage
e. Epidural hematoma
E. MRI not appropriate for patients w/ EDH in unstable condition.
EDH: accumulation of blood in potential space between dura-bone. Brief
linear contact force to the calvaria separation of interposed vessel.
Brief loss of consciousness lucid period loss of consciousness.
Hematoma extension limited by suture line (tight dura attachment at the
suture line). Most common site: temporoparietal. Most common affected
vessel: middle meningeal artery.

6. Computed tomography scanning of the patients head within 2 h ofthe


injury should reveal
a. A normal brain
b. A lens-shaped density over the frontal lobe (biconvex/lenticular
shaped mass)
c. Increased CSF density with a fluid-fluid level
d. Multifocal attenuation of cortical tissue
e. Bilateral sickle-shaped densities over the hemispheres
B

7. The elderly person who suffers relatively mild head trauma, but
subsequently develops a progressive dementia over the course of several
weeks,is most likely to have sustained which of the following?
a. An acute subdural hematoma
b. An acute epidural hematoma
c. A chronic subdural hematoma
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d. An intracerebral hematoma
e. An intracerebellar hematoma
C

8. A 42-year-old woman is involved in a head-on collision with a lamp-post


at 50 mph. Her head hits the windshield. She is highly likely to havean
intracranial hemorrhage in which one of the following structures?
a. Occipital lobe
b. Thalamus
c. Putamen
d. Parietal lobe
e. Temporal lobe
E

9. Computed tomography (CT)of the brain may fail to reveal asmall


subdural hematoma if
a. The lesion is subacute.
b. The hematoma extends into thebrain from the subdural space.
c. The resolution of the CT machine isgreater than 2 mm.
d. The subdural hematoma is less than4 h old.
e. The patient has extensive cerebralatrophy.
A. CT scan of SDH: acute 0-3 d (hyperdense), subacute 3-14 d
(iso/hypodense), chronic >2 weeks (hypodense)

10. A 16-year-old male is struck on the head with a baseball bat during an
a
We is judged to be in coma on the basis of the Glasgow Coma Scale when
he is examined
in the emergency room. Which of the following findings is consistent with
that
conclusion?
A. He makes unidentifiable sounds.
B. He does not open his eyes spontaneously
C. He is breathing spontaneously.
D. He doesn't follow commands.
E. all of the above
E. Coma = GCS 3-8 (severe head trauma)

11. A 45-year-old female is involved in a motor vehicle accident in which


she strikes the
side of her head against the windshield. She is transiently unconscious.
examined
4

in the emergency room she is felt to be fully conscious. On her return


from the
Radiology Department, though, she arouses to vigorous stimulation. The
"lucid
interval" she has experienced is MOST characteristic of of the
B. hemorrhage
C. hemorrhage
D. traumatic hemorrhage
E. ischemic stroke
D. Epidural hematoma: brief loss of consciousness lucid interval loss
of consciousness again or deteriorate into herniation and death.

12. A 30-year-old male falls from bicycle striking his head. He is not
knocked
unconscious and does not seek care. When he attempts resume his
normal
activities he is bothered by a lack of energy, headaches,and an inability
to concentrate.
family physician, who is unable to provide him with an explanation refers
him to a
neurologist. His examination by the neurologist is normal. Which of the
following
disorders is the MOST problem?
A. meningitis
B. cerebrospinal fluid rhonorrhea
C. psychiatric disorder
D. epilepsy
E. postconcussive syndrome
E. postconcussive syndrome occurs within days to weeks. Headache,
dizziness, vertigo, memory problem, trouble concentrating, sleeping
problem, restlessness, irritability, apathy, depression, anxiety. Th: pain &
psychiatric management.

13. Regarding infection in a trauma patient with the following x-ray, the
most
common pathogen is
A. S. aureus.
B. Pseudomonas.
C. Proteus.
D. S. pneumoniae.
E. E. coli.
D
5

14. All of the following characterize adult respiratory distress syndrome


(ARDS)
EXCEPT:
A. late hypoxemia (within 12-48 h to days) + dyspnea
B. diffuse infiltrate
C. leaky capillaries
D. association with sepsis and trauma
E. protein content of fluid greater than with pulmonary edema
A. ARDS: critically ill patients w/ multiorgan failure. Dyspnea + hypoxemia
within 12-48 hours to days. Radiograph: patchy peripheral distribution of
infiltrates.

15. Epidural hematomas in children are the result


A. of an arterial injury.
B. of bone oozing.
C. of bleeding from the periosteal surface.
D. all of the above
E. none of the above
D. EDH more common than SDH in children. EDH in children: as the
complication of skull fracture; source of bleeding meningeal media artery;
prompt removal excellent outcome.

16. All of the following are true of extradural hematomas EXCEPT:


A. They can appear crescentic. SDH
B. The lucid interval is seen in ~80% of patients.
C. A dry eye postoperatively is from traction injury of a nerve.
D. Outcome correlates well with the clinical state prior to surgery.
E. Poor outcome is correlated with delay in surgery.
A, B.

17. The most frequent site for traumatic SAH is


A. Convexity
B. Basal cistern
C. Tentorial edge
D. Sylvian fissure/Interhemispheric associated w/ anterior
communicating artery & middle cerebral artery.
E. None of the above
A. SAH common cause: tearing of veins and arteriestraversing the
subarachnoid space (between arachnoid matter and pia).
Classification: traumatic SAH (located over cerebral convexities),
nontraumatic SAH (aneurismal: anterior COM artery 40%, posterior com
artery 20%, basilar artery 4%, middle cerebral artery 34%; non
aneurismal, perimesencephalic, convexal SAH).
6

18. Classic CT appearance of EDH occur in


A. 84%
B. 74%
C. 94%
D. 64%
E. None of the above
A

19. All are true about traumatic subdural hygroma EXCEPT


A. Contain prealbumin
B. Lack membranes
C. Density of fluid is similar to that of CSF
D. Most common site is inter hemispheric fissure
E. None of the above
D. Subdural hygroma: collection of clear, xanthochromic fluid in subdural
space. Traumatic disruption of arachnoid matter at time of trauma leads to
chronic CSF leak.
chronic CSF
10% of severe HI; acute or later.
CT: hypodense (CSF), mimics chronic SDH.
Symptom: raised IOP.
Th: drainage if symptomatic.

20. 25-year-old man presented with a head injury


A. Skull radiography is essential
B. The risk of chronic subural hematoma is related to theseverity of the
head injury
C. He is said to have had a concussion if only minor macroscopicbrain
damage has occurred
D. Extradural hematoma is usually caused by a rupture of thesagittal or
transverse sinuses
E. The risk of posttraumatic epilepsy is increased if he
developsan epileptic seizures in the first 24 hours after injury
E. Early seizures (0-7 d after injury) predictive of subsequent
epilepsy/seizures. Late = >7d.

21. Best diagnostic method to diagnose post-traumatic CSF fistula


A. Tomography
B. Contrast enhanced CT
C. Postitive ventriculography contrast
D. Air ventriculography
E. Intrathecal contrast ventriculography
7

22. Head trauma results in


A. extracellular K+, intracellular Ca2+
B. glutamine intracellulary
C. extracellular glutamate
D. adenosine
E. All of the above
C. Traumatic brain injury: increasing glutamate, glycine, and aspartate in
CSF, 2-8 fold, peak up to 1 week.

23. A patient is having diffuse axonal injury, histologically thereare axonal


swelling (retraction ball) in cerebral white matter,corpus callosum,
dorsolateral quadrant upper brainstem andsuperior cerebellar peduncle
and a focal lesion in the corpuscallosum. He is having
A. Grade I DAI
B. Grade II DAI
C. Grade III DAI
D. None of the above
E. All of the above
B. Common site of DAI: corpus callosum, grey-white matter junction at
parasagittal, deep periventricular white matter, basal ganglia & internal
capsule, hippocampal & parahippocampal, dorsolateral aspect of
brainstem, cerebellum.
DAI grade 1: axonal damage, 2: axonal damage + hemorrhagic lesions in
corpus callosum, 3: axonal damage + hemorrhagic lesions in corpus
callosum + brain stem.

24.About lesions in diffuse axonal injury (DAI)


A. All are haemorrhagic
B. 80% are haemorrhagic and 20% are non haemorrhagic
C. 20% are haemorrhagic and 80% are non haemorrhagic
D. All are non haemorrhagic
E. None of the above
C

25. Regarding mannitol use in head injury for reduction of brainoedema


A. Mannitol is used at a dose of .25gm 1gm/kg, Serum osmolality should
not exceed 320mosmol/L
B. Repeated long term use result in dilutional hyponatremia,acute renal
failure and disruption of BBB
C. It has a neuroprotective role as it scavanges free radical whichproduce
lipid peroxidation
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D. They can be used sometime conjunctive to chemotherapyfor the


Glioma to increase BBB penetrance
E. All of the above
E. Mannitol: 0,25-1 mg/BB IV bolus, max effect in 20-40 after injection,
may be repeated every 6 hours. Recommended target value 320 mOsm/L
(higher values acute tubular renal failure).

26. The triad of head injury with lucid interval, mydriasis on theside of a
hematoma and contralateral paresis occur in how many% of cases of EDH
A. 18%
B. 28%
C. 38%
D. 48%
E. None of the above
A

27. Burst lobe is often referred to as the combination of


A. Acute SDH + extensive lobar contusion
B. Extensive lobar contusion + intracerebral hemorrhage
C. Acute SDH + extensive intracerebral hemorrhage
D. Acute SDH + extensive lobar contusion +
intracerebralhemorrhage
E. None of the above
D. Burst lobe = complex of SDH, cerebral contusion/laceration, adjacent
intracerebral haematoma.

28. Secondary brainstem hemorrhage is more frequent in


A. Tectum of midbrain and pons
B. Tegmentum of midbrain and tectum of pons
C. Tectum of midbrain and tegmentum of pons
D. Tegmentum of midbrain and pons
D. secondary brainstem hemorrhage = perivascular bleeding in pons or
mesencephalon without edema, glial proliferation or mesencephalon.

29. Which of the following modalities is being used rece


patients of vegetative state due to head injury?
A. Periaqueductal gray matter stimulation
B. Periventricular gray matter of stimulation
C. Anterior column stimulation
D. Dorsal column stimulation

30. Which of the following segments of the optic nerve is mostcommon


one damaged with closed head injury?
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A. Intraocular
B. Intraorbital
C. Intracanalicular
D. Intracranial
C

31. How many percent of patients with closed head injury andhaving
normal CT scan will have intracranial hypertension?
A. 13%
B. 3%
C. 23%
D. 33%
A

32. Cerebrovascular resistance is affected by PaCO2 such that thereis a


linear increase in CBF with increasing PaCO2 within therange of
A. 40 70mmHg
B. 30 80mmHg
C. 20 80mmHg
D. 20 60mmHg
D (20-65)

33. The intracranial hypertension after trauma is maximum between


A. 0 24 hr
B. 24 48 hr
C. 48 72 hr
D. 72 96 hr
D

34. Among all the factors in GCS the most PROGNOSTIC is


A. Verbal response
B. Eye opening
C. Motor response
D. All of the above
C

35. The revised trauma score is the most commonly used


physiologic,estimates of injury used in trauma centers it is based on all
ofthe following except which
A. Systolic blood pressure
B. Pulse rate
C. Respiratory rate
D. Glasgow coma scale
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B. Revised trauma score: GCS, systolic BP, respi rate

36. Which type of seizure among the following does not followhead
trauma
A. Absence (petitmal)
B. Partial complex, psychomotor variety
C. Partial motor with Jacksonian march
D. Partial motor with secondary generalization
A

37. Neurological: What does a score of 9 mean on the Glasgow Coma


Scale?
A.minor brain injury
B.moderate brain injury
C.severe brain injury
D. fully conscious
B. GCS 14-15 = mild, 9-13 = moderate, 3-8 = severe

38. Neurological: Damage to the right hemisphere would result in the


following symptoms except:
A.Left motor praxis
B.Emotion
C.Speech
D.Visual spatial processing
D. Right hemisphere fx: recognizing loss of fx, visuospatial oriented
perception and behavior, musicality, venoal? Inflection and tone of vace
detection?
Left hemisphere: speech & motor fx.

39. You are assessing a traumatic brain injury patient and note that the
patient has a right eyelid droop. This indicates that the patient has
received injury to which cranial nerve?
A. Cranial nerve II
B.Cranial nerve III
C.Cranial nerve VI
D.Cranial nerve VII
B

Choose the following for question 40-41


A. central nervous system injury
B. root or nerve injury
In examining a flaccid limb:
40. preserved reflexes indicates ______A_______
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41. absent reflexes indicates _______B_______

42. A 28-year-old right-handed white male is admitted to the neurosurgical


service after
a rollover motor vehicle accident. He is neurologically normal. Further
examination reveals drainage of clear fluid from the right ear. Which of the
following statements is 'TRUE?
A. Fracture lines transverse to the long axis of the petrous pyramid
commonly result in ottoreae
B. Meningitis in this patient would be unexpected, as it only occurs in 1%
to 2% of patients with traumatic Cerebrospinal fluid leaks ( CSF leaks)
C.Leakage will most likely spontaneously stop within a week
harusnya 3-4 wk
D.Immediate surgery for repair of the CSF leak should be undertaken
E. A glucose level in the fluid of 10% would be highly suggestive a CSF.
A. CSF otorrhea = leakage of CSF through external auditory canal.
Requires pathologic communication between subarachnoid space &
pneumotized area of temporal bone fracture longitudinal / transverse to
the long axis of petrous bone.

43. With (CSF) regard to cerebrospinal fluid leaks, which of the following is
TRUE?
a. Non traumatic CSF Ieakage is rarely due to a tumor.
b. CSF leaks is greater in traumatic leaks than in non traumatic leaks
c. Risks of infections are greater in spontaneous leaks than in non
traumatic leaks
d. Spontaneous cessation of leakage may occur in as many as
one third of non traumatic cases
E. In Spontaneous rhinorrhea, leakage through the cribriform plate itself is
seen rarely
D

44. During a rugby game, a 25 year old male was tackled and became
unconscious. Fellow players say he regained consciousness after a few
minutes. He sat out the rest of the game but otherwise appeared normal.
Later that evening he complained of a headache and soon had a seizure.
At the emergency room he was given a CT. What did the CT most likely
show?

A. diffuse bleeding

B. unilateral hematoma with distinct borders and midline shift


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C. unilateral hematoma with unclear borders and infratentorial


herniation

D. bleeding in the third ventricle

45. A patient exhibits signs in increased ICP (intercranial pressure). Which


of the following interventions are not required?

A Elevate HOB to 30 degrees


B Limit suctioning performed
C Set-up quiet environment
D Provide minimal sensory stimulation

46. A 32-year-old male boxer presents to the emergency room after


sustaining an injury during a local boxing match. He was punched by the
opponent over his right ear about six hours ago . He complains of pain and
swelling over his right ear. He has no hearing deficit or tinnitus or
headaches or blurred vision. He denies nausea or vomiting. Past medical
history is unremarkable. On examination, his vitals are stable. His right
ear is red, warm and swollen with a medium sized anterior auricular
swelling which is tender to palpation. There is no facial swelling. Which of
the following is the most appropriate management?

A Compressive dressing

B Needle aspiration of the Hematoma

C Cold compresses, analgesics and antibiotics

D Incision and Drainage

E Observe and await spontaneous hematoma resolution

E
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47. A 3 year old male child is brought to the emergency room by his
mother after he fell from his tricycle and sustained an injury to his head .
The child was found to be alert and awake after the fall, however, he
reported mild pain on the right side of his head. His mother noted a small
bruise and swelling over the right side of his scalp. There is no history of
vomiting or nausea. He has no past history of convulsions or epilepsy.
Family history is unremarkable. At this time, child is quiet and reports mild
headache. On examination, he is alert and awake. He is not in distress.
There is small contusion on the fronto-parietal aspect of his scalp. There is
no evidence of hematoma. Palpation does not reveal any depressed
fracture. Neurological examination is normal with out any deficits. Rest of
the physical exam is normal. Which of the following is the most
appropriate management at this time?

A) Contact Child Protection Services

B) Perform Head CT scan

C) Admit to Hospital

D) Observe at home

E) Skull X-rays

48. What is the most common cause of subarachnoid hemorrhage (SAH)?


a. Head trauma
b.Vascular lesion
c. Neoplasma
d. Infection
e. Idiopathic
A

49. What is the most common cause of cerebrospinal fluid leakage?


a. Head trauma
b.Vascular lesion
c. Neoplasma
d. Infection
e. Idiopathic
A

50.. Which allele predisposes one to greater risk of Alzheimer disease


after a head injury?
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a. PCNA
b.AGNOR
c. Ki-67
d. Apolipoprotein E4 (APOE4)
e. Deoxyrubicin
D

51. Which IV solution is isotonic?


A. RL
B. D50W
C. Mannitol
D. 3% NaCl
A

52. Which of these would cause vasodilation of cerebral blood vessels?


A. pO2 45 mmHg
B. pO2 90 mmHg
C. pCO2 30 mmHg
D. pCO2 40 mmHg
A PO2 <45

53. Which facial fracture is most likely to have an associated CSF leak?
A. Maxillary ridge
B. Orbital blowout
C. LeFort III
D. Zygoma
B

54. Which condition should trauma be alert for after an older patient is
injured in a fall?
A. Epidural hematomas
B. Subarachnoid bleeds
C. Intracerebral bleeds
D. Subdural hematomas
D

55. If a researcher is interested in measuring both the structure and


function of the brain, which of the following techniques would you
recommend?
A. electroencephalogram (EEG)
B. functional magnetic resonance imaging (fMRI)
C. precise lesioning
D. magnetic resonance imaging (MRI)
B
15

56. In stressful situations, the sympathetic nervous system ___________


glucose (blood sugar) levels and ___________ the pupils of the eyes.
A. raises; contracts
B. lowers; contracts
C. lowers; dilates
D. raises; dilates
D

57. Which lobe of the cerebral cortex is most directly involved in vision?
A. parietal
B. temporal
C. occipital
D. frontal
C

58. The ____________ is responsible for heartbeat and breathing.


A. reticular formation regulation of sleep awake transition, attention
B. thalamus receiving and processing info as well as making proper
connection to send-receive info
C. cerebellum maintain balance and posture, coordination of voluntary
movement, motor learning, cognitive fx
D. Medulla respi, cardiac center, vasomotor receptor (baroreceptor),
reflex center (vomit, cough, sneezing, swallow)
D
59. Ralph was involved in a bar fight and sustained a blow to the back of
the head from a beer bottle. He was dazed and could not see for about 2
minutes. Which lobe was affected?
A. frontal
B. parietal
C. temporal
D. occipital
D

Complete the following, chosse one correct answer


A. Monro-Kellie
B. blood, brain, and CSF
C. constant
D. offset
E. decrease
F. pressure
G. distributed evenly

60. The modified _____A_______ hypothesis states that


16

61. the sum of the intracranial volumes of _____blood________,


_____brain_____, and _____CSF________
62. and other components is _____constant_______
63. An increase in any one must be _____offset______
64. by an equal _____decrease______ in another
65. or else _____increase______ will rise.
66. Pressure is _____distributed evenly_____ throughout the intracranial
cavity.

TRUE OR FALSE
For questions 67 71, choose A or B
A. True B. False
In regard to ICP monitoring, it is permissible to:
67. use antibiotics TRUE
68. not use antibiotics TRUE
69. place monitor in ICU TRUE
70. place monitor in OR TRUE
71. Patients who develop hemorrhage while ICP is being placed is 1.4%
TRUE

For questions 72-75, choose A or B

A. True B. False

Mannitol lowers the ICP within a few minutes of administration by

72. decreasing the production of cerebrospinafluid (CSF) FALSE


(increasing)

73. reducing the hematocrit and blood viscosity TRUE

74. causing an immediate diuresis and decrease in the intravascular


volume FALSE
75. raising the serum osmolarity to establish an osmotic gradient
between the blood
and brain FALSE

76. Following an episode of severe head trauma incurred in a motorcycle


accident, an 18-year-old woman is noted to have decerebrate posturing.
Funduscopic examination reveals marked bilateral papilledema. A CT scan
of the head reveals marked diffuse cerebral edema from an increase in
sodium and water content. There is effacement of lateral ventricles. This
17

edema is most likely to be severest in which of the following parts of the


brain?

A. Gray matter

B. Meninges

C. White matter

D. Dura

E. Ependymal

77. The bellow are not symptoms of herniation in the pons :


A. Cheyne Stokes breathing
B. pin point Pupil
C.Hypertermia
D.Decerebrate rigidity
E. Both eyes are fixed
A medulla.

77. Vasogenic edema that occurs in brain injury will result in the following:
A. Na influx
B. Ca influx
C. ischemia
D. reperfusion injury
E. Blood brain barrier damage
E. Cytotoxic edema = BBB remains intact, disruption in cellular
metabolism impairs fx. NA & K pump in glial cell membrane cellular
retention of sodium & water.
Vasogenic edema = breakdown of tight endothelial junction that make up
BBB intravascular protein & fluid penetrate parenchymal extracellular
space.

78. Sub-arachnoid haemorrhage traumatic, which statement is not


appropriate:
A. Causes delayed neural defects
B. Can be caused by cerebral laceration
C. Can cause vasospasm
D. Ca blockers are always beneficial
18

E. Potential Hydrocephalus
D

79. Most rational treatment of increased ICP in severe head injury is:
A. Sedation Resuscitation - antiepeileptic - Mannitol
B. Sedation Mannitol - Ventricular Drainage antiepeileptic -
Decompression
C. Head Elevation - Mild hyperventilation - antiepeileptic - EVD drainage
D. Intubation - Head Elevation - antiepeileptic - Mannitol - EVD drainage
E. Intubation - sedation - mild Hiperkarbi - antiepeileptic - EVD
Drainage Mannitol
E

80. Increased in ICP due to head injury will result in the following, except :

A. Loss of consensual reflex

B. Anisocor pupil

C. Myosis pupil

D. Mydriatic pupil

E. Loss of pupillary reflex

Choose the correct answers


A. 1,2,3 statement are true
B. 1,3 statement are true
C. 2,4 statement are true
D. 1,2,3,4 statement are true

81. Following statements are true


1. Extradural Hematoma crosses both midline and suture line
2. Subdural Hematoma crosses both midline and suture line
3. Extradural Hematoma crosses midline but does not cross
suture line
4. Subdural Hematoma crosses midline but does not crosses suture
line
B

82. Factors predisposing to chronic subdural hematomas


1. Low intracranial pressure
19

2. Cerebral atrophy
3. All coagulopathies
4. Anticoagulant
D

83. Alcoholics dural Hematoma crosses suture line but does not cross
midline About post-traumatic epilepsy
1. Seizure presenting after 24hr is more common than within
24hr
2. AED do not reduce the frequency of late PE but have effect
on the early PE
3. Fe (ferritin) and Hb are epileptogenic as they decrease the
release of inhibitory neurotransmitter
4. Cerebral contusion, peneterating SDH injury depressed skull
fracture have more incidence of late PTE

84.Optimum initial management for victims of severe closed head injury


without intracranial mass lesions includes:
1. maintaining normal intravascular volume
2. maintaining near normal-arterial
3. keeping the head midline
4. administering intravenous fluids with high dextrose content
A

85. Elevation of an open depressed skull fracture is indicated for:


1. cosmetic deformities
2. improving neurologic function
3. reducing the risk of central nervous system infection
4. reducing risk for seizures

86. Which of the following compounds have been shown to play an


important role in
secondary brain injury following head trauma?
1. H2O2 OH
2. b.Glutamate
3. lactic acid
4. alanine
A

87. Following severe closed head injury, cerebral blood flow (CBF) is:
1. typically abnormally low during the first few hours after injury,
and increases over the next 2-3 days
2. uniformly reduced by 3% to 4% per torr decrease in arterial pCO2 with
little regional variation
20

3. usually the major contributor to brain swelling by the third day


after injury
4. d.Not affected by barbiturates
B

88. Where do contusions occur most frequently?


1. Frontal
2. Parietal
3. temporal lobes
4. Occipital
B

89. What are the sources of bleeding in traumatic epidural


hematoma?
1.Middle meningeal artery
2.Bone Diploe
3.Dural venous sinus (particularly in parietal-occipital region or
posterior fossa)
4.Cerebral Cortex
A

90. What are the best options to treat hypertension when high intracranial
pressure is present (e.g., traumatic brain injury [TBI])?
1. Beta Blocker (drug of choice)
2. Beta Agonis
3.Alpha agonis
4. Alfa blocker
B
Hydralazine (CCB) fast onset
ACE-I slow
Mannitol (decrease ICP 50% in 30)
Loop diuretic (furosemide)
Steroid IV (dexamethasone)

91. How can one differentiate if nasal drainage is CSF or nasal secretion?
1. Glucose
2. Protein
3. Beta Transferin
4. Ki-67
Immunofixation 2-transferin

92. What is the best initial treatment for a CSF leak?


1. Bed Rest
2. Prophylactic antibiotics
3.Head Elevation
4. Lumbal drain
B
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93. What are the areas most prone to diffuse axonal injury after head
trauma?
1. Corpus Callosum
2.Psterior fossa
3. Superior cerebral peduncle
4. Temporal lobes
Corpus callosum & brain stem

94. What is the microscopic hallmark of diffuse axonal injury?


1. Axonal retraction ball
2. Enlargement nucleus
3.Eosinophilic globular swelling
4. Broken cytoplasm
B. Pathognomonic DAI: destroyed axonal cytoskeleton, retraction bulbs.

95.. What are some medications that are neuroprotective?


1. Corticosteroids
2. free-radical scavengers
3. Calcium channel blockers
4. Mannitol
E

96. What does the literature state about hyperventilation in the setting of
traumatic brain injury?
1. decreasing cerebral perfusion pressure
2. delivering O2
3. delivering glucose
4. Decreased ICP

97. Why are epidural hematomas more frequently seen in younger adults
than in the elderly?
1. The duramater is thicker in younger patients
2. The duramater is thinner in younger patients
3. The duramater is more adherent in older patients
4. The skull is harder in older patients
B

98. What are the prerequisites for a growing skull fracture?


1. The skull fracture occurs in infancy or early childhood.
2. There is a dural tear at the time of the fracture.
3. There is brain injury at the time of the fracture with
displacement of leptomeninges and possibly brain through the
dural defect.
4. There is subsequent enlargement of the fracture to form a
cranial defect.

99. How is air embolism treated?


1. Packing the wound with wet sponges
2. lowering the patients head
22

3. using jugular venous compression


4. rotating the patients left side downward
C

100. How does one make the diagnosis of shakenbaby-


syndrome?
1. interhemispheric or tentorial subdural blood
2. Cervical spine fractures
3. Retinal hemorage
4. Skull fractures