Kumpulan Soal 1 [PDF]

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BEDAH DASAR 1. A patient with mild traumatic brain injury has had a traumatically induced physiologic disruption of brain function, as manifested by 1 or more, except: a. Any loss of consciousness up to 3 hours b. Any loss of memory for events immediately before or after the accident for as much as 24 h c. Any alteration of mental state at the time of the accident (eg, feeling dazed, disoriented, or confused) d. Focal neurologic deficits that might or might not be transient, but where the severity of the injury does not exceed 2. Common symptoms of mild traumatic brain injury, except: a. Headache b. Nausea c. Vomiting d. Blurred and then improved vision 3. The common symptoms that arose from infratentrorial brain injury is: a. Seeing stars or lights b. Balance problems c. Dizziness d. Sensitivity to light or noise 4. Behavioral or emotional problems after long term post TBI is : a. Drowsiness b. Fatigue or lethargy c. Irritability d. Depression 5. Cognitive problems in TBI except: a. Feeling “slowed down” b. Feeling “in a fog” or “dazed” c. Seizure d. Difficulty remembering 6. Parietal lobes functions (Blue), except: a. Sense of memory b. Spatial perception (Depth Perception) c. Identification of Sizes, Shapes, Colors d. Visual Perception 7. Brain Stem Functions, except: a. Arousal b. Consciousness c. Heart Rate and Fight d. Sleep & Wake Cycles 8. Cerebellum Functions, which one is false a. Balance & Coordination b. Skilled Motor Activity c. A, B, correct



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d. Visual Perception Injuries of the left side of the brain can cause: a. Difficulties understanding language (receptive language) b. Difficulties and sometimes fluent in speaking or verbal output (expressive language) c. Catastrophic reactions (euphoria) d. Difficulty and easy speaking Injuries of the right side of the brain can cause: a. Visual-spatial improvement b. Visual memory deficits c. Right neglect (inattention to the right side of the body) d. Increased awareness of deficits A concussion can be caused by a. Indirect blows to the head b. Gunshot wounds c. Violent smooth of the head d. Decelerating from a whiplash-type injury Unconsciousness up to 24 hours, signs of brain trauma, contusions, or bleeding, signs of injury on neuroimaging are the sign of : a. Normal brain b. Mild head injury c. Moderate head injury d. Severe head injury A severe brain injury may cause the individual to experience: a. An unconscious the conscious state b. Where one appears to be in a short sleep c. Cannot be aroused d. Respond not purposefully Assessments in severe brain injury will: a. Typically reveal that the individual has sleep and wake cycles b. This loss of consciousness (LOC) is referred to as a somnolent c. Depending on varying factors and the severity of injury, the individual may remain in a coma, emerge from a coma d. Experience an increased level of consciousness A person who is truly in a coma will not be: a. Considered for any type of brain injury rehabilitation program b. Experience the same states of consciousness after brain injury c. Understanding these disorders of consciousness not important d. Discussing treatment and impossible rehabilitation options Diffuse axonal injury refers to: a. Impaired function and gradual improving of some axons b. Causing long extensions of a nerve cell to communicate with each other c. It always located near in parts of the brain d. Cannot be impact in far apart of the brain Another type of diffuse injury is:



a. Ischemia due to Fe2+ deficit b. Insufficient blood supply to certain parts of the brain c. Hyper oxygen d. Hyperglikemia 18. No treatment is required for most linear skull fractures if: a. Complex breaks or “cracks” in the skull b. Possibility that forces strong enough to cause a skull fracture c. Causing some damage to the underlying brain d. Fractures of the base of the skull are not problematic 19. A computed tomography scan (CT or CAT scan) in TBI: a. Not standard for the radiological assessment of a TBI patient. b. CT scan is difficult to perform excellent test for detecting the presence of blood and fractures c. Crucial lesions can not be identified in medical trauma cases. d. Plain x-rays is not better than CT of the skull that are recommended to evaluate patients with only moderate neurological dysfunction. 20. Magnetic resonance imaging (MRI) in TBI is: a. Commonly used for acute head injury b. It takes shorter to perform MRI than a CT c. Can be used to examine infarct cerebri in TBI d. It’s cheaper than CT For no 21-25 a. Epidural hematoma b. Herniated subfalcine c. Herniated uncal d. Herniated tonsillar e. Herniated central



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Occipitalis Depressed fracture Atlas Zygomatic arc Mandible arc Coronal suture Lambdoid suture Soft tissue swelling Linier fracture Fracture < 1 table



57. basal fractures with otorhea may be associated with complications such as: a. cranial nerve injury b. CSF fistula c. Carotid cavernous fistula d. Facial nerve palsy 58. These are confirmation of CSF rhinorrhea : a. Halo test positive b. Always appear as clear fluid c. Β-transferrin levels was confirmed d. Always appear in temporal skull fracture e. When there is CSF leakage, the patient must be unconscious 59. What is the most important structure that is compromised in uncal herniation? a. Calcarine sulcus



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b. Post central gyrus c. Posterior cerebral artery d. Temporal lobe These structures involved in unequal pupil due to uncal herniation, except : a. Oculomotor nerve b. Superior cerebellar artery c. Temporal lobe d. Anterior inferior cerebellar artery What is the optimal parameter in brain injury a. Intracranial pressure b. Mean arterial pressure c. Cerebral perfusion pressure d. Cerebral blood flow How can you make an imaginary midline to define a midline shift in head CT scan imaging? a. From crista galli to protuberanta occipital interna b. From frontal sinus to protuberantia occipital interna c. From glabella to protuberantia occipital externa d. From nasion to inion Complications associated with depressed skull fractures include the following : a. Obstruction of major venous sinuses b. Infection c. Focal brain injury d. All correct Damage to internal carotid artery are highly possible in fracture that involved : a. Frontal bone b. Vomer c. Sphenoid bone d. Occipital bone A recent study classified compound anterior cranial base fracture in these types according to location, except : a. A cribifrom fracture b. Frontoethmoidal fracture c. Nasofrontal fracture d. Lateral frontal fracture Initial management of CSF leakage a. No need to elevate the bed b. Fluid restriction c. Prophylactic antibiotics d. Suggest an emergency operation to repair Differential diagnosis of an intracranial hyperdense (with respect to brain) structure on noncontrast CT: a. Subacute blood b. Vessels with high flow c. Melanosis



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d. Acute intracranial bleeding Head injury in children: a. Airway characteristic is not a big issue b. Principles and optimization of ICP and CPP are similar with adults c. Good thermoregulatory compared to adults d. Non-accidental head injury is not as important as accidental head injury These are reflect the respiratory function in children with severe head injury, except : a. Ability to cry b. Pulse oximetry c. End-arterial pressure levels d. Arterial blood gas analysis Initial management of head injury in elderly : a. Airway management b. Occult cardiogenic shock c. Assessment of ventilation d. A, C are correct Intravenous mannitol should be used with caution in the elderly for several reasons, except : a. They may already be dehydrated b. Pre-existing electrolyte abnormalities c. A sudden increase of circulating blood volume risks cardiac failure d. They always in hypertension therapy due to lost vascular tone Skull base fracture may be associated with injuries following : a. Paranasal sinuses b. Thoracolumbar spine injuries c. Long bone fractures d. Abdominal trauma e. Pelvic injury Indications of surgical treatment by debridement of compound depressed fracture : a. No dural penetration b. Frontal lobe involvement c. Depression less than the thickness of the skull d. Frontal sinus involvement e. Minor cosmetic deformity Cervical spine injury may be excluded in the alert patients with the following features : a. No intoxication b. No neck pain c. High- energy injury d. A, B, C are correct e. A, B are correct Complications of traumatic CSF fistula : a. Low pressure headache b. Cosmetic problem c. Antibiotic resistency d. Neurological deficit



e. High-cost treatment The following picture can be used in questions no. 76-80



76. What is the name of the ‘ongoing bleeding’ in that hemorrhage? a. Halo sign b. Salt and pepper appearance c. Midline shift d. Swirl sign e. Crescent shaped 77. What part of the brain that involved in that picture ? a. Frontal lobe b. Occipital lobe c. Parietal lobe d. Temporal lobe e. Third ventricle 78. What do you suggest for that condition ? a. ICP monitor insertion b. Craniectomy decompression c. Craniotomy evacuation d. Closed observation e. Mannitol administration 79. What structure that looked shift in that picture? a. Pineal gland b. Third ventricle c. Fourth ventricle d. Lateral ventricle e. Falxcerebri 80. How can you measure the blood volume in that CT scan ? a. Direct measurement b. Ellipsoid method



c. Thickness of the blood d. A, B, C are correct e. A, B, are correct Please use the following instructions for another questions : A. B. C. D. E.



1, 2, 3 are correct 1, 3 are correct 2, 4 are correct Only 4 are correct 1, 2, 3, 4 are correct



81. Extracranial insults in head injury that may occur as secondary injury : 1. Hypotension 2. Hypxia 3. Hyponatremia 4. Anemia 82. Risk and complications of intravenous mannitol : 1. Rebound rise of ICP 2. Cardiac arrest 3. Hypotension 4. Minimal complication 83. These are drugs that dilate pupil so we can avoid the misinterpretation of pupil : 1. Morphine sulphate 2. Adrenaline 3. Pyridostigmine bromide 4. Scopolamine 84. Parameters for monitoring in head injured patients : 1. MAP > 90 mmHg 2. ICP > 20 mmHg 3. End tidal CO2 35-40 mmHg 4. Hematocrit 45% 85. Etiologies of pneumocephalus 1. Skull defects 2. Infection 3. Post neurosurgical procedures 4. Barotrauma 86. “Ping-pong” ball fractures 1. Need a craniotomy 2. Seen only in the newborn 3. Usually with neurological deficits 4. A green-stick type fracture 87. Indicators of transtentorial herniation/brainstem compression : 1. Sudden drop of GCS score 2. One pupil fixes and dilates



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3. Paralysis or decerebration 4. Bilateral fixed dilated pupil A high-injury is defined as follows 1. A motor vehicle accident at speeds > 64 km/h 2. Assault with blunt weapon 3. Pedestrians or cyclist hit by motor vehicles 4. Falls > 6 metres In pediatric, hypotension is 1. Neonates (0-28 days of age) : SBP < 60 mmHg 2. Infants (1-12 months) : SBP 70-80 mmHg 3. Children beyond 10 years : SBP < 90 mmHg 4. Children > 1-10 years : SBP < 70 + (1 x age in years ) mmHg The following head injury factors contribute to an increased risk of early seizures : 1. Cortical contusion 2. Depressed skull fractures 3. Penetrating wound 4. Seizure within 24 hours of injury Diastatic skull fracture : 1. Separation of cranial suture more than 1 mm 2. Separation of cranial suture more than 1 cm 3. More common in newborn 4. Can be accompanied by tear of underlying venous sinus Comminuted skull fractures : 1. Multiple fractures 2. Separate fragments 3. Caused by severe force 4. Caused by static loading Indications of head CT scan in GCS 15: 1. Transient vomiting 2. Persistent headache 3. Seizure with recovery 4. Altered behavior Both pupils dilated, non-reactive, shows the lesion due to : 1. Post epileptic state 2. Barbiturates 3. Severe hypotension 4. Brain stem compression Brain death in adults : 1. No pupillary response 2. No KPR reflex 3. No caloric vestibulo-ocular reflex 4. No corneal reflex A partial spinal cord injury may manifest as : 1. Anterior cord syndrome



2. Central cord syndrome 3. Lateral cord syndrome 4. Cauda equina syndrome 97. Middle basilar skull fractures 1. Lies in temporal bone 2. Battle sign always appear 3. The cranial nerve palsy damaged may be irreversible



BEDAH LANJUT 1. Metabolic responses to trauma include each of the following except a. Hypoglycemia b. Increased rate of lipolysis c. Increased rate of Na+ reabsorption d. Increased water reabsorption e. Metabolic alkalosis 2. An 18-year-old girl riding on the back of her boyfriend’s 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 For questions 3-6 A 16-year-old boy is struck on the side of the head by a bottle thrown by a friend involved in a prank. He appears dazed for about 30 s, but is apparently lucid for several minutes before he abruptly become stuporous. His limbs on the side opposite the site of the blow are more flaccid than those on the same side as the injury. On arrival in the emergency room 25 min after the accident, he is unresponsive to painful stimuli. His pulse is 40/min, with an ECG revealing no arrythmias. His blood pressure in both arms is 170/110 mmHg. Although papilledema is not evident in his fundi, he has venous distention and absent pulsations of the retinal vasculature. 3. The best explanation for this young man’s evolving clinical signs is a. A seizure disorder b. A cardiac conduction defect c. Increased intracranial pressure d. Sick sinus syndrome e. Communicating hydrochepalus 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 5. Magnetic resonance imaging of the patient’s head within the first few hours of injury should reveal a. A normal brain b. Intracerebral hematoma c. Temporal lobe contusion d. Subarachnoid hemorrhage e. Epidural hematoma



6. Computed tomography scanning of the patient’s head within 2h of the injury should reveal a. A normal brain b. A lens-shaped density over the frontal lobe c. Increased CSF density with a fluid-fluid level d. Multifocal attenuation of cortical tissue e. Bilateral sickle-shaped densities over the hemispheres 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 d. An intracerebral hematoma e. An intracerebellar hematoma 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 have an intracranial hemorrhage in which one of the following structures? a. Occipital lobe b. Thalamus c. Putamen d. Parietal lobe e. Temporal lobe 9. Computed tomography (CT) of the brain may fail to reveal a small subdural hematoma if a. The lesion is subacute. b. The hematoma extends into the brain from the subdural space. c. The resolution of the CT machine is greater than 2 mm. d. The subdural hematoma is less than 4 h old e. The patient has extensive cerebral atrophy 10. A 16-year-old male is struck on the head with a baseball bat during an a. He 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. 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 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 the a. Hemorrhage b. Hemorrhage c. Traumatic hemorrhage



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d. Ischemic stroke 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 lack of energy, headaches, and an inability to concentrate. Family physicial, 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. Cererbrospinal fluid rhinorrhea c. Psychiatric disorder d. Epilepsy e. Postconcussive syndrome Regarding infection in a trauma patient with the following x-ray, the most common pathogen is a. S. aureus b. Psudomonas c. Proteus d. S. pneumoniae e. E. coli All of the following characterize adult respiratory distress syndrome (ARDS) EXCEPT: a. Late hypoxemia b. Diffuse infiltrate c. Leaky capillaries d. Association with sepsis and trauma e. Protein content of fluid greater than with pulmonary edema 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 All of the following are true of extradural hematomas EXCEPT: a. They can appear crescentic 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 The most frequent site for traumatic SAH is a. Convexity b. Basal cistern c. Tentorial edge d. Sylvian fissure/Interhemispheric e. None of the above Classic CT appearance of EDH occur in a. 84%



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b. 74% c. 94% d. 64% e. None of the above 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 25-year-old man presented with a head injury a. Skull radiography is essential b. The risk of chronic subdural hematoma is related to the severity of the head injury c. He is said to have had a concussion if only minor macroscopic damage has occurred d. Extradural hematoma is usually caused by a rupture of the sagittal or transverse sinuses e. The risk of post-traumatic epilepsy is increased if he develops an epileptic seizures in the firs 24 hours after injury Best diagnostic method to diagnose post-traumatic CSF fistula a. Tomography b. Contrast enhanced CT c. Positive ventriculography contrast d. Air ventriculography e. Intrathecal contrast ventriculography Head trauma results in a. ↑ extracellular K+,↑ intracellular Ca2+ b. ↓ glutamine intracellularly c. ↑ extracellular glutamate d. ↑ adenosine e. All of the above A patient is having diffuse axonal injury histologically there are axonal swelling (retraction ball) in cerebral white matter, corpus callosum, dorsolateral quadrant upper brainstem and superior cerebellar peduncle and a focal lesion in the corpus callosum. 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 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 hemorrhagic e. None of the above Regarding mannitol use in head injury for reduction of brainoedema



A. Mannitol is used at a dose of 0.25gm-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 scavenges free radical which produce lipid peroxidation D. They can be used sometime conjunctive to chemotherapy for the Glioma to increase BBB penetrate E. All of the above 26. The triad of head injury with lucid interval, mydriasis on the side 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 27. Burst lobe is often reffered 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 + intracerebral hemorrhage E. None of the above 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 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 most common one damaged with closed head injury? A. Intraocular B. Intraorbital C. Intracanalicular D. Intracranial 31. How many percent of patients with closed head injury and having normal CT scan will have intracranial hypertension



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A. 13% B. 3% C. 23% D. 33% Cerebrovascular resistance is affected by PaCO2 such that there is a linear increase in CBF with increasing PaCO2 within the range of A. 40-70 mmHg B. 30-80 mmHg C. 20-80 mmHg D. 20-60 mmHg The intracranial hypertension after trauma is maximum between A. 0-24 hr B. 24-48 hr C. 48-72 hr D. 72-96 hr Among all the factors in GCS the most PROGNOSTIC is A. Verbal response B. Eye opening C. Motor response D. All of the above The revised trauma score is the most commonly used physiologic estimates of the injury used in trauma centers it is based on all of the following except which A. Systolic blood pressure B. Pulse rate C. Respiratory rate D. Glasgow coma scale Which type of seizure among the following does not followed head trauma A. Absence (petit mal) B. Partial complex, psychomotor variety C. Partial motor with jacksonian march D. Partial motor with secondary generalization Neurological: what does a score of 9 mean on the Glasgow Comma Scale? A. Minor brain injury B. Moderate brain injury C. Severe brain injury D. Fully conscious Neurological: damage to the right hemisphere would result in the following symptoms except: A. Lest motor praxis B. Emotion C. Speech D. Visual spatial processing You are assessing a traumatic brain injury patient and note that the patient has a right eyelid drop. 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



Choose the following for question 40-41 A. Central nervous system injury B. Root nerve injury In examining a flaccid limb: 40. Preserved reflexed indicates __________ 41. Absent reflexed indicates ____________ 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 eard. Which of the following statements is TRUE? A. Fracture lines transverse to the long axis of the petrous pyramd commonly result in ottoreae B. Meningitis in this patient would be unexpected, as it only occurs in 1% to 2% of patients with traumatic Cerebospinal Fluid Leaks (CSF Leaks) C. Leakage will most likely spontaneously stop within a week D. Immidiate 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 43. With (CSF) regard to cerebrospinal fluid leaks, which of the following is TRUE? A. Non traumatic CSF leakage is rarely due to a tumor B. CSF leaks is greater in traumatic leaks than in non traumatic leaks C. Risk 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 44. During a rugby game, a 25 years old male was tackled and became unconscious. Fellow players say he hegained consciousness after 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 a distinct borders and midline shift 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



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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 A 3 years old male-child is bought 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 adter 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 alart and awake. He is not in distress. There is small contusion on the fromto-parietal aspect of his scalp. There is no evidence of hematoma. Palpation does not reveal any depressed fracture. Neurogical examination is normal without any deficits. Rest of the physical exam is normal. Which of the following is the most appropriate management at tis time? A. Contact child protection services B. Perform head CT scan C. Admit to hospital D. Observe at home E. Skull x-rays What is the most common cause of subarachnoid hemorrhage (SAH)? A. Head trauma B. Vascular lesion C. Neoplasma D. Infection E. Idiopathic What is the most common cause of cerebrospinal fluid leakage? A. Head trauma B. Vascular lesion C. Neoplasma D. Infection E. Idiopathic Which allele predisposes one to greater risk of Alzheimer disease after a head injury? A. PCNA B. AGNOR C. Ki-67 D. Apolipoprotein E4 (APOE4) E. Deoxyrubicin Which IV solution is isotonic? A. RL



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B. D50W C. Mannitol D. 3% NaCl 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 Which facial fracture is the most likely to have an associated CSF leak? A. Maxiillary ridge B. Orbital blowout C. LeFort III D. Zygoma Which condition should trauma be alert for an older patient is injured in a fall> A. Epidural hematomas B. Subarachnoid bleeds C. Intracerebral bleeds D. Subdural hematomas 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) In stressful situations, the sympathetic nervous system _________ glucose (bloos sugar) levels and _________ the pupils of the eyes. A. Raises; contracts B. Lowers; contracts C. Lowers; dilates D. Raises; dilates Which lobe of the cerebral cortex is the most directly involved in vision? A. Parietal B. Temporal C. Occipital D. Frontal The _____________ is responsible for heartbeat and breathing. A. Reticular formation B. Thalamus C. Cerebellum D. Medulla 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 Complete the following, chose one correct answer A. B. C. D. E. F. G.



Monro-Kellie Blood, brain, and CSF Constant Offsent Decrease Pressure Distributed evenly



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The modified _______ hypothesis states that The sum of the intracranial volumes of __________, ___________, and ____________ And other components is _______________ An increase in any one must be ______________ By an equal ___________ in another Or else ____________ will rise. Pressure is ___________ 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. 68. 69. 70. 71.



Use antibiotics Not use antibiotics Place monitor in ICU Place monitor in OR Patients who develop hemorrhage while iCP is being placed is 1.4%



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 cerebrospinal fluid (CSF)



73. Reducing the hematocrit and blood viscocity 74. Causing an immediate diuresis and decrease in the intravascular volume 75. Raising the serum osmolarity to establish an osmotic gradient between the blood and brain



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 soudium and water content. There is a effacement of lateral ventricles. This 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. Hyperthermia D. Decerebrate rigidity E. Both eyes are fixed 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 E. Potential hydrocephalus 79. Most rational treatment of increased ICP in severe head injury is: A. Sedation – Resucitation – Antiepileptic – mannitol B. Sedation – Mannitol – Ventricular Drainage – Antiepileptic – Decompression C. Head elevation – Mild hyperventilation – Antiepileptic – EVD drainage D. Intubation- Head elevation – Antiepileptic – Mannitol – EVD drainage E. Intubation – Sedation – Mild hyperkarbi – Antiepileptic – EVD Drainage – Mannitol 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 relex



Choose the correct answers



A. B. C. D.



1, 2, 3 statements are true 1, 3 statements are true 2,4 statements are true 1, 2, 3, 4 statements 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 82. Factors predisposing to chronic subdural hematomas 1) Low intracranial pressure 2) Cerebral atrophy 3) All coagulopathies 4) Anticoagulant 83. Alcoholic 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, penetrating 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) Administrering intravenous fluids with hig dextrose content 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 seizure 86. Which of the following compounds have been shown to play an important role in secondary brain injury following head trauma? 1) H2O2 2) Glutamate 3) Lactic acid 4) Alanine 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



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2) Uniformly reduced by 3% to 4% per torr decrease in arterial pCO2 with little regional variation 3) Usually the major contributor to brain swelling by the third day after injury 4) Not affected by barbiturates Where do contusions occur most frequently? 1) Frontal 2) Parietal 3) Temporal lobes 4) Occipital What are the sources of bleeding in traumatic epidural hematoma? 1) Middle meningeal artery 2) Bone diploe 3) Dural venous sinus 4) Cerebral cortex What are the best options to treat hypertension when high intracranial pressure is present (e.g. traumatic brain injury (TBI))? 1) Beta blocker 2) Beta agonist 3) Alpha agonist 4) Alpha blocker How can one differentiate if nasal drainage is CSF or nasal secretion 1) Glucose 2) Protein 3) Beta transferrin 4) Ki-67 What is the best initial treatment for a CSF leak? 1) Bed rest 2) Prophylactic antibiotics 3) Head elevation 4) Lumbal drain What are the areas most prone to diffuse axonal injury after head trauma? 1) Corpus callosum 2) Postesior fossa 3) Superior cerebral peduncle 4) Temporal lobes What is the microscopic hallmark of diffuse axonal injury? 1) Axonal retraction bail 2) Enlargement nucleus 3) Eosinophilic globular swelling 4) Broken cytoplasm What are some medications that are neuroprotective? 1) Corticosteroids 2) Free-radical scavengers 3) Calcium-channel blockers



4) Mannitol 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 98. What are the prerequisites for a growing skull fracture? 1) The skull fracture occurs in infancy or early shildhood 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 would with wet sponges 2) Lowering the patient’s head 3) Using jugular venous compression 4) Rotating the patient’s left side downward 100. How does one make the diagnosis of “shakenbaby-syndrome”? 1) Interhemispheric or tentorial subdural blood 2) Cervical spine fractures 3) Retinal hemorrhage 4) Skull fractures