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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
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
3
d. An intracerebral hematoma
e. An intracerebellar hematoma
C
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)
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
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
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
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
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
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
A Compressive dressing
E
13
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?
C) Admit to Hospital
D) Observe at home
E) Skull X-rays
a. PCNA
b.AGNOR
c. Ki-67
d. Apolipoprotein E4 (APOE4)
e. Deoxyrubicin
D
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
57. Which lobe of the cerebral cortex is most directly involved in vision?
A. parietal
B. temporal
C. occipital
D. frontal
C
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
A. True B. False
A. Gray matter
B. Meninges
C. White matter
D. Dura
E. Ependymal
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.
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 :
B. Anisocor pupil
C. Myosis pupil
D. Mydriatic pupil
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
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
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
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
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