2011 Flashcards
CPP berhubungan dengan MAP dan ICP
Sebab
CPP faktor penting dalam metabolisme parenkim otak
B
Epilepsi pasca trauma dapat diakibatkan oleh peningkatan tekanan intrakranial akut
Sebab
Peningkatan tekanan intrakranial akan membentuk fokus epileptogenik pada parenkim otak
C
Herniasi tonsiler dapat mengakibatkan iskemia pada lobus oksipitalis
Sebab
Lobus oksipitalis mendapat vaskularisasi dari arteri serebri posterior
D
Edema sitotoksik sering diakibatkan oleh adanya iskemia atau hipoksia
Sebab
iskemia dan hipoksia akan merusak sawar darah otak
B
Perdarahan subarakhnoid pasca trauma dapat mengakibatkan iskhemia
Sebab
SAH traumatika dapat mengakibatkan hidrosefalus komunikan
B
Hiperpireksia paska trauma kepala dapat terjadi akibat kerusakan batang otak
Sebab
Hiperpireksia paska trauma kepada dapat sebagai prediktor mortalitas yang signifikan
B
Perdarahan subdural pada trauma kepala biasanya diikuti adanya kerusakan akson yang difus
Sebab
Mekanisme gaya yang bekerja pada SDH dan DAI adalah sama yaitu gaya rotasi dan akselerasi deselerasi.
A
Epidural hematoma pada trauma kepala adalah akibat ruptur dari cabang arteri meningika media
Sebab
Arteri meningika media adalah cabang dari arteri karotis interna
C
Herniasi lateral tentorial dapat terjadi akibat perdarahan epidural pada temporal basal
Sebab
Pupil melebar pada sisi psilatera adalah tanda adanya kerusakan pada serat motoris n.III
C
Cidera otak primer dapat diakibatkan oleh gaya yang dirambatkan pada kepala
Sebab
Kerusakan otak primer dapat berupa DAI.
B
Peningkatan tekanan intrakranial dapat mengakibatkan gangguan pola napas
Sebab
Pola napas dapat dipakai sebagai pertanda level kerusakan otak
B
Talk and die pada penderita trauma kepala, paling sering akibat perdarahan intrakranial
Sebab
Perdarahan intrakranial tidak selalu tampak pada CT scan inisial
B
Periorbital ecchymoses adalah tanda dari adanya fraktur basis kranii media
Sebab
Perdarahan dan kebocoran liquor pada fraktur basis kranii jarang memerlukan intervensi bedah
D
Gejala hipertensi intrakranial H dapat berupa triad cushing
Sebab
Bradikardi, hipertensi dan respirasi reguler adalah dalam upaya menjaga ICP dalam batas normal
C
Pengukuran tekanan intrakranial yang paling akurat adalah metoda intraventrikel
Sebab
Pemasangan monitor intraventrikel paling mudah dilakukan
C
Manitol adalah osmotik terapi pada hipertensi intrakranial
Sebab
Pemberian manitol dapat dilakukan pada penderita hipertensi intrakranial akibat trauma kepala pada kondisi apapun.
C
Kelemahan otot, gangguan mental, gangguan ECG (gelombang U) A. Hiponatremia B. Hipokalsemia C. Hipernatremia D. Hipokalemia E. Hipofosfatemia
D
Kelemahan otot, penurunan cardiac output, hemolitik anemia A. Hiponatremia B. Hipokalsemia C. Hipernatremia D. Hipokalemia E. Hipofosfatemia
E
Penurunan cardiac output, hiperrefleksia, tetani A. Hiponatremia B. Hipokalsemia C. Hipernatremia D. Hipokalemia E. Hipofosfatemia
B
Ensefalopati, edema otak, kejang A. Hiponatremia B. Hipokalsemia C. Hipernatremia D. Hipokalemia E. Hipofosfatemia
A
Multiple cranial palsy, penurunan kesadaran A. Hiponatremia B. Hipokalsemia C. Hipernatremia D. Hipokalemia E. Hipofosfatemia
C
Respon metabolik pada cidera otak adalah:
- Peningkatan turn over protein
- Hipo metabolism
- Peningkatan lipolisis
- Penurunan katabolisme
B
Penyebab hiponatremia pada cidera otak adalah :
- Pemberian mannitol
- SIADH
- Gangguan sistem adrenokortikal
- Polidipsi
C
Kriteria diagnosa SIADH
- Hipotonik hiponatremia
- Osmolalitas urin lebih rendah dari plasma
- Ekskresi natrium urine lebih 20 mmol/liter
- Dapat dikoreksi dengan minum banyak
B
Penyebab hipernatremia adalah
- Diabetes insipidus
- Pemberian salin hipertonik
- Diare
- Emboli lemak
E
What structure is most often compressed by herniation of the L4-5 disc A. L4 nerve root B. L5 nerve root C. S1 nerve root D. L5 and S1 nerve roots E. Cauda equine
B
For 8 mo, a 59-yr-oldman has had radiating upper extremity pain that extends from the neck down the lateral left arm and forearm and into the thumb and index finger. He complained of numbness over the tip of the thumb and dorsum of the left hand. On physical examination there was restricted motion of the cervical spine resulting from pain(especially in extension), weakness of the biceps muscle, and depression of the biceps reflex. There was no neurologic involvement in the lower extremities. Nonoperative treatment did not relieve his symptoms. An MRI scan (sagittal arid axial) of the cervical spine is shown in Fig. 1A,B. The most appropriate treatment for this problem is:
A. orthotic immobilization for 6 wk.
B. A neck extension exercise program.
C. Posterior decompressive laminectomy.
D. Anterior Cisc excision with fusion.
E. Posterior laminoplasty.
D
A 45-yr-old woman presented with complains of low back pain radiating into her anterior left thigh. She stated that although there was some gradual relief from the back pain, her leg pain continued. Physical examination revealed a positive femoral stretch sign on the right. An MRI scan of the lumbar spine (L3-4) is shown in Fig.2. The most likely diagnosis is: A. Spinal stenosis B. Dic Herniation C. Facet syndrome D. Conjoined Root E. Back strain
B
What structure is at risk for possible injury if a right-sided surgical approach between C4-6 is used? A. Superior Laryngeal nerve B. Recurrent laryngeal nerve C. Internal Laryngeal nerve D. Thoracic duct E. Esophagus
B
The primary treatment for a 33-yr-old man with acute onset low back pain wit h no leg pain or other symptoms should include
A. 1 to 2 days of bed rest
B. 1 to 2 weeks of bed rest
C. Transcutaneous electrical nerve stimulation
D. Muscle relaxants
E. Traction
A
The most consistent finding in patients who have a cauda equine syndrome (CES) is:
A. Paralysis
B. Sensory deficits in the foot and ankle
C. Motor and sensory deficits distal to the knee
D. Fecal incontinence
E. Urinary retentio
E
A 48-yr-old man injured his neck in a motor vehicle acciccnt 4 wk prior to presentation. He complained of serve, non-radiating neck pain. Physical examination revealed restricted neck motion and no neurologic deficits. Anteroposterior and latcral radiographs revealed no abnormalities. The most appropriate diagnosis test would be:
A. MRI Scan
B. CT sca discography
C. Myelography
D. Flexion and extension lateral radiogr aphs
E. Lateral tomograms
D
After vigorous activity, a 43-yr-old mar experienced pain in right keg. He sought medical attention ad was initially treated with rest and nonsteroidal arti-inflammatory agents. A CT scan of the lumbar spine performed. His symptoms did not hinder his ability to work, but he had continued minimal low back pain and mild lower extremity pain after vigorous sport activity. Neurolog examination was normal, with a straight leg raising test equivocal at 80 degrees. Recommended treatment should be: A. Perculaneous discectomy B. Open surgical disc excision C. Lumbar spine fusion D. Continued nonsurgical care E. Chemonucleolysis
D
What is the occurrence of abnormality on MRI scan of the cervical spine in asymptomatic subjects over the age of 40? A. 81% to 100 B. 61% to 80% C. 41% to 60% D. 21% to 40% E. 0% to 20%
D
Among normal subjects under the age of 40 What is the likelihood that anatomic evidence of a herniated disc of the lumbar spine will be found by imaging techniques such as myelography, CT, or MRI ? A. 10% to 15% B. 21% to 30% C. 31% to 40% D. 41% to 50% E. Greater than 50%
B
A 40 yr-old women presented with complaints of neck pain radiating to the dorsum of her right hard and extending to her middle finger and the radial aspect of her ring finger. She also had weakness of the right wrist flexors, proration of the right forearm, and a mild decrease in the triceps reflex of the right arm. Biceps and brachloradialis reflexes were rormal. The most likely diagnosis is
A. Herniated disc at C4-5
B. Herniated disc at C5-6
C. Herniated disc at C6-7
D. Syririx of the cervical spinal cord
E. Intramedullary spinal cord tumor at C-5
C
The most sensitive test for early diagnosis of discitis is: A. CT scan B. MRI scan C. Gallium scan D. Technetium bone scan E. Plain radiograph
B
A 55-yr-old woman had a 12 y progressive history of low back pain radiating to her thighs bilaterally. She had undergore at L4-S1 posterior fusions 15 yr ago. Radiographs show 7mm of displacement of L-3 or L-4 in flexion as compared to in extension. Based on these clinical and radiographic findings, lhe most likely diagnosis is: A. Pseudoarthrosis B. Isthmic psondylolisthesis C. Vertebral metastatic destruction D. L3-4 instability E. L4-S1 spinal stenosis
D
A 48-yr-old woman presented with severe L5 radiculopathy caused by a herniated disc at L4-5. A CT scan confirmed the diagnosis, and surgical disc excsion was performed. Lower extremity pain was relieved by the surgery but the moderate low back pain persisted. The long-term (10-yr )prognosis is A. Continued moderate low back pain B. Progressive, severe low back pain C. Gradual resolution of low back pain D. Recurrent lower extiemity symptoms E. Spinal instability
C
The prevelance of disc degeneration and/or bulging of a lumbar disc at one or more levels in patients over age 60 yr is: A. 0% to 10% B. 11% to 25% C. 26% to 50% D. 51% to 75% E. 76% to 100%
E
In a primary care setting. approximately 45% of patients who present with back pain will have spinal compression fractures and 3% will have spondylolisthesis. What percentage are thought to have a spinal neoplasm(primary or metastatic)? A Less than 1% B. 5% C. 10% D. 20% E. 25%
A
The most common complications from anterior cervical fusion surgery for a herniated disc occur as a result of
A. The type of surgical approach to the cervical Spine
B. Excision of the herniated disc.
C. Harvesting of bone graft from thc iliac crest.
D. Palcement of bone graft between adjacent vertebra
E. Failure to drain the cervical incision.
C
The bulbocavernous reflex can be permanently interrupted with injures to what spinal anatomic region A. Brain B. Cervical spine C. Thoracic spine D. Thoracolumbar spine E. Sciatic nerve
D
A 40-yr-old barber presented with a 10-wk history of low back and leg pain. An MRI scan sagittal and axial) is shown in Fig.3A B. The most specific physical finding to the verify the clinical significance of this patient’s condition is
A. Loss of sensation
B. Muscle weakness
C. A positive ipsilateral straight leg raising test
D. A positive contralateral straight leg raising test
E. Diminished reflex
D