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Top Score for the Neurosurgery Board Examination (2025) > Coma and Coma Scales > Flashcards

Coma and Coma Scales Flashcards

1
Q

A 30-year-old male with traumatic head injury is admitted in ICU with a GCS of E1VTM3. The decorticate posturing is attributed to what?
● A. Disinhibition of vestibulospinal tract
● B. Disinhibition of pontine reticular formation
● C. Disinhibition by removal of corticospinal pathways above the midbrain
● D. Disinhibition of medullary reticular formation
● E. Transection at inter-collicular level

A

C. Disinhibition by removal of corticospinal pathways above the midbrain

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2
Q

A patient admitted in ICU for monitoring developed an abnormal breathing pattern: the breathing gradually crescendos in amplitude and then trails off, followed by an expiratory pause, and then the pattern repeats. Cheyne-Stokes breathing
indicates dysfunction of which of the following?
● A. High medulla
● B. Lower medulla
● C. Pons
● D. Bilateral cerebral hemispheres
● E. Basilar artery occlusion

A

D. Bilateral cerebral hemispheres

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3
Q

Which of the following is usually a pre-terminal breathing pattern?
● A. Cheyne-Stokes
● B. Cluster
● C. Ataxic
● D. Apneustic
● E. Apneic

A

C. Ataxic

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4
Q

On examination of a middle-aged female patient on assisted ventilation in ICU, bilateral pin point pupils were noted. This finding is due to what?
● A. Unopposed sympathetic input
● B. Loss of sympathetic input
● C. Loss of parasympathetic output
● D. Medullary lesion
● E. Midbrain lesion

A

B. Loss of sympathetic input

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5
Q

Which of the following may be a manisfestation of a lesion in medial longitudinal fasciculus?
● A. Ocular blobbing
● B. Ping pong gaze
● C. Windshield wiper eye
● D. Internuclear ophthalmoplegia
● E. Wrong way gaze

A

D. Internuclear ophthalmoplegia

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6
Q

While testing oculovestibular reflex, contralateral eye fails to adduct. This finding may be labeled as what?
● A. Ocular blobbing
● B. Ping pong gaze
● C. Windshield wiper eye
● D. Internuclear ophthalmoplegia
● E. Wrong way gaze

A

D. Internuclear ophthalmoplegia

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7
Q

A patient develops subfalcine herniation where cingulate gyrus herniates under the falx. Which of the following vessels is at risk of occlusion?
● A. ICA
● B. ACA
● C. MCA
● D. PCA
● E. PICA

A

D. PCA

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8
Q

A patient with mass effect on CT scan deteriorated after lumbar puncture was done. Which of the following herniation syndrome is most likely in this case?
● A. Central
● B. Uncal
● C. Subfalcine
● D. Upward cerebellar
● E. Tonsillar

A

E. Tonsillar

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9
Q

A comatosed patient in ICU had high urinary output. Diabetes insipidus may result from which herniation syndrome?
● A. Central
● B. Uncal
● C. Subfalcine
● D. Upward cerebellar
● E. Tonsillar

A

A. Central

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10
Q

A patient with traumatic brain injury had sustained a hematoma in the lateral middle fossa. His examination revealed sustained hyperpnea breathing, with both pupils in mid position
(5–6 mm) and fixed; oculomotor was impaired and there was bilateral decerebrate rigidity. These finding favor which stage of uncal herniation?
● A. Diencephalic
● B. Midbrain
● C. Midbrain–upper pontine
● D. Lower pons–upper medullary
● E. Medullary

A

C. Midbrain–upper pontine

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10
Q

A patient diagnosed with left temporoparietal brain tumor was brought to emergency department. His examination revealed regular and shallow respiration at 30 breaths/min; pupils were midposition (3–5 mm) and fixed; Doll’s eyes reflex
was unelicitable; bilateral Babinski was positive with occasional lower extremity flexion to pain. These findings are consistent with which stage of tentorial herniation?
● A. Diencephalic
● B. Midbrain
● C. Midbrain–upper pontine
● D. Lower pons–upper medullary
● E. Medullary

A

D. Lower pons–upper medullary

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11
Q

A middle-aged male presented to ER after roadside accident. His brain CT revealed left temporal hematoma and motor examination revealed ipsilateral hemiplegia. Which of the following is a false localizing sign?
● A. Kernohan’s phenomenon
● B. Internuclear ophthalmoplegia
● C. Ocular blobbing
● D. Ataxic respiration
● E. Doll’s eye reflex

A

A. Kernohan’s phenomenon

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12
Q

Anoxemic anoxia in hypoxic shock severely affects which of the following?
● A. Caudate nucleus
● B. Putamen
● C. Globus pallidus
● D. Incisura
● E. Tentorium

A

C. Globus pallidus

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13
Q

A 3-year-old boy was brought to ER by her mother after fall from stairs. On examination, he opened his eyes to pain, was inconsolable, and had a decorticate posture. What is his GCS
score?
● A. 4
● B. 5
● C. 6
● D. 7
● E. 8

A

D. 7

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14
Q

Oculocephalic reflex is contraindicated in which of the following?
● A. Ventilated patient
● B. Cervical spine injury
● C. Pyrexia
● D. Severe head injury
● E. Post craniotomy

A

B. Cervical spine injury

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15
Q

Coma is the severest impairment of arousal and is defined as inability to obey commands, speak, or open the eyes to pain. What GCS score is generally accepted as operational definition of coma?
● A. Less than 9
● B. Less than 8
● C. Less than 6
● D. Less than 7
● E. Less than 5

A

B. Less than 8

16
Q

A patient presents to neurosurgical emergency after road traffic accident. The on-call resident decides to intubate after assessing that GCS score is less than 9. The patient opens his eyes to pain, has incomprehensible verbal response, and has
flexion (decorticate) posturing. What is the GCS score in this
patient?
● A. 8
● B. 7
● C. 6
● D. 5
● E. 4

A

B. 7

17
Q

A 3-year-old child presented in neurosurgical emergency after road traffic accident. This child opens his/her eyes to pain, is inconsistently consolable, is moaning, and localizes to pain.
What is the GCS score in this patient?
● A. 12
● B. 11
● C. 10
● D. 9
● E. 8

A

C. 10

18
Q

Decorticate posturing (abnormal flexion in upper extremities and extension in lower extremities) has slightly better prognosis than decerebrate posturing (abnormal extension in both upper and lower extremities). What pathways are removed or damaged in decorticate posturing and decerebrate
posturing, respectively?
● A. Vestibulospinal tract and corticospinal tract
● B. Corticospinal tract and pontine reticular formation
● C. Corticospinal tract and vestibulospinal tract
● D. Corticospinal tract and vestibulospinal tract + pontine reticular formation
● E. Corticospinal tract and vestibulobulbar tract

A

D. Corticospinal tract and vestibulospinal tract + pontine reticular formation

19
Q

Structural causes of coma include vascular obstruction (like bilateral carotid or thalamo-perforators supplying both medial thalamic areas), any abscess, hemorrhagic contusion or hematoma, brain tumor, and herniation. What amount of midline shift causes stuporous stage of unconsciousness?
● A. 8 to 13 mm
● B. 6 to 8.5 mm
● C. 4 to 6 mm
● D. 3 to 4 mm
● E. None of the above

A

B. 6 to 8.5 mm

20
Q

A comatose patient is brought to emergency for unknown reason. Following are the steps in emergency management of this patient except?
● A. Establishment of airway, stabilization of BP, 25 mL of dextrose 50% given IV, and attachment of oxygen with saturation monitoring
● B. Blood is obtained for electrolytes and toxicology screen
● C. Emergency medicines such as solocurtef, Avil, adrenaline, fluid, naloxone, flumazenil, or thiamine are given if there is suspicion of anaphylactic shock narcotic overdose or benzodiazepine overdose, or Wernicke’s suspected, respectively
● D. No need of core neuro examination in this patient to avoid wasting time
● E. If signs of raised ICP noted, measures to lower ICP started and STAT CT brain plain is obtained

A

D. No need of core neuro examination in this patient to avoid wasting time

21
Q

Following statements regarding pupil examination in a comatose patient are correct except?
● A. Equal and reactive pupils indicate toxic or metabolic cause with few exceptions such as glutethimide toxicity, anoxic encephalopathy, anticholinergics or narcotics overdose
● B. Anisocoria is produced by afferent pupillary defect
● C. Most common causes of anisocoria are herniation syndrome and Horner syndrome
● D. Bilateral fixed and dilated pupil (7–10 mm) is seen in subtotal damage to medulla or immediate post anoxia or hypothermia
● E. Bilateral fixed and mid position pupil (4–6 mm) are due to more extensive midbrain lesion

A

B. Anisocoria is produced by afferent pupillary defect

22
Q

A breathing pattern that gradually crescendos in amplitude and then trails off followed by an expiratory pause and then the pattern repeats is most commonly seen in diencephalic lesion or bilateral cerebral hemisphere dysfunction. What is this pattern of breathing called?
● A. Cheyne-Stokes breathing
● B. Hyperventilation
● C. Cluster breathing
● D. Apneustic breathing
● E. Ataxic breathing

A

A. Cheyne-Stokes breathing

23
Q

All of the following are causes of bilateral conjugate deviation of eyes except?
● A. Frontal lobe lesion
● B. Pontine lesion
● C. Lesion in medial longitudinal fasciculus
● D. Medial thalamic hemorrhage
● E. Midbrain pretectal lesions

A

C. Lesion in medial longitudinal fasciculus

24
Q

Which of the following statements is true regarding herniation syndrome?
● A. Central and uncal herniations are types of supratentorial herniation
● B. Upward cerebellar herniation is seen in posterior fossa mass, and it is exacerbated by ventriculostomy
● C. Tonsillar herniation can be due to supra- or infratentorial masses, elevated ICP from cerebral edema, or obstruction to CSF flow at foramen magnum, and it is exacerbated by LP
● D. Temporal lobe or middle lobe mass lesion produces uncal herniation
● E. All of the above

A

E. All of the above

Top Score for the Neurosurgery Board Examination (2025) (85 decks)

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