Concussion, High Altitude Cerebral Edema, Cerebrovascular Injuries Flashcards
All of the following are correct regarding concussion injury except?
● A. It is considered mild because it is not life-threatening itself
● B. It is a complex pathophysiological process resulting in alteration of the brain function
● C. There is identifiable abnormality in standard structural imaging
● D. It is usually rapid, short lived, and resolves spontaneously
● E. It may include transient deficits in balance, coordination, memory, cognition, strength, and alertness
C. There is identifiable abnormality in standard structural imaging
How a patient with concussion injury is diagnosed?
● A. Abnormal finding in the imaging studies
● B. Self-reporting of abnormal functions like vacant stare, dazed or stunned, headache, nausea, vomiting, fatigue, seeing stars, photophobia, phonophobia, speech alterations or incoordination
● C. Observed physiological abnormalities or assessment of cognitive functions like slow to answer, easy distractibility, disorientation, memory deficits, and unaware of the date, time, and place
● D. Both B and C
● E. With blood tests and LP studies
D. Both B and C
Diffusion tensor imaging, functional MRI, positron emission tomography (PET), single photon emission CT, MR spectroscopy, and quantitative EEG are being used for research purposes for evaluation of concussive injuries. What is the acute pathophysiology of concussion injury?
● A. Potassium efflux and sodium/calcium influx
● B. Unrestricted hyperacute glutamate release from lipid membranes at cellular level
● C. Cortical spread of depression like state by voltage/ligand gated ion channels
● D. Widespread intracellular energy reserve depletion with increase in ADP
● E. All of the above
E. All of the above
Most symptoms from concussion resolve within 7 to 10 days and do not require treatment. About 10 to 15% of concussed individuals can develop postconcussive syndrome with symptoms beginning within 4 weeks of injury and remaining for more than 1 month after onset of symptoms. Which of the following statements is most appropriate regarding second impact syndrome?
● A. Injury occurring within few days of concussion injury
● B. Second injury when the patient is still symptomatic from the earlier one
● C. Second injury when the patient is still symptomatic with no further sequalae
● D. Second injury leading to malignant cerebral edema due to vascular engorgement which is refractory to all treatment and leads to death in 50 to 100% of cases
● E. Second injury leading to severe symptoms with no significant mortality
D. Second injury leading to malignant cerebral edema due to vascular engorgement which is refractory to all treatment and leads to death in 50 to 100% of cases
Diffuse axonal injury is a primary injury of rotational acceleration/deceleration head injury. Which of the following statements is not correct regarding grading of diffuse axonal injury?
● A. Mild clinical grade is coma for 6 to 24 hours followed by mild-to-moderate memory impairment and mild to moderate disabilities
● B. Moderate clinical grade is coma for more than 24 hours followed by confusion and long-lasting amnesia, mild-to-severe memory, and behavioral and cognitive deficits
● C. Severe clinical grade is coma lasting for months with flexor and extensor posturing, cognitive, memory, speech, sensory motor, and personal deficits
● D. Grade 1 histological grade is axonal injury in the white matter of cerebral hemisphere, corpus callosum, brain stem, and less commonly cerebellum
● E. Grade 2 histologic grading is focal lesion in the corpus callosum in addition to the above while grade 3 histologic grade does not exist
E. Grade 2 histologic grading is focal lesion in the corpus callosum in addition to the above while grade 3 histologic grade does not exist
Post-traumatic conductive hearing loss classically occurs due to which of the following?
● A. Longitudinal temporal bone fracture with disruption of the ossicular chain and hemotympanum
● B. Injury to the cochlea with temporal bone fracture or cochlear concussion
● C. Injury to the cranial nerve 8
● D. Injury to the brain stem like inferior colliculi, superficial siderosis of the brain stem, injury to bilateral frontal lobe or middle temporal gyrus
● E. Injury to pinna
A. Longitudinal temporal bone fracture with disruption of the ossicular chain and hemotympanum
A patient presented with headache, insomnia, fatigue, shortness of breath, and edema of hands, feet, lungs, and cerebrum after having rapid ascent to 15,000 feet. On examination, he is found to have retinal hemorrhages, papilledema, and vitreous hemorrhages. What does tight fit hypothesis postulate about the development of this acute mountain sickness?
● A. It occurs because of dilatation of the ventricles and CSF spaces
● B. Because of tight brain spaces
● C. Because of tight CSF spaces like small ventricles and subarachnoid CSF spaces
● D. Because of rapid loss of water content due to developing edema
● E. None of the above
C. Because of tight CSF spaces like small ventricles and subarachnoid CSF spaces
A patient after head trauma presented with blunt cerebrovascular injury. Signs and symptoms of this injury include arterial hemorrhage from neck/nose/mouth (immediately needs to
be taken to OR), cervical bruit in patients less than 50 years old, expanding cervical hematoma, focal neurologic deficit, neurologic deficit inconsistent with head CT, or stroke on CT or MRI of brain. 16 MD CTA (16 slice multidetector CT angiography) or catheter arteriogram is used for diagnosis of this condition. What are the traumatic factors with high risk of BCVI?
● A. Severe cervical hyperextension with rotation or hyperflexion
● B. High energy transfer mechanism with displaced midface fracture or basilar skull fracture
● C. TBI consistent with DAI and GCS less than 6
● D. Cervical vertebral body or transverse foramen fracture or any fracture involving c1 and c3
● E. All of the above
E. All of the above
Which of the following is the treatment for blunt cerebrovascular injuries according to the grade (Denver grading scale)?
● A. Grade 1 is luminal irregularity with less than 25% stenosis which is treated with aspirin only
● B. Grade 2 is more than equal to 25% stenosis or intraluminal thrombus or raised intimal flap which is treated with aspirin only
● C. Garde 3 is pseudoaneurysm which is treated with anticoagulation with heparin (heparin and aspirin are roughly equivalent for grade 3; however, most will need to be studied for 7 to 10 days and heparin is easier to stop for an angiography and if the lesion does not heal then endovascular stenting is considered)
● D. Grade 4 is occlusion and needs endovascular occlusion to prevent embolization
● E. Grade 5 is transection with free extravasation which is a lethal injury needing urgent surgical repair if accessible or endovascular stenting with concurrent thrombosis
● F. All of the above
F. All of the above
Which of the following are the trauma contraindications to anticoagulation?
● A. Active bleeding
● B. Potential for bleeding
● C. In whom the consequences of bleeding are severe like liver or spleen injuries or major pelvic fractures
● D. All of the above
● E. There is no contraindication to anticoagulation after trauma
D. All of the above
A patient presented with complaints of headache, photophobia, and tinnitus after a fall from bicycle. There was no history of loss of consciousness. What is the expected CT finding for the diagnosis of concussion?
● A. Midline shift
● B. Hematoma
● C. Effacement of basal cisterns
● D. Intraventricular hemorrhage
● E. Normal CT of brain
E. Normal CT of brain
Functional MRI consists of two types: task-based and resting. What is it based on?
● A. Blood oxygen level dependent effect
● B. Blood carbon dioxide level dependent effect
● C. Voxel analysis
● D. Tractography
● E. Histogram analysis
A. Blood oxygen level dependent effect
A student athlete who had concussion during a football match is able to do moderate activity with increased heart rate. According to 5-step return-to-play progression scale, this athlete is at what step?
● A. Baseline
● B. Step 1
● C. Step 2
● D. Step 3
● E. Step 4
C. Step 2
A comatosed patient was brought to emergency department after roadside accident and was managed in ICU with mechanical ventilation. He improved partially after 1 day but suffered
confusion and long-lasting amnesia along with mild-to-severe memory, behavioral, and cognitive deficits. There had been no evidence of mass lesion or ischemia on CT scans. What is the clinical grade of diffuse axonal injury in this case?
● A. Minor
● B. Mild
● C. Moderate
● D. Severe
● E. Critical
C. Moderate
What is the histological grading for diffuse axonal injury with axonal injury in the white matter of the cerebral hemisphere, corpus callosum, brain stem, and cerebellum?
● A. I
● B. II
● C. III
● D. IV
● E. V
A. I
