Head Injury: Long-Term Management, Complications, and Outcome Flashcards
The risk of developing DVT is 20% in untreated severe traumatic brain injury. Hence, unless contraindicated, graduated compression stockings or intermittent compression boots are recommended until patients are ambulatory. Low molecular weight heparin (LMWH) or low dose unfractionated heparin in conjunction with mechanical measures lowers the DVT risk but
increases the risk for which of the following?
● A. Drug reaction
● B. Longer hospital stay for administration of heparin
● C. Expansion of intracranial hemorrhage
● D. Infection of the wound
● E. None of the above
C. Expansion of intracranial hemorrhage
Nutritional replacement should begin within 72 hours of head injury in order to achieve 140% of predicted basal energy expenditure (BEE) in nonparalyzed patients while 100% of predicted BEE in paralyzed patients by which post trauma day
(mortality is reduced in patients who receive full caloric replacement by that day)?
● A. 7
● B. 9
● C. 11
● D. 13
● E. 15
A. 7
Isotonic solutions should be used at full strength starting at 30 mL/h along with enteral or parenteral feeding. Gastric residual is checked every 4 hours and feedings is held if residuals exceed what volume?
● A. 400 mL in an adult
● B. 300 mL in an adult
● C. 200 mL in an adult
● D. 125 mL in an adult
● E. 50 mL in an adult
D. 125 mL in an adult
What percentage of daily calories should be provided as protein daily?
● A. 10
● B. 15
● C. 20
● D. 25
● E. 30
B. 15
Incidence of clinically symptomatic hydrocephalus within 3 months of traumatic subarachnoid hemorrhage is approximately 12%. Which of the following are the factors which increase the risk of hydrocephalus after traumatic subarachnoid
hemorrhage?
● A. Older age
● B. Intraventricular hemorrhage
● C. Blood thickness more than or equal to 5 mm
● D. Diffuse distribution of blood versus focal distribution
● E. All of the above
E. All of the above
All of the following are factors favoring shunt placement in a patient with post traumatic hydrocephalus except?
● A. Elevated pressure on one or more LPs
● B. Papilledema on fundoscopy is not present
● C. Symptoms of head/pressure
● D. Finding of transependymal absorption on CT of T2WI MRI
● E. Patients whose neurologic recovery seems worse than expected
B. Papilledema on fundoscopy is not present
The status of basal cisterns is evaluated on axial CT scan at the level of the midbrain where they are divided into three limbs. One posterior limb which is called as quadrigeminal cistern and two lateral limbs which are posterior portions of ambient cisterns. Which of the following options are correct regarding status of basal cisterns compression with Glasgow outcome scale 5 (good outcome)?
● A. Normal—35%
● B. Compressed—19%
● C. Absent—11%
● D. Nonvisualized—12%
● E. All of the above statements are correct
E. All of the above statements are correct
Midline shift is defined at the level of foramen of Monro and is calculated by dividing biparietal diameter (the width of intracranial compartment at this level) by 2 and subtracting SP (the distance from the inner table to the septum pellucidum on
the side of the shift). Midline shift may be most probably associated with which one of the following?
● A. Severe headache
● B. Persistent vomiting
● C. Diplopia
● D. Altered level of consciousness
● E. Ophthalmoplegia
D. Altered level of consciousness
Apolipoprotein (apoE-4) presence portends a worse prognosis following traumatic brain injury. Which of the following are the late complications from traumatic brain injury?
● A. Post-traumatic seizures
● B. Communicating hydrocephalus
● C. Post-traumatic concussive syndrome
● D. Hypogonadotropic hypogonadism
● E. Chronic traumatic encephalopathy or Alzheimer’s disease
● F. All of the above
F. All of the above
A patient after some time of traumatic head injury presents with headache, dizziness, visual disturbances, difficulty concentrating, dementia, emotional difficulties, and personality changes. Supportive and reassuring counselling of this patient is done. What tests can be performed if symptoms from minor head trauma persist for more than 3 months?
● A. Head CT
● B. MRI
● C. BAER
● D. Neuropsychological battery
● E. All of the above
E. All of the above
What is the advantage of early tracheostomy in severe head injury?
● A. Reduces duration for mechanical ventilation
● B. Reduces pneumonia
● C. Reduces mortality
● D. Reduces duration for antibiotics
● E. Reduces ICP
A. Reduces duration for mechanical ventilation
Establishment of full caloric requirement should not be delayed beyond what post-trauma day?
● A. 1
● B. 3
● C. 7
● D. 10
● E. 14
C. 7
Rested comatose patients with isolated head injury have how much metabolic expenditure compared to normal for that patient?
● A. 100%
● B. 140%
● C. 300%
● D. 350%
● E. 500%
B. 140%
Regarding nutritional requirement in head trauma patient, caloric requirement provided with proteins should be how much?
● A. 1%
● B. 5%
● C. 7%
● D. ≥ 15%
● E. 50%
D. ≥ 15%
Following are the factors favoring hydrocephalus for which shunt should be considered except?
● A. Elevated pressure on LP
● B. Papilledema
● C. Symptom of headache
● D. Transependymal absorption on CT/T2WI MRI
● E. Good neurological recovery than expected
E. Good neurological recovery than expected
