SANS Trauma Flashcards
Seorang pria berusia 40 thn dgn kelemahan fasial kiri dan hemiparesis 48 jam setelah kecelakaan kendaraan bermotor meskipun awalnya scr neurologis normal setelah kecelakaan. CT kepala non-kontras pada saat bergejala negatif. Evaluasi diagnostik yg plg tepat berikutnya adalah ? A. Pemeriksaan perfusi serebral B. CT dari cervical spine C. MRI dari cervical spine D. CT angiogram dari cervical spine E. Monitor ICP
D. CT angiogram dari cervical spine This patient’s clinical course (delayed neurological deficit post-trauma in the setting of a negative head CT) is most consistent with a vascular dissection in the neck or at the skull base. For carotid injury, this may become evident within hours of the injury. Vertebrobasilar dissections typically present 2-3 days after the injury. The most sensitive and specific study would be a digital subtraction angiogram (not an option), followed by a CT angiogram. This study allows evaluation of both the carotid and vertebral systems from their origin through the skull base, and is sensitive to both dissection and external compression from fracture-dislocations or hematoma. Carotid Duplex study is not sensitive for injury to the vertebral system, nor will it demonstrate vascular injury at the skull base. Other anatomic imaging of the neck (CT/MRI) may demonstrate a traumatic cause for the vascular injury, but will not specifically demonstrate the vascular abnormality. A cerebral perfusion study may demonstrate the areas at risk due to embolic events, but will not demonstrate the underlying cause. ICP measurement is superfluous since the patient is awake and alert. Treatment for these injuries remains controversial, but in the absence of contraindications (including intracerebral hemorrhage), anticoagulation remains a mainstay of therapy. Depending on the site and length of dissection, endovascular managment with a stent may be indicated.
Comminution dari oksipital condyle yg plg sering dikaitkan dengan palsy saraf kepala? A. X B. IX C. VII D. XI E. XII
E. XII The cranial nerve most commonly affected by occipital condyle fractures is the is CN XII due to the close relationship of the hypoglossal canal to the occipital condyles. Cranial nerves X, IX, and XI (in order) are the next most common cranial nerves affected because they course through the jugular foramen.
Berapakah persentase kehilangan kesadaran pada kejadian gegar otak yg berkaitan dgn olahraga? A. 20-30% B. 10-20% C. < 10% D. 30-40% E. 40-50%
C. < 10% Loss of consciousness (LOC) is noted in less than 10% of sports-related concussions. While LOC used to be considered as a criterion, our current understanding is that concussionmay or may not involve a loss of consciousness. Loss of consciousness in NOT a criteria for the diagnosis of concussion.
Jenis tertentu dari percepatan yang menghasilkan cedera aksonal difus adalah A. Rotasi B. Impact C. Linear D. Translasi
A. Rotasi Diffuse axonal injury can only occur when there is a rotational or angular acceleration applied to the head and neck. Translational acceleration forces would only result in direct injuries such as contusions, intracerebral hematomas or subdural hematomas. Contact forces can similarly cause the same type of injuries but then also most often result in skull fractures and epidural hematomas. Concussion also can result only when rotational acceleration is a significant component of the injury mechanism.
Apakah gejala klinis khas dari second impact syndrome? A. Lebih sering pada anak dibanding dewasa B. Reversibel, perubahan sementara status mental setelah cedera kepala berulang C. Cedera neurologis sementara stlh masa pemulihan cedera kepala dari gegar otak sebelumnya D. Hanya berhubungan dgn gegar otak parah E. Memiliki insidensi yg tinggi diantara atlet
A. Lebih sering pada anak dibanding dewasa Second impact syndrome (SIS) is more common in children than adults. It occurs in the setting of a head injury during the recovery period from a prior concussion. These concussions can be mild or severe in nature. During this time, the cortex is particularly susceptible to trauma and injury may result in malignant cerebral edema with permanent neurological deficit. The overall prognosis is poor in these patients. Albeit a severe complication, it remains a rare entity in sports-related concussions.
Apakah metode terbaik untuk skrining pasien dgn cedera spine cervical yg tidak sadar + multi trauma terintubasi? A. Dynamic traction fluoroscopy B. Fluoroscopic Flexion/ Extension Imaging C. A/P, Lateral, Oblique dan Open Mouth Odontoid radiograf D. C-spine CT E. C-spine MRI
D. C-spine CT C-Spine CT imaging is the current ideal modality to screen unconscious multitrauma patients for cervical spine injury. CT is typically done at the time of initial evaluation in the ED, and abundant evidence now exists that when a high quality helical or multislice CT is done and read by a radiologist, CT can achieve high sensitvity and specificity. The use of plain radiographs has fallen out of favor due to challenges visualizing the entire spine, and the inability to identify unstable injuries in the absence of fracture, so-called “ligamentous injury.” Such injuries typically involve the disc and/or fascet joint capsules. Flexion-extension fluoroscopy is not indicated as a first-line imaging modality for cervical spine injury. Moreover, it has poor visualization of the cervicothoracic junction, particularly in an unconscious patient. MRI is a useful adjunct for patients who may have neurologic deficits, or whose CT scans are suggestive of an unstable injury. However, MRI does not confer additional information for a negative CT C-spine and is less available than CT imaging at most institutions. Dynamic traction imaging is not indicated as a first-line modality for the diagnosis of cervical spine injury.
Apakah definisi dari concussion? A. Hilangnya kesadaran akibat dari trauma kepala dgn gangguan/ abormal parenkim yg signifikan B. Hilangnya kesadaran akibat dari trauma kepala tanpa gangguan/ abormal parenkim yg signifikan C. Gangguan kesadaran sementara akibat dari trauma kepala tanpa gangguan/ abormal parenkim yg signifikan D. Gangguan kesadaran sementara akibat dari trauma kepala dengan gangguan/ abormal parenkim yg signifikan
C. Gangguan kesadaran sementara akibat dari trauma kepala tanpa gangguan/ abormal parenkim yg signifikan A concussion is defined as a transient alteration of consciousness resulting from head trauma, without significant parenchymal disruption or abnormalities. The diagnosis has been used interchangeably with the diagnosis of Mild Traumatic Brain Injury. A period of loss of consciousness is not required for the diagnosis. Any loss of consciousness generally connotes a moderate to severe concussion although grading varies. Although loss of consciousness is widely used to determine grade, post concussive amnesia may have a stronger correlation with degree of persistent cerebral dysfunction.
Manakah fitur utama dari diagnosis concussion? A. ICH B. Perubahan status mental yg cepat dan singkat C. Kejang D. Edema cerebral parah E. Defisit neurologis onset tertunda
B. Perubahan status mental yg cepat dan singkat In the majority of cases, concussion results in a functional rather than a structural injury. The symptoms of concussion are typically rapid, short-lived alterations of consciousness and/or amnesia. Blows to the body can transmit enough force to the head to cause a concussion. Routine CT and MRI imaging are typically unremarkable. Symptoms typically progressively improve and resolve over time. In a small percentage of patients, postconcussive symptoms may be prolonged (i.e. last longer than 3 months). Seizures can be associated with concussion, but they are not a defining condition.
Manakah ciri khas dari second impact syndrome? A. Cedera axonal difus B. Perdarahan pteki pada pencitraan C. Malignant cerebral edema D. Stroke iskemik E. Kejang
C. Malignant cerebral edema Second impact syndrome (SIS) occurs in the setting of a head injury during the recovery period from a prior concussion. During this time, the cortex is particularly susceptible to trauma and injury may result in malignant cerebral edema with permanent neurological deficit. The overall prognosis is poor in these patients. Neuroimaging may not demonstrate intracranial hemorrhage or findings of diffuse axonal injury. Ischemic stroke is not characteristic in SIS. Seizures may occur in a subset of these patients.
Manakah dari pernyataan berikut yg benar mengenai metabolisme glukosa setelah cedera otak traumatik yang parah ?
A. Kontrol glukosa ketat (80-110 mg/dl) dapat mempercepat krisis metabolik
B. Distress seluler akibat dari penurunan rasio lakctate/ pyruvate
C. Peningkatan permintaan metabolik digabungkan dgn peningkatan pasokan glukosa
D. Kejang subklinis tidak mengubah konsentrasi glukosa
A. Kontrol glukosa ketat (80-110 mg/dl) dapat mempercepat krisis metabolik In a randomized study, glucose control with tight (80-110mg/dL) versus less restrictive (120-150mg/dL) ranges was more likely to risk a metabolic crisis after TBI. The majority of patients exhibited higher glucose metabolic rates when glucose was under tight control. Microdialysis studies have shown that glucose availability is frequently reduced in the cerebral extracellular space following severe TBI. There is often a loss of cerebral blood flow (CBF) to metabolism coupling in TBI patients. Cerebral microdialysis markers of cellular distress are a low glucose and a HIGH lactate/pyruvate ratio. Microdialysis also showed more frequent elevations of lactate/pyruvate ratio when glucose levels were kept
