TRAUMA

Question 1

implies a violent shaking or jarring of the brain and a

resulting transient functional impairment

Answer 1

concussion,

Question 2

Even in immediately fatal head injuries,

autopsy reveals an intact skull in _______percent of cases

Answer 2

20 to 30

Question 3

Overall, brain injury
is estimated to be_______ more frequent with skull
fractures than without them and perhaps 20 times more
frequent with severe and multiple fractures

Answer 3

5 to 10 times

Question 4

Fracture of the
________ often deforms the external auditory
canal or tears the tympanic membrane, with resultant
leakage of CSF (otorrhea); or, blood may collect behind an
intact tympanic membrane and discolor it

Answer 4

petrous pyramid

Question 5

If the fracture
extends more posteriorly, damaging the __________
the tissue behind the ear and over the mastoid process
becomes boggy and discolored _______

Answer 5

sigmoid sinus,

Battle sign

Question 6

Basal fracture
of the ________ may also cause blood to leak
into the periorbital tissues, imparting a characteristic
“raccoon” or “panda bear” appearance.

Answer 6

anterior skull

Question 7

The ______, ________ AND ______ are the ones most liable to injury, but any
one, including the twelfth, may be damaged

Answer 7

olfactory, facial, and

auditory nerves

Question 8

A fracture in or near
the sella may tear the stalk of the pituitary gland with
resulting_______

Answer 8

diabetes insipidus.

Question 9

A fracture of the sphenoid bone may lacerate the__________ with blindness from the beginning.

Answer 9

optic

nerve,

Question 10

diplopia that is worse on looking down and compensatory

tilting of the head indicating a _________

Answer 10

trochlear nerve injury

Question 11

Injury to the ________ AND ________ of the
trigeminal nerve may be the result of either a basal fracture across the middle cranial fossa or a direct extracranial injury to the branches of the nerves

Answer 11

ophthalmic and maxillary divisions

Question 12

transverse fractures

through the petrous bone results in ______

Answer 12

immediate

facial palsy,

Question 13

_____of the petrous bone, the facial palsy then
often being delayed for several days, a sequence that may be misinterpreted as progression of the intracranial traumatic lesion.

Answer 13

longitudinal

fractures

Question 14

Injury to the eighth cranial nerve because of petrous
fractures results in a loss of hearing or in ________
and _________ coming on immediately after the trauma

Answer 14

postural vertigo

nystagmus

Question 15

Deafness as a result of nerve injury must be distinguished
from the high-tone hearing loss due to ___________and
from deafness caused by bleeding into the middle ear
and disruption of the ossicular chain

Answer 15

cochlear injury

Question 16

The rare condition of fracture through
the __________ causes weakness of one side of
the tongue.

Answer 16

hypoglossal canal

Question 17

A basal fracture through the _______ may lacerate
the internal carotid artery or one of its intracavernous
branches where it lies in the cavernous sinus

Answer 17

sphenoid bone

Question 18

In CCF, Also, there may be a loss of vision as a result of __________

Answer 18

ischemia of the optic nerve and retina

Question 19

Some
_______ of fistulas resolve spontaneously, but the
remainder must be obliterated by interventional radiologic
means (by a detachable balloon inserted into the
carotid artery via a transfemoral catheter) or by a direct
surgical repair of the fistula

Answer 19

5 to 10 percent

Question 20

How to test for CSF in CSF rhinorrhea?

Answer 20

by testing it for glucose with diabetic test tape (mucus has no glucose)

presence of fluorescein or radionuclide-labeled dye that
is injected into the lumbar subarachnoid space and then
absorbed by pledgets placed in the nasal cavity

detect tau protein in the discharge; it is
present only in CSF and not in mucus or blood

Question 21

Tx of tension pneumocranium

Answer 21

Inhalation
of 100 percent oxygen has a slight salutary effect, but
aspiration of the air is required if the collection is causing
clinical signs.

Question 22

Depressed skull fractures are of significance only
if the _________or the ________They then are surgically
elevated, preferably within the first 24 to 48 h.

Answer 22

underlying dura is lacerated

brain is compressed
by indentation of bone.

Question 23

The duration of the
amnesic period, particularly of ______________, is
but one index of the severity of the concussive injury

Answer 23

anterograde amnesia

Question 24

A majority of patients who

remain in a coma for more than 24 h after a head injury are found to have intracerebral______________

Answer 24

hematomas and contusions.

Question 25

Blows to the front of the head may produce mainly __________lesions, whereas blows to the back of the head may cause mainly_________ lesions. Blows to the side of the head produce___________

Answer 25

coup contrecoup either coup or contrecoup lesions, or both.

Question 26

Irrespective of the site of the impact, the common sites of cerebral contusions are in the_______

Answer 26

frontal and temporal lobes

Question 27

Relative sparing of the occipital lobes in coupcontrecoup | injury has been explained by the __________and subadjacent tentorium,

Answer 27

smooth | inner surface of the occipital bones

Question 28

In most cases of severe head injury, there is damage | to the __________by impact with the falx

Answer 28

corpus callosum

Question 29

all brainstem hemorrhages when there is mass effect that distorts the brainstem

Answer 29

Duret hemorrhage

Question 30

In addition to contusions and extradural, subdural, subarachnoid, and intracerebral hemorrhages, closed head injury induces variable degrees of vasogenic edema that increases during the first ________

Answer 30

24 to 48 h

Question 31

pulmonary symptoms is associated with a petechial rash over the thorax, especially in the axillae and also in the conjunctivea. what is this related to?

Answer 31

Ce re b ra l Fat E m bo l i s m

Question 32

CEREBRAL FAT EMBOLISM CAUSES widespread ________________ involving both white and gray matter and a few larger infarcts

Answer 32

petechial hemorrhages and small infarctions,

Question 33

Most patients with fat embolism recover spontaneously in ___________, although a mortality rate of up to 10 percent is cited

Answer 33

3 or 4 days

Question 34

fracture through the squamous bone and the groove of the middle meningeal artery, which represents a risk for arterial bleeding and ________

Answer 34

epidural hemorrhage.

Question 35

indications of ct scan in head injury

Answer 35

prolonged loss of consciousness (more than 1 min), severe and persisting headache, nausea and vomiting, a confusional state, and any new, objective neurologic signs,

Question 36

T OR F | in children with head injury, it may be advisable to perform the scans more liberally

Answer 36

T

Question 37

Canadian CT head rule

Answer 37

``` age above 60 years, intoxication, more than 30 min of retrograde amnesia, suspected skull fracture, seizure, anticoagulation, and dangerous mechanism of injury, ```

Question 38

A concussion of the ______ of the spinal cord is | another potential mechanism of transient paraplegia

Answer 38

cervical portion

Question 39

Among patients who survived and remained vegetative until death, Adams and colleagues (2000) found that 80 percent had _____________ and 71 percent had findings of ____________

Answer 39

thalamic damage diffuse axonal injury.

Question 40

_________ accelerated slightly the emergence from the vegetative or minimally conscious state; it was given for 4 weeks between the fourth and twelfth weeks after injury, 100 mg twice per day and increasing to 200 mg twice per day

Answer 40

Amantadine

Question 41

epidural hematoma arises with _____________fracture and laceration of the middle meningeal artery or vein. Less often, there is a tear in a ______

Answer 41

a temporal or parietal dural venous sinus.

Question 42

Poor prognosticating factors after surgery of EDH

Answer 42

extended fractures and laceration of the dural | venous sinuses,

Question 43

In _______________ which may be unilateral or bilateral, there may be a brief lucid interval between the blow to the head and the advent of coma

Answer 43

acute s ubdural hematoma,

Question 44

Unlike epidural arterial hemorrhage, which is steadily progressive, the ____________usually arrests the venous bleeding

Answer 44

rising intracranial pressure

Question 45

IN SDH, On CT scans, the acute clot is initially hyperdense but becomes slowly more isodense after a period of ________ Over the subsequent weeks, all image sequences show it as hyperintense as a result of ____________ formation

Answer 45

1 or more weeks methemoglobin

Question 46

The acute clot is hypointense on T2-weighted images, reflecting the presence of _______

Answer 46

deoxyhemoglobin

Question 47

In SDH, With contrast infusion, both imaging procedures usually reveal the _________

Answer 47

vascular and reactive border surrounding the | clot.

Question 48

Usually, by the fourth week, sometimes later, the hematoma becomes very hypodense, giving rise to a ___________

Answer 48

chronic subdural hygroma

Question 49

The chronic subdural hematoma becomes gradually encysted by fibrous membranes _________ that grow from the dura

Answer 49

(pseudomembranes)

Question 50

the most important factor in the expansion | of subdural fluid is a pathologic___________

Answer 50

permeability of the developing capillaries in the outer pseudomembrane of the hematoma

Question 51

In most cases of acute hematoma it is sufficient to place ________ and evacuate the clot before coma has developed

Answer 51

burr holes

Question 52

the interval between__________________ is perhaps the most important determinant of outcome in serious cases

Answer 52

loss | of consciousness and the surgical drainage of the clot

Question 53

To remove the more chronic hematomas a _______ must be performed and an attempt made to strip the membranes that surround the clot

Answer 53

craniotomy

Question 54

This i s a thinly encapsulated collection o f clear o r slightly xanthochromic fluid in the subdural space; such collections form after an injury, as well as after meningitis

Answer 54

subdural hygroma

Question 55

Occasionally a hygroma originates from a tear in an _________. Another cause is from _________

Answer 55

arachnoidal cyst IC hypotension

Question 56

In contusion hematoma, the swelling in the | region of an acute contusion is precipitated by _______

Answer 56

excessive | administration of intravenous fluids

Question 57

basal ganglia hemorrhages were prone to enlarge in the day or two after closed head injury and that those greater than ____________ in volume were fatal in 9 of 10 cases

Answer 57

25 mL

Question 58

The diagnosis is suspected from the combination | of subdural hematomas and retinal hemorrhages,

Answer 58

Shaken baby syndrome

Question 59

In most penetrating injuries from high-velocity missiles, the object (such as a bullet) causes a _____________that is sterile and does not require surgery if the projectile exits the skull

Answer 59

high-temperature | coagulative lesion

Question 60

Cx of penetrating injuries

Answer 60

In these instances, the main considerations are the development of infection or CSF leaks or, in the long term, epilepsy or aneurysms in distal blood vessels

Question 61

factors leading to coma in penetrating injuries

Answer 61

cerebral necrosis, edema, and hemorrhage

Question 62

The shock wave o f a n explosive device such a s bomb can propel objects into the cranium but there is also a direct form of organ damage from the dissipation of energy that occurs at the interfaces of tissues of different densities

Answer 62

blast injury

Question 63

Seizures are the most common delayed sequela of craniocerebral trauma, with an overall incidence of approximately ________in patients with closed head injuries and ________ in those who had sustained a compound skull fracture and direct wounds of the brain.

Answer 63

5 percent 50 percent

Question 64

risk of seizures after severe head injury

Answer 64

was 7 percent within 1 year and 1 1 .5 percent | in 5 years.

Question 65

Some _________percent of hospitalized head-injured individuals are said to have one or more seizures within the first week of their injury ___________

Answer 65

4 to 5 (early epilepsy) .

Question 66

The______________have a good prognosis and we tend not to treat them as if they represented epilepsy; on the other hand, ______________ are significantly more frequent in patients who had experienced epilepsy in the first week after injury

Answer 66

immediate seizures late seizures

Question 67

seizures that develop several weeks or months after closed head injury (1 to 3 months in most cases).

Answer 67

posttraumatic epilepsy

Question 68

Approximately 6 months after injury, half the patients who will develop epilepsy have had their first episode; by the end of 2 years, the figure rises to _____________

Answer 68

80 percent

Question 69

T OR F Individuals who have early attacks (within a week of injury) are more likely to have a complete remission of their seizures than those whose attacks begin a year or so after injury

Answer 69

T

Question 70

An extensive randomized study by Temkin and colleagues demonstrated that when administered within a day of injury and continuing for 2 years,____________ reduced the incidence of seizures in the first week, but not thereafter.

Answer 70

phenytoin

Question 71

A worrisome consequence of severe head injury, which is observed in some comatose patients and particularly in the vegetative state, is a syndrome of episodic vigorous extensor posturing, profuse diaphoresis, hypertension, and tachycardia lasting minutes to an hour.

Answer 71

"diencephalic epilepsy"

Question 72

in "diencephalic epilepsy" Narcotics such as morphine and benzodiazepines have a slightly beneficial effect but__________which may be used in combination with sedatives or with small doses of morphine, has been most effective

Answer 72

bromocriptine,

Question 73

When cerebellar ataxia is caused by the trauma itself, it is frequently unilateral and the result of injury to the ________

Answer 73

superior cerebellar peduncle

Question 74

T or F, the longer the posttraumatic gap in the formation of new memories (anterograde amnesia), the less likely the patient is to suffer some permanent cognitive and personality changes

Answer 74

F

Question 75

a delayed neurodegenerative cerebral disease that follows mild traumatic brain injury after many years

Answer 75

chronic traumatic encephalopathy

Question 76

More recent studies show that in about one-half of all professional boxers, both active and retired, the CT scan discloses____________and _____________and a _________

Answer 76

ventricular dilatation sulcal widening cavum septi pellucidi

Question 77

Pathologic changes of dementia pugilistica

Answer 77

Neurofibrillary changes were scattered diffusely through the cerebral cortex and brainstem but were most prominent in the mediotemporal gray matter

Question 78

Pathology in Post traumatic HCP

Answer 78

adhesive basilar arachnoiditis.

Question 79

Other terms for post concussion syndrome

Answer 79

posttraumatic nervous instability syndrome and traumatic neurasthenia, PTSD

Question 80

It has also been reported that military personnel who experience head injuries of any degree have a higher incidence of __________ than those with other somatic injuries

Answer 80

posttraumatic stress disorder | PTSD

Question 81

The____________has been considered a "gold standard" of pressure measurements as it is directly coupled to the CSF compartment, which should best reflect the summated pressures within the cranium.

Answer 81

ventricular | catheter

Question 82

Guidelines given by the American Association of Neurological Surgeons and allied groups have been that monitoring is appropriate if:

Answer 82

Glasgow Coma Scale is between 3 and 8 and there are abnormalities on CT scan, or if there is no abnormality on the CT but the patient has any two of age over 40, posturing, or has systolic blood pressure below 90 mm Hg

Question 83

the risk of infection with a ventricular catheter is low,___________, prolonged use may be complicated by bacterial meningitis

Answer 83

less than 3 percent

Question 84

The catheter may be left in place for__________, or fewer if the clinical state and ICP are stable for 24 to 48 h.

Answer 84

3 to 5 days

Question 85

Trial of steroids in TBI

Answer 85

Clinical Randomization of an Antifibrinolytic | in Significant Hemorrhage (CRASH) trial,

Question 86

findings of Clinical Randomization of an Antifibrinolytic | in Significant Hemorrhage (CRASH) trial,

Answer 86

The effect of the infusion of methylprednisolone 2 g, followed by 0.4 g/h for 48 h, favored survival in the untreated patients by a small but clear margin, leading to the current recommendation that steroids not be used routinely following head injury

Question 87

severe hypertension in TBI leads to ______________and an augmentation of the edema surrounding contusions and hemorrhages

Answer 87

increased perfusion | of the brain

Question 88

IN TBI, ________ AND _______may be preferable for | reducing agitation because they are minimally sedating.

Answer 88

Etomidate and dexmedetomidine

Question 89

The use of ________ or ________ to quiet episodes of vigorous extensor posturing and accompanying adrenergic activity

Answer 89

bromocriptine AND __________

Question 90

What is the DECRA trial

Answer 90

Decompression did indeed reduce ICP, as expected, when the intracranial contents are exposed to atmospheric pressure, but surgery did not improve outcome.

Question 91

In the survey of the large European Brain Injury Consortium, comprising 1 0,005 adult patients, the injury proved fatal in____________; __________ were left in a persistent vegetative state, and 16 percent remained severely disabled neurologically

Answer 91

31 percent 3 percent

Question 92

prognosis of head injury is dependent on:

Answer 92

The age of the patient | is the most important factor

Question 93

Of patients with a period of amnesia lasting less than 1 h, ____________percent were back at work within 2 months

Answer 93

95