Trauma and Neurocritical Care

Question 1

NG tubes used in the critically ill neurotrauma patient give a higher rate of what complication?

However, what effect does early feeding with NGT have on death and poor outcome?

Answer 1

Increased risk of ventilator-associated pneumonia

Reduces risk of death and poor outcome

Question 2

What are some findings on imaging which suggest towards tumefactive multiple sclerosis rather than a true neoplasm?

Answer 2

Partial ring enhancement, subtle deficits for size of lesion, minimal mass effect or midline shift, presence of veins on dynamic MRI

Otherwise, a relatively normal EEG and steroid responsiveness also may suggest

Question 3

Ketamine is a unique anesthestic. What effect does it have on CBF and CMRO2?

Answer 3

Increases both of them

Question 4

What is another name for traumatic encephalomeningocele?

Answer 4

Growing skull fracture
Or
Leptomeningeal cyst

Question 5

What is the relationship between the elasticity of tissue and the amount of tissue damage done by a bullet?

Answer 5

Inverse

Question 6

What is the most common type of infection seen post-head injury?

Answer 6

UTI

Question 7

Why is CN VI particularly susceptible to injury during embolization of a CCF?

Answer 7

CN VI is relatively free floating in the cavernous sinus and is not covered up by dural folds

Question 8

What is the preferred sedative of choice in pediatric severe TBI, specifically patients with high ICP, and why?

Answer 8

Fentanyl. It has no effect on blood pressure and oxygen saturation

Question 9

Moderate to severe pediatric TBI most commonly causes what symptomatic hormonal deficiency?

Answer 9

Growth Hormone

Question 10

Preserved mental status in combination with severe dysmetria and a rash is classic for what self-limited syndrome related to viral illnesses?

Answer 10

Post-infectious cerebellar ataxia. Often associated with varicella, mumps, EBV, mycoplasma

Question 11

What Pa CO2 level is required to indicate brain death?

Answer 11

PaCo2 level of 60

Question 12

In treating status epilepticus in adults what medication should be co-administered with benzodiazepines?

Answer 12

Phenytoin

Question 13

What is one of the earliest signs of the development of malignant hyperthermia?

Answer 13

Rising end-tidal carbon dioxide

Question 14

What circulating antibodies are found in patients with myasthenia gravis?
What are appropriate treatment options?

Answer 14

nACH receptor antibodies

Thymectomy, acetylcholinesterases, plasmaparhesis, steroids

Question 15

How are barbiturates theorized to decrease ICP?

Answer 15

They reduce cerebral metabolism and couple this to cerebral blood flow

Question 16

In patients with low serum sodium and osmolality with high urinary sodium what additional metric is required to distinguish SIADH from cerebral salt wasting and why?

Answer 16

Circulating blood volume

SIADH will have elevated circulating volume due to ADH causing retained water

CSW will have decreased because free water is being pulled out of the kidneys causing hypovolemia

Question 17

What is an indication to operate on an anterior frontal wall of frontal sinus fracture?

Answer 17

Likelihood of cosmetic deformity

Question 18

What is the appropriate intervention for tension pneumocephalus?

Answer 18

Surgical evacuation, often with burr holes

Question 19

What is the most common bacterial isolate in patients with ventilator-associated pneumonia?

Answer 19

S. aureus

Question 20

In the physiologic compensation for acute anemia what happens to systemic vascular resistance?

Answer 20

Decreases

Question 21

Hyperventilation will have what effects on:
PaCo2
Hemoglobin-oxygen curve
Oxygen affinity for hemoglobin

Answer 21

Decrease PaCO2
Left shift curve
Oxygen binds more tightly to Hb and less likely to be released and delivered to tissues

Question 22

Define a grade I and a grade II concussion.

What bearing do they have on athletes returning into games when they occur during a game?

Answer 22

Grade I is confusion without concussion lasting 15 mins or less
Grade II is confusion without concussion lasting more than 15 minutes

Grade I: player can return into game
Grade II: player must exit the game

Question 23

What is the reason for the development of malignant edema, especially, in pediatric TBI?

Answer 23

Loss of cerebral autoregulation

Question 24

In the diagnostic criteria for ARDS why is the threshold of arterial pulmonary wedge pressure < 18 mm Hg important for the diagnosis?

Answer 24

Pressures above that suggest left atrial strain and elevated pressures which may suggest PE

Question 25

What is the threshold for brain oxygen tension below which is considered hypoxia?

Answer 25

< 20 mm Hg

Question 26

In the first 16 days post pregnancy and the peripartum period are the women hyper- or hypocoaguable?

Answer 26

Hypercoaguable and more susceptible to venous thrombosis

Question 27

What is the most common headache type post-blast injury?

Answer 27

Trigeminal autonomic cephalgia

Question 28

What is the relationship between arterial CO2 and cerebral blood flow?
If PaCO2 increases by 1mm Hg what happens to cerebral blood flow?

Answer 28

Direct

Increases by 1-2 cc/100g/min

Question 29

After aneurysmal SAH what is the most significant cardiac indicator to have a bearing on morbidity?

Answer 29

Cardiac failure

Question 30

What modality has the highest sensitivity for identifying venous air embolism?

Answer 30

Transvenous intracardiac echocardiography

Question 31

After surgical resection of epidermoid tumors is there any role for chemo or radiation?

Answer 31

No, just observe

Question 32

What should CPP be maintained between in severe TBI?

Answer 32

50-70mm Hg

Question 33

Define vegetative state

Answer 33

Complete lack of awareness to environment with maintained sleep-wake cycles

Question 34

Distinguish between the hyphae branching characteristics in Aspergillus vs Mucor/Rhizopus

Answer 34

Aspergillus has acute angle (V shaped) branching patterns

Mucor/Rhizopus has 90 degree angle branching hyphae

Question 35

What are the AHA/ASA guidelines for evacuation/posterior fossa craniectomy in patients with cerebellar hemorrhages?

Answer 35

May be indicated for clots > 3 cm or if evidence of brainstem compression or hydrocephalus

Question 36

Meta-analyses including DESTINY, HAMLET, and DECIMAL have found that DHC for malignant edema due to stroke leads to decreased mortality and improved functional outcomes if completed within what time period?

Answer 36

48 hrs

Question 37

In what situations is it recommended to evacuate an acute SDH < 10mm thick with < 5mm shift?

Answer 37

If GCS drops by > 2 points from injury to admission, if ICP > 20, if asymmetric pupils or exam

Question 38

What is the cause of primary amebic meningoencephalitis?

Answer 38

Naegleri fowleri