Trauma NEW Flashcards
This brain micrograph of a 68 yo male nursing home resident who had a vague history of dementia and relatively rapid decline shows which of the following?
a. Chronic Traumatic Encephalopathy
b. Pick’s Disease
c. Acute traumatic brain injury
d. Jakob-Creutzfeldt Disease
e. Subacute brain degeneration
a. Chronic Traumatic Encephalopathy
A 65-year-old man presents with one week history of agitation and confusion. He sustained a generalized tonic-clonic seizure and is hallucinating. On exam, he is febrile, confused and has a left pronator drift with hyper-reflexia. An MRI of the brain is shown (figure). Which of the following is the most likely diagnosis?
a. Herpes simlex virus
b. Low grade glioma
c. Neurosyphilis
d. Hemorrhagic stroke
e. Sarcodosis
a. Herpes simlex virus
A 58-year-old male dies from respiratory failure after battling a disease for 3 years. Microscopic examination of the spinal cord is shown below. Which disease lead to the death of patient?
a. Spinal muscular atrophy (SMA)
b. Guillain-Barre syndrome
c. Vitamin B12 deficiency
d. Spinal muscular bulbar atrophy (SMBA)
e. Amyotrophic lateral sclerosis
e. Amyotrophic lateral sclerosis
A 45 year old man presents with sudden onset of vomiting, dysarthria and ataxia and a CT scan demonstrating a cerebellar infarction. Thirteen hours after onset of symptoms, he develops abducens nerve palsy and depressed mental status. What is the most appropriate definitive management of this patient?
a. Intravenous tPA
b. Suboccipital craniectomy
c. Barbiturate coma
d. Hypertonic saline
e. High dose Dexamethasone
b. Suboccipital craniectomy
A 70-year-old man presents with new onset progressive confusion, expressive dysphasia, and right hemiparesis. MRI shows multiple enhancing intracerebral masses with surrounding edema that resolve after a short course of steroids. What is the most likely diagnosis of these lesions?
a. multiple metastases.
b. primary central nervous system lymphoma.
c. multifocal glioma.
d. multiple sclerosis.
e. central nervous system sarcoidosis.
b. primary central nervous system lymphoma.
A 47 year old man presents with confusion, agitation, fatigue, fever (104F), hyponatremia, hypoglycemia, and hypotension after resection of a right frontal metastasis lesion 3 weeks ago. Phenytoin and steroids were discontinued at 2.5 weeks post-operatively. Head CT reveals no acute abnormality. What is the most appropriate management of this patient?
a. Fosphenytoin
b. Heparin
c. Haloperidol
d. Hydrocortisone
e. Fludricortisone
d. Hydrocortisone
A 21-year-old male presents to the emergency department after being involved in a gunfight. His GCS is 15 with a non-focal examination but several bullet holes are noted in his scalp with protruding cerebral tissue. His CT scan of the head is shown in the figure. What is the BEST definitive management strategy for this injury?
a. Surgical removal of all bullet fragments
b. 14-day course of antibiotics
c. Bedside laceration repair
d. Surgical durotomy repair
e. Cranioplasty and removal of accessible fragments
e. Cranioplasty and removal of accessible fragments
A patient with a baclofen pump presents with a temperature of 104 degrees F and hyperreflexia. What is the next appropriate treatment?
a. Broad spectrum antibiotics
b. Intravenous acetaminophen
c. Intravenous dantrolene
d. Intrathecal baclofen administration
e. Cooling blanket
d. Intrathecal baclofen administration
A 17 year old sustains a gunshot wound to the head. On examination, he has decorticate posturing on the right and he localizes on the left. His left pupil is 2 mm larger than the right but is still reactive. His non-contrast head CT (see figures) demonstrates metal and bone fragments within the left frontal region with an associated subdural hematoma with midline shift. What is the most appropriate management of this patient?
a. Superficial debridement of wound
b. Right frontal ventriculostomy placement
c. Craniotomy, hematoma evacuation, removal of all bone and metal fragments
d. Craniotomy, hematoma evacuation, superficial debridement
e. Expectant care
d. Craniotomy, hematoma evacuation, superficial debridement
What characteristic imaging finding on MRI would best differentiate neuromyelitis optica from multiple sclerosis?
a. Presence of high burden of periventricular, juxtacortical and infratentorial demyelinating lesions.
b. An intramedullary spinal cord lesion spanning 3 or more segments.
c. Multiple enhancing intramedullary spinal lesions spanning 1-2 segments.
d. Optic nerve enhancement.
e. Multiple non-enhancing intramedullary spinal lesions spanning 1-2 segments.
b. An intramedullary spinal cord lesion spanning 3 or more segments.
An 18 year old man who was involved in a motor vehicle accident is admitted to the ICU and intubated and sedated on high dose continuous propofol infusion (4mg/kg/h). Ten days later, he is following command in all four extremities. Suddenly, on hospital day 12, he becomes acutely altered. CT head is stable from admission. Laboratory studies reveal a markedly profound hypertriglyceridemia, metabolic acidosis and rhabdomyolysis. Which one of the following is the next step in management?
a. Obtain 12 lead EKG and troponin
b. Stop propofol infusion immediately
c. Start hemodialysis
d. Order MRI brain
e. Obtain CT-angio of chest
b. Stop propofol infusion immediately
A 22 year-old woman presents after a motor vehicle collision with neck pain. She is neurologically intact. She has a non-displaced C4 lamina fracture. CTA of the neck shows a Biffi Grade 2 injury to the right internal carotid artery. What is the most appropriate next step in management?
a. Initiation of aspirin
b. Transcranial Doppler with emboli detection
c. OMRI of the brain
d. Carotid Doppler
e. Diagnostic cerebral angiogram
a. Initiation of aspirin
Based on the Guidelines for the Acute Management of Severe Traumatic Brain Injury, in patients with severe head injury, what should the cerebral perfusion pressure (CPP, mmHg) should be maintained between?
a. 50-70
b. 70-90
c. 30-50
d. 90-110
e. 10-30
a. 50-70
An 18 year-old college basketball player suffers from transient disorientation, dizziness, and imbalance following a hard foul. Her symptoms resolve after approximately 1 minute. What is the most appropriate management for this athlete regarding return-to-play?
a. Refrain from all physical activity and external stimulation for 1 week before full return to play.
b. Brief period of rest with graduated increase in physical activity, followed by return to play if asymptomatic at each activity level.
c. Return to full physical and cognitive activity in 24 hours if asymptomatic.
d. Emergent head CT.
e. Return to play immediately since symptoms have resolved.
b. Brief period of rest with graduated increase in physical activity, followed by return to play if asymptomatic at each activity level.
What combination of findings is most consistent with the diagnosis of central diabetes insipidus?
a. Urine output of 40 cc/hr, urine specific gravity of 1.002 and serum sodium of 135.
b. Urine output of 40 cc/hr, urine specific gravity of 1.010, and serum sodium of 145.
c. Urine output of 300 cc/hr, urine specific gravity of 1.030 and serum sodium of 145.
d. Urine output of 100 cc/hr, urine specific gravity of 1.030 and serum sodium of 135.
e. Urine output of 300 cc/hr, urine specific gravity of 1.002, and serum sodium of 145.
e. Urine output of 300 cc/hr, urine specific gravity of 1.002, and serum sodium of 145.
A 50 year old man who was intubated for acute respiratory distress syndrome develops flaccid and symmetric weakness in the lower greater than upper extremities and more distally than proximally. There is no cranial nerve involvement. What is the most likely diagnosis for the weakness?
a. Critical illness myopathy and neuropathy
b. Poliomyelitis
c. Acute intermittent porphyria
d. Myasthenia gravis
e. Guillain-Barré syndrome
a. Critical illness myopathy and neuropathy
An ABG with PCO2 25 mmHg, pH 7.55, HCO3- 24 mEq/L is most consistent with which diagnosis?
a. Metabolic alkalosis
b. Respiratory alkalosis with metabolic compensation
c. Respiratory alkalosis
d. Metabolic alkalosis with respiratory compensation
c. Respiratory alkalosis
A 36 year old woman with a known history of epilepsy treated with phenytoin presents in convulsive status epilepticus. After administration of lorazepam and supplementation with IV phenytoin, convulsions cease. Two hours later she remains unresponsive despite a normal head CT and normal serum electrolyte levels and blood counts. What is the most appropriate next diagnostic test?
a. Electroencephalogram
b. Angiogram
c. Repeat serum sodium
d. Lumbar puncture
e. MRI of the brain, including diffusion imaging
a. Electroencephalogram
You are called about a 14 year old girl with severe intractable spasticity in whom you placed a baclofen pump 6 months ago. She presents with increase in tone and agitation due to severe itching. Pump interrogation reveals normal telemetry and indicates it is not due for a refill. Her temperature is 40.0 C. She is confused and hypertonic. Pump X-rays do not show evidence of a disconnection. What is the next appropriate step in management?
a. Replacement of baclofen via oral administration and admission to ward
b. Emergent surgery for pump exploration and replacement
c. Replacement of baclofen via intrathecal administration and admission to ICU
d. Treatment with IV benzodiazepines and admission to ICU
e. Replacement of baclofen via oral administration and discharge with clinic follow up
c. Replacement of baclofen via intrathecal administration and admission to ICU
A 40 year old male develops left facial droop and left hemiparesis 48 hours after a motor vehicle accident despite initially being neurologically intact after the accident. A non-contrast head CT at the time of deterioration is negative. The most appropriate next diagnostic evaluation is:
a. Cerebral perfusion study.
b. CT of the cervical spine.
c. CT angiogram of the cervical spine.
d. Flexion Extension C-spine XRay
e. ICP monitoring.
c. CT angiogram of the cervical spine.
Which of these treatments influences the incidence of chronic subdural hematoma (cSDH) recurrence?
a. External subdural drain
b. Tranexamic Acid
c. Burr hole drainage
d. Amount of irrigation
e. Craniotomy
a. External subdural drain
What monitoring modality has the greatest sensitivity for detection of a venous air embolus?
a. Precordial Doppler
b. Pulmonary artery pressure
c. Pulse oximetry
d. EKG
e. Transvenous intracardiac echocardiography
e. Transvenous intracardiac echocardiography
In addition to the negative effects on cerebral blood flow, hyperventilation should be avoided in the management of severe closed head injury for which of the following reasons?
a. Increased pH and potential for increased oxygen delivery
b. Right shift of hemoglobin-oxygen dissociation curve and potential oxygen delivery impairment O
c. Right shift of hemoglobin-oxygen dissociation curve and potential CO2 removal impairment
d. Left shift of the hemoglobin-oxygen dissociation curve and potential oxygen delivery impairment
e. Left shift of the hemoglobin-oxygen dissociation curve and potential CO2 removal impairment
d. Left shift of the hemoglobin-oxygen dissociation curve and potential oxygen delivery impairment
Which symptomatic hormone deficiency is most common after pediatric moderate-to-severe traumatic brain injury?
a. Prolactin
b. Thyroid Hormone
c. Cortisol
d. Gonadotropic Hormones
e. Growth Hormone
e. Growth Hormone