Abstract
A 28 Y/M, presented in emergency room with a severe traumatic head injury after being in a motorcycle accident without wearing a helmet. The physical examination revealed a Glasgow Coma Scale of 6, decerebrate posturing, pupils bilaterally fixed and 4 mm in size, and cerebral spinal fluid otorrhea on the right side. Computed tomography of the head showed left frontal and temporal subdural haemorrhage and underlying contusion with 8-mm midline shift, effacement of the suprasellar cisterns and effacement of the 3rdand 4th ventricles. Systemic examination revealed bradycardia, and hypertension with an initial blood pressure of 221/105 mm Hg.
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Multiple Choice Questions
Multiple Choice Questions
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1.
Which of the following statements is not true regarding raised intracranial pressure?
-
(a).
Normal values of ICP range from 10 to 15Â mmHg in adults
-
(b).
Normal values of ICP range from 7 to 8Â mmHg in full term infants
-
(c).
The values higher than 20–25 mmHg need to be treated
-
(d).
The values more than 40Â mmHg can be immediate life-threatening
-
(a).
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2.
The following statements are true regarding signs and symptoms of raised intracranial pressure, except.
-
(a).
Cushing's triad includes: hypertension, bradycardia and irregular respiration
-
(b).
Subfalcine herniation may lead to contralateral leg weakness
-
(c).
Central transtentorial herniation may lead to Diabetes insipidus in late stages
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(d).
Uncal herniation presents as decorticate and decerebrate posture and Cheyne-Stokes respiration
-
(a).
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3.
Which of the following is not a radiological finding of raised intracranial pressure
-
(a).
Loss of sulci-gyri and grey-white matter distinction
-
(b).
Effacement of lateral ventricles
-
(c).
Opening of perimesencephalic cisterns
-
(d).
Midline shift
-
(a).
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4.
Which of the following is true regarding intracranial pressure monitoring?
-
(a).
Subarachnoid bolt should be zeroed at the level of external auditory meatus
-
(b).
Intraparenchymal catheter is considered as gold standard technique
-
(c).
Intraparenchymal can be re-zeroed after insertion
-
(d).
Intraventricular catheter must be re-zeroed each time the level of the patient’s head is altered
-
(a).
-
5.
All of the following can cause secondary brain damage, except.
-
(a).
Hypothermia
-
(b).
Hypoxia
-
(c).
Severe Hypocapnia
-
(d).
Hypovolemia
-
(a).
-
6.
Which of the following statement is true regarding initial management of raised intracranial pressure
-
(a).
Adequate cerebral perfusion pressure should be maintained at first place
-
(b).
Positive end-expiratory pressure must be avoided as it increases intracranial pressure
-
(c).
Airway, breathing and circulation should be managed initially in all the cases prior to raised intracranial pressure
-
(d).
Glasgow Coma Scale of more than 8 is an indication of securing the airway
-
(a).
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7.
All of the following can impede the cerebrospinal fluid drainage, except.
-
(a).
Abdominal compartment syndrome
-
(b).
Tight cervical collar
-
(c).
30° head elevation
-
(d).
Hemothorax
-
(a).
-
8.
Which of the fluids should not be used in initial resuscitation of patients with raised intracranial pressure
-
(a).
Plasma-lyte-A
-
(b).
25% Dextrose
-
(c).
Normal Saline
-
(d).
7.5% saline
-
(a).
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9.
Which of the following treatment modality in not included in tier-1?
-
(a).
Mannitol
-
(b).
Hypertonic saline
-
(c).
Hyperventilation
-
(d).
Hypothermia
-
(a).
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10.
Following are true about hypothermia, except.
-
(a).
It reduces cerebral metabolism beyond the isoelectrical activity
-
(b).
There may be rebound severe intracranial hypertension during rewarming
-
(c).
Moderate to severe hypothermia is beneficial in reducing intracranial pressure
-
(d).
There is a risk of severe dyselectrolytemia during rewarming phase
-
(a).
Answers: 1. (b), 2. (d), 3. (c), 4. (d), 5. (a), 6. (c), 7. (c), 8. (b), 9. (d), 10. (c)
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Jangra, K., Bhagat, H., Panda, N. (2020). Raised ICP and Brain Herniation. In: Bidkar, P., Vanamoorthy, P. (eds) Acute Neuro Care. Springer, Singapore. https://doi.org/10.1007/978-981-15-4071-4_7
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DOI: https://doi.org/10.1007/978-981-15-4071-4_7
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