head Injuries and crerbral l11
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Questions and Answers

Which of the following is most likely to be associated with a penetrating injury to the brain?

A) Diffuse axonal injury B) Depressed skull fracture C) Acute subdural hematoma (SDH) D) Contusion

  • Diffuse axonal injury
  • Depressed skull fracture (correct)
  • Acute subdural hematoma (SDH)
  • Contusion

    • According to the Monro-Kellie Doctrine, what happens when one component of the intracranial contents increases in volume?

  • The other components must decrease in volume to maintain stable intracranial pressure. (correct)
  • Intracranial pressure will remain unchanged.
  • The brain will compensate by increasing the volume of cerebrospinal fluid (CSF).
  • The blood flow to the brain will increase to accommodate the added volume.

    • Which of the following is the most likely consequence when compliance of the brain decreases in the setting of increased intracranial volume?

    A) A compensatory decrease in cerebrospinal fluid (CSF) volume. B) A rapid increase in intracranial pressure. C) A reduction in blood volume within the brain. D) No change in intracranial pressure.

  • A compensatory decrease in cerebrospinal fluid (CSF) volume.
  • A rapid increase in intracranial pressure. (correct)
  • A reduction in blood volume within the brain.
  • No change in intracranial pressure.

    • Which of the following is a common consequence of raised intracranial pressure (ICP) in the brain?

    A) Decreased intracranial pressure due to compensatory mechanisms B) Herniation syndromes leading to brainstem compression C) Improved cerebral perfusion and oxygenation D) Decreased blood flow to the brain resulting in hyperperfusion

    <p>Herniation syndromes leading to brainstem compression</p> Signup and view all the answers

    Raised intracranial pressure (ICP) can lead to reduced cerebral perfusion pressure (CPP). Which of the following is a consequence of reduced CPP?

    <p>Decreased cerebral blood flow, leading to ischemia and possible brain injury</p> Signup and view all the answers

    Which of the following is the most critical systemic factor to control in order to prevent secondary brain injury after traumatic brain injury (TBI)?

    <p>Hypoxia</p> Signup and view all the answers

    Secondary brain injury following traumatic brain injury can result from which of the following?

    A) Controlled cerebral vasodilation B) Intracranial pressure normalization C) Systemic hypoxia and hypotension D) Reduced blood-brain barrier permeability

    <p>Systemic hypoxia and hypotension</p> Signup and view all the answers

    In the context of traumatic brain injury, which of the following is a common cause of raised intracranial pressure (ICP)?

    <p>Brain swelling</p> Signup and view all the answers

    Which of the following interventions is most likely to reduce the risk of secondary brain injury in a patient with a traumatic brain injury?

    A) Maintaining hyperglycemia for energy production B) Correcting hypoxia and hypotension C) Allowing hyperthermia to prevent brain swelling D) Limiting fluid intake to decrease brain volume

    <p>Correcting hypoxia and hypotension</p> Signup and view all the answers

    What is the primary cause of brain shift and herniation in the setting of raised intracranial pressure?

    A) Excessive cerebral blood flow B) Accumulation of cerebrospinal fluid (CSF) C) Brain swelling and compressed tissue displacement D) Decreased oxygen demand by the brain

    <p>Brain swelling and compressed tissue displacement</p> Signup and view all the answers

    Which of the following factors is most likely to exacerbate brain injury in the first few hours following trauma?

    <p>Hyperthermia</p> Signup and view all the answers

    The prevention of post-traumatic seizures is a crucial component of managing traumatic brain injury. Which of the following is considered a risk factor for post-traumatic seizures?

    <p>Severe brain swelling</p> Signup and view all the answers

    Which of the following best describes the goal of management for traumatic brain injury (TBI)?

    <p>Preventing secondary brain injury</p> Signup and view all the answers

    The management of hypoglycemia after a traumatic brain injury is crucial because it can lead to which of the following?

    <p>Increased risk of post-traumatic seizures</p> Signup and view all the answers

    Extradural hematomas (EDH) are most commonly associated with which type of trauma?

    <p>Blunt trauma</p> Signup and view all the answers

    Which of the following skull fractures is most commonly associated with an extradural hematoma (EDH)?

    <p>Linear fractures</p> Signup and view all the answers

    In which part of the skull is an extradural hematoma (EDH) most commonly located?

    <p>Temporal region</p> Signup and view all the answers

    What is the most common cause of an extradural hematoma (EDH)?

    <p>Tear of the middle meningeal artery</p> Signup and view all the answers

    What characteristic shape is typically seen in an extradural hematoma (EDH) on imaging?

    <p>Biconvex</p> Signup and view all the answers

    Acute subdural hematomas (ASDH) are most commonly caused by which of the following?

    <p>Venous tears or brain laceration</p> Signup and view all the answers

    Which of the following best describes the shape of an acute subdural hematoma (ASDH) on imaging?

    <p>Crescent-shaped</p> Signup and view all the answers

    In an acute subdural hematoma (ASDH), where is the hematoma typically located?

    <p>Covers the entire cerebral surface</p> Signup and view all the answers

    What underlying injury is commonly associated with an acute subdural hematoma (ASDH)?

    <p>Parenchymal injury</p> Signup and view all the answers

    The specific vulnerability of the bridging veins in acute subdural hematomas (ASDH) is due to:

    <p>The mechanical difference in mobility between the brain and the rigid dura</p> Signup and view all the answers

    The treatment of choice for an acute subdural hematoma (ASDH) requiring surgical intervention is:

    <p>Emergency craniotomy</p> Signup and view all the answers

    Chronic subdural hematomas (CSDH) are most commonly associated with which of the following?

    A) Severe head trauma B) History of minor trauma C) Arterial rupture D) Cerebral aneurysms

    <p>History of minor trauma</p> Signup and view all the answers

    Which of the following factors is considered a risk factor for the development of chronic subdural hematoma (CSDH)?

    <p>All of the above</p> Signup and view all the answers

    Chronic subdural hematomas (CSDH) are more likely to develop in individuals with which of the following?

    <p>Brain atrophy</p> Signup and view all the answers

    What is the most common cause of venous bleeding that leads to chronic subdural hematoma (CSDH)?

    <p>Slow venous bleeding due to repetitive minor trauma</p> Signup and view all the answers

    What is the typical treatment for chronic subdural hematoma (CSDH) in the presence of raised intracranial pressure (ICP) or lateralizing signs?

    <p>Burr hole drainage</p> Signup and view all the answers

    The underlying mechanism in chronic subdural hematoma (CSDH) involves which of the following?

    <p>The shrinking of the brain that increases tension on the bridging veins</p> Signup and view all the answers

    Which of the following is a common characteristic of chronic subdural hematoma (CSDH)?

    <p>Gradual enlargement of the hematoma over time</p> Signup and view all the answers

    Which of the following is a common complication of chronic subdural hematoma (CSDH)?

    <p>Infection following drainage</p> Signup and view all the answers

    Intracerebral hematomas (ICH) are associated with which of the following?

    A) Subarachnoid hemorrhage B) Contusions C) Epidural hematomas D) Aneurysms

    <p>Contusions</p> Signup and view all the answers

    In which of the following cases is evacuation of an intracerebral hematoma (ICH) most likely required?

    <p>In the presence of raised intracranial pressure (ICP) or marked midline shift</p> Signup and view all the answers

    What is the primary treatment approach for intracerebral hematoma (ICH) when there is no significant neurological deterioration?

    <p>Conservative management</p> Signup and view all the answers

    Which of the following conditions is most likely to occur alongside intracerebral hematomas (ICH)?

    <p>Subdural hematoma (SDH)</p> Signup and view all the answers

    Which of the following best describes the treatment approach for intracerebral hematomas (ICH) with a significant midline shift?

    <p>Perform urgent surgical evacuation of the hematoma</p> Signup and view all the answers

    Diffuse axonal injury is commonly associated with which of the following?

    <p>Intracerebral hematomas</p> Signup and view all the answers

    A key indication for the evacuation of an intracerebral hematoma (ICH) is:

    <p>Marked midline shift and raised ICP</p> Signup and view all the answers

    Which of the following is most characteristic of Diffuse Axonal Injury (DAI)?

    <p>Prolonged unconsciousness in the absence of a mass lesion</p> Signup and view all the answers

    Which imaging finding is most associated with Diffuse Axonal Injury (DAI)?

    <p>Petechial hemorrhage and effacement of basal cisterns</p> Signup and view all the answers

    In Diffuse Axonal Injury (DAI), which of the following is commonly observed in brain imaging?

    <p>Compressed ventricles and invisible sulci</p> Signup and view all the answers

    What is the primary mechanism of injury in Diffuse Axonal Injury (DAI)?

    <p>Rapid acceleration or deceleration forces</p> Signup and view all the answers

    The management of Diffuse Axonal Injury (DAI) typically involves which of the following?

    <p>Conservative management or decompressive craniectomy</p> Signup and view all the answers

    In patients with Diffuse Axonal Injury (DAI), which of the following is the expected clinical feature?

    <p>Prolonged unconsciousness with minimal or no focal neurological findings</p> Signup and view all the answers

    What is a key feature of brain imaging in cases of Diffuse Axonal Injury (DAI)?

    <p>Widespread axonal damage without a focal lesion</p> Signup and view all the answers

    Penetrating head injuries commonly result in which of the following complications?

    <p>Vascular injury in one-third of cases</p> Signup and view all the answers

    What is the expected outcome of a penetrating brain injury if it crosses the midline?

    <p>Universally fatal</p> Signup and view all the answers

    What is the first step in managing a patient with a penetrating brain injury?

    <p>Stabilize airway, breathing, and circulation (ABC)</p> Signup and view all the answers

    What percentage of patients with penetrating head injuries also have an associated cervical spine injury?

    <p>5-10%</p> Signup and view all the answers

    Which of the following is NOT a recommended part of the management for a penetrating brain injury?

    <p>Immediate cranial surgery in all cases</p> Signup and view all the answers

    Which of the following steps should be prioritized in the management of penetrating brain injuries?

    <p>Rapid transfer to a Neurosurgical Unit (NSU)</p> Signup and view all the answers

    Which of the following is a common consequence of penetrating brain injuries? A) Hemorrhagic stroke B) Infections in one-third of cases C) Increased intracranial pressure D) Seizures in all cases

    <p>Infections in one-third of cases</p> Signup and view all the answers

    Which of the following procedures is crucial in the management of a patient with a penetrating brain injury?

    <p>Early anesthetic involvement</p> Signup and view all the answers

    What diagnostic tool is most commonly used to assess vascular injury in patients with penetrating brain injury?

    <p>Angiography</p> Signup and view all the answers

    What is a key factor in determining the outcome of a penetrating head injury?

    <p>Whether the injury crosses the midline</p> Signup and view all the answers

    In the Glasgow Coma Scale, what is the highest possible score for the Best Eye Response?

    <p>6</p> Signup and view all the answers

    What does a score of 3 on the Best Verbal Response in the Glasgow Coma Scale indicate?

    <p>Inappropriate words</p> Signup and view all the answers

    Which of the following is the correct description of a score of 4 on the Best Motor Response?

    A) Obeys commands B) Localises to pain C) Normal flexion to pain D) Abnormal flexion to pain

    <p>Normal flexion to pain</p> Signup and view all the answers

    What does a score of 2 on the Best Eye Response in the Glasgow Coma Scale indicate?

    A) Open to verbal command B) Open to pain C) Open spontaneously D) Does not open eyes

    <p>Open to pain</p> Signup and view all the answers

    A patient is able to localise pain but does not obey commands. What is the Glasgow Coma Score for Best Motor Response?

    A) 6 B) 5 C) 4 D) 3

    <p>5</p> Signup and view all the answers

    Which of the following Glasgow Coma Scale findings would indicate a patient is in a coma?

    A) 15 B) 9 C) 5 D) 3

    <p>3</p> Signup and view all the answers

    What does a score of 1 on the Best Motor Response in the Glasgow Coma Scale indicate?

    A) Localises to pain B) No movement C) Extension to pain D) Abnormal flexion to pain

    <p>No movement</p> Signup and view all the answers

    What is the total maximum score a patient can achieve on the Glasgow Coma Scale?

    <p>15</p> Signup and view all the answers

    What is the recommended head position for a patient with raised intracranial pressure (ICP)?

    <p>30° head up</p> Signup and view all the answers

    Which of the following medications is commonly used to reduce intracranial pressure in cases of traumatic brain injury?

    <p>Mannitol</p> Signup and view all the answers

    In the management of raised ICP, which of the following is used to prevent seizures?

    <p>Anti-epileptics</p> Signup and view all the answers

    Hypertonic saline is used in the management of raised ICP because it:

    <p>Creates an osmotic gradient that draws water out of the brain tissue</p> Signup and view all the answers

    Which of the following is the purpose of ICP monitoring?

    <p>To detect any increases in intracranial pressure</p> Signup and view all the answers

    Sedation in the management of raised intracranial pressure (ICP) is important because it helps to:

    <p>Minimize cerebral metabolic rate and oxygen consumption</p> Signup and view all the answers

    In the management of raised intracranial pressure (ICP), which of the following is typically used for analgesia?

    <p>Fentanyl</p> Signup and view all the answers

    Hyperventilation in the management of raised ICP is used to:

    A) Lower PCO2, causing cerebral vasodilation B) Raise PCO2, causing cerebral vasoconstriction C) Lower PCO2, causing cerebral vasoconstriction D) Increase oxygen delivery to the brain

    <p>Lower PCO2, causing cerebral vasoconstriction</p> Signup and view all the answers

    Hypothermia is used in the anaesthetic management of raised ICP because it:

    <p>Reduces brain temperature and cerebral metabolism</p> Signup and view all the answers

    The primary goal of intracranial pressure (ICP) monitoring is to:

    <p>Detect increased intracranial pressure</p> Signup and view all the answers

    An external ventricular drain (EVD) is commonly used in the management of raised ICP because it:

    <p>Provides a method to drain cerebrospinal fluid (CSF) and reduce pressure</p> Signup and view all the answers

    When using an external ventricular drain (EVD), it is important to:

    A) Monitor the ICP levels regularly to avoid over-drainage B) Limit fluid intake to prevent excessive CSF production C) Perform surgery immediately after placing the EVD D) Keep the head of the bed flat at all times

    <p>Monitor the ICP levels regularly to avoid over-drainage</p> Signup and view all the answers

    Which of the following is a potential complication of placing an external ventricular drain (EVD)?

    <p>Increased risk of infection</p> Signup and view all the answers

    The goal of a craniotomy for hematoma evacuation is to:

    <p>Remove a hematoma and relieve increased ICP</p> Signup and view all the answers

    In the management of raised intracranial pressure (ICP), what is the rationale for performing a craniotomy and leaving the skull open temporarily?

    <p>To allow the brain to swell and then replace the bone after the swelling decreases</p> Signup and view all the answers

    Which of the following is a risk factor for developing post-traumatic epilepsy (PTE)?

    A) Mild concussion B) Post-traumatic amnesia >24 hours C) No loss of consciousness D) Non-penetrating brain injury

    <p>Post-traumatic amnesia &gt;24 hours</p> Signup and view all the answers

    What is the recommended duration for prophylactic antiepileptic drugs (AEDs) in preventing post-traumatic epilepsy after TBI?

    <p>No benefit in giving AEDs beyond 1 week</p> Signup and view all the answers

    The incidence of post-traumatic epilepsy (PTE) is higher in which of the following cases?

    <p>Intracranial hematoma and depressed skull fracture</p> Signup and view all the answers

    Post-concussion syndrome (PCS) commonly presents with which of the following symptoms?

    A) Seizures and confusion B) Behavioural changes, headaches, dizziness, and irritability C) Loss of consciousness and memory loss D) Complete resolution of symptoms within 24 hours

    <p>Behavioural changes, headaches, dizziness, and irritability</p> Signup and view all the answers

    Which of the following factors contributes to an increased risk of post-concussion syndrome (PCS)?

    <p>Significant behavioral change and irritability post-injury</p> Signup and view all the answers

    A brain tumor located in the intracranial space but outside the brain tissue (extra-axial) is most likely to affect which structures?

    <p>Blood vessels and meninges</p> Signup and view all the answers

    Which of the following is a classic clinical sign of raised intracranial pressure due to a brain tumor?

    <p>Early morning headache and vomiting</p> Signup and view all the answers

    A tumor located within the brain parenchyma (intra-axial) will most likely affect which of the following?

    <p>Cerebral cortex and white matter</p> Signup and view all the answers

    Which clinical presentation is most commonly associated with tumors in the brainstem or cranial nerves?

    <p>Progressive neurological deficit</p> Signup and view all the answers

    Hydrocephalus, caused by a tumor obstructing CSF flow, is typically characterized by which symptom?

    <p>Vomiting and early morning headaches</p> Signup and view all the answers

    Seizures are a common symptom of brain tumors. Which type of seizure is most often associated with tumors in the cerebral cortex?

    A) Generalized tonic-clonic seizures B) Absence seizures C) Focal seizures D) Status epilepticus

    <p>Focal seizures</p> Signup and view all the answers

    Which of the following types of tumors are considered extra-axial tumors?

    <p>Meningiomas</p> Signup and view all the answers

    Which of the following is a possible endocrine disturbance that could arise from a brain tumor affecting the pituitary gland?

    <p>Cushing’s syndrome</p> Signup and view all the answers

    Where are intracranial tumors typically located?

    <p>Within the skull, often in the brain itself</p> Signup and view all the answers

    Tumors described as extracranial are located in which of the following?

    <p>Outside the skull, affecting structures like the head, neck, or body</p> Signup and view all the answers

    What type of tumor is described as intra-axial?

    <p>Tumors within the brain tissue, such as gliomas or astrocytomas</p> Signup and view all the answers

    What is the initial imaging modality typically used to screen for brain tumors?

    <p>CT Scan</p> Signup and view all the answers

    Which imaging technique is considered the best for evaluating brain tumors in terms of detailed anatomical structure?

    <p>MRI</p> Signup and view all the answers

    Which imaging modality can be used for functional assessment of brain activity, particularly near a brain tumor?

    <p>fMRI</p> Signup and view all the answers

    What is the purpose of performing CSF cytology in brain tumor investigations?

    <p>To identify tumor cells or infection in cerebrospinal fluid</p> Signup and view all the answers

    Which of the following is NOT a primary brain tumor cell origin?

    A) Glial Cells B) Neurons C) Schwann Cells D) Blood vessels

    <p>Schwann Cells</p> Signup and view all the answers

    What is the most common type of primary brain tumor in adults?

    <p>Glial tumors</p> Signup and view all the answers

    Which of the following makes up 60% of primary brain tumors in adults?

    <p>Glial tumors</p> Signup and view all the answers

    Which type of tumor is most commonly found in the pituitary gland?

    <p>Pituitary adenomas</p> Signup and view all the answers

    What is the peak age for the development of glioblastoma (GBM)?

    <p>45-60 years</p> Signup and view all the answers

    Which of the following is a characteristic feature of glioblastoma pathology?

    <p>Both A and C</p> Signup and view all the answers

    What is the first step in the treatment of glioblastoma (GBM)?

    <p>Maximal safe resection</p> Signup and view all the answers

    What percentage of astrocytomas are low-grade astrocytomas?

    <p>15%</p> Signup and view all the answers

    What is a common feature of low-grade astrocytomas?

    <p>They have a high risk of transforming into a higher grade.</p> Signup and view all the answers

    What is the 5-year survival rate for low-grade astrocytomas with gross resection and radiotherapy?

    <p>70%</p> Signup and view all the answers

    Where do meningiomas primarily arise from?

    <p>Cap cells of the arachnoid</p> Signup and view all the answers

    Meningiomas are classified as which type of tumor based on their location?

    <p>Extra-axial</p> Signup and view all the answers

    For residual or recurrent meningioma, what treatment options are used?

    <p>Radiation and/or focused radiation</p> Signup and view all the answers

    From which cranial nerve do vestibular schwannomas arise?

    <p>Cranial nerve VIII</p> Signup and view all the answers

    What is the most common symptom of a vestibular schwannoma?

    <p>Progressive hearing loss</p> Signup and view all the answers

    In which condition are vestibular schwannomas typically bilateral?

    <p>Neurofibromatosis type 2 (NF2)</p> Signup and view all the answers

    What are the treatment options for vestibular schwannomas?

    <p>Surgery or stereotactic radiosurgery, observation</p> Signup and view all the answers

    Which of the following is a characteristic feature of vestibular schwannomas in NF2?

    <p>Bilateral occurrence</p> Signup and view all the answers

    What is the most common presentation of a non-functioning pituitary adenoma?

    <p>Visual symptoms, headache, and hypopituitarism</p> Signup and view all the answers

    Which hormone is associated with prolactin-producing pituitary adenomas?

    <p>Prolactin</p> Signup and view all the answers

    What condition is commonly caused by an ACTH-secreting pituitary adenoma?

    <p>Cushing’s syndrome</p> Signup and view all the answers

    Which of the following is a rare but serious complication of pituitary adenomas?

    <p>Pituitary apoplexy</p> Signup and view all the answers

    What are the primary treatments for pituitary adenomas?

    <p>Medications, surgery, and radiation</p> Signup and view all the answers

    Which of the following is the standard treatment for Primary CNS Lymphoma?

    <p>Biopsy and chemotherapy</p> Signup and view all the answers

    What trend has been observed regarding the rate of Primary CNS Lymphoma?

    <p>It is increasing irrespective of immune suppression.</p> Signup and view all the answers

    Which type of cancer most commonly metastasizes to the brain?

    <p>Lung cancer</p> Signup and view all the answers

    What percentage of brain metastases are attributed to breast cancer?

    <p>40%</p> Signup and view all the answers

    What is the second most common childhood tumor?

    <p>Pediatric glial tumors</p> Signup and view all the answers

    What is the most common brain tumor in childhood?

    <p>Medulloblastoma</p> Signup and view all the answers

    Which of the following statements about cerebellar astrocytoma is true?

    <p>It has a cure rate of 90%.</p> Signup and view all the answers

    At what age is cerebellar astrocytoma most commonly diagnosed?

    <p>5-10 years</p> Signup and view all the answers

    Where does medulloblastoma typically arise? A) Frontal lobe B) Cerebellar vermis C) Temporal lobe D) Brainstem

    <p>Cerebellar vermis</p> Signup and view all the answers

    Medulloblastoma is classified as which type of tumour?

    <p>Primitive neuroectodermal tumour (PNET)</p> Signup and view all the answers

    Which of the following is true about medulloblastoma?

    <p>It is one of the most common brain tumors in children.</p> Signup and view all the answers

    What is a characteristic feature of medulloblastoma?

    <p>Ability to seed along CSF pathways</p> Signup and view all the answers

    Which of the following is a common metastatic site for medulloblastoma?

    <p>Spinal axis</p> Signup and view all the answers

    What is the malignancy grade of medulloblastoma?

    <p>Extremely malignant</p> Signup and view all the answers

    Which of the following is NOT a feature of medulloblastoma?

    <p>Originates from ependymal cells</p> Signup and view all the answers

    Ependymomas originate from cells that line which structures?

    <p>Ventricles or central canal of the spinal cord</p> Signup and view all the answers

    Which age group is most commonly affected by ependymomas?

    <p>Children and young adults</p> Signup and view all the answers

    What is the prognosis for diffuse brain stem tumors?

    <p>Poor prognosis</p> Signup and view all the answers

    Which of the following is a clinical feature of diffuse brain stem tumors?

    <p>Cerebellar dysfunction</p> Signup and view all the answers

    Diffuse brain stem tumors infiltrate which structures?

    <p>Brain stem layers</p> Signup and view all the answers

    Which complication is least likely to be caused by diffuse brain stem tumors?

    <p>Increased intracranial pressure</p> Signup and view all the answers

    What is the primary role of 5-ALA during surgical procedures?

    <p>To illuminate the boundaries of tumors</p> Signup and view all the answers

    Which imaging technique is crucial for surgeries involving eloquent brain areas?

    <p>fMRI and DTI</p> Signup and view all the answers

    Awake craniotomy is most often performed for tumors situated in which regions?

    <p>Eloquent brain regions</p> Signup and view all the answers

    Which of the following is not a standard indication for performing an awake craniotomy?

    <p>Preference for patient sedation</p> Signup and view all the answers

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