TBI Questions PDF

**What are the primary components considered in the Monroe-Kellie Doctrine?** - A\) Tissue, blood, oxygen - B\) CSF, tissue, blood - C\) Blood, oxygen, glucose - D\) Blood, CSF, oxygen - **Answer**: B **What happens if an increase in one component of the cranial compartment is not co...

**What are the primary components considered in the Monroe-Kellie Doctrine?** - A\) Tissue, blood, oxygen - B\) CSF, tissue, blood - C\) Blood, oxygen, glucose - D\) Blood, CSF, oxygen - **Answer**: B **What happens if an increase in one component of the cranial compartment is not compensated by a decrease in another?** - A\) Cerebral autoregulation improves - B\) Intracranial pressure (ICP) decreases - C\) Herniation occurs due to increased ICP - D\) Cerebral perfusion pressure (CPP) remains stable - **Answer**: C **Which is the gold standard for measuring intracranial pressure (ICP)?** - A\) Epidural catheter - B\) Intraventricular catheter - C\) Subarachnoid bolt - D\) Lumbar puncture - **Answer**: B **What is the typical site of cerebrospinal fluid (CSF) production?** - A\) Arachnoid villi - B\) Superior sagittal sinus - C\) Choroid plexus in the ventricles - D\) Subdural space - **Answer**: C **A Glasgow Coma Scale (GCS) score of ≤7 indicates what?** - A\) Brain death - B\) Need for mechanical ventilation - C\) Requirement for ICP monitoring - D\) Immediate neurosurgery - **Answer**: C **Which of the following is a method to reduce ICP?** - A\) Administer vasodilators - B\) Position patient in Trendelenburg - C\) Use hyperventilation to induce vasoconstriction - D\) Allow hypoxemia to decrease metabolic demand - **Answer**: C **What drug is commonly used as a diuretic to reduce ICP?** - A\) Acetazolamide - B\) Propofol - C\) Ketamine - D\) Isoflurane - **Answer**: A **Which ICP-lowering technique is related to venous drainage?** - A\) Elevating the head of the bed \>30 degrees - B\) Using vasopressors - C\) Administering corticosteroids - D\) Performing a craniotomy - **Answer**: A **In diffuse brain injury, what phenomenon may occur despite decreased cerebral blood flow (CBF)?** - A\) Hyperemia - B\) Ischemia - C\) Hypercapnia - D\) Vasospasm - **Answer**: A **What is the typical range for normal cerebral autoregulation?** - A\) 20-60 mmHg - B\) 40-80 mmHg - C\) 60-160 mmHg - D\) 80-180 mmHg - **Answer**: C **Which factors can disrupt cerebral autoregulation?** - A\) Hypoxia, ischemia, hypercapnia - B\) Hypothermia, vasoconstriction, anemia - C\) Hyperglycemia, low ICP, hyperoxia - D\) Alkalosis, hypoperfusion, steroids - **Answer**: A **Cushing's reflex is triggered by:** - A\) Low mean arterial pressure (MAP) - B\) ICP exceeding MAP - C\) Elevated CBF - D\) CPP \>100 mmHg - **Answer**: B **What clinical signs constitute Cushing's triad?** - A\) Tachycardia, hypertension, rapid breathing - B\) Hypertension, bradycardia, irregular respirations - C\) Hypotension, tachycardia, normal breathing - D\) Bradycardia, hypertension, hypoventilation - **Answer**: B **The most common type of brain herniation involves:** - A\) Temporal uncus into the brainstem - B\) Cerebellum into the foramen magnum - C\) Frontal lobe through the cribriform plate - D\) Occipital lobe into the tentorium - **Answer**: A **What is a key biochemical change in excitotoxicity?** - A\) Increase in acetylcholine levels - B\) Elevation of glutamate levels - C\) Decrease in inflammatory mediators - D\) Reduction in oxidative stress - **Answer**: B 16. **What happens if CPP is too low?** - A\) Brain ischemia due to reduced blood flow - B\) Improved cerebral autoregulation - C\) Increased risk of herniation - D\) Hyperemia in uninjured areas - **Answer**: A 17. **What is the treatment goal when managing low CPP?** - A\) Decrease blood pressure - B\) Maintain ICP above 20 mmHg - C\) Increase MAP or decrease ICP - D\) Reduce CBF - **Answer**: C 18. **Which secondary brain injury is characterized by metabolic and inflammatory changes?** - A\) Coup-contrecoup injury - B\) Excitotoxicity - C\) Traumatic subarachnoid hemorrhage - D\) Epidural hematoma - **Answer**: B 19. **What clinical condition involves idiopathic intracranial hypertension with no clear cause?** - A\) Temporal herniation - B\) Pseudotumor cerebri - C\) Diffuse axonal injury - D\) Brain contusion - **Answer**: B 20. **What type of brain injury involves \"walk and drop\" symptoms?** - A\) Subdural hematoma - B\) Epidural hematoma - C\) Intracerebral hematoma - D\) Diffuse brain injury - **Answer**: B 21. **Which method reduces cerebral edema?** - A\) Use of vasoconstrictors - B\) Administration of hypertonic saline - C\) Reduced intrathoracic pressure - D\) All of the above - **Answer**: D 22. **What is a hallmark of diffuse axonal injury?** - A\) LOC \>6 hours due to nerve cell shearing - B\) Brief LOC with disorientation - C\) Specific impact-related injury - D\) Subdural hematoma - **Answer**: A 23. **What distinguishes a coup-contrecoup brain injury?** - A\) A localized bruise at the site of impact - B\) Bilateral injuries at the impact site and opposite site - C\) Damage to the cerebellum - D\) Ischemia caused by elevated ICP - **Answer**: B 24. **Which skull fracture type is most likely associated with a CSF leak and bruising around the eyes and ears?** - A\) Depressed fracture - B\) Diastatic fracture - C\) Basilar fracture - D\) Linear fracture - **Answer**: C 25. What type of skull fracture is the most serious? Basilar 26. **Which induction agent can decrease CPP due to its effects on reducing MAP and SVR?** - A\) Etomidate - B\) Propofol - C\) Ketamine - D\) Phenylephrine - **Answer**: B 27. What agents cause a reduction in CBF and CRMO2 due to cerebral vasoconstriction? Propofol, barbiturates, etomidate 28. What commonly used anesthetic agents cause cerebral vasodilation and therefore increased blood flow? ketamine, N2O 29. What effect do volatile agents have on CBF? They increase CBF despite decreasing CMRO2 30. **Which neuromuscular blocker should be preceded by a defasciculating dose to avoid increasing ICP?** - A\) Rocuronium - B\) Vecuronium - C\) Succinylcholine - D\) Pancuronium - **Answer**: C 31. **Why are steroids detrimental in the management of TBI?** - A\) They decrease glucose levels and worsen ischemia - B\) They increase blood glucose, exacerbate secondary brain injury, and impair immune response - C\) They reduce inflammation and worsen edema - D\) They improve autoregulation but reduce CPP - **Answer**: B 32. **What fluid is preferred in TBI management to avoid cerebral edema?** - A\) Lactated Ringer\'s - B\) 5% Dextrose - C\) Normal Saline - D\) 5% Albumin - **Answer**: C 33. **What anesthetic maintenance agent is avoided in TBI due to the risk of increasing ICP by increasing CMRO2 and vasodilating cerebral blood vessels?** - A\) Fentanyl - B\) Isoflurane - C\) Nitrous Oxide - D\) Remifentanil - **Answer**: C 34. **Why is the sitting position contraindicated in patients with a right-to-left intracardiac shunt?** - A\) Increased risk of midline shift - B\) Facilitates embolization of air i.e. VAE - C\) Promotes hyperperfusion - D\) Exacerbates hypoxia - **Answer**: B 35. **What is the goal for arterial CO2 during ventilation in TBI patients?** - A\) PaCO2 \~20 - B\) PaCO2 \~30 - C\) PaCO2 \~40 - D\) PaCO2 \~50 - **Answer**: B 36. **Which mechanism allows for rapid but self-limited SNS activation during CNS ischemia?** - A\) Carotid reflex - B\) Vasomotor tone depression - C\) Cerebral ischemic response - D\) Hypercapnic vasodilation - **Answer**: C 37. **Which drug combination is recommended to manage acute increases in ICP?** - A\) Furosemide followed by mannitol - B\) Mannitol followed by acetazolamide - C\) Corticosteroids and diuretics - D\) Ketamine and propofol - **Answer**: A 38. **What intervention is essential in post-operative TBI management?** - A\) Trendelenburg positioning - B\) Elevating the head of the bed \>30 degrees with head and neck midline - C\) Administering vasodilators - D\) Inducing hypothermia - **Answer**: B 38. **What type of TBI is characterized by brief loss of consciousness and confusion?** - A\) Moderate TBI - B\) Severe TBI - C\) Mild TBI - D\) Diffuse axonal injury - **Answer**: C 39. **Which hematoma is caused by tearing of bridging veins?** - A\) Epidural hematoma - B\) Subdural hematoma - C\) Intracerebral hematoma - D\) Traumatic subarachnoid hematoma - **Answer**: B 40. **Which anesthetic induction agent should be avoided in acute trauma due to adrenocortical suppression?** - A\) Ketamine - B\) Etomidate - C\) Propofol - D\) Thiopental - **Answer**: B 41. **What positioning technique minimizes risk of midcervical injury in the sitting position?** - A\) Use of an axillary roll - B\) Maintaining 3 fingerbreadths between chin and chest - C\) Ensuring unrestricted abdominal movement - D\) Elevating the legs - **Answer**: B 42. What nerve injuries are associated with the sitting position? Sciatic and midcervical 43. **What systemic effect is commonly seen in response to traumatic brain injury?** - A\) Hypotension and bradycardia - B\) Tachycardia and hypertension - C\) Hyperventilation and hyperthermia - D\) Respiratory alkalosis and hypothermia - **Answer**: B 44. **How does hyperventilation reduce ICP?** - A\) By inducing vasodilation - B\) By lowering PaCO2, leading to cerebral vasoconstriction - C\) By increasing CBF to damaged areas - D\) By decreasing blood viscosity - **Answer**: B 45. **What is the risk of using Nitrous Oxide in neurosurgical patients?** - A\) Decrease in CBF - B\) Increase in ICP and risk of venous air embolism - C\) Preservation of autoregulation - D\) Decrease in metabolic demand - **Answer**: B 46. **What is the treatment of choice for an acute subdural hematoma?** - A\) Full craniotomy - B\) Burr holes for drainage - C\) Administration of diuretics - D\) Elevating the head of the bed - **Answer**: B 47. What is the mechanism of action for acetazolamide? It is a carbonic anhydrase inhibitor that works by reducing the secretion of cerebrospinal fluid (CSF) through the choroid plexus  48. What is the difference between Cushing's triad and Cushing's reflex? Cushing's triad are clinical signs that are a result of Cushing\'s reflex 49. What happens if CPP is too high? **leaky capillaries and edema** 50. **What skull fracture is the most common and does not require intervention? Linear** 51. Where do diastatic fractures occur? Increased space along normal suture lines 52. What is the goal CPP during surgery? \>70