Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Neurologic Disorders--->Neurotrauma
Page: 2

Question 6#Print Question

A 60-year-old male with prior deep vein thrombosis (DVT) and pulmonary embolism (PE) on therapeutic anticoagulation, hypertension, and alcohol abuse is brought to the ED after being found down at the bottom of a flight of stairs. His GCS was 6 (eyes did not open 1, no verbal output 1, withdrawal of all extremities to painful stimulation 4). Given his poor neurologic examination, he was intubated. A head CT was completed and is shown in the image below. His initial trauma evaluation did not demonstrate any major injury, and his vital signs are normal.

Axial noncontrast head CT. Bilateral acute subdural hemorrhage with parafalcine subdural hemorrhage. There is cortical subarachnoid hemorrhage. Bilateral right more than left frontal contusions with intraparenchymal hemorrhage.

What is the next best step in management of the patient?


a. Obtain an MRI of the brain to further evaluate the extent of TBI
b. Obtain a computed tomography angiography (CTA) head and neck for evaluation of potential intracranial aneurysm
c. Place a subdural ICP monitor
d. Start IV fluids with dextrose source

Question 7#Print Question

A 29-year-old male was riding a motorcycle and was involved in a collision with a truck. He was placed in a cervical collar, and his GCS at the site was 7 for which he was intubated. After 3 days in the ICU, he started to move all extremities to command. An MRI of the brain is obtained, and it showed scattered foci of bleeding, as follows:

Axial susceptibility weighted imaging (SWI) on MRI. The arrows point to areas of microhemorrhages within the brain stem and temporal lobes. There is also tentorial subdural hematoma present.

Based on what is seen on the MRI, which of the following is true?

a. Immediate hemicraniectomy will reduce risk of long-term disability
b. He is likely to return back to baseline and have no clinical deficits 30 days from admission
c. He will likely have focal seizures after 6 months from the event
d. He is likely to have cervical spinal cord injury
e. The distribution of the hemorrhagic areas is helpful in determining severity of injury

Question 8#Print Question

A 47-year-old female with a past medical history of diabetes mellitus and asthma fell down a flight of stairs. When EMS arrives, she is unconscious (GCS 4). She is intubated in the field and brought to the ED. In the ED, she is found to have extensor posturing. CT head is obtained and shown below:

Axial noncontrast head CT. There is a large right temporal intraparenchymal hemorrhage with surrounding edema. There is mass effect with uncal herniation and compression of the midbrain and loss of the quadrageminal and ambient cisterns.

Which of the following is true about decompressive hemicraniectomy?

a. It reduces long-term disability
b. It reduces mortality rates
c. Smaller hemicraniectomies are preferable to larger ones
d. The primary benefit is in reducing the risk of posttraumatic epilepsy
e. The skull on the opposite side of the contusion must be removed to reduce contrecoup swelling

Question 9#Print Question

A 52-year-old female is admitted to the neuro ICU after a fall down five stairs. She did not lose consciousness but was confused for several hours after the fall. She is not intubated. A CT head was obtained and demonstrated SAH overlaying the cerebral cortex.

Axial noncontrast head CT. The arrows point out areas of subarachnoid hemorrhage present in the deep sulci of the bilateral frontal lobes.

Which of the following is true about this patient?

a. She is at high risk for vasospasm in the 4 to 14 days postbleed period
b. A catheter angiogram is to be obtained within the first 48 hours to rule out vascular malformations and repeated in 1 week if the first one was negative
c. She does not need to be worked up for polycystic kidney disease
d. She is at high risk of ischemic stroke in the left middle cerebral artery (MCA) territory
e. She is likely to have a coagulopathy

Question 10#Print Question

A 47-year-old male is found to have refractory elevation in ICP following a TBI in the setting of a motor vehicle accident. His neuro examination is poor, with GCS of 5. A head CT was obtained which demonstrated signs of bilateral frontal and temporal contusions.

Which of the following methods will help reduce ICP?

a. Loading with topiramate
b. Cooling to 34°C
c. Supination with flat head of the bed
d. Maintaining a serum sodium strictly less than 145 mg/dL
e. Adjusting the ventilator to target PaCO2 of 35 to 40

Category: Critical Care Medicine-Neurologic Disorders--->Neurotrauma
Page: 2 of 2