1.

Most importantly effect(s) of sedation is:

a. Decrease metabolic rate of brain tissue
b. Improving cerebral tissue tolerance to ischemia
c. Reduce ICP
d. Seizure prevention

Answer C.

2. All is correct according paroxysmal sympathetic Hyperreactivity (PSH), except:

a. This syndrome is recognized in all subgroup of traumatic brain injured patients
b. Simultaneous increase in sympathetic and motor activity is key presentation
c. Syndrome is paroxysmal and transient
d. Level of evidence supporting PSH therapy is low
e. Opioids, intravenous sedatives Beta and alpha blockers main drugs used for treatment

Answer A.

3. According respiratory management in Traumatic Brain Injured patient:

a. Head up position at 30 reduce ICP due to better venous drainage
b. Similar to medical patient, in acute brain injured patient early and ultra early tracheostomy is
associated with reduced mortality
c. Head up position at 30 is part of the ventilator care bundle
d. Optimal timing of tracheostomy inTBI patient is well defined

Answer: TFTF

4. Metabolism in sever traumatic brain injures patient

a. There is no difference between in catabolic response be seen in multiple trauma patient with
TBI an without TBI
b. Nutrition should be started as early as possible
c. There is no date from randomaized clinical trails about superiority of enteral route of nutrition
d. Severe TBI is independent risk factors for stress ulceration

Answer : FTTF

5. Which of the following is not cause of Hypernatremia in severe TBI

a: central diabetes insipidus

b: osmotic diuresis

c: daibetes mellitus

d: SAIDH – syndrome of inappropriate ADH secretion

Answer: c

6. Which of the following is not a signs of central diabetes insipidus

a: High Urine output ( >3ml/kg BW/H)

b: Low urine specific gavity 1001-1005

c: urine osmolality <150 mOsmol/kg

d: Urine sodium >100mmol/l

Answer: d

7. Commonest cause of Hyponatremia in severe TBI is all ,except:

a: Low sodium intake

b: use of hypotonic solution

c: increased sodium lose via the gastric tube

d: rigorous use of diuretics

Answer : d

8. Which is difference between SAIDH and CWS (cerebral Salt wasting syndrome)

a: elevated urinary sodium in SAIDH

b: hyponatremia during CWS and Hypernatremia during SAIDH

c: high urine osmolality in SAIDH

d: low urine volume in SAIDH an high in CWS

Answer: d

9. Which of the following is true regarding control of glucose in severe TBI

a: Last Brain Trauma Foundation guidelines recommended glucose in range 150-180mmhg

b: appropriate Glucose range in severe TBI is 90-120mmhg

c: if tight glucose control is planed, cerebral micro dialysis monitoring is recommended

d: Tight glucose control is associated with lower mortality

Answer: C

10. According latest Brain Trauma Foundation guideline, earliest safe day for DVT prophylaxis with
LMWH defined:
a: 3 day post injury
 b:7th day post injury
c: 2nd day post injury
d: d Brain Trauma Foundation guideline do not provide guidance for the timing of initiation of
VTE prophylaxis in TBI patients.

Answer : d
CT evolution for hemoragic core intraparenchimal lesion is unlikely after first 3 days post injury
11. Patient with other injuries:
a. Any type of Cord injury should be stabilized surgically as early as possible
b. Cervical spine lesions may have had anterior stabilization and tracheostomy should be done
as soon as possible
c. Post surgical paralysis don’t affect on the ICP
d. Patient with long bone fracture best stabilized as soon, as possible, preferable with internal
devices

Answer : a

12. About Post- traumatic hydrocephalus all is true except :

a. 2/3 of severe TBI patients suffer from Post- traumatic hydrocephalus
b. True post-traumatic communicating Hydrocephalus occurs in 1-5% of patient
c. Prolonged recovery from coma is main clinical marker
d. CSF shunt is definitive therapy

Answer: a

13. Which of the following is not a independent risk factor for development of Post traumatic
meningitis
a. Ventricular catheter for ICP measurement
b. Open, contaminated wound
c. CSF leakage
d. Sever sepsis

Answer d

14. The primary effect of mannitol in the treatment of elevated

intracranial pressure (ICP) is:
a. Osmotic fluid removal from the brain
b. Rheologic effects to change the shape of red blood cells and
decrease blood viscosity
c. Free radical sequestration
d. Decrease in the cerebral metabolic rate
Answer b
15. Ventriculostomy infections have been demonstrated to:
a. Increase with the duration of use, and infection rates increase
substantially after 7 days
b. Occur in less than 3% of patients
c. Occur less commonly in patients with intraventricular
 hemorrhage (IVH)
d. Significantly decrease with routine catheter exchange every 5
days
Answer a
16. Which of the following is specific for post-traumatic meningitis
a. Glucosae in CSF 70mg/dl
b. leukocyte>10000/mm3 in CSF
c. WBC >10000/mm3 in blood
d. Isolation of causative organism from CSF

Answer d

17. Regarding management of post-traumatic meningitis is true

a. Antibiotic prophylaxis in patient with basilar skull fractures is effective in preventing
meningitis
b. Post –traumatic CSF leakage must be treated surgically
c. Imipenem is recommended for treatment meningitis if causative organism is Streptococcus
Pneumoniae
d. Routine replacement of external drainage is effective strategy to prevent meningitis
18. What Factors are most likely to affect outcome after traumatic brain injury
a. The patient’s age
b. The depth and duration of post-traumatic coma
c. General medical health
d. Quality of available critical care
e. All of above

Answer e

19. Outcome after severe traumatic brain injury best measured through:
a. Glasgow Coma scale
b. Glasgow outcome Scale
c. Fischer scale
d. APPACHE II scale

Answer b

20. Factors involved in maintaining the cerebral perfusion pressure is:

a. Mean arterial pressure
b. Intracranial pressure
c. CVP
d. Pco2
e. All of above

Answer e.

21. Main Goal of Critical Care in management patient with severe traumatisinjuri is:
a. Prevent secondary brain damage
b. Predicting outcome
c. Reduce cost of treatment
d. Monitor ICP

Answer a.