TBI TBI Acute Care & Emergency Management 3

Question 1

Secondary brain injury in TBI is best defined as:

Accepted Answer

Cellular damage from ischemia, inflammation, and excitotoxicity that develops after the primary impact

Answer

A second traumatic impact sustained after the initial injury

Answer

Spinal cord injury resulting from a TBI mechanism

Answer

Psychological trauma and PTSD that develops after TBI

Question 2

Decompressive craniectomy is indicated in severe TBI when:

Accepted Answer

ICP is refractory to maximal medical management

Answer

GCS drops below 12 on initial assessment

Answer

CT scan reveals any cerebral contusion

Answer

The patient experiences a single post-traumatic seizure

Question 3

Why is hypoxia (SpO2 < 90%) particularly dangerous in acute TBI?

Accepted Answer

It exacerbates secondary brain injury and is independently associated with dramatically worse outcomes and mortality

Answer

It primarily causes pulmonary edema that complicates ventilator management

Answer

It increases the risk of wound infection at the injury site

Answer

It primarily causes cardiac arrhythmias requiring treatment

Question 4

Which anticonvulsant(s) are recommended for prophylaxis of early post-traumatic seizures (within 7 days) in severe TBI?

Accepted Answer

Phenytoin or levetiracetam

Answer

Valproic acid

Answer

Carbamazepine

Answer

Lorazepam continuous infusion

Question 5

What type of intravenous fluid is preferred for resuscitation in acute TBI, and why?

Accepted Answer

Isotonic crystalloid (0.9% NaCl or lactated Ringer's) to maintain serum osmolality

Answer

Hypotonic saline (0.45% NaCl) to reduce renal workload

Answer

5% dextrose in water (D5W) to provide cerebral energy substrate

Answer

Albumin (4%) to maximize oncotic pressure

Question 6

Which device is used to directly measure intracranial pressure in the management of acute severe TBI?

Accepted Answer

Intraventricular catheter (ventriculostomy/EVD)

Answer

Bispectral index (BIS) monitor

Answer

Near-infrared cerebral oximetry probe

Answer

Transcranial Doppler ultrasound

Question 7

What best characterizes diffuse axonal injury (DAI) in the context of acute TBI?

Accepted Answer

Widespread axonal disruption from rotational shear forces, often with normal or subtle CT findings

Answer

Focal cortical contusion clearly visible on initial non-contrast CT scan

Answer

Epidural hematoma from middle meningeal artery rupture seen on both CT and MRI

Answer

Subarachnoid hemorrhage from ruptured berry aneurysm triggered by head trauma