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SAEM M4 CURRICULUM 2 EXAM
UPDATED EXAM WITH VERIFIED
SOLUTIONS.
What vital avoid in brain ijury? Goal? - correct answers -
hypotension bc resutls in decreased cerebral perfusion pressure
which makes ujury worse
-MAP above 80 is goal
Epidural v. Subdrual hematoma - correct answers -epidural does
not cross suture lines
Chronic subdural - correct answers -occur in those with
signfnificnat atropy as a result of minor trauma
Cerebral contusions prognosis - correct answers --may convert to
intracerbral hemorrhage several days after initial injsry so any
new neuro signs neeeds another ct
, Page | 2
Diffuse axonal injury results frm? Caused by - correct answers -
shearing forces on axonal fibers of white matter and brain stem
-caused by sudden deceleration
CT of diffuse anxonal injury - correct answers -. Initial CT scans
may be read as negative, although classically display punctate
hemorrhages along the gray-white junction of the cerebral cortex
and in deep structures of the brain
Signs of basilar skull fractures - correct answers --CSF otorrhea
or rhinorrhea
-hemotypanum
-deafness
-7thn erve palsy
-racoon and batle sign
Skull fracture +overlying lac=_______. Need_____ - correct
answers -open. Need abx
4 herniation syndromes - correct answers --uncal herniation
-central transtentorial herniation
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-cerebellotonsillar nernation
-upwards transtentorial herniation
Uncal herniation: describe and sx - correct answers --when uncus
of medial temporal lobe is displaced inferiorly thru the tentorium
-ispilateral fixed and dialted pupil and c/l motor paralysis
Central transtentorial hernation - correct answers --occurs from
midline lesions of the frontal or temporal lobes with downward
displacement of the parenchyma through the tentorium.
-sx: b/l pinpoint pulpils, b/l babinski, inc muscle tone
Cerebello tonsillar hernation - correct answers --cerebellar tonsils
are displaced through the foramen magnum,
-resulting in bilateral pinpoint pupils, flaccid paralysis, and sudden
death
Upwards transtntorial herniation - correct answers -results from
posterior fossa lesions, consisting of conjugate downward gaze
with lack of vertical eye movements and pinpoint pupils.
, Page | 4
Second impact syndrome - correct answers --2 concussion in a
row can lead to cerebral edema and death
Indicaitons of head ct in trauma 4 - correct answers --gcs under
15
-neuro deficit
-coaguloapthy
-on anticoags
2 decision tools for head ct - correct answers --canadian (83%
sensitive, 38% specific). Meant to detect things can itnervene
-new orleans (100% sensitivty, 5% specific). Meant to detect any
abnormality
Ways to lower icp - correct answers --raise head to 30 degree
-mannitol
-hypertonic saline
-intube and provide sedation and analgesia
-hyperventilate goal co2 30-35
SAEM M4 CURRICULUM 2 EXAM
UPDATED EXAM WITH VERIFIED
SOLUTIONS.
What vital avoid in brain ijury? Goal? - correct answers -
hypotension bc resutls in decreased cerebral perfusion pressure
which makes ujury worse
-MAP above 80 is goal
Epidural v. Subdrual hematoma - correct answers -epidural does
not cross suture lines
Chronic subdural - correct answers -occur in those with
signfnificnat atropy as a result of minor trauma
Cerebral contusions prognosis - correct answers --may convert to
intracerbral hemorrhage several days after initial injsry so any
new neuro signs neeeds another ct
, Page | 2
Diffuse axonal injury results frm? Caused by - correct answers -
shearing forces on axonal fibers of white matter and brain stem
-caused by sudden deceleration
CT of diffuse anxonal injury - correct answers -. Initial CT scans
may be read as negative, although classically display punctate
hemorrhages along the gray-white junction of the cerebral cortex
and in deep structures of the brain
Signs of basilar skull fractures - correct answers --CSF otorrhea
or rhinorrhea
-hemotypanum
-deafness
-7thn erve palsy
-racoon and batle sign
Skull fracture +overlying lac=_______. Need_____ - correct
answers -open. Need abx
4 herniation syndromes - correct answers --uncal herniation
-central transtentorial herniation
, Page | 3
-cerebellotonsillar nernation
-upwards transtentorial herniation
Uncal herniation: describe and sx - correct answers --when uncus
of medial temporal lobe is displaced inferiorly thru the tentorium
-ispilateral fixed and dialted pupil and c/l motor paralysis
Central transtentorial hernation - correct answers --occurs from
midline lesions of the frontal or temporal lobes with downward
displacement of the parenchyma through the tentorium.
-sx: b/l pinpoint pulpils, b/l babinski, inc muscle tone
Cerebello tonsillar hernation - correct answers --cerebellar tonsils
are displaced through the foramen magnum,
-resulting in bilateral pinpoint pupils, flaccid paralysis, and sudden
death
Upwards transtntorial herniation - correct answers -results from
posterior fossa lesions, consisting of conjugate downward gaze
with lack of vertical eye movements and pinpoint pupils.
, Page | 4
Second impact syndrome - correct answers --2 concussion in a
row can lead to cerebral edema and death
Indicaitons of head ct in trauma 4 - correct answers --gcs under
15
-neuro deficit
-coaguloapthy
-on anticoags
2 decision tools for head ct - correct answers --canadian (83%
sensitive, 38% specific). Meant to detect things can itnervene
-new orleans (100% sensitivty, 5% specific). Meant to detect any
abnormality
Ways to lower icp - correct answers --raise head to 30 degree
-mannitol
-hypertonic saline
-intube and provide sedation and analgesia
-hyperventilate goal co2 30-35
