1. ICP is what type of fluid?
A. Intracellular fluid
B. Extracellular fluid
C. Intravascular plasma only
D. Cytoplasm of neurons
ANS: B
Rationale:
B (Correct): ICP is defined as extracellular fluid inside the cranium
(blood, CSF, interstitial fluid).
A (Incorrect): Intracellular is inside cells, not ICP.
C (Incorrect): Plasma is one contributor but not the total ICP.
D (Incorrect): Cytoplasm refers to within cells, not ICP.
2. Which factor most influences secondary brain injury severity?
A. Degree of ATP depletion
B. Number of neurons lost initially
C. Amount of CSF produced
D. Extent of hematoma size
ANS: A
Rationale:
A (Correct): Secondary injury outcomes strongly depend on ATP
depletion, which drives ischemic cascades.
B (Incorrect): Primary neuronal death is less critical than secondary
progression.
C (Incorrect): CSF affects pressure but not main determinant of cell
fate.
D (Incorrect): Hematoma size relates to primary injury.
3. Ischemia and hypoxia in the brain primarily affect which substrates?
A. Protein and fat metabolism
B. Oxygen and glucose supply
C. Calcium and magnesium balance
D. Water and sodium regulation
,ANS: B
Rationale:
B (Correct): The brain cannot tolerate loss of oxygen or glucose.
A (Incorrect): Brain relies almost entirely on glucose.
C/D (Incorrect): Imbalances occur secondarily, not the key issue.
4. Which process describes reperfusion injury?
A. Free radicals stealing electrons from cell structures
B. Cells replenishing ATP stores
C. Increased protein synthesis during healing
D. Rapid glucose influx into neurons
ANS: A
Rationale:
A (Correct): Reperfusion → oxidative stress: free radicals steal
electrons, damaging lipids, proteins, DNA.
B (Incorrect): ATP replenishment is the goal, not injury.
C/D (Incorrect): Not the central injury process.
5. Which describes autoregulation of cerebral blood flow when PaCO₂
rises?
A. Vessels constrict, decreasing ICP
B. Vessels dilate, increasing ICP
C. Vessels close completely, preventing blood flow
D. No change occurs
ANS: B
Rationale:
B (Correct): Increased PaCO₂ causes vasodilation, which increases
ICP.
A (Incorrect): Decreased PaCO₂ causes vasoconstriction.
C (Incorrect): Complete closure doesn’t happen in autoregulation.
D (Incorrect): Autoregulation is highly responsive to CO₂.
, 6. Which finding is the most common secondary brain injury?
A. Intracranial hemorrhage
B. Cerebral edema
C. Hydrocephalus
D. Hypoglycemia
ANS: B
Rationale:
B (Correct): Cerebral edema is the most common secondary injury
after brain insult.
A (Incorrect): Hemorrhage is primary injury.
C (Incorrect): Hydrocephalus can develop but is not most common.
D (Incorrect): Hypoglycemia is a metabolic complication.
7. According to the Monroe-Kellie hypothesis, what occurs if one
component of the cranial volume increases?
A. Other components must decrease to maintain ICP
B. ICP remains stable regardless of changes
C. Blood volume decreases but CSF cannot change
D. Brain tissue cannot be compressed under any condition
ANS: A
Rationale:
A (Correct): Monroe-Kellie: brain tissue, CSF, blood balance → one
increase requires another decrease.
B (Incorrect): ICP will rise if compensation fails.
C (Incorrect): CSF is a compensatory mechanism as well.
D (Incorrect): Brain tissue can herniate.
8. Which are initial signs of increased ICP?
A. Headache and vomiting
B. Irregular breathing and hypertension
C. Bradycardia and widened pulse pressure
D. Pupils blown and fixed
, ANS: A
Rationale:
A (Correct): Early signs include headache, vomiting, and drowsiness.
B/C (Incorrect): These are late Cushing’s triad signs.
D (Incorrect): Fixed pupils = ominous late finding.
9. Which triad of signs indicates Cushing’s response to increased ICP?
A. Tachycardia, hypotension, shallow breathing
B. Hypertension, bradycardia, irregular respirations
C. Hypotension, tachypnea, narrow pulse pressure
D. Bradypnea, hypothermia, seizures
ANS: B
Rationale:
B (Correct): Cushing’s triad = hypertension, bradycardia, irregular
breathing.
A/C/D (Incorrect): Do not match triad.
10. What is the most sensitive early indicator of altered brain
function?
A. Pupillary dilation
B. Loss of motor function
C. Change in level of consciousness
D. Hypertension
ANS: C
Rationale:
C (Correct): LOC changes are earliest and most sensitive to brain
injury.
A (Incorrect): Pupils change later.
B (Incorrect): Motor deficits develop after.
D (Incorrect): Hypertension reflects late brainstem involvement.
A. Intracellular fluid
B. Extracellular fluid
C. Intravascular plasma only
D. Cytoplasm of neurons
ANS: B
Rationale:
B (Correct): ICP is defined as extracellular fluid inside the cranium
(blood, CSF, interstitial fluid).
A (Incorrect): Intracellular is inside cells, not ICP.
C (Incorrect): Plasma is one contributor but not the total ICP.
D (Incorrect): Cytoplasm refers to within cells, not ICP.
2. Which factor most influences secondary brain injury severity?
A. Degree of ATP depletion
B. Number of neurons lost initially
C. Amount of CSF produced
D. Extent of hematoma size
ANS: A
Rationale:
A (Correct): Secondary injury outcomes strongly depend on ATP
depletion, which drives ischemic cascades.
B (Incorrect): Primary neuronal death is less critical than secondary
progression.
C (Incorrect): CSF affects pressure but not main determinant of cell
fate.
D (Incorrect): Hematoma size relates to primary injury.
3. Ischemia and hypoxia in the brain primarily affect which substrates?
A. Protein and fat metabolism
B. Oxygen and glucose supply
C. Calcium and magnesium balance
D. Water and sodium regulation
,ANS: B
Rationale:
B (Correct): The brain cannot tolerate loss of oxygen or glucose.
A (Incorrect): Brain relies almost entirely on glucose.
C/D (Incorrect): Imbalances occur secondarily, not the key issue.
4. Which process describes reperfusion injury?
A. Free radicals stealing electrons from cell structures
B. Cells replenishing ATP stores
C. Increased protein synthesis during healing
D. Rapid glucose influx into neurons
ANS: A
Rationale:
A (Correct): Reperfusion → oxidative stress: free radicals steal
electrons, damaging lipids, proteins, DNA.
B (Incorrect): ATP replenishment is the goal, not injury.
C/D (Incorrect): Not the central injury process.
5. Which describes autoregulation of cerebral blood flow when PaCO₂
rises?
A. Vessels constrict, decreasing ICP
B. Vessels dilate, increasing ICP
C. Vessels close completely, preventing blood flow
D. No change occurs
ANS: B
Rationale:
B (Correct): Increased PaCO₂ causes vasodilation, which increases
ICP.
A (Incorrect): Decreased PaCO₂ causes vasoconstriction.
C (Incorrect): Complete closure doesn’t happen in autoregulation.
D (Incorrect): Autoregulation is highly responsive to CO₂.
, 6. Which finding is the most common secondary brain injury?
A. Intracranial hemorrhage
B. Cerebral edema
C. Hydrocephalus
D. Hypoglycemia
ANS: B
Rationale:
B (Correct): Cerebral edema is the most common secondary injury
after brain insult.
A (Incorrect): Hemorrhage is primary injury.
C (Incorrect): Hydrocephalus can develop but is not most common.
D (Incorrect): Hypoglycemia is a metabolic complication.
7. According to the Monroe-Kellie hypothesis, what occurs if one
component of the cranial volume increases?
A. Other components must decrease to maintain ICP
B. ICP remains stable regardless of changes
C. Blood volume decreases but CSF cannot change
D. Brain tissue cannot be compressed under any condition
ANS: A
Rationale:
A (Correct): Monroe-Kellie: brain tissue, CSF, blood balance → one
increase requires another decrease.
B (Incorrect): ICP will rise if compensation fails.
C (Incorrect): CSF is a compensatory mechanism as well.
D (Incorrect): Brain tissue can herniate.
8. Which are initial signs of increased ICP?
A. Headache and vomiting
B. Irregular breathing and hypertension
C. Bradycardia and widened pulse pressure
D. Pupils blown and fixed
, ANS: A
Rationale:
A (Correct): Early signs include headache, vomiting, and drowsiness.
B/C (Incorrect): These are late Cushing’s triad signs.
D (Incorrect): Fixed pupils = ominous late finding.
9. Which triad of signs indicates Cushing’s response to increased ICP?
A. Tachycardia, hypotension, shallow breathing
B. Hypertension, bradycardia, irregular respirations
C. Hypotension, tachypnea, narrow pulse pressure
D. Bradypnea, hypothermia, seizures
ANS: B
Rationale:
B (Correct): Cushing’s triad = hypertension, bradycardia, irregular
breathing.
A/C/D (Incorrect): Do not match triad.
10. What is the most sensitive early indicator of altered brain
function?
A. Pupillary dilation
B. Loss of motor function
C. Change in level of consciousness
D. Hypertension
ANS: C
Rationale:
C (Correct): LOC changes are earliest and most sensitive to brain
injury.
A (Incorrect): Pupils change later.
B (Incorrect): Motor deficits develop after.
D (Incorrect): Hypertension reflects late brainstem involvement.
