Ultimate Board Prep

Question 1

GCS combines scores from which three categories?

Answer 1

Eye opening
Verbal response
Best motor response

Question 2

How is the GCS score for eye opening determined?

Answer 2

4: spontaneous
3: to speech
2: to pain
1: does not open

Question 3

What determines the GCS for verbal response?

Answer 3

5: oriented
4: confused
3: inappropriate
2: incomprehensible
1: no response

Question 4

What determines GCS motor score?

Answer 4

6: follows commands
5: localized to pain
4: withdraws to pain
3: decorticating flexion
2: decerebrate extension
1: no response

Question 5

Which GCS scores indicate severe, moderate, or mild injury in trauma?

Answer 5

Severe: 8 or less
Moderate 9 to 12
Mild 13 or more

Question 6

What is the optimum cerebral perfusion pressure in trauma?

Answer 6

Unknown

Below 60 may cause cerebral ischemia
Above 70 may increase incidence of ARDS

Question 7

How does mannitol reduce ICP? (3)

Answer 7

Osmotic shift from brain to intravascular compartment

Reduced CSF production

Reduces blood viscosity, inducing reflex Vado constriction

Question 8

What is the concern with hyperventilation in head trauma?

Answer 8

Risk of reducing cerebral blood flow and causing ischemia

Question 9

Deleterious effects of hypothermia? (4)

Answer 9

Coagulopathy
Dysrhythmias
Renal compromise
Poor wound healing

Question 10

Effect of mild hypothermia on neurprotection in trauma?

Answer 10

By reducing cerebral metabolic rate, there is theoretical benefit; how we evidence has not shown improved outcomes.

Question 11

Four major criteria of fat embolism syndrome

Answer 11

Petechial rash
Hypoxemia
Central nervous system depression
Pulmonary edema

Question 12

Differential for hypoxemia with diffuse bilateral infiltrates? (6)

Answer 12

Pneumonitis
Pulmonary edema
Neurogenic pulmonary edema
ARDS 
TRALI
TACO

Question 13

Diagnostic criteria for ARDS? (4)

Answer 13

P/F ratio < 300

Onset within 7days of inciting event

Bilateral infiltrates

Respiratory failure not fully explained by cardiac failure or fluid overload

Question 14

How to discriminate between cerebral salt wasting syndrome and syndrome of inappropriate ADH? (3)

Answer 14

CSWS hypovolemia
SIADH euvolemia

ADH not elevated in CSWS

Urine Na levels often > 100 only in CSWS

Question 15

Treatment for SIADH (4)

Answer 15

Water restriction
Diuresis
Demeclocycline (ADH blocker)
Sodium replacement