CORRECT ANSWERS 2022

NRNP Finals 6560 QUESTIONS WITH

CORRECT ANSWERS 2022

coup-contrecoup injury - correct answerDual impacting of the brain into the skull; coup injury occurs at the point of impact; contrecoup injury occurs on the opposite side of impact, as the brain rebounds.

Scalp laceration: what, effect, management - correct answerPrimary head injury

profuse bleeding - signs of hypovolemia Apply direct pressure Suture/ staple laceration Lidocaine 1% with epi to control bleeding, not close to nose/ ears

Skull fracture: types, effect, management - correct answerPrimary head injury

Simple: no displacement of bone. Observe and protect spine

Depressed: bone fragment depressing thickness of scull

Surgery for debridement. Give tetanus and seizure precautions

Basilar: fracture at floor of skull

Raccoon eye - periorbital bruising

battle's sign: mastoid bruising

otorrhea/ rhinorrhea - halo sign: do not obstruct flow

Give Ab's Oral intubation and oral gastric instead of nasal 1 / 4

Brain injury: types, effect, management - correct answerPrimary head injury

Concussion: reversible change in brain functioning

loss of consciousness, amnesia Do not give opioids, admit for unconsciousness greater than 2min

Contusion: bruising to surface of brain with edema

Frontal and temporal region

Brainstem contusion: posturing, variable temp, variable vital signs

N/V, dizziness, visual changes seizure precautions Hematoma - neuro: types, effect, management - correct answerEpidural hematoma: commonly temporal/ parietal region with skull fracture, causing bleeding into epidural space Loss of consciousness Rapid deterioration: obtunded, contralateral hemiparesis, ipsilateral pupil dilation CT scan (non contrast) Treatment based on Brain trauma foundation. Surgical if greater than 30cm Subdural hematoma most common type of intracranial bleed

Acute (hours): drowsy, agitated, confused, headache, pupil dilation,

CT scan (noncontrast) surgery for 10mm thickness or 5mm midline shift or for worsening GCS

Chronic (days): headache, memory loss, incontinence

CT scan (noncontrast)

Surgery: burr holes/ crani 2 / 4

Cerebral edema/ ICP elevated/ herniation: symptoms, management - correct answerdecreased level of consciousness Blown pupil Cushing triad: HTN (widening pulse pressure), decreased resp rate, bradycardia (means increased intracranial pressure) Neuro exam components - correct answerAVPU: awake, response to verbal stimuli, painful stimuli, unresponsive

GCS: 8 or below is comatose

Posturing:

decorticate = arms, legs in decerebrate = arms, legs out Electrolyte imbalances in brain injury - correct answerHyponatremia: SIADH and cerebral salt wasting

Hypernatremia: DI (give mannitol)

Management of traumatic brain injury - correct answer- Consult neurosurgery

• Limit secondary injury
• Prevent hypotension (syst 90) and hypoxemia (PaO2 60). May give blood to improve tissue perfusion.
• Treat cerebral edema: elevate bed, sedate, paralyse, mannitol, hyperventilation (PaCO2 25-30), during

first 24hrs.

• sedation and analgesia: opioids to reduce ICP (Fentanyl) with propofol. Could give Nimbex or Vec. to

help oxygenate/ ventilate

- steroids: avoid

• Give mannitol or hypertonic saline for herniation: bolus then gtt. monitor serum osmolality, sodium,

and bp.

- Seizure precautions: give phenytoin or keppra

- DVT prophylaxis: stockings, LMWH

• head injury means spine injury until proven otherwise 3 / 4

- hypothermia: can control ICP (89 - 91F)

- decompressive crani: ICP refractory to tx

• brain O2 monitoring (jugular vein O2 sats)

ICP monitoring - correct answerFor: GCS 3-8 with abnormal CT and comatose pt's with normal CT and older than 40, posturing, hypotension.

Normal value: 5-10 mmHg

Recommend initiating treatment if ICP > 20 mmHG.Can calculate CPP (CPP = MAP - ICP). Should be 60

Brain death criteria - correct answerMust have all:

No spontaneous movement Absence brain stem reflexes (fixed/ dilated pupils, no corneal reflexes, absent doll's eyes, absent gag, absent vestibular response) Absence breathing drive/ apnea can't be declared brain dead when: hypothermia, drug intoxication, severe electrolyte/ acid-base imbalance EEG, CTA of brain, Cerebral angiography, transcranial doppler Spinal cord trauma: cause and who - correct answer- MVA, falls, acts of violence, sports, wounds

• Rapid acceleration/ deceleration causes hyperextension (fall, rear-end collision)(central cord

syndrome), hyperflexion (bilateral facet dislocation), vertical column loading (compression and then shattering from falls/ dive lands on butt, at C1 from diving), whiplash

- Distraction injury: from hanging

- penetrating trauma: from wound

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