MCQs on stroke and TBI - the Peninsula MRCPsych Course

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MCQs on stroke and TBI
John O’Donovan
MCQs 1-10
PTA
GCS scores and TBI
• Length of PTA is strongly
associated with outcome from
mild traumatic brain injury.
• PTA ends when anterograde
amnesia ends.
• PTA in excess of 2 hours
suggests a severe injury
• PTA includes retrograde
amnesia from event
• PTA can be measured in PVS
via CSF clusterin and S100 beta
• GCS of 13 should make a good
recovery
• GCS of 8 at 3 hours with PTA of
13 days suggests a severe
head injury.
• Accurate GCS in ICU is
frequently impossible.
• GCS of 3 is equivalent to being
dead.
• GCS whilst intoxicated may be
falsely elevated.
MCQs 10-20
In SAH
• 50% of patients die.
• Hydrocephalus may be a
complication in 10%
• Psychiatric complications from
an PICA aneurysm may include
a Wernicke-Korsakoff state.
• Depression is commoner post
event then in lacunar stroke
• AVMs may be associated with
psychosis
Depression post stroke
• Has a prevalence of up to
79% at 3/12
• Responds best to
serotinergic medication
• Is reduced by anosagnosia
• Is strongly associated with
lesion location
• Can be prevented by
prophylactic treatment with
SSRIs
MCQS 20-30
RISK FACTORS FOR TBI
• A 21 woman has a risk
approximately half that of a 21
man
• Low IQ is associated with TBI
• Prior head injury is the most
significant known risk factor .
• High levels of testosteronne
• Platelet MAO levels are
associated with risks for TBI
Mania post stroke
• Is more common then
psychosis.
• Is associated with non
dominant lesions.
• Jung might have considered
this as a manic defence.
• Responds well to lithium
• Can arise from symptomatic
seizures from cortical
infarcts.
MCQs 30-40
In diffuse TBi
The catastrophic reaction is
• A grade 1 axon lesion is
associated with PTA of 6 days.
• A grade 4 axonal lesion will
always die.
• It’s the rapid stopping that
causes the problem.
• CSF is not always helpful as a
cushion.
• Petechial haemorrhages are
common and visible on CT
74% of the time.
• Associated with cheating on
one’s spouse.
• Minor frustration being unable
to perform complex and
difficult tasks.
• Associated with bilateral
frontal damage.
• May be helped by SSRIs
• Generally something which
always improves over time and
acceptance of disability
MCQs 40-50
Match them up
• CADASIL
• Moya Moya
• PTA of 15 days
• Head of caudate lesion
• Leucoaraiosis/multiple
lacunar strokes
Match them up
• Rising sun
• DTI
• Saying and doing very little
• Photophobia and flashing
lights
• Vascular depression
MCQs 40-50
Match them up
• PVS
• Dominant MCA stroke
• Anterograde amnesia
• Blind on a cardiology ward
• CO poisoning
• falling over in McDonalds
and banging your head
Match them up
• Wearing wigs
• Catalytic converters
• “it’s curtains for you”
• Zolpidem
• Psychic gaze apraxia

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