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DOI: 10.1055/s-0035-1555666
Neurotrauma Quiz – June 2015
Publication History
Publication Date:
30 June 2015 (online)
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Q1. Which of the following is not an inclusion criterion for patient selection in RESCUE – ICP trial?
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Requiring ICP monitoring with raised ICP (>25 mmHg >1–12 h), refractory to initial medical measures
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Patient may have an immediate operation for amass lesion but not a decompressive craniectomy
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Abnormal CT scan
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A devastating injury not expected to survive for 24 h
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Q2. Which of the following is not correct regarding modified marshal grading?
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Grade 1: diffuse injury with no visible pathology
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Grade 3: diffuse injury and brain swelling
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Grade 4: diffuse injury and midline shift >5 mm
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Grade 5: diffuse injury with non-evacuated mass lesion (EDH, SDH, ICH > 25cc)
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Q3. Which of the following is not true regarding surgical steps used following decompressive craniectomy in RESCUE – ICP trial?
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Wide decompressive craniectomy (>15 cm in diameter)
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Opening the dura and leaving it open
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Documenting the size of the created bony window in the data collection proforma
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Avoiding tight bandage or positioning patient head on craniotomy side, after decompression
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Q4. Which of the following is not an inclusion criterion for patient selection in STICH (Trauma) trial?
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Patient should be present within 72 h of injury
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Traumatic ICH more than 10 cc on CT scan
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No associate significant surface hematoma (EDH, SDH)
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Treating neurosurgeon should be in equipoise
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Q5. What is not true about STICH (Trauma) trial?
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Primary objective is to determine whether a policy of early surgery in patients with traumatic intracerebral hemorrhage improves outcome compared to a policy of initial conservative treatment
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Another objective is to confirm appropriate thresholds for intracranial pressure (ICP) and cerebral perfusion pressure (CPP) for clinical management of head injured patients with TICH
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840 patients recruited between October 2009 and March 2013
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Outcome will be measure at 3, 6, 9, 12 months via a postal questionnaire using extended Glasgow Outcome Scale
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Q6. DECRA trial was criticized on the following aspects except?
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27% of patients randomized to surgery had bilateral nonreactive pupils, compared to only 12% of patients in medical group
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The DECRA trial contains no data or valuable information to inform modern management of TBI and thus should be ignored by practitioners treatment options for severe TBI
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The medical and surgical teams were aware of study-group assignments but assessors were not
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The median ICP during the 12 h before randomization was 20 mmHg
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Q7. RESCUE-ICP trial differs from DECRA trial on the following aspects except?
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ICP threshold were 25 mmHg vs. 20 mmHg
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Duration of refractory raised ICP (>1 h vs. 15 min)
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Acceptance of contusions
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Shorter follow vs. longer follow up
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Q8. All is true about the evidence-based medicine, except?
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Class 1: Systemic reviews of prospective randomized controlled trials
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Class 2: Observational studies
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Class 3: Case control studies
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Technology assessment includes device accuracy and reliability
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Q9. Which of the following is not true about CRASH 3 trial?
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Aim of study were to provide reliable evidence about the effect of tranexamic acid (TXA) on mortality, disability, risk of vascular occlusive events in patients with TBI
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To be included in study patients should be admitted within 8 h of injury with intracranial bleeding on CT scan and GCS should be10 or below
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Treatment consistent of 1 g loading dose of TXA followed by maintenance 1 g dose over 8 h
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Patient recruitmentwas takenplace inover 30 countries,was started on April 2012 and will be end on 31 December 2016
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Q10. Indian institution has participated in the following trials except?
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STICH Trial
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RESCUE-ICP Trial
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CRASH Trial
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CRASH 3 Trial
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Q11. According to the CRASH trial, which of the following statements about outcome at 6 months among patients hospitalized with TBI who received 1 g methylprednisolone vs. placebo care is not correct?
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Risk of death were higher in corticosteroid group than placebo
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Risk of death were higher in placebo group than corticosteroid group
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Risk of severe disability were higher in corticosteroid group than placebo
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There was no clear evidence that the relative risk of death or disability at 6 months differed substantially between groups when stratified by injury severity or time since injury
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Q12. Which of the following is not true about neural-stem trial for chronic spinal cord injury?
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First FDA approved trial
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It requires transplantation of stem cell in white matter of patient's spinal cord
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Stem cells works with replacing damaged cells, neuroprotection or the creation of an environment conducive to regeneration by endogenous cells
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Total 4 patients recruited
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Q13. What is true about The Neurotrauma Society of India except?
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First established as Neurotraumatology Committee under NSI in 1992
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Neurotrauma Society was officially announced on 18th August 1999
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The Logo depicts head and the spine and prepared in 1992
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First issue of The Indian Journal of Neurotrauma was published in 2004
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Q14. Mild traumatic brain injury includes all except
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Any period of loss of consciousness for up to 15 min
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Any loss of memory for events immediately before or after the accident for as much as 24 h
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Any alteration of mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused)
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Focal neurological deficit(s) that may or may not be transient
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Q15. According to brain trauma foundation, which of the following statement is incorrect regarding the use of steroid in severe traumatic brain injury?
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Level 1 evidence which do not support use of steroids in moderate to severe TBI
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High dose methylprednisolone is associated with increased mortality secondary to increased risk of infection and gastrointestinal bleeding and is contraindicated
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Steroids were introduced in early 1960s as a treatment for brain edema
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Glucocorticoid within 24 h associated with 74% increased risk of first late seizure
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