SOAL UJIAN BEDAH SARAF

(BEDAH DASAR/BEDAH LANJUT)

1. The basic steps in managing scalp wounds are as follows, except :

a. debriding
b. haemostasis
c. primary closure
d. palpation
e. inspection

2. In traumatic brain injury, radiological investigations are mostly indicated

when :
a. a blunt injury is suspected
b. a penetrating injury is revealed
c. a full conscious patients with open wound on the head
d. suspected for alcohol consumption
e. an elderly patient with wound on the head

3. Basal fractures may be associated with complication such as :

a. cranial nerve injury
b. CSF fistula
c. Carotid cavernous fistula
d. A, B, C are correct
e. A, B are correct

4. These are confirmation of CSF rhinorrea :

a. glucose levels <50% of that in the serum ( <30mg/dl ) in fluid
collected from the nostrils
b. always appear as a clear fluid
c. beta transferrin levels was confirmed
d. always appear in basilar skull fracture
e. when there is CSF leakage, the patient must be unconscious

5. That is the most important structure that is compromised in subfalcine

herniation :
a. calcarine sulcus
b. post central gyrus
c. posterior cerebral artery
d. cingulate gyrus
e. temporal lobe

6. These structures involved in unequal pupil due to uncal herniation,

except :
a. occulomotor nerve
b. superior cerebellar artery

7. a
8. b
9. c
10. d
11. e
12. f
13. Pneumochepalus in truamatik brain injury
a. Appear as hyperdense lesion
b. Might be due to dural tear
c. Present inlinear fracture
d. No need for oxygen administration
e. Cannot lead to acute increase of ICP
14. These are clinical evaluation of frontal sinus fracture :
a. local pain
b. periorbital hemorrhage
c. forehead laceration
d. A B C are correct
e. B, C are correct
15. These are actions of mannitol 20% as osmotherapy :
a. vasoconstriction and reduced blood volume
b. osmotic dehydration
c. reduction of CSF production
d. A, B, C are correct
e. B, C are correct
16. What is the dossage of mannitol administration?
a. 0,25-0,5 g/kg
b. 2g/kg
c. 1-2 g/kg
d. 0,25-1mg/kg
e. 1g/kg
17. How can you maintain the adequate ventilation in traumatic brain injury:
a. PaCO2 >40 mmHg
b. PaCO2 30-40 mmHg
c. PaCO2 <30 mmHg
d. PaCO2 20-30 mmHg
e. PaCO2 50mmHg
18. These are physiological lines that you can find in lateral cervical x ray :
a. . Marginal line, spinolaminar line, psoterior laminar line, posterior .
b.
19. m
20. n
21. o
22. p
23. q
24. Intravenous mannitol should be used with caution in the elderly for
several reasons, except :
a. They may already be dehydrated
b. Pre-exixting electrolyte abnormalities
c. A sudden increase of circulating blood volume risk cardiac failure
d. They may have renal impairment
e. They always in hypertension therapy due to lost of vascular tone
25. Skull base fracture may be associated with injuries following :
a. Paranasal sinuses
b. Thoracolumbar spine injuries
c. Long bone fractures
d. Abdominal trauma
e. Pelvic injury

26. Indications of surgical treatment by debridement of compound depressed

fracture :
a. No dural penetration
b. Frontal bone involvement
c. Depression less than the thickness of the skull
d. Frontal sinus involvement
e. Minor cosmetic deformity

27. Cervical spine injury may be excluded in the alert patients with the
following features :
a. No intoxication
b. No neck pain
c. High-energy injury
d. A,B,C are correct
e. A,B are correct

28. Complication of traumatic CSF fistula :

a. Low pressure headache
b. Cosmetic problem
c. Antibiotic resistency
d. Neurological deficit
e. High cost treatment

29. What is the name of the ongoing bleeding in that hemorrhage ?

a. halo sign
b. salt and pepper appearance
c. midline shift
d. swirl sign
e. crescent shaped

30. What part of the brain that involved in that picture ?

a. frontal lobe
b. occipital lobe
c. parietal lobe
d. temporal lobe
e. third ventricle

31. What do you suggest for that condition ?

a. ICP monitor insertion
b. Craniectomy decompression
c. Craniotomy evacuation
d. Closed observation
 e. Mannitol administration

32. What structure that looked stuff in that picture ?

a. Pineal gland
b. Third ventricle
c. Fourth ventricle
d. Lateral ventricle
e. Falx cerebri

33. Ad
Please use the following instruction for another questions :

A. 1,2,3 are correct

B. 1,3 are correct
C. 2,4 are correct
D. Only 4 are correct
E. 1,2,3,4 are correct

34. Extracranial insults in head injury that may

1. Hypotension
2. Hypoxis
3. Hyponatremin
4. Anemia

35. Risk and complications of intravenous manitol :

1. Rebound rise of ICP
2. Cardiac arrest
3. Hypotension
4. Minimal complication

36. These are drugs that dilate pupil

1. Morphine sulphate
2. Adrenalin
3. Pyridostigmine bromide
4. Scopolamine

37. Parameters for monitoring in head injured patients :

1. MAP >90mmHg
2. ICP >20mmHg
3. End tidal CO2 35-40mmHg
4. Hematocrit 45%

38. Etiologies of pneumocephalus

1. Skull defects
2. Infection
3. Post neurosurgical procedures
4.

39. Ping-pong ball fractures :

 1. Need a Craniotomy
2. Seem only n the newborn
3. Usually with neurological deficits
4. A green-stick type fracture

40. Indication of transtentorial herniation brainstem compression

1. Sudden drop GCS score
2. One pupil fixes and dilates
3. Paralysis or decebration
4. Bilateral fixed dilated pupil

41. A high-injury is defined as follows :

1. A motor vehicle accident at speeds >64km/h
2. Assault with blunt weapon
3. Pedestrians or cyclist hit by motor vehicle
4. Falls >6 meters

42. In peditric, hypotension is :

1. Neonates (0-28 days of age) : SBP <60mmHg
2. Infants (1-12 months) : SBP 70-80 mmHg
3. Children beyond 10 years : SBP <90 mmHg
4. Children >1-10 years : SBP < 70 + (1x age in years ) mmHg

43. The following head injury factors contribute to an increased risk of early
seizures :
1. Cortical contusion
2. Depressed skull fractures
3. Penetrating head wound
4. Seizure within 24 hours of injury

44. Diastatic skull fractures :

1. Separation of cranial suture more than 1mm
2. Separation of cranial suture more than 1cm
3. More common in newborn
4. Can be accompanied by tear of underlying venous sinus

45. Comminuted skull fractures :

1. Multiple fractures
2. Separate fragments
3. Caused by severe force
4. Cause by static loading

46. Indication of head CT scan

1.
2.
3.
4.

47. Both pupils dilated ...

 1. post epileptic
2. barbiturates
3. severe hypotension
4. brain stem compression

48. Brain death in adult

1. No papillary response
2. No KPR reflex
3. No caloric vestibule-ocular effect
4. No corneal reflex

49. A partial spinal cord injury may manifest in :

1. Anterior cord syndrome
2. Central cord syndrome
3. Lateral cord syndrome
4. Cauda equine syndrome

50. Middle basillar skull fractures

1. Lies in temporal base
2. Battle sign always appear
3. The cranial nerve pulsy damaged may be irreversible
4. Fracture line in CT scan routinely appear

51. Middle basilar skull fracture

1. lies in temporal bone
2. battle sign always appear
3. the cranial nerve palsy damaged may be irreversible
4. fracture line in ct scan routinly appear
52. The bone that involved in that picture
a. Temporal bone
b. Parietal bone
c. Occipital bone
d. Petrous bone
e. Freontal bone
53. What is the Biomekanik Principles in That condition
a. low-force impact in wide area of the bone
b. high-force impact in narrow area of the bone
c. acceleration-deceleration injury
d. angulation injury
e. diffuse injury
54. If that following condition affect the infant of young children
complication that might happened
a. carotid-cavernous fistula
b. intracerebral hemorrhage
c. epidural hemorrhage
d. leptomeningeal cyst
e. traumatic CSF fistula
55. What will you suggest as a treatment of it
a. craniectomy debridement
 b. craniectomy decompression
c. craniotoy elevation
d. closed observation
56.