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Old 10-19-2012
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Arrow Billy Step 1 Questions # 38

A 36-year-old woman is involved in a motor vehicle accident. She is not wearing a safety belt and is ejected from the
vehicle. When paramedics arrive, her vital signs are stable with pulse 80/min, respirations 17/min, and blood pressure
125/80 mm Hg. On examination in the emergency department, she has multiple contusions and abrasions over the skin of
her head, torso, and extremities. There is no papilledema, there is no decerebrate posturing, and she has no spontaneous
movements. She is not conscious. CT scan of the head shows no intracranial hemorrhage or edema and no skull
fractures. She remains in a persistent vegetative state. What lesion is most likely to be present in this patient?


□ (A) Acute hydrocephalus
□ (B) Cerebellar tonsillar herniation
□ (C) Diffuse axonal injury
□ (D) Hypoxic neuronal damage
□ (E) Multiple cortical contusions
□ (F) Myelinolysis
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Old 10-19-2012
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i think it's between C and D

will choose C) diffuse axonal injury.....just a random guess

thanks

Last edited by venky2600; 10-19-2012 at 02:06 PM.
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Old 10-19-2012
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Unconscious ?? I'll go for D ! Hypoxia injury
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Quote:
Originally Posted by venky2600 View Post
i think it's between C and D

will choose C) diffuse axonal injury.....just a random guess

thanks
I am thinking between C and D and guessing C too,because hypoxia would lead to alteration in the vitals,which are not abnormal in this situation.
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Old 10-19-2012
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Diffuse axonal injury
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Old 10-20-2012
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Correct Answer C is correct

Angular acceleration with torsional forces applied to white matter tracts can cause stretching and tearing of axons,
followed by axonal swelling or “retraction balls” within hours. Acute hydrocephalus requires a blockage of CSF flow, and
there is no mass lesion, hemorrhage, or brain swelling in this case. Herniation requires brain swelling or a large
hemorrhage or a mass that enlarges rapidly. Hypoxic injury is most likely to affect neurons of the hippocampus, Purkinje
cells, and cortical neurons in watershed areas first; the patient's vital signs suggest that this did not occur. Contusions
represent areas of superficial cortical hemorrhage. Central pontine myelinolysis can occur from rapid correction of
hyponatremia.
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Old 10-20-2012
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Its C. That is a Kaplan Q bank question
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Old 10-20-2012
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I remember doing this question somewhere. May be Robbins patho.
But remember question not answer. Hehe
My best guess- diffuse axonal injury
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