A 45-year-old male patient present to the emergency department with a severe head injury following a car accident. His Glasgow Coma Scale (GCS) score is 8, and he shows signs of increased intracranial pressure (ICP). Which of the following interventions should be prioritized to manage his ICP?
Administering mannitol intravenously
Encouraging the patient to hyperventilate
Administering a high-dose corticosteroid
Performing a lumbar puncture immediately
The Correct Answer is A
A. Administering mannitol intravenously: Mannitol is an osmotic diuretic that helps reduce ICP by drawing fluid out of brain tissue and decreasing cerebral edema, making it a priority intervention.
B. Encouraging the patient to hyperventilate: Controlled hyperventilation may reduce ICP temporarily by lowering CO₂ levels and causing cerebral vasoconstriction. However, it should only be done cautiously under close monitoring, and other ICP management techniques like mannitol administration take priority.
C. Administering a high-dose corticosteroid: Corticosteroids are generally ineffective for reducing ICP in traumatic brain injury and are typically not recommended in this scenario.
D. Performing a lumbar puncture immediately: Lumbar puncture is contraindicated in cases of increased ICP because it may lead to brain herniation due to the sudden release of pressure.
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Correct Answer is B
Explanation
A. Inflammation of the motor cortex leads to decreased coordination and balance. Parkinson’s disease is not caused by inflammation in the motor cortex; it primarily involves the loss of dopamine-producing neurons.
B. Degeneration of dopamine-producing neurons in the substantia nigra of the brain leads to motor dysfunction. Parkinson’s disease is caused by the degeneration of dopamine-producing neurons in the substantia nigra, leading to motor symptoms such as tremors, rigidity, and bradykinesia.
C. A loss of acetylcholine in the brain leads to memory problems and cognitive decline. While a loss of acetylcholine is associated with Alzheimer’s disease, it is not the primary issue in Parkinson’s disease.
D. Excess production of dopamine in the basal ganglia leads to tremors and muscle rigidity. In Parkinson’s disease, there is a decrease, not an excess, in dopamine production, which contributes to motor symptoms.
Correct Answer is D
Explanation
A. Irritable bowel syndrome. IBS management typically involves dietary changes, fiber, and stress management, not antibiotics or clear liquids.
B. Chronic diverticulosis. Diverticulosis, when asymptomatic, does not require antibiotics. Treatment focuses on a high-fiber diet to prevent diverticulitis.
C. Complicated diverticulitis with abscess. Complicated diverticulitis may require IV antibiotics, hospitalization, or even surgical intervention if there are abscesses.
D. Uncomplicated diverticulitis. Uncomplicated diverticulitis, without abscess or perforation, is treated with oral antibiotics and a clear liquid diet for bowel rest.