A apolipoprotein e 4 genotype b apolipoprotein b

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a. Apolipoprotein E-4 genotype b. Apolipoprotein B level c. College education d. Right hemispheric injury e. Use of propofol treatment 1- The answer is d. ¡Ü 15, the maximum on the GCS, they may still have more subtle cognitive difficulties that are not reflected by this easy-to-use and simple scale. Head injuries may be defined on the basis of the GCS: mild injury (GCS 14¨C15), moderate injury (GCS 9¨C13), and severe injury (GCS 8). Of note, although patients with mild head injuries may receive a score of 2- The answer is e. The presence of periorbital ecchymosis (raccoon eyes), ecchymosis over the mastoid region (Battle¡¯s sign), hemotympanum (blood behind the eardrum), or CSF rhinorrhea or otorrhea should be considered evidence of a basilar skull fracture. 3- The answer is a. Diffuse axonal injury is the most common cause of coma in the head-injured patient without an intracranial mass lesion. It is characterized pathologically by diffusely spread axonal swellings affecting white matter, corpus callosum, and upper brainstem. These foci are usually hemorrhagic. The etiology is thought to be due to shearing forces on axons in certain susceptible regions of the brain, notably those that are particularly vulnerable to rotational forces, such as the subcortical white matter, corpus callosum, and upper brainstem. Uncontrolled hypertension may occur in patients with hypertension, but would be unlikely to produce this pattern of injury. Amyloid angiopathy causes multiple hemorrhages, but affects elderly patients. The decreased cerebral perfusion pressure
associated with brain swelling and increased intracranial pressure could cause ischemic infarction, but this would not be expected to give this appearance on MRI. Coagulopathies also occur in up to 20% of patients. 4- The answer is d. Hypothermia has been shown to reduce cerebral injury from ischemia both in experimental models and in clinical studies in patients with traumatic brain injury. Hypothermia decreases cerebral metabolism, reduces acidosis, attenuates changes in the blood-brain barrier, and inhibits the release of excitatory neurotransmitters that can be harmful. Corticosteroids, prophylactic hyperventilation, and prophylactic anticonvulsants have not been shown to be of benefit in the long-term prognosis of severely head- injured patients. Hyperthermia is detrimental to such patients. 5- The answer is a. Genetic studies have recently shown that patients with the apolipoprotein E-4 genotype have an increased risk of developing Alzheimer¡¯s disease, posttraumatic encephalopathy associated with boxing, and worse outcome after traumatic brain injury. Other predictors of a poor outcome are increasing age, lower premorbid level of education, substance abuse history, diffuse axonal injury, subarachnoid hemorrhage, severity of the initial injury, and presence of other systemic injuries. Propofol has been shown in recent studies to improve outcome after injury.

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