DIMITRI P. AGAMANOLIS, M. D. Akron Childrens Hospital NorthEastern Ohio Universities College of Medicine Neuropathology
TEST-CHAPTER FOUR
TRAUMATIC BRAIN INJURY
Questions marked with * are more appropriate for residents.
1. Ischemic lesions or HIE are a major component of the shaken baby syndrome
A.True
B. False
2. Which of the following identifies damaged axons in diffuse axonal injury?
A. Beta amyloid.
B. Beta amyloid precursor protein
3. Epidural hematomas do not occur without skull fractures
A. True
B. False
4. All subdural hematomas have a free interval between the trauma and onset of symptoms
A. True
B. False
5. Pure diffuse axonal injury is characterized by severe brain swelling
A. True
B. False
6. Transsection of the cervical spinal cord may occur in the shaken baby syndrome
A. True
B. False
7. Beta amyloid precursor protein is produced by neurons at the time of traumatic brain injury
A. True
B. False
*8. A fibrous inner membrane encapsulating the subdural hematoma develops in:
A. 5 days
B. 10 days
C. 20 days
D. 4 to 6 weeks
9. Who is more susceptible to developing a subdural hematoma?
A. A 6 month old infant living with the mother and her boyfriend
B. A 16 year old skate boarder
C. A 40 year old race driver
D. A 72 year old patient with Alzheimer disease
10. The most common traumatic brain injury is:
A. Epidural hematoma
B. Subdural hematoma
C. Subarachnoid hemorrhage
D. Intracerebral hemorrhage
*11. Yellow (or orange) plaques ("Taches Jaunes") are:
A. Areas of organized subdural hematoma
B. Old subarachnoid hemorrhage
C. Old contusions
D. Old intracranial hemorrhages
12. Axonal swellings occur mainly in :
A. Ischemic infarcts
B. Diffuse axonal injury
C. Around intracerebral hematomas
D. All of the above
13. The mechanism by which axonal swellings occur in diffuse axonal injury involves all of the following processes except:
A. Snapping of axons as a result of mechanical force
B. Deformation of axons at internodes
C. Compaction of neurofilaments
D. Influx of calcium into the axoplasm
*14. Among the following structures, petechiae, in diffuse axonal injury, are found most commonly in:
A. The internal capsule
B. The corpus callosum
C. The subcortical white matter
D. The dentate nuclei of the cerebellum
*15. Petechiae, in diffuse axonal injury, are most commonly found in which of the following?
A. The inferior frontal lobes
B. The caudate nuclei
C. The basis pontis
D. The dorsolateral brainstem
*16. The Bielschowsky stain shows axonal swellings in:
A. 2 to 3 hours
B. 8 hours
C. 15 hours
D. 24 hours
*17. The brain of a 62 year old former professional boxer who has dementia and Parkinsonian manifestations shows:
A. Neurofibrillary tangles
B. Alzheimer plaques
C. Both
D. Neither (dementia results from multiple traumatic frontal lobe lesions)
18. A patient with a glioblastoma multiforme in the right frontoparietal area develops right hemiparesis and a fixed dilated right pupil. The cause of these neurological findings is:
A. Extension of the tumor across the corpus callosum to the lefthemisphere
B. Extension of the tumor to the brainstem
C. Right temporal lobe herniation
D. Cerebellar tonsillar herniation

20. The pathology in the section across the midbrain shown below is the result of:
uncal herniation

A. A 2 day old right MCA infarct
B. A left subdural hematoma
C. A right hemisphere GBM
D. An intrinsic midbrain glioma
21. The pathological lesions shown below are the result of: Secondary brainstem hemorrhages
A. Diffuse axonal injury
B. Anticoagulant treatment
C. Arteriovenous malformation
D. Hypertension
E. Increased intracranial pressure
22. The lesions in this 7 month old baby girl shown below are most likely caused by: Shaken baby syndrome
A. Coagulopathy
B. Resuscitation
C. Chest trauma
D. Traumatic brain injury
E. All of the above
*23. The most likely mechanism for the lesions shown below is: Gliding contusions
A. Embolus from bacterial endocarditis
B. Anticoagulant therapy
C. Auto accident
D. A fall to the back
24. The brain lesions in the 57 year old man shown below are most likely due to: Herpes simplex encephalitis
A. A fall to the back
B. A viral encephalitis
C. A posterior cerebral artery embolic infarct
D. Thrombotic thrombocytopenic purpura
25. The lesions illustrated below are most likely to occur as a result of: Contre coup contusions
A. An auto accident
B. The shaken baby syndrome
C. A fall to the back
D. A long boxing career
*26. This image below shows:
Subdural hematoma
A. An epidural hematoma
B. A subdural hematoma
C. Both
D. Neither