The Management of Posthemorrhagic Hydrocephalus

The Management of Posthemorrhagic Hydrocephalus
Order 5940397
The Management of Posthemorrhagic Hydrocephalus
1. An 8-month-old previously healthy child
presents with macrocephaly and delayed
milestones. MRI is shown below. Which
one of the following is his most likely ETV
success score?
a. 40
b. 50
c. 60
d. 70
e. 80
2. A preterm neonate is born at 28 weeks gestation with a birth weight of 1000 g. Cranial US
performed in the first 24 h of birth due to a
bulging fontanelle and episodes of apnoea
revealed Papile grade III germinal matrix
hemorrhage with hydrocephalus. Which
one of the following statements is most
accurate?
a. The majority of intraventricular hemorrhage in low birthweight preterm infants
is Grade III and IV
b. The proportion of infants with posthemorrhagic hydrocephalus who require
permanent shunt placement is lower in
preterm than term births
c. Sunset phenomenon consists of impaired
downgaze
d. Term infants usually present with spontaneous apnea or bradycardia in the first
24 h after IVH
e. The rate of intraventricular hemorrhage
in both term and preterm babies is 30%,
but the mean Papile grade is higher in
preterms
3. Which one of the following statements
regarding the management of posthemorrhagic hydrocephalus LEAST correct:
a. Ventriculosubgaleal shunts increase the
need for daily CSF aspiration compared
with ventricular access devices
b. The use of prophylactic serial lumbar
puncture is not recommended as it does
not reduce the need for shunt placement
or avoid the progression of hydrocephalus
in premature infants compared to
observation alone
c. Intraventricular thrombolytic agents are
not recommended as methods to reduce
the need for shunt placement in premature infants with PHH
d. Acetazolamide and furosemide are not
recommended as methods to reduce the
need for shunt placement in premature
infants with PHH
e. There is insufficient evidence to recommend a specific infant weight or CSF
parameter to direct the timing of shunt
placement in premature infants with PHH
f. There is insufficient evidence to recommend the use of endoscopic third ventriculostomy (ETV) in premature infants
with PHH
4. Which one of the following statements
regarding the treatment of CSF shunt infection is most accurate?
a. Evidence recommends shunt externalization over complete shunt removal as the
preferred surgical strategy in management of CSF shunt infection
b. Evidence recommends the combination
of intrathecal and systemic antibiotics
for patients with CSF shunt infection
when the infected shunt hardware cannot
be fully removed
c. Evidence recommends the combination
of intrathecal and systemic antibiotics
for patients with CSF shunt infection
when caused by gram-negative organisms
d. Evidence recommends supplementation
of antibiotic treatment with partial (externalization) or with complete shunt hardware removal
e. Evidence recommends the combination
of intrathecal and systemic antibiotics
for patients with CSF shunt infection
when the shunt must be removed and
immediately replaced
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