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PRM Board Exam > Acquired Brain Injury > Flashcards

Acquired Brain Injury Flashcards

1
Q

What age group in children has the highest incidence of TBI

A

Less than 5 years old

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2
Q

What age group in children has the highest rate of TBI requiring hospitalization?

A

15 years and older

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3
Q

What is the leading cause of TBI requiring hospitalization in children less than 10 years old?

A

Falls

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4
Q

What is the leading cause of TBI requiring hospitalization in children older than 10 years old?

A

Motor vehicle accidents

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5
Q

What is the most common CT finding in children with moderate to severe TBI?

A

Contusion

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6
Q

What brain imaging finding is more common in children with abusive head trauma?

A

Subdural hematoma

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7
Q

What mechanism is consistent with a hemispheric hypodensity on head CT?

A

Abusive head trauma

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8
Q

What is the most common cause of cardiac arrest in children?

A

Respiratory arrest

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9
Q

What is the most common etiology for childhood arterial ischemic stroke?

A

Arteriopathy

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10
Q

What vessels does focal cerebral arteriopathy most commonly affect? (3 segments)

A

Terminal internal carotid, Proximal ACA, Proximal MCA

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11
Q

What risk factor puts a child at increased risk for hemorrhagic conversion of ischemic stroke?

A

Underlying cardiac disease

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12
Q

By what mechanism does cerebral venous thrombosis lead to brain injury?

A

Backpressure causing venous hypertension, edema, and possible hemorrhage

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13
Q

What are the most common vascular malformations in children with hemorrhagic stroke?

A

Arteriovenous malformations (AVMs)

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14
Q

What should be suspected in a child who experience trauma and whose neurological examination is not explained by head CT?

A

Blunt cerebrovascular injury

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15
Q

What are three craniofacial anomalies required for the diagnosis of fetal alcohols syndrome?

A

Flattened philtrum, thin upper lip, railroad-track ears

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16
Q

What brain imaging findings are seen in fetal alcohol syndrome? (3)

A

Corpus callosum a genesis, small/atypical white matter, small grey matter

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17
Q

What is the ICP target in TBI?

A

Less than 20mmHg

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18
Q

What is the most important treatment for moyamoya?

A

Surgical revascularization

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19
Q

In addition to arterial ischemic stroke, what brain abnormality are children with congenital heart disease at risk for?

A

White matter injury

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20
Q

What is the definitive treatment for arteriovenous malformations?

A

Surgical excision

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21
Q

Besides surgical excision, what other treatment has good outcomes for AVMs?

A

Radiation therapy

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22
Q

What may be suspected in a child with new onset of seizures in the setting of a sinus infection?

A

Intracranial abscesss

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23
Q

What is the most common vision impairment in children after TBI?

A

Decreased visual acuity

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24
Q

What is the treatment for vision deficits related to TBI?

A

Teaching compensatory strategies (scanning etc.)

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25
Q

What type of hearing loss is more common in children with temporal bone fracture?

A

Conductive

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26
Q

What is the prognosis for conductive hearing loss in the setting of temporal bone fracture?

A

Good, hearing often improves with time as fluids in the middle air space resolve.

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27
Q

Referrals to what specialties should be made for a child with a temporal bone fracture?

A

ENT, Audiology

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28
Q

What should be suspected in a child with impaired language acquisition after TBI?

A

hearing loss

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29
Q

Why is referral for cochlear implantation time-sensitive in children with bacterial meningitis induced sensorineural hearing loss?

A

Infection-related labyrinthine ossification can prevent electrode implantation

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30
Q

What should be suspected with a change in eating habits after acquired brain injury?

A

Anosmia

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31
Q

What class of medications can cause obstructive olfactory dysfunction?

A

Anticholinergics

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32
Q

What are the two main causes of acquired ventriculomegaly?

A

Hydrocephalus and ex vacuo ventricular dilation

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33
Q

What type of acquired ventriculomegaly usually requires intervention?

A

Hydrocephalus

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34
Q

What are typical imaging findings in ex vacuo ventricular dialation?

A

Diffuse cerebral atrophy and sulcal prominence

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35
Q

What type of hydrocephalus typically shows enlargement of all ventricles?

A

Communicating

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36
Q

Which area is typically first to expand in communicating hydrocephalus?

A

Temporal horns of the lateral ventricles

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37
Q

What are signs of hydrocephalus in individuals with severe brain injury? (4)

A

Emesis, failure to progress as expected/decline, PSH, unexplained spasticity

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38
Q

What is the definition for early seizures after TBI?

A

After 24 hrs but within 7 days

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39
Q

What are 5 risk factors for post traumatic epilepsy in children after traumatic brain injury?

A

Young age, early seizures, severe TBI, penetrating injury, hemorrhage

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40
Q

What is one risk factor for development of epilepsy in children with arterial ischemic stroke?

A

Early seizures

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41
Q

For at least how long should patients have seizure prophylaxis after TBI?

A

7 days

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42
Q

What are signs of PSH? (6)

A

Diaphoresis, posturing, tachycardia, tachypenea, hypertension, hyperthermia

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43
Q

What type of brain injury more commonly is associated with PSH?

A

Anoxic

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44
Q

What are two outcomes associated with PSH in the setting of anoxic brain injury?

A

Worse functional outcomes, prolonged hospitalization

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45
Q

What are two life-threatening conditions that may mimic PSH?

A

Infection, pulmonary embolism

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46
Q

What conditions can trigger PSH? (6)

A

Full bladder, constipation, fracture, skin breakdown, renal/bladder stones, cholelithiasis

47
Q

What is one of the most common endorcrinologic finding associated with pediatric TBI?

A

Growth hormone deficiency

48
Q

What is the prognosis for endocrine abnormalities after pediatric TBI?

A

Many resolve by 1 year post injury

49
Q

What may be suspected in a child with fatigue, cognitive changes, and mood changes after TBI?

A

Growth hormone deficiency

50
Q

Why are children with acquired brain injury at risk for early pubertal development?

A

Brain injury can interfere with normal inhibition of gonadotropin release

51
Q

What condition after TBI presents with decreased ADH?

A

DI

52
Q

How can one distinguish between CSW and SIADH?

A

In CSW, patients are hypovolemic whereas in SIADH patients are isovolemic

53
Q

When should a child with a severe TBI be assessed for a endocrine dysfunction?

A

At one year as abnormalities found then are more likely to be permanent

54
Q

What presents with joint pain, warmth, swelling, and decreased range of motion in a TBI patient?

A

HO

55
Q

What is the most frequent site for HO in the child and adult TBI patient?

A

Hip

56
Q

What is the standard for diagnosis of HO?

A

Triple phase bone scan

57
Q

What are three factors associated with development of HO in children with acquired brain injury?

A

longer duration of DOC, older age (over 11 yo), long bone or multiple extremity fractures

58
Q

Within what time frame is establishing enteral feeding in TBI recommended?

A

72 hours

59
Q

What are risks of nasogastric feeding tubes?

A

Displacement into airway, blockage, esophageal/nasopharyngeal irritation

60
Q

What is recommended maintenance therapy for constipation in brain injury?

A

Polyethylene glycol (PEG)

61
Q

What is the typical cause of urinary incontinence in brain injury?

A

Disinhibited/overactive bladder

62
Q

What is a common treatment for bladder incontinence in TBI?

A

Timed voiding

63
Q

What type of pediatric patient is most at risk for VTE?

A

Postpubertal, congenital heart disease (single ventricle in particular), post-surgery, CVC in place

64
Q

What is gold standard for diagnosis for pulmonary embolism?

A

CT pulmonary angiography (CTPA)

65
Q

For how long is VTE prophylaxis usually continued in a non-ambulatory brain injury patient?

A

3 months

66
Q

Which outcome measure is associated with worse outcomes after pediatric TBI?

A

Time to follow commands greater than 26 days

67
Q

What imaging finding in children with cardiac arrest places a child at high risk for a poor outcome?

A

Restricted diffusion on DWI in the first two weeks

68
Q

General step-wise approach to treating DOC patients?

A

1) Wean sedating medications
2) Optimize sleep: melatonin, trazodone
3) Evaluate and optimize hearing and vision
4) Await stabilization of medical issues
5) Consider neurostimulant trial

69
Q

What differentiates unresponsive wakefulness from a coma?

A

Sleep-wake cycles

70
Q

Denotes minimally conscious minus state?

A

Visual fixation, localization of noxious stimuli

71
Q

Denotes minimally conscious plus state?

A

Command following, yes/no response

72
Q

Denotes emergence to a conscious state?

A

Functional object use or functional communication

73
Q

What are two factors associated with better outcomes in children with acquired brain injury?

A

Higher level of function on admission/discharge from IPR, traumatic etiology

74
Q

What are two of the most common behavioral/emotional disorders in children after TBI?

A

ADHD, anxiety

75
Q

What academic discipline has been shown to be most affected after TBI?

A

Math

76
Q

What are three categories for factors related to increased risk for neurobehaviorial difficulties after TBI?

A

Preinjury, injury-related, family

77
Q

Injury related factors for poor cognitive and behavioral outcomes?

A

More severe injury (GCS score), more extensive damage on imaging, length of PTA

78
Q

How is age related to development of neurobehavioral impairments in the setting of TBI?

A

Those younger than 2 have more impairment than those over 7

79
Q

Are preinjury family factors related to cognitive outcomes in anoxic brain injury?

A

No

80
Q

What are the cognitive findings with ACA stroke?

A

Impaired judgement, flat affect

81
Q

What are the cognitive outcomes with dominant MCA stroke?

A

Aphasia

82
Q

What is the cognitive outcome with PCA strokes?

A

Alexia without agraphia

83
Q

What types of children with pediatric brain injury are likely to respond to family based problems-solving?

A

Older, with lower IQ and with lower socioeconomic status

84
Q

What is the mechanism for stimulant medications managing attention?

A

Increasing dopamine and/or norepinephrine in the frontal cortex

85
Q

What medication has been shown to help adolescents with severe TBI with memory?

A

Donepezil

86
Q

What is the mechanism of amantadine for arousal?

A

Dopamine agonist, NMDA antagonist

87
Q

What are the typical side effects for dopamine agonists?

A

Nausea, vomiting

88
Q

What are three dopamine agonists used for arousal in TBI?

A

Amantadine, bromocriptine, carbidopa/levodopa

89
Q

What is the mechanism of action of modafinil?

A

Inhibits dopamine reuptake

90
Q

What is the mechanism of valproic acid for treating agitation?

A

GABA agonist

91
Q

What is the mechanism of methylphenidate?

A

Dopamine and norepinephrine agonist

92
Q

What is the mechanism of action for donepezil?

A

Inactivates acetylcholinesterase

93
Q

What is the mechanism of action of donepezil?

A

Inactivates acethylcholinesterase

94
Q

What class of medication is duloxetine?

A

SNRI

95
Q

What class of medication is escitalopram?

A

SSRI

96
Q

What is the mechanism of action of trazodone?

A

Histamine and alpha-adrenergic receptor antagonist. At higher doses it inhibits serotonin reuptake

97
Q

What motor impairment is seen with ACA stroke?

A

Hemiparesis with the leg more affected than the arm

98
Q

What motor impairment is seen with stroke of the superior division of the MCA?

A

Hemiparesis with the arm and face more involved than the leg

99
Q

Are there consensus guideline for return to sport after severe TBI?

A

No

100
Q

What is the leading cause of death in children over 1 year old?

A

traumatic brain injury

101
Q

Is the presence of skull fractures generally indicative of the severity of pediatric TBI?

A

No

102
Q

GCS consistent with a moderate brain injury

A

9-12

103
Q

GCS - eye scale (4)

A

spontaneous, to speech, to pain, none

104
Q

GCS - verbal scale (5)

A

appropriate, confused, inappropriate, incomprehensible, none

105
Q

GCS - movement (6)

A

follows commands, localize to pain, withdraw to pain, flexion to pain, extension to pain, no response

106
Q

Length of PTA consistent with a moderate brain injury?

A

1-24 hours

107
Q

Duration of unconsciousness consistent with a moderate brain injury?

A

15 min to 24 hours

108
Q

What contributes most to disability in TBI?

A

cognitive/communication deficits

109
Q

Why is use of etidronate contraindicated in growing children?

A

can cause rachitic syndrome

110
Q

What are 4 lab values that can be elevated in HO?

A

alk phos, GGT, creatine phosphokinase, and ESR

111
Q

For a unilateral oropharyngeal dysphagia, which direction should one turn the head when swallowing?

A

Towards the WEAK side

112
Q

For unilateral oropharyngeal dysphagia, which way should one tilt the head when swallowing?

A

Towards the STRONG side (and maybe forward)

113
Q

DOC medications to avoid with feeding intolerance?

A

amantadine, levodopa-carbidopa

PRM Board Exam (17 decks)

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