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Cognitive Communication Disorders > Cognitive Lecture 1 > Flashcards

Cognitive Lecture 1 Flashcards

1
Q

What is a sign?

A

What the examiner finds upon examination

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2
Q

What is a symptom?

A

What the patient reports

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3
Q

What does “sp” (s/p) mean?

A

Status post (sp appendectomy: seeing them after appendectomy)

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4
Q

What does SOA mean?

A

short of air

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5
Q

What is the definition of TBI?

A

an insult or injury to the brain, not of degenerative or congenital nature but is caused by an external force that may produce (has to result in) diminished or altered state of consciousness; if you’re dazed/nauseous, it’s still mild

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6
Q

mTBI

A

mild traumatic brain injury

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7
Q

How many brain injuries occur annually

A

1.5 to 1.9 million

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8
Q

TBIs are the #1 cause of death in…

A

children and young adults (there’s a lot of growing left to do–long-term effects)

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9
Q

Demographic variables that determine risk factors for TBI

A

Age, SES, ethnicity, gender, substance abuse, recurrent TBI

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10
Q

Myelin & neural connections are still forming until age ___

A

25

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11
Q

Age range of increased risk of TBI

A

15-24 years old

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12
Q

Gender at greater risk of TBI

A

males (2:1)

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13
Q

Race and TBI

A

too variable for determination in USA

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14
Q

High Alcohol & TBI

A

1 study found that 56% of TBI patients had this

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15
Q

Risk for recurrent TBI for second TBI (chance of having another if you’ve already had 1)

A

2.8-3.0 times more likely

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16
Q

Risk for recurrent TBI for third TBI (chance of having another if you’ve already had 2)

A

7.8-9.3 times more likely

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17
Q

Closed Head Injury (CHI)

A

Non-penetrating injury-no penetration to cranial vault; Blunt head trauma
Meninges remain intact; Skull may be fractured
Associated with diffuse injury; more common type of injury

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18
Q

Open Head Injury (OHI)

A

Penetrating injury-brain is exposed
Military more susceptible
Coverings of brain susceptible to tearing of the dura by skull fragments &/or other penetrating force
Associated with focal injury; more common in wartime

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19
Q

Overall most common cause of TBI

A

Falls

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20
Q

MVAs and TBIs

A

account for about 50% in ages 15-24 years old

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21
Q

Brain Injury in KY

A

Affects 1 in 5 households; rate is more than twice the national avg

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22
Q

How many ED visits are accounted for by BI

A

1/3

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23
Q

A child’s skull is _____ as strong as an adult’s

A

1/8

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24
Q

State with highest number of ATV fatalities

A

Kentucky

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25
Q

Leading cause of sports-related deaths

A

Brain injury

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26
Q

65% of all sports-related BI treated annually occurs in people between ages…

A

5 and 18 years

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27
Q

Activities associated with the greatest number of ED visits annually

A

bicycling, football, playground activities, basketball, horseback riding, & riding ATVs
Estimated that less than 13% of sports-related BI are seen in the ED

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28
Q

Concussion Rates

A

on the rise among high school athletes with females sustaining a greater number than males in sports played by both sexes

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29
Q

Primary Brain Damage

A

Damage that is complete at the time of impact
Skull fracture, contusion (bruise), hematoma (blood clot), laceration, nerve damage (DAI)
Part(s) of the brain damaged are greater than the size of the overall injury

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30
Q

DAI

A

diffuse axonal injury

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31
Q

Secondary Brain Damage

A

Things that develop after the initial traumatic event
Edema, increased ICP, infection, fever (febrile), anemia, epilepsy, hypo/ hyperthermia, abnormal blood coagulation, cardiac changes, pulmonary changes, nutritional changes, other results

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32
Q

Edema

A

swelling

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33
Q

ICP

A

intracranial pressure

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34
Q

Fever indicates…

A

infection (body is trying to fight it)

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35
Q

Anemia

A

iron deficiency

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36
Q

Hypo/hyperthermia

A

lose ability to regulate body temperature

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37
Q

ABC

A

abnormal blood coagulation: body either makes blood too thick or not thick enough (risk for stroke)

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38
Q

Classic Closed Head Injury

A

BI that occurs secondary to impact to the head causing deformation of the brain resulting in characteristic pathological changes
MVAs, assault, suicides, falling objects, & falls
Leading cause of death under age 45 years
Accounts for 25-33% of all deaths related to trauma
Coup/contra-coup

39
Q

Coup/contracoup injuries

A

brain acceleration vs. deceleration

40
Q

Penetrating Head Injury

A

Less common than CHI
Occurs secondary to penetration of an object like a: bullet, knife, bolt, shrapnel, nails, teeth, screwdriver, etc.
Often described as: depressed, penetrating, perforating
Mortality rate appears lower for AP (anterior-posterior) wounds (25%) than lateral wounds (83%)

41
Q

Depressed Penetrating Head Injury

A

Object doesn’t enter cranial vault but causes a depressed fracture & cortical contusions

42
Q

Penetrating-type head injury

A

Object enters the cranial cavity but doesn’t pass through to the other side

43
Q

Perforating-type head injury

A

Object traverses the cranial cavity & exits through a wound characteristically larger than the entry wound

44
Q

Because of the recent wars, the US is now treating…

A

more TBIs than chest or abdominal wounds

45
Q

Combat forces at risk for TBI

A

as many as 1/3

46
Q

Ratio of Wounded to fatalities between Iraq/Afghanistan & Vietnam

A

Iraq/Afghanistan: 16:1

Vietnam: 2.6:1

47
Q

TBI and PTSD

A

separate but are co-related

48
Q

Blast Injury

A

Explosion resulting in over-pressurization related trauma

49
Q

Blast-induced BI is most frequently associated with

A

high-power explosives

50
Q

Four (+) basic mechanisms of blast injury:

A

primary, secondary, tertiary, quaternary (quinary & psychological trauma (PTSD)

51
Q

Primary Blast Injury

A

occurs secondary to over-pressurization impulse created by a detonated high- explosive usually impacting auditory, GI, &/or pulmonary systems (rupture of TM, abdominal cavity)

52
Q

Secondary Blast Injury

A

Injuries that occur secondary to flying objects (rocks, shrapnel)

53
Q

Tertiary Blast Injury

A

Injury sustained due to person becoming airborne (picked up by pressure wave)

54
Q

Quaternary Blast Injury

A

References burns & crushing injuries from falling objects

55
Q

Quinary Blast Injury

A

chemical, biological, &/or radiological exposure

56
Q

Explosives

A

classified as either high-order or low-order

57
Q

High-order Explosives (HE)

A

dynamite, ammonium nitrate

58
Q

Low-order Explosives (LE)

A

result in shrapnel-like injuries

59
Q

Improvised Explosive Device (IED)

A

Contain both HE, LE

60
Q

Concussion

A

Injury to the brain that is loosely defined as a “jarring” of the brain; at the least are said to have a mTBI
Most common type of TBI
Frequently occurs secondary to violent shaking, direct blow to head, whiplash

61
Q

Grade 1 Concussion

A

no LOC; PTA less than 30 minutes

62
Q

Grade 2 Concussion

A

LOC less than 5 minutes; PTA between 30 minutes & less than 24 hours

63
Q

Grade 3 Concussion

A

LOC greater than 5 minutes; PTA greater than 24 hours

64
Q

PTA

A

post-traumatic amnesia

65
Q

Pyramidal System

A

responsible for volitional motor control; direct activation pathways

66
Q

Extrapyramidal System

A

Responsible for modulating & regulating motor movements; indirect activation pathways

67
Q

Cerebellum

A

Does not initiate movement, rather it works in tandem with the EPS to maintain balance/posture & coordination of motor movements; includes motor learning

68
Q

Dementia Pugilistica

A

aka punch-drunk syndrome or chronic traumatic encephalopathy
Occurs secondary to repeated concussive blows to the head
Can only be diagnosed in autopsy
Common in football players too

69
Q

Dementia Pugilistica & Boxing

A

Estimated that 10-25% of boxers ultimately develop post-boxing neurological syndrome characterized by cerebral atrophy, cellular loss in the cerebellum, & increased cortical & subcortical neurofibrillary tangles
S/s may begin to appear 12-16y post initiation of career
Occurs in professionals & amateurs

70
Q

Stages of Dementia Pugilistica

A

3 stages

71
Q

Stage 1 of Dementia Pugilistica

A

affective disorder, mild incoordination

72
Q

Stage 2 of Dementia Pugilistica

A

aphasia, apraxia, agnosia, apathy, flat affect, neuro s/s

73
Q

Stage 3 of Dementia Pugilistica

A

global cognitive decline & parkinsonism

74
Q

Second Impact Syndrome

A

Occurs when a second TBI occurs prior to initial TBI completing the healing process
Most likely to cause edema & diffuse damage
LOC doesn’t have to be present

75
Q

Long-term implications of Second Impact Syndrome

A

Increased muscle tone (spasticity), rapidly changing emotions (emotional lability), muscle spasms, hallucinations, difficulty thinking & learning

76
Q

TBI in Infancy & Childhood

A

Projected mean of incidence of TBI in children younger than 15y is ~180 per 100K
Fracture of the skull is present in around 20-40% of cases

77
Q

Abusive Head Trauma

A

Accounts for 25% of hospital admits in children less than 2yo
AKA shaken baby syndrome, non-accidental trauma, child maltreatment, child abuse
Subdural hemorrhage (SDH) is most common intracranial injury as a result
May lack communication skills to report headaches, sensory problems, communication, &/or similar symptoms

78
Q

Symptoms manifested by Children with TBI

A

refusal to eat, appear listless & cranky, altered sleep pattern, changes in school performance, loss of interest in preferred activities

79
Q

Abusive Head Trauma Statistics

A

SBS is the leading cause of child abuse deaths in USA (KY is #1);
Babies (newborn-4mos) are at greatest risk
Inconsolable crying is #1 trigger
1 in 4 shaken babies will die
Rare that a single instance of noted injury present in ED is 1st occurrence; usually a chronic history of abuse; (usually mom’s boyfriend is perpetrator)

80
Q

Possible Abusive Head Trauma s/s & results:

A

Glassy eyes, fixed pupil, fixed stare; seizures; lethargy & irritability; somnolence/ inactivity; respiratory problems; vomiting; choking; inability to lift head &/or turn to side; retinal hemorrhage; rigidity; decreased appetite; bluish color

81
Q

Diffuse Axonal Injury

A

References the neuropathological changes that occur at the axonal level following trauma
Damage results from twisting, tearing, &/or shearing of axon
If tear enough, will see s/s
Has to occur in greater clumps to diagnose

82
Q

Cerebral Edema

A

Brain swelling frequently follows trauma; appears to be more of a secondary injury than a primary injury; focal more common in adults whereas diffuse more common in pediatrics; results in increased cranial pressure (ICP)

83
Q

Intracranial Pressure (ICP)

A

should be less than 20mmHg (millimeter Mercury); when exceeded, neurosurgical intervention is necessary

84
Q

3 Mechanisms for Measuring ICP:

A

EVD, screw/bolt, epidural sensor

85
Q

EVD

A

extraventricular drain (or intraventricular catheter); thin, flexible tube threaded into 1 of 2 lateral ventricles

86
Q

Screw/Bolt (subarachnoid)

A

placed into the space between arachnoid membrane & cortex

87
Q

Epidural Sensor

A

sensor placed in the epidural space below skull

88
Q

Fontanelle

A

Allow for greater amount of cerebral edema; allow skull to separate & expand

89
Q

Bulging Fontanelle

A

Increased CSF, brain swelling, etc. along with other symptoms

90
Q

Craniocynestosis

A

as fontanelles grow together, sometimes they grow together weird

91
Q

Monroe-Kellie Hypothesis

A

states the cranial compartment is incompressible; Skull, CSF, & brain tissue create a volume equilibrium such that any increase in volume of 1 of the cranial constituents must be compensated by a decrease in volume of another

92
Q

Brain shift & herniation

A

if hematoma continues to enlarge or focal edema of adjacent brain tissue increases, brain may be shifted away from growing mass, & structures that normally lie in midline may be displaced; tumor is violation of Monroe-Kellie Hypothesis

93
Q

Cushing’s Triad

A

Significant sign of intracranial HTN

Precursor to herniation

94
Q

3 components of Cushing’s Triad

A

hypertension (HTN) (red face, etc.); bradycardia (slow rate; check pulse); respiratory irregularity (fast-slow; long-short, etc.)

Cognitive Communication Disorders (5 decks)

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