Final Review Flashcards
1
Q
True or False
Severity of the original concussion or brain injury appears to be strongly associated with post concussion syndrome.
A
False
2
Q
True or False
With postconcussion syndrome, there is no correlation between the severity of the initial concussion and the increased likelihood of having this syndrome.
A
True
3
Q
True or False
“Baselining” refers to the process of evaluating an athlete before playing and then using that information later for comparison when a concussion is suspected during competition.
A
True
4
Q
True or False
“Baselining” refers to the process of evaluating an athlete immediately after sustaining a suspected concussion and using that information during the period after the injury to measure the athlete’s level of improvement.
A
False
5
Q
What are some symptoms of post concussion syndrome?
A
- Headaches
- Dizziness
- Fatigue
- Insomnia
- Irritability
- Personality changes
- Memory difficulties
- Problems concentrating
6
Q
Post concussion syndrome lasts for ___ after the injury.
A
weeks and/or months
7
Q
What are five risk factors for post concussion syndrome?
A
- Prior concussions
- Younger age
- Females > males
- History of cognitive dysfunction
- Pre-existing affective disorders such as anxiety and depression
8
Q
What is a subconcussion?
A
Cranial impact that does not result in a known diagnosed concussion on clincal grounds
9
Q
Subconcussion can occur with impact to the head or ___
A
rapid acceleration-deceleration to the body or torso
10
Q
In which circumstance does subconcussion have the greatest effect?
A
Repetitive occurrences; cumulative exposure becomes deleterious
11
Q
What is the term for the often fatal, malignant, and uncontrollable increase in intracranial pressure caused by diffuse cerebral edema after a head impact sustained before complete recovery from a previous head trauma?
A
Second impact syndrome
12
Q
In second impact syndrome, what causes the uncontrollable increase in intracranial pressure?
A
Diffuse cerebral edema
13
Q
Second impact syndrome results from even a mild concussion that occurs ___ after the intitial concussion.
A
day or weeks
14
Q
What sorts of injuries can lead to second impact syndrome in someone with a concussion that has yet to fully heal?
A
Relatively minor impact, maybe only a blow to the chest or torso that impart forces to the brain
15
Q
What are some symptoms/consequences of second impact syndrome?
A
- Usually NO LOC
- May collapse after impact
- Dilated pupils
- Loss of eye movement
- Progresses to unconscious state
- Repiratory distress/failure
- Death
16
Q
What is the current theory of the pathophysiology of second impact syndrome?
A
- Second hit within vulnerable window
- Brain loses ability to autoregulate cerebral vasculature
- Dysfunction in maintenance of cerebral perfusion pressures and normal intracranial pressure
- Significant brain swelling may lead to brain herniation
17
Q
severe head injury
What is the most common traumatic intracranial mass lesion?
A
Subdural hematoma
18
Q
severe head injury
What is a subdural hematoma?
A
Accumulation of blood beneath the dura
19
Q
When, after a severe head injury, will a subdural hematoma manifest?
A
48-72 hours post injury
20
Q
neuroradiology
What is the value of a plain film x-ray in imaging a patient with a traumatic brain injury?
A
Least reliable study; rarely used
21
Q
neuroradiology
What is the best choice for advanced imaging in a patient with a recent traumatic head injury?
A
CT scan without contrast
contrast medium may make interpretation more difficult
22
Q
neuroradiology
What is diffusion tensor imaging able to detect?
When is it used?
A
Able to detect signs of axonal injury
Often used in research, carries promise for diagnosing concussions
23
Q
neuroradiology
What is the reliable routine imaging finding for a concussion/traumatic brain injury?
A
None
24
Q
What are three things that football helmets can do to protect the head from injury?
A
- Prevent skull fractures
- Decrease catastrophic head injuries
- Limit incidence of brain contusion
25
What are two things that football helmets **cannot** do to protect the head from injury?
* Prevent violent movement of the head
* Mitigate slosh effect of the brain during impact
26
# True or False
It's theorized that mouthguards in football players can reduce risk of concussion.
True
27
How do mouthguards help to reduce risk of concussion in athletes?
Help absorb shock, stabilize the nead and neck, and limit movement caused by a direct hit to the jaw
28
___ of a mouthguard has been shown to be a factor that contributes to the level of protection
Thickness
29
Bighorn sheep ritually ram their heads into each other hundreds of times a day, mostly durin greproductive season, often sustaining collisions reaching 20-30 mph with no evidence of brain damage.
This is due to what effect?
Bubble wrap effect
| impacts are more linear and direct
## Footnote
Horns made of porous bone covered by elastic keratin provide give and distribute forces to lengthen duration of impacts
30
# bubble wrap effect
Rams have a mechanism whereby they can re-breathe some of their air and increase CO2 in their bloodstream.
What is the effect of this?
* Slows return of blood from the head to the body, increasing blood volume that fills their brain's vascular tree
* Increases intracranial fluid pressure
* Decreases the slosh effect
31
What are some recovery check points made before return-to-sport?
* Symptom resolution at rest
* Complete symptom resolution
* Return-to-learn
* Return-to-sport
32
What are some types of adjustments made for return-to-learn?
* Environmental adjustments
* Physical adjustments
* Curriculum adjustments
* Testing adjustments
33
Return to play decisions should always be made by ___
a concussion specialist
34
What is an athlete's ImPACT score if they have been cleared by a concussion specialist to return to play?
Back to baseline
## Footnote
final score is set as new baseline
35
# return to play
What is sandbagging?
Faking performance on baseline neurocognitive testing to make postconcussion test scores look better and improve chances of returning to play sooner
36
What are the six steps of exercise strategies in the return-to-sport protocol?
What are their goals?
1. **Symptom-limited activity** - gradual reintroduction
2. **Aerobic exercise** (light and moderate) - increase heart rate
3. **Individual sport-specific exercise** - add movement, change direction
4. **Non-contact training drills** - resume usual intensity of exercise, coordination, and increased thinking
5. **Full contact practice** - restore confidence and asses functional skills
6. **Return to sport**
37
What are the five steps of gradual return to play protocol?
1. No activity
2. Light aerobic exercise
3. Sport specific exercise
4. Non-contact training drills
5. Full contact practice
38
# CTE
What is executive function?
* Self-regulation skills
* Mental skills that help get things done e.g. managing time, being organized, focusing, paying attention
* Mostly frontal lobe function
39
What is CTE?
Progressive neurodegenerative disease characterized by abnormal depositions of tau proteins in neurons
40
What can cause CTE?
Single or repetitive blunt force impact to the head and/or body with the transfer of acceleration-deceleration forces to the brain
41
Which of the following is **not** associated with CTE?
* Personality changes with aggressive tendencies
* Problems with "executive skills/function"
* Changes in appetite with associated weight loss
* Memory loss/dementia
Changes in appetite with associated weight loss
42
The following are all symptoms of which head injury?
* Personality/mood changes
* Poor impulse control
* Aggression
* Cognitive impairment
* Memory loss/dementia
* Altered neuromuscular coordination
* Anxiety
* Depression
* Suicidal tendencies
* Death
CTE
43
What are some symptoms of CTE?
* Personality/mood changes
* Poor impulse control
* Aggression
* Cognitive impairment
* Memory loss/dementia
* Altered neuromuscular coordination
* Anxiety
* Depression
* Suicidal tendencies
* Death
44
How might the first stage of CTE present?
* Headaches
* Loss of attention and concentration
* Some show signs of short-term memory problems, early depression, aggression, and executive function issues
45
According to the CDC, what is the method of injury for a concussion?
"a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth"
46
According to the CDC, how does the brain moving rapidly back and forth hypothetically lead to concussion?
The brain bounces around or twists in the skull, stretching and damaging the brain cells and creating chemical changes in the brain
| slosh effect
47
Diffuse axonal injury by shearing leads to the initiation of ___
**neurometabolic cascade**
## Footnote
breakdown in communication between the neurons
48
#neurometabolic cascade
What events precede the energy crisis?
* Axonal shearing
* K+ outflow
* Release of neurotransmitters, EAA (glutamate)
* Influx of Ca++
49
#neurometabolic cascade
What events follow the energy crisis?
* Decreased cerebral blood flow
* Mitochondrial dysfunction and apoptosis
* 7-10 days symptoms return to normal
* Metabolic changes last longer than symptoms appear
50
# True or False
The risk for second impact syndrome is usually greater in the younger athlete because their overall physiological susceptibility to traumatic brain injuries is greater due to their age.
True
51
Which of the following statements regarding CTE is **true**?
* Most patients don't exhibit any significant personality changes
* Patients develop increasing problems with executive function skills
* One of the first signs of CTE is a significant change in appetitie with associated weight loss
* Patients begin to exhibit a more docile affect with decreasing aggressive behavior
Patients develop increasing problems with executive function skills
52
After diagnosing an athlete with a concussion, what is something you should **not** do?
Leave the athlete alone
53
# True or False
The reason second impact syndrome is a more significant diagnosis than a routine concussion is because the mortality rate for SIS is around 50%.
True
54
Which of the following is **not** a modifer that may predict potential lengthening of concussion recovery time?
* Concussion history
* Diet
* History of migraine or mental health issues
* Age
Diet
55
Of the following diagnoses, which one is **least likely** to yield a positive finding on an MRI or CT scan?
* Post concussion syndrome
* Epidural hematoma
* Depressed skull fracture
* Second impact syndrome
Post concussion syndrome
56
Which condition may be caused by a concussive blow that occurs after sustaining a diagnosed concussion that has not healed properly resulting in severe brain edema and swelling?
Second impact syndrome
57
# True or False
Football helmets help in reducing fractures and catastrophic head injuries but are limited in preventing concussions.
True
58
Which of the following statements is **false** about the use of equipment in reducing concussion risk?
* The use of a custom made, properly fitted mouthpiece in football may reduce the risk of concussion as compared to using an "off the shelf" mouthpiece
* In contact sports, the use of a helmet is the most significant measure an athlete can take to reduce their risk for concussion
* The use of a helmet with a full faceguard along with a custom mouthpiece can reduce concussion risk in ice hockey
* Using a football helmet with the most up to date and advance features may help to mitigate concussion risk
In contact sports, the use of a helmet is the most significant measure an athlete can take to reduce their risk for concussion
59
What is the name of the phenomenon whereby increased intracranial blood volume can reduce the risk of concussion?
Bubble wrap effect
60
Which of the following is **true** regarding chronic traumatic encephalopathy (CTE)?
* It has a short latency with symptoms arising only a few years after a major concussion
* It is characterized solely on the basis of Alzheimer-like memory loss
* It is a pathology that involves disruption of tau proteins in brain neurons
* It can be diagnosed fairly early and is treatable
It is a pathology that involves disruption of tau proteins in brain neurons
61
# True or False
A patient's level of CTE can be graded along a spectrum of 3 stages, each reflecting a different contellation of signs and symptoms.
False
62
What is the imaging method that is most reliable for routine concussions?
There are no reliable imaging findings for a concussion
63
What is the most serious sequela in second impact syndrome?
Tentorial or tonsillar herniation
64
Which of the following is true regarding postconcussion syndrome?
* Personality changes, mood swings, and memory difficulties all may last for several weeks
* While some symptoms of concussion remain in postconcussion, the athlete returns to baseline
* Symptoms of postconcussion occur after 72 hours and persist until the end of the first week
* All of the above
Personality changes, mood swings, and memory difficulties all may last for several weeks
65
# return to play guidelines
___ are used from full rest to full contact practice with ___ intervals before an athlete can be returned to the field of competition.
**Graded and progressive protocols** are used from full rest to full contract practice with **24 hour** intervals...
66
What term best describes the condition caused by impacts that commonly occur in sports in which there are no visible signs or symptoms of neurological dysfunction, but underlying injury may be present and significantly exacerbated by repeated additional impacts?
Subconcussion
67
What condition is a progressive neurodegenerative disorder caused by repeated head injuries and presents clinically after a long latent period?
Chronic traumatic encephalopathy (CTE)
68
Which of the following is **not** a symptom of second impact syndrome?
* Dilated pupils
* Pupillary miosis
* Loss of consciousness
* Respiratory distress
Pupillary miosis
69
What are three symptoms of second impact syndrome?
* Dilated pupils
* Loss of consciousness
* Respiratory distress
70
# True or False
Custom fitted mouth guards have been shown to reduce concussion risk in football players.
True
71
# True or False
The use of extra oxygen and high energy caffeinated drinks in football is associated with a slight decrease in concussion risk.
False
72
Why is the CT scan a preferred imaging study when a serious complication is suspected after a patient sustains a head injury?
The procedure is quick and results can be obtained very fast
73
Evidence of diffuse axonal injury may be detected using which imaging study?
Diffusion tensor imaging
74
# True or False
When there is a high index of suspicion for a fracture of the face, skull, or cervical spine after a sports injury, the CT scan is the preferred advanced imaging study.
True
75
Once you get the athlete on the sidelines, what assessments would you perform for the athlete?
* Rule out serious cervical spine injury
* Perform SCAT 6
* Cranial nerve and neurological exam
* Monitor vitals
76
During a concussion assessment on the sideline, the athlete "fails" some of the testing. You diagnose them with a concussion.
What steps are you taking moving forward?
* Remove athlete from game
* Refer to concussion specialist
* Educate parents about signs/symptoms to look out for
