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C. Year 3: SBOM > Head Injury > Flashcards

Head Injury Flashcards

1
Q

A traumatic brain injury is any injury to the head. There are 2 types of traumatic head injury, open and closed. What is a closed head injury?

1 - damage to the head but no penetration of skull
2 - damage to the skull and membranes of skull and brain are compromised
3 - skull damaged leading to PTSD
4 - skull damaged and infection follows

A

1 - damage to the head but no penetration of skull

  • range form toddler bumping head to a severe car accident
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2
Q

A traumatic brain injury is any injury to the head. There are 2 types of traumatic head injury, open and closed. What is a open head injury?

1 - damage to the head but no penetration of skull
2 - damage to the skull and membranes of skull and brain are compromised
3 - skull damaged leading to PTSD
4 - skull damaged and infection follows

A

2 - damage to the skull and membranes of skull and brain are compromised

  • more common in the military settings
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3
Q

A traumatic brain injury is any injury to the head. There are 2 types of traumatic head injury, open and closed. Which one is more common?

A
  • closed
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4
Q

During a closed loop traumatic injury we can hurt our heads from the initial impact (coup) followed by the rebound to the back of the head (contrecoup). During the initial head trauma there are three things that are damaged in the brain, what are they?

1 - neuronal, vascular and/or hearing injury
2 - neuronal, cardiac and/or axonal injury
3 - neuronal, vascular and/or axonal injury
4 - vision, vascular and/or axonal injury

A

3 - neuronal, vascular and/or axonal injury

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5
Q

During a closed loop traumatic injury we can hurt our heads from the initial impact (coup) followed by the rebound to the back of the head (contrecoup). During the initial head trauma there may be injury to neuronal, vascular and/or axons. What generally follows this?

1 - metabolic and inflammatory process (oedema)
2 - metabolic and cardiac changes
3 - vision and cardiac changes
4 - inflammatory process and blood clot formation

A

1 - metabolic and inflammatory process (oedema)

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6
Q

During a closed loop traumatic injury we can hurt our heads from the initial impact (coup) followed by the rebound to the back of the head (contrecoup). During the initial head trauma there may be injury to neuronal, vascular and/or axons, followed by metabolic and inflammatory process (oedema). What does this then cause in the CSF?

1 - increased amounts
2 - decreased amounts
3 - impaired regulation in CSF flow
4 - blocked CSF flow

A

3 - impaired regulation in CSF flow

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7
Q

Following a traumatic brain injury we can damage the brain which can lead to hypo-perfusion. Which of the following does NOT occur due to the hypo-perfusion?

1 - insufficient oxygen
2 - anaerobic glycolysis
3 - aerobic glycolysis
4 - build up of lactic acid

A

3 - aerobic glycolysis

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8
Q

Following a traumatic brain injury we can damage the brain which can lead to cytotoxic & inflammatory processes, altered cerebral microcirculation and hypoperfusion and failure to deliver vital metabolites. Does this lead to a decrease or increase in excitatory neurotransmitters?

A
  • increase excitatory neurotransmitters
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9
Q

NMDA receptors are now understood to critically regulate a physiologic substrate for memory function in the brain. Following a traumatic brain injury we can damage the brain which can lead to cytotoxic & inflammatory processes, altered cerebral microcirculation and hypoperfusion and failure to deliver vital metabolites. Are the NMDA levels and pathways affected?

A
  • yes
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10
Q

Following a traumatic brain injury we can damage the brain which can lead to cytotoxic & inflammatory processes, altered cerebral microcirculation and hypoperfusion and failure to deliver vital metabolites. What happens to Ca2+ and Na+ levels and what does this lead to?

1 - both increase increasing neuronal excitation
2 - both increase leading to neuronal and axon destruction
3 - both decrease leading to neuronal and axon destruction
4 - both decrease increasing neuronal excitation

A

2 - both increase leading to neuronal and axon destruction

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11
Q

Following a traumatic brain injury we can damage the brain which can lead to cytotoxic & inflammatory processes, altered microcirculation and hypoperfusion and failure to deliver vital metabolites. This can lead to different types of oedema, vasogenic and cytotoxic oedema. What is vasogenic oedema?

1 - fluid collects inside brain stopping transport across blood brain barrier
2 - fluid collects in space between the brain and skull stopping transport across blood brain barrier
3 - fluid collects inside brain stopping increasing across blood brain barrier
4 - fluid collects extracellularly between the brain and skull increasing permeability of the blood brain barrier

A

4 - fluid collects extracellularly between the brain and skull increasing permeability of the blood brain barrier

  • vasogenic is characterised by fluid collecting extracellularly
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12
Q

Following a traumatic brain injury we can damage the brain which can lead to cytotoxic & inflammatory processes, altered cerebral microcirculation and hypoperfusion and failure to deliver vital metabolites. This can lead to different types of oedema, vasogenic and cytotoxic oedema. What is cytotoxic oedema?

1 - injured cells leak osmotic solutes that are taken up by other cells in the brain causing oedema
2 - injured cells absorb osmotic solutes that are released from healthy cells in the brain causing oedema
3 - blood brain barrier leaks allowing solutes into brain and causing oedema

A

1 - injured cells leak osmotic solutes that are taken up by other cells in the brain causing oedema

  • Na+ and Cl- move intracellularly and draw fluid into the cells, causing swelling
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13
Q

What is the most common cause of death and disability in those aged 1-40?

1 - stroke
2 - heart attack
3 - traumatic brain injury
4 - infection

A

3 - traumatic brain injury

  • 40% have a skull fracture
  • <1% arriving at ED die
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14
Q

How would we assess a patient with suspected brain trauma?

1 - Mini mental state examination
2 - Glasgow comma scale
3 - Addenbrooke’s Cognitive Examination
4 - Montreal Cognitive Assessment

A

2 - Glasgow comma scale

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15
Q

Which of the following is not a category of the GCS?

1 - verbal response
2 - eye opening
3 - reflex response
4 - motor response

A

3 - reflex response

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16
Q

The GCS has 3 sections: verbal response, eye opening and motor response. What is the range of the scores?

1 - 0-15
2 - 1-15
3 - 3-15
4 - 5-15

A

3 - 3-15

  • patients get a 1 for failure to complete a task
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17
Q

What is defined as a mild GCS score?

1 - >14
2 - >13
3 - >12
4 - >8

A

3 - >12

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18
Q

What is defined as a moderate GCS score?

1 - 12-14
2 - 10-13
3 - >10
4 - 9-12

A

4 - 9-12

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19
Q

What is defined as a severe GCS score?

1 - <12
2 - <10
3 - >8
4 - <8

A

4 - <8

  • patients are determined as unable to breathe independently
  • major fatality patients have moderate or severe GCS
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20
Q

Which of the following is NOT a common symptom of a traumatic brain injury?

1 - Headaches
2 - Dizziness
3 - Hypotension
4 - Nausea and vomiting
5 - Diplopia (double vision)
7 - Deafness
8 - Amnesia (antro and retrograde)

A

3 - Hypotension

21
Q

Which of the following is NOT a common sign of a traumatic brain injury?

1 - Bruises / lacerations / bleeding scalp, mouth, nose , ear
2 - Skull deformities
3 - sleepy, irritability altered consciousness
4 - disorientation
5 - psychosis
6 - seizures
7 - focal neurological signs eg hemiparesis
8 - IMPAIRED CONSCIOUSNESS – reduced wakefulness, not orientated (Time, Place and Person) Eyes can be open
9 - UNCONSCIOUS (=COMA) Absence of awareness of surroundings or self. GCS <8

A

5 - psychosis

22
Q

If a patient has had a suspected traumatic brain injury, there are indications set out by NICE indicating which patients need to be seen at a hospital for assessment. Which of the following is NOT an indication for assessment in a hospital?

1 - GCS < 15 on initial assessment
2 - loss of consciousness
3 - focal neurological deficit (hemiparesis)
4 - skull fracture / penetrating HI
5 - amnesia (before or after)
6 - vomiting
7 - loss of bowel function
8 - seizure
9 - previous brain injury
10 - high-energy head injury

A

7 - loss of bowel function

23
Q

If a patient has had a suspected traumatic brain injury, there are indications set out by NICE indicating which patients need to be seen at a hospital for assessment. Which of the following is NOT a risk factor and does not need assessment in a hospital?

1 - history of bleeding or clotting disorders
2 - current anti-coagulant therapy
3 - drug or alcohol intoxication
4 - professional is “worried”
5 - no-one at home
6 - hypertension
7 - Safeguarding issues

A

6 - hypertension

24
Q

If a patient attends ED with a suspected traumatic brain injury, they would need to be assessed. Place the assessments in the correct order?

1 - analgesics
2 - ABCDE
2 - GCS
4 - head scan

A

2 - ABCDE
2 - GCS
4 - head scan
1 - analgesics

25
Q

If a patient attends ED with a suspected traumatic brain injury, they would need to be assessed. A score of what on the GCS would make you get ITU involved?

1 - <15
2 - <13
3 - <10
4 - <8

A

4 - <8

26
Q

If a patient attends ED with a suspected traumatic brain injury, they would need to be assessed. If a patient is high risk, what should they be assessed to have as soon as possible?

1 - fluids
2 - head CT scan
3 - analgesics
4 - head X-ray

A

2 - head CT scan

  • history of bleeding or clotting disorders
  • current anti-coagulant therapy
27
Q

If a patient attends ED with a suspected traumatic brain injury, they would need to be assessed. If a patient is high risk they should receive a head CT scan. Which of the following is NOT an indication for a head CT scan?

1 - GCS < 13 on initial assessment
2 - GCS < 15 at 2 hours
3 - suspected open or depressed skull fracture
4 - basal skull fracture – haemotympanum, “panda” eyes,, CSF leak, Battle’s sign
5 - diplopia (double vision)
6 - Seizure
7 - Focal neurological sign
8 - > 1 episode vomiting

A

5 - diplopia (double vision)

28
Q

If a patient attends ED with a suspected traumatic brain injury, they would need to be assessed. If a patient is high risk they should receive a head CT scan. In addition to normal indications for a head CT, there are 4 main times when you would do a CT head scan regardless of how the patient appears. Which of the following is NOT 1 of these 4?

1 - > 65 years
2 - bleeding or clotting disorder
3 - dangerous mechanism injury
4 - > 30 minutes retrograde amnesia before HI
5 - blood loss

A

5 - blood loss

29
Q

If a patient with a GCS <8 who has is suspected of having a having a traumatic brain injury, where should they be transferred to ideally?

1 - ED
2 - neuroscience centre
3 - walk in centre
4 - fracture clinic

A

2 - neuroscience centre

  • patient may need burr holes to help relieve intracranial pressure
30
Q

Should steroids be given to a patient with a suspected traumatic brain injury?

A
  • no
31
Q

Which of the following can be given to a patient following a suspected traumatic brain injury if we suspect an increased intracranial pressure?

1 - steroids
2 - mannitol
3 - ramipril
4 - liraglutide

A

2 - mannitol

  • can also give hyperosmolar saline to draw solutes out of brain cells and fluid follows
  • usually affective for 1 hour
32
Q

Mannitol can be given to a patient following a suspected traumatic brain injury if we suspect an increased intracranial pressure. What is the mechanism of action of this drug in this setting?

1 - acts as analgesic increasing NMDA firing
2 - not absorbed by cell but draws fluid out of cells
3 - absorbed by cells and increases fluid absorption
4 - absorbed by cells and increases fluid release

A

2 - not absorbed by cell but draws fluid out of cells

  • reduces the pressure on the cells and shrinks brains
  • can also lower the size of RBCs
33
Q

If a patient is suspected of a traumatic brain injury with increased intracranial pressure, why can hyperventilation be useful?

1 - increases CO2 retention and vasodilates blood vessels in the brain
2 - decreases CO2 retention and vasodilates blood vessels in the brain
3 - decreases CO2 retention and vasoconstricts blood vessels in the brain
4 - increases CO2 retention and vasoconstricts blood vessels in the brain

A

3 - decreases CO2 retention and vasoconstricts blood vessels in the brain

  • vasoconstriction decreased cerebral blood flow, which reduces cerebral blood volume and, ultimately, decreases the patient’s ICP
34
Q

The tentorium is a reflex of the dural matter that separates the cerebellum and brainstem from the occipital lobes of the cerebrum. If a patient has a traumatic brain injury, this can cause tentorium herniation. What can then happen?

1 - cerebellum can protrude into the cerebrum
2 - increased ICP causes tentorium herniation and brain pushes down through the herniation
3 - increased ICP causes tentorium herniation and brain begins leading CSF

A

2 - increased ICP causes tentorium herniation and brain pushes down through the herniation

35
Q

What is a subdural haematoma?

1 - blood collects below the dura mater, and in the space between the dura and arachnoid mater
2 - blood collects in the ventricles of the brain
3 - blood collects between the cranium and the dura mater
4 - blood collects between the arachnoid mater and the pia mater

A

1 - blood collects below the dura mater, and in the space between the dura and arachnoid mater
- commonly caused by a venous bleed, typically the bridging veins

  • subdural = below dura matter
  • epidural = above dura matter
36
Q

What is a extradural (also known as an epidural) haematoma?

1 - blood collects below the dura mater, and in the space between the dura and arachnoid mater
2 - blood collects in the ventricles of the brain
3 - blood collects between the cranium and the dura mater
4 - blood collects between the arachnoid mater and the pia mater

A

3 - blood collects between the cranium and the dura mater

  • dura peels of the skull
  • epidural = looks like lemon on CT/MRI
  • subdural = looks like banana on CT/MRI
37
Q

In a extradural (also known as an epidural) haematoma, which blood vessel is likely to have ruptured?

1 - middle meningeal artery
2 - middle cerebral artery
3 - vertebral artery
4 - internal carotid artery

A

1 - middle meningeal artery

  • normally an arterial bleed
38
Q

Patients can present with a variety of symptoms if they have a subdural bleed. Which of the following is not commonly present?

1 - Headache
2 - Drowsiness
3 - Confusion
4 - Seizure
5 - Focal neurological signs
6 - Personality change

A

4 - Seizure

39
Q

Do subdural haemorrhage always present acutely?

A
  • no typically present later, but can also be acute
  • treatment is typically conservative
40
Q

Which one of these groups of patients is NOT at a greater risk of subdural haemorrhage?

1 - alcoholics
2 - elderly
3 - obese
4 - anti-coagulant medication

A

3 - obese

41
Q

In a subdural haemorrhage, will the blood appear white or dark on a CT scan?

A
  • dark
42
Q

When looking at CT brian scans, if you are trying to distinguish if a haemorrhage is subdural or extradural you can remember this:

  • extra-dural haematoma is lentiform like a lemon
  • subdural haematoma is sickle shaped like a banana
A
43
Q

In the image attached, is this a subdural or extradural haemorrhage?

A
  • subdural
  • subdural haematoma is sickle shaped like a banana
  • can also see:
    a) With midline shift
    b) Compressed right lateral ventricle
44
Q

In a patient with a suspected epidural haemorrhage, why do we need to monitor them closely?

A
  • can be lucid, before deteriorating rapidly
45
Q

In patients with mild to moderate traumatic head injuries 1 year following the injury, what % return to work?

1 - 10%
2 - 30%
3 - 50%
4 - 75%

A

4 - 75%

  • but 85% will have symptoms such as headache, irritability, poor concentration, forgetfulness and fatigue
46
Q

What is the best outcome marker following a mild to moderate head injury?

1 - NEWS2 score
2 - initial GCS
3 - CT scan
4 - post traumatic amnesia

A

4 - post traumatic amnesia

  • how long from head injury before you can remember anything
47
Q

In a patient who has had a severe traumatic brain injury, what % are able to return to their jobs?

1 - 5%
2 - 25%
3 - 50%
4 - 75%

A

3 - 50%

  • but 38% will have a reduced salary
48
Q

In a patient who has had a severe traumatic brain injury, which of the following has the largest drop in functionality?

1 - Balance
2 - Headaches
3 - Cognitive complaints
4 - Anxiety
5 - Depression

A

3 - Cognitive complaints

  • 20-33% will have disabilities

C. Year 3: SBOM (39 decks)

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