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CBIS Exam > Medical and Physical Complications > Flashcards

Medical and Physical Complications Flashcards

1
Q

orthostatic HTN, aspiration pneumonia, and DVT are what kinds of brain injury complications?

A

chronic cardiopulmonary issues

DVT = deep vein thrombosis

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2
Q

dysautonomia

A

aka autonomic storming, sympathetic storming, autonomic dysreflexia

occurs generally at GCS 3-8, usually resolves in early recovery

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3
Q

a patient presents with HR 69, BP 140/85, respiration 18 breaths per minute. Which vital sign is abnormal?

A

HR: 60-90 bpm
BP: 100/65 - 137/84 (this is high in patient presenting)
respiration: 12-20 breaths per minute

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4
Q

heterotopic ossification

A

abnormal bone growth in soft tissue adjacent to joints

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5
Q

involuntary exaggerated deep tendon reflexes

A

hyperreflexia

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6
Q

involuntary increased muscle tone

A

spasticity

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7
Q

contractures

A

abnormal, usually permanent condition of joints - often in flexed position, fixation due to wasting away/shortening of muscle fibers and loss of skin elasticity

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8
Q

what interventions can be used for spasticity and contractures that are secondary to brain injury?

A

exercise, casting, e-stim to improve flexibility and tone, oral anti-spasticity meds, nerve blockers, botox, surgically implanted baclofen pump

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9
Q

why might a surgically implanted baclofen pump be used following a TBI?

A

to treat musculoskeletal complications of spasticity/contractures

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10
Q

T/F: metabolism decreases following mod-severe brain injury

A

FALSE: metabolism increases (~40% more calories)

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11
Q

G-tube vs J-tube

A

G-tube: surgically placed into stomach or small bowel

J-tube: through skin of abdomen into midsection of small intestine

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12
Q

pulmonary/ lung aspiration

A

breathing in foreign substance (food, liquid, mucus, medicine, saliva, etc)
can lead to choking or aspiration pneumonia

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13
Q

describe the 3 phases of swallowing

A

1: oral preparatory stage - mastication, bolus formation, propulsion of bolus into pharynx
2: pharyngeal phase - bolus passes epiglottis and upper esophageal sphincter. tongue blocks oral cavity, epiglottis blocks larynx, soft palate blocks nasal cavity
3: esophageal phase - bolus moves towards lower esophageal sphincter

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14
Q

compare level 1 dysphagia diet to level 3

A

level 1 dysphagia requires pureed food (nothing that requires bolus formation)
level 3 dysphagia allows all food except hard, sticky, crunchy

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15
Q

cause of and medication to treat diabetes insipidus

A

diabetes insipidus due to decreased vasopressin (ADH) –> decreased fluid levels
treat with desmopressin

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16
Q

pressure sores and how to prevent them

A

areas of bony prominence (shoulders, elbows, lower back, hips, etc)
prevent by keeping skin clean/dry, changing position every 2 hours, using pressure-relieving devices (mattresses, cushions, tilt-in-space wheelchairs)

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17
Q

what are the stages of pressure ulcers

A

stage 1: intact skin
stage 2: skin breaks open
stage 3: deep wound, full thickness tissue loss, subcutaneous fat may be visible
stage 4: very deep tissue loss, exposed bone/tendon/muscle

unstageable: full thickness tissue loss, but actual depth of ulcer is obscured by slough or eschar in wound bed
deep tissue injury: discolored intact skin or blood-filled blister, area around may be warmer or cooler

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18
Q

immediate post-traumatic convulsions (IPTC)

A

occur within moments of injury, considered to represent non-epileptic events, associated with low risk for recurrent seizures

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19
Q

T/F: EPTS do not increase risk of secondary brain damage

A

FALSE: early post-traumatic seizures (1 week or earlier AI) are a strong risk factor for development of late post-traumatic seizures (LPTS). Detection and treatment of EPTS is necessary to minimize potential secondary brain damage

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20
Q

missile wounds, bilateral or multiple contusions, and multiple craniotomies are the strongest risk factors of (EPTS/LPTS)

A

late post-traumatic seizures

LPTS are a strong predictor of recurrent seizures

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21
Q

status epilepticus

A

seizures that last longer than 5 minutes, seizures so close together that person cannot recover in between

high mortality risk

benzodiazepine is the first line of treatment (tx), provides rapid seizure control

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22
Q

what is benzodiazepine used for

A

first line of treatment for rapid seizure control (esp. status epilepticus)

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23
Q

phenytoin

A

anticonvulsant, antiepileptic prophylaxis for adult patients with severe TBI, given for 7 days to decrease risk of early post-traumatic seizures

24
Q

T/F: continuing antiepileptic prophylaxis such as phenytoin, carbamazepine, or valproate beyond the first week AI has been shown to decrease risk of LPTS

A

FALSE

25
Q

what are the two most common pain pathways in persons with TBI, and compare their respective pharmacological approaches

A

nociceptive pain - due to damage to tissue, pain related to peripheral nerve fibers. Treat with NSAIDS (aspirin, ibuprofen, naproxen), acetaminophen, anti-spasticity meds, opioids

neuropathic pain - damage to nerves (primary lesion). Treat with opioids, tramadol, anticonvulsants, antidepressants (including tricyclics), nerve blocks

26
Q 
which of these interventions would NOT be effective for managing neuropathic pain?
opioids
Lyrica
anticonvulsants
NSAIDS
tricyclics/antidepressants
epidural steroids
A

NSAIDS (useful for nociceptive pain)

27
Q

criteria of chronic headache

A

occurs at least 15 days per month for at least 3 months

28
Q

tension type headache (TTH)

A

bilateral head pain that feels like pressing/clamping
occurs from either neck or head muscle strain/injury
does not get worse with physical activity
does not present with hypersensitivity
treat with NSAIDs/ acetaminophen, antidepressants, botox

29
Q

which of these is TRUE:
tension type headache worsens with physical activity
tension type headache does not present with hypersensitivity

A

TTH does not worsen with physical activity, does not present with hypersensitivity

30
Q

craniomandibular headache is a subtype of ___

A

craniomandibular headache is subtype of tension type headache, associated with temporal mandibular join

31
Q

cervicogenic headache diagnosis method and treatment?

A

defined as head pain from cervical spine
clinical diagnosis made by nerve block or provoking the headache by manipulation
treat with nerve injections (short term) or burning nerves to severe (long term)

32
Q

T/F: migraines are usually bilateral

A

FALSE: migraines usually affect only one side (but not always). usually in back of head

33
Q

4 phases of migraines

A

prodrome - food cravings, mood changes
aura - numbness, tingling, vertigo
headache - peaks 24 h
postdrome - similar to prodrome

34
Q

tricyclic antidepressants (serotonin re-uptake inhibitors), topiramate (inhibits trigeminal nerve), beta-blockers, and calcium channel blockers are all preventative medications for ____

A

migraines

35
Q

obstructive/ non-communicating hydrocephalus

A

obstruction/ blockage of CSF causing increased pressure (increased CSF in ventricles)

36
Q

hydrocephalus ex-vacuo

A

brain tissue causes neuronal loss, brain tissue shrinkage, brain atrophy, but pressure is usually normal

37
Q

spasticity as motor disorder is due to damage to (UMN/LMN)

A

UMN

38
Q

heterotrophic ossification

A

formation of new bone around joints as consequence of trauma/ immobility

39
Q

Heparin

A

anti-coagulant

can be used as prophylaxis to DVT

40
Q

T/F: pulmonary embolism is the 3rd leading cause of death in those who survive first day of brain injury

A

TRUE

41
Q

damage to corpus callosum can cause this kind of coordination disorder

A

interlimb coordination

42
Q

damage to cerebellum can cause this kind of coordination disorder, affecting voluntary movements and decreasing coordination

A

ataxia

43
Q

athetoid

A

slow, involuntary, convoluted writhing movements in fingers, toes, hands, feet

44
Q

choreiform

A

continuous, rapid, unpredictable movements

45
Q

anosognosia

A

deficit of awareness

46
Q

somatognosia

A

unaware of a body part

47
Q

apraxia

A

deficit in motor planning

48
Q

diplopia

A

double vision

49
Q

paraplegia vs tetraplegia

A

paraplegia - trunk/legs/pelvic organs paralyzed (SCI)

tetraplegia - arms, hands, trunk, legs, pelvic organs paralyzed (SCI)

50
Q

what are the 3 levels of disorders of consciousness (DOC)

A

coma –> vegetative –> minimally conscious

51
Q

criteria for emergence from DOC (disorder of consciousness)

A

must meet 1 of 2 behavioral criteria: functional communication (verbal/gestural answer to yes or no question) OR functional use of 2 or more objects (cup, toothbrush, etc)

52
Q

a patient is unconscious for an extended period of time. They should spontaneous or stimulus-induced eye opening (due to sleep/wake cycle) and grimace to pain. Are they in a coma or vegetative state?

A

vegetative state

in coma there is no eye opening or behavioral signs of awareness

53
Q

T/F: patients in minimally conscious state display spontaneous eye opening due to sleep-wake cycle

A

TRUE

54
Q

Visual Analogue Scale for Fatigue

A

assesses fatigue and energy at a single point in time

55
Q

Fatigue Severity Scale

A

assesses impact of fatigue on daily function using 7 point scale

56
Q

periodic limb movement disorder

A

sleep disorder characterized by periodic episodes of repetitive and highly stereotyped limb (usually leg) movements during sleep

CBIS Exam (9 decks)

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