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Med Surg 2 > MIDTERMS: TBI > Flashcards

MIDTERMS: TBI Flashcards

1
Q

What is the definition of Traumatic Brain Injury (TBI)?

A

Physical injury to the brain caused by an external mechanical force or projectile, resulting in loss of consciousness, post-traumatic amnesia, and neurological deficits.

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2
Q

What are the three primary results of TBI?

A

Loss of consciousness, post-traumatic amnesia, and neurological deficits.

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3
Q

What are the most common causes of TBI?

A

ransportation-related incidents, falls, violence, and suicide attempts.

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3
Q

Which age groups are most affected by TBI?

A

15-24 years old and 65-75 years old.

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4
Q

What are some risk factors for TBI?

A

Alcohol intake, pre-injury personality disturbances, family discord, and antisocial behavior.

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4
Q

What is the male to female ratio in TBI cases?

A

2:1, with more severe injuries observed in males.

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5
Q

What are secondary mechanisms of injury in TBI?

A

Intracranial hemorrhage, brain swelling, excitotoxicity, oxidant injury, and hypoxia.

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5
Q

What is a concussion?

A

The mildest form of TBI characterized by a state of unconsciousness due to minor diffuse axonal injury.

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5
Q

What are the primary mechanisms of injury in TBI?

A

Diffuse axonal injury (DAI), multiple petechial hemorrhages, contusions, and cranial nerve injuries.

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6
Q

What are cerebral contusions?

A

Bruises on the cortex, commonly located in the inferior frontal lobe and anterior temporal lobe, associated with seizures and focal deficits.

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7
Q

What types of hemorrhages are associated with secondary brain damage?

A

Subarachnoid hemorrhage (SAH), subdural hematoma (SDH), epidural hematoma, and intracerebral hemorrhage (ICH).

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8
Q

What are the types of herniation that can occur in TBI?

A

Subfalcine, central, transtentorial (uncal), and tonsillar herniation.

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9
Q

What is the difference between tangential and penetrating cranial wounds?

A

Tangential wounds involve scalp lacerations and depressed skull fractures, while penetrating wounds involve objects like metal particles or bone fragments entering the skull.

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10
Q

What are the main surgical concerns for gunshot wounds to the brain?

A

revention of infection, control of intracranial pressure (ICP), and management of potential complications like CSF leaks and seizures.

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11
Q

(4)If there is also edema or hemorrhage causing swelling in the cerebellum, the tonsil (or tonsils) of the cerebellum herniates downward into the foramen magnum.

A

Tonsillar Herniation:

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12
Q

Due to the cerebral edema, the uncus of the temporal lobe (medial temporal lobe) herniates downward into the posterior fossa.

A

Transtentorial (Uncal) Herniation:

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13
Q

occurs when there is downward pressure centrally and can result in?

A

Central herniation

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14
Q

The cingulate gyrus is pushed laterally away from the expanding mass and herniates beneath the falx cerebri.

A

Subfalcine
Herniation:

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15
Q

Which cranial nerves are most commonly injured in basal skull fractures?

A

Olfactory nerve, facial nerve, and auditory nerve.

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16
Q

What is a clinical sign of olfactory nerve injury?

A

Anosmia (loss of smell) and apparent loss of taste.

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16
Q

What are common signs of a fracture of the petrous pyramid?

A

Otorrhea (ear drainage) and blood behind the tympanic membrane (TM).

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16
Q

What is “Battle Sign”?

A

A bruising behind the ear indicating a possible skull fracture.

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16
Q

Which cranial nerve injury can lead to diabetes insipidus?

A

: Injury to the sella (pituitary gland).

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16
Q

What does Raccoon Eyes indicate?

A

Periorbital ecchymosis associated with basal skull fractures.

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17
Q

What indicates a trochlear nerve injury?

A

Diplopia worse when looking down and compensatory head tilting

17
Q

What are signs of optic nerve injury due to sphenoid bone fracture?

A

Blindness, unreactive pupils to direct light, and partial vision loss (scotoma).

17
Q

What are the signs of oculomotor nerve injury?

A

Ptosis, divergent globes, loss of medial and vertical movements, diplopia, and fixed dilated pupil.

17
Q

What is a carotid-cavernous fistula and its signs?

A

A laceration of the internal carotid artery causing pulsating exophthalmos, cranial nerve palsies (CN VI > III > IV), loss of vision, and glaucoma.

17
Q

What symptoms are associated with trigeminal nerve injury?

A

Numbness, paresthesias, and neuralgia from basal fracture.

17
Q

What are coup and contrecoup lesions?

A

Coup lesions occur at the site of impact; contrecoup lesions occur on the opposite side of the brain.

17
Q

How can facial nerve injury manifest after a skull fracture?

A

Immediate facial palsy with transverse fractures and delayed facial palsy with longitudinal fractures.

17
Q

What are common symptoms of vestibulocochlear nerve injury?

A

Hearing loss, postural vertigo, and nystagmus.

17
Q

What is the Glasgow Coma Scale (GCS)?

A

: A scale used to measure consciousness, with a score range from 3 (unresponsive) to 15 (fully alert).

17
Q

What is the prognosis for regaining consciousness after PVS?

A

50% chance of regaining consciousness within a year; 28% chance of achieving independence.

18
Q

How is cognition demonstrated in patients recovering from coma?

A

By the ability to communicate.

18
Q

What are the immediate clinical manifestations of a cerebral concussion?

A

Loss of consciousness, suppression of reflexes, transient respiratory arrest, and brief bradycardia.

18
Q

What is an acute epidural hemorrhage?

A

Hemorrhage usually caused by meningeal arteries, leading to immediate loss of consciousness, lucid interval, and potential brainstem herniation.

18
Q

: What is a subdural hematoma and its CT appearance?

A

: What is a subdural hematoma and its CT appearance?

18
Q

What is the recovery pattern in coma?

A

Eye-opening and sleep-wake cycles ➔ following commands ➔ speaking.

18
Q

What is the management goal for intracranial pressure (ICP)?

A

Maintain ICP < 20 mmHg and cerebral perfusion pressure (CPP) > 60 mmHg.

18
Q

What causes coma and unconsciousness?

A

Disruption of input to surface brain structures from deeper structures that subserve arousal and wakefulness, due to factors like diffuse axonal injury or brainstem compression.

18
Q

What pharmacologic agents are used to increase arousal and facilitate recovery of consciousness?

A

Methylphenidate, Amantadine, and Bromocriptine

18
Q

Define Persistent Vegetative State (PVS).

A

A condition where the patient is unresponsive for more than 2-4 weeks, has spontaneous sleep-wake cycles, but lacks cortical activity.

19
Q

What factors indicate a positive prognosis for emergence from unconsciousness?

A

Young age, reactive pupils, decorticate posturing, early spontaneous eye opening, and absence of ventilator dependence.

20
Q

What are management strategies for MCS?

A

Electrical stimulation, dopaminergic agents, and multimodal sensory stimulation.

21
Q

What is Posttraumatic Amnesia (PTA)?

A

The period during which the patient’s ability to learn new information is minimal or non-existent, often accompanied by retrograde amnesia.

21
Q

What are the main goals in the rehabilitation of patients with impaired consciousness?

A

Remove obstacles to recovery, treat medical complications, and provide education and support to family members.

22
Q

What is the GOAT and what does it measure?

A

The Galveston Orientation and Amnesia Test, measuring orientation and memory in PTA, with scores over 75 indicating the patient is out of PTA.

23
Q

Describe agitation in the context of brain injury.

A

A neurobehavioral syndrome with cognitive confusion, extreme emotional lability, motor overactivity, and potential aggression.

23
Q

What medications are used to manage agitation in brain injury patients?

A

Beta-blockers, anti-epileptics, dopamine agonists, TCAs, and benzodiazepines.

24
Q

What is heterotopic ossification (HO)?

A

Formation of lamellar bone in soft tissue and periarticular areas, often seen in patients with prolonged coma or limb spasticity.

25
Q

What characterizes a Minimally Conscious State (MCS)?

A

Evidence of awareness with visual tracking and nonreflexive motor behavior, but inconsistent following of commands or intelligible communication.

26
Q

: What are the symptoms and management of posttraumatic epilepsy?

A

Late seizures may occur, and risk factors include penetrating injuries and early seizures. Carbamazepine is the drug of choice for management.

27
Q

What complications are associated with brain injury?

A

Spasticity, posttraumatic epilepsy, hydrocephalus, cranial nerve damage, pulmonary complications, and nutritional complications.

28
Q

What nutritional strategies are used in brain injury rehabilitation?

A

Total enteral nutrition (TEN) and total parenteral nutrition (TPN) to manage metabolic responses and achieve positive nitrogen balance.

29
Q

What are common pulmonary complications following brain injury?

A

Pneumothorax, hemothorax, atelectasis, pneumonia, and neurogenic pulmonary edema.

29
Q

A neurological disorder caused by repeated blows to the head, characterized by dementia and symptoms of Parkinson’s disease.

A

dementia pugilistica

30
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Med Surg 2 (16 decks)

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