Pediatric Acquired Brain Injury

Question 1

ICP target in TBI

Answer 1

less than 20mmHg

Question 2

Leading cause of TBI leading to hospitalization.

Answer 2

<10- Falls, followed by MVA.

>10- MVA, followed by falls

Question 3

Treatment for Paroxysmal Sympathetic Hyperactivity

Answer 3

Propranolol, clonidine, bromocriptine, gabapentin and BZD.

Question 4

Most common endocrinology findings after TBI

Answer 4

GH deficiency and pubertal disturbances. Many endocrine abnormalities resolve 1 year post injury.

Question 5

Diabetes Insipidus
ADH:
Serum sodium and osmolality: 
Extracellular volume: 
Urine osmolality: 
Treatment:

Answer 5

ADH: decreased
Serum sodium and osmolality: Increased
Extracellular volume: Hypovolemic or isovolemic.
Urine osmolality: Decreased
Treatment: Fluid replacement, DDAVP

Question 6

SIADH
ADH:
Serum sodium and osmolality: 
Extracellular volume: 
Urine osmolality: 
Treatment:

Answer 6

ADH: Increased
Serum sodium and osmolality: Decreased
Extracellular volume: Isovolemic
Urine osmolality: Increased
Treatment: Fluid restriction, Sodium replacement, Chronic: demeclocycline

Question 7

CSW
ADH:
Serum sodium and osmolality: 
Extracellular volume: 
Urine osmolality: 
Treatment:

Answer 7

ADH: Increased 
Serum sodium and osmolality:  Decreased 
Extracellular volume: Hypovolemic
Urine osmolality: Increased
Treatment: Fluid replacement, sodium replacement

Question 8

Precocious puberty

Answer 8

Inhibition of gonadotropin release resulting in pubertal development earlier than 8 years in girls and 9 years in boys. It is associated with early accelerated linear growth and early epiphyseal fusion.

Question 9

Most frequent site of HO

Answer 9

Hip

Question 10

Risk factors for HO

Answer 10

longer duration of disorder of consciousness, long bone fractures and older age.

Question 11

Gold standard for diagnosing HO

Answer 11

Triple phase bone scan

Question 12

Pharmacologic intervention for HO

Answer 12

Antiinflammatories (Indomethacin), biphosphonates (etidronate)

Question 13

Guidelines for VTE prophylaxis

Answer 13

Postpubertal children hospitalized due to trauma with low risk of bleeding and injury severity score of >25.

Question 14

Patients who do not achieve ambulation beforehand, VTE prophylaxis is often discontinued at ___ months post injury

Answer 14

3

Question 15

Time to follow commands of more than ____ days is associated with worse outcome after pediatric TBI.

Answer 15

26

Question 16

Coma

Answer 16

lacks of sleep wake cycle, no interaction with the environment, does not localize to noxious stimuli

Question 17

VS

Answer 17

unresponsive wakefulness, Marked by the resumption of sleep wake cycle, noted by eye opening.

Question 18

MCS

Answer 18

inconsistent purposeful responses to the environment. Emergence is marked by either the ability to demonstrate functional use of two objects or an accurate yes/no response to six visual or auditory questions.

Question 19

Risk factors for poor neurobehavioral outcomes after TBI

Answer 19

injury-related factors, child preinjury factors, and family factors.

Question 20

Children who sustain a TBI before 2 years of age demonstrate more global neurobehavioral impairments than those who sustain a TBI after 7 years of age

Answer 20

True