TBI

Question 1

What is single most common cause of death and injury in automobile accidents?

Answer 1

Ejection of occupant from vehicle

Question 2

Leading cause of TBI?

Answer 2

Falls

Question 3

Marital status of most TBI’s?

Answer 3

Single more than married

Question 4

Definition of TBI contusion

Answer 4

Bruising of cortical tissue

Question 5

What happens with diffuse axonal injury?

Answer 5

Disruption of axons due to acceleration-deceleration and rotational forces that cause shearing upon impact

Question 6

What is most common cause of unconsciousness during and following first 24 hrs of injury?

Answer 6

Axonal injury

Question 7

Two mechanisms of plasticity

Answer 7

1. Neuronal regeneration/neuronal sprouting
2. Functional reorganization/unmasking neural reorganization;
   PUN

Question 8

Diaschisis mechanism?

Answer 8

Lesion to one region of CNS leads to altered function in other areas of brain that were not severed if connection exists b/w two sites

Question 9

What is consciousness a function of?

Answer 9

Ascending reticular activating system and cerebral cortex

Question 10

What is vegetative state characterized by?

Answer 10

Resumption of sleep-wake cycle on EEG

Question 11

Of the GCS items, which is best acute predictor of outcome?

Answer 11

Motor response

Question 12

What does resolution of PTA clinically correspond to?

Answer 12

Period when incorporation of ongoing daily events occurs in the working memory

Question 13

What defines end of PTA relative to GOAT?

Answer 13

Patients scores 75 or higher in GOAT for 2 consecutive days

Question 14

Name a few examples of neuropsych testing

Answer 14

Halstead-Reitan Neuropsych Battery;
Wechsler Adult Intelligence Scale (WAIS);
Minnesota Multiphasic Personality Inventory (MMPI)

Question 15

How to define elevated ICP?

Answer 15

ICP over 20 mmHg for more than 5 mins

Question 16

What factors can increase ICP?

Answer 16

Turning head, loud noise, vigorous PT, chest PT, suctioning, elevated BP

Question 17

Majority of post-traumatic seizures are

Answer 17

simple partial

Question 18

Risk factors associated with late post-traumatic seizures

Answer 18

1. Penetrating head injury
2. Intracranial hematoma
3. Early PTS
4. Depressed skull fx
5. Prolonged coma or PTA (over 24 hrs)

Question 19

When are therapeutic anti-convulsant meds usually started after TBI?

Answer 19

Once late seizures occur

Question 20

When reasonable to consider withdrawal of anti-epileptic drugs?

Answer 20

After 2-year, seizure-free interval

Question 21

Medication best suited for post-traumatic agitation?

Answer 21

Beta-blockers

Question 22

Classic drug cause of SIADH, particularly in TBI population?

Answer 22

Carbamazepine

Question 23

Classic treatment of SIADH?

Answer 23

Fluid restriction;
can do salt tabs;
if severe symptoms, can infuse some hypertonic saline

Question 24

What particular fx could cause DI?

Answer 24

In or near the sella turcica, which could tear stalk of pituitary gland

Question 25

After concussion, what is each stage for return to play?

Answer 25

1. Symptom-limited activity (re-intro of school work activities)
2. Light aerobic exercise (increase HR)
3. Sports-specific exercise (Add movement)
4. Non-contact training drills (Exercise, coordination and cognitive load)
5. Full-contact practice (Restore confidence and assess functional skills)
6. RTP

Question 26

When are therapeutic anticonvulsant medications usually started in the TBI population?

Answer 26

Once late seizures occur

Question 27

In the TBI population, what two anti-epileptic medications are preferred?

Answer 27

Carbamazepine, valproic acid

Question 28

Agitated Behavior Scale rating

Answer 28

Below 21: normal;
22-28: mild agitation;
29-35: moderate agitation;
35-54: severe agitation