Traumatic brain injury

Question 1

Occupational therapists

Answer 1

train patients to perform activities of daily living (dressing, bathing, toileting, grooming). They can also provide targeted therapies for deficits in strength or coordination in the upper extremity.

Question 2

Vocational counselors

Answer 2

facilitate transitions back to a former occupation or find a new job within the abilities

Question 3

Physical therapists

Answer 3

focus on mobility training which includes balance, gait, endurance and lower extremity strengthening.

Question 4

Rehabilitation psychologists

Answer 4

assist with coping with disability, behavioral therapy and treating mood disorders

Question 5

Signs of traumatic brain injury are?

Answer 5

1. Any period of loss of or decreased consciousness
2. Any loss of memory for events immediately before (retrograde amnesia) or after the injury (post-traumatic amnesia)
3. Neurologic deficits such as muscle weakness, loss of balance and coordination, disruption of vision, change in speech and language, or sensory loss
4. Any alteration in mental state at the time of injury such as confusion, disorientation, slowed thinking, or difficulty with concentration

Question 6

Glascow Coma Scale is used to classify the severity of a TRuamtic brain injury , what is on scale?

Answer 6

• Eye opening Scoring:
  
  • 1 None
  • 2 To pain
  • 3 To voice
  • 4 Spontaneous
• Motor Scoring:
  
  • 1 None
  • 2 Extensor posturing
  • 3 Flexor posturing
  • 4 Withdraws to pain
  • 5 Localizes to pain
  • 6 Normal
• Verbal scoring:
  
  • 1 None
  • 2 No words, only sounds
  • 3 Words, but not coherent
  • 4 Disoriented conversation
  • 5 Normal conversation

Question 7

Focal neurologic signs of brain injury

Answer 7

post-traumatic seizures, anosmia/hyposmia, cranial nerve deficits, visual field cuts, aphasia, gait/balance problems, tinnitus, and photosensitivity.

Question 8

Complex regional pain syndrome

Answer 8

severe pain disorder occasionally caused by direct nerve injury, but most often after a quite minor distal extremity trauma without any evident nerve trauma, sometimes even following a prolonged interval of immobilization, such as occurs when splinted or casted.

Question 9

first-line therapy for chronically painful diabetic neuropathy?

Answer 9

tricyclic antidepressants” (TCAs) and “serotonin/norepinephrine re-uptake inhibitors” (SNRIs)

Question 10

Impaired function of the descending inhibitory pain modulation system plays a key role in which of the following?

Answer 10

Central sensitization pain syndromes such as seen in fibromyalgia pain.

Question 11

Hyperalgesia

Answer 11

Increased pain intensity from a stimulus that “normally” provokes pain. Augmented pain response to an otherwise normal threshold

Question 12

Sensitization PNS and CNS

Answer 12

• Peripheral: Increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields.
  
  • cell body locates in the dorsal root ganglion
• Central: Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input.
  
  • dorsal horn, medulla, cerebral and cortical neuroplasticity

Question 13

Goal of chronic pain treatment:

Answer 13

Improve function and quality of life.

Question 14

Goal of acute pain treatment:

Answer 14

Reduce pain intensity

Question 15

What is acute pain?

Answer 15

Acute pain persists for less than 3 months, generally the time needed for disease, injury, or a threat to the body to resolve or heal.

Question 16

Goal of palliative pain treatment:

Answer 16

Comfort and dignity at the end of life.

Question 17

Complex regional pain syndrome

Answer 17

• severe pain disorder occasionally caused by direct nerve injury, but most often after a quite minor distal extremity trauma without any evident nerve trauma, sometimes even following a prolonged interval of immobilization, such as occurs when splinted or casted.
• Touch and/or minimal movement is extremely painful (“tactile” or “mechanical” allodynia).
• sensory and/or motor “neglect” and astereognosis (inability to identify objects by touch) of an affected extremity

Question 18

2 weeks after a 25 yo sprained her ankle while trail running, was medically evaluated, and fully compliant with advised non-weight bearing and splinting/immobilization, she now presents with 10/10 pain and excess sweating in her injured leg. Physical exam findings: normal temperature, pulse and BP. Antalgic gait. Affected lower leg is swollen, and skin over ankle and foot is red and shiny. You note tactile and mechanical allodynia, cool skin and hyperhidrosis. Her diagnosis is which of the following?

Answer 18

Complex regional pain syndrom

Question 19

Irritable bowel syndrome and chronic pelvic pain are both associated with:

Answer 19

Post-traumatic stress disorder (PTSD) and Fibromyalgia

Question 20

first-line therapy for chronically painful diabetic neuropathy?

Answer 20

tricyclic antidepressants” (TCAs) and “serotonin/norepinephrine re-uptake inhibitors” (SNRIs)

Question 21

Allodynia

Answer 21

Experience of pain to a non-noxious (ordinarily non-painful stimulus); “When touch becomes pain”. Involves a change in the very nature of a sensation, whether tactile, thermal, or of any other sort. A damage alarm when there’s no damage at all.

Question 22

Nociceptive pain:

Answer 22

Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors. C and delta fibers