Traumatic Brain Injury

Question 1

Three types of primary injury

Answer 1

contusions, diaschisis, DAI

Question 2

what is diaschisis?

Answer 2

damage to one area affects remote area connected to damaged area

Question 3

two most common site of brain contusions

Answer 3

inferior frontal and anterior temporal

Question 4

three locations of white matter involved with DAI

Answer 4

brain stem, corpus callous, central white matter

Question 5

secondary injury in TBI

Answer 5

detrimental biochemical cascade

Question 6

decorticate posture

Answer 6

arms flexed due to lesion above the brainstem

Question 7

decerebrate posture

Answer 7

arms extended due to brainstem involvement

Question 8

three locations of brain bleeds

Answer 8

epidural, subdural, subarachnoid

Question 9

most commonly injured cranial nerve in TBI

Answer 9

CN 1

Question 10

most common presentation of brain tumor

Answer 10

headaches with cognitive deficits

Question 11

two most common posterior fossa tumors in children

Answer 11

1 - astrocytoma, 2- medulloblastoma

Question 12

most common primary brain tumor in adults

Answer 12

GBM

Question 13

most common site that metastasizes to the brain

Answer 13

lung

Question 14

part of brain that regulates consciousness

Answer 14

RAS

Question 15

persistent vegetative state

Answer 15

over one month

Question 16

permanent vegetative state

Answer 16

over one year ( 3 months if non-TBI)

Question 17

most important predictor of outcome in GCS

Answer 17

motor score at two weeks post injury

Question 18

GCS for moderate TBI

Answer 18

9-12

Question 19

2 ways to define emergence from PTA

Answer 19

75 or higher on GOAT or 25 or higher on O-Log for two days straight

Question 20

most common type of post-traumatic seizure

Answer 20

simple partial

Question 21

Treatment for post-traumatic seizure

Answer 21

1 week of AED for prophylaxis and 2 years if a late seizure occurs

Question 22

common cause of post traumatic hydrocephalus

Answer 22

subarachnoid hemorrhage

Question 23

GCS scoring?

Answer 23

EVM

Question 24

Rancho Los Amigos scoring

Answer 24

• Scored 1 - 8
• 1 = no response
• 2= generalized response
• 3 = localized response
• 4 = confused agitated
• 5 = confused inappropriate
• 6 = confused appropriate
• 7 = automatic appropriate
• 8 = purposeful appropriate

Question 25

Classification of post-traumatic seizures

Answer 25

* immediate = within 1 day * early = within one week * late = over one week

Question 26

Tx for SIADH

Answer 26

restrict free water or demeclocyline (blocks ADH)

Question 27

Tx for CSW

Answer 27

IV fluids

Question 28

Tx for diabetes insipidus

Answer 28

ADH (vasopressin or DDAVP)

Question 29

what is post-concussion syndrome?

Answer 29

cognitive deficit and symptoms for over 3 months that interfere with daily life.

Question 30

most common cause of death in MVA?

Answer 30

ejection from the vehicle

Question 31

archtypal TBI patient demographic?

Answer 31

20 yo single white male employed with HS education

Question 32

leading cause of TBI (2014 data)

Answer 32

falls

Question 33

leading cause of TBI-related death?

Answer 33

intentional self-harm

Question 34

What does diffuse axonal injury look like on imaging?

Answer 34

white matter punctate petechial hemorrhages

Question 35

most common cause of unconsciousness in first 24hrs of TBI?

Answer 35

axonal injury (DAI)

Question 36

What are the two mechanisms of brain plasticity?

Answer 36

neuronal sprouting and reogranization

Question 37

prominent imaging in finding in vegetative state?

Answer 37

bilateral thalamic lesions

Question 38

scoring on glasgow outcome scale

Answer 38

1. Death 2. Vegetative state 3. Severe disability 4. Moderate disability 5. Good recovery

Question 39

What ICP level is fatal?

Answer 39

\> 60 mmHg

Question 40

What are two respiratory treatments that may increase intracranial pressure?

Answer 40

suctioning and chest PT

Question 41

Four risk factors associated with late posttraumatic seizures?

Answer 41

* "EPILepsy" * Early seizure * Penetrating injury * Intracranial hematoma * Long coma

Question 42

Posttraumatic seizure classificaton

Answer 42

* Immediate: within first 24 hrs * Early: after 24 hrs but within one week * Late: after the first week

Question 43

Probability of recurrent posttraumatic seizure within 2 years after first late posttraumatic seizure?

Answer 43

86%

Question 44

When can you consider withdrawal of antiepliptic drugs in a patient who had a late post-traumatic seizure?

Answer 44

after they are seizure free for two years

Question 45

What is a Craig bed?

Answer 45

Floor bed used for agitated, non-ambulatory patients with 1:1 supervision

Question 46

Atypical antipsychotic with higher incidence of EPS than others in the same class?

Answer 46

Risperidone

Question 47

Atypical antipsychotic with D2 agonist/antagonist action, is the least sedating and has fewest EPS?

Answer 47

Aripiprazole (Abilify)

Question 48

Two benzodiazepines with short duration of action?

Answer 48

Midazolam (Versed) and Alprazolam (Xanax)

Question 49

Most common location for heterotopic ossification in TBI patient?

Answer 49

Hip

Question 50

Inexpensive test for early detection of heterotopic ossification?

Answer 50

serum alkaline phosphatase

Question 51

What is a patient with GI tube feeding at increased risk for?

Answer 51

aspiration (futher increased with GERD or proximal tube placement)

Question 52

Seizure medication that can cause SIADH?

Answer 52

Carbamazepine

Question 53

What is the maximum that sodium can be corrected in order to avoid pontine myelinolysis

Answer 53

No more that 10mEq/L over 24hrs until reaching 125mEq/L

Question 54

Fracture location that can cause diabetes insipidus?

Answer 54

sella turcica

Question 55

Treatment for diabetes insipidus?

Answer 55

DDAVP (desmopressin acetate - an ADH analog)

Question 56

pharmacologic agent that can be used in chronic SIADH?

Answer 56

demeclocycline (inhibits ADH action in the kidney)