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PM&R > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

Three types of primary injury

A

contusions, diaschisis, DAI

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2
Q

what is diaschisis?

A

damage to one area affects remote area connected to damaged area

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3
Q

two most common site of brain contusions

A

inferior frontal and anterior temporal

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4
Q

three locations of white matter involved with DAI

A

brain stem, corpus callous, central white matter

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5
Q

secondary injury in TBI

A

detrimental biochemical cascade

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6
Q

decorticate posture

A

arms flexed due to lesion above the brainstem

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7
Q

decerebrate posture

A

arms extended due to brainstem involvement

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8
Q

three locations of brain bleeds

A

epidural, subdural, subarachnoid

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9
Q

most commonly injured cranial nerve in TBI

A

CN 1

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10
Q

most common presentation of brain tumor

A

headaches with cognitive deficits

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11
Q

two most common posterior fossa tumors in children

A

1 - astrocytoma, 2- medulloblastoma

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12
Q

most common primary brain tumor in adults

A

GBM

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13
Q

most common site that metastasizes to the brain

A

lung

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14
Q

part of brain that regulates consciousness

A

RAS

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15
Q

persistent vegetative state

A

over one month

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16
Q

permanent vegetative state

A

over one year ( 3 months if non-TBI)

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17
Q

most important predictor of outcome in GCS

A

motor score at two weeks post injury

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18
Q

GCS for moderate TBI

A

9-12

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19
Q

2 ways to define emergence from PTA

A

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

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20
Q

most common type of post-traumatic seizure

A

simple partial

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21
Q

Treatment for post-traumatic seizure

A

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

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22
Q

common cause of post traumatic hydrocephalus

A

subarachnoid hemorrhage

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23
Q

GCS scoring?

A

EVM

24
Q

Rancho Los Amigos scoring

A
  • 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
25
Q

Classification of post-traumatic seizures

A
  • immediate = within 1 day
  • early = within one week
  • late = over one week
26
Q

Tx for SIADH

A

restrict free water or demeclocyline (blocks ADH)

27
Q

Tx for CSW

A

IV fluids

28
Q

Tx for diabetes insipidus

A

ADH (vasopressin or DDAVP)

29
Q

what is post-concussion syndrome?

A

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

30
Q

most common cause of death in MVA?

A

ejection from the vehicle

31
Q

archtypal TBI patient demographic?

A

20 yo single white male employed with HS education

32
Q

leading cause of TBI (2014 data)

A

falls

33
Q

leading cause of TBI-related death?

A

intentional self-harm

34
Q

What does diffuse axonal injury look like on imaging?

A

white matter punctate petechial hemorrhages

35
Q

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

A

axonal injury (DAI)

36
Q

What are the two mechanisms of brain plasticity?

A

neuronal sprouting and reogranization

37
Q

prominent imaging in finding in vegetative state?

A

bilateral thalamic lesions

38
Q

scoring on glasgow outcome scale

A
  1. Death
  2. Vegetative state
  3. Severe disability
  4. Moderate disability
  5. Good recovery
39
Q

What ICP level is fatal?

A

> 60 mmHg

40
Q

What are two respiratory treatments that may increase intracranial pressure?

A

suctioning and chest PT

41
Q

Four risk factors associated with late posttraumatic seizures?

A
  • “EPILepsy”
  • Early seizure
  • Penetrating injury
  • Intracranial hematoma
  • Long coma
42
Q

Posttraumatic seizure classificaton

A
  • Immediate: within first 24 hrs
  • Early: after 24 hrs but within one week
  • Late: after the first week
43
Q

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

A

86%

44
Q

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

A

after they are seizure free for two years

45
Q

What is a Craig bed?

A

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

46
Q

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

A

Risperidone

47
Q

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

A

Aripiprazole (Abilify)

48
Q

Two benzodiazepines with short duration of action?

A

Midazolam (Versed) and Alprazolam (Xanax)

49
Q

Most common location for heterotopic ossification in TBI patient?

A

Hip

50
Q

Inexpensive test for early detection of heterotopic ossification?

A

serum alkaline phosphatase

51
Q

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

A

aspiration (futher increased with GERD or proximal tube placement)

52
Q

Seizure medication that can cause SIADH?

A

Carbamazepine

53
Q

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

A

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

54
Q

Fracture location that can cause diabetes insipidus?

A

sella turcica

55
Q

Treatment for diabetes insipidus?

A

DDAVP (desmopressin acetate - an ADH analog)

56
Q

pharmacologic agent that can be used in chronic SIADH?

A

demeclocycline (inhibits ADH action in the kidney)

PM&R (21 decks)

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