TBI

Question 1

caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.

Answer 1

TBI

Question 2

Who has higher risk of TBI?

Answer 2

Males

1-34

> 65

Question 3

Risk factors for TBI death

Answer 3

Male
Older
Previous TBI
Drug/ LQ use

Question 4

What is used to measure severity of TBI

Answer 4

Glasgow coma scale

Question 5

What can alter score on glasgow coma scale?

Answer 5

Intoxication
Intubation
Language barrier

Question 6

What is best predictor of outcome of TBI?

Answer 6

Depth and duration of unconciousness

Question 7

How is amnesia assessed?

Answer 7

GOAT (>75 twice withing 48hr)

Orientation log (>25 2 days in a row)

Question 8

Primary injury ….

Answer 8

Coup

Focal, diffuse

Question 9

Secondary injury

Answer 9

Contre coup

Diffuse, inflammation, cell receptor dysfunction seen

Question 10

Bleeding b/w skull and dura?

Answer 10

Epidural hematoma

Question 11

First symptom of epidural hemorrhage?

Answer 11

Fixed and dilated pupil on side of injury

Question 12

Worst case of epidural hematoma?

Answer 12

Transtentrial herniation

Question 13

Bleed b/w dura and brain?

Answer 13

Subdural hematoma

Question 14

What is most deadly of all head injuries?

Answer 14

Acute subdural hematoma

Question 15

Bleeding into subarachnoid space?

Answer 15

Subarachnoid hemorrhage

Question 16

Signs and symptom of subarachnoid hemorrhage?

Answer 16

Headache
Vomit
Confusion
Seizures

Question 17

Bleeding into brain tissue

Answer 17

Intraparenchymal hemorrhage

Question 18

Bleeding into ventricles?

Answer 18

Intraventricular Hemorrhage

Question 19

Which herniation compresses pericallosal arteries?

PCA/occulomotor nerve?

Pons and medulla?

Answer 19

Subfalcine

Transtentorial

Tonsillar

Question 20

Secondary mechanisms of injury include

Answer 20

Ischemia
Hypoxemia
Hypotension
Cerebral edema
^ ICP
Acidosis
Excitotoxicity

Question 21

Level 1 clinical consciousness description

2?

3?

Answer 21

Coma

Vegetative state

Minimally conscious

Question 22

State of unarousable unresponsiveness

Answer 22

Coma

Question 23

Brainstem function intact; cortical function severely impaired

Sleep/wake cycle returns

General response to stimuli?

Answer 23

Vegetative state

Question 24

inconsistent, but clearly discernible behavioral evidence of consciousness

Answer 24

Minimall conscious state

Question 25

Favorable prognosis

Answer 25

``` GCS>5 Smart Pupil response Social support Young Low severity ```

Question 26

Unfavorable prognosis

Answer 26

Midline shift Repeat Anoxia Elevated ICP

Question 27

Around 30% of patients with moderate to severe TBI will experience some manifestation of

Answer 27

Agitation

Question 28

Agitation comes from damage to

Answer 28

Front/temporal lobe

Question 29

Pharmacological managment of agitation?

Answer 29

``` Anti-epileptics Dopamine Antidepressant Antipsychotics Betablockers ```

Question 30

•“motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflex as one component of the UMN Syndrome

Answer 30

Spasticity

Question 31

Spasticity is loss of

Answer 31

Descending inhibitory control (reticulospinal)

Question 32

observe resting position in bed and in wheelchair and note side to side differences in resting postures of extremities, head, and neck

Answer 32

Clinical observation

Question 33

0,1,1+,2,3 in ashworth

Answer 33

``` 0=no increase in tone 1=increase (catch +release) 1+= catch with minimal resistance following 2=increase through most of range 3=passive movement difficult ```

Question 34

1/10 ppl with TBI have

Answer 34

Seizures

Question 35

caused by electrical disturbances in the brain, usually localized to the area of initial trauma

Answer 35

Seizure

Question 36

Mgmt of seizure?

Answer 36

Anti-epileptics

Question 37

Can be caused by either overproduction of CSF, blockage of CSF flow, or insufficient absorption of CSF (or combination)

Answer 37

Post-traumatic hydrocephalus

Question 38

Postraumatic hydrocephalus classified as

Answer 38

Noncommunicating (obstructive) Communicating

Question 39

Symptoms of hydrocephalus

Answer 39

Gait disorder Impaired cognition Urinary incontinence

Question 40

Most common symptoms of non-comunicating hydrocephalus

Answer 40

Papilledema | Cognitive changes

Question 41

Mgmt of hydrocephalus

Answer 41

Shunt | PT

Question 42

Why is pediatric TBI unfavorable prognosis?

Answer 42

Lack of brain maturation and skillz

Question 43

Concussion described by having at least on of the following

Answer 43

Loss of consciousness Memory loss Alter mental state Neuro defecits (focal)

Question 44

Injury severity of concussion does not exceed

Answer 44

PTA<24 hours LOC<30 minute GCS 13-15