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WorksheetsTraumatic Brain Injury 1
Total questions: 25
Worksheet time: 13mins
A 115 yo F is admitted to inpatient rehabilitation after TBI from an unhelmeted motor cycle accident. She was found to have widespread white matter lesions with focal findings within the corpus callosum on MRI. What is the most likely diagnosis?
Diffuse axonal injury Grade I
Subdural Hematoma
Diffuse axonal injury Grade II
Subarachnoid Hemorrhage
Diffuse axonal injury Grade III
What is true regarding penetrating traumatic brain injuries?
Lower mortality rate compared to non-penetrating
Greater risk of long-term post-traumatic epilepsy compared to non-penetrating
Patients who are initially comatose have a favorable prognosis
50% of patients with through and through injuries survive
The term diaschisis is described by which of the following?
Healthy structures not previously used for a given function are repurposed to do functions for the lesioned area
Intact axons in damaged areas establish synaptic connections through dendritic and axonal sprouting
Techniques/new strategies are learned to compensate for deficits
Lesions at one area of the CNS alter function at other distant areas of the brain where there are connections between the two sites
Areas of the brain alter their properties in order to subserve a particular function
What disorder of consciousness is characterized by resumption of the sleep-wake cycle on EEG?
Vegetative state
Coma
Minimally conscious state
Full consciousness
A patient with TBI shows wakefullness and is able to give a thumbs up on command about 30% of the time. What stage of consciousness is he in?
Permanent vegetative state
Persistent vegetative state
Coma
Conscious
Minimally conscious state
Patient with MVA TBI presents to the ED but the preferred CT scanner is down. Which neuropsychological assessment would be the best for assessment of brain damage?
Minnesota Multiphasic Personality Inventory
Wechsler Adult Intelligence Scale - Revised
Halstead-Reitan Neuropsychological Battery
Token Test
Which of the following indicators of demographics and imaging indicate a worse outcome?
Age < 45, right hemisphere lesion in right handed individual.
Age >75, left sided lesion in right handed individual.
Age <25, bi-hemispheric lesion.
Age > 65, bi hemispheric lesion.
Comatose patient presents with GCS score of 6 is brought into the ED. Careful endotracheal intubation is done as patient may have cervical instability. What should his PO2 and PCO2 goals be in mmHg?
PO2 100 to 120 & PCO2 28-32
PO2 65 to 85 & PCO2 14 to 18
PO2 160 to 180 & PCO2 40 to 44
An intubated TBI patient in the ICU starts to have more prolonged episodes of hypotension, bradycardia and bradypnea with apneic episodes. What is not a possible reason?
The benzodiazepines used for agitation are scheduled too closely, resulting in increasing toxicity
The patient's ICP is rising and thus causing herniation compressing the brainstem
The propofol infusion is set too rapid, resulting in compounding adverse effects
What FIM level is associated with "cueing, coaxing, and prompting"?
4: Minimal Assist
5: Supervision
6: Modified Independent
7: Independent
This is the leading cause of death in people ages 1 to 44:
Cancer
Heart Disease
Trauma
Marijuana
The single most common cause of death and injury in automobile accidents is:
Crush injury
Asphyxiation
Occupant ejection
Blood loss
Nearly half of TBI patients are:
Not married
Single
Married
Divorced
Alcohol is involved in what percent of TBIs?
5%
25%
45%
75%
Which area of the brain is most likely to experience a contusion?
Inferior frontal lobe
Inferior occipital lobe
Posterior temporal lobe
Anterior parietal lobe
Superior occipital lobe
76 y/o M with a TBI from a fall has Posttraumatic Amnesia. At what length of PTA would you suspect the patient to likely have poor recovery?
2 weeks
1 month
2 months
4 months
54 y/o F with a TBI from a GSW which has been complicated with PTA. You have been assessing his Galveston Orientation and Amnesia Test (GOAT) every day. GOAT scores are as follows: August 1st: 55, August 2nd: 65, August 3rd: 75, August 4th: 80, August 5th: 85. On what day was the PTA resolved?
August 1st
August 2nd
August 3rd
August 4th
August 5th
23 y/o M with a TBI from an MVA has been making progressive cognitive recovery during his ARF. He was previously requiring seroquel for agitation but has not required it for 3 days. He is currently confused but inappropriate with staff. What is his Rancho score?
2
4
5
7
On your TBI service, you have 4 patients with various severities of TBI. Which patient would you suspect to have poor outcome with their TBI?
Patient requiring continued phenytoin
35 y/o female
Patient with reactive pupils following TBI
Decorticate posturing observed following initial TBI
54 y/o M with a TBI following motorcycle accident has had PTA. His GOAT scores are as follows: Day 5: 60, Day 6: 75, Day 7: 70, Day 8: 75, Day 9: 80. Based on duration of PTA, what would you determine the severity of his TBI to be?
Mild TBI
Moderate TBI
Severe TBI
You evaluate a patient who exhibits simple command following, object manipulation, and intelligible verbalization that are inconsistent but reproducible. Which of the following level of consciousness would you describe this as?
Coma
Vegetative state
Minimally conscious state
Persistent vegetative state
What is the mechanism of action for amantadine in the treatment of disorders of consciousness?
increases endogenous dopamine
increases exogenous dopamine
stimulates dopamine, histamine, serotonin, norepinephrine, and orexin
blocks reuptake of dopamine and norepinephrine
A patient is exhibiting posturing that involves opisthotonos, clenched jaws, and stiff, extended limbs with internal rotation of the arms and ankle plantar flexion. What is this posturing called and where is the lesion/compression?
Decerebrate; midbrain, cerebellum, or posterior fossa
Decerebrate; cerebral hemisphere/white matter, internal capsule, or thalamus
Decorticate; midbrain, cerebellum, or posterior fossa
Decorticate; cerebral hemisphere/white matter, internal capsule, or thalamus
When using GCS to evaluate TBI prognosis what is the best acute predictor of outcome?
Total GCS within 3 hours of injury
Highest verbal response within 48 hours of injury
Highest GCS within 1 week of injury
Highest motor score 2 weeks postinjury
Which of the following is true?
Metabolic causes of coma have a better prognosis than anoxic causes
Anoxic causes of coma have a better prognosis than metabolic
Severe disability is likely when coma lasts < 2 weeks
Good recovery is still likely even when coma lasts > 4 weeks
