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WorksheetsTraumatic Brain Injury 2
Total questions: 29
Worksheet time: 15mins
In patients with severe TBI, two thirds occur in which region of the brain?
Occipital region
Hypothalamic Pituitary Region
Basal Cisterns
Mamillary Bodies
24 yo F, MVA with TBI is monitored in the ICU. Sodium is noted to be 129 and ADH levels are elevated. She is diagnosed with SIADH. Which of the medications on her med list is the most likely offending agent?
Nicotine replacement
Morphine PRN
Amitriptyline nightly
Carbamazepine daily
24 yo F, MVA with TBI is monitored in the ICU. Sodium is noted to be 129 and ADH levels are elevated. She is diagnosed with SIADH. She complains of anorexia and nausea, no vomiting. Denies confusion or convulsions. In addition to stopping any offending agent, what is the next best step?
Fluid restrict to 1L per day, consider adding a loop diuretic
Administration of hypertonic fluid infusion.
Rapid correction Desmopressin
25M, TBI with MRI showing fracture of turcica. Which sodium disorder would you most likely expect to see?
Psychogenic Polydipsia
Diabetes Insipidus
Cerebral Salt Wasting
SIADH
Which of the following is not true when classifying Mild TBI's (Concussions)?
LOC must be 30 minutes or less
Post traumatic amnesia (PTA) must be at least 48 hours
Initial GCS of 13 or higher
Loss of memory for events before or after an injury
Mild TBI Constitutes what percentage of TBI cases in the United States?
30%
50%
80%
10%
Second Impact Syndrome which occurs when a person suffers a secondary insult to the brain before symptoms of a prior concussion have resolved can result to rapid deterioration and death. What is the proposed mechanism involved in this syndrome?
Impairment of the brain's vascular autoregulation system
Flooding of excitatory neurotransmitters
Abnormal fluctuation in sodium levels
Shearing forces against long connecting nerve fibers
Which domain is not included when classifying Concussion severity?
Cognitive
Intelligence
Affective
Sleep Changes
After sustaining a concussion, when is the earliest possible allowable return to play?
24 hours
1 week
4 weeks
3 months
The majority of posttraumatic seizures are
Complex partial
Simple partial
Grand mal
Tonic-clonic
Absence
In the TBI population, which medications are preferred for partial seizure and generalized seizure, respectively?
Carbamazepine, Valproic acid
Valproic acid, Phenytoin
Phenytoin, Valproic acid
Valproic acid, Carbamazepine
Which of the following risk factors is NOT associated with a higher risk of late posttraumatic seizures?
Penetrating head injury
Intracranial hematoma
Coma or PTA lasting 12 hours
Posttraumatic seizures on 3 days s/p injury
Depressed skull fracture
If a late post-traumatic seizure occurs, the probability of recurrent late PTS is:
5%
15%
50%
85%
95%
Which AED is associated with gastrointestinal side effects?
Valproic Acid
Gabapentin
Levetiracetam
Phenobarbital
Phenytoin
A 65 yo patient with posttraumatic epilepsy with breakthrough seizures on phenobarbital and carbamazepine has valproic acid added to his regimen. What symptoms would most likely occur if a drug interaction results in toxicity?
Nystagmus and ataxia
Sedation, irritability, and hyperactivity
Absence status epilepticus
Steven-Johnson syndrome
When is it reasonable to consider withdrawal of antiepileptic drugs for patients with posttraumatic epilepsy?
After seizure-free for 6 months
After seizure-free for 1 year
After seizure-free for 2 years
After seizure-free for 1 year on only 1 AED
A higher level patient with TBI on inpatient rehab unit develops decreased appetite, weight loss, and altered feeding pattern. What CN was most likely injured?
CN XI
CN I
CN VII
CN VIII
CN XII
A TBI patient is in a floor (Craig) bed thrashing about. What is the most appropriate next step?
Place the patient in the least restrictive physical restraints possible
Administer IM Haldol
Administer IM olanzapine
Allow the patient to thrash
What is the first line treatment for a patient with TBI who develops HTN, tachycardia, and perspiration?
Indomethacin
Valium
Cooling blankets and NGT lavage
Dantrolene
Propranolol
In regards to the dopamine pathways, decreasing dopamine in the nigrostriatal pathway leads to which of the following?
Increased prolactin
Increased movement disorders
Increased negative symptoms
Decreased positive symptoms
Of the following, which class of medications was shown by the Cochrane Review to have the best evidence for efficacy in treating post-traumatic agitation?
Benzodiazepines
Atypical antipsychotics
Anticonvulsants
Beta-blockers
Which of the following atypical antipsychotic medications has the serious side effect of agranulocytosis?
Clozaril
Seroquel
Zyprexa
Risperdal
Which class of medications was shown to impair motor recovery (with early daily administration) and cause transient recurrence of hemiparesis (with late administration) in cortically injured rats?
Anticonvulsants
Antidepressants
Benzodiazepines
Lithium
Which of the following medications may be a good choice for TBI patients whose aggression is related to manic effects and for those with cyclic mood disorders?
Lithium
Methylphenidate
Medroxyprogesterone Acetate
Carbamazepine
23 y/o M w/ Hx TBI 3 months ago reports worsening pain and decreased range of motion in his right hip. On exam, his hip is warm and with mild swelling. On labs, his alkaline phosphatase is elevated. What is the most likely cause of his lower extremity pain?
DVT
Osteoarthritis
Heterotopic Ossification
Septic Arthritis
What is the preferred medication for new onset of hypertension following TBI?
Lisinopril
Metoprolol
Amlodipine
Propranolol
What is the first line treatment for a TBI patient with neurogenic bladder?
Oxybutynin
Bethanecol
Tamsulosin
Timed voiding trials
Which of the following is true when comparing parenteral to enteral nutrition?
Parenteral nutrition has better absorption compared to enteral nutrition.
Enteral feeding is the preferred method of artificial feeding in most TBI patients.
Enteral nutrition has higher incidence of electrolyte and metabolic abnormalities which require closer monitoring than parenteral nutrition.
Parenteral nutrition is less expensive than enteral nutrition.
Which of the following are more likely potential risks associated with enteral feeding compared to parenteral feeding?
GERD
Infection
Pneumothorax during placement
Electrolyte/metabolic abnormalities
