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Traumatic Brain Injury 2

Total questions: 29

Worksheet time: 15mins

Name
Class
Date
1.

In patients with severe TBI, two thirds occur in which region of the brain?

a)

Occipital region

b)

Hypothalamic Pituitary Region

c)

Basal Cisterns

d)

Mamillary Bodies

2.

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?

a)

Nicotine replacement

b)

Morphine PRN

c)

Amitriptyline nightly

d)

Carbamazepine daily

3.

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?

a)

Fluid restrict to 1L per day, consider adding a loop diuretic

b)

Administration of hypertonic fluid infusion.

c)

Rapid correction Desmopressin

4.

25M, TBI with MRI showing fracture of turcica. Which sodium disorder would you most likely expect to see?

a)

Psychogenic Polydipsia

b)

Diabetes Insipidus

c)

Cerebral Salt Wasting

d)

SIADH

5.

Which of the following is not true when classifying Mild TBI's (Concussions)?

a)

LOC must be 30 minutes or less

b)

Post traumatic amnesia (PTA) must be at least 48 hours

c)

Initial GCS of 13 or higher

d)

Loss of memory for events before or after an injury

6.

Mild TBI Constitutes what percentage of TBI cases in the United States?

a)

30%

b)

50%

c)

80%

d)

10%

7.

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?

a)

Impairment of the brain's vascular autoregulation system

b)

Flooding of excitatory neurotransmitters

c)

Abnormal fluctuation in sodium levels

d)

Shearing forces against long connecting nerve fibers

8.

Which domain is not included when classifying Concussion severity?

a)

Cognitive

b)

Intelligence

c)

Affective

d)

Sleep Changes

9.

After sustaining a concussion, when is the earliest possible allowable return to play?

a)

24 hours

b)

1 week

c)

4 weeks

d)

3 months

10.

The majority of posttraumatic seizures are

a)

Complex partial

b)

Simple partial

c)

Grand mal

d)

Tonic-clonic

e)

Absence

11.

In the TBI population, which medications are preferred for partial seizure and generalized seizure, respectively?

a)

Carbamazepine, Valproic acid

b)

Valproic acid, Phenytoin

c)

Phenytoin, Valproic acid

d)

Valproic acid, Carbamazepine

12.

Which of the following risk factors is NOT associated with a higher risk of late posttraumatic seizures?

a)

Penetrating head injury

b)

Intracranial hematoma

c)

Coma or PTA lasting 12 hours

d)

Posttraumatic seizures on 3 days s/p injury

e)

Depressed skull fracture

13.

If a late post-traumatic seizure occurs, the probability of recurrent late PTS is:

a)

5%

b)

15%

c)

50%

d)

85%

e)

95%

14.

Which AED is associated with gastrointestinal side effects?

a)

Valproic Acid

b)

Gabapentin

c)

Levetiracetam

d)

Phenobarbital

e)

Phenytoin

15.

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?

a)

Nystagmus and ataxia

b)

Sedation, irritability, and hyperactivity

c)

Absence status epilepticus

d)

Steven-Johnson syndrome

16.

When is it reasonable to consider withdrawal of antiepileptic drugs for patients with posttraumatic epilepsy?

a)

After seizure-free for 6 months

b)

After seizure-free for 1 year

c)

After seizure-free for 2 years

d)

After seizure-free for 1 year on only 1 AED

17.

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?

a)

CN XI

b)

CN I

c)

CN VII

d)

CN VIII

e)

CN XII

18.

A TBI patient is in a floor (Craig) bed thrashing about. What is the most appropriate next step?

a)

Place the patient in the least restrictive physical restraints possible

b)

Administer IM Haldol

c)

Administer IM olanzapine

d)

Allow the patient to thrash

19.

What is the first line treatment for a patient with TBI who develops HTN, tachycardia, and perspiration?

a)

Indomethacin

b)

Valium

c)

Cooling blankets and NGT lavage

d)

Dantrolene

e)

Propranolol

20.

In regards to the dopamine pathways, decreasing dopamine in the nigrostriatal pathway leads to which of the following?

a)

Increased prolactin

b)

Increased movement disorders

c)

Increased negative symptoms

d)

Decreased positive symptoms

21.

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?

a)

Benzodiazepines

b)

Atypical antipsychotics

c)

Anticonvulsants

d)

Beta-blockers

22.

Which of the following atypical antipsychotic medications has the serious side effect of agranulocytosis?

a)

Clozaril

b)

Seroquel

c)

Zyprexa

d)

Risperdal

23.

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?

a)

Anticonvulsants

b)

Antidepressants

c)

Benzodiazepines

d)

Lithium

24.

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?

a)

Lithium

b)

Methylphenidate

c)

Medroxyprogesterone Acetate

d)

Carbamazepine

25.

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?

a)

DVT

b)

Osteoarthritis

c)

Heterotopic Ossification

d)

Septic Arthritis

26.

What is the preferred medication for new onset of hypertension following TBI?

a)

Lisinopril

b)

Metoprolol

c)

Amlodipine

d)

Propranolol

27.

What is the first line treatment for a TBI patient with neurogenic bladder?

a)

Oxybutynin

b)

Bethanecol

c)

Tamsulosin

d)

Timed voiding trials

28.

Which of the following is true when comparing parenteral to enteral nutrition?

a)

Parenteral nutrition has better absorption compared to enteral nutrition.

b)

Enteral feeding is the preferred method of artificial feeding in most TBI patients.

c)

Enteral nutrition has higher incidence of electrolyte and metabolic abnormalities which require closer monitoring than parenteral nutrition.

d)

Parenteral nutrition is less expensive than enteral nutrition.

29.

Which of the following are more likely potential risks associated with enteral feeding compared to parenteral feeding?

a)

GERD

b)

Infection

c)

Pneumothorax during placement

d)

Electrolyte/metabolic abnormalities