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1. Approximately 1.5 million Americans survive a traumatic brain injury (TBI) each year and:
A. Approximately 175,000 are hospitalized and nearly 30,000 Americans die each year following traumatic brain injury
B. The leading cause of TBI is motor vehicle accidents, which account for 32% of brain injuries
C. The vast majority of total reported TBIs are mild, and approximately 90% of these follow a predictable course and experience few, if any, ongoing symptoms
D. Only about 22% of patients experience post-injury symptoms of a long lasting nature
2. The management of patients who present with symptoms following a concussion or mild TBI (m/TBI) injury should focus on promoting recovery and avoiding harm.
3. Physical symptoms of post-concussion/mTBI include:
A. Attention and memory impairments
B. Anxiety and aggression
C. Sleep disturbance and seizure
D. None of the above
4. Post-traumatic amnesia that continues for 5 days or more after TBI is considered to be severe.
5. Although the elapsed time since exposure to the head injury and the self reporting of symptoms to the primary care provider may vary, this period is very important in assessing the risk of developing concussion/mTBI symptoms and determining the appropriate intervention.
6. Taking an accurate history is an essential part of the diagnostic work-up following mild TBI, and should include:
A. Detailed information on the patient's symptoms and health concerns
B. Injury specifics including mechanism of injury, duration and severity of alteration of consciousness, immediate symptoms, symptom course and prior treatment
C. Assessing of danger to self or others
D. All of the above
7. When assessing a patient's perception of symptoms, the clinical should observe the patients attitude, reactions, and __________ while being questioned.
A. Verbal clues
8. Referral to specialty care is required in the majority of patients with concussion/mTBI as a precaution, even if their symptoms resolve in the early post acute recovery period.
9. Activity restrictions as a part of the treatment regimen for patients with concussion/mTBI do not imply complete bed rest but rather a restful pattern of activity throughout the day with minimal physical and mental exertion.
10. Pharmacologic treatment for headaches following m/TBI include each of the following EXCEPT:
B. Non narcotic pain meds
11. Medication for ameliorating the neurocognitive effects attributed to concussion/mTBI is not recommended.
12. Which of the following is NOT an accurate statement about what is recommended as part of physical rehabilitation after m/TBI?
A. Non-contact aerobic and recreational activities should be encouraged within the limits of the patient
B. Specific vestibular, visual, and proprioceptive therapeutic exercise is suggested for dizziness and spatial impairments
C. One should consider a gradual increase in duration and intensity of an activity
D. Focal impairments benefit most from generalized exercise programs that increase cardiovascular health
13. All patients should receive follow-up care in _________ to confirm resolution of symptoms and address any concerns the patient may have.
A. 2-4 weeks
B. 4-6 weeks
C. 6-8 weeks
D. 8-10 weeks
14. In patients with persistent post-concussive symptoms that have been refractory to treatment, consideration should be given to other factors including behavioral health, psychosocial support, and compensation/litigation.
15. Peri-injury risk factors for poor overall outcomes following m/TBI include lower levels of intelligence and pre-neurological conditions.
16. Persistent psychological post-concussive symptoms include:
A. Problems with memory
B. Functional status limitations
C. Problems controlling emotions
D. Insomnia and sleep disturbance
17. A consultation or referral to specialists should occur in a patient with concussion/mTBI who complains of persistent or chronic symptoms when:
A. An atypical pattern or course (worsening or variable symptom presentation) is demonstrated
B. The patient is experiencing difficulties in return to pre-injury activity (work/duty/school)
C. Problems emerge in the role of the patient in family or social life
D. All of the above
18. Individuals who present with memory, attention, and/or executive function problems which did not respond to initial treatment may be considered for referral to cognitive rehabilitation therapists with expertise in TBI rehabilitation.
19. Case managers facilitate access to supportive services for the patient and family and serve as _____________ for both.
20. Therapeutically-based treatment following m/TBT should include the reestablishment of structured routines, marriage/family dynamics, educational activities, vocation, and community involvement, while encouraging a return to the normal patterns of daily life.
21. A structured program that promotes community integration may be considered when risidual persistent post-consussion symptoms impede an individual's return to pre-injury participation in customary roles.
22. After the initial m/TBI follow up visit, every____________ is the next recommended follow-up period if the patient is doing well.
A. 5-6 months
B. 4-5 months
C. 3-4 months
D. 2-3 months
23. Localized muscle tenderness is typical in post-traumatic migraine-like headaches.
24. Dizziness, impaired balance, and altered coordination have been reported in as many ____ of people after TBI.
25. Pharmacological approaches to sleep regulation and/or cognitive behavioral sleep interventions may be useful to assist sleep disturbance following concussion.
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