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Care of the Patient with Mild Traumatic Brain Injury

1. Diagnostic criteria for mild traumatic brain injury (MTBI) includes disruption of brain function manifested by at least one of the following characteristics EXCEPT:

A. Loss of consciousness

B. Loss of memory for events immediately before or after the accident

C. Alteration in mental state at the time of the accident (feeling, dazed, disoriented, or confused)

D. Transient external neurologic deficits

Scope of the Problem

2. According to the World Health Organization (WHO) definition of MTBI, loss of consciousness for 60 minutes or less and post-traumatic amnesia for less than 12 hours must be present.

A. True

B. False

Recommendation: Epidemiology

3. Between ______________ emergency department (ED) visits occur in the United States annually for TBI and approximately ____ of these are MTBI.

A. 1-1.5 million; 80%

B. 1.5-2 million; 75%

C. 2-2.5 million; 70%

D. 2.5-3 million; 65%


4. Health promotion efforts to prevent MTBI in adults include promoting and supporting educational programs directed toward violence and suicide prevention in the community.

A. True

B. False

5. Educating parents and families about the potential stresses of parenthood and primary prevention activities to successfully manage stress are important factors for decreasing incidences of MTBI in children.

A. True

B. False


6. Concussion is always a primary injury as is initial neurological insult, and while the primary event cannot be changed steps can be taken to prevent secondary injury.

A. True

B. False


7. With indirect brain injury, brain dysfunction related to MTBI is altered _________________ rather than damage to the structure.

A. Focal response

B. Neuronal function

C. Brain metabolism

D. None of the above

Physiologic Differences Related to Age-Children

8. Although children commonly experience more severe symptoms of post-concussion syndrome than adults, the incidence of brain swelling after moderate brain injury is higher in adults than children.

A. True

B. False

Older Adults

9. Which of the following accurately describes physiologic brain differences related to older age?

A. The brain decreases in size by approximately 15% and brain weight decreases 4-5% between ages 30-70

B. There is a rapid decline in the number of neurons in the cortex of the cerebellum and hippocampus

C. Nerve conduction slows up to 20%

D. Cerebral blood flow declines 15%-20%

Computed Tomography (CT)

10. A noncontrast head CT is the first-line radiographic modality used in traumatic brain injury.

A. True

B. False

Table 1: CHALICE Criteria

11. The Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) criteria states that a CT scan is required if which of the following is present?

A. Witnessed loss of consciousness of >5 min duration or history of amnesia > 5 min duration

B. Abnormal drowsiness or > 3 vomits after head injury

C. Suspicion of nonaccidental injury or seizure after head injury in a patient who has no history of epilepsy

D. All of the above

Magnetic Resonance Technology Use In Concussion

12. Susceptibility Weighted Imaging (SWI) is a type of magnetic resonance technology that detects brain function by tracking blood flow to activated areas of the brain during a cognitive task.

A. True

B. False

13. The location of intracranial lesions in children has been associated wth attention deficit disorder, post-traumatic attention deficit hyperactivity disorder, personality disorder, and obsessive compulsive disorder.

A. True

B. False

Assessment and Monitoring

14. Which of the following is NOT included in the initial assessment of injury characteristics following MTBI?

A. History of the events leading to the concussion

B. Mechanism of injury

C. Duration and severity of alteration in mental status

D. Current symptoms and history of prior concussions

Assessment Tools

15. A combination of strategies that have been examined for utility in clinical practice is preferred to assess MTBI rather than a single measurement tool.

A. True

B. False

Assessment of Rehabilitation Needs

16. While most patients with MTBI experience a natural recovery occurring within minutes to several weeks following injury, approximately 20-25% have persistent symptoms or limitations.

A. True

B. False

Patient Problems-Acute Problems

17. Since headaches and other concussion symptoms are often experienced by the general population, it is important to understand the pre-injury occurrence of headache as well as the acute post-injury complaints.

A. True

B. False

18. Fatigue, exhaustion, or lack of energy is common following MTBI, as nearly ________ of persons suffering with MTBI demonstrate severe fatigue 6 months post-injury.

A. One-half

B. One-third

C. One-fourth

D. One-fifth

Sleep Disturbance Treatment Options-Pharmacologic

19. Fluoxetine is the first-line pharmacologic therapy for sleep disturbance related to TBI, while use of tricyclic antidepressants are undesirable due to potential interference with neuronal recovery.

A. True

B. False

Post-Injury Symptoms Reported In Pediatric Patients

20. Which of the following is NOT one of the common symptoms reported in children after MTBI?

A. Headache

B. Fatigue

C. Balance Problems

D. Visual Disturbances

Chronic Problems and Rehabilitation Issues

21. Post Concussive Symptoms (PVS) affect the patient in behavioral, cognitive, physical, and social aspects, and treatment is challenging because of the varied symptomatology relating to the dysfunction following MTBI.

A. True

B. False


22. An important component of cognitive rehabilitation for TBI is compensatory memory interventions, which include word-list learning and paragraph listening.

A. True

B. False

23. Risk factors that can cause ongoing memory impairments include each of the following EXCEPT:

A. Previous head injury

B. Age 50 years and older

C. Alcohol and drug abuse

D. Lower socioeconomic and/or intellect level

Education for the Patient and Family Related To Childhood MTBI Injuries

24. Premature return to sports for those who have suffered sport-related concussion is especially dangerous because the brain may not have fully recovered from the initial trauma, and adequate rest for brain healing may not have occurred.

A. True

B. False

Education for All Patients Following MTBI

25. Current literature addressing patient monitoring following MTBI strongly recommends awaking the patient several times throughout the first night after injury.

A. True

B. False


26. Asprin or ____________ and alcohol and may exacerbate symptoms of MTBI/PCS or prolong recovery time.

A. Anticoagulants

B. Beta-blockers

C. Stimulants


Pediatric Patients

27. Recommendations for resumption of activity for pediatric patients should include:

A. Notification of teachers, coaches, and counselors of the concussion upon return to play or school

B. Modified work load, non-strenuous play, rest periods, repetitive instructions

C. Frequent communication with parents

D. All of the above

Expected Outcomes: Recommendation

28. Any decline in neurologic status should prompt more frequent assessments as well as a medical evaluation during initial post-injury assessment.

A. True

B. False


29. In some cases, persistent symptoms after MTBI may be related to depression, _________, and anxiety.

A. Stress

B. Pain

C. Fatigue

D. Trauma

30. Children and adolescents tend to experience symptom recovery from MTBI at a much more rapid rate than adults.

A. True

B. False

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