Medical and Physical Complications

Question 1

orthostatic HTN, aspiration pneumonia, and DVT are what kinds of brain injury complications?

Answer 1

chronic cardiopulmonary issues

DVT = deep vein thrombosis

Question 2

dysautonomia

Answer 2

aka autonomic storming, sympathetic storming, autonomic dysreflexia

occurs generally at GCS 3-8, usually resolves in early recovery

Question 3

a patient presents with HR 69, BP 140/85, respiration 18 breaths per minute. Which vital sign is abnormal?

Answer 3

HR: 60-90 bpm
BP: 100/65 - 137/84 (this is high in patient presenting)
respiration: 12-20 breaths per minute

Question 4

heterotopic ossification

Answer 4

abnormal bone growth in soft tissue adjacent to joints

Question 5

involuntary exaggerated deep tendon reflexes

Answer 5

hyperreflexia

Question 6

involuntary increased muscle tone

Answer 6

spasticity

Question 7

contractures

Answer 7

abnormal, usually permanent condition of joints - often in flexed position, fixation due to wasting away/shortening of muscle fibers and loss of skin elasticity

Question 8

what interventions can be used for spasticity and contractures that are secondary to brain injury?

Answer 8

exercise, casting, e-stim to improve flexibility and tone, oral anti-spasticity meds, nerve blockers, botox, surgically implanted baclofen pump

Question 9

why might a surgically implanted baclofen pump be used following a TBI?

Answer 9

to treat musculoskeletal complications of spasticity/contractures

Question 10

T/F: metabolism decreases following mod-severe brain injury

Answer 10

FALSE: metabolism increases (~40% more calories)

Question 11

G-tube vs J-tube

Answer 11

G-tube: surgically placed into stomach or small bowel

J-tube: through skin of abdomen into midsection of small intestine

Question 12

pulmonary/ lung aspiration

Answer 12

breathing in foreign substance (food, liquid, mucus, medicine, saliva, etc)
can lead to choking or aspiration pneumonia

Question 13

describe the 3 phases of swallowing

Answer 13

1: oral preparatory stage - mastication, bolus formation, propulsion of bolus into pharynx
2: pharyngeal phase - bolus passes epiglottis and upper esophageal sphincter. tongue blocks oral cavity, epiglottis blocks larynx, soft palate blocks nasal cavity
3: esophageal phase - bolus moves towards lower esophageal sphincter

Question 14

compare level 1 dysphagia diet to level 3

Answer 14

level 1 dysphagia requires pureed food (nothing that requires bolus formation)
level 3 dysphagia allows all food except hard, sticky, crunchy

Question 15

cause of and medication to treat diabetes insipidus

Answer 15

diabetes insipidus due to decreased vasopressin (ADH) –> decreased fluid levels
treat with desmopressin

Question 16

pressure sores and how to prevent them

Answer 16

areas of bony prominence (shoulders, elbows, lower back, hips, etc)
prevent by keeping skin clean/dry, changing position every 2 hours, using pressure-relieving devices (mattresses, cushions, tilt-in-space wheelchairs)

Question 17

what are the stages of pressure ulcers

Answer 17

stage 1: intact skin
stage 2: skin breaks open
stage 3: deep wound, full thickness tissue loss, subcutaneous fat may be visible
stage 4: very deep tissue loss, exposed bone/tendon/muscle

unstageable: full thickness tissue loss, but actual depth of ulcer is obscured by slough or eschar in wound bed
deep tissue injury: discolored intact skin or blood-filled blister, area around may be warmer or cooler

Question 18

immediate post-traumatic convulsions (IPTC)

Answer 18

occur within moments of injury, considered to represent non-epileptic events, associated with low risk for recurrent seizures

Question 19

T/F: EPTS do not increase risk of secondary brain damage

Answer 19

FALSE: early post-traumatic seizures (1 week or earlier AI) are a strong risk factor for development of late post-traumatic seizures (LPTS). Detection and treatment of EPTS is necessary to minimize potential secondary brain damage

Question 20

missile wounds, bilateral or multiple contusions, and multiple craniotomies are the strongest risk factors of (EPTS/LPTS)

Answer 20

late post-traumatic seizures

LPTS are a strong predictor of recurrent seizures

Question 21

status epilepticus

Answer 21

seizures that last longer than 5 minutes, seizures so close together that person cannot recover in between

high mortality risk

benzodiazepine is the first line of treatment (tx), provides rapid seizure control

Question 22

what is benzodiazepine used for

Answer 22

first line of treatment for rapid seizure control (esp. status epilepticus)

Question 23

phenytoin

Answer 23

anticonvulsant, antiepileptic prophylaxis for adult patients with severe TBI, given for 7 days to decrease risk of early post-traumatic seizures

Question 24

T/F: continuing antiepileptic prophylaxis such as phenytoin, carbamazepine, or valproate beyond the first week AI has been shown to decrease risk of LPTS

Answer 24

FALSE

Question 25

what are the two most common pain pathways in persons with TBI, and compare their respective pharmacological approaches

Answer 25

nociceptive pain - due to damage to tissue, pain related to peripheral nerve fibers. Treat with NSAIDS (aspirin, ibuprofen, naproxen), acetaminophen, anti-spasticity meds, opioids neuropathic pain - damage to nerves (primary lesion). Treat with opioids, tramadol, anticonvulsants, antidepressants (including tricyclics), nerve blocks

Question 26

``` which of these interventions would NOT be effective for managing neuropathic pain? opioids Lyrica anticonvulsants NSAIDS tricyclics/antidepressants epidural steroids ```

Answer 26

NSAIDS (useful for nociceptive pain)

Question 27

criteria of chronic headache

Answer 27

occurs at least 15 days per month for at least 3 months

Question 28

tension type headache (TTH)

Answer 28

bilateral head pain that feels like pressing/clamping occurs from either neck or head muscle strain/injury does not get worse with physical activity does not present with hypersensitivity treat with NSAIDs/ acetaminophen, antidepressants, botox

Question 29

which of these is TRUE: tension type headache worsens with physical activity tension type headache does not present with hypersensitivity

Answer 29

TTH does not worsen with physical activity, does not present with hypersensitivity

Question 30

craniomandibular headache is a subtype of ___

Answer 30

craniomandibular headache is subtype of tension type headache, associated with temporal mandibular join

Question 31

cervicogenic headache diagnosis method and treatment?

Answer 31

defined as head pain from cervical spine clinical diagnosis made by nerve block or provoking the headache by manipulation treat with nerve injections (short term) or burning nerves to severe (long term)

Question 32

T/F: migraines are usually bilateral

Answer 32

FALSE: migraines usually affect only one side (but not always). usually in back of head

Question 33

4 phases of migraines

Answer 33

prodrome - food cravings, mood changes aura - numbness, tingling, vertigo headache - peaks 24 h postdrome - similar to prodrome

Question 34

tricyclic antidepressants (serotonin re-uptake inhibitors), topiramate (inhibits trigeminal nerve), beta-blockers, and calcium channel blockers are all preventative medications for ____

Answer 34

migraines

Question 35

obstructive/ non-communicating hydrocephalus

Answer 35

obstruction/ blockage of CSF causing increased pressure (increased CSF in ventricles)

Question 36

hydrocephalus ex-vacuo

Answer 36

brain tissue causes neuronal loss, brain tissue shrinkage, brain atrophy, but pressure is usually normal

Question 37

spasticity as motor disorder is due to damage to (UMN/LMN)

Answer 37

UMN

Question 38

heterotrophic ossification

Answer 38

formation of new bone around joints as consequence of trauma/ immobility

Question 39

Heparin

Answer 39

anti-coagulant | can be used as prophylaxis to DVT

Question 40

T/F: pulmonary embolism is the 3rd leading cause of death in those who survive first day of brain injury

Answer 40

TRUE

Question 41

damage to corpus callosum can cause this kind of coordination disorder

Answer 41

interlimb coordination

Question 42

damage to cerebellum can cause this kind of coordination disorder, affecting voluntary movements and decreasing coordination

Answer 42

ataxia

Question 43

athetoid

Answer 43

slow, involuntary, convoluted writhing movements in fingers, toes, hands, feet

Question 44

choreiform

Answer 44

continuous, rapid, unpredictable movements

Question 45

anosognosia

Answer 45

deficit of awareness

Question 46

somatognosia

Answer 46

unaware of a body part

Question 47

apraxia

Answer 47

deficit in motor planning

Question 48

diplopia

Answer 48

double vision

Question 49

paraplegia vs tetraplegia

Answer 49

paraplegia - trunk/legs/pelvic organs paralyzed (SCI) | tetraplegia - arms, hands, trunk, legs, pelvic organs paralyzed (SCI)

Question 50

what are the 3 levels of disorders of consciousness (DOC)

Answer 50

coma --> vegetative --> minimally conscious

Question 51

criteria for emergence from DOC (disorder of consciousness)

Answer 51

must meet 1 of 2 behavioral criteria: functional communication (verbal/gestural answer to yes or no question) OR functional use of 2 or more objects (cup, toothbrush, etc)

Question 52

a patient is unconscious for an extended period of time. They should spontaneous or stimulus-induced eye opening (due to sleep/wake cycle) and grimace to pain. Are they in a coma or vegetative state?

Answer 52

vegetative state in coma there is no eye opening or behavioral signs of awareness

Question 53

T/F: patients in minimally conscious state display spontaneous eye opening due to sleep-wake cycle

Answer 53

TRUE

Question 54

Visual Analogue Scale for Fatigue

Answer 54

assesses fatigue and energy at a single point in time

Question 55

Fatigue Severity Scale

Answer 55

assesses impact of fatigue on daily function using 7 point scale

Question 56

periodic limb movement disorder

Answer 56

sleep disorder characterized by periodic episodes of repetitive and highly stereotyped limb (usually leg) movements during sleep