TBI flashcards

Question 1

Patients with ___ and ___ have been associated with doubling mortality

Answer 1

hypotension and hypoxia

Question 2

what medication used for intubation does not increase ICP?

Answer 2

ketamine

Question 3

what is hyperventilation used for in acute management of TBI

Answer 3

decrease ICP through hypocarbic vasoconstriction

Question 4

when is surgical intervention appropriate for EDH?

Answer 4

EDH >30cm or GCS <9, clot thickness >15mm, midline shift >5mm or focal Neuro deficits

Question 5

when is surgical intervention appropriate for SDH?

Answer 5

SDH >10mm or those associated with midline shift >5mm, GCS <8 with rapid decline or ICP <20mmHg

Question 6

what positional changes can you do to help with intracranial hypertension

Answer 6

HOB >30 or reverse trendelenberg position to decrease ICP

Question 7

when should ICP monitoring be used

Answer 7

patients with Severe TBI and abnormal CT scan to reduce 2-week and in-hospital mortality

Question 8

what fluids are used to reduce ICP?

Answer 8

hypertonic saline 3% and mannitol 20%

Question 9

what study indicated that corticosteroids should not be used in TBI?

Answer 9

CRASH trial

Question 10

what is the equation for CPP

Answer 10

MAP - ICP

Question 11

what are the secondary brain Injuries?

Answer 11

impaired CBF regulation and alteration in brain metabolism

Question 12

what are the goals for ICP and CPP after Brain injury

Answer 12

ICP: <20

CPP between 50-70

Question 13

what are the primary brain injuries?

Answer 13

DAI and cerebral contusion

Question 14

where does DAI typically occur

Answer 14

axons of brainstem, parasagittal white matter of cerebral cortex, corpus callous and gray-white matter junctions of cerebral cortex

Question 15

how do you classify DAI?

Answer 15

Adams classification

Question 16

what is the most common cause of persistent coma after TBI?

Answer 16

DAI

Question 17

what aphasia is not fluent, cannot comprehend and can repeat?

Answer 17

mixed transcortical

Question 18

what aphasia is not fluent, can comprehend but cannot repeat

Answer 18

brocas

Question 19

what aphasia is not fluent, can comprehend and can repeat

Answer 19

transcortical motor

Question 20

what aphasia is fluent, cannot comprehend and can repeat

Answer 20

transcortical sensory

Question 21

what aphasia is fluent, can comprehend but cannot repeat

Answer 21

conduction

Question 22

most common abnormal hormone after brain injury?

Answer 22

growth hormone

Question 23

how do you treat SIADH

Answer 23

fluid restriction and if moderate/severe= demeclocycline

Question 24

most common cause of hypernatremia after brain injury?

Answer 24

Diabetes insipidus

Question 25

how do you treat diabetes insipidus

Answer 25

free water replacement and more severe DDAVP

Question 26

what are the Rancho levels (1-8)

Answer 26

1: no response 2. generalized response 3. localized response 4. confused agitated 5. confused inappropriate 6. confused-appropriate 7. automatic-appopriate 8. purposeful-appropriate

Question 27

what are the levels of the agitated behavior scale

Answer 27

14-21: normal 22-28: mild 29-35: moderate 35+ severe

Question 28

what score on CRSR means minimally conscious state

Answer 28

12 or higher

Question 29

most common site for TBI

Answer 29

anterior inferior frontal and temporal lobes

Question 30

most common brain tumor in childrens

Answer 30

astrocytomas and medulloblastomas

Question 31

most common brain tumor in adults

Answer 31

metastatic

Question 32

most common primary brain tumor in adults

Answer 32

GBM

Question 33

what is the clinical presentation of supratentorial tumors

Answer 33

seizures, increased ICP and focal neurological deficits

Question 34

what is the clinical presentation of infratentorial brain tumors

Answer 34

increased ICP, cranial nerve deficits and ataxia

Question 35

what cancer is the most common to metastasize to the brain

Answer 35

small cell lung cancer

Question 36

what is the second most common primary CNS neoplasm

Answer 36

meningioma

Question 37

what is the most common intratentorial tumor in adults

Answer 37

acoustic neuroma/schwannoma

Question 38

when does focal cerebral radiation necrosis typically occur

Answer 38

15-18 mints after XRT

Question 39

when does diffuse cerebral radiation injury occur

Answer 39

6-18 months after XRT

Question 40

what scale attempts to quantify outcome in quality of life in individuals with brain tumors

Answer 40

Karnofsky scale

Question 41

what variables are related to good quality of life in individuals with Brain tumors

Answer 41

freedom from depression, active social life, greater energy, fewer symptoms

Question 42

what complication of radiation for brain tumors is indistinguishable from recurrence of tumor on imaging and requires pathology for confirmation

Answer 42

FCRN

Question 43

what is the incidence of HO after TBI

Answer 43

11-35%

Question 44

what is the incidence of HO after SCI

Answer 44

16-53%

Question 45

what is the incidence of HO after burns

Answer 45

0.1-3.1%

Question 46

what is the peak occurrence for HO

Answer 46

2 months

Question 47

where is HO most common with SCI

Answer 47

hip

Question 48

where is HO most common in burn victims

Answer 48

elbow

Question 49

why is indomethacin used in HO

Answer 49

inhibits prostaglandin synthetase; inhibits inflammatory response and suppresses mesenchymal cell proliferation

Question 50

what are the gradings for HO around the him

Answer 50

0- no heterotopic bone 1- occupies less than 50% of the distance between femur and pelvis 2-occupies >50% of, but not bridging, the distance between the femur and the pelvis 3- formation of bridging heterotopic bone

Question 51

surgical timing for HO

Answer 51

traumatic HO can be resected at 6 months SCI HO at 1 year TBI HO at 1.5 years

Question 52

what is the major cause of post-TBI NPH

Answer 52

SAH

Question 53

what is the most important acute predictor of TBI outcome

Answer 53

ICP

Question 54

what are the cutoffs for ICP for not good vs fatal

Answer 54

>40 is not good | >60 is fatal

Question 55

what things make someone more prone to developing both NPH and seizures

Answer 55

SAH, depressed skull fracture, meningitis

Question 56

what is the most common cause of TBI in the USA

Answer 56

falls

Question 57

what is the most common cause of TBI world-wide

Answer 57

MVCs

Question 58

what age demographics are most likely to develop TBi

Answer 58

15-19 yo, >75 yo (falls) and 0-4yo

Question 59

where is CSF produced

Answer 59

at the choroid plexus in the lateral ventricles

Question 60

what is the most common cause of communicating NPH

Answer 60

TBI

Question 61

what are the CT findings for post-traumatic hydrocephalus

Answer 61

distended appearance of anterior horns of the lateral ventricles enlargement of the temporal horns of the 3rd ventricles normal or absent sulci enlargement of the basal cisterns or 4th ventricles periventricular lucency

Question 62

lifetime incidence of TBI is ____ greater in alcoholics

Answer 62

4x

Question 63

what percentage of TBIs occurred while the person was drunk

Answer 63

~50%

Question 64

how much more likely are TBI survivors to have another TBI

Answer 64

3-8 times higher risk

Question 65

how common is depression within the first year of a TBI

Answer 65

8 times more common

Question 66

what are the CAGE screening questions

Answer 66

C- cut back A-annoyed G-guilty E-eye-opener

Question 67

what are the most significant prognostic indicators after TBI

Answer 67

PTA duration and age

Question 68

how do you know if someone is out of PTA

Answer 68

GOAT >75 for 2 consecutive days or | O-log 25+ for 2 straight days

Question 69

what are the areas of scoring for CRSR

Answer 69

auditory (0-4), visual (0-5), motor (0-6), promoter (0-3), communication (0-2), arousal (0-3)

Question 70

coma lasting longer than ____ is very unlikely to have good outcome

Answer 70

2 weeks

Question 71

PTA less than ____ usually has good outcome

Answer 71

<2 weeks

Question 72

define coma

Answer 72

deep sustained pathologic unresponsiveness in which eyes remain closed and the patient cannot be aroused

Question 73

define vegetative state

Answer 73

condition in which awareness of self and environment is presumed to be absent and there is an inability to interact with others, although the capacity for spontaneous or stimulus-induced arousal (wakefulness) is preserved

Question 74

when does vegetative state become persistent

Answer 74

after 1 month

Question 75

mechanism of amantadine (most supported)

Answer 75

weak, non-competitive antagonist of the NMDA receptor, which increases dopamine release and prevents dopamine reuptake

Question 76

what is the primary thing found in SIADH

Answer 76

low sodium

Question 77

diagnostic labs for SIADH

Answer 77

low sodium, low serum. osmolarity, urine osmolarity> serum osmolarity, high urine sodium

Question 78

what happens with rapid correction of low sodium

Answer 78

central pontine myelinosis

Question 79

what is the primary symptom of DI

Answer 79

elevated sodium