Trauma

Question 1

TBI - pathophys - primary brain damage - diffuse axonal injury

Answer 1

disruption and tearing of axons and small BVs from shear strain of angular acceleration
results in neuronal death and petechial hemorrhages

Question 2

TBI - pathophys - primary brain damage - focal injury

Answer 2

contusions, lacerations, mass effect from hemorrhage and edema

Question 3

TBI - pathophys - primary brain damage - Coup contracoup injury

Answer 3

injury at point of impact and opposite point of impact

Question 4

TBI - pathophys - secondary brain damage - hypoxic-ischemic injury

Answer 4

results from systemic problems that compromise cerebral circulation

Question 5

TBI - pathophys - secondary brain damage - swelling/edema -

Answer 5

can result in mass effect, with inc intracranial pressures, brain herniation, and death

Question 6

TBI - pathophys - concussion

Answer 6

loss of consciousness either temporary or permanent - resulting from injury or blow to head with impaired functioning of brainstem reticular activating system (RAS)

Question 7

TBI - recovery stages from diffuse axonal injury - coma

Answer 7

state of unconsciousness in which there is neither arousal nor awareness
eyes remain closed
no sleep/wake cycles

Question 8

TBI - recovery stages from diffuse axonal injury - unresponsive vigilence/vegetative state

Answer 8

marked by the return or sleep/wake cycles and normalization of vitals
persistent veg state id remains in veg state for over 1 yr of TBI

Question 9

TBI - recovery stages from diffuse axonal injury - mute responsiveness/minimally responsive

Answer 9

state in which pt is not vegetative and does show signs, even if intermittent, of fluctuating awareness

Question 10

TBI - recovery stages from diffuse axonal injury - confusional state

Answer 10

mainly a disturbance of attention mechanisms
all cognitive operations are affected
pt is unable to form new memories
may demonstrate either hypoarousal or hyperarousal

Question 11

TBI - recovery stages from diffuse axonal injury - emerging independence

Answer 11

cofusion is clearing and some memory is possible; significant cognitive problems and limited insight remain; frequently uninhibited social bx

Question 12

TBI - recovery stages from diffuse axonal injury - intellectual/social competance

Answer 12

inc indp. although cog difficulties persist along with bx and social problems

Question 13

SCI - etiology - traumatic causes

Answer 13

MVA (most common cause of SCI)

jumps, falls, diving, gunshot wounds

Question 14

SCI - etiology - mechanism of injury

Answer 14

flexion - most common for lumbar
flexion-rotation - most common for cervical
compression, hyperextension

Question 15

SCI - spinal areas of greatest frequency of injury

Answer 15

C5, C7, T12, L1

Question 16

SCI - nontraumatic causes

Answer 16

disc prolapse, vascular insult, cancer, infection

Question 17

SCI - pathophys - primary injury -

Answer 17

interruption of blood supply

Question 18

SCI - pathophys - secondary sequelae -

Answer 18

ischemia, edena, demyelination, necrosis of axons, progressing to scar tissue formation

Question 19

SCI - classification - level of injury -

Answer 19

lesion level indicates most distal uninvolved nerve root segment with normal function
MM must have a grade of at least 3+ or fair+ function

Question 20

SCI - tetra/quad

Answer 20

injury occurs between C1 and C8 levels, involves all 4 extremities and the trunk

Question 21

SCI - para

Answer 21

injury occurs between T1 and T12-L1

Involves both lower extremeties and trunk

Question 22

SCI - degree of injury - complete

Answer 22

no sensory or motor function below level of lesion

Question 23

SCI - degree of injury - incomplete

Answer 23

preservation of sensory or motor function below level of inury; spotty sensation, some mm function

Question 24

SCI - ASIA scale A

Answer 24

complete, no motor or sensory function is preserved in sacral segment S4/5

Question 25

SCI - ASIA scale B

Answer 25

incomplete, sensory but no motor function is preserved below neuro level and includes sacral segments S4/5

Question 26

SCI - ASIA scale C

Answer 26

incomplete, motor function is preserved below neuro level and most key muscle below the neuro level have a muscle grade of less than 3

Question 27

SCI - ASIA scale D

Answer 27

incomplete, motor function is preserved below the neuro level, and most key mm below neuro level have a muscle grade of 3 or more

Question 28

SCI - ASIA scale E

Answer 28

normal - motor and sensory function is normal

Question 29

SCI - clinical syndromes - central cord syndrome

Answer 29

loss of more centrally located cervical tracts/arm function, with preservation of more peripherally located lumbar and sacral tracts/leg function Typically caused by hyperextension injuries to C spine

Question 30

SCI - clinical syndromes - Brown sequard syndrome

Answer 30

hemisection of spinal cord typically caused by penetration wounds (gunshot or knife) with asymmetrical symptoms

Question 31

SCI - clinical syndromes - Anterior cord syndrome

Answer 31

damage is mainly in anterior cord resulting in loss of motor function, pain and temp with preservation of light touch, prop, and postiion sense Typically caused by flexion injuries to C spine

Question 32

SCI - clinical syndromes - Posterior cord syndrome

Answer 32

loss of post columns with preservation of motor function, sense of pain and light tough extremely rare

Question 33

SCI - clinical syndromes - cauda equina

Answer 33

injury below L1 results in injury to lumbar and sacral roots of peripheral nerves (LMN) with sensory loss and parlysis and some capacity for regeneration LMN lesion with auonomous or nonreflex bladder

Question 34

SCI - clinical syndromes - sacral sparing

Answer 34

sparing of tracts to sacral segments, with preservation of perianal sensation, rectal sphincter tone, or active toe flexion

Question 35

WC - patients with high cervical lesion (C1-C4)

Answer 35

electric wc with tilt in space seating or reclining seat back microswitch or puff and sip controls

Question 36

WC - pts with cervical lesions, shoulder function, elbow flexion (C5)

Answer 36

manual chair for propulsion with aids indp. for short distances on smooth flat surfaces may choose electric for longer distance for energy conservation

Question 37

WC - pts with cervical lesions, radial wrist extensors (C6)

Answer 37

manual wheelchair with friction surface hand rims | indpendent

Question 38

WC - pts with cervical lesions, triceps (C7)

Answer 38

manual wc with friction surface hand rims with icnreased propulsion

Question 39

WC - pts with hand function (C8-T1 and below)

Answer 39

manual wc with standard hand rims

Question 40

Locomotor training - pts with midthoracic lesions (T6-9)

Answer 40

supervised ambulation for short distances require KAFOs and crutches swing to gait pattern

Question 41

Locomotor training - pts with high lumbar lesions (T12 - L3)

Answer 41

inp in ambulation on all surfaces and stairs using swing through or four gait pattern with bilateral KAFOs and crutches

Question 42

LT - pts with low lumbar lesions (l4-5)

Answer 42

inp with bilateral AFOs and crutches or canes