1
diaschisis
Of the three items in GCS (glascow coma scale), which is the best predictor of outcome
Motor response
Which cranial nerve is the most commonly damaged by blunt head trauma
Cranial Nerve I, olfactory
What is second impact syndrome?
When a person suffers a second brain injury (usually minor in severity) before symptoms of prior concussion have cleared. There is rapid decompensation with collapse, pupil dilation, respiratory failue. Failure of brains vascular autoregulation leads to increased ICP resulting in herniation. Morbidity 100% with mortality 50%.
Which medical school did i attend
LECOM- Erie
This is the leading cause of all TBIs in the united states
Falls
What type of injury is a result of a rapid change in position of the brain within the cranial vault results in shearing forces that primarily affect white matter
Traumatic Axonal Injury (TAI) aka Diffuse Axonal injury (DAI).
What imagining modality best demonstrates DAI?
Describe the difference between primary and secondary brain injury, and give examples
primary: resulting from the trauma itself (EDH,SAH, DAI).
secondary: cascading affects after the primary injury which extends to days, weeks, months and even years (neurotransmitter/electrolyte/metabolic dysfunction resulting in swelling, cell death, hypoxia, ischemic/reperfusion)
Which type intracranial bleed is described here...blood leakage from enlarged ectactic capillaries or sinusoids on the outer membrane attached to the dura, which are supplied by the middle meningeal artery.
Chronic SDH...this is pathologically different from acute/subacute SDH, NOT just simply an older bleed from bridging veins.
What is my favorite food?
Favorite dessert?
Favorite soda?
pizza
ice cream
Dr Pepper
This type of diet can be instituted in patients with refractory post traumatic epilepsy, particularly in pediatric population, to decrease seizure burden
ketogenic
What is the leading cause of of TBI related deaths according to the CDC
Intentional self harm
What Ranchos Level should someone be at before a modified diet with direct supervision can be start?
What ranchos should someone be at to sustain oral intake
IV --> confused agitated
VI -->confused appropriate
Which intracranial mass lesion is described...subdural collection of cerebrospinal fluid
subdural hygroma
What is my Wife's name?
Kimberly
What percentage of patients who suffer a TBI and present to the hospital have alcohol use disorder?
50%
This mental health disorder is twice as likely to occur in military personal (compared to civilians) after TBI and is associated with longer duration of symptoms and more severe symptoms. If a military personal were to commit suicide this mental health disorder occurs in 73% of the cases.
Post Traumatic Stress Disorder (EMDR)
What is the pathognomonic findings of chronic traumatic encephalopathy on autopsy.
perivascular p-tau neurofibrillary tangles and abnormal neurites at the depths of the cortical sulci in an irregular pattern in the cerebral cortex.
This neurosurgical emergency is when there is bifrontal subdural air compressing and separating the frontal lobes. Bonus points for the radiologic sign....extra bonus points for the physical exam maneuver to "diagnose."
Tension pneumocephalus
Mount Fuji sign
"bruit hydroaerique" when you can auscultate the succession splash
What are my kids names?
Leo, Noah, Mollie
What are the five mechanism of injuries from a blast injury
primary: primary blast over/underpressurization
secondary: blast propelling objects
tertiary: thrown to ground/object
quaternary: blast products like heat/light/fumes
quinary: post blast environment like radiation, chemical burns, infections
What are the 5 domains (aka categories) for sleep disturbances after TBI
Circadian Rhythym
polypharmacy
medical disorders
mood disorders
primary sleep disorder
What are the physiologic criteria that must be met when performing a brain death exam.
What is the final examination for brain death and the cut off to confirm
off all sedating medications, no severe electrolyte abnormalities, core temp >36.5C, SBP >90, coma + absent cranial nerves
lack of spontaneous breathing with significant hypercapnia (PaCO2 > 60mmHg or > 20 above baseline)
Is EEG acceptable --> no false positives too high due to background noise
This diagnosis should be ruled out when patients complain of dizziness post TBI
BPPV (benign paroxysmal positional vertigo). should do bilateral testing
Where did i go on my honey moon
Costa Rica