Deck 5: Head Injuries

Question 1

When an injury results from a direct blow to the skull and the injured tissues lie beneath the point of contact, the injury is considered a ____________.

A) coup injury
B) contrecoup injury
C) contralateral injury
D) concussive injury

Answer 1

A

Question 2

Which of the following statements is not true with respect to head injury?

A) Concussions are caused by direct blows to the head or elsewhere in the body resulting in sudden, turbulent, and mechanical loading of the cerebral hemisphere.
B) Impacts between the cortex and bony walls of the skull can cause immediate and short-lived impairment of neurological function.
C) Signs and symptoms associated with concussions typically do not resolve sequentially.
D) Concussion is most often associated with normal results on conventional neuroimaging studies.

Answer 2

C

Question 3

Diffuse brain injuries typically arise following which of the following mechanisms of injury?

A) Moments of successive acceleration and deceleration
B) Movement of the brain that occurs linearly or rotationally
C) Shaking of the brain within the skull
D) A & C
E) A, B, & C

Answer 3

E

Question 4

Diffuse axonal injury, the most severe type of diffuse brain injury, typically results in ___________.

A) decreased concentration
B) decreased memory
C) decreased cognitive function
D) A & B
E) A, B, & C

Question 5

Which of the following best describes what a cerebral concussion is?

A) Transient neurological dysfunction resulting from applied force to the head
B) Having your bell rung by a head-to-head collision during a football game
C) Experiencing periods of amnesia following a direct head impact
D) All of the above

Question 6

Which of the following stresses are fairly well tolerated by neural tissue?

A) Compressive
B) Shear
C) Tensile
D) Rotational

Question 7

When we discuss concussions, the term traumatic brain injury is often used. How many classifications exist for focal brain injury?

A) 2
B) 3
C) 4
D) 6

Question 8

The colloquial terms "got dinged" or "got his bell rung" are often used to describe __________.

A) a stunned, confused state that resolves in minutes
B) a full-blown concussion
C) a concussion resulting in very-short lived signs and symptoms
D) A & C
E) A, B, & C

Question 9

Signs and symptoms of focal vascular injuries include________.

A) loss of consciousness
B) cranial nerve deficits
C) heightened mental status
D) A & B
E) A & C

Question 10

Focal brain injuries include which of the following medical conditions?

A) Subdural hematomas
B) Cerebral contusions
C) Intracerebral hemorrhaging
D) Intracerebral hematomas
E) All of the above

Question 11

At what point should a grade for a concussion be established?

A) Immediately following the injury and during the initial evaluation
B) Immediately following serial evaluations that are taking place on the sidelines
C) One week following the initial injury
D) After symptoms have completely resolved themselves

Question 12

__________ typically do not present with macroscopic brain lesions and will involve global disruption of neurological function.

A) Diffuse brain injury
B) Focal brain injury
C) Subdural hematoma
D) Intracranial bleeding

Question 13

When describing the mechanism of injury for severe diffuse brain injuries, it has been determined that the primary loading that is occurring involves __________.

A) rotational acceleration
B) rotational deceleration
C) rotational acceleration and deceleration
D) linear compression and decompression

Question 14

___________ are posttraumatic intracranial mass lesions that may include subdural hematomas.

A) Focal brain injuries
B) Diffuse brain injuries
C) Cerebral contusions
D) All of the above

Question 15

Which of the following are not applied forces typically responsible for injury to the brain?

A) Compressive
B) Shear
C) Tensile
D) Rotational

Question 16

What are the key elements in causing coup and contrecoup injuries to the brain?

A) Involvement of cerebrospinal fluid
B) Brain lag and disproportionate distribution of cerebrospinal fluid during movement
C) Whether or not the head is moving prior to impact
D) A & C only
E) A, B, & C

Question 17

_______ is the most common sports-related traumatic brain injury.

A) Cerebral concussion
B) Subdural hematoma
C) Intracranial bleeding
D) None of the above

Question 18

___________ forces acting on the brain involve forces moving across parallel tissue organization.

A) Compressive
B) Shear
C) Tensile
D) Rotational

Question 19

When an athlete's head hits an unyielding object producing maximum brain injury opposite the site of cranial impact due to the rebound, the brain injury is classified as a ___________.

A) coup injury
B) contrecoup injury
C) contralateral injury
D) concussive injury

Question 20

Mild concussions will typically not result in _________.

A) alterations in mental status
B) impairments in cognitive function
C) dizziness and tinnitus
D) significant loss of gross motor coordination

Question 21

If you suspect that an athlete is regaining consciousness when you arrive at the athlete's side on the field, how should you manage the athlete?

A) Initially you must treat the athlete as if he has a cervical spine injury.
B) You would ask the athlete if he lost consciousness and then have the athlete sit up.
C) You would bring the athlete to his feet and walk him off the playing field.
D) None of the above

Question 22

An athlete presents to you on the sideline with the following signs and symptoms: tinnitus, transient mental confusion, unsteadiness, and prolonged posttraumatic amnesia. The patient also indicates that he may have lost consciousness briefly, which is something you confirmed with teammates. Although you would normally grade the concussion after all symptoms had been resolved, you suspect that your athlete has suffered a __________ concussion.

A) mild
B) medium
C) moderate
D) severe

Question 23

Which of the following is not one of the primary objectives for the clinician when dealing with an athlete with a head injury?

A) Recognizing the injury and its severity
B) Determining if the athlete requires additional attention or assessment
C) Deciding when it is safe for the athlete to return to sports activity
D) All of the above

Question 24

Which of the following observations and palpations should take place during the initial on-field evaluation to rule out more serious conditions?

A) Altered facial expressions
B) Altered speech patterns
C) Changes in respiration
D) Removal of the helmet
E) Gentle palpation of the skull and cervical spine

Question 25

When performing a more thorough sideline examination, what should be the first element of your assessment?

A) Assessment of cranial nerve function
B) Check for basilar fractures
C) Assessment of pulse rate and blood pressure
D) Assessment of strength

Question 26

____________ often occurs within 1 week of an unreported concussion and involves rapid brain swelling and herniation.

A) Subdural hematoma
B) Cerebral hematoma
C) Second impact syndrome
D) None of the above

Question 27

The Balance Error Scoring System (BESS) was developed to __________.

A) provide for an objective means of assessing postural stability
B) provide for an objective means of assessing proprioception
C) provide for an objective means of assessing balance during the injury recovery process
D) A & C

Question 28

_________ typically occurs in conjunction with a skull fracture in the temporoparietal region. The injury itself usually develops quickly and involves blood collecting between the dura mater and inner surface of the skull.

A) Cerebral contusion
B) Cerebral hematoma
C) Epidural hematoma
D) Subdural hematoma

Question 29

Which of the following questions would not be appropriate for assessing whether or not an athlete with a concussion is suffering from retrograde amnesia?

A) What play were you running in the last series?
B) What team are you playing today?
C) Who scored the last touchdown for your team?
D) What is the first thing you remember after the hit?

Question 30

Which of the following tests can and should be used as a brief mental screening, even by clinicians who have little experience with neuropsychological testing?

A) Standardized Assessment of Concussion
B) Loss of Control (LOC) Scale
C) Automated Neurophysiological Assessment Metrics (ANAM)
D) CogState
E) All except B

Question 31

What percentage of cerebral concussions involves a loss of consciousness?

A) 50%
B) 75%
C) 85%
D) Greater than 90%

Question 32

__________ may result after an object strikes the skull, causing vessels to bleed internally. This condition may result in partial paralysis, one-sided pupil dilation, or altered vital signs.

A) Cerebral hematoma
B) Cerebral contusion
C) Cerebral concussion
D) Subdural hematoma

Question 33

Management for concussions should include ________.

A) rest only
B) rest and serial evaluations
C) rest and physician referral prior to clearance
D) return to play following symptoms subsiding
E) C & D