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CERTIFIED BRAIN INJURY SPECIALIST EXAM Questions with 100% Correct Answers Verified Updated 2024.
Typology: Exams
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4 Ts - ✔✔Elements affecting sexual energy within a marriage. Time together; talking together; trusting each other; touching each other 504 Plan Section 504 of the Rehabilitation Act of 1973 - ✔✔A written plan developed by a general education school committee outlining accommodations to be made by a K-12 or post-secondary school that receives federal funds for a student with a disabling condition that substantially limits a major life activity.
Chronic Traumatic Encephalopathy (CTE) - ✔✔Also known as dementia pugilistica, refers to a condition, diagnosed after death, relative to multiple concussions caused by significant force. A progressive degenerative disease that is most often sustained by athletes participating in contact sports, where it is sometimes termed punch drunk. May also be observed in domestic violence victims or abused children who have sustained numerous blows to the head. It begins very slowly with deterioration in concentration, attention, memory, judgment, and insight, occasionally accompanied by dizziness and headaches. Severe symptoms of eventually show symptoms of Parkinsonism, including disturbed coordination, slowed gait, slurred speech, masked facies, difficulty swallowing and tremors. Acquired Brain Injury (ABI) - ✔✔An injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma Traumatic Brain Injury (TBI) - ✔✔an alteration in brain function, or other evidence of brain pathology, caused by an external force
closed injuries - ✔✔Can cause brain lacerations and contusions, or intracerebral hemorrhage within the brain causing focal injuries. i.e. coup-countercoup, and/or diffuse injury resulting from tearing or shearing of axons i.e. Diffuse axonal injury (DAI) Open injuries - ✔✔Breach of the skull or a breach of the meninges. These injuries often result in focal injuries (such as epidural or SDH, or ICH) or penetrating injury i.e. gunshot wound Mild TBI (mTBI) - ✔✔Can have either brief or no loss of consciousness and its presentation may demonstrate vomiting, lethargy, dizziness, and inability to recall what just happened. Moderate TBI - ✔✔Will be marked by unconsciousness for any period of time up to 24hours, will have neurological signs of brain trauma, including skull fractures
with contusion or bleeding, and may have focal findings on an electroencephalograph (EEG)/computed tomography (CT) scan. Normal or abnormal structural imaging; LOC >30min and <24 hr; AOC >24 hr severity based on other criteria; PTA >1 and <7 days; GCS = 9 - 12 Severe TBI - ✔✔Marked by a period of loss of consciousness of 24 hours or greater. Normal or abnormal structural imaging; LOC >24 hr; PTA >7 days; GCS = 3 - 8 Incidence - ✔✔occurrence; i.e. a certain number of brain injuries within a given year. Prevalence of Injury - ✔✔The number of people with a given condition (i.e. ABI) at a specific point in time
Mild Brain Injury (mBI) - ✔✔Injury to the brain, with Glasgow Coma Scores (GCS) between 13-15; Normal Structural Imaging; LOC = 0-30 minutes; AOC = from a moment up to 24hr; PTA = 0 - 1 day Akinesia - ✔✔slowness or loss of movement epidural hematoma (EDH) - ✔✔Hematoma on the surface of the meninges but inside the skull, displacing the brain Subdural Hematoma - ✔✔Bleeding between the dura mater and the arachnoid layers of the meninges. Hypoxia - ✔✔decreased amount of O2 to the brain Anoxia - ✔✔no O2 to the brain completely
Medulla - ✔✔the base of the brainstem; controls heartbeat, breathing, blood pressure, swallowing, vomiting, and sneezing Pons - ✔✔Part of the brainstem that is essential for facial movement and sensations, hearing and coordinating eye movements. Enables the thinking part of the brain (Cortex) to work with the moving part of the brain (Cerebellum) Mid Brain - ✔✔Part of the brain stem that plays a pivotal role in alertness and arousal Basal Ganglia - ✔✔directs intentional movements
computed tomography (CT) - ✔✔a scanning technique using multiple X-rays to construct three-dimensional images magnetic resonance imaging (MRI) - ✔✔a technique that uses magnetic fields and radio waves to produce computer-generated images that distinguish among different types of soft tissue; allows us to see structures within the brain, also in 3D Diffusion Tensor Imaging (DTI) - ✔✔an imaging method that uses a modified MRI scanner to reveal bundles of myelinated axons in the living human brain; illustrates the neural pathways that are affected. Synaptogenesis - ✔✔formation of new synapses Excitotoxicity - ✔✔the property by which neurons die when overstimulated, as with large amounts of glutamate; This makes the neurons fire repeatedly therefore accumulating fatal levels of sodium and calcium.
Closed (non-penetrating) Injury - ✔✔Brain contusions; brain lacerations; intracerebral hemorrhage; diffuse axonal injury Open (penetrating) Injury - ✔✔Epidural hematoma; subdural hematoma; intracerebral hemorrhage; Infection Rotational/angular forces non contact injury - ✔✔Diffuse axonal injury; white matter lesions; hemorrhage Severe reduction in blood flow or hemorrhage due to clotting - ✔✔White matter lesions; hemorrhage Meninges - ✔✔ 3 Layers of tissue that separate the skull and the brain They P-A-D the brain: P= Pia Mater A= Arachnoid D= Dura Mater S= Skull
Physical/Somatic mTBI Symptoms - ✔✔Headache Light Sensitivity Fatigue Noise Sensitivity Seizure Impaired Hearing Nausea Blurred Vision Numbness Dizziness/loss of balance Poor Sleep Neurologic abnormalities Cognitive mTBI Symptoms - ✔✔Inattentiveness Diminished Concentration Poor Memory Impaired Judgement Slowed Processing Speed Executive Dysfunction
Behavioral/Emotional mTBI Symptoms - ✔✔Depression Anxiety Agitation Irritability Aggression Impulsivity Occipital Neuralgia - ✔✔Generally associated with pain in the back of the head that worsens as the day progresses. Chronic Traumatic Encephalopathy Progression - ✔✔Diffuse Axonal Injury => Tau Protein => Inflammation => Progressive Dementia Disorder of Consciousness (DOC) - ✔✔A state of impaired consciousness as a result of an injury to the brain
Vegetative State - ✔✔After a coma, a low level of consciousness in which a person appears awake but can only perform certain involuntary responses, not the more complex thoughts or actions associated with awareness such as following commands; planning, remembering, and communicating. Levels of Consciousness (lowest to highest) - ✔✔Injury => Coma => Vegetative => Minimally Conscious Arousal - ✔✔Primitive, involuntary responsiveness to the world, as demonstrated by reflex (generalized) responses to both internal and external stimuli. Reticular Activation System (RAS) - ✔✔A collection of primitive structures and nerve pathways in the brain, responsible for maintaining arousal Awareness - ✔✔The ability to receive and process sensory information and use that information to relate in an intentional way to the outside world. It is required
for voluntary responses to stimuli and is regulated by the higher cortical areas in the cerebrum. Minimally Conscious State - ✔✔A condition of altered consciousness where the person displays some acknowledgment of self or environment. Central Apnea - ✔✔Lack of signals from the brain to the muscles controlling breathing Metabolic Distress - ✔✔Abnormal hormone response producing a marked increase in energy demands Dystonia - ✔✔Involuntary muscle contraction causing slow, repetitive movements or abnormal postures. Coma (diagnostic Criteria) - ✔✔No arousal/eye-opening
No behavioral signs of awareness Impaired spontaneous breathing Impaired brainstem reflexes No Vocalizations > 1 hour Vegetative State (Diagnostic Criteria) - ✔✔Arousal/spontaneous or stimulus induced eye opening No behavioral signs of awareness Preserved spontaneous breathing Preserved brainstem reflexes No purposeful behaviors No language production or comprehension Preservation (partial or complete) of hypothalamic and brain stem autonomic functions May grimace to pain, localize to sounds inconsistently Atypical: visual fixation, response to threat, inappropriate single words
Minimally Conscious State (Diagnostic Criteria) - ✔✔Arousal/spontaneous eye opening Fluctuating but reproducible behavioral signs of awareness Response to verbal directive Enviornmentally-contingent smiling or crying Object localization and manipulation Sustained visual fixation and pursuit Verbalizations Intentional but unreliable communication Emergence fro MCS: functional communication, functional object use Parenteral Diet - ✔✔Tube feeding or IV support
National Dysphagia Diet Levels: Food - ✔✔Level I: Puree consistency diet (homogenous, very cohesive, pudding-like, foods requiring bolus formation, controlled manipulation and chewing are not allowed) Level 2: Mechanically Altered (cohesive, moist, semisolid foods, requiring some chewing) Level 3: Dysphagia-Advanced (soft foods that require more chewing ability) Level 4: Regular (all foods allowed) Diabetes Insipidus - ✔✔Caused by problems related to the antidiuretic hormone (ADH). Too little vasopressin is produced and makes a person have significantly more urine. It causes the individual to have excessive thirst; it can be become severely dehydrated and confused; treated by encouraging the individual to drink more fluids. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - ✔✔Caused by changes in the hypothalamus or certain medications. Symptoms include nausea, vomiting, irritability, confusion, seizures, or coma. Blood sodium is typically very
low and urine not concentrated. Fluid restrictions are the recommended treatment. Metabolic Syndrome - ✔✔a combination of medical disorders that, when occurring together, increase the risk of developing cardiovascular disease and diabetes. Common in aging adults it is marked by abdominal obesity, insulin resistance, high blood pressure, and dyslipidemia. Immediate Post-Traumatic Convulsions (IPTC)` - ✔✔Events that involve the loss of consciousness and involuntary movement upon impact. Tonic Posturing - ✔✔As a person loses consciousness during a seizure, the muscles stiffen and the eyes roll back; the back arches as the muscles in the chest tighten; and it becomes more difficult for the person to breathe. Clonic or Myoclonic Jerks - ✔✔Muscle spasms causing a jerking of limbs
Postictal Period - ✔✔Short period of time following a seizure where there is an altered state of consciousness; ranges from 5 to 30 minutes and may be accompanied with headache, migraine, nausea, confusion, hypertension, and drowsiness as the brain recovers from the trauma of the seizure. Retrograde Amnesia - ✔✔an inability to retrieve information from one's past; Loss of access to memories before the event that caused the amnesia. Anterograde Amnesia - ✔✔an inability to form new memories Early Post-Traumatic Seizures (EPTS) - ✔✔Occur within 7 days following the injury and are purported to occur as a direct result of the trauma, with approximately 50% occurring within 24 hours of impact. EPTS is also a strong risk factor of late post traumatic seizures.
Status Epilepticus - ✔✔Seizure that lasts longer than 5 minutes or seizures that occur close together without recovery between seizures Late Post Traumatic Seizures (LPTS) - ✔✔Occur later than one week after the initial head injury and generally seen within the first 18 to 24 months. Interchangeably used with the term post-traumatic epilepsy (PTE) Tension Type Headache (TTH) - ✔✔Bilateral head pain of pressing quality, much like that of a tight hat or vice clamping across the head. These headaches do not get worse with physical activity and patients do not present with other symptoms, such as sensitivity to light, sound, or taste. They are often mistaken for other headaches Cervicogenic Headache - ✔✔A head pain generated primarily from the cervical spine. C1-C2 Refers pain to - ✔✔perioribital region
C2-C3 Refers pain to - ✔✔parietal and frontal region of the head C3-C4 Refers pain to - ✔✔upper thoracic region and lateral cervical region Craniomandibular Headache - ✔✔subtype of tension headache that can cause difficulty with eating and talking Post-Traumatic Migraine (PTM) - ✔✔Chronic migraines brought on by trauma to the head and neck Migraine Headache - ✔✔a headache characterized by throbbing pain on one side of the head. May be referred to as vascular headache or trigemino-neurovascular headache
Headache Review of Symptoms C-O-L-D-E-R Acronym - ✔✔(C)haracter - sensation and intensity (throbbing, etc) (O)nset - pattern to timing (morning, triggers) (L)ocation - where does it start? does it radiate? (D)uration and frequency (E)xacerbation - what intensifies the headache (R)elief - what reduces the headache Physiological Fatigue - ✔✔is a direct result of injury to the brain. May be associated with muscle weakness or injuries in the peripheral nervous system. Psychological Fatigue - ✔✔A state of weariness related to reduced motivation, prolonged mental activity, or boredom that occurs in situations such as chronic stress, anxiety or depression. Primary Fatigue - ✔✔Fatigue that results directly from injury or disease
Secondary Fatigue - ✔✔factors that may exacerbate fatigue such as pain, sleep disturbance, or stress Highest Rate of TBIs due to Falls by Age Group - ✔✔Children 0-4 (50% of all TBIs) Adults 65 or older (61% of all TBIs) Highest Rates of Death From TBI due to falls - ✔✔Adults aged 75 or older Highest Rate of Death from TBI all causes - ✔✔Adults aged 75 or older Highest Rate of Death From TBI (Firearms) - ✔✔Adults ages 20- 24 Adults 75 or older
Percentage of Children with TBI from Physical Abuse - ✔✔Children 0-3 years old (67%) Highest Rates of TBI from Motor Vehicle Crashes - ✔✔Adults ages 20 - 24 Highest Rates of TBI Death from Motor vehicle Crashes - ✔✔Adults 16 - 19 Right Hemisphere - ✔✔Holistic Visual-Spatial Intuitive Controls Left Side of Body Music, Art, Shapes Left Hemisphere - ✔✔Linear Verbal-Analytic
Logical Controls Right Side of Body Speaking, Reading, Writing Rehabilitation Act of 1973 - ✔✔Establishing vocational rehabilitation systems TBI Model systems of 1987 - ✔✔Started in DOE, Conducts perspective longitudinal research to demonstrate the course of recovery and outcomes following TBI at 16 centers across the US TBI Act of 1996 - ✔✔Single most important piece of federal legislation for persons with brain injury. This law acknowledged and set the stage for subsequent funding of surveillance research on TBI, effectiveness research, and improving systems of care
Olmstead Decision (1999) - ✔✔Court mandated that people with disabilities must be moved out of institutions and into less restrictive settings and that the waiting list for services must be reduced. Utilizes Title II of the Americans with Disabilities act in asserting that states administer their services, programs, and activities "in the most integrated setting appropriate to the needs of qualified individuals with disabilities" Primary Motor Cortex - ✔✔Curves over the top part of the head (like a head band) Controls Voluntary Movement Injury causes weakness or paralysis to the opposite side of the body PreFrontal Cortex - ✔✔Located at the front part of the frontal lobes Evaluates options, predicts outcomes and decides the best course of action Influences abilities to learn from consequences
Injury causes difficulty making decisions, organizing and prioritizing, initiating and inhibiting actions, controlling emotions and interacting socially Temporal Lobe - ✔✔Function: Memory, Language, Hearing Impairment: Auditory processing, new learning, Understanding, storing and retrieving new information Occiptal Lobe - ✔✔Function: Visual processing, interpret visual information, recognition of size, light, color, dimensions, etc Impairment: Cortical blindness, Agraphia, Field cuts, Movement agnosia, visual agnosia Primary Sensory Cortex - ✔✔Function: Sensation and Perception: responds to touch, temperature, and pain; Process sensory information Impairment: Difficulty in location and type (temp, pain, movement) of sensation