CBIS Assessment and Diagnosis 3 — Questions and Answers
Question 1: When using the Functional Independence Measure (FIM), which score indicates that the patient requires minimal assistance and performs at least 75% of the task independently?
- FIM score of 4
- FIM score of 5 (Correct answer)
- FIM score of 6
- FIM score of 3
Correct answer: FIM score of 5
A FIM score of 5 (supervision) means the patient needs stand-by assistance or cueing but does ≥75% of the effort.
Question 2: Which of the following best describes the distinction between coup and contrecoup injuries in TBI assessment?
- Coup is injury at the impact site; contrecoup is injury opposite the impact site (Correct answer)
- Coup is diffuse injury; contrecoup is focal injury
- Coup affects white matter; contrecoup affects gray matter
- Coup is hemorrhagic; contrecoup is ischemic
Correct answer: Coup is injury at the impact site; contrecoup is injury opposite the impact site
Coup injury occurs directly at the site of impact, while contrecoup occurs on the opposite side due to brain rebound within the skull.
Question 3: A patient exhibits difficulty recognizing familiar faces despite intact visual acuity. This presentation is most consistent with damage to which brain region?
- Left hemisphere Broca's area
- Right fusiform face area in the temporal lobe (Correct answer)
- Primary visual cortex in the occipital lobe
- Anterior cingulate cortex
Correct answer: Right fusiform face area in the temporal lobe
Prosopagnosia (inability to recognize faces) is associated with bilateral or right fusiform gyrus damage in the temporal lobe.
Question 4: In TBI rehabilitation assessment, 'spasticity' is most accurately defined as:
- Velocity-dependent increase in tonic stretch reflexes (Correct answer)
- Constant muscle rigidity regardless of movement speed
- Involuntary rhythmic muscle contractions
- Loss of voluntary muscle control
Correct answer: Velocity-dependent increase in tonic stretch reflexes
Spasticity is specifically a velocity-dependent hypertonic state caused by upper motor neuron lesions, distinguishing it from rigidity.
Question 5: Which screening tool is most commonly recommended for identifying depression in the TBI population during routine clinical assessment?
- Hamilton Anxiety Rating Scale (HAM-A)
- Patient Health Questionnaire-9 (PHQ-9) (Correct answer)
- Mini-Mental State Examination (MMSE)
- Beck Anxiety Inventory (BAI)
Correct answer: Patient Health Questionnaire-9 (PHQ-9)
The PHQ-9 is widely validated for depression screening in TBI populations and is brief, standardized, and easy to administer.
Question 6: A patient with TBI demonstrates intact recall of events before the injury but cannot form new memories. This pattern is classified as:
- Retrograde amnesia only
- Anterograde amnesia only (Correct answer)
- Both retrograde and anterograde amnesia
- Transient global amnesia
Correct answer: Anterograde amnesia only
Anterograde amnesia is the inability to form new memories after the injury, while pre-injury memories remain intact.
Question 7: During TBI assessment, a positive Babinski sign (upgoing plantar reflex) indicates:
- Peripheral nerve damage
- Upper motor neuron pathology (Correct answer)
- Cerebellar dysfunction
- Brainstem herniation
Correct answer: Upper motor neuron pathology
An upgoing big toe in response to plantar stimulation (positive Babinski) is a sign of upper motor neuron dysfunction such as corticospinal tract injury.
CBIS Assessment and Diagnosis 3
When using the Functional Independence Measure (FIM), which score indicates that the patient requires minimal assistance and performs at least 75% of the task independently?