CCSP Concussion Evaluation and Management 3 — Questions and Answers
Question 1: Which balance assessment tool is incorporated into the SCAT5 and commonly used for objective sideline concussion evaluation?
- Romberg Test
- Balance Error Scoring System (BESS) (Correct answer)
- Fukuda Step Test
- Star Excursion Balance Test
Correct answer: Balance Error Scoring System (BESS)
The Balance Error Scoring System (BESS) is the standardized balance test incorporated into the SCAT5, assessing postural stability under six conditions.
Question 2: A chiropractor suspects a concussion in an athlete who had no loss of consciousness but reports headache and 'feeling foggy.' Which Maddocks question would be most appropriate to assess orientation?
- What is today's date?
- What team did we play last week? (Correct answer)
- What is your home address?
- How many days until your next game?
Correct answer: What team did we play last week?
Maddocks questions assess sport-specific orientation; asking about recent game opponents tests short-term memory relevant to the sporting context rather than general orientation.
Question 3: Which medication class is generally CONTRAINDICATED in the acute phase of concussion management due to potential masking of symptoms?
- Acetaminophen
- NSAIDs (Correct answer)
- Opioid analgesics
- Magnesium supplements
Correct answer: NSAIDs
NSAIDs (and aspirin) are generally avoided in the acute phase due to risk of intracranial bleeding and potential to mask symptoms that guide clinical decision-making.
Question 4: In pediatric concussion management, return to learn protocols should be initiated before return to sport protocols. What is the primary rationale?
- Academic performance is more important than athletic performance
- School reintegration is less physically demanding and ensures cognitive recovery (Correct answer)
- Teachers can monitor symptoms better than coaches
- Legal requirements mandate academic clearance first
Correct answer: School reintegration is less physically demanding and ensures cognitive recovery
Return to learn is prioritized first because academic reintegration is less cognitively demanding than sport and serves as a functional checkpoint for cognitive recovery before physical exertion.
Question 5: Which physiological mechanism explains why a second concussion shortly after the first can be catastrophically more severe?
- Cumulative axonal shearing from repeated impacts
- Loss of cerebrovascular autoregulation during neurometabolic vulnerability period (Correct answer)
- Permanent disruption of the blood-brain barrier
- Accelerated neuroinflammation from microglial priming
Correct answer: Loss of cerebrovascular autoregulation during neurometabolic vulnerability period
Second Impact Syndrome results from loss of cerebrovascular autoregulation during the neurometabolic vulnerability window, causing massive cerebral swelling and potentially fatal outcomes.
Question 6: A 22-year-old basketball player completes all stages of the graduated return-to-sport protocol without symptoms. Who should provide final medical clearance for full return to contact sport?
- Athletic trainer
- Team coach
- Licensed physician or authorized healthcare provider (Correct answer)
- Physical therapist
Correct answer: Licensed physician or authorized healthcare provider
Final medical clearance from a licensed physician or authorized healthcare provider is required before an athlete returns to full contact sport following concussion.
Question 7: The King-Devick Test primarily assesses which aspect of concussion-related dysfunction?
- Postural stability
- Saccadic eye movement speed and accuracy (Correct answer)
- Verbal memory recall
- Reaction time
Correct answer: Saccadic eye movement speed and accuracy
The King-Devick Test measures saccadic eye movements by timing the speed and accuracy of reading single-digit numbers, which is impaired following concussive injury.
CCSP Concussion Evaluation and Management 3
Which balance assessment tool is incorporated into the SCAT5 and commonly used for objective sideline concussion evaluation?