Mixed Deck — All MACE Topics Flashcards

What is the significance of repeated low-level blast exposure?

Answer: Cumulative subconcussive blast exposure may cause progressive brain injury even without diagnosable concussions, similar to repeated head impacts in contact sports

Research suggests that repeated exposure to blast overpressure during training (breaching, artillery, heavy weapons) may cause subclinical brain changes over time, leading to concerns about occupational exposure limits.

What is a concussion (mild TBI)?

Answer: A traumatic brain injury caused by a bump, blow, jolt, or blast that alters brain function, typically without structural damage visible on standard imaging

Concussion is a functional (not structural) brain injury that disrupts normal neural function through metabolic cascade, ionic imbalance, and neuroinflammation, usually with normal CT and MRI findings.

Who is authorized to administer the MACE in a military setting?

Answer: Trained medical personnel such as corpsmen, medics, PAs, and physicians

The MACE is designed to be administered by trained military medical personnel including combat medics, corpsmen, physician assistants, and physicians.

Which component is NOT part of the MACE neurological examination?

Answer: Physical endurance test

The MACE focuses on neurological and cognitive assessments relevant to concussion, such as symptom evaluation, cognitive screening (memory, orientation), and neurological screening (balance, coordination). A physical endurance test, which measures stamina and physical exertion, is not a component of the MACE neurological examination as it does not directly assess concussion-related brain function.

What cognitive rehabilitation strategies are used for concussion recovery?

Answer: Graduated cognitive loading, compensatory strategy training, attention and memory exercises, and psychoeducation about expected recovery

Cognitive rehabilitation may include progressive cognitive loading (reading, problem-solving), compensatory strategies (note-taking, checklists), targeted attention/memory training, and education about normal recovery expectations.

What is the primary purpose of the Military Acute Concussion Evaluation (MACE)?

Answer: To evaluate acute concussions

The Military Acute Concussion Evaluation (MACE) is specifically designed as a standardized tool for healthcare providers to assess service members immediately following a suspected concussion. Its primary purpose is to identify and evaluate the acute symptoms and cognitive deficits associated with a recent mild traumatic brain injury. This allows for timely diagnosis and appropriate management.

What is the dual diagnosis challenge of TBI and PTSD in military populations?

Answer: TBI and PTSD share overlapping symptoms (sleep disturbance, concentration problems, irritability), making differential diagnosis and treatment complex

TBI and PTSD frequently co-occur in combat veterans and share symptoms including concentration difficulty, irritability, sleep disruption, and memory problems. Accurate diagnosis requires careful evaluation of symptom onset, mechanism, and course.

What cognitive function is tested by asking the patient to follow multi-step commands?

Answer: Executive function

Multi-step commands require the patient to understand, remember, sequence, and execute several actions in a specific order. These abilities are core components of executive function, which encompasses planning, working memory, and problem-solving. Therefore, struggling with such tasks can indicate an impairment in these higher-level cognitive processes.

What should be done if a patient shows significant cognitive impairment during the MACE?

Answer: They should be sent for immediate advanced medical evaluation

Significant cognitive impairment identified during the MACE, especially if severe or worsening, indicates a potentially more serious brain injury or complication. In such cases, the protocol mandates immediate referral for advanced medical evaluation (e.g., neuroimaging, specialist consultation) to rule out conditions like intracranial bleeding.

What is the Warfighter Brain Health Initiative?

Answer: A DoD program focused on protecting service members' brain health through education, exposure monitoring, treatment advances, and policy development

The Warfighter Brain Health Initiative addresses the full spectrum of brain health: blast exposure monitoring, concussion prevention and treatment, mental health, sleep optimization, and long-term brain health for military personnel.

What research is being conducted on military blast-related TBI?

Answer: Studies on blast physics, biomarkers, neuroimaging, blast exposure thresholds, protective equipment, and long-term outcomes of repeated blast exposure

Active research areas include blast wave modeling, blood-based biomarkers for rapid diagnosis, advanced neuroimaging (DTI, fMRI), blast exposure monitoring devices, improved helmet design, and longitudinal studies of blast-exposed veterans.

Which symptom might indicate the need for immediate medical attention during a MACE evaluation?

Answer: Severe headache

While mild symptoms are common with concussions, a severe headache, especially one that worsens, can be a "red flag" symptom indicating a more serious brain injury, such as an intracranial hemorrhage. The MACE protocol emphasizes identifying such severe symptoms that warrant immediate advanced medical evaluation.

What is a key aspect of concentration tested in the MACE cognitive section?

Answer: Recalling a series of numbers in reverse order

Recalling a series of numbers in reverse order (e.g., "digits backward") is a common task used in the MACE to assess attention, concentration, and working memory. This task requires sustained mental effort and manipulation of information, which can be challenging for individuals with a concussion.

How soon after a suspected concussion should the MACE be administered?

Answer: Immediately

The MACE is designed for acute assessment, meaning it should be administered as soon as possible after a suspected concussion. Immediate evaluation is crucial for establishing baseline symptoms, identifying any red flag signs, and initiating appropriate medical management and removal from activity to prevent further injury.

What is chronic traumatic encephalopathy (CTE)?

Answer: A progressive neurodegenerative disease associated with repeated head trauma, diagnosed definitively only at autopsy

CTE is associated with repeated head impacts over years, causing tau protein accumulation in the brain. Symptoms include cognitive decline, behavioral changes, and depression. Currently, definitive diagnosis requires post-mortem brain examination.

What is the recommended action if a service member scores ≤25 on the MACE SAC?

Answer: Remove from duty and initiate rest and further medical evaluation

A score of ≤25 is a positive screen requiring the service member to be removed from duty and receive further medical evaluation and rest.

In the MACE, what is the significance of asking patients to recall a list of words?

Answer: To assess short-term memory and attention

Asking patients to recall a list of words is a standard component of the MACE cognitive assessment. This task specifically evaluates immediate and short-term verbal memory, as well as the patient's ability to pay attention and encode new information, which are often impaired following a concussion.

A service member scores 28 out of 30 on the MACE SAC with no neurological abnormalities and no loss of consciousness. What does this generally indicate?

Answer: Negative screen — likely no significant cognitive impairment from concussion

A score above 25 (e.g., 28/30) with no neurological deficits is generally a negative screen, suggesting no significant concussion-related cognitive impairment.

When should the Delayed Recall portion of the MACE be administered relative to Immediate Memory?

Answer: At least 5 minutes after the Immediate Memory trials

Delayed Recall is administered after a delay of at least 5 minutes following the Immediate Memory trials, typically after the neurological exam.

Which of the following is typically included in the cognitive testing section of the MACE?

Answer: Memory recall

Memory recall is a core component of the cognitive testing section in the MACE. This typically involves tasks like recalling a list of words immediately and after a delay, which helps assess both immediate and short-term memory function, frequently affected by concussion.