Mixed Deck — All TBI Topics Flashcards

Which substrate is the brain's primary energy source under normal conditions?

Answer: Glucose

The brain relies mainly on glucose and uses roughly 20% of the body's oxygen despite being about 2% of its weight.

The Brain Injury Association of America (BIAA) serves which primary functions for TBI survivors and families?

Answer: Advocacy, education, support group coordination, and resource connection for TBI survivors and caregivers

BIAA is the leading national TBI advocacy organization, providing educational resources, supporting state affiliates, and promoting TBI awareness and policy change.

Guardianship for a TBI patient is a legal process that differs from healthcare proxy in which important way?

Answer: Guardianship involves court appointment and oversight, removing broader legal rights; healthcare proxy is limited to medical decisions only

Full guardianship is a more sweeping court-supervised process that can restrict many civil rights, while a healthcare proxy is a narrower, less restrictive advance directive.

Which type of therapy helps TBI patients relearn daily living skills like grooming and dressing?

Answer: Occupational therapy

Occupational therapy (OT) focuses on helping TBI patients regain the skills necessary for daily living and participation in meaningful activities. Occupational therapists assist patients in relearning tasks such as grooming, dressing, bathing, cooking, and managing household chores. They also adapt environments and provide assistive devices to enhance independence and quality of life.

Which legal standard is used to determine whether a TBI patient should receive life-sustaining treatment when preferences are unknown?

Answer: Substituted judgment (what the patient would have wanted) or best interests standard

Surrogate decision-makers first apply substituted judgment (known values and wishes), and if unknown, fall back on the best interests standard.

Which sport has implemented the most comprehensive evidence-based concussion management protocols in the US?

Answer: American football (NFL with independent spotters, SCAT testing, concussion protocol)

The NFL's concussion protocol includes independent neurological consultants, unaffiliated neurotrauma consultants, and standardized sideline assessment tools.

Which glial cells are most involved in supporting the blood-brain barrier and buffering extracellular potassium?

Answer: Astrocytes

Astrocytes support the blood-brain barrier, regulate ions and clear neurotransmitters.

Which cells produce myelin in the central nervous system?

Answer: Oligodendrocytes

Oligodendrocytes myelinate CNS axons, while Schwann cells do so in the peripheral nervous system.

In criminal law, how may a severe TBI affect competency to stand trial?

Answer: TBI-related cognitive deficits may render a defendant unable to understand the proceedings or assist in their own defense, requiring competency evaluation

Competency to stand trial requires understanding the charges and being able to assist counsel — severe TBI can impair both, triggering competency restoration proceedings.

What is the maximum score for the verbal component of the Glasgow Coma Scale?

Answer: 5

Verbal response scores range 1–5, with 5 meaning oriented, while eye is 1–4 and motor 1–6.

Which TBI involves bleeding beneath the dura mater, often due to torn veins?

Answer: Subdural hematoma

A subdural hematoma is a collection of blood that accumulates between the dura mater and the arachnoid mater, two of the membranes surrounding the brain. It typically results from the tearing of bridging veins that connect the brain's surface to the dura, often due to head trauma. Subdural hematomas can be acute, subacute, or chronic, and can exert pressure on the brain.

Why is aspirin generally avoided in the immediate post-TBI period?

Answer: It inhibits platelet aggregation and raises bleeding risk

Aspirin's antiplatelet effects can worsen intracranial hemorrhage in the acute TBI setting.

Which resource provides federally-funded TBI support services, information, and referrals in all US states?

Answer: State TBI Lead Agencies funded through HRSA's TBI Program

HRSA's TBI State Partnership Program funds state-level TBI lead agencies that coordinate services, provide education, and connect survivors and families to resources.

Which international classification system guides disability assessment and goal-setting in TBI community reintegration?

Answer: ICF (International Classification of Functioning, Disability and Health)

The WHO's ICF framework addresses body functions, activity limitations, participation restrictions, and environmental factors — essential for comprehensive TBI reintegration planning.

Which nursing action is important for preventing aspiration in TBI patients with swallowing difficulties?

Answer: Elevate head of bed during feeding

Elevating the head of the bed during feeding is a crucial nursing action to prevent aspiration in TBI patients with swallowing difficulties (dysphagia). This position helps gravity guide food and liquids down the esophagus, reducing the risk of them entering the airway and causing choking or pneumonia. It promotes a safer and more effective swallowing mechanism.

Which standardized neuropsychological assessment battery is commonly used to evaluate cognitive outcomes after TBI?

Answer: Repeatable Battery for Assessment of Neuropsychological Status (RBANS)

RBANS assesses immediate/delayed memory, language, visuospatial skills, and attention — domains commonly impaired after TBI.

What is 'caregiver burden' in the TBI context, and why is it an important clinical consideration?

Answer: The physical, emotional, and social strain on family caregivers that increases caregiver depression and burnout

Caregiver burden significantly impacts both the caregiver's health and the quality of care provided to TBI survivors, making caregiver support an integral part of TBI management.

What is the main pharmacological goal when managing elevated ICP in a TBI patient?

Answer: Reduce ICP while maintaining adequate cerebral perfusion pressure

Management aims to lower ICP while ensuring CPP remains adequate (typically >60 mmHg) to prevent secondary ischemic injury.

Sleep disturbance after TBI most commonly manifests as which pattern?

Answer: Insomnia, fragmented sleep, fatigue, and excessive daytime sleepiness

TBI disrupts sleep architecture through hypothalamic and brainstem damage, resulting in mixed sleep disorders including insomnia and hypersomnia.

Why is corticosteroid use (e.g., dexamethasone) contraindicated in acute TBI?

Answer: The CRASH trial showed increased mortality with corticosteroids in TBI

The landmark CRASH trial demonstrated that methylprednisolone infusion in acute TBI significantly increased 2-week mortality.