1. Which of the following are clinical signs that indicate a traumatic brain injury when there is a new onset or worsening immediately following the event?
A. Any period of loss of or a decreased level of consciousness B. Any loss of memory for events immediately before or after the injury C. Any alteration in mental state at the time of the injury D. Neurological deficits that may or may not be transient E. All of the above2. Traumatic Brain Injury is further categorized as to severity into mild, moderate, or severe based on all of the following, EXCEPT?
A. Loss of consciousness B. Alteration of consciousness C. The force of the object striking the head D. Post-traumatic amnesia3. Loss of consciousness for greater than 24 hours and post-traumatic amnesia for greater that 7 days fits which classification of traumatic brain injury severity?
A. Mild B. Moderate C. Severe D. All of the above4. Which of the following is NOT one of the three categories that the most typical signs and symptoms after concussion fall into?
A. Spiritual B. Physical C. Cognitive D. Behavioral5. Symptomatic individuals will frequently present days, weeks, or even months after the trauma. These delays are associated with the injured person doing which of the following?
A. Discounting symptoms B. Incorrectly interpreting symptoms C. Guilt over the circumstances involved in the injury D. Denial that anything serious occurred E. All of the above6. Somatic, cognitive, and behavioral symptoms after concussion/mTBI rarely resolve by 2 to 4 weeks in the majority of individuals.
A. True B. False7. Which term is used to describe a constellation of symptoms occurring at least 1 to 3 months after concussion?
A. Neurologic symptoms B. Symptomatic delay C. Post-concussion syndrome D. None of the above8. The first and most critical step in the evaluation of a person with possible concussion symptoms should clearly characterize the initial injury and determine whether the symptoms are temporally related to the event characterized as a concussion/mTBI.
A. True B. False9. The physical examination of the person sustaining a concussion/mTBI should focus on all of the following, EXCEPT?
A. An electroencephalogram B. A focused neurologic examination C. A focused vision examination D. A focused musculoskeletal examination10. A focused neurologic examination includes which of the following?
A. Mental status examination B. Cranial nerve testing C. Extremity tone testing D. Deep tendon reflexes E. All of the above11. Which of the following is currently the modality of choice as a diagnostic tool for acute concussion/mTBI?
A. Magnetic Resonance Imaging B. Computed Tomography (CT) scan C. Diffusion Tensor Imaging (DTI) D. None of the above12. Treatment of patients with concussion/mTBI focuses on symptom management and education of patient and family.
A. True B. False13. Education should emphasize which of the following?
A. Recovery B. Gradual resumption of work and social responsibilities C. Teaching compensatory strategies D. Teaching environmental modifications E. All of the above14. Prior to return to work or military duty, what may help to ensure adequate resolution of symptoms in a high stress state or combat environment?
A. Activity restrictions B. Simulated use testing C. Exertional testing D. All of the above15. Players who sustain which of the following grade of concussion should be sidelined for at least one month, after which they can return to play if they are asymptomatic for one week?
A. Grade I B. Grade II C. Grade III D. All of the above16. A consultation or referral to specialists for further assessment should occur when any of the following occur, EXCEPT?
A. Symptoms are linked to a concussion event B. An atypical symptom pattern or course is present C. Findings indicate an acute neurologic condition that requires urgent neurologic/neuro-surgical intervention D. There are other major co-morbid conditions requiring special evaluation17. Non-pharmacologic treatment for the common symptom of headaches includes?
A. Sleep hygiene education B. Physical therapy C. Relaxation D. All of the above18. Anti epileptics are the recommended pharmacologic treatment for cognitive difficulties such as; concentration, memory, and decision-making.
A. True B. False19. Therapeutic exercise has been shown to positively impact the vast majority of disabilities.
A. True B. False20. All of the following are specific therapeutic exercises recommended for dizziness, disequilibrium, and spatial disorientation impairments after concussion/mTBI, EXCEPT?
A. Vestibular exercise B. Flexibility C. Visual exercises D. Proprioceptive exercise21. Compensation, litigation, co-occurrence of psychiatric disorders or chronic pain conditions are all examples of which of the following?
A. Pre-injury risk factors B. Peri-injury risk factors C. Post-injury risk factors D. All of the above22. Which would be the appropriate referral after a failed response to the initial non-pharmacologic treatment of physical therapy for loss of balance and poor coordination?
A. Gastro Intestinal B. Speech and Language Pathology C. Neurology D. Mental Health23. Vocational interventions for the patient with persistent symptoms following concussion/mTBI may include modifications such as?
A. Modification of the length of the work day B. Gradual work re-entry C. Additional time for task completion D. Environmental modifications E. All of the above24. The goal of follow-up visits is to monitor the severity of symptoms, impact of the symptoms on activities, effects of treatments, and presence of adverse effects to treatments, and to assess patients for new symptoms suggestive of other diagnoses.
A. True B. False25. Four key factors have been found to influence perceptions of trust and credibility during discussions of high-concern issues. They include all of the following, EXCEPT?
A. Caring and empathy B. Competence and expertise C. Dedication and commitment D. Subtlety and indirect E. Honesty and openness26. Post-traumatic headaches occur acutely in up to 30% of all individuals who sustain a concussion.
A. True B. False27. The symptoms of vertigo, disequilibrium, lightheadedness, and neck pain may indicate which of the following diagnosis, which may benefit from a physical therapy referral?
A. Temporal bone fracture B. Flexion-extension cervical injury C. Depression D. None of the above28. Fatigue with concussion/mTBI can be due to which of the following?
A. A primary effect related to central nervous system dysfunction B. A secondary effect such as common co-existing disorders of depression or sleep disturbances C. Mediations, substance use and lifestyle D. All of the above29. All of the following are encouraged to establish a regular, normalized sleep-wake pattern, EXCEPT?
A. Moderate alcohol use prior to bed B. Restrict the night-time sleep period to about eight hours C. Avoid stimulants, caffeinated beverages, and nicotine during the evening D. Wake at a regular time in the morning E. Reduce or abolish daytime naps30. Effective drugs for pain relief for the patient with concussion include nonsteroidal anti-inflammatory drugs (NSAIDs), or muscle relaxants.
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