CBIS(CERTIFIED BRAIN INJURY SPECIALIST B) NEWEST VERSION WITH GRADED ANSWERS (ASSURED PA, Exams of Nursing

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CBIS(CERTIFIED BRAIN INJURY

SPECIALIST B) NEWEST VERSION WITH

GRADED ANSWERS (ASSURED PASS)

Nuerocognitive Issues Assoicated with Frontal Lobe - -- VERIFIED ANSWER - Emotional control, behavioral control, verbal expression, problem solving, decision making, social control, attention, motivation Autonomic Storming - -- VERIFIED ANSWER - Also called dysautonomia, autonomic hyperreflexia, sympathetic storming A disorder of the autonomic nervous system that involves failure of the sympathetic/parasympathetic components of the ANS. Characterized by resting tachycardia, labored breathing, gastroparesis, sweating irregularities, hypotension, constipation, and erectile disfunction 15 - 33% of TBIs sustainees experience AS Deep Vein Thrombosis (DVT) - -- VERIFIED ANSWER - Bloodclots

TBI - -- VERIFIED ANSWER - An alteration in brain function or other evidence of brain pathology, casused by an external force Mild TBI Characteristics - -- VERIFIED ANSWER - Brief or no loss of consciousness for 0-30mins, altered state of consciousness is most common and must be <24 hours, account for 75% of TBIs, 13 - 15 on the GCS, normal imaging, highest prevalence of maltreatment as 16-25% never seek care, often considered a concussion Moderate TBI Characteristics - -- VERIFIED ANSWER - Loss of consciousness for up to 24 hours, may appear on scans, skull fractures and bleeding are common, 9-12 on the GCS Severe TBI Characteristics - -- VERIFIED ANSWER - Loss of consciousness >24 hours, 3-8 on the GCS Likelihood of Additional Injury - -- VERIFIED ANSWER - 1 BI increases risk of 2nd by 3x and 2nd BI increases risk of 3rd by 8x! Most Frequent Cause of TBI - -- VERIFIED ANSWER - Falls

How many people sustain a BI per year? - -- VERIFIED ANSWER - 2.5 million. 81% visit ED, 16% hsopitalized, 3% result in death How many people are living with effects of a TBI? - -- VERIFIED ANSWER - 13.5 million Likelihood of BI by gender - -- VERIFIED ANSWER - Men are 1.4x more likely than women Most common cause of TBI and death by age - 75+ - -- VERIFIED ANSWER - Falls! Most common cause of TBI and death by age - 0 - 3 - -- VERIFIED ANSWER - AHT! Most common cause of TBI and death by age - 20 - 24 - -- VERIFIED ANSWER - MVAs and Firearms Most common cause of TBI and death by age - 16 - 19 - -- VERIFIED ANSWER - MVAs!

Symptoms of Mild TBI - -- VERIFIED ANSWER - Headache, fatigue, seizures, nausea, numbness, poor sleep, light sensitivity, noise sensitivity, impaired hearing, blurred vision, dizziness, loss of balance, neurological abnormality, in attentiveness, decreased concentration, poor memory, impaired judgment, slow proccessing speed, executive dysfunction, depression, anxiety, agitation, irritability, aggression, impulsivity Primary causes of Mild TBI - -- VERIFIED ANSWER - Traumatic intertial - brain moving inside skull Traumatic impact - head hits directly Early Treatment for Mild TBI - -- VERIFIED ANSWER - Relaxation techniques, rest, slow return to normal activity, and reduction of normal activity if symptoms recur Peristent Post Concussive Symptoms (PPCS) - -- VERIFIED ANSWER - Symptoms of Mild TBI last >1 month, occurs 10% of the time in Mild TBI cases

Chronic Traumatic Encephalopathy (CTE) - -- VERIFIED ANSWER - Often cause by repeated blows to the head, is a progressive, degenerative condition characterized by broken nuerons which continually release tau protein cashing dementia over time Diffuse axonal injury - > tau protein release - > inflammation of the brain - > progressive dementia Define Skull - -- VERIFIED ANSWER - Bony shell that protects the brain, has bony prominences inside which can worsen brain injury Cerebral Spinal Fluid (CSF) - -- VERIFIED ANSWER - Provides cushion to nerve tissue, produced by ventricles (4) which also store and circulation CSF through the brain Meninges - -- VERIFIED ANSWER - Pia Mater - molds around suclhi and gyri, deepest layer Arachnoid Mater - spiderweb-like, middle layer

abilities; attention; concentration; mental flexibility; speaking - all executive functions Functions of the Temporal Lobe - -- VERIFIED ANSWER - Hearing functions, memory, understanding language, organization and sequencing Functions of the Brain Stem - -- VERIFIED ANSWER - Breathing, HR, arousal, consciousness, sleep/wake functions, attention, concentration Transmits all sensory information from body to brain and movement signals from the brain to the body Contains sensory centers for hearing, touch, taste, and balance Even if the cerebral cortex is gravelly damaged, the brain stem can keep someone alive - or in a vegetative state Functions of the Cerebellum - -- VERIFIED ANSWER - Balance, coordination, skilled motor activity

Reticular Activating System (RAS) - -- VERIFIED ANSWER - Part of the brain stem - collection of nerve fibers that modulate changed in arousal, alertness, concentration, and biological rhythms Can be turned down or up much like a light dimmer switch - i.e during a coma, it is turned down - if turned down too much, can result in death Medulla - -- VERIFIED ANSWER - Part of the brain stem- responsible for basic living functions such as breathing, HR, BP, swallowing, and vomiting Pons - -- VERIFIED ANSWER - Part of the brain stem- responsible for facial movements, facial sensation, hearing and coordinating eye movements Serves as a bridge between the cerebral cortex (thinking part of brain) and cerebellum (moving part of brain)

Amygdala - -- VERIFIED ANSWER - Part of the limbic system - responsible for emotional memories, closely tied to sense of smell "Fight of flight structure" Hippocampus - -- VERIFIED ANSWER - Part of the limbic system - responsible for the organization of memories Described at the pole in a closet - without pole, all clothing falls

• without hippocampus memories become disorganized Basal Ganglia - -- VERIFIED ANSWER - Part of the limbic system - relays information from cerebral cortex to brain stem and cerebellum for movement, the checking system that comes to attention when things are not working as they should be i.e. restoring equilibrium Cerebellum - -- VERIFIED ANSWER - Governs a person's movements by controlling rate, direction, force and steadiness of movements

Cerebral Cortex - -- VERIFIED ANSWER - Made up of right and left hemisphere and corpus collosum Functions of the Right Hemisphere - -- VERIFIED ANSWER - Holistic, visual spatial and , intuitive in nature Associated with art, shapes, music, and faces Functions of Left Hemipshere - -- VERIFIED ANSWER - Linear, verbal-analytic, logical in nature Associated with speaking, reading, and calculating Corpus Collosum - -- VERIFIED ANSWER - Pencil-thick band that exhanges info between L and R hemispheres Afferent Signals - -- VERIFIED ANSWER - Signals sent along the spinal cord through foremen magnum towards the central nervous system

tissue damage, can detect changes in blood flow and track cellular activity Blood Brain Barrier - -- VERIFIED ANSWER - A filter within the red blood cells which allows blood to enter the brain but blocks harmful substances from entering Neuroplasticity - -- VERIFIED ANSWER - The ability of the nervous system to change, grow, or compensate for an injury The brain can change and re-map! Based on the Hebbian Principle which states that every rehearsal of a skill strengthens memory trace in the brain *Hippocampus may contain stem cells which can generate new brain cells if optimized by therapy! Synaptogenesis - -- VERIFIED ANSWER - A part of nueroplasticity

• the formation of synapses between nuerons

The more synapses there are the more efficiently nuerons can communicate! Nueroprotection - -- VERIFIED ANSWER - Preventing secondary damage post injury Apoptosis - -- VERIFIED ANSWER - Process in which a brain cell self destructs if it is not working as it should be Experience Dependent Learning - -- VERIFIED ANSWER - Neural connections that are established which depend entirely on and are due to an environmental experience UTI's extremely common due to cathing - risk of UTI is increased with use of in-dwelling catheters, especially if cognitive impairment is present Aspiration - -- VERIFIED ANSWER - Caused by dysphagia - when liquid enters into the lungs Commonly leads to aspiration pneumonia

Associated with the following risk factors: penetrating TBI, severity of injury, hematomas, contusions, post traumatic amnesia lasting more than 24 hours, alcohol use, being a child or adolescent Cranial Nerve Damage - -- VERIFIED ANSWER - Associated with higher level severity BIs Cranial nerve 1 is most commonly injured, all are susceptible to injury due to placement near bony skull prominences Can heal and repair selves if stretched or bruised, tingling and pain can be a sign of repair Cranial Nerve Functions - -- VERIFIED ANSWER - I Olfactory (smell) II Optic (sight) III Occulomotor (eye movement) IV Trochlear (downward, inward eye movement) V Trigeminal (sense of touch in the face)

VI Abducens (horizontal eye movement) VII Facial (facial expressions) VIII Auditory-Vestibular IX Glossopharyngeal (throat, taste, BP) X Vagus (heart, lungs, abdominal organs) XI Spinal Accessory (throat & neck muscles) XII Hyposglossal (speech) Nocioceptive Pain - -- VERIFIED ANSWER - Pain relating to damage to body tissue Treated with NSAIDS, Tylenol, topical agents, anti-spasticity meds, and opioids Neuropathic Pain - -- VERIFIED ANSWER - Pain relating to dysfunction of nervous system itself - damage to actual nerves Treated with NSAIDS, Tylenol, topical agents, anti-spasticity meds, opioids, anti-depressants, nerve blocks, trigger point injections, anti-convulsants, and epidural steroids