HEADS UP

Which of the following statements is FALSE: A. A relatively minor force can lead to significant symptoms in some children. B. mTBI symptoms look the same in children of different ages. C. Rotational force may increase the severity of mTBI. D. The effects of multiple mTBIs may be cumulative. E. Both A and C are false.

B. mTBI symptoms look the same in children of different ages.

Which indications should prompt admission to a hospital for a patient with mTBI? Any signs of intracranial injury that require monitoring and repeat neurological exams. Fluctuating or deteriorating neurological or cognitive symptoms. Patient complains of trouble concentrating and feeling fatigued. Both A and B. All of the above.

Both A and B.

Students should be referred for further evaluation by a specialist when: A. Problems with attention, memory and learning, response speed, and other cognitive impairments interfere with school. B. The student experiences ongoing headaches 2 to 3 days after the injury. C. Sleep problems emerge or continue despite the student engaging in appropriate sleep hygiene measures. And the student experiences ongoing headaches 2 to 3 days after the injury. D. Both A and C. E. All of the above.

Both A and C

Which of the following factors are associated with a prolonged recovery from an mTBI?Neurological or psychiatric disorder.Higher cognitive ability.Older age (older children/adolescents).Both A and C.All of the above.

Both A and C

A healthcare provider should order a head CT scan for a student with suspected mTBI: A. In all cases. B. If indicated by a validated decision tool. C. When requested by the patient's parents. D. Both B and C. E. Never.

Both B and C

Which of the following statements are important to educate parents and students about mTBI? A. Wearing a helmet during sports activities eliminates the risk of mTBI. B. Seat belts and child passenger safety seats help prevent mTBI. C. Falls are the most common cause of mTBI among children. D. Both B and C. E. All of the above.

Both B and C

Following an mTBI, students should do which of the following? A. Rest cognitively and physically for one to two weeks until they no longer experience symptoms. B. Return to sports if their symptoms aren't severe. C. Following one to two days of rest, gradually begin return to non-sports activity as long as symptoms do not worsen. D. None of the above.

C. Following one to two days of rest, gradually begin return to non-sports activity as long as symptoms do not worsen.

A healthcare provider should order a head CT scan for patients with suspected mTBI:In all cases.If indicated by a validated decision tool.When requested by the patient's parents.Both B and C.Never.

If indicated by a validated decision tool.When requested by the patient's parents.

Symptoms of mTBI generally fall into the following four categories: A. Somatic, Cognitive, Affective, Sleep. B. Cognitive, Affective, Physical, Peripheral. C. Cognitive, Affective, Consciousness, Balance. D. None of the above.

Somatic, Cognitive, Affective, Sleep.

What happens when an athlete's symptoms return after they've initiated a step-wise return to play progression? The athlete should progress to the next level so long as they do not lose consciousness, vomit or have problems with balance. The athlete should drop back to the previous level at which they were asymptomatic and try to move forward only after a 24-hour period of rest has passed and they are again asymptomatic. If they are on Step 1-3, the athlete should repeat the step-wise process, starting at Step 1. If they are on Step 4 - 5, they should stay on the same step another day. The athlete should rest for 10 to 14 days.

The athlete should drop back to the previous level at which they were asymptomatic and try to move forward only after a 24-hour period of rest has passed and they are again asymptomatic.

Which of the following is TRUE regarding validated mTBI symptom rating scales:They can be used as the sole diagnostic criteria.Only computer-based assessment scales are validated.They should assess changes from a patient's usual or baseline symptom presentation.Both B and C are true.All of the above are true.

They should assess changes from a patient's usual or baseline symptom presentation.

The pediatric brain is more susceptible to mTBI due to: A. Heightened susceptibility to chemical and metabolic changes. B. Axons are not as myelinated or insulated. C. Less developed cervical and shoulder musculature. D. A and C only. E. All the above.

All the above

A 14-year old patient hit her head while playing soccer. She presents with a headache and says she "just doesn't feel right." What is the appropriate course of action? Conduct a symptom assessment, and if she receives an acceptable score, provide approval for return to sports. Order a CT scan to evaluate for intracranial injury. Assess her symptoms and concussion history and require that she be observed at home for 24 to 48 hours for signs of deteriorating neurological function. Set a date no sooner than 14 days from today for her to return to play if her symptoms have lasted more than 30 minutes; 7 days if they lasted less than 30 minutes.

Assess her symptoms and concussion history and require that she be observed at home for 24 to 48 hours for signs of deteriorating neurological function.

Which indications should prompt a referral of a student with a possible mTBI for immediate emergency care? A. Any signs of intracranial injury that require monitoring and repeat neurological exams. B. Fluctuating or deteriorating neurological or cognitive symptoms. C. Student complains of trouble concentrating and feeling fatigued. D. Both A and B. E. All of the above.

Both A and B

When discharging a patient with mTBI, you should counsel patients and their parents to:Rest cognitively and physically for one to two weeks until they no longer experience symptoms.Give them approval to return to sports if their symptoms aren't severe.Following one to two days of rest, gradually begin return to non-sports activity as long as symptoms do not worsen.None of the above.

Following one to two days of rest, gradually begin return to non-sports activity as long as symptoms do not worsen.

A 6-year-old boy diagnosed with mTBI complains of continuing headaches one week after the injury, but no other neurological symptoms. What is the appropriate action to manage his headaches?Refer him to neurology for baseline neurocognitive testing.Recommend over-the-counter analgesics.Recommend complete ("strict") physical and cognitive rest until he is asymptomatic.Both B and C.None of the above.

Recommend over-the-counter analgesics.

Prior to discharging a patient from the ED or your office, it is important to counsel patients and their parents that: Children are allowed to return to sports activities before school if they feel well enough. Most children will experience a prolonged recovery. Within a few weeks, the patient can begin non-strenuous activities that do not exacerbate symptoms. They should monitor for signs of deteriorating neurological function. All of the above.

They should monitor for signs of deteriorating neurological function.