exam 1 emergency care

Which sport is known for being the cause of the most concussions in athletes:

football

In older patients, the most common cause for traumatic brain injury occurs from which mechanism:

falls

Which age group is at greatest risk for being hospitalized and dying from a traumatic brain injury:

Adults age 65 and older

Regarding traumatic brain injury and gender, which of the following is true:

Men are more likely to be hospitalized and are nearly three times more likely to die from a TBI than women

Which type of sport activity was discussed as being particularly associated with the occurrence of traumatic brain injury:

contact sports

Which of the following is true regarding concussion's relationship to traumatic brain injury:

concussion is a subset of the overall traumatic brain injury classification

Which of the following would be considered an example of an indirect traumatic force to the head that is capable of inducing a concussion:

whiplash

Approximately what percent of concussions are thought to occur but remain unreported by the patient:

50%

The highest percentage of sports-related concussions in female athletes occurs in which sport:

soccer

When it comes to males and females who participate in identical sports, which of the following is true:

Female athletes suffer concussions about twice as often as male participant

Select all of the correct statements listed below:

The acute symptoms of a concussion are due primarily to a structural injury rather than a functional disturbance

 

Imaging tends to reveal swelling and/or pooling of blood with a concussion injury

 

Imaging (e.g. MRI, CT) is expected to be negative with concussion

 

The pathophysiologic mechanism of a concussion is quite simple in that it involves neuronal injury

 

The acute symptoms of a concussion are due primarily to a functional disturbance rather than structural injury

 

The pathophysiologic mechanism of a concussion is complex

 

Neurochemical and neurometabolic events after an injury to the head result in an alteration of neurologic function

• Imaging (e.g. MRI, CT) is expected to be negative with concussion

• The acute symptoms of a concussion are due primarily to a functional disturbance rather than structural injury

• The pathophysiologic mechanism of a concussion is complex

• Neurochemical and neurometabolic events after an injury to the head result in an alteration of neurologic function

Which four neurometabolic events after concussion were discussed as being at least partially responsible for altered neurologic function after concussion:

Changes to glucose metabolism with decreased cerebral blood flow

Acute axonal injury via disruption of neurofilament organization

Mitochondrial dysfunction

A release of neurotransmitters and subsequent neurologic dysfunction

Which of the following is true regarding concussion evaluations:

A new baseline examination should be completed annually for adolescent athletes, those with a recent concussion, and, when feasible, all athletes

 

All statements are correct

 

Athletes at high risk of concussion should undergo baseline examinations before the competitive season

 

The baseline examination should consist of a clinical history (including any symptoms), physical and neurologic evaluations, measures of motor control (eg, balance), and neurocognitive function

All statements are correct

Which of the following is true regarding baseline and post-concussion evaluations:

 

they should be administered in similar environments

Which of the following statements is not true:

Concussion is a symptom-based diagnosis

Symptoms developing hours to days after the event generally indicates that a concussion has not occurred

The development of symptoms related to a concussion does not always occur immediately after an injury

Any athlete suspected of sustaining a concussion should be immediately removed from participation and evaluated

Symptoms developing hours to days after the event generally indicates that a concussion has not occurred

The most common symptom associated with concussion is:

headache

The SCAT6 is approved for and recommended for any patient aged ____ and over:

13

The Child SCAT6 is designed to screen for concussion in children aged ____ to ____:

5 to 12

Which Glasgow Coma Scale score listed below would rank the patient in the "severe" category:

 

12

 

14

 

9

 

4

4

Who would best be able to tell whether the athlete's personality or emotional state has changed since recent head trauma occurred:

 

the school's athletic director

 

the athletic trainer performing the evaluation

 

the athlete's family or friends

 

the athlete

the athlete's family or friends

Checking for observable signs of concussion

on field

Conducting a neurological screen

off-field

Examining the level of consciousness using the Glasgow Coma Scale

on-field

Cervical spine assessment

on-field

Taking a comprehensive history of the player’s condition

off-field

Assessment of concentration

off-field

Memory assessment

on field

Approximately what percent of concussions are transient in nature, with symptoms resolving in 10-14 days:

90

"Persistent" post-concussion syndrome occurs when symptoms related to post-concussion syndrome last beyond what time point:

3 months

A repeat blow or injury to the head before the complete resolution of the initial concussion has a strong likelihood of leading to which medical condition:

Second Impact Syndrome

Which one of the following statements is true:

 

second impact syndrome is a relatively rare condition with devastating effects

Which of the following represents what researchers have concluded occurs with second impact syndrome:

the brain loses its ability to auto regulate intracranial and cerebral perfusion pressures

Which protein has been determined to be the cause behind chronic traumatic encephalopathy:

 

tau

Chronic traumatic encephalopathy is overwhelmingly more prevalent among athletes from which sport:

boxing

Chronic traumatic encephalopathy is considered to belong to which categorization of disease:

neurodegenerative

Atlanto-occipital dislocation affects which two cervical bones:

C1 and C2

A wedge fracture affects which component of the vertebral bone:

anterior

Which type of force is required for a burst fracture to occur:

axial loading

A 'Jefferson fracture' affects which cervical component:

 

C1

Which ASIA impairment grade indicates the most severe cervical compromise:

ASIA "A"

An odontoid fracture occurs within which cervical bone:

C2

A "Hangman's Fracture" occurs within which vertebral bone:

C2

Minimal displacement, significant angulation

Type IIA

Displacement with facet dislocation

Type III

Minimal displacement, no angulation

Type I

Significant displacement and angulation

Type II

Which of the following represents the most common cause for cervical spine injury:

trauma

Which of the following statements is true:

Bone integrity (i.e. 'strength') increases as you move distally through the spine

Which neck position effectively increases the risk that an axial load would be likely to cause cervical injury:

Slight forward flexion

According to the National Emergency X-Radiography Utilization Study, imaging should be ordered if any of which five criteria listed below are met:

Altered level of consciousness

 

Intoxication

Focal neurologic deficit

Distracting injury

 

Midline tenderness

When should manual cervical immobilization be initiated:

as soon as possible once a cervical spine injury is suspected

Which two factors should be prioritized for a patient suspected of having a cervical spine injury

maintaining cervical spine spinal immobilization and minimizing neck movement

In which situation might it be necessary or permitted for a rescuer to use his or her knees to maintain the patient's cervical spine alignment:

when the rescuer is alone

Which three situations below would require that the rescuer not attempt to re-position the cervical spine to a neutral position:

 

the movement causes or increases pain, neurologic symptoms, or muscle spasm

 

the patient expresses apprehension

 

it is unusually easy to perform the re-positioning

 

the movement seems to improve the patient's airway

 

resistance is encountered during the attempt to realign the cervical spine

the movement causes or increases pain, neurologic symptoms, or muscle spasm

the patient expresses apprehension

resistance is encountered during the attempt to realign the cervical spine

Which one of the following statements is true:

 

the log roll technique has been reported to produce less motion at the head and in the cervical spine than the lift-and-slide technique

 

no athlete transfer technique has been shown to be better than any other when transferring an athlete to an immobilization device

 

the lift-and-slide technique has been reported to produce less motion at the head and in the cervical spine than the log-roll technique

 

the lift-and-slide technique should never be used on an athlete suspected of having a cervical spine injury

the lift-and-slide technique has been reported to produce less motion at the head and in the cervical spine than the log-roll technique

Select all of the correct statements listed below:

Removal of the helmet or shoulder pads in American football and ice hockey is recommended in cases where the athlete states that he or she feels as though 'something is wrong'

Removal of the helmet and shoulder pads in these sports should be considered an all-or-nothing endeavor

Face masks that interfere with the ability to access the airway should be completely removed from the helmet

Removal of the helmet or shoulder pads in American football and ice hockey is not recommended, because removing one and not the other compromises spinal alignment

A rigid cervical immobilization collar should be placed on the athlete before transfer to a spine board

A rigid cervical immobilization collar should be placed on the athlete once he or she has been transferred to a spine board

Face-mask removal should be initiated once the decision to immobilize and transport has been made

If the helmet is not properly fitted to prevent movement of the head, it should always be removed

Removal of the helmet and shoulder pads in these sports should be considered an all-or-nothing endeavor

Face masks that interfere with the ability to access the airway should be completely removed from the helmet

Removal of the helmet or shoulder pads in American football and ice hockey is not recommended, because removing one and not the other compromises spinal alignment

A rigid cervical immobilization collar should be placed on the athlete before transfer to a spine board

Face-mask removal should be initiated once the decision to immobilize and transport has been made

When it comes to facemask removal, a 'combined tool' approach is represented by which of the following:

using a powered screwdriver but also having a backup tool available in case the straps must be cut

Which of the following is considered the mouthguard style that provides the highest degree of dental protection:

 

custom-fit

Which of the following is true regarding the mouthguard's ability to reduce the risk of concussion:

 

Mouthguards were once thought to play a role in concussion prevention, but the literature is not currently as strong as used to be thought

When using head circumference as a measure, how far above the eyebrows should that measurement be taken:

 

1 inch

For proper fit, a face mask should be how far from the chin:

 

three fingers-width

For proper helmet fit, ear holes should align with which anatomical structure:

 

ear canal

When fitting a helmet that includes air bladders, which of the following is correct:

 

make sure the air bladders are inflated

When wearing a properly-fit helmet, where should the front portion of the helmet sit in proportion to the athlete's eyes:

 

two finger-widths above

For normal crutch use, elbow-bend should be at approximately what level:

 

30 degrees

For normal crutch use, the top of the crutch should sit approximately how far below the armpit:

 

2 inches

When measuring proper fit, how far should the tip of the crutch be placed out to the side and slightly in front of the foot:

 

4-6 inches

Which three recommendations were listed for how to walk with crutches:

Shift one's weight to the hands on the crutches

 

Complete the step by placing one's strong leg forward, landing on it

 

Bring one's body forward between the crutches

Which of the following is correct instruction for an individual going up a flight of stairs while using crutches:

 

step up with the strong leg first, then bringing up the injured leg and crutches

Which of the following is the correct procedure for going down a flight of stairs when using crutches:

 

step down with one's injured leg and crutches first, followed by the strong leg

What is the purpose of a baseline concussion test:

 

To provide a reference point against postinjury data to determine when the athlete has returned to the pre-concussion level of functioning

What is 'sandbagging' as it relates to concussion baseline testing:

 

when a test taker deliberately underperforms on a baseline concussion test

How does an existing mental health condition influence a patient's likelihood for incurring a concussion:

 

Athletes with preexisting mental health conditions have consistently demonstrated higher symptom scores at baseline than athletes without preexisting conditions

How does having a history of concussion influence a patient's future psychological health and quality of life:

 

there is evidence that a history of concussion can result in worse psychological health and quality of life

A high school athlete sustains a concussion during a football game and experiences headaches, dizziness, difficulty concentrating, and sensitivity to light. Another student develops the same symptoms after being involved in a motor vehicle accident. Which statement best reflects an appropriate medical approach to managing these two students:

 

Both students should receive similar medical consideration and symptom-based management because a concussion produces the same physiological brain injury regardless of whether it occurred during sports or an automobile accident

Which of the following represents current best practices for individuals who have incurred a recent concussion:

 

an immediate initial period of relative rest (24 to 48 hours) followed by symptom-limited cognitive and physical activity as well as symptom-tolerated aerobic exercise treatment and clinician-directed activities may be appropriate

An athletic trainer hears a coach describe an athlete's head injury as "just a bell ringer." According to current best practices, what should the athletic trainer do in such a case:

 

Use and promote proper terminology such as concussion or mild traumatic brain injury rather than colloquial terms like "ding" or "bell ringer

Which group should be included in concussion education efforts coordinated by an athletic trainer and school administrators:

 

Relevant stakeholders including athletes, parents, coaches, school administrators, student resources personnel, and organizational management teams

A football player is recovering from a concussion. During the evaluation, the athletic trainer identifies several factors that may prolong recovery, including a history of previous concussions and migraines. What is the most appropriate action:

 

Document the potential modifying factors and educate the athlete on how these conditions may affect recovery and return-to-play timelines

A coach tells athletes that wearing the newest helmet will prevent them from getting a concussion. How should the athletic trainer respond:

 

Educate coaches, athletes, and parents that protective equipment has limitations and cannot completely prevent concussions, and encourage all parties to review equipment warning labels

Which of the following best describes the athletic trainer's responsibilities regarding concussion management and communication:

 

Be familiar with applicable concussion policies, document the athlete's understanding of concussion signs and symptoms and reporting responsibilities, and regularly communicate the athlete's status to the managing physician

Which of the following statements are consistent with current best practices for concussion assessment and management: (Select all that apply):

 

Baseline cognitive testing is required for every athlete and must be used as the primary determinant of recovery

 

Visual-vestibular function should be considered an important domain during concussion assessment

 

Concussion management should focus exclusively on physical symptoms because social and psychological factors have little impact on recovery

 

Concussion should be viewed as a biopsychosocial injury, requiring consideration of cultural, social, psychological, and physical factors

 

A clinical examination, including cervical spine and neurologic evaluation, should be performed after injury and repeated throughout the recovery process

 

Baseline cognitive assessments are not mandatory but may be useful in certain situations when utilized under the guidance of the directing physician

 

Visual-vestibular function should be considered an important domain during concussion assessment

Concussion should be viewed as a biopsychosocial injury, requiring consideration of cultural, social, psychological, and physical factors

 

A clinical examination, including cervical spine and neurologic evaluation, should be performed after injury and repeated throughout the recovery process

 

Baseline cognitive assessments are not mandatory but may be useful in certain situations when utilized under the guidance of the directing physician

Which of the following statements reflect appropriate concussion management and return-to-activity practices (Select all that apply):

 

An athlete diagnosed with a concussion may return to play on the same day if symptoms completely resolve

 

Return to physical activity should occur only after evaluation and clearance by a physician or a properly trained and experienced designate, such as an athletic trainer

 

Baseline and postinjury assessments should be used to help guide recovery strategies

 

Athletic trainers should use clinical reasoning to determine which assessment domains should be evaluated and how frequently they should be reassessed during recovery

 

A concussed athlete may return to physical activity without formal clearance if the athlete feels ready

 

A concussed athlete should not return to athletic participation on the day of injury

Return to physical activity should occur only after evaluation and clearance by a physician or a properly trained and experienced designate, such as an athletic trainer

 

Baseline and postinjury assessments should be used to help guide recovery strategies

 

Athletic trainers should use clinical reasoning to determine which assessment domains should be evaluated and how frequently they should be reassessed during recovery

 

A concussed athlete should not return to athletic participation on the day of injury

A patient has been diagnosed with a concussion. Which five of the following instructions are consistent with recommended post-concussion management:

Avoid alcohol because it may interfere with cognitive function and neurologic recovery

 

Have all current medications reviewed by the physician

Avoid medications other than acetaminophen unless otherwise directed by a physician

 

Avoid illicit drugs and other substances that may impair cognitive function or recovery

 

Follow a period of rest after the initial monitoring phase because rest remains an important component of recovery

Which four of the following statements regarding exercise and activity after a concussion are supported by current best practices:

Early sub-symptom threshold aerobic exercise, prescribed after determining the athlete's exercise tolerance, may improve recovery and outcomes

 

Properly prescribed aerobic exercise that does not worsen symptoms more than mildly can be considered a therapeutic intervention for concussion recovery

 

Student-athletes should be restricted from team activities and other physically demanding activities that place them at risk for another head injury

 

During the first 24–48 hours after injury, patients should avoid physical or mental exertion that worsens symptoms more than mildly

Which statement best reflects current recommendations for concussion recovery and long-term management in young athletes:

 

Recovery in children and adolescents may take longer than in adults, and clinicians should recognize the risks of second-impact syndrome and cumulative head impacts

What is a 'concussion protocol':

 

an organization’s set of policies, tools, and assessments for caring for a concussion

Which of the following is true regarding state laws specific to the requirement for concussion protocols:

 

Most states in the United States have laws requiring schools to have protocols for their athletes

House bill 2038 in Texas, which relates to concussion treatment, is commonly known as:

 

Natasha's Law

In Texas, state law requires which four elements to be met before a concussed student-athlete can return to practice or competition:

The treating physician has provided a written statement indicating that, in his or her professional judgment, it is safe for the student to return to play

 

The student and the student's parent acknowledge that the student has completed the requirements of the return-to-play protocol

 

He or she has successfully completed each requirement of the return-to-play protocol established by the concussion oversight team

 

He or she has been evaluated, using established medical protocol based on peer-reviewed scientific evidence, by a treating physician chosen by the student or by the student's parent

Who is allowed to immediately remove a student from any activities that may result in a further risk of head injury:

 

Any school professional

All of the following would be acceptable to include in a return-to-learn plan for a concussed student-athlete except:

reasonable periods of cognitive rest and physical restrictions

requiring him or her to follow the same academic schedule as other students so as not to build resentment toward the student-athlete from other students

monitoring of learning, emotional functioning and behavior across all school settings

implementing a Medical Care Plan

requiring him or her to follow the same academic schedule as other students so as not to build resentment toward the student-athlete from other students

Which of the following is the primary goal of protective equipment in athletic training:

 

Prevent injury without unnecessarily limiting function or performance

Which responsibilities are part of the athletic trainer's role in using protective equipment (select all that apply):

Fabricating or customizing protective devices when needed

Assessing injury risk

 

Maintaining and inspecting equipment

 

Selecting appropriate protective devices

Educating athletes on proper use and care

Which type of protective device is designed primarily to improve function or mobility:

 

Assistive device

Examples of prophylactic devices include which of the following:

Mouthguards

Ankle taping 

Prophylactic knee braces

Lace-up ankle braces

When selecting protective equipment, which factors should be considered (select all that apply):

Cost and available budget

Evidence of the equipment's benefit being touted on social media

Proper fit and function

Quality of construction and materials

Scientific evidence supporting its use

Whether every athlete gets to wear the same device regardless of risk

Appropriate role and intended purpose

Cost and available budget

Proper fit and function

Quality of construction and materials

Scientific evidence supporting its use

Appropriate role and intended purpose

Which classification of protective equipment is designed primarily to limit motion and protect healing tissue:

 

Restrictive device