The mom of a patient who sustained a concussion while skiing asks the NP, "If
my child had a brain injury, why can't you see anything when you scan his
head?" The NP knows:
A. Concussions are always visible on imaging.
B. A concussion is a functional injury, not structural
C. The injury will not show on imaging initially.
D. Imaging is never indicated in concussion. Right Ans - B. A concussion is a
functional injury, not structural
Possible symptoms of concussion include all of the following except:
A. Clear nasal discharge
B. Headache
C. Nausea
D. Amnesia of minutes leading up to the event. Right Ans - A. Clear nasal
discharge
You are discharging a patient from urgent care after being seen for concussion
sustained while playing sports. As you review the return precautions, the
parents ask you how long children experience symptoms of concussion on
average. You know to explain:
A. Most children have intermittent symptoms for years following injury.
B. The symptoms resolve within 1-2 days for the majority of children.
C. Most children experience resolution of symptoms within 3 weeks.
D. The symptoms get worse for most children before they improve. Right
Ans - C. Most children experience resolution of symptoms within 3 weeks.
A 14-year-old female patient is brought to the urgent care after crashing into
another player on the hockey rink during a tournament. The patient and
parents report that the two players collided, and the patient fell backwards
hitting her head on the ice. She was wearing a helmet, however she was
briefly unconscious. On physical exam, the patient appears cognitively intact
but has cervical pain. The NP states that she would like to do some additional
testing. The parents ask if it can wait because the patient would like to return
to the tournament with her team. The NP considers:
,A. The patient was wearing a helmet, so serious injury is unlikely.
B. The patient should be allowed to return to her teammates and can come
back later.
C. The patient should learn to tough it out in order to stay in competitive
sports.
D. The patient needs monitoring and further work-up now due to her HPI and
PE findings. Right Ans - D. The patient needs monitoring and further work-
up now due to her HPI and PE findings.
It is important to document a thorough neurological exam on a patient with
possible concussion because (select all that apply):
A. A baseline to compare to is crucial for monitoring.
B. Neurologic findings may not appear immediately.
C. The coach will need to know the details of the exam.
D. A patient cannot return to school without seeing neurology. Right Ans -
B. Neurologic findings may not appear immediately.
Which of the following patients would be most at risk for prolonged
concussion symptomatology?
A. A patient with a headache 5 days after injury.
B. A patient with multiple concussions over the course of 5 years.
C. A patient with underlying anxiety.
D. A patient with vomiting immediately after the injury. Right Ans - B. A
patient with multiple concussions over the course of 5 years.
An NP is seeing a patient in urgent care following a playground accident and
diagnoses concussion. The patient complained of dizziness at the time of the
event that resolved, but he continues to have a headache now 2 hours post-
injury. His exam is otherwise normal. Which of the following discharge plans
would be appropriate?
A. Follow-up with a pediatrician in 2-7 days or soon with worsening
symptoms.
B. Refer to ED now for head CT to rule out more serious injury.
C. No follow-up recommended.
, D. Wake the patient up every 2 hours throughout the night. Right Ans - A.
Follow-up with a pediatrician in 2-7 days or soon with worsening symptoms.
An NP is seeing a patient in urgent care following a playground accident and
diagnoses concussion. The patient complained of dizziness at the time of the
event that resolved, but he continues to have a headache now 2 hours post-
injury. When preparing for discharge, the mother asks if the patient can play
outside. The NP recommends:
A. He must rest in a dark room with no stimulation for the next 48 hours.
B. He cannot play outside until all his symptoms have completely resolved due
to risk of re-injury.
C. He can play outside as soon as he returns home since the concussion is mild.
D. He should rest quietly for the rest of the day, but can return to light activity
with safety precautions to avoid additional injury in 24-48 hours. Right Ans
- D. He should rest quietly for the rest of the day, but can return to light
activity with safety precautions to avoid additional injury in 24-48 hours.
An adolescent with concussion reports that her older brother was not allowed
to use electronics for a week after sustaining a concussion and wonders if she
also has to avoid electronics. The NP knows to counsel that:
A. All electronic devices should be avoided until full symptom resolution.
B. There is no evidence that use of electronics worsens outcomes
C. The recommendation is for absolute rest including avoiding all visual and
auditory stimulation.
D. Electronic devices should only be used for 1 hour a day until full-recovery.
Right Ans - B. There is no evidence that use of electronics worsens outcomes
A 10-year-old patient presents to the urgent care with his dad. The dad
reports they were seen 12 days ago and the child was diagnosed with a
concussion. He states the headaches now seem to be worsening and the child
seems withdrawn and more tired than usual. The NP knows:
A. This is a normal progression of symptoms in pediatric concussion.
B. This patient may be experiencing post-concussive syndrome and needs to
be seen by a specialist.
C. These symptoms are not likely related to the concussion and something else
must be going on.
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