MCQ Quiz: Brain Injury

Brain injury, whether from a traumatic event or a stroke, represents a critical medical emergency requiring rapid and precise care. Pharmacists play an essential role in all phases, from acute management with thrombolytics and ICP-lowering agents to long-term secondary prevention and management of sequelae. This quiz for PharmD students will test your knowledge on the pathophysiology, assessment, and complex pharmacotherapy involved in caring for patients with a brain injury.


1. A patient presents to the emergency department with sudden onset of facial droop, arm weakness, and speech difficulty. This presentation is highly suggestive of:

  • A myocardial infarction.
  • A stroke.
  • A seizure.
  • A hypoglycemic event.

Answer: A stroke.


2. The Glasgow Coma Scale (GCS) is used in the initial assessment of a trauma patient to evaluate their:

  • Respiratory rate.
  • Blood pressure.
  • Level of consciousness.
  • Risk of infection.

Answer: Level of consciousness.


3. Ischemic stroke is caused by a(n) __________, while hemorrhagic stroke is caused by a(n) __________.

  • Bleed in the brain; infection in the brain.
  • Obstruction of blood flow to the brain; rupture of a blood vessel in the brain.
  • Seizure; traumatic impact.
  • Low blood sugar; high blood pressure.

Answer: Obstruction of blood flow to the brain; rupture of a blood vessel in the brain.


4. In the first response to a suspected stroke, what is one of the most critical pieces of information to determine?

  • The patient’s insurance provider.
  • The time the patient was “last known well”.
  • The patient’s preferred hospital.
  • The patient’s allergy history.

Answer: The time the patient was “last known well”.


5. The primary mechanism of secondary brain injury after a traumatic event involves:

  • The initial physical impact on the brain tissue.
  • A cascade of neurochemical and inflammatory processes that occur hours to days after the initial injury.
  • The development of a scalp laceration.
  • The patient’s emotional response to the trauma.

Answer: A cascade of neurochemical and inflammatory processes that occur hours to days after the initial injury.


6. For a patient with an acute ischemic stroke who presents within the therapeutic window, which pharmacologic therapy is used to dissolve the clot?

  • Aspirin
  • Intravenous heparin
  • Intravenous alteplase (tPA).
  • Warfarin

Answer: Intravenous alteplase (tPA).


7. A major risk factor for developing an ischemic stroke is:

  • Young age.
  • Atrial fibrillation.
  • A history of migraines.
  • A vegetarian diet.

Answer: Atrial fibrillation.


8. Increased intracranial pressure (ICP) is a life-threatening complication of severe brain injury. Which of the following is an osmotic agent used to reduce ICP?

  • Furosemide
  • Normal saline
  • Mannitol.
  • D5W

Answer: Mannitol.


9. The concept of the “ischemic penumbra” refers to:

  • The area of dead brain tissue that is unsalvageable.
  • The area of brain tissue surrounding the core ischemic region that is at risk but potentially salvageable.
  • A type of hemorrhagic stroke.
  • The cause of a transient ischemic attack (TIA).

Answer: The area of brain tissue surrounding the core ischemic region that is at risk but potentially salvageable.


10. Patients who are immobilized after a severe brain injury are at high risk for developing:

  • Hypertension.
  • Venous thromboembolism (VTE).
  • Hyperglycemia.
  • Anemia.

Answer: Venous thromboembolism (VTE).


11. A key strategy for secondary prevention after a non-cardioembolic ischemic stroke is:

  • Lifelong corticosteroid therapy.
  • Antiplatelet therapy, such as aspirin or clopidogrel.
  • High-dose vitamin C.
  • Discontinuation of all blood pressure medications.

Answer: Antiplatelet therapy, such as aspirin or clopidogrel.


12. The pathophysiology of excitotoxicity after a brain injury involves the excessive release of which excitatory neurotransmitter?

  • Serotonin
  • Dopamine
  • GABA
  • Glutamate.

Answer: Glutamate.


13. A patient who has had a hemorrhagic stroke while on warfarin requires immediate reversal. The pharmacist would anticipate preparing:

  • Naloxone.
  • Protamine sulfate.
  • Vitamin K and 4-Factor Prothrombin Complex Concentrate (4F-PCC).
  • Idarucizumab.

Answer: Vitamin K and 4-Factor Prothrombin Complex Concentrate (4F-PCC).


14. A patient with a traumatic brain injury (TBI) may be given seizure prophylaxis. Which class of medication is commonly used for this purpose in the acute setting?

  • Antidepressants
  • Anticonvulsants.
  • Antipsychotics
  • Antibiotics

Answer: Anticonvulsants.


15. One of the primary goals in the acute management of a major brain injury is to:

  • Increase the patient’s blood pressure significantly.
  • Maintain adequate cerebral perfusion pressure (CPP).
  • Administer a sedative to keep the patient asleep.
  • Start physical therapy immediately.

Answer: Maintain adequate cerebral perfusion pressure (CPP).


16. Which of the following is a common long-term sequela of a moderate to severe brain injury?

  • Cognitive impairments.
  • Mood disorders like depression and anxiety.
  • Chronic pain.
  • All of the above.

Answer: All of the above.


17. The use of high-intensity statin therapy is a cornerstone of secondary prevention after an ischemic stroke of atherosclerotic origin to:

  • Lower blood pressure.
  • Reduce the risk of recurrent cardiovascular events.
  • Dissolve an existing clot.
  • Treat post-stroke depression.

Answer: Reduce the risk of recurrent cardiovascular events.


18. What is a key difference in the acute management of ischemic versus hemorrhagic stroke?

  • Blood pressure goals are the same for both.
  • Ischemic stroke may be treated with thrombolytics, while these are strictly contraindicated in hemorrhagic stroke.
  • Anticoagulants are started immediately in all hemorrhagic stroke patients.
  • There is no difference in management.

Answer: Ischemic stroke may be treated with thrombolytics, while these are strictly contraindicated in hemorrhagic stroke.


19. A pharmacist’s role in the neuro-ICU often involves:

  • Managing sedation and analgesia.
  • Dosing medications based on renal and hepatic function.
  • Recommending seizure prophylaxis.
  • All of the above.

Answer: All of the above.


20. A patient with atrial fibrillation requires anticoagulation to prevent a cardioembolic stroke. Which of the following would be an appropriate choice?

  • Aspirin only
  • A direct oral anticoagulant (DOAC) like apixaban or rivaroxaban.
  • Clopidogrel only
  • A high-intensity statin

Answer: A direct oral anticoagulant (DOAC) like apixaban or rivaroxaban.


21. A patient with a subarachnoid hemorrhage is at risk for developing cerebral vasospasm. Which medication is used to prevent this complication?

  • Aspirin
  • Nimodipine.
  • Heparin
  • Atorvastatin

Answer: Nimodipine.


22. The term “primary injury” in TBI refers to:

  • The damage that occurs at the moment of impact.
  • The swelling and inflammation that occurs hours later.
  • The development of an infection.
  • The patient’s long-term disability.

Answer: The damage that occurs at the moment of impact.


23. Why is tight glucose control important in a patient with an acute brain injury?

  • Both hyperglycemia and hypoglycemia can worsen neurological outcomes.
  • Hyperglycemia helps reduce brain swelling.
  • It is not important in this patient population.
  • Hypoglycemia is protective for brain tissue.

Answer: Both hyperglycemia and hypoglycemia can worsen neurological outcomes.


24. The pharmacist’s role in transitions of care for a brain injury patient moving from hospital to rehabilitation is to:

  • Ensure the discharge medication list is accurate and the patient/caregiver understands the regimen.
  • Discontinue all of the patient’s medications.
  • Only focus on the medications prescribed in the hospital.
  • Make follow-up appointments with all specialists.

Answer: Ensure the discharge medication list is accurate and the patient/caregiver understands the regimen.


25. Mind-body skills and resilience training can be beneficial for brain injury survivors and their caregivers to:

  • Reverse the physical damage to the brain.
  • Help cope with the stress and emotional challenges of recovery.
  • Eliminate the need for all medications.
  • Ensure a full and rapid recovery.

Answer: Help cope with the stress and emotional challenges of recovery.


26. A patient who experiences stroke-like symptoms that resolve completely within an hour is likely to have had a(n):

  • Hemorrhagic stroke.
  • Transient Ischemic Attack (TIA).
  • Myocardial infarction.
  • Seizure.

Answer: Transient Ischemic Attack (TIA).


27. The management of a TIA is critical because it:

  • Is a strong predictor of a future, full-blown stroke.
  • Is not a serious medical condition.
  • Requires immediate thrombolytic therapy.
  • Guarantees the patient will never have another stroke.

Answer: Is a strong predictor of a future, full-blown stroke.


28. Which of the following vital signs is most critical to control in the acute management of an intracerebral hemorrhage?

  • Heart rate
  • Respiratory rate
  • Temperature
  • Blood pressure.

Answer: Blood pressure.


29. A patient with a GCS score of 8 is considered to have:

  • A mild brain injury.
  • A moderate brain injury.
  • A severe brain injury.
  • No brain injury.

Answer: A severe brain injury.


30. The brain’s blood supply is primarily provided by which two pairs of arteries?

  • The femoral and brachial arteries.
  • The subclavian and axillary arteries.
  • The internal carotid and vertebral arteries.
  • The pulmonary and coronary arteries.

Answer: The internal carotid and vertebral arteries.


31. The pharmacist’s expertise in pharmacokinetics is essential for managing drugs in brain injury patients, especially when:

  • The patient has normal organ function.
  • There are concurrent renal or hepatic injuries that alter drug clearance.
  • The patient is only taking oral medications.
  • The patient is fully awake and alert.

Answer: There are concurrent renal or hepatic injuries that alter drug clearance.


32. Long-term management after a brain injury often includes medications to treat spasticity, such as:

  • Lisinopril
  • Baclofen.
  • Furosemide
  • Metformin

Answer: Baclofen.


33. What is the primary role of an antiplatelet agent like aspirin in secondary stroke prevention?

  • To dissolve an existing clot.
  • To prevent the formation of new clots by inhibiting platelet aggregation.
  • To lower cholesterol.
  • To control blood pressure.

Answer: To prevent the formation of new clots by inhibiting platelet aggregation.


34. The “ABC”s of first response stand for:

  • Aspirin, Beta-blocker, Clopidogrel.
  • Assess, Be Calm, Call 911.
  • Airway, Breathing, Circulation.
  • Alert, Bleeding, Conscious.

Answer: Airway, Breathing, Circulation.


35. A “craniectomy” is a surgical procedure sometimes performed in severe TBI to:

  • Repair a skull fracture.
  • Relieve intracranial pressure by removing a portion of the skull.
  • Drain excess cerebrospinal fluid.
  • Place a monitoring device in the brain.

Answer: Relieve intracranial pressure by removing a portion of the skull.


36. A pharmacist in a disaster scenario might need to manage medications for:

  • Multiple trauma patients simultaneously.
  • Routine refills only.
  • Patients with minor illnesses.
  • A single, stable patient.

Answer: Multiple trauma patients simultaneously.


37. A key challenge in managing a brain-injured patient on an anticoagulant for a different indication (e.g., atrial fibrillation) is:

  • Balancing the risk of thrombosis versus the risk of intracranial bleeding.
  • Ensuring the patient gets a higher dose of the anticoagulant.
  • Finding a pharmacy that stocks the medication.
  • The high cost of anticoagulants.

Answer: Balancing the risk of thrombosis versus the risk of intracranial bleeding.


38. The use of hypertonic saline in TBI works to reduce brain edema by:

  • Directly constricting cerebral blood vessels.
  • Creating an osmotic gradient that draws water out of brain tissue.
  • Sedating the patient.
  • Decreasing the production of cerebrospinal fluid.

Answer: Creating an osmotic gradient that draws water out of brain tissue.


39. Rehabilitation after a brain injury is a multidisciplinary effort that focuses on:

  • Helping the patient regain lost function and improve their quality of life.
  • Curing the underlying cause of the initial injury.
  • Preventing all future medical problems.
  • Ensuring the patient remains in the hospital.

Answer: Helping the patient regain lost function and improve their quality of life.


40. A patient who sustains a brain injury from a fall is an example of what type of trauma?

  • Penetrating trauma
  • Blast injury
  • Blunt force trauma
  • Thermal trauma

Answer: Blunt force trauma


41. The pharmacist’s knowledge of sterile compounding is critical for preparing which medications used in acute brain injury?

  • Oral tablets
  • Topical creams
  • Intravenous infusions of mannitol or hypertonic saline.
  • Transdermal patches

Answer: Intravenous infusions of mannitol or hypertonic saline.


42. Which of the following is NOT a classic symptom of a stroke according to the FAST acronym?

  • Facial drooping
  • Arm weakness
  • Speech difficulty
  • Foot pain

Answer: Foot pain


43. A pharmacist is part of the team responding to an in-hospital “stroke alert.” Their role would be to:

  • Perform a neurological exam.
  • Prepare the thrombolytic agent and verify the dose and contraindications.
  • Transport the patient to the CT scanner.
  • Notify the patient’s family.

Answer: Prepare the thrombolytic agent and verify the dose and contraindications.


44. A major long-term goal for a patient who has had a stroke is:

  • To regain full motor function.
  • To manage risk factors like hypertension and dyslipidemia to prevent another event.
  • To return to work within one week.
  • To stop taking all medications.

Answer: To manage risk factors like hypertension and dyslipidemia to prevent another event.


45. Why is fever control important in a patient with an acute brain injury?

  • Fever increases the metabolic demand of the brain, which can worsen secondary injury.
  • Fever helps to reduce intracranial pressure.
  • It is not important.
  • Fever is a sign of a good prognosis.

Answer: Fever increases the metabolic demand of the brain, which can worsen secondary injury.


46. A patient with a TBI might be at risk for a stress-related gastrointestinal bleed. Prophylaxis for this could include:

  • An NSAID
  • A proton pump inhibitor or H2 receptor antagonist.
  • An anticoagulant
  • A laxative

Answer: A proton pump inhibitor or H2 receptor antagonist.


47. The “time is brain” concept emphasizes that:

  • The human brain is similar to a clock.
  • There is a limited window of time to intervene in an acute stroke to prevent irreversible damage.
  • It takes a long time to recover from a brain injury.
  • All brain injuries are untreatable.

Answer: There is a limited window of time to intervene in an acute stroke to prevent irreversible damage.


48. A pharmacist working with a brain injury patient’s caregiver should provide education on:

  • The medication regimen.
  • When to call for help.
  • Potential side effects to watch for.
  • All of the above.

Answer: All of the above.


49. The Circle of Willis is an important anatomical feature related to:

  • The venous drainage of the legs.
  • The collateral blood supply of the brain.
  • The electrical conduction of the heart.
  • The structure of the kidney nephron.

Answer: The collateral blood supply of the brain.


50. The ultimate goal of the pharmacy team in caring for a patient with a brain injury is to:

  • Ensure the patient is discharged from the hospital quickly.
  • Use the most expensive medications possible.
  • Optimize pharmacotherapy to minimize secondary injury and support recovery.
  • Complete all charting requirements.

Answer: Optimize pharmacotherapy to minimize secondary injury and support recovery.

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