Day 1 - Neuro Part 2 Quiz

Question 1

Tx worsening subdural hematoma

Answer 1

Surgical evacuation of clot via burr hole

Question 2

Most common predisposing condition for ICH

Answer 2

HTN

Question 3

CT Head shows lacunar shaped lesion - likely cause?

Answer 3

Subdural hematoma - blunt head trauma, rupture of bridging veins

Question 4

Indications for carotid endarterectomy

Answer 4

(1) Symptomatic 70-99%, clear benefit, both sexes (2) Symptomatic 50-69%, marginal benefit, more for men and within 2 weeks of stroke/TIA (3) Asymptomatic 80-99% w/ at least 5 year life expectancy & surgeon w/ low complication rate

Question 5

Common cause of lacunar infarct

Answer 5

HTN

Question 6

Preferred tx for febrile seizures

Answer 6

Antipyretics (Acetaminophen or Ibuprofen), Reassurance; NO anticonvulsants

Question 7

Pt w/ PMH of DVT develops stroke - which study reveals etiology?

Answer 7

Transesophageal Echocargiogram (TEE) (PFO)

Question 8

Abnormality seen w/ infarction of following arteries: (1) ACA (2) MCA (3) PCA (4) Lacunar arteries (5) Basilar artery

Answer 8

(1) Contralateral loss of sensory &/or motor in legs/feet/trunk (2) Contralateral loss of sensory &/or motor in face/arms/hands, Aphasia - Broca/Wernicke/Conduction/Global (3) Vision defects - unilateral hemianopia w/ macular sparing (4) Lacunar syndrome (see following card) (5) CN abnormalities, Contralateral body weakness (LCST), Coma or alterations of consciousness (Reticular activating system); Decreased sensation, Vertigo, Lack of coordination, Difficulty speaking, or Visual abnormalities

Question 9

5 Main Lacunar syndromes from lacunar infarct

Answer 9

(1) Pure motor hemiparesis - most common (2) Pure sensory hemiparesis (3) Ataxic hemiparesis (4) Sensory-motor hemiparesis (5) Dysarthria, lumsy hand

Question 10

Tx for subarachnoid hemorrhage

Answer 10

(1) D/c anticoagulants (2) BP

Question 11

Lab w/u in status epillepticus

Answer 11

CBC, glucome, lytes, BUN/Cr, LFTs, Tox screen, Mg/Ca, may or may not do LP/CT/MRI

Question 12

NPH - p/w & tx

Answer 12

Wacky, Wet, Wobbly; Ventriculoperitoneal shunt

Question 13

Target bp in ischemic stroke pt

Answer 13

220/120; Not tx unless approach this; If giving tPA, bp not greater than 185/110

Question 14

Different components of radiological w/u of TIA or Stroke

Answer 14

CT head (r/o hemorrhage); Carotid duplex (no carotid stensosi); Echocardiogram (no vegetations, AS, mural thrombis, PFO); CTA/MRA (pinpoint vascular abnormality in brain)