Neuro

Question 1

What is ischemic penumbra?

Answer 1

CVA - Area of brain around primary injury that can be salvaged!!!

Question 2

A patient presents with sensory and motor changes, including aphasia and agnosia. How do you manage?

Answer 2

CVA

Door to doc in 10 min

Door to CT in 25 min

45 min to read CT

Question 3

A patient comes in with a hemorrhagic stroke. How do you treat? What about ischemic stroke?

Answer 3

Hemorrhagic: Tight BP control: <180/110 with nitroprusside or labetalol

Ischemic: TPA/endovascular treatment

Question 4

What are the contraindications for TPA use? 6

Answer 4

• Current/Prior hemorrhagic stroke
• Any stroke within past 3 months
• Known intracranial neoplasm, AVM, aneurysm
• Active bleeding (except menses)
• Suspected aortic dissection
• Allergy

Question 5

10%-25% of pts have stroke within how many months? How many of those occur within the first 2 days?

Answer 5

3 months

1/2

Question 6

What is the most common cause of sudden death from a stroke?

Answer 6

Subarachnoid hemorrhage

Question 7

What are the main risk factors for a subarachnoid hemorrhage?

Answer 7

Chronic HTN

Polycystic kidney disease

Question 8

A patient comes in with a really bad HA, neck stiffness, N/V. How do you manage and tx?

Answer 8

Subarachnoid hemorrhage

Emergent noncontrast CT

Call neurosurg

BP controlled to <160

Reverse anticoags

Question 9

A patient comes in with a unilateral pulsating HA. How do you treat?

Answer 9

Migraine

Sumitriptan

Antiemetic

Toradol

Fioricet

Question 10

What is a disease of the elderly and of alcoholics?

Answer 10

Subdural hematoma

Question 11

What is an acceleration-deceleration injury?

Answer 11

Subdural hematoma

Question 12

A patient comes in after an MVA. CT shows crescent shaped hematoma. What is it?

Answer 12

Subdural hematoma

Question 13

What is a disease of the young?

Answer 13

Epidural hematoma

Question 14

A patient fell on his head. They lost consciousness and then had a lucid interval. What would a head CT show?

Answer 14

Epidural hematoma

Hyperdense, biconvex, ovid, sharply defined bulges in the brain

Question 15

A patient comes in with complaints of seizures. You note he is on antiepileptic meds. What should you watch out for that causes these continual seizures?

Answer 15

Being on subtherapeutic antiepileptic doses

Question 16

List the risk factors of seizures

Answer 16

Sleep deprivation
EtOH
Medication noncompliance

Question 17

A patient presents with seizures. How do you manage?

Answer 17

Fingerstick glucose

Question 18

A patient is actively seizing. How do you treat?

Answer 18

Place in left lateral decubitus position + lorazepam

Question 19

A patient presents with meningitis. What symptoms do you look for?

Answer 19

Neck stiffness
HA
Fever

Question 20

A patient has positive kernig and brudinski signs. What are these and what do they determine

Answer 20

Meningitis

Kernig: pain when extending the knee after flexing it

Brudinski: knee flexion with neck flexion

Question 21

A <50 yo male presents with meningitis. How do you treat?

Answer 21

Cetriaxone +Vanco

+ IV dexamethasone

Question 22

A >50 yo male presents with meningitis. How do you treat?

Answer 22

Ceftriaxone + Vanco + Ampicillin (to cover for listeria)

+ IV dexamethasone

Question 23

List the red flags of back pain

Answer 23

Fever

Leg weakness

Saddle anesthesia

Urinary retention/bowel incontinence

IV Drug use

Anticoagulation

Trauma

Question 24

A patient presents with backache with progression to localized pain, fever, sweats, rigors, neuro deficits, and AMS. How do you manage?

Answer 24

Epidural abscess

Emergent MIR