Neurologic/Neurosurgery

Question 1

What cerebral infarct is most associated with visual changes?

Answer 1

Posterior cerebral artery (PCA)

Because of the occipital lobe involvement, a variety of visual symptoms may be present. These include visual agnosia, face blindness (prosopagnosia), visual hallucinations, lack of visual imagery in dreams, and visual neglect (if the nondominant hemisphere is involved). Patients may also experience difficulty with reading comprehension (alexia) with preserved ability to write and anomic aphasia.

Question 2

What artery is the most commonly involved in stroke?

Answer 2

Middle Cerebral Artery (MCA)

Question 3

What artery is implicated in “locked-in” syndrome?

Answer 3

Basilar artery

Question 4

What is the most common type of stroke?

Answer 4

Ischemic stroke

Question 5

What is the most important initial imaging study for a suspected acute stroke?

What test should be completed at the time of presentation?

Answer 5

Non-contrast CT scan

Point of care glucose

Question 6

Which of the following is a contraindication for the administration of tissue plasminogen activator (tPA) in acute ischemic stroke?

A) Onset of symptoms within 3 hours
B) Blood pressure of 180/100 mmHg
C) History of recent major surgery within 2 weeks
D) Patient age over 80

Answer 6

History of recent major surgery within 2 weeks

Recent major surgery is a contraindication for tPA due to the increased risk of bleeding.

Question 7

A 67-year-old man with a history of hypertension and atrial fibrillation presents to the emergency department with sudden onset of right-sided weakness and difficulty speaking. On examination, he has a facial droop and right arm and leg weakness. What is the most appropriate initial diagnostic test?

A) MRI of the brain
B) Non-contrast CT scan of the head
C) Carotid Doppler ultrasound
D) Echocardiogram

Answer 7

Non-contrast CT scan of the head

Question 8

A 58-year-old woman presents with acute left-sided weakness and slurred speech that started 2 hours ago. Her medical history includes type 2 diabetes and hyperlipidemia. CT of the head reveals no intracranial hemorrhage. What is the next best step in management?

A) Administer tissue plasminogen activator (tPA)
B) Start aspirin therapy
C) Administer heparin
D) Perform emergency carotid endarterectomy

Answer 8

Administer tissue plasminogen activator (tPA)

If no contraindications are present, tPA should be administered within 4.5 hours of symptom onset for ischemic stroke to improve outcomes

Question 9

A 68-year-old woman with carotid artery stenosis presents for evaluation after a recent TIA. She is asymptomatic currently, but her carotid ultrasound shows 80% stenosis on the right side. What is the most appropriate management?

A) Medical management with antiplatelet therapy only
B) Carotid endarterectomy
C) Carotid stenting
D) No further treatment

Answer 9

Carotid endarterectomy

Carotid endarterectomy is recommended for symptomatic or high-grade (>70%) stenosis in asymptomatic patients to reduce the risk of stroke

Question 10

A 50-year-old man is brought to the ED after a motor vehicle accident. He was unconscious at the scene but briefly regained consciousness before deteriorating again. His vital signs show hypertension and bradycardia. Which of the following best explains this phenomenon?

A) Neurogenic shock
B) Cushing’s triad
C) Carotid artery dissection
D) Spinal shock

Answer 10

Cushing’s Triad

Cushing’s triad (hypertension, bradycardia, and irregular respirations) indicates increased intracranial pressure and is often associated with severe head injuries like an epidural hematoma

Question 11

What is Cushing’s Triad?

Answer 11

• Hypertension
• Bradycardia
• Irrgular Breathing

Question 12

What is the most common cause of an epidural hematoma?

A) Spontaneous bleeding
B) Skull fracture involving the temporal bone
C) Rupture of a cerebral aneurysm
D) Chronic hypertension

Answer 12

Skull fracture involving the temporal bone

Epidural hematomas are most commonly associated with trauma that leads to skull fractures, especially those involving the temporal bone, which can injure the middle meningeal artery.

Question 13

What is the classic clinical presentation of an epidural hematoma?

A) Gradual onset of headache and confusion over days
B) Loss of consciousness followed by a lucid interval and then rapid deterioration
C) Sudden, severe headache with photophobia
D) Progressive weakness and numbness over weeks

Answer 13

Loss of consciousness followed by a lucid interval and then rapid deterioration

Question 14

Which imaging modality is preferred for diagnosing an epidural hematoma?

A) MRI of the brain
B) CT scan of the head without contrast
C) Carotid Doppler ultrasound
D) Skull X-ray

Answer 14

CT scan of the head without contrast

A non-contrast CT scan is the preferred imaging study for diagnosing an epidural hematoma, showing a biconvex, hyperdense collection

Question 15

A 25-year-old male is brought to the emergency department after a head injury during a football game. He initially lost consciousness but then regained it and seemed lucid for an hour before becoming progressively drowsy and confused. On examination, his right pupil is dilated and non-reactive. What is the most likely diagnosis?

A) Subdural hematoma
B) Epidural hematoma
C) Concussion
D) Intracerebral hemorrhage

Answer 15

Epidural hematoma

Question 16

A 40-year-old man falls off a ladder and hits his head. He arrives at the emergency department awake and alert, but within two hours, he becomes confused and unresponsive. A CT scan shows a hyperdense, biconvex collection between the skull and dura. What is the appropriate next step in management?

A) Observation and repeat imaging in 24 hours
B) Administration of mannitol and supportive care
C) Emergent surgical evacuation
D) Start anticoagulation therapy

Answer 16

Emergent surgical evacuation

An epidural hematoma is a neurosurgical emergency that requires prompt surgical evacuation to prevent brain herniation and death