Untitled Deck Flashcards
What is the next best step for a 72-year-old male with sudden-onset right-sided weakness and slurred speech, within 2 hours of last known normal?
C) Administer alteplase (tPA)
The patient is within the 4.5-hour window for IV thrombolysis with alteplase (tPA).
What is the most likely diagnosis for a patient presenting with ‘the worst headache of their life’ and loss of consciousness?
B) Subarachnoid hemorrhage
Aneurysmal subarachnoid hemorrhage classically presents with a sudden, severe headache and possible loss of consciousness.
What is the best next step in management for a 60-year-old woman with a 30-minute episode of left-sided weakness that completely resolved?
C) Start aspirin and perform a stroke workup including carotid ultrasound and echocardiogram
A TIA is a warning sign for stroke, and workup should include identifying the source of embolism.
What is the best diagnostic test to confirm suspected Guillain-Barré Syndrome in a patient with progressive ascending weakness after a GI illness?
B) Lumbar puncture
CSF findings show elevated protein with normal WBC (albuminocytologic dissociation).
Which test would most likely confirm the diagnosis of Myasthenia Gravis in a patient with fatigue and drooping eyelids?
B) Anti-acetylcholine receptor antibody test
The anti-ACh receptor antibody test is the most specific diagnostic test.
What is the next best step for a patient actively seizing for 7 minutes after receiving 4 mg IV lorazepam?
B) Initiate IV phenytoin or fosphenytoin
Status epilepticus requires benzodiazepines as first-line therapy, followed by a second-line anti-epileptic drug if seizures persist.
What is the most appropriate initial management for a 22-year-old college student with fever, headache, and neck stiffness?
A) Start ceftriaxone and vancomycin, then perform lumbar puncture
In suspected bacterial meningitis, empiric antibiotics must be started immediately before LP.
What is the most likely diagnosis for a patient with fever, severe headache, photophobia, and altered mental status with CSF analysis showing elevated WBCs, low glucose, and high protein?
B) Bacterial meningitis
Bacterial meningitis presents with high WBC count, low glucose, and high protein in CSF analysis.
What is the best next step in management for a 55-year-old man with atrial fibrillation, sudden left-sided weakness, and facial droop, who was last seen normal 6 hours ago?
Perform CT angiography to assess for large vessel occlusion
The patient is outside the 4.5-hour tPA window, but endovascular thrombectomy is an option if large vessel occlusion is confirmed.
What is the most likely diagnosis for a 68-year-old male with confusion, headache, fever, and a new systolic murmur, with a history of IV drug use?
Endocarditis with septic emboli
Fever, altered mental status, and a new murmur in an IV drug user raise strong suspicion for infective endocarditis with septic emboli to the brain.
What is the most appropriate first-line treatment for a 68-year-old woman with sudden-onset left-sided weakness and slurred speech, with a CT scan showing no hemorrhage, if symptoms started 2 hours ago?
IV alteplase (tPA)
The patient is within the 4.5-hour window for thrombolysis.
What is the next best step for a 75-year-old man with uncontrolled hypertension who develops sudden-onset right-sided weakness and loss of consciousness, with a CT scan showing intracerebral hemorrhage?
Initiate IV labetalol to control BP
In hemorrhagic stroke, BP control is key to prevent further bleeding.
Which of the following is a contraindication to IV thrombolysis in ischemic stroke?
Recent major surgery within 2 weeks
Bleeding risk makes tPA contraindicated.
What is the expected neurological finding for a stroke affecting the left middle cerebral artery?
Right-sided hemiparesis and aphasia
Left MCA stroke affects motor function on the right and causes language deficits in dominant hemisphere (usually left).
Which diagnostic test is most important in assessing stroke risk for a 64-year-old man with transient left-sided weakness and slurred speech that resolved in 30 minutes?
Carotid ultrasound
Carotid stenosis is a major cause of TIA and stroke.
What is the first-line treatment for stroke prevention in TIA?
Clopidogrel or aspirin
Antiplatelet therapy is recommended for stroke prevention in non-cardioembolic TIA.
