Headache and Neurologic, SAEM Peds, SAEM -
Procedures, Psych Emergencies, Derm, SAEM
Tox, Infxn, Optho, Foreign Bodies, SAEM AMS,
2017 CV, 2017 trauma, SAEM MISC, SAEM -
Shock and Sepsis, Environment and Endocrine,
Pulm Emergencies/ 389 Qs with Ans &
Definitions.
Generally speaking, a patient with a TIA history who presents with a new stroke,
likely has which kind of stroke?
A. thrombotic
B. there is equal likelihood for any stroke type
C. hemorrhagic
D. hypoperfusion
Page 1 of 241
,E. embolic - Answer: The answer is A. TIAs are associated with increased risk for
thrombotic strokes, the result of ulceration of cerebral artery plaque. Patients
with TIA have a 5 to 6% percent chance per year of having a stroke. Antiplatelet
therapy reduces risk of stroke in these patients.
Which of the following is not a known complication of subarachnoid hemorrhage
in the immediate several weeks following the initial bleed?
A. rebleeding
B. hydrocephalus
C. hypernatremia
D. seizure
E. cerebral artery vasospasm - Answer: C
A 36 year old woman presents to the emergency department two hours after the
sudden onset of a severe occipital headache and nausea. She has a history of
migraine headaches that typically occur in the right frontal area and are
associated with an aura. Her temperature is 98.8 degrees Fahrenheit, her neck is
supple, and her neurological exam is normal. A non-contrast CT scan of her head is
normal. Of the options below, what is the next step in her management?
A. Consult a neurologist for evaluation of atypical migraines.
B. Perform a lumbar puncture to rule out the possibility of subarachnoid
hemorrhage.
Page 2 of 241
,C. Discharge her home with prochlorperazine and close instructions to return if
her symptoms worsen.
D. Observe for 6 hours, administer acetaminophen and normal saline, and
discharge home if she feels better.
E. Observe for 6 hours and then obtain a repeat CT scan; if normal, discharge
home. - Answer: The answer is B. Sudden onset headache with nausea, vomiting,
photophobia, or neck stiffness should raise the concern for spontaneous
subarachnoid hemorrhage. Sensitivity of a non-contrast CT scan varies with
respect to many factors (e.g. time since bleed) but is generally in the range of
90%; therefore, if the clinical suspicion is high, a lumbar puncture should be
performed and a cell count for red blood cells done.
Which of the following descriptors of epidural hematoma is FALSE?
A. Present in only about 1% of severe head injury patients
B. Most often a result of a skull fracture that traverses a venous sinus
C. Biconcave blood collection between the skull and dura
D. Immediate surgical evacuation is indicated
E. Classically associated with a "lucid" interval prior to coma - Answer: The
answer is B. Epidural hemorrhage is most often associated with skull fracture
across the course of the middle meningeal artery.
Epidural hematomas are least likely in which age group?
A. Children less than 2 years
B. Prevalence is the same throughout age groups
Page 3 of 241
, C. Adults excluding elderly
D. Children between 8 and 14
E. Elderly - Answer: The answer is A. Epidural hematoma (EDH) is less likely in
children and elderly because of the close attachment of the dura to the
periostium of the skull. This is especially true of children less than 2 years because
of the added elasticity of the skull.
Which of the following symptoms is not associated with epidural hematomas?
A. Severe headache
B. Neurologic deficits
C. Nausea
D. Sleepiness
E. Hemotympanum - Answer: The answer is E. Although hemotympanum may be
found in a patient with an epidural hematoma, it is specifically associated with
basilar skull fracture.
A 21-year-old woman presents to the emergency department with fevers,
headache, neck stiffness, and mild confusion over the past several days. Her
temperature is 38.0 C (100.4 F), pulse 106, and blood pressure 116/74. On
physical exam she looks ill, and her neck is stiff. Her neurologic exam is normal. A
lumbar puncture reveals 105 WBC and 1240 RBC in tube #1 and 126 WBC and
1360 RBC in tube #4; all white cells are lymphocytes. The CSF protein is 68 and the
glucose is 78. This patient most likely has which of the following?
Page 4 of 241
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