Emergency Medicine - Neurologic Emergencies

Question 0

Classic Sx of acute bacterial meningitis (4)?

Answer 0

HA, stiff neck, fewer and altered mental status

Question 1

Causes of acute bacterial meningitis

Answer 1

Strep pneumo, N. Meningitidis most common. Listeria in 1/4 of >60yo.

Question 2

Classic Sx of acute bacterial meningitis (4)?

Answer 2

HA, stiff neck, fewer and altered mental status. Almost all patients present with at least two of these.

Question 3

Elderly patients with altered mental status and high white counts in UA most likely have what? Treatment (3)?

Answer 3

Urosepsis.

Empiric antibiotics, aggressive IV fluid resuscitation, and hospital admission.

Question 4

Most common site of embolism for acute ischemic stroke? Most common site of thrombus for acute ischemic stroke?

Answer 4

Heart. Site of an atherosclerotic plaque.

Question 5

Classic presentation of left MCA stroke (4)?

Answer 5

Aphasia. Right sided hemiparesis (worse in face and upper limbs). Left hemianopsia. Gaze preference towards the stroke.

Question 6

Treatment of acute MCA stroke. Stat actions (3)? Other Tests?

Answer 6

Stat Head CT and MRI. Stat neuro consult.

The usuals…Glucose, CBC, BMP, EKG, UA, CXR.

Question 7

Timeline for Thrombolysis in Acute Ischemic Stroke?

Answer 7

Within four hours of onset of symptoms.

Question 8

How to dose tPa?

Answer 8

0.9mg/kg(maxdose90mg); 10% of total dose given as IV bolus, remaining 90% infused over 60 minutes.

Question 9

Absolute contraindications to thrombolytics (7)

Answer 9

Prior hemorrhagic stroke. Any stroke within past three months. Known intracranial neoplasm, AVM, or aneurysm. Active bleeding (except menses). Suspected aortic dissection. Acute pericarditis. Allergy

Question 10

Indications for Head CT Prior to Lumbar Puncture for suspected Meningitis (6)?

Answer 10

Seizure.
Focal neurologic deficit.
Head trauma.
Profoundly depressed mental status.
Immunocompromised state.
Papilledema.

Question 11

CSF findings on LP for patient with bacterial meningitis (5)?

Answer 11

Elevated opening pressure (often> 40 cm H2O).
WBC>5/mm3. 
Elevated protein.
Low glucose. 
Presence of organism on gram stain.

Question 12

Antibiotic to help cover Listeria?

Answer 12

Ampicillin

Question 13

Which type of meningitis is most responsive to Dexamethasone?

Answer 13

pneumococcal meningitis

Question 14

Does Exposure to a patient with Pneumococcal meningitis require prophylaxis?

Answer 14

Nope. As long as you didnt do mouth to mouth, intubate, or suction.

Question 15

How should a member of a household (with Meningococcal meningitis) be treated prophylactically?

Answer 15

Rifampin OR Ciprofloxacin every 12 hours for 4 doses.

Question 16

Most common cause of subarachnoid hemorrhage?

Answer 16

Ruptured intracranial aneurysm.

Question 17

Family history of polycystic kidney disease or Ehlers–Danlos syndrome predisposes you to what neurological complication?

Answer 17

Subarachnoid hemorrhage.

Question 18

What is Pseudotumor cerebrii?

Answer 18

Idiopathic intracranial hypertension.