Neuro/Pulmonology

Question 1

worst headache of my life

big risk factor _?

Answer 1

subarachnoid hemorrhage (SAH)
smoking

Question 2

symptoms of SAH

Answer 2

brief LOC
n/v
nuchal rigidity
NO FOCAL NEURO DEFICITS

Question 3

diagnosis of SAH

Answer 3

CT without contrast
LP if (-) but high suspicion

Question 4

LP findings for SAH

Answer 4

xanthochromia (RBCs)

increased CSF pressure

Question 5

treatment for SAH

Answer 5

bedrest and anti-anxiety
clipping/coiling aneurysms
seizure prophylaxis and stop blood thinners

Question 6

common causes of spontaneous intracranial hemorrhage

Answer 6

HTN

AVM (arteriovenous malformation)

Question 7

symptoms of spontaneous ICH

Answer 7

LOC
h/a
n/v

Question 8

diagnosis of spontaneous ICH

Answer 8

CT without contrast

Question 9

MC cause of SAH

Answer 9

“berry aneurysm” (MC circle of willis)

Question 10

types of hemorrhagic stroke

Answer 10

SAH

spon. ICH

Question 11

MC ischemic stroke

Answer 11

middle cerebral artery (anterior circulation)

Question 12

symptoms of lacunar infarct

Answer 12

pure motor MC (otherwise pure sensory)

ataxic hemiparesis

Question 13

diagnosis of ischemic stroke

Answer 13

CT without contrast

*must first r/o hemorrhagic

Question 14

treatment of lacunar infarct

Answer 14

ASA
control risks (*HTN, DM)

Question 15

causes of ischemic stroke

Answer 15

thrombotic
emboli
cerebrovascular occlusion

Question 16

symptoms of middle cerebral artery stroke

Answer 16

contralateral face/arm > leg/foot sensory and motor loss
dominant hemisphere = global aphasia
non dominant = hemineglect

Question 17

treatment of middle cerebral artery stroke

Answer 17

thrombolytics (tPA)

Question 18

symptoms of anterior cerebral artery stroke

Answer 18

leg/foot > face/arm

Question 19

MC cause of TIA

Answer 19

embolus

Question 20

definition of TIA

Answer 20

transient episode of neuro deficit WITHOUT acute infarction

Question 21

monocular vision loss

Answer 21

amaurosis fugal

“lamp shade down on one eye”

Question 22

diagnosis of TIA

Answer 22

CT without contrast
carotid doppler
diffusion weighted MRI

Question 23

when is a carotid endarterectomy advised?

Answer 23

> 70% stenosis

Question 24

treatment of TIA

Answer 24

ASA +/- plavix
lay supine to increase perfusion
*NO THOMBOLYTICS

Question 25

MC cause of epidural hematoma

Answer 25

middle meningeal artery (skull fx)

Question 26

symptoms of epidural hematoma

Answer 26

brief LOC –> lucid interval –> coma
focal neuro sxs
h/a, n/v
rhinorrhea (CSF)

Question 27

appearance of epidural hematoma on CT scan

Answer 27

lentiform

does NOT cross suture lines

Question 28

treatment of epidural hematoma

Answer 28

evacuation

Question 29

MC cause of subdural hematoma

Answer 29

tearing of bridging veins (often in elderly)

Question 30

appearance of subdural hematoma on CT scan

Answer 30

crescent

CAN cross suture lines

Question 31

common causes of emboli

Answer 31

atrial fibrillation

carotid artery plaque rupture

Question 32

what BP for ischemic stroke

Answer 32

<220/120

Question 33

what BP for hemorrhagic stroke?

Answer 33

<160/90

nicardipine drip often used if needed

Question 34

initial treatment for stroke patients

Answer 34

admit to ICU

ABC’s

Question 35

treatment for ischemic strokes

Answer 35

assess possibility of tPA
OTHERWISE
full dose ASA within 48 hours

Question 36

what needs to be normal to consider tPA

Answer 36

CT SCAN!!
don’t give in hemorrhagic
if you see something suggestive of ischemia, then it has already been too long

Question 37

treatment of hemorrhagic stroke

Answer 37

HOB @ 30 degrees
analgesia and sedation to decrease blood flow
+/- osmotic diuretics (ie mannitol)