N2

Question 1

focal neurologic findings

Answer 1

head CT without Contrast

Question 2

skull fracture, esp signs of basilar skull fracture

Answer 2

head CT without Contrast

Question 3

seizure

Answer 3

head CT without Contrast

Question 4

prolonged loss of consciousness

Answer 4

head CT without Contrast

Question 5

persistent altered mental status (agitation, lethargy, slow response)

Answer 5

head CT without Contrast

Question 6

GCS = 15 with vomiting

Answer 6

clinical preference: observation for 4-6hrs or head CT without contrast

Question 7

GCS = 15 with headache

Answer 7

clinical preference: observation for 4-6hrs or head CT without contrast

Question 8

GCS = 15 with questionable or brief LOC

Answer 8

clinical preference: observation for 4-6hrs or head CT without contrast

Question 9

GCS = 15 with injury caused by high risk MOI

Answer 9

clinical preference: observation for 4-6hrs or head CT without contrast

Question 10

GCS = 15 with severe MOI

Answer 10

clinical preference: observation for 4-6hrs or head CT without contrast

Question 11

Minor head trauma

Answer 11

GCS = 15 with non severe mechanism and no vomiting, headache, LOC or signs of fracture - no head CT

Question 12

Severe mechanism

Answer 12

car crash with patient ejection, passenger fatality, rollover, pedestrian versus car, fall height > 5ft, head + high impact object

Question 13

mild TBI =

Answer 13

head injury with GCS of 13-15. LOC less than 5 min, headache, loss of memory (amnesia) before/after injury for less than 24hours, alteration in mental status at time of injury, and/or vomiting

Question 14

signs of basilar skull fracture

Answer 14

cerebrospinal fluid rhinorrhea, raccoon eyes, battle sign, anterior, longitudinal, transverse fracture

Question 15

battle sign

Answer 15

mastoid or post auricular ecchymosis = CSF otorrhea

Question 16

potential risk of cancer due to CT scan associated radiation

Answer 16

increases with decreasing age (1 in 1500 at age 1; 1 in 5000 at age 10)

Question 17

triad of NPH

Answer 17

abnormal gait, incontinence and dementia

Question 18

NPH is a clinical syndrome accompanied by

Answer 18

inc ventricular size without persistent elevations in intracranial presure

Question 19

dementia in NPH is characterized by

Answer 19

memory loss but no focal neurologic changes

Question 20

pathogenesis of NPH

Answer 20

transient inc in intracrainial pressure that causes ventricular enlargement, after ventricles enlarge the pressure returns to normal

Question 21

increase in ventricular size is due to

Answer 21

either dec CSF absorption at the arachnoid villi or obstructive hydrocephalus

Question 22

CSF production tends to increase at

Answer 22

night

Question 23

hallmark of multi infarct dementia

Answer 23

small vessel cerebral ischemia

Question 24

newborn with grade 4 IVH results from

Answer 24

bleeding in the germinal matrix

Question 25

most significant risk factor for bleeding in the germinal matrix

Answer 25

premature and low birth weight infants

Question 26

vascular perfusion injuries associated with IVH

Answer 26

1) hypoxic or ischemic episodes 2) hypotension 3) reperfusion of damaged vessels 4) inc venous pressure 5) abrupt changes in cerebral blood flow

Question 27

newborn with predisposing risk factors for IVH

Answer 27

transfontanel ultrasound since many cases remain asymsptomatic

Question 28

patients with IVH may present with

Answer 28

pallor, cyanosis, hypotension, seizures, focal neurologic signs, bulging or tense fontanel, apnea and bradycardia

Question 29

small body size with microcephaly, hypoplasia of the distal phalanges of the fingers and toes, excess hair and a cleft palate

Answer 29

fetal hydantoin syndrome - phenytoin and carbamazepine

Question 30

fetal hydrantoin syndrome is characterized by

Answer 30

midfacial hypoplasia, microcephaly, cleft lip and palate, digital hypoplasia, hirsutism and developmental delay

Question 31

presentation following birth of: rhinitis, hepatosplenomegaly, and skin lesions

Answer 31

congenital syphilis

Question 32

interstitial keratitis, Hutchinson teeth, saddle nose, saber shins, deafness and CNS involvement

Answer 32

late stages of congenital syphilis

Question 33

similarities between fetal alcohol syndrome and fetal hydrantoin syndrome

Answer 33

midfacial hypoplasia, microcephaly, and stunted growth | -also: CNS damage = hyperactivity, mental retardation or learning disability

Question 34

differences between fetal alcohol syndrome and fetal hydrantoin syndrome

Answer 34

cleft palate and excess hair is not typical for fetal alcohol syndrome

Question 35

cocain abuses' effect on the fetus

Answer 35

increases the risk of placental abruption - may cause fetal loss or CNS dysfunction due to hypoperfusion in utero

Question 36

azithromycin in pregnancy

Answer 36

category B

Question 37

unconscious child found in room now can’t move right arm and right leg - resolves in 24 hr

Answer 37

seizure - Todd's paralysis

Question 38

todd's paralysis indicates

Answer 38

a structural abnormality is underlying the seizure

Question 39

Migraine and hemiplasia

Answer 39

can result in reversible paralysis - history of headaches is typical

Question 40

internal carotid dissection

Answer 40

related to a specific trauma and usually manifests as a persistent neuro defect

Question 41

loss of monement, pain and temp but still able to feel position, vibration and touch

Answer 41

anterior cord syndrome

Question 42

ASA supplies

Answer 42

two thirds of the spinal cord (motor tracts - anterior corticospinal tract- and sensory tracts involved in pain / temperature sensation -spinothalamic tract)

Question 43

ASA is particularly dependant on blood supply from

Answer 43

the radicular arteries that origiinate from the thoracic aorta such as artery of Adamkiewicz

Question 44

relation between thoracic aortic surgery and ant spinal cord syndrome

Answer 44

aortic cross clamping and or systemic hypotension can reduce blood flow through the radicular arteries -- ant spinal cord infarction

Question 45

abrupt onset of bilateral flacid paralysis and loss of pain and temperature sensation below the level of the injury

Answer 45

anterior spinal cord syndrome

Question 46

the flacid paralysis in ant spinal cord syndrome is due to

Answer 46

spinal shock

Question 47

in anterior spinal syndrome what develops over days to weeks

Answer 47

upper motor neuron signs such as spasticity and hyperreflexia

Question 48

ant spinal cord syndrome and bowel and bladder dysfunction

Answer 48

can result from autonomic dysfunction due to involvement of the intermediolateral cell column and its descending tracts

Question 49

Ant spinal cord - sparing vibration and proprioception

Answer 49

dorsal column of the spinal cord is usually not affected

Question 50

peripheral neuropathy characterized by asymmetrical focal weakness, numbness, and paresthesias due to involvement of multiple adjacent nerve roots

Answer 50

lumbar plexopathy

Question 51

abrupt onset of contralateral neurologic deficits not bilateral

Answer 51

ischemic stroke due to right carotid artery atherosclerosis

Question 52

acute vertebral compression fracture

Answer 52

occurs in older men with osteoporosis but is more common in post menopausal women

Question 53

acute back pain after bending, coughing, lifting or a fall

Answer 53

acute vertebral compression fracture

Question 54

acute vertebral compression fracture rare complication

Answer 54

myelopathy due to retropulsion of bone fragments into the spinal canal is a rare complication