• Home
  • Textbooks
  • Emergency Medicine Examination & Board Review
  • Neurologic Emergencies

Emergency Medicine Examination & Board Review

Susan Promes

Chapter 15

Neurologic Emergencies - all with Video Answers

Educators

Chapter Questions

Problem 1

Which patient has the highest likelihood of a carotid artery dissection?
(A) A 20-year-old male complaining of severe headache immediately after a physical therapy treatment followed by right-sided weakness 2 days later.
(B) A 60-year-old hypertensive male presenting with painless right-sided weakness after he was out rowing.
(C) An 8-year-old boy with a history of recurrent headaches associated with vomiting and right-sided weakness who comes from school with these symptoms and has family members with a similar history.
(D) A 5-year-old male with sickle cell disease who presents with focal weakness and a headache following a hike.

Check back soon!

Problem 2

What is the recommended treatment for a previously hypertensive patient with subarachnoid hemorrhage, normal swallowing, and a mean arterial pressure of 150 mmHg?
(A) Intravenous antihypertensive medication to lower the mean arterial pressure to 90 mmHg .
(B) Nifedipine by mouth.
(C) Immediate neurosurgery .
(D) Prophylactic phenytoin loading.

Check back soon!
02:19

Problem 3

Which of the following is TRUE of Bell's palsy?
(A) Sudden onset is common.
(B) Preservation of motor function in the upper face is seen.
(C) Associated pain generally rules out the diagnosis.
(D) Steroids are indicated and should be started at any phase of the disease.

Ummatul Choudary
Ummatul Choudary
Numerade Educator

Problem 4

Which clinical finding or findings would be caused by a complete paralysis of cranial nerve III?
(A) Dilated pupil with downward and outward deviation and ptosis.
(B) Afferent pupillary defect.
(C) Impaired corneal reflex.
(D) Difficulty abducting the globe.

Check back soon!

Problem 5

A 40-year-old previously healthy female presents with sudden onset of a severe occipital and nuchal headache following a coughing fit. Vital signs and physical examination are normal. Which of the following is indicated?
(A) Contrast CT scan of the brain followed by lumbar puncture if negative.
(B) Noncontrast CT scan of the brain followed by lumbar puncture if negative.
(C) MRI scan of the brain.
(D) Trial of pain medication and CT scan of the head and lumbar puncture only if headache is unrelieved.

Check back soon!

Problem 6

Which is considered an indication for emergent neuroimaging?
(A) Headache after lumbar puncture.
(B) A cluster headache in a patient with a prior history of them.
(C) New headache in an HIV-positive patient.
(D) Headache, isolated fever, stiff neck, and photophobia.

Check back soon!

Problem 7

Which is a recommended sequential treatment for migraine?
(A) Dihydroergotamine (DHE), then metoclopramide.
(B) Sumatriptan, then dexamethasone.
(C) Metoclopramide, then meperidine.
(D) DHE, then sumatriptan.

Check back soon!
01:13

Problem 8

Which finding is MOST suggestive of a lesion in the dominant cerebral cortex?
(A) Right-sided lesion on CT scan.
(B) Inattention by the patient to a person approaching from the left.
(C) Difficulty with naming common objects.
(D) Inability to identify by touch a coin placed in the patient's hand.

Sanchit Jain
Sanchit Jain
Numerade Educator

Problem 9

Which clinical scenario is MOST suspicious for temporal arteritis?
(A) An obese 16-year-old female on tetracycline and birth control pills with 1 month of headache, nausea, and visual disturbances.
(B) A 26-year-old female with frequent facial pains lasting for seconds at a time.
(C) A 60-year-old female with new-onset throbbing frontal headache and a sedimentation rate of $90 \mathrm{~mm} /$ hour.
(D) A 30-year-old male with 1 week of severe, daily, unilateral temporal headache and rhinorrhea relieved with high-flow oxygen.

Check back soon!

Problem 10

Which of the following is TRUE of the condition depicted in Figure 15-1?
(A) Postvoid residual urine volume of $50 \mathrm{~mL}$ is suggestive.
(B) Normal reflexes generally rule out this diagnosis.
(C) Injection drug use is a risk factor.
(D) A narrow-based shuffling gait is common.

Check back soon!

Problem 11

Which clinical picture is MOST consistent with the findings on the CT image shown in Figure 15-2?
(A) Contralateral leg greater than arm weakness.
(B) Contralateral weakness and numbness affecting the face and arm more than the legs.
(C) No weakness noted, but reduced contralateral sensation to pinprick and light touch.
(D) Diplopia with contralateral limb weakness.

Check back soon!

Problem 12

Which of these scenarios is MOST consistent with delirium?
(A) An alert patient with acute onset of auditory hallucinations and delusions.
(B) An alert patient who has lost short-term memory over the past several years.
(C) A patient who for several days has been more somnolent during the day and confused and agitated at night.
(D) An unarousable patient with hypothermia.

Check back soon!

Problem 13

Which of the following statements is TRUE regarding a patient with increased intracranial pressure?
(A) Paralysis and sedation should not be used after such a patient is placed on a ventilator as they will obscure the neurologic exam.
(B) Ketamine is a good choice for rapid sequence intubation.
(C) Hypotension and tachycardia classically accompany this finding.
(D) The increased intracranial pressure may lead to cerebral ischemia.

Check back soon!

Problem 14

In a patient with possible coma, which finding is correctly linked with its etiology?
(A) Pinpoint pupils and uncal herniation.
(B) Lack of pupillary response and toxic-metabolic coma.
(C) Nystagmus with caloric vestibular testing and pseudocoma.
(D) Localizing signs and hypoxia.

Check back soon!
02:17

Problem 15

Which is TRUE of cerebrospinal fluid shunts?
(A) A lumbar puncture performed by the emergency physician is indicated when a shunt infection is suspected.
(B) Shunt infections are more common the longer the shunt has been in place.
(C) Staphylococcus epidermidis is the pathogen responsible for half of all shunt infections.
(D) Vomiting is the cardinal sign of a shunt malfunction.

Leah Lampen
Leah Lampen
Numerade Educator
02:16

Problem 16

Which of the following is the MOST common sign or symptom of brain abscess?
(A) Neck stiffness.
(B) Fever.
(C) Increased intracranial pressure.
(D) Headache.

Dennis Howard
Dennis Howard
Numerade Educator
02:16

Problem 17

Which of the following is the MOST common sign or symptom of brain abscess?
(A) Neck stiffness.
(B) Fever.
(C) Increased intracranial pressure.
(D) Headache.

Dennis Howard
Dennis Howard
Numerade Educator

Problem 18

Which is TRUE concerning chemoprophylaxis for high-risk contacts of patients with Neisseria meningitidis?
(A) All health care providers who cared for the patient should be treated.
(B) Four doses of rifampin are first-line treatment.
(C) School contacts for the last month should be treated.
(D) Anyone who was exposed to the patient in the last week should be treated.

Check back soon!
02:19

Problem 19

Which of the following is TRUE regarding the workup and treatment of suspected bacterial meningitis?
(A) Steroids should always be given.
(B) A CT scan must always precede the lumbar puncture.
(C) Empiric antibiotic therapy should always be given in the ED.
(D) Lumbar puncture results should always guide initial antibiotic choice.

Ummatul Choudary
Ummatul Choudary
Numerade Educator

Problem 20

Which clinical scenario is correctly linked with the neuroimaging modality?
(A) A 69-year-old male with an AICD in whom a basilar skull fracture is suspected and plain skull films.
(B) An otherwise well-appearing 2-year-old male with a broken arm in whom child abuse is suspected and CT scan of the brain.
(C) A 69-year-old female with a pacemaker, difficulty breathing, and a suspected posterior fossa lesion and MRI of the brain.
(D) A 3-month-old female with focal neurologic signs and ultrasound of the brain imaging through the open fontanels.

Check back soon!

Problem 21

Which is TRUE of Meniere's disease?
(A) It usually occurs in patients aged 65 and older.
(B) The duration of vertigo is short.
(C) Attacks usually occur daily.
(D) Hearing loss is not an associated finding.

Check back soon!
01:39

Problem 22

Which finding is suggestive of benign paroxysmal positional vertigo?
(A) It is worse in the evening.
(B) Attacks are precipitated by rolling over in bed.
(C) Hearing loss can be associated.
(D) Nausea is generally not associated.

Rikhil Makwana
Rikhil Makwana
Numerade Educator

Problem 23

A 1-year-old child is brought to the ED with ataxia 7 days after the onset of chicken pox. Which of the following management plans is appropriate?
(A) Administer acyclovir.
(B) Warn the parents of likely residual symptoms.
(C) Perform a lumbar puncture.
(D) No intervention is necessary.

Check back soon!
01:39

Problem 24

Which treatment of benign paroxysmal positional vertigo associated with nausea is unlikely to be effective?
(A) Diphenhydramine intramuscularly.
(B) Ondansetron intravenously.
(C) Scopolamine transdermal patch.
(D) Intramuscular promethazine followed by the Epley maneuver.

Rikhil Makwana
Rikhil Makwana
Numerade Educator

Problem 25

Which of the following is the appropriate management for an uncomplicated seizure of 2 minutes duration?
(A) Intravenous lorazepam.
(B) Bag-valve-mask ventilation.
(C) Insertion of a bite block.
(D) Observation and monitoring.

Check back soon!

Problem 26

Which is TRUE of seizures in pregnancy?
(A) All previously prescribed anticonvulsants should be stopped due to the risk of teratogenic effects.
(B) Eclampsia is a serious cause of seizures as early as the 16th week of pregnancy .
(C) MRI or CT of the head with shielding of the abdomen are considered acceptable.
(D) Phenytoin is the first-line anticonvulsant in a 32-week pregnant patient with new-onset seizures.

Check back soon!

Problem 27

Which is TRUE of alcohol withdrawal seizures?
(A) Phenytoin loading is indicated.
(B) Patients should be admitted to the hospital.
(C) Seizures usually occur between 6 and 48 hours after stopping or reducing alcohol intake.
(D) Workup of first-time alcohol withdrawal seizure can be less complex than the workup for other first-time seizures.

Check back soon!
00:29

Problem 28

Which of the following is TRUE of carpal tunnel syndrome?
(A) It is worse at the end of the workday.
(B) Generally it is unilateral.
(C) It is exacerbated by pregnancy.
(D) Numbness is localized to the hand.

Sam Limsuwannarot
Sam Limsuwannarot
Numerade Educator
02:19

Problem 29

Which of the following is TRUE of Guillain-Barre syndrome?
(A) The only danger of death is from respiratory failure.
(B) It is more common in HIV-infected patients.
(C) In classic cases, sensation on exam is usually abnormal.
(D) It is easily distinguished from Lyme disease.

Ummatul Choudary
Ummatul Choudary
Numerade Educator

Problem 30

A 30-year-old male presents with normal mentation, sensation, and reflexes but a complaint of proximal limb weakness. Besides weakness, extraocular movements are abnormal, and there is an absence of the pupillary light reflex. What is the MOST likely diagnosis?
(A) Botulism.
(B) Myasthenia gravis.
(C) Acute intermittent porphyria.
(D) Tick paralysis.

Check back soon!

Problem 31

A patient with known myasthenia gravis and a normal airway anatomy presents with weak respirations. Which of the following drugs would be preferred for intubation?
(A) Pancuronium.
(B) Tubocurarine.
(C) Succinylcholine.
(D) Propofol.

Check back soon!

Problem 32

Which of the following is TRUE of multiple sclerosis?
(A) Central visual loss is a common presenting complaint.
(B) MRI is normal in most cases of multiple sclerosis.
(C) The majority of patients have a reduction in life expectancy.
(D) Relapses are more common in pregnancy.

Check back soon!

Problem 33

Which disease has the lowest incidence of respiratory failure?
(A) Parkinson's disease.
(B) Lambert-Eaton myasthenic syndrome.
(C) Myasthenic crisis.
(D) Amyotrophic lateral sclerosis.

Check back soon!