What's that CT finding?
What's your go to antibiotic/antiviral?
How would you treat?
What's the diagnosis?
Neuro random's
100
45M pt presents Head trauma after a fall from the roof onto his head, family says he was initially talking but then became unresponsive. What does the CT show?
Epidural Hematoma
100
Undifferentiated meningitis in a healthy 34 y/o M
Vancomycin, third-generation cephalosporin, and acyclovir
Cover Strep, Staph and HSV
100
A patient with a hx of Myasthenia Gravis presents to the ED with rapid shallow breathing and concern for a viral infection. Your RT obtains an FVC on the pt and it shows a value of VC <20cc/kg. What should be your next step?
Proceed to intubation
NIV has been shown to lead to delays in neuromuscular disease and elevates the risk of aspiration.
100
A patient presents with multiple back-to-back seizures without returning to baseline. What is the diagnosis?
Status Epilepticus
100
What is the equation for CPP?
CPP= MAP-ICP
200
66F with ESRD and uncontrolled HTN presents with sudden onset HA and vomiting. What does the CT show?
SAH
200
What additional antibiotic should be given to patients aged>50 with concerns for meningitis?
Ampicillin
To cover for Listeria Monocytogenes
200
A patient with concerns for hemorrhagic stroke presents to the resus bay with two episodes of seizure activity w/o regain of consciousness. You must treat the pt, but you don't have vascular access. What is the well-studied medication and dose (max) that can be given intramuscularly to abort the seizure?
Versed 10mg IM (max)
200
A 2y M presents to the ED via parents with concern for seizure-like activity. The mother stated that the patient had a 1-minute shaking episode that self-resolved. She states that her son has been trying to get over a cold he got in daycare. Upon evaluation, the patient was found to have a fever and irritability but without FND. You give the patient Tylenol and obtain normal glucose. You observe the patient for six hours; his fever breaks, he is eating and playing, and has no subsequent seizure-like episodes. What's the diagnosis?
Febrile seizure
considered in children age <5
- < 15 minute duration
- No focal features
- Single seizure in 24 hours
- Medication not required to stop seizure
- Return to neurologic baseline
200
What is the target blood pressure needed before giving TNK or TPA?
systolic <185 and diastolic less <105
300
64M presents as a stroke alert from the field, with initial BP 230/110 with multiple bouts of emeses and a left gaze preference. what does the CT show, be specific?
R. Intracerebral Hemorrhage with Intraventricular extension and Midline shift
300
20Y college students present to the ED with multiple days of fever and worsening HA, now with AMS. Examining his skin reveals numerous erythematous spots, which increases your concern for meningitis. What first-line prophylactic antibiotic would you provide to the patient's close contacts?
Rifampin
N. Meningitidis
300
A 33M with a hx of epilepsy presents with seizures. He was given IM versed in the ambulance but continues to seize. You give him Ativan, and the pharmacist asks if you want to start another agent. What are the three second-line antiepileptics used in Status Epilepticus?
Keppra, Phenytoin, Valproate
300
A cachetic-appearing pt with a hx of HIV presents with Fever, HA, and vision changes. You obtain a CD4 count of 50 and an MRI showing multiple ring-enhancing lesions throughout the brain. What is the diagnosis?
Neurotoxoplasmosis
(will take toxoplasmosis)
300
What is the Monroe-Kellie doctrine?
There are three volumes in the skull: brain, blood, and CSF which are all constant; if one increases, then one or both of the others must decrease.
400
Pt with Hypertension, bradycardia and abnormal breathing, and right-sided pupillary dilation. what is the CT finding
Uncal Herniation
400
A patient presents with Fever, HA, and projectile vomiting. They have a hx of HIV, however, have been nonadherent with their antivirals for multiple years. The pt appears cachectic and altered and the exam is significant for peripheral vision changes and an ataxic gait. MRI with contrast shows ring-enhancing lesions. What is your first-line choice of antibiotics for the particular infectious organism?
Pyrimethamine and sulfadiazine
Toxoplasmosis
400
A patient with some displays of cushing triad has a CT finding concerning for impending herniation, the team asks you if you want to trial osmotherapy. What are the two different drugs used for osmotherapy?
HTS or Mannitol
400
A 65F with no documented hx presents to the ED with new-onset seizures. She states that she is an archeologist originally from a rural part of Central America, but moved to America to be closer to her daughter. She complains of persistent headaches and has a seizure in the ED. She receives treatment and is taken for CT imaging; what does the imaging show concerns for?
Neurocystercicosis
recognized as one of the leading causes of adult-onset epilepsy worldwide.
Endemic in Central and South America, Sub-Sahara Africa, India and East Asia
400
Patients with a minimum of what NIHSS score have been shown to benefit from Thrombectomy for stroke?
500
A pt presents with left-sided hemiparesis and this CT finding. What is the name of the sign on the CT?
Hyperdense MCA sign
500
A 55F with a hx of HIV presents with a week of worsening HA that is now associated with vomiting and diplopia. exam s/f menigismus. Initial CT shows no acute abnormalities. LP is performed revealing very high opening pressures. What is the initial induction therapy for this patient's feared condition?
Initial antibiotics are Amphotericin B + Flutocytosine.
Cryptococcus Meningitits
500
A patient presented with thunderclap HA and was found to have a high-grade SAH. What medication has been shown to decrease mortality and morbidity in patients with SAH?
(think vasospasm)
Nimodipine
500
A 34M presents to the trauma bay with TBI after rollover MVC. He's intubated and sedated s/t having a GCS <8 and an inability to protect his airway. CTH is non-revealing except for some punctate microhemorrhages. The next day in the TSICU, the team weans sedation to check his neuro exam. The pt doesn't awaken, increasing concern for what diagnosis?
Diffuse axonal injury
defined by GCS <8 for greater than six hours in the setting of TBI
caused by the shearing forces damage to axonal white matter tracts, disrupting the interconnection between white matter and gray matter junctions.
500
In patients with bacterial meningitis, what medication other than antibiotics should be given, and when should it be given regarding the timing of antibiotic administration?
Steroids (dexamethasone), shortly before (20 min) or at the same time.
Steroids decrease mortality and morbidity in S. pneumococcal meningitis.