SAEM M4 FINAL EXAM ACTUAL QUESTIONS AND
ANSWERS GRADED A+
✔✔to US for torsion must - ✔✔compare side to side
✔✔when managing torsion - ✔✔do not delay OR trip to use US as torison is mostly a
clinical dx
✔✔4 types of intracranial hemorrhages - ✔✔-epidural
-subdural
-subarachnoid
-intracerebral
✔✔sx of all intracrnial hemorrhages 4 - ✔✔-headache
-N/v
-altered
-seizure
✔✔who is at risk for big bleed even with minor trauma - ✔✔-old
-alcohol
-anticoagulated
✔✔subarachnoid hemorrhage classic - ✔✔-thunderclap ha
-reach max intensity within sec
✔✔sah sx - ✔✔-loc
-vomit
-neck stiff
✔✔sentinel ha - ✔✔-small headache=small bleed before a much larger bleed
✔✔grading system for sah - ✔✔hunt and hess
✔✔most common cause sah - ✔✔saccular aneurysms
✔✔interestng risk factor for sah - ✔✔recent exertion
✔✔epidural hematoma patho - ✔✔-trauma causes fracture of temporal bone to rupture
middlemeningeal artery
✔✔classic story of epidural. but really - ✔✔-brief LOC after blow to head then lucid
period than loc again
-but most either dont hve loc or if they do, they dont get better
,✔✔subdural hematomas patho - ✔✔bridging eins are sheared during acceler-decel of
head
✔✔timeline of subdural/ esp what pop, why - ✔✔-can present late because the
hematoma gros slow
-esp delayed in those with brain atrophy bc there is more space in head for blood
✔✔subdural in kid - ✔✔think childabuse
✔✔shaken baby syndrome 3 - ✔✔-subdural
-retinal hemorrhages
-long bone fractures
✔✔chronic subdural in 2 pops? 2 reasons why - ✔✔-old and alcoolic bc most prone to
atrophy and coaugloapthy
✔✔cushings triad= - ✔✔htn
-brady
-abnormal resp patterns
✔✔signifcance of cushings - ✔✔physiologic response to rapidly increasing intracranial
pressure and imminent brain herniation
✔✔colors of blood on ct by time - ✔✔-white if acute
-3-14d then same color as brain
-after 2 weeks=hypodense
✔✔diagnostic pathway of sah - ✔✔-CT
-then LP if after 6hrs of start of sx
✔✔subdural on ct - ✔✔crescent
✔✔sah on ct - ✔✔starfish. fillls sulci
✔✔epidural on ct - ✔✔lens
✔✔CSF of Sah - ✔✔-absence or clearing of blood
-xanthocromia
✔✔blood in csf ddx 3 - ✔✔-sah
-infection
-traumatic tap
✔✔how know its traumatic tap - ✔✔if fourth tube has almost no lbood in it
, ✔✔if CT or LP pos in CAH next step - ✔✔angiogprahy
✔✔if unsure if should get head ct - ✔✔-canadian ct rules
✔✔what consider in hemorrhages - ✔✔seizure prophylaxis
✔✔control inc ICP 5 - ✔✔-lower BP
-elevate head of bed 30degrees
-provide adequate sedation and analgesia
-consider mannitol
-or higer ventilation (goal CO2 around 30)
✔✔3 ways to have to stroke - ✔✔-embolus
-thrombosis
-bleed (under 15%)
✔✔aca stroke sx - ✔✔-LE>UE (weak and sensory loss)
✔✔mca stroke sx - ✔✔-weak and sneosry loss of face and upper extremitiy with
aphasia or neglect
✔✔pca stroke sx - ✔✔homonomynous hemianopsia
✔✔vertebrobasilar syndromes - ✔✔-c/l sensory and weakness
-ipsilateral cn palsies
-D signs: diplopia, dysarthria, dysphagia, droopy face, dysequelibrium, dusmetria, dec
level fo conciosuness
-N/V
✔✔what is lacunar infarct - ✔✔cclusion of one of the deep perforating arteries which
supplies the subcortical structures and brainstem.
✔✔5 diff presentations of lacunar syndromes - ✔✔-pure motor hemipareiss
-sensorimotor troke
-ataxic hemiparesis
-pure sensory
-dysathria-clumsy hand syndrome
✔✔most commmon ct findign in ishcmeic stroke= - ✔✔normal bc cant see findigns for
several hours
✔✔earliest stroke finding on CT - ✔✔hyperdensity representing acute thrombus or
embolus in a major intracranial vessel.
ANSWERS GRADED A+
✔✔to US for torsion must - ✔✔compare side to side
✔✔when managing torsion - ✔✔do not delay OR trip to use US as torison is mostly a
clinical dx
✔✔4 types of intracranial hemorrhages - ✔✔-epidural
-subdural
-subarachnoid
-intracerebral
✔✔sx of all intracrnial hemorrhages 4 - ✔✔-headache
-N/v
-altered
-seizure
✔✔who is at risk for big bleed even with minor trauma - ✔✔-old
-alcohol
-anticoagulated
✔✔subarachnoid hemorrhage classic - ✔✔-thunderclap ha
-reach max intensity within sec
✔✔sah sx - ✔✔-loc
-vomit
-neck stiff
✔✔sentinel ha - ✔✔-small headache=small bleed before a much larger bleed
✔✔grading system for sah - ✔✔hunt and hess
✔✔most common cause sah - ✔✔saccular aneurysms
✔✔interestng risk factor for sah - ✔✔recent exertion
✔✔epidural hematoma patho - ✔✔-trauma causes fracture of temporal bone to rupture
middlemeningeal artery
✔✔classic story of epidural. but really - ✔✔-brief LOC after blow to head then lucid
period than loc again
-but most either dont hve loc or if they do, they dont get better
,✔✔subdural hematomas patho - ✔✔bridging eins are sheared during acceler-decel of
head
✔✔timeline of subdural/ esp what pop, why - ✔✔-can present late because the
hematoma gros slow
-esp delayed in those with brain atrophy bc there is more space in head for blood
✔✔subdural in kid - ✔✔think childabuse
✔✔shaken baby syndrome 3 - ✔✔-subdural
-retinal hemorrhages
-long bone fractures
✔✔chronic subdural in 2 pops? 2 reasons why - ✔✔-old and alcoolic bc most prone to
atrophy and coaugloapthy
✔✔cushings triad= - ✔✔htn
-brady
-abnormal resp patterns
✔✔signifcance of cushings - ✔✔physiologic response to rapidly increasing intracranial
pressure and imminent brain herniation
✔✔colors of blood on ct by time - ✔✔-white if acute
-3-14d then same color as brain
-after 2 weeks=hypodense
✔✔diagnostic pathway of sah - ✔✔-CT
-then LP if after 6hrs of start of sx
✔✔subdural on ct - ✔✔crescent
✔✔sah on ct - ✔✔starfish. fillls sulci
✔✔epidural on ct - ✔✔lens
✔✔CSF of Sah - ✔✔-absence or clearing of blood
-xanthocromia
✔✔blood in csf ddx 3 - ✔✔-sah
-infection
-traumatic tap
✔✔how know its traumatic tap - ✔✔if fourth tube has almost no lbood in it
, ✔✔if CT or LP pos in CAH next step - ✔✔angiogprahy
✔✔if unsure if should get head ct - ✔✔-canadian ct rules
✔✔what consider in hemorrhages - ✔✔seizure prophylaxis
✔✔control inc ICP 5 - ✔✔-lower BP
-elevate head of bed 30degrees
-provide adequate sedation and analgesia
-consider mannitol
-or higer ventilation (goal CO2 around 30)
✔✔3 ways to have to stroke - ✔✔-embolus
-thrombosis
-bleed (under 15%)
✔✔aca stroke sx - ✔✔-LE>UE (weak and sensory loss)
✔✔mca stroke sx - ✔✔-weak and sneosry loss of face and upper extremitiy with
aphasia or neglect
✔✔pca stroke sx - ✔✔homonomynous hemianopsia
✔✔vertebrobasilar syndromes - ✔✔-c/l sensory and weakness
-ipsilateral cn palsies
-D signs: diplopia, dysarthria, dysphagia, droopy face, dysequelibrium, dusmetria, dec
level fo conciosuness
-N/V
✔✔what is lacunar infarct - ✔✔cclusion of one of the deep perforating arteries which
supplies the subcortical structures and brainstem.
✔✔5 diff presentations of lacunar syndromes - ✔✔-pure motor hemipareiss
-sensorimotor troke
-ataxic hemiparesis
-pure sensory
-dysathria-clumsy hand syndrome
✔✔most commmon ct findign in ishcmeic stroke= - ✔✔normal bc cant see findigns for
several hours
✔✔earliest stroke finding on CT - ✔✔hyperdensity representing acute thrombus or
embolus in a major intracranial vessel.
