NR 603 WEEK 2 PARTS ONE TWO CASE
STUDY DISCUSSIONS VIEW AHEAD RESOURCE
2026 RESULTS GUARANTEED A+
◉ A 37-year-old man fell from a ladder as he finished hanging the
Christmas lights on his house. The right side of his head hit the alley
cement, and he lost consciousness for about 1 minute; he woke up
with a headache, but he had no other complaints. A few hours later,
the patient is brought to the emergency room by his neighbor
because of an intense headache, confusion, and left hand
hemiparesis. On examination, the patient has a bruise located over
the right temporal region, mydriasis, and right deviation of the right
eye, papilledema, and left extensor plantar response. An emergency
CT scan of the head without contrast reveals a lens-shaped hyper-
density under the right temporal bone with mass effect and edema.
What is the most likely diagnosis?
Answer Choices
1 Epidural hematoma
2 Subdural hematoma
3 Subarachnoid hemorrhage
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis
ANS: 1. Answer: Epidural Hematoma
,Epidural hematoma most often results from a traumatic tear of the
middle meningeal artery. Although a lucid interval ranging from
minutes to hours followed by altered mental status and focal deficits
is typical for epidural hematoma, this clinical picture is only
encountered in up to 1/3 of the patients. The collection of blood
between the skull and dura mater causes an evident mass effect with
ophthalmic nerve palsy and the contralateral hemiparesis. Surgical
evacuation of the clot via burr holes is the treatment of choice.
Subdural hematoma results from a traumatic rupture of the bridging
veins that connect the cerebrum to the venous sinuses within the
dura. This venous hemorrhage will result in a gradual increase of the
hematoma, with a progressive clinical picture over days or weeks.
The CT scan will show a concave, crescent-shaped hyper-density
compared to the convex, lens-shaped hyper-density in epidural
hematoma.
Subarachnoid hemorrhage is the result of an aneurysm rupture; the
most common is the congenital berry aneurysm. The clinical picture
is of a sudden, severe headache with meningeal irritation. A CT scan
will show blood in the subarachnoid space, and a lumbar puncture
will reveal xanthochromia CSF.
Intracerebral parenchymal hemorrhage is most likely caused by
hypertension complicated with Charcot-Bouchard aneurysms. The
blood accumulates into the brain substance and most commonly
involves the basal ganglia.
,Acute meningitis is not associated with trauma. Fever and signs of
meningeal irritation dominate the clinical picture. Lumbar puncture,
indicated if there are no focal neurological signs on clinical
examination, will be the diagnostic procedure. The CT scan of the
patient presented in this case is characteristic for epidural
hematoma, and there is no indication for a lumbar punctu
◉ A 31-year-old woman presents with a purpural rash covering her
arms, legs, and abdomen. She also has fever, chills, nausea,
abdominal tenderness, tachycardia, and generalized myalgias. Prior
to the development of the rash, the patient noted that she had a
headache, cough, and sore throat. Laboratory studies were positive
for Gram-negative diplococci in the blood, along with
thrombocytopenia and an elevation in PMNs. Urinalysis showed
blood, protein, and casts. Vital signs are as follows: PB 92/66, P 96,
RR 14, T 39. The patient denies any foreign travel and does not have
any sick contacts. However, she does work part time as a nurse in a
local hospital.
Question
The patient is diagnosed with Meningococcemia; she is admitted to
the hospital and placed in respiratory isolation. What major course
of therapy should this patient receive?
Answer Choices
1 Steroids
, 2 Supportive care
3 Antibiotics
4 Transfusion
5 Bacterici. Answer: Antibiotics
Antibiotics are the treatment of choice for meningococcemia. The
preferred drug for active infection is penicillin G. For those allergic
to penicillin, chloramphenicol and cephalosporins (ie, cefotaxime,
cefuroxime) may be used as alternatives.
Patients will also receive supportive care, but antibiotic therapy
must be initiated quickly if the patient is to survive. Intensive care
placement may be necessary if organ failure is imminent. Ventilatory
support, inotropic support, and IV fluids are necessary in some. If
adrenal insufficiency occurs, corticosteroid replacement may be
considered. A central venous line helps to provide large amounts of
volume expanders and inotropic medications for adequate tissue
perfusion.
Steroids have not been shown to play a major role in the treatment
of meningococcemia. However, they have been used in addition to
antibiotic therapy. In the case of adrenal insufficiency, for example,
steroid replacement has been shown to be beneficial.
Transfusion does not generally play a major role in treatment. If the
patient suffers from a devastating coagulopathy, blood or blood
products may be replaced as necessary.
STUDY DISCUSSIONS VIEW AHEAD RESOURCE
2026 RESULTS GUARANTEED A+
◉ A 37-year-old man fell from a ladder as he finished hanging the
Christmas lights on his house. The right side of his head hit the alley
cement, and he lost consciousness for about 1 minute; he woke up
with a headache, but he had no other complaints. A few hours later,
the patient is brought to the emergency room by his neighbor
because of an intense headache, confusion, and left hand
hemiparesis. On examination, the patient has a bruise located over
the right temporal region, mydriasis, and right deviation of the right
eye, papilledema, and left extensor plantar response. An emergency
CT scan of the head without contrast reveals a lens-shaped hyper-
density under the right temporal bone with mass effect and edema.
What is the most likely diagnosis?
Answer Choices
1 Epidural hematoma
2 Subdural hematoma
3 Subarachnoid hemorrhage
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis
ANS: 1. Answer: Epidural Hematoma
,Epidural hematoma most often results from a traumatic tear of the
middle meningeal artery. Although a lucid interval ranging from
minutes to hours followed by altered mental status and focal deficits
is typical for epidural hematoma, this clinical picture is only
encountered in up to 1/3 of the patients. The collection of blood
between the skull and dura mater causes an evident mass effect with
ophthalmic nerve palsy and the contralateral hemiparesis. Surgical
evacuation of the clot via burr holes is the treatment of choice.
Subdural hematoma results from a traumatic rupture of the bridging
veins that connect the cerebrum to the venous sinuses within the
dura. This venous hemorrhage will result in a gradual increase of the
hematoma, with a progressive clinical picture over days or weeks.
The CT scan will show a concave, crescent-shaped hyper-density
compared to the convex, lens-shaped hyper-density in epidural
hematoma.
Subarachnoid hemorrhage is the result of an aneurysm rupture; the
most common is the congenital berry aneurysm. The clinical picture
is of a sudden, severe headache with meningeal irritation. A CT scan
will show blood in the subarachnoid space, and a lumbar puncture
will reveal xanthochromia CSF.
Intracerebral parenchymal hemorrhage is most likely caused by
hypertension complicated with Charcot-Bouchard aneurysms. The
blood accumulates into the brain substance and most commonly
involves the basal ganglia.
,Acute meningitis is not associated with trauma. Fever and signs of
meningeal irritation dominate the clinical picture. Lumbar puncture,
indicated if there are no focal neurological signs on clinical
examination, will be the diagnostic procedure. The CT scan of the
patient presented in this case is characteristic for epidural
hematoma, and there is no indication for a lumbar punctu
◉ A 31-year-old woman presents with a purpural rash covering her
arms, legs, and abdomen. She also has fever, chills, nausea,
abdominal tenderness, tachycardia, and generalized myalgias. Prior
to the development of the rash, the patient noted that she had a
headache, cough, and sore throat. Laboratory studies were positive
for Gram-negative diplococci in the blood, along with
thrombocytopenia and an elevation in PMNs. Urinalysis showed
blood, protein, and casts. Vital signs are as follows: PB 92/66, P 96,
RR 14, T 39. The patient denies any foreign travel and does not have
any sick contacts. However, she does work part time as a nurse in a
local hospital.
Question
The patient is diagnosed with Meningococcemia; she is admitted to
the hospital and placed in respiratory isolation. What major course
of therapy should this patient receive?
Answer Choices
1 Steroids
, 2 Supportive care
3 Antibiotics
4 Transfusion
5 Bacterici. Answer: Antibiotics
Antibiotics are the treatment of choice for meningococcemia. The
preferred drug for active infection is penicillin G. For those allergic
to penicillin, chloramphenicol and cephalosporins (ie, cefotaxime,
cefuroxime) may be used as alternatives.
Patients will also receive supportive care, but antibiotic therapy
must be initiated quickly if the patient is to survive. Intensive care
placement may be necessary if organ failure is imminent. Ventilatory
support, inotropic support, and IV fluids are necessary in some. If
adrenal insufficiency occurs, corticosteroid replacement may be
considered. A central venous line helps to provide large amounts of
volume expanders and inotropic medications for adequate tissue
perfusion.
Steroids have not been shown to play a major role in the treatment
of meningococcemia. However, they have been used in addition to
antibiotic therapy. In the case of adrenal insufficiency, for example,
steroid replacement has been shown to be beneficial.
Transfusion does not generally play a major role in treatment. If the
patient suffers from a devastating coagulopathy, blood or blood
products may be replaced as necessary.
