lOMoAR cPSD| 67691079
Exam 6 Study Guide
Exam Breakdown
*this list is not all inclusive
Neurology (~25 Questions)
• Types of CVA
• ICP
• CPP
• Circulation of brain
• CSF/Meningitis
• GCS GBS
• Seizures
• Multiple Sclerosis
Renal/Urology (~25 Questions)
• Bowman’s capsule pressures
• Glomerular filtration rate
• Renal Medulla and osmolarity
• Loop of Henle
• Collecting ducts
• Urine specific gravity
• Nephrotic syndrome
• Nephritic syndrome
• Kidney stones
• Lupus Nephritis
• AKI (prerenal, intrinsic and post obstructive)
• CKD and its stages
• Polycystic kidneys
• DM nephropathy
• ATN
• UA and its components
• Kidney stones
Prior Content (~10 Questions)
• Covers modules 1-10
, lOMoAR cPSD| 67691079
Neurology - 25 questions
Types of CVA
1. Definition
• Sudden interruption of blood flow to the brain, causing loss of brain function.
• Can lead to irreversible brain damage.
• Deficits depend on location and extent of injury.
2. Main Types of Stroke
A. Ischemic Stroke (~90%)
• Cause: Obstruction of cerebral artery → decreased blood flow → cell death.
• Subtypes:
1. Thrombotic Stroke:
Clot forms in brain artery (atherosclerosis).
Risk factors: Hypertension, diabetes, hyperlipidemia, smoking. Onset:
Gradual, symptoms may fluctuate.
2. Embolic Stroke:
Clot travels from elsewhere (e.g., heart in atrial fibrillation) → blocks
cerebral artery.
Onset: Sudden, severe deficits.
3. Cryptogenic Stroke: Unknown cause after full workup.
4. Lacunar Stroke:
Small, deep infarcts (0.5–15 mm) in subcortical areas.
Risk factors: Hypertension, diabetes.
Focal symptoms: pure motor/sensory, ataxia, clumsy hand; usually no
cortical deficits.
Can be silent (20–50% of older adults).
Related Concepts
• TIA (Transient Ischemic Attack): Symptoms <24h, no permanent damage, warning
sign (9–17% risk of stroke in 3 months).
• RIND (Reversible Ischemic Neurologic Deficit): Deficits >24h, resolve within 3
weeks, no permanent damage.
B. Hemorrhagic Stroke (~10%)
• Cause: Ruptured blood vessel → bleeding → increased ICP → tissue damage.
• Risk factors: Hypertension, aneurysms, AVMs, anticoagulants, trauma, drugs.
Subtypes
1. Intracerebral Hemorrhage (ICH):
o Bleeding into brain tissue. o Causes: HTN, AVMs, aneurysm. o Symptoms:
Focal deficits, headache (less severe than SAH), nausea/vomiting.
2. Subarachnoid Hemorrhage (SAH):
, lOMoAR cPSD| 67691079
o Bleeding in subarachnoid space. o Causes: Aneurysm rupture, trauma. o
Symptoms: Sudden severe headache (“worst headache of life”), neck pain,
photophobia, nausea/vomiting, altered consciousness.
Key: Differentiation is critical; CT scan distinguishes ischemic vs hemorrhagic → guides
treatment (tPA vs surgery).
3. The 5 Ps Framework for Stroke Management
1. Pipes: Restore blood flow (e.g., tPA for ischemic stroke).
2. Prevention: Prevent recurrent strokes → antiplatelets, anticoagulants, lifestyle, carotid
surgery.
3. Parenchyma: Protect brain tissue → neuroprotective strategies to limit infarction.
4. Perfusion: Ensure adequate blood/oxygen delivery → maintain cerebral perfusion
pressure.
5. Penumbra: Salvage ischemic but viable tissue → timely reperfusion improves outcomes.
4. Time-Sensitive Management
• “Time is Brain”
o <3 hours: Optimal for tPA → limits tissue damage, reduces disability. o
Golden Hour (first 60 min): Critical for intervention.
o >6 hours: Irreversible brain damage, higher disability risk.
• Not all patients qualify for tPA → strict criteria apply.
• Other treatments: Endovascular thrombectomy, supportive care.
5. Summary Table: Ischemic vs Hemorrhagic Stroke
Feature Ischemic (Thrombotic/Embolic) Hemorrhagic (ICH/SAH)
Gradual (thrombotic), sudden
Onset Sudden
(embolic)
Cause Clot/embolus Vessel rupture
HTN, diabetes, atherosclerosis, A- HTN, aneurysm, AVM, trauma,
Risk Factors fib anticoagulants
Severe headache, focal deficits, nausea,
Symptoms Focal deficits, fluctuating
LOC changes
Imaging CT/MRI: infarct CT: bleed
Treatment tPA, thrombectomy BP management, surgery, supportive
care
A 68-year-old man with a history of atrial fibrillation presents with sudden onset right-sided
weakness and slurred speech. CT scan shows no hemorrhage. Which of the following
mechanisms most likely explains his stroke?
A. Rupture of an intracerebral vessel due to chronic hypertension
B. Thrombus formation at the site of atherosclerotic plaque in a cerebral artery
C. Embolus originating from the left atrium occluding a cerebral artery
D. Rupture of an aneurysm in the subarachnoid space
Answer: C. Embolus originating from the left atrium occluding a cerebral artery
, lOMoAR cPSD| 67691079
Rationale:
• Sudden onset deficits in a patient with A-fib suggest a cardioembolic ischemic
stroke.
• No hemorrhage is present, so hemorrhagic causes (A, D) are excluded.
Thrombotic stroke (B) typically develops gradually and fluctuates.
Which of the following best describes the pathophysiologic changes in the ischemic penumbra
after an acute thrombotic stroke?
A. Neurons are dead and irreversibly damaged
B. Neurons are metabolically impaired but potentially salvageable with timely reperfusion
C. Brain tissue is unaffected due to collateral circulation
D. Tissue undergoes hemorrhagic transformation immediately
Answer: B. Neurons are metabolically impaired but potentially salvageable with
timely
reperfusion
Rationale:
• The penumbra is hypoperfused tissue surrounding the infarct core.
• Cells are viable but at risk for apoptosis if reperfusion is delayed. Timely
intervention (e.g., tPA) can restore function.
A patient presents with sudden, severe headache described as “the worst headache of my life,”
neck stiffness, photophobia, and nausea. Neurologic exam reveals confusion but no lateralizing
motor deficits. Which type of stroke is most likely?
A. Thrombotic ischemic stroke
B. Embolic ischemic stroke
C. Subarachnoid hemorrhage
D. Lacunar stroke
Answer: C. Subarachnoid hemorrhage
Rationale:
• Classic SAH presentation: sudden severe “thunderclap” headache, neck stiffness,
photophobia.
• Often caused by aneurysm rupture; may have minimal focal deficits.
• Ischemic strokes (A, B, D) usually present with focal neurologic deficits rather than
global symptoms.
Which of the following best explains why lacunar strokes often lack cortical symptoms such as
aphasia or visual field deficits?
A. They occur in the cerebellum, which does not control language or vision
B. They affect deep penetrating subcortical arteries, sparing cortical regions
C. Collateral circulation prevents ischemia in eloquent brain regions
D. Hemorrhagic transformation mitigates symptom severity
Answer: B. They affect deep penetrating subcortical arteries, sparing cortical regions
Rationale:
Exam 6 Study Guide
Exam Breakdown
*this list is not all inclusive
Neurology (~25 Questions)
• Types of CVA
• ICP
• CPP
• Circulation of brain
• CSF/Meningitis
• GCS GBS
• Seizures
• Multiple Sclerosis
Renal/Urology (~25 Questions)
• Bowman’s capsule pressures
• Glomerular filtration rate
• Renal Medulla and osmolarity
• Loop of Henle
• Collecting ducts
• Urine specific gravity
• Nephrotic syndrome
• Nephritic syndrome
• Kidney stones
• Lupus Nephritis
• AKI (prerenal, intrinsic and post obstructive)
• CKD and its stages
• Polycystic kidneys
• DM nephropathy
• ATN
• UA and its components
• Kidney stones
Prior Content (~10 Questions)
• Covers modules 1-10
, lOMoAR cPSD| 67691079
Neurology - 25 questions
Types of CVA
1. Definition
• Sudden interruption of blood flow to the brain, causing loss of brain function.
• Can lead to irreversible brain damage.
• Deficits depend on location and extent of injury.
2. Main Types of Stroke
A. Ischemic Stroke (~90%)
• Cause: Obstruction of cerebral artery → decreased blood flow → cell death.
• Subtypes:
1. Thrombotic Stroke:
Clot forms in brain artery (atherosclerosis).
Risk factors: Hypertension, diabetes, hyperlipidemia, smoking. Onset:
Gradual, symptoms may fluctuate.
2. Embolic Stroke:
Clot travels from elsewhere (e.g., heart in atrial fibrillation) → blocks
cerebral artery.
Onset: Sudden, severe deficits.
3. Cryptogenic Stroke: Unknown cause after full workup.
4. Lacunar Stroke:
Small, deep infarcts (0.5–15 mm) in subcortical areas.
Risk factors: Hypertension, diabetes.
Focal symptoms: pure motor/sensory, ataxia, clumsy hand; usually no
cortical deficits.
Can be silent (20–50% of older adults).
Related Concepts
• TIA (Transient Ischemic Attack): Symptoms <24h, no permanent damage, warning
sign (9–17% risk of stroke in 3 months).
• RIND (Reversible Ischemic Neurologic Deficit): Deficits >24h, resolve within 3
weeks, no permanent damage.
B. Hemorrhagic Stroke (~10%)
• Cause: Ruptured blood vessel → bleeding → increased ICP → tissue damage.
• Risk factors: Hypertension, aneurysms, AVMs, anticoagulants, trauma, drugs.
Subtypes
1. Intracerebral Hemorrhage (ICH):
o Bleeding into brain tissue. o Causes: HTN, AVMs, aneurysm. o Symptoms:
Focal deficits, headache (less severe than SAH), nausea/vomiting.
2. Subarachnoid Hemorrhage (SAH):
, lOMoAR cPSD| 67691079
o Bleeding in subarachnoid space. o Causes: Aneurysm rupture, trauma. o
Symptoms: Sudden severe headache (“worst headache of life”), neck pain,
photophobia, nausea/vomiting, altered consciousness.
Key: Differentiation is critical; CT scan distinguishes ischemic vs hemorrhagic → guides
treatment (tPA vs surgery).
3. The 5 Ps Framework for Stroke Management
1. Pipes: Restore blood flow (e.g., tPA for ischemic stroke).
2. Prevention: Prevent recurrent strokes → antiplatelets, anticoagulants, lifestyle, carotid
surgery.
3. Parenchyma: Protect brain tissue → neuroprotective strategies to limit infarction.
4. Perfusion: Ensure adequate blood/oxygen delivery → maintain cerebral perfusion
pressure.
5. Penumbra: Salvage ischemic but viable tissue → timely reperfusion improves outcomes.
4. Time-Sensitive Management
• “Time is Brain”
o <3 hours: Optimal for tPA → limits tissue damage, reduces disability. o
Golden Hour (first 60 min): Critical for intervention.
o >6 hours: Irreversible brain damage, higher disability risk.
• Not all patients qualify for tPA → strict criteria apply.
• Other treatments: Endovascular thrombectomy, supportive care.
5. Summary Table: Ischemic vs Hemorrhagic Stroke
Feature Ischemic (Thrombotic/Embolic) Hemorrhagic (ICH/SAH)
Gradual (thrombotic), sudden
Onset Sudden
(embolic)
Cause Clot/embolus Vessel rupture
HTN, diabetes, atherosclerosis, A- HTN, aneurysm, AVM, trauma,
Risk Factors fib anticoagulants
Severe headache, focal deficits, nausea,
Symptoms Focal deficits, fluctuating
LOC changes
Imaging CT/MRI: infarct CT: bleed
Treatment tPA, thrombectomy BP management, surgery, supportive
care
A 68-year-old man with a history of atrial fibrillation presents with sudden onset right-sided
weakness and slurred speech. CT scan shows no hemorrhage. Which of the following
mechanisms most likely explains his stroke?
A. Rupture of an intracerebral vessel due to chronic hypertension
B. Thrombus formation at the site of atherosclerotic plaque in a cerebral artery
C. Embolus originating from the left atrium occluding a cerebral artery
D. Rupture of an aneurysm in the subarachnoid space
Answer: C. Embolus originating from the left atrium occluding a cerebral artery
, lOMoAR cPSD| 67691079
Rationale:
• Sudden onset deficits in a patient with A-fib suggest a cardioembolic ischemic
stroke.
• No hemorrhage is present, so hemorrhagic causes (A, D) are excluded.
Thrombotic stroke (B) typically develops gradually and fluctuates.
Which of the following best describes the pathophysiologic changes in the ischemic penumbra
after an acute thrombotic stroke?
A. Neurons are dead and irreversibly damaged
B. Neurons are metabolically impaired but potentially salvageable with timely reperfusion
C. Brain tissue is unaffected due to collateral circulation
D. Tissue undergoes hemorrhagic transformation immediately
Answer: B. Neurons are metabolically impaired but potentially salvageable with
timely
reperfusion
Rationale:
• The penumbra is hypoperfused tissue surrounding the infarct core.
• Cells are viable but at risk for apoptosis if reperfusion is delayed. Timely
intervention (e.g., tPA) can restore function.
A patient presents with sudden, severe headache described as “the worst headache of my life,”
neck stiffness, photophobia, and nausea. Neurologic exam reveals confusion but no lateralizing
motor deficits. Which type of stroke is most likely?
A. Thrombotic ischemic stroke
B. Embolic ischemic stroke
C. Subarachnoid hemorrhage
D. Lacunar stroke
Answer: C. Subarachnoid hemorrhage
Rationale:
• Classic SAH presentation: sudden severe “thunderclap” headache, neck stiffness,
photophobia.
• Often caused by aneurysm rupture; may have minimal focal deficits.
• Ischemic strokes (A, B, D) usually present with focal neurologic deficits rather than
global symptoms.
Which of the following best explains why lacunar strokes often lack cortical symptoms such as
aphasia or visual field deficits?
A. They occur in the cerebellum, which does not control language or vision
B. They affect deep penetrating subcortical arteries, sparing cortical regions
C. Collateral circulation prevents ischemia in eloquent brain regions
D. Hemorrhagic transformation mitigates symptom severity
Answer: B. They affect deep penetrating subcortical arteries, sparing cortical regions
Rationale:
