SAEM Peds, SAEM - Procedures, Psych Emergencies,
Derm questions with correct answers
Generally speaking, a patient with a TIA history who presents with a
new stroke, likely has which kind of stroke?
A. thrombotic
B. there is equal likelihood for any stroke type
C. hemorrhagic
D. hypoperfusion
E. embolic Correct Answer-The answer is A. TIAs are associated with
increased risk for thrombotic strokes, the result of ulceration of cerebral
artery plaque. Patients with TIA have a 5 to 6% percent chance per year
of having a stroke. Antiplatelet therapy reduces risk of stroke in these
patients.
Which of the following is not a known complication of subarachnoid
hemorrhage in the immediate several weeks following the initial bleed?
A. rebleeding
B. hydrocephalus
C. hypernatremia
D. seizure
E. cerebral artery vasospasm Correct Answer-C
,A 36 year old woman presents to the emergency department two hours
after the sudden onset of a severe occipital headache and nausea. She has
a history of migraine headaches that typically occur in the right frontal
area and are associated with an aura. Her temperature is 98.8 degrees
Fahrenheit, her neck is supple, and her neurological exam is normal. A
non-contrast CT scan of her head is normal. Of the options below, what
is the next step in her management?
A. Consult a neurologist for evaluation of atypical migraines.
B. Perform a lumbar puncture to rule out the possibility of subarachnoid
hemorrhage.
C. Discharge her home with prochlorperazine and close instructions to
return if her symptoms worsen.
D. Observe for 6 hours, administer acetaminophen and normal saline,
and discharge home if she feels better.
E. Observe for 6 hours and then obtain a repeat CT scan; if normal,
discharge home. Correct Answer-The answer is B. Sudden onset
headache with nausea, vomiting, photophobia, or neck stiffness should
raise the concern for spontaneous subarachnoid hemorrhage. Sensitivity
of a non-contrast CT scan varies with respect to many factors (e.g. time
since bleed) but is generally in the range of 90%; therefore, if the
clinical suspicion is high, a lumbar puncture should be performed and a
cell count for red blood cells done.
Which of the following descriptors of epidural hematoma is FALSE?
A. Present in only about 1% of severe head injury patients
B. Most often a result of a skull fracture that traverses a venous sinus
,C. Biconcave blood collection between the skull and dura
D. Immediate surgical evacuation is indicated
E. Classically associated with a "lucid" interval prior to coma Correct
Answer-The answer is B. Epidural hemorrhage is most often associated
with skull fracture across the course of the middle meningeal artery.
Epidural hematomas are least likely in which age group?
A. Children less than 2 years
B. Prevalence is the same throughout age groups
C. Adults excluding elderly
D. Children between 8 and 14
E. Elderly Correct Answer-The answer is A. Epidural hematoma (EDH)
is less likely in children and elderly because of the close attachment of
the dura to the periostium of the skull. This is especially true of children
less than 2 years because of the added elasticity of the skull.
Which of the following symptoms is not associated with epidural
hematomas?
A. Severe headache
B. Neurologic deficits
C. Nausea
D. Sleepiness
, E. Hemotympanum Correct Answer-The answer is E. Although
hemotympanum may be found in a patient with an epidural hematoma, it
is specifically associated with basilar skull fracture.
A 21-year-old woman presents to the emergency department with fevers,
headache, neck stiffness, and mild confusion over the past several days.
Her temperature is 38.0 C (100.4 F), pulse 106, and blood pressure
116/74. On physical exam she looks ill, and her neck is stiff. Her
neurologic exam is normal. A lumbar puncture reveals 105 WBC and
1240 RBC in tube #1 and 126 WBC and 1360 RBC in tube #4; all white
cells are lymphocytes. The CSF protein is 68 and the glucose is 78. This
patient most likely has which of the following?
A. HSV encephalitis
B. Pneumococcal meningitis
C. Subarachnoid hemorrhage
D. Subdural hematoma Correct Answer-A
Which of the following are potential complications of bacterial
meningitis?
A. Seizure disorder
B. Focal paralysis or sensory loss
C. Intellectual impairment
D. Sensorineural hearing loss
E. All of the above Correct Answer-E
Derm questions with correct answers
Generally speaking, a patient with a TIA history who presents with a
new stroke, likely has which kind of stroke?
A. thrombotic
B. there is equal likelihood for any stroke type
C. hemorrhagic
D. hypoperfusion
E. embolic Correct Answer-The answer is A. TIAs are associated with
increased risk for thrombotic strokes, the result of ulceration of cerebral
artery plaque. Patients with TIA have a 5 to 6% percent chance per year
of having a stroke. Antiplatelet therapy reduces risk of stroke in these
patients.
Which of the following is not a known complication of subarachnoid
hemorrhage in the immediate several weeks following the initial bleed?
A. rebleeding
B. hydrocephalus
C. hypernatremia
D. seizure
E. cerebral artery vasospasm Correct Answer-C
,A 36 year old woman presents to the emergency department two hours
after the sudden onset of a severe occipital headache and nausea. She has
a history of migraine headaches that typically occur in the right frontal
area and are associated with an aura. Her temperature is 98.8 degrees
Fahrenheit, her neck is supple, and her neurological exam is normal. A
non-contrast CT scan of her head is normal. Of the options below, what
is the next step in her management?
A. Consult a neurologist for evaluation of atypical migraines.
B. Perform a lumbar puncture to rule out the possibility of subarachnoid
hemorrhage.
C. Discharge her home with prochlorperazine and close instructions to
return if her symptoms worsen.
D. Observe for 6 hours, administer acetaminophen and normal saline,
and discharge home if she feels better.
E. Observe for 6 hours and then obtain a repeat CT scan; if normal,
discharge home. Correct Answer-The answer is B. Sudden onset
headache with nausea, vomiting, photophobia, or neck stiffness should
raise the concern for spontaneous subarachnoid hemorrhage. Sensitivity
of a non-contrast CT scan varies with respect to many factors (e.g. time
since bleed) but is generally in the range of 90%; therefore, if the
clinical suspicion is high, a lumbar puncture should be performed and a
cell count for red blood cells done.
Which of the following descriptors of epidural hematoma is FALSE?
A. Present in only about 1% of severe head injury patients
B. Most often a result of a skull fracture that traverses a venous sinus
,C. Biconcave blood collection between the skull and dura
D. Immediate surgical evacuation is indicated
E. Classically associated with a "lucid" interval prior to coma Correct
Answer-The answer is B. Epidural hemorrhage is most often associated
with skull fracture across the course of the middle meningeal artery.
Epidural hematomas are least likely in which age group?
A. Children less than 2 years
B. Prevalence is the same throughout age groups
C. Adults excluding elderly
D. Children between 8 and 14
E. Elderly Correct Answer-The answer is A. Epidural hematoma (EDH)
is less likely in children and elderly because of the close attachment of
the dura to the periostium of the skull. This is especially true of children
less than 2 years because of the added elasticity of the skull.
Which of the following symptoms is not associated with epidural
hematomas?
A. Severe headache
B. Neurologic deficits
C. Nausea
D. Sleepiness
, E. Hemotympanum Correct Answer-The answer is E. Although
hemotympanum may be found in a patient with an epidural hematoma, it
is specifically associated with basilar skull fracture.
A 21-year-old woman presents to the emergency department with fevers,
headache, neck stiffness, and mild confusion over the past several days.
Her temperature is 38.0 C (100.4 F), pulse 106, and blood pressure
116/74. On physical exam she looks ill, and her neck is stiff. Her
neurologic exam is normal. A lumbar puncture reveals 105 WBC and
1240 RBC in tube #1 and 126 WBC and 1360 RBC in tube #4; all white
cells are lymphocytes. The CSF protein is 68 and the glucose is 78. This
patient most likely has which of the following?
A. HSV encephalitis
B. Pneumococcal meningitis
C. Subarachnoid hemorrhage
D. Subdural hematoma Correct Answer-A
Which of the following are potential complications of bacterial
meningitis?
A. Seizure disorder
B. Focal paralysis or sensory loss
C. Intellectual impairment
D. Sensorineural hearing loss
E. All of the above Correct Answer-E
