NR 603 WEEK 1
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A 75-year-old man is Central Cord Syndrome
involved in a motor the central cord syndrome involves loss of motor
vehicle accident and function that is more severe in the upper extremities
strikes his forehead on the than in the lower extremities, and is more severe in the
windshield. He complains hands. There is typically hyperesthesia over the
of neck pain and severe shoulders and arms. Anterior cord syndrome presents
burning in his shoulders with paraplegia or quadriplegia, loss of lateral
and arms. His physical spinothalamic function with preservation of posterior
examination reveals column function. Brown-Séquard syndrome consists
weakness of his upper of weakness and loss of posterior column function on
extremities. What type of one side of the body distal to the lesion with
spinal cord injury does this contralateral loss of lateral spinothalamic function
patient have? one to two levels below the lesion. Complete cord
transection would affect motor and sensory function
A anterior cord syndrome distal to the lesion. Cauda equina syndrome typically
B central cord syndrome presents as low back pain with radiculopathy.
C Brown-Séquard
syndrome
D complete cord
transection
E cauda equina syndrome
ANS: B
, Epidural Hematoma
A 37-year-old man fell Epidural hematoma most often results from a
from a ladder as he traumatic tear of the middle meningeal artery.
finished hanging the Although a lucid interval ranging from minutes to
Christmas lights on his hours followed by altered mental status and focal
house. The right side of his deficits is typical for epidural hematoma, this clinical
head hit the alley cement, picture is only encountered in up to 1/3 of the
and he lost consciousness patients. The collection of blood between the skull
for about 1 minute; he and dura mater causes an evident mass effect with
woke up with a headache, ophthalmic nerve palsy and the contralateral
but he had no other hemiparesis. Surgical evacuation of the clot via burr
complaints. A few hours holes is the treatment of choice.
later, the patient is
brought to the emergency Subdural hematoma results from a traumatic rupture
room by his neighbor of the bridging veins that connect the cerebrum to
because of an intense the venous sinuses within the dura. This venous
headache, confusion, and hemorrhage will result in a gradual increase of the
left hand hemiparesis. On hematoma, with a progressive clinical picture over
examination, the patient days or weeks. The CT scan will show a concave,
has a bruise located over crescent-shaped hyper-density compared to the
the right temporal region, convex, lens-shaped hyper-density in epidural
mydriasis, and right hematoma.
deviation of the right eye,
papilledema, and left Subarachnoid hemorrhage is the result of an
extensor plantar response. aneurysm rupture; the most common is the congenital
An emergency CT scan of berry aneurysm. The clinical picture is of a sudden,
the head without contrast severe headache with meningeal irritation. A CT scan
reveals a lens-shaped will show blood in the subarachnoid space, and a
hyper-density under the lumbar puncture will reveal xanthochromia CSF.
right temporal bone with
mass effect and edema. Intracerebral parenchymal hemorrhage is most likely
What is the most likely caused by hypertension complicated with Charcot-
diagnosis? Bouchard aneurysms. The blood accumulates into the
brain substance and most commonly involves the
Answer Choices basal ganglia.
1 Epidural hematoma
2 Subdural hematoma Acute meningitis is not associated with trauma. Fever
,3 Subarachnoid and signs of meningeal irritation dominate the clinical
hemorrhage picture. Lumbar puncture, indicated if there are no
4 Intracerebral focal neurological signs on clinical examination, will
parenchymal hemorrhage be the diagnostic procedure. The CT scan of the
5 Acute meningitis patient presented in this case is characteristic for
ANS: 1 epidural hematoma, and there is no indication for a
lumbar punctu
, A 31-year-old woman Antibiotics
presents with a purpural Antibiotics are the treatment of choice for
rash covering her arms, meningococcemia. The preferred drug for active
legs, and abdomen. She infection is penicillin G. For those allergic to penicillin,
also has fever, chills, chloramphenicol and cephalosporins (ie, cefotaxime,
nausea, abdominal cefuroxime) may be used as alternatives.
tenderness, tachycardia,
and generalized myalgias. Patients will also receive supportive care, but
Prior to the development antibiotic therapy must be initiated quickly if the
of the rash, the patient patient is to survive. Intensive care placement may be
noted that she had a necessary if organ failure is imminent. Ventilatory
headache, cough, and support, inotropic support, and IV fluids are
sore throat. Laboratory necessary in some. If adrenal insufficiency occurs,
studies were positive for corticosteroid replacement may be considered. A
Gram-negative diplococci central venous line helps to provide large amounts of
in the blood, along with volume expanders and inotropic medications for
thrombocytopenia and an adequate tissue perfusion.
elevation in PMNs.
Urinalysis showed blood, Steroids have not been shown to play a major role in
protein, and casts. Vital the treatment of meningococcemia. However, they
signs are as follows: PB have been used in addition to antibiotic therapy. In
92/66, P 96, RR 14, T 39. the case of adrenal insufficiency, for example, steroid
The patient denies any replacement has been shown to be beneficial.
foreign travel and does
not have any sick contacts. Transfusion does not generally play a major role in
However, she does work treatment. If the patient suffers from a devastating
part time as a nurse in a coagulopathy, blood or blood products may be
local hospital. replaced as necessary.
Question
The patient is diagnosed Bactericidal/permeability-increasing protein is a
with Meningococcemia; protein stored in the granules of neutrophils. It binds
she is admitted to the to endotoxin in vitro and neutralizes it. This technique
hospital and placed in is experimental, and it is not used in everyday
respiratory isolation. What treatment of meningococcemia.
major course of therapy
should this patient
receive?
Save
A 75-year-old man is Central Cord Syndrome
involved in a motor the central cord syndrome involves loss of motor
vehicle accident and function that is more severe in the upper extremities
strikes his forehead on the than in the lower extremities, and is more severe in the
windshield. He complains hands. There is typically hyperesthesia over the
of neck pain and severe shoulders and arms. Anterior cord syndrome presents
burning in his shoulders with paraplegia or quadriplegia, loss of lateral
and arms. His physical spinothalamic function with preservation of posterior
examination reveals column function. Brown-Séquard syndrome consists
weakness of his upper of weakness and loss of posterior column function on
extremities. What type of one side of the body distal to the lesion with
spinal cord injury does this contralateral loss of lateral spinothalamic function
patient have? one to two levels below the lesion. Complete cord
transection would affect motor and sensory function
A anterior cord syndrome distal to the lesion. Cauda equina syndrome typically
B central cord syndrome presents as low back pain with radiculopathy.
C Brown-Séquard
syndrome
D complete cord
transection
E cauda equina syndrome
ANS: B
, Epidural Hematoma
A 37-year-old man fell Epidural hematoma most often results from a
from a ladder as he traumatic tear of the middle meningeal artery.
finished hanging the Although a lucid interval ranging from minutes to
Christmas lights on his hours followed by altered mental status and focal
house. The right side of his deficits is typical for epidural hematoma, this clinical
head hit the alley cement, picture is only encountered in up to 1/3 of the
and he lost consciousness patients. The collection of blood between the skull
for about 1 minute; he and dura mater causes an evident mass effect with
woke up with a headache, ophthalmic nerve palsy and the contralateral
but he had no other hemiparesis. Surgical evacuation of the clot via burr
complaints. A few hours holes is the treatment of choice.
later, the patient is
brought to the emergency Subdural hematoma results from a traumatic rupture
room by his neighbor of the bridging veins that connect the cerebrum to
because of an intense the venous sinuses within the dura. This venous
headache, confusion, and hemorrhage will result in a gradual increase of the
left hand hemiparesis. On hematoma, with a progressive clinical picture over
examination, the patient days or weeks. The CT scan will show a concave,
has a bruise located over crescent-shaped hyper-density compared to the
the right temporal region, convex, lens-shaped hyper-density in epidural
mydriasis, and right hematoma.
deviation of the right eye,
papilledema, and left Subarachnoid hemorrhage is the result of an
extensor plantar response. aneurysm rupture; the most common is the congenital
An emergency CT scan of berry aneurysm. The clinical picture is of a sudden,
the head without contrast severe headache with meningeal irritation. A CT scan
reveals a lens-shaped will show blood in the subarachnoid space, and a
hyper-density under the lumbar puncture will reveal xanthochromia CSF.
right temporal bone with
mass effect and edema. Intracerebral parenchymal hemorrhage is most likely
What is the most likely caused by hypertension complicated with Charcot-
diagnosis? Bouchard aneurysms. The blood accumulates into the
brain substance and most commonly involves the
Answer Choices basal ganglia.
1 Epidural hematoma
2 Subdural hematoma Acute meningitis is not associated with trauma. Fever
,3 Subarachnoid and signs of meningeal irritation dominate the clinical
hemorrhage picture. Lumbar puncture, indicated if there are no
4 Intracerebral focal neurological signs on clinical examination, will
parenchymal hemorrhage be the diagnostic procedure. The CT scan of the
5 Acute meningitis patient presented in this case is characteristic for
ANS: 1 epidural hematoma, and there is no indication for a
lumbar punctu
, A 31-year-old woman Antibiotics
presents with a purpural Antibiotics are the treatment of choice for
rash covering her arms, meningococcemia. The preferred drug for active
legs, and abdomen. She infection is penicillin G. For those allergic to penicillin,
also has fever, chills, chloramphenicol and cephalosporins (ie, cefotaxime,
nausea, abdominal cefuroxime) may be used as alternatives.
tenderness, tachycardia,
and generalized myalgias. Patients will also receive supportive care, but
Prior to the development antibiotic therapy must be initiated quickly if the
of the rash, the patient patient is to survive. Intensive care placement may be
noted that she had a necessary if organ failure is imminent. Ventilatory
headache, cough, and support, inotropic support, and IV fluids are
sore throat. Laboratory necessary in some. If adrenal insufficiency occurs,
studies were positive for corticosteroid replacement may be considered. A
Gram-negative diplococci central venous line helps to provide large amounts of
in the blood, along with volume expanders and inotropic medications for
thrombocytopenia and an adequate tissue perfusion.
elevation in PMNs.
Urinalysis showed blood, Steroids have not been shown to play a major role in
protein, and casts. Vital the treatment of meningococcemia. However, they
signs are as follows: PB have been used in addition to antibiotic therapy. In
92/66, P 96, RR 14, T 39. the case of adrenal insufficiency, for example, steroid
The patient denies any replacement has been shown to be beneficial.
foreign travel and does
not have any sick contacts. Transfusion does not generally play a major role in
However, she does work treatment. If the patient suffers from a devastating
part time as a nurse in a coagulopathy, blood or blood products may be
local hospital. replaced as necessary.
Question
The patient is diagnosed Bactericidal/permeability-increasing protein is a
with Meningococcemia; protein stored in the granules of neutrophils. It binds
she is admitted to the to endotoxin in vitro and neutralizes it. This technique
hospital and placed in is experimental, and it is not used in everyday
respiratory isolation. What treatment of meningococcemia.
major course of therapy
should this patient
receive?
