BCEN BCEN Neurological Emergencies 1 — Questions and Answers
Question 1: A patient presents with sudden onset of the 'worst headache of their life.' What condition should be suspected first?
- Tension headache
- Subarachnoid hemorrhage (Correct answer)
- Migraine with aura
- Cluster headache
Correct answer: Subarachnoid hemorrhage
Sudden severe 'thunderclap' headache is a classic hallmark of subarachnoid hemorrhage until proven otherwise.
Question 2: Which scale is most commonly used in the ED to assess level of consciousness and neurological status?
- AVPU scale
- Rankin scale
- Glasgow Coma Scale (Correct answer)
- NIHSS
Correct answer: Glasgow Coma Scale
The Glasgow Coma Scale (GCS) evaluates eye, verbal, and motor responses to provide a standardized neurological assessment in emergency settings.
Question 3: A patient with ischemic stroke arrives within 2 hours of symptom onset. What is the first-line pharmacological intervention if eligible?
- Heparin infusion
- Warfarin loading dose
- IV alteplase (tPA) (Correct answer)
- Aspirin 325 mg
Correct answer: IV alteplase (tPA)
IV alteplase (tPA) is the standard fibrinolytic therapy for eligible ischemic stroke patients within the 3–4.5 hour window.
Question 4: Which finding on CT scan is most consistent with an epidural hematoma?
- Crescent-shaped hyperdensity
- Midline shift only
- Biconvex (lens-shaped) hyperdensity (Correct answer)
- Diffuse axonal injury
Correct answer: Biconvex (lens-shaped) hyperdensity
An epidural hematoma classically appears as a biconvex (lens-shaped) hyperdensity on CT due to arterial bleeding between the skull and dura.
Question 5: A patient seizing for more than 5 minutes is considered to have status epilepticus. What is the first-line IV treatment?
- Phenytoin
- Levetiracetam
- Phenobarbital
- Lorazepam (Correct answer)
Correct answer: Lorazepam
Benzodiazepines such as lorazepam are first-line treatment for status epilepticus due to rapid onset and CNS inhibitory action.
Question 6: Cushing's triad (hypertension, bradycardia, irregular respirations) indicates which life-threatening condition?
- Neurogenic shock
- Increased intracranial pressure (Correct answer)
- Hypoglycemic encephalopathy
- Basilar skull fracture
Correct answer: Increased intracranial pressure
Cushing's triad is a late sign of severely elevated intracranial pressure and impending brainstem herniation.
BCEN BCEN Neurological Emergencies 1
A patient presents with sudden onset of the 'worst headache of their life.' What condition should be suspected first?