CEN Neurological Emergencies 2

Question 1

Which clinical sign differentiates a herniation syndrome from a metabolic cause of coma?

Accepted Answer

Unilateral fixed and dilated pupil

Answer

Bilateral pinpoint pupils

Answer

Symmetric sluggish pupils

Answer

Small reactive pupils bilaterally

Question 2

A patient with increased intracranial pressure (ICP) is being managed. Which intervention is most appropriate as a temporizing measure?

Accepted Answer

Elevate head of bed to 30 degrees and hyperventilate to PaCO2 35 mmHg

Answer

Administer normal saline bolus 1L

Answer

Administer morphine for pain

Answer

Lower blood pressure to below 120/80 mmHg

Question 3

What is the NIH Stroke Scale (NIHSS) primarily used for in the emergency setting?

Accepted Answer

Quantifying neurological deficits and guiding thrombolysis decisions

Answer

Determining eligibility for surgery

Answer

Predicting long-term functional outcome only

Answer

Classifying hemorrhagic vs. ischemic stroke

Question 4

A patient post-trauma has a GCS of 8. According to current guidelines, what intervention is most appropriate?

Accepted Answer

Intubate to protect the airway

Answer

Observe with serial neuro checks only

Answer

Administer mannitol empirically

Answer

Perform immediate lumbar puncture

Question 5

Which medication is first-line for treatment of an acute hypertensive encephalopathy with a BP of 240/140 mmHg?

Accepted Answer

IV labetalol or nicardipine with goal of 20–25% MAP reduction in 1 hour

Answer

Oral nifedipine

Answer

Furosemide 80 mg IV push

Answer

Sublingual nitroglycerin

Question 6

A patient presents with sudden onset severe vertigo, nausea, and inability to walk. Head impulse test is negative and there is direction-changing nystagmus. What diagnosis should be suspected?

Accepted Answer

Cerebellar stroke

Answer

Benign paroxysmal positional vertigo (BPPV)

Answer

Labyrinthitis

Answer

Vestibular neuritis