CEN Neurological Emergencies

Question 1

A 58-year-old patient presents with sudden-onset 'worst headache of my life.' CT head is negative. What is the next most important diagnostic step?

Accepted Answer

Lumbar puncture for xanthochromia

Answer

MRI brain with gadolinium

Answer

Repeat CT in 6 hours

Answer

Cerebral angiography immediately

Question 2

A patient presents with right-sided facial droop, left arm weakness, and slurred speech that started 45 minutes ago. CT shows no hemorrhage. The patient has no contraindications. What is the priority treatment?

Accepted Answer

IV alteplase (tPA) within the 3–4.5 hour window

Answer

Anticoagulation with heparin drip

Answer

Aspirin 325 mg and admit for observation

Answer

Emergent carotid endarterectomy

Question 3

Which of the following is a contraindication to administering IV tPA for acute ischemic stroke?

Accepted Answer

Recent ischemic stroke within the last 3 months

Answer

Age over 80 years

Answer

Blood pressure 175/95 mmHg after treatment

Answer

Blood glucose of 110 mg/dL

Question 4

A patient is brought in seizing continuously for 10 minutes. Lorazepam has been given twice without effect. What is the next drug to administer?

Accepted Answer

Levetiracetam or fosphenytoin IV

Answer

Phenobarbital 20 mg/kg IV

Answer

Propofol infusion

Answer

Midazolam 10 mg IM

Question 5

A patient with bacterial meningitis should receive which treatment combination as soon as possible?

Accepted Answer

Vancomycin + ceftriaxone + dexamethasone

Answer

Ceftriaxone alone

Answer

Ceftriaxone + dexamethasone + acyclovir

Answer

Acyclovir alone until cultures return

Question 6

The Glasgow Coma Scale (GCS) assesses which three components?

Accepted Answer

Eye opening, verbal response, motor response

Answer

Pupil reactivity, verbal response, motor response

Answer

Eye opening, pupil reactivity, verbal response

Answer

Respiratory effort, eye opening, motor response