CNS CNS Neurocritical Care and Emergency Neurology 2

Question 1

Which finding on CT angiography is the strongest predictor of hematoma expansion in spontaneous intracerebral hemorrhage?

Accepted Answer

The 'spot sign' (contrast extravasation within the hematoma)

Answer

The CT angiography spot sign, representing active contrast extravasation into the hematoma, is the strongest independent predictor of subsequent hematoma expansion.

Question 2

A patient in the neurological ICU develops fever, neck stiffness, photophobia, and CSF showing >1000 WBC with predominantly neutrophils and low glucose. The MOST appropriate immediate intervention is:

Accepted Answer

Start empirical IV antibiotics and dexamethasone immediately

Answer

Bacterial meningitis is a medical emergency; empirical broad-spectrum antibiotics plus dexamethasone must be started immediately without waiting for cultures.

Question 3

Which neuroprotective intervention has the STRONGEST evidence for improving neurological outcomes after out-of-hospital cardiac arrest?

Accepted Answer

Targeted temperature management (TTM) to 32–36°C

Answer

TTM prevents secondary neuronal injury after cardiac arrest by reducing metabolic demand and inflammatory cascades, with the strongest evidence base for post-cardiac arrest neuroprotection.

Question 4

A patient with myasthenia gravis develops rapidly worsening dysphagia and respiratory distress. The CNS specialist recognizes this as:

Accepted Answer

Myasthenic crisis requiring ICU monitoring and possible intubation

Answer

Myasthenic crisis is life-threatening deterioration of neuromuscular transmission causing respiratory failure and requires urgent ICU care, plasmapheresis, or IVIG.

Question 5

In a patient with acute spinal cord injury, neurogenic shock presents with hypotension and which cardiovascular finding that distinguishes it from hemorrhagic shock?

Accepted Answer

Bradycardia and warm, vasodilated extremities

Answer

Loss of sympathetic tone in neurogenic shock produces bradycardia and peripheral vasodilation, contrasting with the compensatory tachycardia seen in hemorrhagic shock.

CNS - Certified Neuro Specialist Practice Test

CNS - Certified Neuro Specialist Practice Test

CNS CNS Neurocritical Care and Emergency Neurology 2