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Neurological Emergencies Flashcards

7 cards from real CPEN practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Neurological Emergencies flashcards as text

  1. A 9-year-old with ALL presents with altered mental status and bilateral papilledema. Lumbar puncture is deferred. Which intervention is MOST immediately indicated?

    Answer: Start dexamethasone and obtain urgent head CT

    Papilledema contraindicates LP before imaging; dexamethasone reduces cerebral edema while CT defines the cause in this immunocompromised patient.

  2. Hypertonic saline (3% NaCl) is ordered for a pediatric patient with severe TBI. The GOAL serum sodium target is:

    Answer: 150–160 mEq/L

    For ICP management with hypertonic saline, the goal serum sodium is typically 150–160 mEq/L to create an osmotic gradient that reduces cerebral edema.

  3. An infant presents with opisthotonus, high-pitched cry, and a bulging fontanelle. Bacterial meningitis is confirmed. When should dexamethasone be given?

    Answer: 15–20 minutes before or with the first antibiotic dose

    Dexamethasone is most effective when given 15–20 minutes before or concurrently with the first antibiotic dose to blunt the inflammatory response.

  4. Which EEG pattern is pathognomonic for absence seizures in children?

    Answer: 3 Hz spike-and-wave discharges

    Absence seizures (petit mal) are characterized by 3 Hz generalized spike-and-wave discharges on EEG, often provoked by hyperventilation.

  5. A 15-year-old presents with thunderclap headache — worst of life, sudden onset. After a negative CT, the NEXT step is:

    Answer: Lumbar puncture to detect xanthochromia

    CT misses ~2% of subarachnoid hemorrhages; LP detecting xanthochromia or blood in CSF is essential when CT is negative after thunderclap headache.

  6. Which finding differentiates pseudotumor cerebri (idiopathic intracranial hypertension) from other causes of elevated ICP in a 13-year-old obese girl?

    Answer: Normal brain MRI with elevated CSF opening pressure >25 cmH2O

    IIH is diagnosed by elevated opening pressure (>25 cmH2O) with normal brain imaging, CSF composition, and no identifiable cause.

  7. A 4-year-old presents with acute onset right-sided facial droop and inability to close the right eye, but normal eye movements and no limb weakness. The MOST likely diagnosis is:

    Answer: Bell's palsy (peripheral CN VII palsy)

    Bell's palsy is a peripheral CN VII palsy causing complete unilateral facial weakness including forehead and eye closure, distinguishing it from central causes.