Neurologists Exam Emergency Response & Critical Care 5

Question 1

In Guillain-Barré syndrome, which finding most strongly supports elective intubation?

Accepted Answer

Forced vital capacity below 20 mL/kg

Answer

The 20/30/40 rule (FVC <20 mL/kg, MIP weaker than −30, MEP <40 cmH2O) predicts the need for intubation.

Question 2

A patient in myasthenic crisis needs antibiotics for pneumonia. Which agent should be avoided?

Accepted Answer

Levofloxacin

Answer

Fluoroquinolones carry an FDA boxed warning because they can worsen myasthenia gravis, as can aminoglycosides.

Question 3

What apnea test result is consistent with brain death in adults?

Accepted Answer

No respiratory effort with PaCO2 ≥60 mmHg or ≥20 mmHg above baseline

Answer

The test is positive when there are no breathing efforts despite PaCO2 of at least 60 mmHg or a rise of at least 20 mmHg above baseline.

Question 4

Which feature best distinguishes serotonin syndrome from neuroleptic malignant syndrome?

Accepted Answer

Hyperreflexia and inducible clonus with rapid onset

Answer

Serotonin syndrome starts within hours with clonus and hyperreflexia, while NMS develops over days with bradyreflexic lead-pipe rigidity.

Question 5

A malnourished patient with alcohol use disorder arrives confused with ophthalmoplegia and ataxia. What is the most appropriate treatment?

Accepted Answer

High-dose IV thiamine (e.g., 500 mg TID) before or with glucose

Answer

Suspected Wernicke encephalopathy needs high-dose parenteral thiamine, and glucose alone can make it worse.

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