Deck 2: Neurological Disorders: Meningitis, Encephalitis, Cerebral Abscess, Stroke, Seizures, and Headaches

Question 1

Which statement is incorrect regarding meningitis?

A)90% of cases occur in the first 5 years, with peak at 6 months of age.
B)Damage is due to the inflammatory response not bacterial toxins.
C)Brudzinski's sign is involuntary hip flexion with passive neck flexion.
D)CT may be normal even in the presence of elevated ICP in up to 45%.
E)LP is always abnormal with bacterial meningitis.

Answer 1

LP is always abnormal with bacterial meningitis.

Question 2

A CSF shows opening pressure of 30 cm H2O , protein of 0.1, glucose of 2.0, WCC of 100, and no organisms on gram stain. Which type of meningitis does this fit with?

A)Acute bacterial.
B)Viral meningitis.
C)Normal result.
D)TB meningitis
E)TB meningitis or partly treated bacterial meningitis.

Answer 2

TB meningitis or partly treated bacterial meningitis.

Question 3

Which is true regarding treatment of meningitis?

A)Empiric treatment in adults consists of ceftriaxone 2g IV.
B)There is no evidence to support dexamethasone in infants with meningitis especially with Hib meningitis.
C)Strep pneumoniae is becoming increasingly resistant to ceftriaxone in Australia as well as penicillin.
D)Neisseria meningitis has high rates of resistance to benzylpen, so ceftriaxone is the first treatment of choice now.
E)There is no parental treatment available for cryptocccocal meningitis.

Answer 3

Strep pneumoniae is becoming increasingly resistant to ceftriaxone in Australia as well as penicillin.

Question 4

Which is incorrect regarding encephalitis?

A)MRI shows characteristic temporal and frontal lobe changes in HSV.
B)CSF usually shows aseptic meningitis.
C)PCR for HSV is insensitive but very specific.
D)Acyclovir has only been shown to be effective in HSV, but is also used in herpes zoster encephalitis.
E)Mortality from HSV is higher than herpes zoster or CMV.

Question 5

Which is INCORRECT regarding cerebral abscess?

A)Classical triad of headache, fever and focal neurological deficit occurs in over 80% of patients.
B)CT without contrast may miss the diagnosis.
C)Lumbar puncture is contraindicated.
D)Spread is haematogenous, contiguous or from neursurg or penetrating trauma.
E)Anaerobes predominate as infecting organisms.

Question 6

Which is not a risk factor for subarachnoid haemorrhage?

A)female
B)1st degree relative with SAH
C)polycystic ovaries
D)smoking
E)Marfans syndrome, coarctation of the aorta

Question 7

What percentage of pts with SAH have a prior sentinal warning hemorrhage ?

A)10%
B)20%
C)30%
D)40%
E)50%

Question 8

A patient with a SAH has a severe headache with nuchal rigidity but no focal neurological signs.What is her Hunt and Hess classification?

A)1
B)2
C)3
D)4
E)5

Question 9

Which statement is incorrect with regards to non contrast CT in SAH

A)<12 hours =97.5% detection
B)24 hours=95% detection
C)1 week 50% detection
D)3 days = 75% detection
E)1 hour= 100% detection

Question 10

Which statement is FALSE about zanthocromia and SAH?

A)Inspection of CSF with the naked eye reliably detects zanhtochromia
B)it is present in all CSF at 6 hours
C)it remains in CSF for 2 weeks
D)it is not present in a traumatic tap
E)it is detected with spectrophotometry

Question 11

Which statement is INCORRECT with regards to vasospasm in SAH?

A)it usually occurs at day 4-14
B)it effects 30% of pts with SAH
C)it has a 30% morbidity and mortality untreated
D)hypertensive therapy with iv fluids and inotropes is contrindicated
E)the treatment of choice is Nimodipine

Question 12

Which interventions are NOT recommended and proven in Australia for treatment of ischemic strokes?

A)thrombolysis if less than 3 hours and normal CT
B)aspirin
C)specialized stoke unit
D)warfarin if atrial fibrillation
E)clopridogil

Question 13

A patient presents with right sided arm weakeness and a R facial droop with aphasia. Which artery distribution is the likely to be the cause of her stoke?

A)right MCA
B)left MCA
C)right anterior cerebral artery
D)left anterior cerebral artery
E)left vertebrobasilar system

Question 14

Which is true of the recent trial (NINDS) of thrombolysis in acute ischemic stroke?

A)streptokinase has the same risk benefit profile as tPA
B)the mortaility rate of tPA given within three hours of onset of ischemic stroke is lower than that of the stoke without thrombolysis
C)the mortality rate of tPA given within three hours of onset of ischemic stroke is higher than that of the stoke without thrombolysis
D)the long term disability rate in patients surviving their stoke is less if they were given tPA
E)the long term disability rate in patients surviving their stoke is higher if they were given tPA

Question 15

Which statement is FALSE about carotid stenoses?

A)in a patient with an anterior circulation ischemic event, the presence of a bruit suggests a moderately severe stenosis
B)in a patient with an anterior circulation ischemic event, the absence of a bruit dismisses a moderately severe stenosis
C)a symptomatic stenosis >70% is often operated upon
D)an asymptomatic stenosis of > 70% is usually not operated upon
E)all patient with stenoses < 30% should not be considered for endarterectomy

Question 16

When would heparin be given in an ischemic stroke or TIA?

A)all
B)vertebro basilar ischemic stroke
C)anterior circulation ischemic stroke with no prior history of cerebrovascular disease
D)ischemic stroke or TIA secondary to proven cardioembolic source
E)lacunar infarct with 80% carotid stenosis

Question 17

Which statement is FALSE regarding migraine?

A)pathophysiology involves inflammation of the trigeminovascular system
B)serotonin plays an integral part
C)the aura, if present, should last less than 60 mins and be totally reversible
D)it is typically bilateral, pulsating and occipital
E)the headache usually last 4-72 hours

Question 18

Which is incorrect regarding the pharmacological treatment of migraine?

A)chlorpromazine is a first line agent
B)sumotriptan is a first line agent
C)dihydroergotamine should not be given if sumotriptan has already been taken
D)pethidine is not as effective in treatment and has a higher rebound c.f other agents
E)dexamethasone has been proven to decrease rate of recurrence

Question 19

Which statement is FALSE regarding other headaches?

A)cluster headaches are short lived lasting 15-180 mins
B)oxygen can releve a majority of cluster headaches
C)temperal arteritis usually produces an ESR of 20
D)temporal arteritis can cause ischemic optic neuritis if left untreated
E)treatment of temperal arteritis involves oral prednisolone

Question 20

What percentage of the population will have at least one seizure in their lifetime?

A)2.5%
B)5%
C)10%
D)15%
E)17.5%

Question 21

How long does a pt have to be seizing for to be in Status Epilepticus?

A)20 mins
B)30 mins
C)40 mins
D)50 mins
E)60 mins

Question 22

Which statement is false about Phenytoin?

A)the loading dose is 15-20 mg/kg
B)if a pt on phenytoin arrives in status epilepticus then the full loading dose should still be given
C)side effects include hypotension and bradyarrythmias
D)it is extremely effective in alcohol induced seizures
E)it is contraindicated in 2nd and 3rd degree heart block

Question 23

Which statement is false about benzodiazepines and seizures?

A)there is little evidence to support any particular one
B)the dose of clonazepam in a child is 0.5 mg, and an adult 1mg
C)diazepam can be safely used PR, IM or IV
D)the rectal dose of diazepam for a 3 year old is about 5mg
E)the IV dose of diazepam in a 1 year old is about 2-3mg

Question 24

Which of the features below is not consistent with a pseudoseizure?

A)rhythmic thrusting of the pelvis
B)extremity movements out of phase bilaterally
C)head rolling from side to side
D)recall of events during the seizure
E)tongue biting

Question 25

What is the recommended antibiotic regimen for empirical treatment of bacterial meningitis in a 40 year old?

A)Ceftriaxone 2gm and Benzylpenicillin 1.8gm
B)Ceftriaxone 2gm
C)Benzylpenicillin 1.8gm
D)Ceftriaxone 2gm and Benzylpenicillin 1.8gm and Vancomycin 500mg
E)Ceftriaxone 2gm and Vancomycin 500mg