NSF Week 6

An 8-year-old girl has episodes of behavioral arrest with simultaneous eyelid flutter lasting for 10 seconds at a time. Afterwards, she resumes activity as if nothing happened. Similar events happen multiple times daily. She performs well at school and on the soccer field. What is the most appropriate treatment for this child?

A 35-year-old teacher suddenly stops what she is doing. This is followed by smacking of her lips and repetitive grasping with her right hand. She does not respond when you talk to her and she stares vacantly. This lasts 45 seconds and afterwards she feels sleepy for 5 minutes. What is the cause of her symptoms?

Which of the following is the most likely physiologic effect seen during a 3 minute tonic-clonic seizure?

A 6 month old baby begins having multiple episodes daily where the neck and trunk flex and the arms go out to the side, lasting 1-2 seconds. Over the last week, he has been sleeping more and interacting with his family less. A 60 minute EEG does not record any seizures, but the background is very disorganized and has frequent epileptiform discharges. What epilepsy syndrome is present?

A 35 year old woman has had epilepsy since she was 19 years old. Her typical seizure begins with a sense of epigastric rising at which time she usually calls for help. She then stares for the next 30-60 seconds while making grasping motions of the right hand and smacking her lips. She does not respond when others talk to her. She is often sleepy and confused for 15 minutes after the event. Which abnormality on the brain MRI is most common for this type of seizure?

How do benzodiazepines exert an anti-convulsive effect?

How would zero order kinetics affect the use of phenytoin in the treatment of a patient with epilepsy?

A healthy, young medical student is trying not to fall asleep during a boring lecture. Suddenly, a high pitch loud noise makes him feel alert and very aware of his environment. Sensory projections are received by what part of his reticular formation (RF)?

A 54-year-old woman suddenly cries out in pain, clutches her head and loses consciousness. She is brought into the emergency department where she is intubated for airway protection. On neurological exam, she does not open her eyes to pain, does not grimace, and has decerebrate (extensor) posturing to noxious stimulation. Her level of consciousness is best described as which of the following?

Serotonin is involved in creating and maintaining arousal. From which reticular formation nucleus is serotonin released?

A 50-year-old male presents to the ED after falling. His head CT shows an enlarging subdural hematoma. His Glasgow Coma Score is 10, his right pupil is dilated and unreactive, and he has hemiparesis. His vital signs show hypertension. Which of the following can explain these findings?

Which of the following best characterizes the effect of mean arterial pressure (MAP) on cerebral blood flow?

Emergency medical services responded to a call in the community about a 27 year old woman who was seizing. Upon arrival, she has bilateral tonic stiffening that her friend says has been going on for 7 minutes. What is the appropriate first-line treatment given by the paramedics?

What is the electrical substrate that is responsible for the waveforms recorded in an EEG?

A 17 year old boy has bilateral stiffening of the arms and legs. Which of the following signs would be most suggestive of a nonepileptic spell?

An otherwise healthy 50-year-old veteran comes in 4 days after undergoing a trans-sphenoidal biopsy of the pituitary gland for potential adenoma. According to his significant other, he has been confused for the last 8 hours and has clear liquid draining from his nose. Neurosurgery is consulted and he undergoes a lumbar puncture which shows gram positive diplococci. What would be the most likely findings on the CSF?

A 68-year-old woman is found to have a cerebello-pontine angle tumor. Which of the following tumors is most likely to occur in this region?

A 6-year-old boy is found to have a posterior fossa brain tumor. Given the patient's age and the location of the tumor, which of the following is the most likely diagnosis?

Which of the following is a feature of Cushing's triad?

Please refer to the attached image to answer the following question: In the image shown, the most important factor in determining whether or not this is a neurologic emergency is which of the following?

Which of the following causes cytotoxic edema?

What does the Meyer-Overton Hypothesis suggest about inhaled anesthetic agents?

Why should care be exercised when administering inhaled anesthetic agents to patients with cardiovascular instability?

A 60-year old female presents to the emergency department with neurological signs and symptoms. Her diffusion-weighted imaging (DWI) (shown in the attached image) is diagnostic of which of the following?

A 30-year old male presents to the emergency department with fever, headache, seizure, and behavior changes. Lumbar puncture is performed to collect CSF for laboratory analysis. MRI shows FLAIR hyperintensity of the temporal lobe, hippocampi and insula (arrows in the provided images). Of the following, which is the most appropriate treatment?

A 35 year old female presents to your outpatient clinic with severe low back pain and pain radiating into the right leg. This began acutely 3 weeks ago. Based on history and physical, you exclude all the "red flag" conditions that can be associated with back pain. Of the following, which is the most appropriate next step?

You are treating an 18-year old patient for bacterial meningitis. Based on her age, what is the most likely cause of the infection?

A healthy 23-year-old man presents during a hot day in August with headache, fever, nausea, vomiting, and confusion. He was swimming in a local fresh water swimming hole with his family 3 days prior to presentation. On exam he is febrile and has a Kernig and Brudzinski sign. CT imaging is negative for abnormality. LP shows 10,000 cells with 85% neutrophils, glucose was 14 and protein was 200. Opening pressure was very high. Gram stain was negative. He is placed on vancomycin, ceftriaxone and ampicillin but does not improve and dies 2 days later. His CSF culture was performed BEFORE antibiotics were given and was negative. What do you suspect as the causative organism?

A patient being treated for a moderate traumatic brain injury begins to demonstrate pupillary enlargement, bradycardia, and hypertension. Which of the following is an appropriate treatment option?