Absolute Neurocritical Care Review ä[]; ä (ä): 1-48 PMIDC7123049show ga
Which of the following is the most common form of incomplete spinal cord injury?A.Central cord syndromeB.Cauda equina syndromeC.Anterior spinal cord syndromeD.Posterior spinal cord syndromeE.Brown-Sequard lesionA 64-year-old male with a history of chronic alcohol abuse and congestive heart failure is currently recovering from excision of a large right shoulder lesion suspicious for melanoma. Postoperatively, he is experiencing bleeding and oozing from his surgical site that has persisted despite suture repair and direct pressure for an extended period of time. His labs are drawn, and are as follows: platelets 141 × 103/mL, INR 1.2, fibrinogen 90 mg/dL. Which of the following blood products should be administered next?A.Fresh frozen plasmaB.CryoprecipitateC.Prothrombin complex concentrateD.Recombinant activated factor VIIE.Aminocaproic acidA 75-year-old, 90 kg male with a history of peripheral vascular disease, coronary artery disease, and epilepsy following a recent cerebral infarction presents to the emergency department after having three witnessed seizures at home. He was intubated at the scene by the paramedics, and received 8 mg of intravenous lorazepam and 1 g of phenytoin. While you are evaluating him, he has another generalized tonic-clonic seizure, and the nurse asks if you would like to initiate a continuous propofol infusion. His blood pressure is 94/42 mmHg, and he is having numerous premature ventricular contractions (PVCs) on the electrocardiographic monitor. He has no history of platelet or liver dysfunction. Which of the following should be performed next?A.Complete the phenytoin load to attain 20 mg/kg, then start propofol infusionB.Complete the phenytoin load to attain 20 mg/kg onlyC.Administer valproate, 30 mg/kg over 10 min, as well as midazolam 0.2 mg/kgD.Start immediate midazolam infusion at 2 mg/kg/hE.Give a 1 L normal saline bolus, and start a norepinephrine infusion to normalize blood pressureA 38-year-old male is brought to the emergency department after a motor vehicle accident. He is found to have significant ecchymoses on his chest and face, with multiple apparent rib fractures. He is in mild respiratory distress, with an oxygen saturation of 89% on room air, and hypotensive, with a systolic blood pressure of 88 mmHg. He has absent breath sounds on the right side. There is currently a delay in obtain a bedside portable chest x-ray. Which of the following should be performed next?A.28-French chest tube placementB.16-French chest tube placementC.Obtain computed tomography (CT) of the chestD.Administer 30 cc/kg crystalloidE.Obtain urgent cardiothoracic surgery consultStress ulcer prophylaxis is often undertaken to prevent clinically important upper gastrointestinal (GI) bleeding. Which of the following factors puts patients at highest risk for such bleeding episodes?A.Respiratory failureB.History of alcohol abuseC.NPO statusD.DiverticulitisE.All of the aboveIn an intact heart, the Frank-Starling mechanism describes contractility increases in responses to:A.Decreased preloadB.Increased afterloadC.Decreased left ventricular end-diastolic pressureD.Increased left ventricular end-diastolic volumeE.Increased pulmonary vascular resistanceA 68-year-old female with a history of hyperlipidemia, hypothyroidism, and gastric cancer on total parenteral nutrition is currently in the ICU following a small traumatic subdural hemorrhage. On hospital day 5, the patient begins to spike fevers that persist despite broad spectrum antibiotic coverage with vancomycin and piperacillin-tazobactam. She is otherwise hemodynamically stable. The lab calls you to notify you that multiple sets of blood cultures display budding yeast forms and pseudohyphae. Which of the following should be administered next?A.FluconazoleB.PosaconazoleC.AnidulafunginD.CaspofunginE.Amphotericin BA 56-year-old male with a past medical history of hypertension, hyperlipidemia, and morbid obesity is currently intubated in the ICU following a left middle cerebral artery infarct. The respiratory therapist alerts you the fact that the patient has become markedly dysynchronous with the ventilator, including breath holding episodes, breath stacking, and resisting ventilator-delivered breaths. A variety of pressure- and volume-regulated ventilator modes have been attempted without improvement, as well as boluses of both fentanyl and midazolam. The most recent arterial blood gas is as follows: pH 7.19, PaCO2 78 mmHg, PaO2 61 mmHg. The patient is now hypotensive to 91/66 mmHg with sinus tachycardia at 117 beats/min. A recent bedside chest x-ray shows no consolidation or pneumothorax. Which of the following should be performed next?A.Prone the patientB.Administer nitric oxide at 10 parts per millionC.Administer 10 mg of cisatracuriumD.Administer a mixture of 60% helium/40% oxygenE.Administer a continuous infusion of phenobarbitalCompared to lactulose for the treatment of hepatic encephalopathy, polyethylene glycol (PEG) has been shown to:A.Decrease in-hospital mortalityB.More rapidly improve symptomsC.Increase the rate of gastrointestinal complicationsD.Increase the incidence of major electrolyte abnormalitiesE.None of the aboveWhich of the following neurologic insults is the least likely to cause central (non-infectious) fever in the ICU?A.Intracranial neoplasmB.Intraventricular hemorrhageC.Normal pressure hydrocephalusD.Subarachnoid hemorrhageE.Traumatic brain injuryA 57-year-old male with a history of epilepsy and medication noncompliance is admitted to a small community hospital after a brief tonic-clonic seizure. A non-contrast head CT on admission is normal. On the second hospital day, the patient begins to complain of severe substernal chest pressure, and an urgent bedside EKG shows evidence of an acute inferior myocardial infarction (MI). The nearest percutaneous coronary intervention (PCI) capable center is approximately 150 min away by the fastest transport method available. Which of the following is the most appropriate next step in this patient?s care?A.Arrange for transport to the closest PCI center with anticipated balloon time within 30 min of arrivalB.Prepare to administer fibrinolytic therapyC.Consult cardiothoracic surgery for possible coronary artery bypass grafting (CABG)D.Place the patient on a continuous nitroglycerine infusion and administer aspirin, clopidogrel, and heparinE.Await serum cardiac biomarkers and repeat EKG in 1 hA 62-year-old male with unknown past medical history who recently immigrated from El Salvador is currently in the stroke unit after suffering from an acute left middle cerebral artery infarction. The patient is aphasic; his wife states that he been in his usual state of health lately, and denies any recent weakness, dizziness, chest pain, cough, shortness of breath, or fevers. On reviewing this patient?s belongings, the nurse discovers a bottle of isoniazid, as well as paperwork demonstrating a positive quantiferon gold test performed at a local clinic approximately 3 weeks ago. He does not appear to be on any other medications. A bedside portable chest x-ray is performed, which preliminarily appears normal. Which of the following should be performed next?A.Move the patient to a negative pressure isolation room, continue isoniazidB.Isolate the patient, continue isoniazid, add rifampinC.Isolate the patient, continue isoniazid, add rifampin and pyrazinamideD.Isolate the patient, continue isoniazid, add rifampin, pyrazinamide and ethambutolE.None of the aboveA 56-year-old, 70 kg female patient in oliguric renal failure would be expected to have a daily urine output of:A.No more than 50 mLB.No more than 400 mLC.No more than 800 mLD.Less than 70 mL/hE.Less than 35 mL/hA 37-year-old female with a history of epilepsy is admitted to the ICU with status epilepticus. She required several doses of lorazepam in the emergency department in addition to fosphenytoin, intubation, and a continuous propofol infusion. There was concern for aspiration in the prehospital setting. Approximately 3 days after being admitted to the hospital, her respiratory status has worsened; she is increasingly hypoxic, and her chest x-ray demonstrates diffuse bilateral interstitial infiltrates. The patient is afebrile with minimal secretions. Her most recent arterial blood gas is as follows: pH 7.21, PaO2 107 mmHg, PCO2 55 mmHg, 100% FiO2, and a positive end-expiratory pressure (PEEP) of 8 cm H2O. According to the Berlin criteria, how would you categorize this patient?s acute respiratory distress syndrome (ARDS)?A.Acute lung injury (ALI)B.Mild ARDSC.Moderate ARDSD.Severe ARDSE.None of the aboveAn 80-year-old male presents to the emergency department with multiple episodes of bright red blood per rectum. He is on aspirin and clopidogrel for a history of coronary artery disease and a previous transient ischemic attack. He underwent aortic graft surgery for repair of an abdominal aortic aneurysm 2 years ago. A complete blood count and coagulation profile are all within normal limits. His vital signs are as follows: blood pressure 102/58 mmHg, heart rate 98 beats/min, respiratory rate 18 breaths/min, oxygen saturation 98% on room air, and temperature 98.3 °F. Which of the following is the next best step in the care of this patient?A.Transfuse platelets, fresh frozen plasma, and recombinant factor VIIaB.Consult gastroenterology for emergent upper endoscopyC.Consult gastroenterology for emergent colonoscopyD.CT angiogram of the abdomen and pelvisE.Expectant management with fluids and blood transfusionsA thrombus in which of the following veins would not be considered a deep vein thrombosis (DVT)?A.Popliteal veinB.Soleal veinC.Femoral veinD.Gastrocnemius veinE.Greater saphenous veinAfter partial resection of the pituitary stalk, secretion of which of the following hormones will be most affected?A.OxytocinB.Adrenocorticotrophic hormoneC.Melanocyte-stimulating hormoneD.Thyroid-stimulating hormoneE.All will be equally affectedA 58-year-old female with a history of hypertension, rheumatoid arthritis, metastatic ovarian cancer, and bilateral deep venous thrombosis status post recent inferior vena cava filter placement presents to the emergency department with right flank pain. She states the pain began approximately 1 h ago when bending down to pick something off the floor, and that it is constant and severe in nature. She denies dysuria or hematuria. Her vital signs are as follows: blood pressure 108/62 mmHg, heart rate 121 beats/min, respiratory rate 20 breaths/min, oxygen saturation 99% on room air, and temperature 99.6 °F. A CT scan of the abdomen is obtained (see Image 1). Which of the following is the next best step in this patient?s management?A.Administer vancomycin and cefepime, and draw two sets of blood culturesB.Urgent vascular surgery consultC.Immediately place the patient on her left sideD.Rapid sequence intubation with mechanical ventilationE.Perform bedside diagnostic peritoneal lavage
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Absolute+Neurocritical+Care+Review ä ; ä (ä): 1-48
