Exam 3 Questions

1. Which of thefollowing is true regarding the Barrow classification system for carotid cavernous fistulae? A. Type A shunts are indirect shunts between branches of the internal carotid artery (ICA) and cavernous sinus. B. Type B shunts are direct shunts between the ICA and cavernous sinus. C. Type C shunts are indirect shunts between branches of the external carotid artery (ECA) and cavernous sinus. D. Type D shunts are high-flow shunts. E. All of the above. 2. A 80-year-old male with an intracranial neoplasm presents to the emergency department with weight loss, drowsiness, and tachypnea for 1 month. On examination, his respiratory rate is 28 breaths/minute with a normal oxygen saturation. His lungs are clear to auscultation. An arterial blood gas reveals the following: pH 7.60, PCO(2) 14 mmHg, PaO(2) A. Central neurogenic hyperventilation. B. Cheyne-Stokes respirations. C. Apneustic breathing. D. Ataxic breathing. E. Cluster breathing. 3. A 48-year-old female is admitted to the ICU with a Hunt-Hess 2 modified Fisher 2 subarachnoid hemorrhage (SAH). She remains intact neuro-cognitively, but has transcranial doppler (TCD) mean flow velocities up to 150 cm/s, and a serum platelet count twice her baseline. You are worried about vasospasm and impending delayed cerebral ischemia. Which of the following should be performed next? A. An additional 100 mL/h of normal saline should be given on top of maintenance fluids. B. CT perfusion scan to assess for any ongoing hypoperfusion. C. Evaluate volume status with hemodynamic monitoring and give fluid boluses accordingly. D. Induce hypertension to a systolic pressure of 160 mmHg. E. Conventional angiography. 4. A 25-year-old male is currently in the ICU with an anoxic brain injury after diving into shallow waters and suffering a high cervical cord transection. Two weeks after his injury, he remains comatose, has diffuse loss of gray-white differentiation on noncontrast head CT, and exhibits myoclonic status epilepticus. The family is devastated by his poor prognosis, and distraught by his uncontrollable shaking. What is your rationale behind your decision about starting an antiepileptic regimen? A. Phenytoin and propofol will be used, and escalated until eradication of his myoclonus to assess his underlying brain damage. B. Levetiracetam and lacosamide will be used, and escalated until eradication of his myoclonus to assess his underlying brain damage. C. If EEG reveals dyssynchronous spikes on a severely slow background, myoclonus invariably portends death or a vegetative state, and midazolam should only be used for palliative purposes. D. Regardless of EEG or clinical exam, half of patients in myoclonic status epilepticus will have a good neurologic recovery by 90 days. E. Regardless of EEG or clinical exam, myoclonic status epilepticus is always ominous, not amenable to treatment. and should lead to immediate withdrawal of life-support. 5. An 18-year-old female presents to the emergency department with several months of progressive left-sided hearing loss and tinnitus. An MRI of the brain is performed, demonstrating bilateral enhancing dumbbell shaped lesions extending from the auditory canal to the cerebellopontine angle. Which of the following genetic disorders is associated with this finding? A. Von Hippel-Lindau syndrome. B. Neurofibromatosis type II. C. Tuberous sclerosis. D. Schwannomatosis. E. Alport syndrome. 6. A 23-year-old female is brought to the emergency department by her boyfriend with difficulty breathing. She cannot provide her history, but her boyfriend states that she has asthma, although he is unsure of her medications. On physical exam the woman is noted to have nasal flaring, is diaphoretic, cannot lie flat, and is breathing at a rate of 40 breaths/minute. She is given short acting ß(2) agonist treatments with no obvious relief of her symptoms. Serial arterial blood gases are done and show a pCO(2) A. Continue short-acting ß(2) agonist treatment, as her pCO(2) is normalizing, and continue observation in the emergency department. B. Intubate the patient and admit to the ICU. C. Administer intravenous corticosteroids and admit to the general medical ward. D. Place the patient on non-invasive positive pressure ventilation and admit to the general medical ward. E. Administer a long-acting ß(2) agonist agent and admit to the general medical ward. 7. Cerebellar hypoplasia without displacement through the foramen magnum is best described as a: A. Chiari I malformation. B. Chiari II malformation. C. Chiari III malformation. D. Chiari IV malformation. E. Chiari V malformation. 8. A 77-year-old female with a history of hypertension, atrial fibrillation, and diabetes mellitus has recently been taken off of warfarin due to frequent falls and gait instability. She has not had any prior significant bleeding or ischemic events. A recent echocardiogram demonstrates moderate aortic regurgitation with grossly preserved systolic and diastolic function. Which of the following elements is not a stroke risk factor in this patient? A. Age. B. Female gender. C. Hypertension. D. Diabetes mellitus. E. Aortic regurgitation. 9. Which of the following is the most effective measure to prevent aspiration in an intubated patient? A. Elevation of the head of the bed. B. Subglottic drainage. C. Gastric volume monitoring. D. Nasogastric tube placement. E. Percutaneous endoscopic gastrotomy. 10. Which of the following is a unique feature of Comprehensive Stroke Centers? A. Dedicated stroke unit availability. B. 24/7 ability to administer tPA. C. 24/7 interventional neuroradiology availability. D. 24/7 CT angiography availability. E. Ambulance receiving capability. 11. Which of the following segments of the internal carotid artery is farthest from it’s origin? A. Ophthalmic segment. B. Petrous segment. C. Cavernous segment. D. Clinoid segment. E. Lacerum segment. 12. A 44-year-old male is intubated secondary to a high-grade subarachnoid hemorrhage, and is admitted to the ICU. On the sixth postoperative day, he develops worsening hypoxemia and bilateral interstitial infiltrates on his chest x-ray, consistent with acute respiratory distress syndrome (ARDS). Which of the following interventions has not been demonstrated to improve outcomes in ARDS in a prospective randomized trial? A. Prone positioning. B. Lung-protective ventilation. C. Extracorporeal membrane oxygenation (ECMO). D. Neuromuscular blocking agents. E. High-frequency oscillatory ventilation (HFOV). 13. A 56-year-old female is currently intubated in the ICU following a left basal ganglia hemorrhage. The nurse reports the patient is having copious thick secretions, and you are considering initiating inhaled N-acetylcysteine therapy. What element of the patient’s past medical history may serve as a relative contraindication to this treatment? A. Amiodarine-induced pulmonary fibrosis. B. Newly diagnosed metastatic adenocarcinoma of the lung. C. Recent course of outpatient antibiotics for community-acquired pneumonia. D. Poorly controlled asthma. E. All of the above. 14. An 18-year-old female is currently being evaluated for amenorrhea. In addition, she endorses fatigue, cold intolerance, polyuria and dizziness upon standing. On examination, she is thin but appears well hydrated. Blood pressure and heart rate when supine are 90/60 mmHg and 80 beats/minute, respectively. When standing, they are 60/40 mmHg and 120 beats/minute, respectively. Pubic and axillary hair growth is sparse. Eye examination reveals an asymmetric bitemporal hemianopsia. Imaging reveals a cystic, calcified suprasellar mass. Which of the following statements is true regarding the most likely diagnosis? A. Medical management is the mainstay of treatment. B. Recovery of pituitary function is common. C. This patient likely has the papillary subtype of this neoplasm. D. This neoplasm has a bimodal age distribution. E. This neoplasm arises from modified glial cells that reside in the infundibular neurohypophysis. 15. A 55-year-old female presents to the emergency department after collapsing at home. The patient was arguing with her husband before she suddenly became unresponsive. The patient is intubated, and a non-contrast head CT is performed (see Image 1). The patient then undergoes conventional angiography, revealing occlusion of the proximal bilateral middle cerebral and anterior cerebral arteries with extensive collateral vessels noted. All of the following are true regarding the most likely diagnosis except: A. The disease can be either congenital or acquired. B. Patients may suffer recurrent infarcts, or remain completely asymptomatic. C. There are no effective surgical interventions available. D. It is more commonly seen in women than in men. E. Patients may initially present with persistent headaches;