I85PREP
⌘ K
ABA Neurocritical Care study materials
ABA Neurocritical Care study resources

ABA Neurocritical Care practice questions

One question at a time. Build your ABA Neurocritical Care understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Neurocritical Care

A patient with an acute aneurysmal subarachnoid hemorrhage has a serum sodium of 118 mEq/L with a rising urine output and a urine osmolality of 620 mOsm/kg. Which finding best distinguishes cerebral salt wasting from SIADH in this setting?

  1. Serum osmolality relative to 275 mOsm/kg
  2. Extracellular volume status on clinical assessment Correct answer.
  3. Urine sodium concentration above 40 mEq/L
  4. Presence of subarachnoid blood on imaging

Explanation

Both cerebral salt wasting and SIADH produce hyponatremia with concentrated urine and high urine sodium, so volume status is the discriminator. CSW causes hypovolemia, whereas SIADH causes euvolemia or mild hypervolemia. Treatment diverges accordingly: volume and salt replacement for CSW versus fluid restriction for SIADH.

Question 2Neurocritical Care

Which finding on noncontrast head CT most strongly suggests an underlying intracranial arterial aneurysm in a patient with subarachnoid hemorrhage?

  1. Blood limited to the cortical surface
  2. Blood centered in the basal cisterns and sylvian fissures Correct answer.
  3. Blood confined to the convexity sulci
  4. Blood isolated in the posterior fossa

Explanation

Aneurysmal hemorrhage characteristically fills the basal cisterns, sylvian fissures, and interhemispheric fissure. Convexity or sulcal blood in an older patient more often reflects cortical amyloid angiopathy or trauma. The distribution therefore guides whether to pursue vascular imaging.

Question 3Neurocritical Care

A comatose patient is found to have a fixed and dilated right pupil with a right-sided uncal herniation. Which immediate intervention is most appropriate while definitive treatment is arranged?

  1. Rapid intravenous infusion of hypotonic fluids
  2. Placement of the patient in the Trendelenburg position
  3. Immediate lumbar puncture for cerebrospinal fluid analysis
  4. Intravenous mannitol or hypertonic saline with head elevation Correct answer.

Explanation

Uncal herniation with a blown pupil reflects elevated intracranial pressure and brainstem compression. Osmotherapy with mannitol or hypertonic saline, along with head elevation and airway protection, buys time before surgical decompression. Hypotonic fluids and lumbar puncture would worsen the pressure gradient.

Question 4Neurocritical Care

Which parameter is the most reliable indicator of adequate cerebral perfusion when managing a patient with a severe traumatic brain injury?

  1. Central venous pressure
  2. Serum lactate concentration
  3. Mixed venous oxygen saturation
  4. Cerebral perfusion pressure calculated as mean arterial pressure minus intracranial pressure Correct answer.

Explanation

Cerebral perfusion pressure is the driving gradient for cerebral blood flow and is calculated as mean arterial pressure minus intracranial pressure. Guidelines target a cerebral perfusion pressure of roughly 60 to 70 mm Hg in adults. The other parameters reflect systemic hemodynamics rather than cerebral perfusion.

Question 5Neurocritical Care

A patient with a severe traumatic brain injury is being managed with hyperventilation. Which consequence limits the duration of this therapy?

  1. Increased cerebral blood volume with rebound edema
  2. Cerebral vasoconstriction with risk of ischemia Correct answer.
  3. Increased cerebrospinal fluid production
  4. Paradoxical cerebral vasodilation

Explanation

Hyperventilation lowers arterial carbon dioxide, which constricts cerebral arterioles and reduces cerebral blood volume and intracranial pressure. Prolonged or aggressive hyperventilation can reduce cerebral blood flow enough to cause ischemia. It is therefore reserved for brief rescue of impending herniation.

Question 6Neurocritical Care

Which electroencephalographic finding is most characteristic of nonconvulsive status epilepticus in a comatose patient after cardiac arrest?

  1. Isolated sharp waves separated by normal background
  2. Periodic discharges occurring once per minute
  3. Diffuse beta activity at 20 Hz
  4. Continuous or recurrent rhythmic epileptiform discharges lasting more than 10 seconds Correct answer.

Explanation

Nonconvulsive status epilepticus is defined by continuous or recurrent electrographic seizures without prominent motor features, typically lasting at least 10 minutes or recurrently without recovery. Rhythmic or periodic epileptiform patterns in a comatose patient warrant consideration of treatment. Routine EEG or continuous monitoring is required because clinical signs are absent.

Question 7Neurocritical Care

A patient is admitted after a witnessed cardiac arrest with return of spontaneous circulation but remains comatose. Which intervention has the strongest evidence for improving neurologic outcome in this setting?

  1. Targeted temperature management with avoidance of fever Correct answer.
  2. Immediate aggressive rewarming to 38 degrees Celsius
  3. Routine high-dose corticosteroid administration
  4. Prophylactic hyperventilation to a PaCO2 of 25 mm Hg

Explanation

Targeted temperature management, along with strict avoidance of fever, is a cornerstone of post-arrest care supported by trial evidence. Hyperventilation, corticosteroids, and deliberate hyperthermia have not shown benefit and may cause harm. Neurologic prognostication is deferred until confounders such as sedation and temperature are controlled.

Question 8Neurocritical Care

Which clinical sign is the earliest reliable indicator of transtentorial herniation in a patient with an expanding supratentorial mass?

  1. Bilateral fixed pupils
  2. Respiratory arrest
  3. Contralateral hemiparesis
  4. Ipsilateral pupillary dilation with decreased level of consciousness Correct answer.

Explanation

Uncal herniation compresses the oculomotor nerve, producing ipsilateral pupillary dilation, often accompanied by declining consciousness. Contralateral hemiparesis may follow as the cerebral peduncle is compressed. Bilateral fixed pupils and respiratory arrest are late and often irreversible findings.

Question 9Neurocritical Care

A patient with a ruptured middle cerebral artery aneurysm is being monitored for delayed cerebral ischemia. Which finding most reliably indicates the onset of delayed cerebral ischemia?

  1. A single elevated white blood cell count
  2. Sudden bradycardia with hypertension
  3. New focal neurologic deficit or decline in consciousness with angiographic vasospasm Correct answer.
  4. New fever without focal findings

Explanation

Delayed cerebral ischemia typically presents with new focal deficits or altered consciousness, often accompanied by angiographic or transcranial Doppler evidence of vasospasm. Surveillance combines serial examinations with vascular imaging. Fever and isolated laboratory abnormalities are nonspecific and do not define the syndrome.

Question 10Neurocritical Care

A patient with a severe traumatic brain injury has an intracranial pressure of 25 mm Hg despite sedation and cerebrospinal fluid drainage. Which osmotic agent is appropriate for acute intracranial pressure reduction?

  1. Intravenous dextrose 5 percent in water
  2. Intravenous lorazepam
  3. Hypertonic saline Correct answer.
  4. Intravenous furosemide as monotherapy

Explanation

Hypertonic saline is an effective osmotic agent for acute intracranial pressure reduction and has advantages when blood pressure is tenuous. Mannitol is an alternative but can cause hypovolemia and hypotension. Hypotonic fluids and loop diuretics as monotherapy are not appropriate for acute pressure control.

Question 11Neurocritical Care

Which finding on physical examination is most consistent with brain death in an apneic patient with an established irreversible cause?

  1. Preserved oculocephalic reflexes
  2. Decerebrate posturing to painful stimulation
  3. Spontaneous respiratory effort at a PaCO2 of 60 mm Hg
  4. Absent brainstem reflexes with a positive apnea test Correct answer.

Explanation

The clinical diagnosis of brain death requires coma, absent brainstem reflexes, and apnea documented by a formal apnea test showing no respiratory effort at an adequate PaCO2 threshold. Decerebrate posturing and preserved reflexes indicate residual brainstem function. Spontaneous breathing excludes the diagnosis.

Question 12Neurocritical Care

A patient with a large hemispheric infarct develops progressive drowsiness and a new ipsilateral pupil dilation on day 3. Which intervention is most likely to be life-saving?

  1. Decompressive hemicraniectomy Correct answer.
  2. Hyperbaric oxygen therapy
  3. Permissive hypertension to 220 mm Hg systolic
  4. Intravenous thrombolysis

Explanation

Malignant cerebral edema after a large hemispheric infarct causes mass effect and herniation, and decompressive hemicraniectomy reduces mortality and improves functional outcomes in selected patients. Thrombolysis is time-limited and contraindicated at this stage. Permissive hypertension and hyperbaric oxygen do not relieve the mass effect.

Question 13Neurocritical Care

Which blood pressure target is appropriate for a patient with an acute intracerebral hemorrhage who presents with a systolic pressure of 210 mm Hg?

  1. Lower systolic pressure gradually toward approximately 140 mm Hg Correct answer.
  2. No antihypertensive therapy regardless of pressure
  3. Rapid reduction to a systolic pressure of 100 mm Hg
  4. Reduction only if the patient develops seizures

Explanation

Current guidance supports smooth, controlled blood pressure reduction in acute intracerebral hemorrhage, often targeting a systolic pressure near 140 mm Hg. Abrupt or excessive lowering risks cerebral ischemia. Untreated severe hypertension promotes hematoma expansion.

Question 14Neurocritical Care

A patient with a subarachnoid hemorrhage develops hyponatremia and is being treated for suspected cerebral salt wasting. Which fluid strategy is most appropriate?

  1. Hypotonic saline infusion
  2. Free water restriction with a low-sodium diet
  3. Diuresis with furosemide
  4. Isotonic saline with supplemental sodium chloride Correct answer.

Explanation

Cerebral salt wasting involves renal salt loss with hypovolemia, so treatment is volume and sodium replacement with isotonic fluids. Free water restriction and diuretics would worsen the hypovolemia. Hypotonic fluids would further lower the serum sodium.

Question 15Neurocritical Care

Which clinical feature most helps distinguish an epileptic seizure from psychogenic nonepileptic spells?

  1. Postictal confusion with a lateral tongue laceration Correct answer.
  2. Closed eyes during the event
  3. Gradual onset with waxing and waning course
  4. Pelvic thrusting

Explanation

Postictal confusion and lateral tongue biting are strong indicators of a true epileptic seizure. Gradual onset, fluctuating course, closed eyes, and pelvic thrusting are more suggestive of psychogenic spells. Video electroencephalography remains the definitive test when the diagnosis is uncertain.

Question 16Neurocritical Care

Which finding on lumbar puncture is most consistent with bacterial meningitis in a patient presenting with fever, headache, and neck stiffness?

  1. Lymphocytic pleocytosis with normal glucose
  2. Normal cell count with normal protein
  3. Elevated neutrophil count with low glucose and high protein Correct answer.
  4. Elevated red blood cell count with xanthochromia

Explanation

Bacterial meningitis typically produces a neutrophilic pleocytosis, low cerebrospinal fluid glucose, and elevated protein. Lymphocytic pleocytosis with normal glucose is more characteristic of viral meningitis. Xanthochromia with red cells suggests subarachnoid hemorrhage rather than infection.

Question 17Neurocritical Care

Which organism is the most common cause of bacterial meningitis in adults beyond the neonatal period in the United States?

  1. Haemophilus influenzae type b
  2. Listeria monocytogenes
  3. Streptococcus pneumoniae Correct answer.
  4. Neisseria meningitidis

Explanation

Streptococcus pneumoniae is the leading cause of community-acquired bacterial meningitis in adults. Listeria is more relevant in neonates, older adults, and immunocompromised patients. Widespread vaccination has made Haemophilus influenzae type b uncommon.

Question 18Neurocritical Care

A patient with myasthenia gravis develops worsening weakness and respiratory distress. Which bedside measure best guides the decision for intubation?

  1. Serial vital capacity and negative inspiratory force Correct answer.
  2. Arterial oxygen saturation alone
  3. Serum creatine kinase level
  4. Deep tendon reflex testing

Explanation

Respiratory muscle strength is assessed with serial vital capacity and negative inspiratory force, which detect impending respiratory failure before oxygen desaturation. Oxygen saturation can remain normal until collapse. Creatine kinase and reflexes do not assess ventilatory capacity.

Question 19Neurocritical Care

Which finding on transcranial Doppler most suggests vasospasm after aneurysmal subarachnoid hemorrhage?

  1. Normal velocities with symmetric waveforms
  2. Elevated mean flow velocity in the middle cerebral artery Correct answer.
  3. Absent flow in the middle cerebral artery
  4. Reduced flow velocity with increased pulsatility index

Explanation

Elevated mean flow velocities in the middle cerebral artery suggest vasospasm and correlate with angiographic narrowing. Absent flow would suggest occlusion or brain death, and reduced velocities are not characteristic of vasospasm. Serial measurements improve reliability.

Question 20Neurocritical Care

Which intervention reduces the risk of rebleeding in a patient with an aneurysmal subarachnoid hemorrhage awaiting definitive treatment?

  1. Aggressive blood pressure elevation
  2. Anticoagulation with heparin
  3. Early aneurysm securing with clipping or coiling Correct answer.
  4. Lumbar drainage of cerebrospinal fluid

Explanation

The most effective measure against rebleeding is early securing of the aneurysm by surgical clipping or endovascular coiling. Anticoagulation and induced hypertension increase the risk of rupture. Lumbar drainage does not treat the aneurysm and may be hazardous with raised intracranial pressure.

Question 21Neurocritical Care

A patient with status epilepticus has received adequate doses of a benzodiazepine without cessation of seizures. Which medication is the recommended next step?

  1. A second class of benzodiazepine at a higher dose
  2. Intravenous levetiracetam or fosphenytoin Correct answer.
  3. Oral carbamazepine
  4. Intravenous mannitol

Explanation

After benzodiazepines fail to terminate status epilepticus, a second-line antiseizure medication such as levetiracetam, fosphenytoin, or valproate is indicated. Repeated benzodiazepine dosing delays definitive therapy and risks respiratory depression. Oral agents are inappropriate in an acute emergency.

Question 22Neurocritical Care

Which finding on head CT is most characteristic of an epidural hematoma?

  1. Crescent-shaped collection crossing suture lines
  2. Diffuse loss of gray-white differentiation
  3. Biconvex hyperdense collection that does not cross suture lines Correct answer.
  4. Hyperdensity confined to the basal cisterns

Explanation

Epidural hematomas arise from arterial bleeding, typically the middle meningeal artery, and appear as biconvex collections limited by cranial sutures. Crescent-shaped collections that cross sutures are subdural hematomas. Basal cistern blood suggests subarachnoid hemorrhage.

Question 23Neurocritical Care

A patient with a severe traumatic brain injury is found to have a serum sodium of 152 mEq/L after several days of hypertonic saline therapy. Which complication is most associated with this sodium level?

  1. Hyponatremic seizures
  2. Cerebral edema
  3. Diabetes insipidus
  4. Osmotic demyelination with rapid correction Correct answer.

Explanation

Overly rapid correction of chronic hyponatremia, or overly aggressive hypertonic therapy, can cause osmotic demyelination. Careful titration of sodium therapy is required to avoid this injury. Cerebral edema and hyponatremic seizures occur with low, not high, sodium.

Question 24Neurocritical Care

Which electroencephalographic pattern in a comatose patient after cardiac arrest carries the poorest prognosis?

  1. Low-voltage beta activity
  2. Burst suppression with generalized epileptiform discharges Correct answer.
  3. Normal sleep spindles
  4. Continuous alpha rhythm with reactivity

Explanation

Burst suppression with generalized epileptiform activity, especially when persistent, indicates severe cortical injury and predicts poor neurologic outcome. Reactive alpha rhythm and sleep spindles suggest preserved cortical function. Prognostication combines EEG with examination and other modalities.

Question 25Neurocritical Care

A patient with a cerebellar hemorrhage develops progressive lethargy and obstructive hydrocephalus. Which intervention is most appropriate?

  1. Lumbar puncture
  2. Observation with serial imaging
  3. Intravenous thrombolysis
  4. Emergent posterior fossa decompression Correct answer.

Explanation

Cerebellar hemorrhage with mass effect and hydrocephalus requires urgent surgical decompression, often with hematoma evacuation and ventricular drainage. Lumbar puncture risks herniation. Thrombolysis is contraindicated in hemorrhage, and observation is unsafe with progressive deterioration.

Question 26Neurocritical Care

Which intracranial pressure threshold is most commonly used to define intracranial hypertension and guide therapy in adults with severe traumatic brain injury?

  1. 30 mm Hg
  2. 15 mm Hg
  3. 10 mm Hg
  4. 22 mm Hg Correct answer.

Explanation

Intracranial hypertension is generally defined as an ICP sustained above 20–22 mm Hg, and treatment is typically initiated at this threshold to maintain cerebral perfusion pressure.

Question 27Neurocritical Care

A patient with severe traumatic brain injury has a mean arterial pressure of 80 mm Hg and an intracranial pressure of 20 mm Hg. What is the cerebral perfusion pressure?

  1. 80 mm Hg
  2. 40 mm Hg
  3. 60 mm Hg Correct answer.
  4. 100 mm Hg

Explanation

Cerebral perfusion pressure is calculated as mean arterial pressure minus intracranial pressure, so 80 minus 20 equals 60 mm Hg.

Question 28Neurocritical Care

In a patient with an acute ischemic stroke who is being considered for intravenous thrombolysis, which blood pressure threshold generally precludes treatment unless it can be lowered safely?

  1. Systolic >160 mm Hg or diastolic >100 mm Hg
  2. Systolic >185 mm Hg or diastolic >110 mm Hg Correct answer.
  3. Systolic >140 mm Hg or diastolic >90 mm Hg
  4. Systolic >220 mm Hg or diastolic >120 mm Hg

Explanation

Intravenous thrombolysis is generally contraindicated when blood pressure exceeds 185/110 mm Hg because of an increased risk of symptomatic intracranial hemorrhage, and blood pressure must be lowered below this threshold before treatment.

Question 29Neurocritical Care

Which clinical finding is most suggestive of basilar artery occlusion in a patient presenting with acute stroke symptoms?

  1. Isolated hemiparesis
  2. Sudden severe headache with neck stiffness
  3. Dense homonymous hemianopia
  4. Fluctuating consciousness with cranial nerve palsies and quadriparesis Correct answer.

Explanation

Basilar artery occlusion often produces fluctuating or stuttering symptoms including altered consciousness, cranial nerve deficits, and quadriparesis due to brainstem ischemia.

Question 30Neurocritical Care

A patient with a severe traumatic brain injury is being monitored with jugular venous oxygen saturation. Which value suggests cerebral ischemia and may prompt an increase in cerebral perfusion pressure?

  1. 55% to 75%
  2. Above 90%
  3. Above 80%
  4. Below 50% Correct answer.

Explanation

Jugular venous oxygen saturation below 50% indicates increased oxygen extraction by the brain, suggesting inadequate cerebral blood flow or ischemia.

Question 31Neurocritical Care

Which finding on CT angiography is most predictive of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage?

  1. Amount of subarachnoid blood on initial CT Correct answer.
  2. Presence of hydrocephalus
  3. Patient age
  4. Location of the aneurysm

Explanation

The amount of subarachnoid blood on the initial CT, often graded by the Fisher or modified Fisher scale, correlates with the risk of vasospasm and delayed cerebral ischemia.

Question 32Neurocritical Care

Which medication is first-line for the prevention of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage?

  1. Phenytoin
  2. Mannitol
  3. Heparin
  4. Nimodipine Correct answer.

Explanation

Nimodipine, a calcium channel blocker, is the only medication shown to reduce the risk of delayed cerebral ischemia and poor outcome after aneurysmal subarachnoid hemorrhage.

Question 33Neurocritical Care

A patient with a severe traumatic brain injury has a serum sodium of 118 mEq/L due to syndrome of inappropriate antidiuretic hormone. Which is the most appropriate initial management?

  1. Administration of desmopressin
  2. Fluid restriction and slow correction of sodium Correct answer.
  3. Rapid correction with hypertonic saline to a sodium of 135 mEq/L within 6 hours
  4. Aggressive free water administration

Explanation

Symptomatic hyponatremia in neurocritical care is typically managed with fluid restriction and gradual correction to avoid osmotic demyelination; rapid overcorrection should be avoided.

Question 34Neurocritical Care

Which finding on MRI is most characteristic of hypoxic-ischemic encephalopathy after cardiac arrest?

  1. Enlarged ventricles with transependymal edema
  2. Periventricular white matter demyelination
  3. Multiple ring-enhancing lesions
  4. Diffuse cortical and deep gray matter restricted diffusion Correct answer.

Explanation

Hypoxic-ischemic encephalopathy typically shows restricted diffusion in the cortex and deep gray matter structures such as the basal ganglia and thalamus on diffusion-weighted imaging.

Question 35Neurocritical Care

A comatose patient after cardiac arrest is being evaluated for prognostication. Which multimodal finding is most strongly associated with poor neurologic outcome?

  1. Bilaterally absent N20 somatosensory evoked potentials Correct answer.
  2. Serum neuron-specific enolase of 10 mcg/L
  3. GCS motor score of 4 on day 1
  4. Presence of sleep spindles on EEG

Explanation

Bilaterally absent N20 responses on somatosensory evoked potentials are a robust predictor of poor neurologic outcome after cardiac arrest, especially when combined with other modalities.

Question 36Neurocritical Care

Which clinical sign is most indicative of brain death in a patient with a catastrophic brain injury?

  1. Presence of corneal reflexes
  2. Spontaneous respiratory effort
  3. Fixed dilated pupils with absent brainstem reflexes Correct answer.
  4. Decerebrate posturing to painful stimulation

Explanation

Brain death is characterized by coma, absent brainstem reflexes, and apnea; fixed dilated pupils with absent reflexes is consistent with this state when properly evaluated.

Question 37Neurocritical Care

A patient with a severe traumatic brain injury is undergoing therapeutic hypothermia. Which complication is most commonly associated with this therapy?

  1. Coagulopathy Correct answer.
  2. Hypertension
  3. Hypernatremia
  4. Hyperkalemia

Explanation

Therapeutic hypothermia can cause coagulopathy by impairing platelet function and clotting enzyme activity, among other complications.

Question 38Neurocritical Care

Which parameter is most important to monitor during hyperventilation therapy for elevated intracranial pressure?

  1. Serum magnesium
  2. Urine output
  3. End-tidal carbon dioxide Correct answer.
  4. Serum lactate

Explanation

Hyperventilation lowers PaCO2, which reduces cerebral blood volume and ICP, but excessive reduction can cause ischemia; end-tidal CO2 helps guide the degree of hyperventilation.

Question 39Neurocritical Care

A patient with a severe traumatic brain injury is being treated with hypertonic saline. Which electrolyte abnormality is most likely to occur?

  1. Hypochloremia
  2. Hyperkalemia
  3. Hypernatremia Correct answer.
  4. Hypocalcemia

Explanation

Hypertonic saline increases serum sodium and can cause hypernatremia, which requires monitoring and adjustment of the infusion rate.

Question 40Neurocritical Care

Which finding on head CT is most consistent with a subdural hematoma?

  1. Hyperdense crescent-shaped collection that does not cross suture lines Correct answer.
  2. Hypodense lesion in the white matter
  3. Hyperdense biconvex collection crossing suture lines
  4. Hyperdense collection in the basal cisterns

Explanation

Subdural hematomas appear as crescent-shaped collections that can cross suture lines but are limited by dural reflections, unlike epidural hematomas.

Question 41Neurocritical Care

A patient with a traumatic brain injury develops diabetes insipidus with high urine output and rising serum sodium. Which hormone deficiency is responsible?

  1. Cortisol
  2. Aldosterone
  3. Thyroid hormone
  4. Antidiuretic hormone Correct answer.

Explanation

Diabetes insipidus results from deficient antidiuretic hormone (vasopressin), leading to inability to concentrate urine and causing polyuria and hypernatremia.

Question 42Neurocritical Care

Which medication is most appropriate for seizure prophylaxis in a patient with severe traumatic brain injury during the first week after injury?

  1. Lorazepam
  2. Propofol
  3. Levetiracetam Correct answer.
  4. Phenobarbital

Explanation

Levetiracetam is commonly used for early seizure prophylaxis after severe traumatic brain injury because of its favorable side effect profile and lack of need for routine level monitoring.

Question 43Neurocritical Care

A patient with a severe traumatic brain injury is being monitored with continuous EEG and has electrographic seizures. Which medication is considered a first-line agent for status epilepticus after benzodiazepines?

  1. Levetiracetam Correct answer.
  2. Topiramate
  3. Phenytoin
  4. Valproic acid

Explanation

Levetiracetam is often used as a first-line second agent for status epilepticus after benzodiazepines due to its rapid onset and favorable safety profile.

Question 44Neurocritical Care

Which finding on CT head is most suggestive of an acute hypertensive intracerebral hemorrhage?

  1. Hyperdense lesion in the basal ganglia Correct answer.
  2. Diffuse cerebral edema
  3. Ring-enhancing lesion
  4. Hypodense lesion in the cortex

Explanation

Hypertensive intracerebral hemorrhage most commonly occurs in the basal ganglia, thalamus, pons, or cerebellum and appears as a hyperdense collection on noncontrast CT.

Question 45Neurocritical Care

A patient with an acute intracerebral hemorrhage is on warfarin. Which agent is most appropriate for urgent reversal of anticoagulation?

  1. Vitamin K alone
  2. Platelet transfusion
  3. Fresh frozen plasma
  4. Prothrombin complex concentrate Correct answer.

Explanation

Prothrombin complex concentrate is recommended for urgent reversal of warfarin in patients with intracerebral hemorrhage because it rapidly replenishes vitamin K-dependent clotting factors.

Question 46Neurocritical Care

Which clinical feature most strongly suggests that a patient with a severe headache has a subarachnoid hemorrhage rather than a migraine?

  1. Associated photophobia
  2. Relief with sumatriptan
  3. Gradual onset over hours
  4. Thunderclap onset reaching maximum intensity within seconds Correct answer.

Explanation

A thunderclap headache that reaches maximum intensity within seconds is the classic presentation of subarachnoid hemorrhage and warrants urgent evaluation.

Question 47Neurocritical Care

A patient with a ruptured aneurysm and subarachnoid hemorrhage is at risk for rebleeding. Which intervention most effectively reduces this risk?

  1. Strict bed rest
  2. Blood pressure reduction alone
  3. Early aneurysm securing by clipping or coiling Correct answer.
  4. Antifibrinolytic therapy

Explanation

Early securing of the aneurysm by surgical clipping or endovascular coiling is the most effective way to prevent rebleeding after aneurysmal subarachnoid hemorrhage.

Question 48Neurocritical Care

Which finding on lumbar puncture is most consistent with viral meningitis?

  1. Elevated opening pressure with neutrophilic pleocytosis and low glucose
  2. Xanthochromia
  3. Lymphocytic pleocytosis with normal glucose Correct answer.
  4. Elevated protein with normal cell count

Explanation

Viral meningitis typically presents with a lymphocytic pleocytosis and normal glucose, distinguishing it from bacterial meningitis.

Question 49Neurocritical Care

A patient with myasthenia gravis is admitted with respiratory distress. Which test is most appropriate for assessing respiratory muscle strength?

  1. Peak expiratory flow rate
  2. Forced vital capacity Correct answer.
  3. Arterial blood gas
  4. Chest radiograph

Explanation

Forced vital capacity is the most useful bedside measure of respiratory muscle strength in myasthenia gravis and helps guide the need for mechanical ventilation.

Question 50Neurocritical Care

Which EEG pattern in a comatose patient after cardiac arrest is associated with the poorest prognosis?

  1. Alpha coma
  2. Generalized periodic discharges
  3. Burst suppression Correct answer.
  4. Normal sleep architecture

Explanation

Burst suppression on EEG after cardiac arrest is strongly associated with poor neurologic outcome and is considered a malignant pattern.