Answer and Explanation 25

25.  Choice A is the correct answer.  The patient meets numerous exclusion criteria for TPA.  His stroke scale is high enough but he has a INR greater than 1.7 and is on coumadin which is an exclusion criteria.  Other exclusion criteria include evidence of intracranial hemorrhage, improving symptoms, active internal bleeding in the last 21 days or bleeding risk, Platelet count less than 100,000, heparin in the last 48 hours with an elevated PTT, major surgery in the last 14 days, serious head trauma or intracranial surgery in the preceding 3 months, recent arterial puncture at non compressible site, recent lumbar puncture in the last 7 days, SBP> 185 or DBP >110 mmHg, recent seizure, recent MI, recent TIA, or history of ICH, neoplasm, AV malformation, or aneurysm.

Question 25

25.   Your patient is a 53 year old male who was a history of atrial fibrillation presents with an acute thrombotic CVA that is seen on his CT scan of his head with no evidence of bleeding.  He is on coumadin but his INR is only 1.8.   His symptoms began 2 hours prior to arrival when he was eating lunch with his wife that has been with him the entire time.  His NIH stroke scale is 11.  His vital signs are as follows BP 118/62, HR 82, RR-16, Temp 98.0.  He has hot had any recent procedures.  No history of bleeding problems.  His CBC shows his WBC-7.9 Hgb-14.7, Hct-43.0 and Platelets 154,000.  Based upon this data, which is the best treatment option?

A.  Give the patient ASA and admit him to the hospital

B.  Give the patient TPA and admit to the hospital

C.  Start the patient on a heparin drip because his INR is sub therapeutic

D.  Give the patient heparin and plavix.

Answer and Explanation 24

24.  Choice B is the correct answer.  L4 nerve root is associated with the patellar reflex.  The achilles reflex is associated with the S1 reflex.  L3 and L5 have no deep tendon reflexes associated with them.  

Question 24

24.  Which nerve root is associated with the Patellar reflex?

A.  L3

B.  L4

C.  L5

D.  S1

Answer and Explanation 23

23.   Choice D is the correct answer.  C7 is associated with the C7 nerve root.  C5 nerve root is associated with the biceps reflex.  The C6 nerve root is associated with the brachioradialis reflex.

Question 23

23.  The triceps reflex is associated with what nerve root?

A.  C5

B.  C6

C.  C8

D.  C7
 

Answer and Explanation 22

22.  Choice C is the correct answer.  Adie pupil is when the affected dilated pupil fails to react or reacts slowly to light.  It responds to convergence.  It is caused by impairment of postganglionic parasympathetic innervation to the sphincter pupillae muscle or ciliary malfunction.  Miosis is pupillary constriction usually less than 2 mm.  Argyll Robertson Pupil is when there is bilateral miotic, irregular shaped pupils that fail to constrict with light and retain constriction with convergence.  Pupils may or may not be equal.  Sometimes seen in neurosyphillis.

Question 22

22.  Accurately describe the pupils depicted in the picture below.

A. Adie Pupil

B.  Aygll Robertson Pupil

C.  Anisocoria

D.  Miosis

Answer and Explanation 21

21.  Choice D is the correct answer.  Hypertension has not been associated with Multiple Sclerosis.  Common signs and symptoms of multiple sclerosis include:  unilateral vision disturbance, double vision, paresthesias, ataxia, vertigo, fatigue, muscle weakness, urinary disturbance, dysarthria, optic neuritis, internuclear ophthalmoplegia, nystagmus, hyperreflexia, positive Babinski, no abdominal reflexes, intention tremor, change in mood, and decreased sensation.

Question 21

21.  Which of the following is not associated with signs and symptoms of Multiple Sclerosis?

A.  Unilateral Visual Disturbance

B.  Double Vision

C.  Urinary Disturbance

D.  Hypertension