Stack: 2004-2005

Head CT scan questions:

Question 1.

A 45 year-old female presents to the emergency department with a sudden onset of severe diffuse headache with radiation into her neck. Her examination reveals a blood pressure of 170/100 mmHg and a normal neurological examination. A non-contrasted head CT scan is obtained and is shown below.

Which of the following is the correct next step of this patient’s ED management?

A. Neurosurgery consultation for admission and cerebral angiogram

B. Lumbar Puncture

C. Pain control and discharge home with neurology follow-up

D. Contrasted CT scan of the brain

E. Nitroprusside drip

Correct answer B.

Question 2.

A 17-year old male star running back for the local high school team presents to the emergency department after sustaining a loss of consciousness for 2 minutes after being tackled in the first play of the game. He complains of a headache and mild nausea. His examination is normal. A non-contrasted head CT scan is obtained and is shown below.

Which of the following is the correct next step of this patient’s management?

A. Neurosurgery consultation for admission and observation

B. Lumbar Puncture

C. Pain control and discharge back to the game to play full contact

D. Contrasted CT scan of the brain

E. Discharge home with no contact sports for 1 week.

Correct answer E.

Question 3.

A 79 year-old male nursing home resident presents to the emergency department with a significant change in mental status. He has a history of Alzheimer’s disease but is able to care for himself with minimal assistance. He takes warfarin because of prosthetic heart valve. The patient’s vital signs are normal. He is babbling and confused and he us unable to walk. The rest of his examination is normal. The patient’s laboratory studies are normal except for an INR of 6. A non-contrasted CT scan of the head is obtained and is shown below.

Which of the following is the correct next step of this patient’s management?

A. Neurology consultation for admission

B. Lumbar Puncture

C. Fresh frozen plasma

D. Contrasted CT scan of the brain

E. MRI of the brain and spinal cord

Correct answer C.

Question 4.

A 46 year-old male presents to the emergency department by ambulance because of a new onset seizure. He is unable to protect his airway and is intubated. He remains post-ictal after intubation. His blood pressure is 165/95 mmHg. The remainder of his examination is normal. A non-contrasted CT scan of the head is obtained and is shown below.

Which of the following is the correct next step of this patient’s management?

A. Neurosurgery consultation for admission and cerebral angiogram

B. Lumbar Puncture

C. Fresh frozen plasma

D. Contrasted CT scan of the brain

E. Nitroprusside drip

Correct answer A.

Question 5.

A 16 year-old male presents to the emergency department because of a headache after a fall. He is now nauseated and vomits. His mental status is slightly depressed. He has an occipital contusion. The remainder of his examination is normal. A non-contrasted CT scan is obtained.

Which of the following is the correct next step in this patient’s management?

A. Lumbar Puncture

B. MRI

C. Fresh frozen plasma

D. Neurosurgery consultation for admission, observation and serial head CT scans

E. Contrasted CT scan of the brain

Correct Answer: D