Pathology EMQ template.

Name: Gemma Buckley

Theme: Intracranial Haemorrhage

 

OPTION LIST

 

A

Extradural haemorrhage

I

Acute subdural haemorrhage

B

Intracerebellar haemorrhage

J

Chronic subdural haemorrhage

C

Intraventricular heamorrhage

K

 

D

Subarachnoid haemorrhage

L

 

E

Lacunar infarction of the posterior limb or the internal capsule

M

 

F

Anterior cerebral artery territory

N

 

G

Middle cerebral artery territory

O

 

H

Lateral medullary syndrome

P

 

 

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1. A 60 year old hypertensive woman presents with a 4 hour history of rapidly progressing drowsiness. Prior to that she had a severe pain in the back of her head and vomited twice. On examination she has a GCS score of 6/15 and has a grossly dilated left pupil. She remains confused and drowsy but appears to be moving all her limbs. Her reflexes are brisk but symmetrical and her plantars are extensor.

 

 

2. An 81 year old hypertensive man developed an acute onset of severe weakness in his right side involving his lower face, arm and leg. On examination, he has a right hemiplegia with no sensory loss.

 

 

3. A 50 year old hypertensive man with no previous history of neurological events presents with an abrupt onset of right-sided hemiparesis and hemisensory loss. He is also noted to have an expressive aphasia. He is right-handed.

 

 

4. A 65 year old woman presents 40 minutes after a sudden onset of severe headache. She initially lost consciousness but is now conscious and drowsy (GCS14). She continues to report a severe headache and neck stiffness. A lumbar puncture demonstrates xanthochromia.

 

 

5. A 75 year old type 2 diabetic presents with acute onset of vertigo and imbalance. He also reports that the right side of his face ‘feels strange’ and he has problems swallowing. On examination he has a right-sided Horner’s syndrome, right-sided loss of pain and temperature sensation, his uvula moves to the left and he has pooling of saliva in his pharynx. He has a mild left-sided weakness and right-sided dysmetria. Over the following 2 weeks, he almost makes a full recovery.

 

 

ANSWERS

1. B

2. E

3. G

4. D

5. H