Pathology EMQ template.

Name: Jonathan Buckley

Theme: Cerebrovascular disease (2)

 

OPTION LIST

 

A	Amaurosis fugax	I	Postural hypotension
B	Cerebellar haemorrhage	J	Subarachnoid haemorrhage
C	Cerebral haemorrhage	K	Subdural haemorrhage
D	Cerebral infarction	L	Transient ischaemic attack
E	Concussion	M
F	Cranial trauma	N
G	Extradural haemorrhage	O
H	Intracerebral haemorrhage	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. An unusually tall young man with arachnodactyly and pectus excavatum presents with loss of vision in one eye. He also complains a very serve, sudden headache at the back of his head which begun whilst playing basket ball.

 

 

2. A 80 year old, chronically hypertensive lady presented with acute hemiparesis and a severe headache. She develops nausea, vomiting and a sudden decrease in consciousness. Anticoagulant medication is immediately stopped but she unfortunately dies.

 

 

3. A 65 year old gentleman complains of sudden blindness in his right eye. He reports generalised weakness. Upon auscultation you find carotid bruits. His vision returns well within 24 hours of onset.

 

 

4. A 50 year old publican presents, confused, with vomiting and headache. Kernig’s sign is positive and he has a bruise on his forehead.

 

 

5. A 70 year old gentleman presents in the morning after difficulty eating his dinner the night before. He reports previous weakness of the right side and almost choking after his wife helped to feed him. He ate a nice breakfast this morning.

 

 

 

ANSWERS

1. J

2. C

3. A

4. J

5. L

 

1.   This man has Marfan’s syndrome, a rare association with SAH. The loss of vision is posibly retinal haemorrhage or retinal detachment/dislocated lens associated with Marfan’s.

2.   Hard to tell from thrombo-embolitic stroke, poorer prognosis. ~10% of strokes.

3.   A specific event/type of TIA, so is the best answer.