Podcast
Questions and Answers
In the context of nonaccidental trauma, which of the following findings would most persuasively argue against a benign explanation for a 2-month-old infant's injuries?
In the context of nonaccidental trauma, which of the following findings would most persuasively argue against a benign explanation for a 2-month-old infant's injuries?
- Conflicting historical details provided by caregivers regarding the mechanism of injury. (correct)
- Bruising located on the shins of a mobile toddler who is learning to walk.
- Presence of a linear, well-demarcated burn on an extremity.
- Injury is consistent with the developmental stage.
A 3-month-old infant presents with a history of a witnessed, unwitnessed roll off the bed. Which clinical finding would most strongly suggest abusive head trauma over accidental injury?
A 3-month-old infant presents with a history of a witnessed, unwitnessed roll off the bed. Which clinical finding would most strongly suggest abusive head trauma over accidental injury?
- Retinal hemorrhages with papilledema and tense fontanelle. (correct)
- A skull fracture crossing suture lines.
- Linear skull fracture in the parietal region.
- Subgaleal hematoma without skull fracture.
An infant presents with a seizure and is suspected of having abusive head trauma. Which of the following mechanisms best explains the pathophysiology of the subdural hematoma formation in this condition?
An infant presents with a seizure and is suspected of having abusive head trauma. Which of the following mechanisms best explains the pathophysiology of the subdural hematoma formation in this condition?
- Direct impact causing laceration of the brain parenchyma.
- Venous congestion leading to diffuse cerebral edema.
- Shearing forces causing rupture of bridging veins. (correct)
- Arterial rupture due to rapid acceleration-deceleration forces.
A 2-month-old with abusive head trauma from violent shaking is likely to develop which of the following pathognomonic findings?
A 2-month-old with abusive head trauma from violent shaking is likely to develop which of the following pathognomonic findings?
A 2 month old baby presents after report of a fall. Which neurological feature, if present, would necessitate further investigation into possible non-accidental trauma?
A 2 month old baby presents after report of a fall. Which neurological feature, if present, would necessitate further investigation into possible non-accidental trauma?
An elderly patient on anticoagulants presents with acute confusion and a subdural hematoma seen on CT scan. Which mechanism primarily explains the development of subdural hematoma in this population?
An elderly patient on anticoagulants presents with acute confusion and a subdural hematoma seen on CT scan. Which mechanism primarily explains the development of subdural hematoma in this population?
A patient presents with progressive gait difficulties, cognitive decline, and urinary incontinence. Neuroimaging reveals ventricular enlargement out of proportion to sulcal atrophy. Which pathophysiological mechanism most likely explains these findings?
A patient presents with progressive gait difficulties, cognitive decline, and urinary incontinence. Neuroimaging reveals ventricular enlargement out of proportion to sulcal atrophy. Which pathophysiological mechanism most likely explains these findings?
A 27-year-old male presents with lethargy, headache, and vomiting following an altercation. A CT scan reveals a biconvex hyperdensity that does not cross suture lines. What is the MOST critical pathophysiological consequence to address in the management of this patient?
A 27-year-old male presents with lethargy, headache, and vomiting following an altercation. A CT scan reveals a biconvex hyperdensity that does not cross suture lines. What is the MOST critical pathophysiological consequence to address in the management of this patient?
A young adult presents with headache, vomiting, and a brief loss of consciousness after a head injury. A CT scan shows a biconvex lesion not crossing suture lines. Which vascular structure is the most likely source of bleeding in this condition?
A young adult presents with headache, vomiting, and a brief loss of consciousness after a head injury. A CT scan shows a biconvex lesion not crossing suture lines. Which vascular structure is the most likely source of bleeding in this condition?
A patient presents with signs suggestive of increased intracranial pressure and a CT scan reveals an epidural hematoma. If left untreated, which of the following is the most likely sequence of neurological events?
A patient presents with signs suggestive of increased intracranial pressure and a CT scan reveals an epidural hematoma. If left untreated, which of the following is the most likely sequence of neurological events?
A patient with HIV who is nonadherent to antiretroviral therapy presents with subacute headaches, lethargy, and basilar meningeal enhancement on CT. A CD4 count is 400/mm³. What underlying mechanism is the most likely cause of the patient's condition?
A patient with HIV who is nonadherent to antiretroviral therapy presents with subacute headaches, lethargy, and basilar meningeal enhancement on CT. A CD4 count is 400/mm³. What underlying mechanism is the most likely cause of the patient's condition?
A breast cancer survivor undergoes routine follow-up and develops a persistent, band-like burning pain along her lower and mid rib locations after undergoing radiotherapy as part of the chemotherapy treatment.
A breast cancer survivor undergoes routine follow-up and develops a persistent, band-like burning pain along her lower and mid rib locations after undergoing radiotherapy as part of the chemotherapy treatment.
A 28-year-old with a recent history of a fall presents experiencing a left-sided headache, left eye ptosis and meiosis, and transient leg weakness. Which mechanism of injury is most plausible given the combined symptoms?
A 28-year-old with a recent history of a fall presents experiencing a left-sided headache, left eye ptosis and meiosis, and transient leg weakness. Which mechanism of injury is most plausible given the combined symptoms?
An unresponsive patient with no obvious injuries is intubated after a fall. A CT scan shows no acute findings, and diffuse axonal injury is suspected when his metal status and respiratory rate worsen. What neuroimaging can confirm a diagnosis of diffused axonal injury?
An unresponsive patient with no obvious injuries is intubated after a fall. A CT scan shows no acute findings, and diffuse axonal injury is suspected when his metal status and respiratory rate worsen. What neuroimaging can confirm a diagnosis of diffused axonal injury?
A 62-year-old patient presents with progressive unsteadiness, gait disturbance, urinary incontinence, impaired vibratory sensation, and small pupils only. What disease does this patient have?
A 62-year-old patient presents with progressive unsteadiness, gait disturbance, urinary incontinence, impaired vibratory sensation, and small pupils only. What disease does this patient have?
An 18-year-old presents intubated and presenting with a head trauma has no improvement in mentation and is suspected of diffuse axonal injury. Which observation will support and not negate his injury?
An 18-year-old presents intubated and presenting with a head trauma has no improvement in mentation and is suspected of diffuse axonal injury. Which observation will support and not negate his injury?
A 2-month-old infant presents with seizures, a tense fontanelle, and retinal hemorrhages. The mother reports a minor fall from the bed. What constellation of factors makes abusive head trauma more likely than accidental injury, considering the biomechanical vulnerabilities of infants?
A 2-month-old infant presents with seizures, a tense fontanelle, and retinal hemorrhages. The mother reports a minor fall from the bed. What constellation of factors makes abusive head trauma more likely than accidental injury, considering the biomechanical vulnerabilities of infants?
A 2-month-old infant is brought to the ED after a reported fall from a changing table. Retinal hemorrhages and a subdural hematoma are identified on examination and imaging. Considering the potential biomechanical forces at play in abusive head trauma, what mechanism is most likely to cause the observed retinal hemorrhages?
A 2-month-old infant is brought to the ED after a reported fall from a changing table. Retinal hemorrhages and a subdural hematoma are identified on examination and imaging. Considering the potential biomechanical forces at play in abusive head trauma, what mechanism is most likely to cause the observed retinal hemorrhages?
A 2-month-old infant presents with a seizure, bilateral retinal hemorrhages, and a full fontanelle. The reported history is a short fall from the sofa. Which of the following best describes the underlying pathophysiology contributing to the bulging anterior fontanelle?
A 2-month-old infant presents with a seizure, bilateral retinal hemorrhages, and a full fontanelle. The reported history is a short fall from the sofa. Which of the following best describes the underlying pathophysiology contributing to the bulging anterior fontanelle?
A 2-month-old infant presents with a witnessed seizure. Examination reveals retinal hemorrhages and a tense anterior fontanelle. The mother states the infant rolled off the bed. What would be the acute neurological consideration given that the infant was born prematurely?
A 2-month-old infant presents with a witnessed seizure. Examination reveals retinal hemorrhages and a tense anterior fontanelle. The mother states the infant rolled off the bed. What would be the acute neurological consideration given that the infant was born prematurely?
A 2-month-old infant born prematurely presents with seizures, retinal hemorrhages, and an increasing head circumference. If this presentation is due to abusive head trauma, what is the most likely mechanism for the increasing head circumference?
A 2-month-old infant born prematurely presents with seizures, retinal hemorrhages, and an increasing head circumference. If this presentation is due to abusive head trauma, what is the most likely mechanism for the increasing head circumference?
A 2-month-old infant comes to the emergency department by ambulance after a seizure. The mother states that he rolled off the bed. The anterior fontanelle is full and tense and funduscopy reveals bilateral papilledema and retinal hemorrhages. What acute physiological affect will this presentation have on the infant?
A 2-month-old infant comes to the emergency department by ambulance after a seizure. The mother states that he rolled off the bed. The anterior fontanelle is full and tense and funduscopy reveals bilateral papilledema and retinal hemorrhages. What acute physiological affect will this presentation have on the infant?
A previously healthy 2-month-old infant presents following a witnessed seizure; bilateral retinal hemorrhages and a large, tense fontanelle are noted on examination. What specific characteristic of subdural hemorrhages is most indicative of abusive head trauma, rather than accidental injury?
A previously healthy 2-month-old infant presents following a witnessed seizure; bilateral retinal hemorrhages and a large, tense fontanelle are noted on examination. What specific characteristic of subdural hemorrhages is most indicative of abusive head trauma, rather than accidental injury?
A 2-month-old presents with retinal hemorrhages, seizures, and a tense fontanelle after a "fall". What specific aspect of the infant's ophthalmic findings would support a diagnosis of abusive head trauma?
A 2-month-old presents with retinal hemorrhages, seizures, and a tense fontanelle after a "fall". What specific aspect of the infant's ophthalmic findings would support a diagnosis of abusive head trauma?
A 2-month-old infant is brought to the emergency department by ambulance after a seizure. His mother reports minor fall. On examination, the infant is limp and withdraws from painful stimuli. Funduscopy reveals bilateral papilledema and retinal hemorrhages. Which physical findings would be most influential when consulting child protective services?
A 2-month-old infant is brought to the emergency department by ambulance after a seizure. His mother reports minor fall. On examination, the infant is limp and withdraws from painful stimuli. Funduscopy reveals bilateral papilledema and retinal hemorrhages. Which physical findings would be most influential when consulting child protective services?
A 2-month-old infant presents with a seizure and retinal hemorrhages. The mother reports the baby rolled off the bed. Beyond a CT scan of the head to assess the acute intracranial injury what other diagnostic measure would be most useful to evaluate for non-accidental trauma?
A 2-month-old infant presents with a seizure and retinal hemorrhages. The mother reports the baby rolled off the bed. Beyond a CT scan of the head to assess the acute intracranial injury what other diagnostic measure would be most useful to evaluate for non-accidental trauma?
A somnolent 27-year-old male presents with a biconvex hyperdensity on CT imaging that does not cross suture lines after an altercation at a bar. What is the MOST relevant factor that drives the rapid deterioration?
A somnolent 27-year-old male presents with a biconvex hyperdensity on CT imaging that does not cross suture lines after an altercation at a bar. What is the MOST relevant factor that drives the rapid deterioration?
A 27-year-old male presents with lethargy, vomiting and confusion after sustaining blunt head trauma during a bar fight. A head CT reveals a biconvex lesion not crossing suture lines. What is the likely source of his condition?
A 27-year-old male presents with lethargy, vomiting and confusion after sustaining blunt head trauma during a bar fight. A head CT reveals a biconvex lesion not crossing suture lines. What is the likely source of his condition?
A 27-year-old male presents somnolent with an epidural hematoma. What is the acute management step will prevent against uncal herniation?
A 27-year-old male presents somnolent with an epidural hematoma. What is the acute management step will prevent against uncal herniation?
A 27 year old male presents after an altercation becoming increasingly lethargic. CT scan results biconvex hyperdensity consistent with epidural hematoma. If proper treatment is not rendered what neurological decline is he at risk for
A 27 year old male presents after an altercation becoming increasingly lethargic. CT scan results biconvex hyperdensity consistent with epidural hematoma. If proper treatment is not rendered what neurological decline is he at risk for
A patient presents with a crescent-shaped hyperdensity on head CT reveals that crosses suture lines. What is the underlying mechanism for this condition?
A patient presents with a crescent-shaped hyperdensity on head CT reveals that crosses suture lines. What is the underlying mechanism for this condition?
An 80-year-old female on anticoagulants presents due to gait instability, generalized weakness, and progressive confusion. A head CT shows a crescent shaped hyperdensity that does cross suture lines. She is at risk for all of the following EXCEPT:
An 80-year-old female on anticoagulants presents due to gait instability, generalized weakness, and progressive confusion. A head CT shows a crescent shaped hyperdensity that does cross suture lines. She is at risk for all of the following EXCEPT:
An 80-year-old female presents due to gait instability, recent fall and progressive confusion. Imaging shows acute subdural hematoma (SDH) from traumatic shearing forces on the bridging veins. What best describes the anatomy of acute SDH?
An 80-year-old female presents due to gait instability, recent fall and progressive confusion. Imaging shows acute subdural hematoma (SDH) from traumatic shearing forces on the bridging veins. What best describes the anatomy of acute SDH?
A patient presents due to a cerebroembolic stroke that resulted from atrial Afib. Where would the lesions likely be located?
A patient presents due to a cerebroembolic stroke that resulted from atrial Afib. Where would the lesions likely be located?
A patient presents with lacunar stroke because of hypertension. Where is the most likely vessel location in the brain?
A patient presents with lacunar stroke because of hypertension. Where is the most likely vessel location in the brain?
A patient presents with progressive gait difficulties, cognitive decline, and urinary incontinence. Imaging shows ventricular enlargement that is out of proportion to the sulci in the brain. What progressive disease does this patient have?
A patient presents with progressive gait difficulties, cognitive decline, and urinary incontinence. Imaging shows ventricular enlargement that is out of proportion to the sulci in the brain. What progressive disease does this patient have?
A patient presents after trauma to the sphenoid bone of the head with an epidural hematoma. What other injury is most likely going to be present?
A patient presents after trauma to the sphenoid bone of the head with an epidural hematoma. What other injury is most likely going to be present?
A patient presents with a sudden thunderclap headache, brief loss of consciousness and meningismus. What condition do they most likely have?
A patient presents with a sudden thunderclap headache, brief loss of consciousness and meningismus. What condition do they most likely have?
A patient has diffuse axonal injury from a traumatic acceleration/deceleration injury. Where will the small bleeds be located on a CT scan?
A patient has diffuse axonal injury from a traumatic acceleration/deceleration injury. Where will the small bleeds be located on a CT scan?
A patient recently had an occipital ischemic stroke. What deficit does he most likely have?
A patient recently had an occipital ischemic stroke. What deficit does he most likely have?
A patient presents with has headache, seizure and focal neurologic deficits due to a mass effect. His imaging shows evidence of partially calcified regions in the cells, what origin is the tumor most likely from?
A patient presents with has headache, seizure and focal neurologic deficits due to a mass effect. His imaging shows evidence of partially calcified regions in the cells, what origin is the tumor most likely from?
A 68-year-old woman presents with persistent burning pain on the right side of her chest. No associated cough, and temperature is normal. Prior history includes being treated for breast cancer that was treated with surgery, chemotherapy, hypertesnion, and type 2 diabetes. Chest examination shows no skin rash, but there is a band-like area of hyperesthesia on the right side. What action will treat the underlying cause?
A 68-year-old woman presents with persistent burning pain on the right side of her chest. No associated cough, and temperature is normal. Prior history includes being treated for breast cancer that was treated with surgery, chemotherapy, hypertesnion, and type 2 diabetes. Chest examination shows no skin rash, but there is a band-like area of hyperesthesia on the right side. What action will treat the underlying cause?
A 28-year-old woman who is otherwise healthy and a medical family history negative for stroke presents with left-sided headache and mild ptosis and miosis after a fall during a ski trip the previous morning. What is most likely cause of the headaches?
A 28-year-old woman who is otherwise healthy and a medical family history negative for stroke presents with left-sided headache and mild ptosis and miosis after a fall during a ski trip the previous morning. What is most likely cause of the headaches?
An intubated 60-year-old man is evaluated after he was was found unresponsive at the bottom of a stairwell. The CT scan of the head is negative for skull fractures. Which is the MOST suggestive finding on the the patient's injury?
An intubated 60-year-old man is evaluated after he was was found unresponsive at the bottom of a stairwell. The CT scan of the head is negative for skull fractures. Which is the MOST suggestive finding on the the patient's injury?
A 62-year-old man comes to the clinic with his daughter due to unsteadiness with difficulty walking. Physical examination shows small & irregular pupils poorly light to light. Treatment would include:
A 62-year-old man comes to the clinic with his daughter due to unsteadiness with difficulty walking. Physical examination shows small & irregular pupils poorly light to light. Treatment would include:
What key aspect needs to be considered when evaluating a previously healthy kidney recipient with recent nausea and neck stifness due to a recent kidney transplant.
What key aspect needs to be considered when evaluating a previously healthy kidney recipient with recent nausea and neck stifness due to a recent kidney transplant.
A 2-month-old infant presents with seizures, retinal hemorrhages, and a tense fontanelle. The mother reports a fall from a changing table. Which constellation of findings is LEAST consistent with the provided history but most suggestive of abusive head trauma?
A 2-month-old infant presents with seizures, retinal hemorrhages, and a tense fontanelle. The mother reports a fall from a changing table. Which constellation of findings is LEAST consistent with the provided history but most suggestive of abusive head trauma?
A 2-month-old infant is evaluated for possible abusive head trauma after presenting with seizures and retinal hemorrhages. While the history is not clear, which specific neuroimaging finding would provide the STRONGEST evidence against accidental trauma?
A 2-month-old infant is evaluated for possible abusive head trauma after presenting with seizures and retinal hemorrhages. While the history is not clear, which specific neuroimaging finding would provide the STRONGEST evidence against accidental trauma?
A 27-year-old male presents with an epidural hematoma after an altercation. Considering the Monro-Kellie doctrine pertaining to intracranial volume regulation, which compensatory mechanism, if exhausted, would LEAST contribute to rapid neurological decompensation and herniation?
A 27-year-old male presents with an epidural hematoma after an altercation. Considering the Monro-Kellie doctrine pertaining to intracranial volume regulation, which compensatory mechanism, if exhausted, would LEAST contribute to rapid neurological decompensation and herniation?
A somnolent 27-year-old male exhibits signs of uncal herniation due to an expanding epidural hematoma. Which specific anatomical relationship is MOST directly responsible for the oculomotor nerve palsy observed in this patient?
A somnolent 27-year-old male exhibits signs of uncal herniation due to an expanding epidural hematoma. Which specific anatomical relationship is MOST directly responsible for the oculomotor nerve palsy observed in this patient?
In an 80-year-old female with an acute subdural hematoma (SDH) secondary to a fall, which pathophysiological change predisposes the elderly to SDH formation?
In an 80-year-old female with an acute subdural hematoma (SDH) secondary to a fall, which pathophysiological change predisposes the elderly to SDH formation?
An 80-year-old female with gait instability and a history of falls presents with progressive confusion. Imaging reveals an acute subdural hematoma. If the presentation is due to traumatic shearing forces on the bridging veins. What best describes the anatomy of acute SDH?
An 80-year-old female with gait instability and a history of falls presents with progressive confusion. Imaging reveals an acute subdural hematoma. If the presentation is due to traumatic shearing forces on the bridging veins. What best describes the anatomy of acute SDH?
A patient with a history of hypertension presents with a lacunar stroke affecting the posterior limb of the internal capsule. Which specific vascular pathology is MOST directly implicated in the etiology of this stroke subtype?
A patient with a history of hypertension presents with a lacunar stroke affecting the posterior limb of the internal capsule. Which specific vascular pathology is MOST directly implicated in the etiology of this stroke subtype?
An elderly patient presents with progressive gait difficulties, cognitive decline, and urinary incontinence. MRI reveals ventriculomegaly with normal opening pressures on lumbar puncture. In normal-pressure hydrocephalus, which mechanism is primarily responsible for the observed gait disturbance?
An elderly patient presents with progressive gait difficulties, cognitive decline, and urinary incontinence. MRI reveals ventriculomegaly with normal opening pressures on lumbar puncture. In normal-pressure hydrocephalus, which mechanism is primarily responsible for the observed gait disturbance?
A patient presents with a suspected basilar skull fracture involving the sphenoid bone and an associated epidural hematoma. Damage to WHICH structure is MOST likely to result from this type of injury?
A patient presents with a suspected basilar skull fracture involving the sphenoid bone and an associated epidural hematoma. Damage to WHICH structure is MOST likely to result from this type of injury?
A patient presents with a thunderclap headache, meningismus, and a negative initial CT scan. Given the potential for subarachnoid hemorrhage, and after ruling out traumatic causes, what is MOST likely the underlying etiology?
A patient presents with a thunderclap headache, meningismus, and a negative initial CT scan. Given the potential for subarachnoid hemorrhage, and after ruling out traumatic causes, what is MOST likely the underlying etiology?
A patient who suffered a traumatic brain injury presents with diffuse axonal injury (DAI). Identify the PRIMARY mechanism contributing to the long-term cognitive and functional deficits observed in patients with severe DAI.
A patient who suffered a traumatic brain injury presents with diffuse axonal injury (DAI). Identify the PRIMARY mechanism contributing to the long-term cognitive and functional deficits observed in patients with severe DAI.
Following an ischemic stroke in the PCA territory, a patient exhibits contralateral homonymous hemianopia with macular sparing. Which mechanism explains this sparing?
Following an ischemic stroke in the PCA territory, a patient exhibits contralateral homonymous hemianopia with macular sparing. Which mechanism explains this sparing?
Which molecular mechanism is MOST likely implicated in the persistent, band-like burning pain experienced by cancer survivors who underwent radiotherapy?
Which molecular mechanism is MOST likely implicated in the persistent, band-like burning pain experienced by cancer survivors who underwent radiotherapy?
A patient presents with left-sided headache, ptosis, and miosis following a mild closed head injury. Which scenario is MOST indicative of a carotid artery dissection as the underlying cause?
A patient presents with left-sided headache, ptosis, and miosis following a mild closed head injury. Which scenario is MOST indicative of a carotid artery dissection as the underlying cause?
Following a fall, an intubated man is found unresponsive at the bottom of a stairwell. A CT scan is negative for acute findings. A follow-up MRI suspected diffuse axonal injury. What observation MOST suggests diffuse axonal injury?
Following a fall, an intubated man is found unresponsive at the bottom of a stairwell. A CT scan is negative for acute findings. A follow-up MRI suspected diffuse axonal injury. What observation MOST suggests diffuse axonal injury?
Given the clinical picture (unsteady gait, urinary incontinence, vibration impairment, and irregular pupils following a fall), Romberg's sign would be positive, indicating an impairment in proprioception. What underlying cause are the symptoms related to?
Given the clinical picture (unsteady gait, urinary incontinence, vibration impairment, and irregular pupils following a fall), Romberg's sign would be positive, indicating an impairment in proprioception. What underlying cause are the symptoms related to?
In the presented case of an infant with retinal hemorrhages, tense fontanelle, and reported history of rolling off a bed, what aspect of infant ophthalmic findings would STRONGLY support a diagnosis of non-accidental trauma (NAT)?
In the presented case of an infant with retinal hemorrhages, tense fontanelle, and reported history of rolling off a bed, what aspect of infant ophthalmic findings would STRONGLY support a diagnosis of non-accidental trauma (NAT)?
A 42-year-old HIV+ (CD4 400) male presents with subacute HA, lethargy, meningeal enhancement & hydrocephalus. Given his partial response to empiric antibacterial therapy, what CSF findings MOST strongly suggest tuberculosis?
A 42-year-old HIV+ (CD4 400) male presents with subacute HA, lethargy, meningeal enhancement & hydrocephalus. Given his partial response to empiric antibacterial therapy, what CSF findings MOST strongly suggest tuberculosis?
What is a possible treatment for persistent, band-like burning pain along her lower and mid rib locations on a 68-year-old woman who is a breast cancer survivor and developed a transient rash?
What is a possible treatment for persistent, band-like burning pain along her lower and mid rib locations on a 68-year-old woman who is a breast cancer survivor and developed a transient rash?
Which of the following would be the MOST effective treatment intervention for an individual presenting with progressive gait unsteadiness, sensory impairment, irregular pupils, bladder dysfunction who lives in rural Nigeria?
Which of the following would be the MOST effective treatment intervention for an individual presenting with progressive gait unsteadiness, sensory impairment, irregular pupils, bladder dysfunction who lives in rural Nigeria?
A patient has a GCS score of 7 after a stairwell fall. After a nonrevealing CT scan what neuroimaging is most suggestive of a diffused axonal injury (DAI)?
A patient has a GCS score of 7 after a stairwell fall. After a nonrevealing CT scan what neuroimaging is most suggestive of a diffused axonal injury (DAI)?
Flashcards
Abusive head trauma signs?
Abusive head trauma signs?
Seizure, disproportionately large head circumference, full fontanelle, papilledema, and retinal hemorrhages.
Red flags for child abuse
Red flags for child abuse
Injury inconsistent with developmental stage; Delay in seeking care; Conflicting historical details
Clinical features of abuse
Clinical features of abuse
Patterned bruising/burns, multiple fractures, head trauma with retinal/subdural hemorrhages
Management for child abuse.
Management for child abuse.
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Shaken baby syndrome mechanism?
Shaken baby syndrome mechanism?
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Child abuse suspicion
Child abuse suspicion
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Abusive head trauma
Abusive head trauma
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Acute subdural hematoma
Acute subdural hematoma
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Acute SDH on CT scan
Acute SDH on CT scan
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Epidural Hematoma
Epidural Hematoma
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Epidural hematoma diagnosis
Epidural hematoma diagnosis
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Epidural hematoma treatment
Epidural hematoma treatment
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Epidural hematoma cause
Epidural hematoma cause
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Likely Diagnosis?
Likely Diagnosis?
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Cryptococcal meningitis signs
Cryptococcal meningitis signs
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Diagnose Cryptococcal meningitis
Diagnose Cryptococcal meningitis
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Cryptococcal meningitis
Cryptococcal meningitis
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Her office visit chest examination
Her office visit chest examination
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burning pain on the chest
burning pain on the chest
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Intracranial pressure signs
Intracranial pressure signs
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Physical examination
Physical examination
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Patient description
Patient description
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Patient description on ventilation
Patient description on ventilation
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Brain death description
Brain death description
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Pt Description
Pt Description
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Patient description headaches
Patient description headaches
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Study Notes
Abusive Head Trauma in Infants
- A 2-month-old boy is brought to the emergency department via ambulance after a seizure.
- The mother reports the child rolled off the bed and "cried for a few minutes but fed well last night".
- Today the patient experienced a tonic-clonic seizure lasting 4 minutes after feeding.
- The child was born at 31 weeks gestation, complicated by respiratory distress and hypoxia requiring intubation for several days.
- The child is a limp infant withdrawing from painful stimuli, has a full and tense anterior fontanelle.
- Funduscopy reveals bilateral papilledema and retinal hemorrhages.
- Height and weight are at the 50th percentile, head circumference is at the 98th percentile.
- Temperature is 36.7 C (98 F), blood pressure is 90/50 mm Hg, and pulse is 144/min.
- The abdomen is soft with no hepatosplenomegaly.
- The most likely etiology of seizure is nonaccidental trauma given the injury inconsistent with developmental stage.
Red Flags for Nonaccidental Trauma
- Injury is inconsistent with developmental stage.
- There is a delay in seeking care.
- Conflicting historical details emerge.
Clinical Features of Nonaccidental Trauma
- Bruises exhibiting a patterned appearance, occurring in nonmobile children or over noninjury-prone areas.
- Linear, well-demarcated burns.
- Fractures: Multiple fractures in various stages of healing and femur fractures in nonambulatory children. Also posterior rib fractures, metophyseal corner fractures.
- Head trauma presents as retinal and subdural hemorrhages.
Management of Nonaccidental Trauma
- Disposition: ensure immediate safety of the child via inpatient management and child protective services.
- Evaluation: includes skeletal survey, CT scan of the head, and funduscopy.
Abusive Head Trauma Specifics
- A seizure, a disproportionately large head circumference, a full fontanelle, papilledema, retinal hemorrhages suggest abusive head trauma, i.e. shaken baby syndrome.
- Infants are susceptible due to a relatively large, heavy head, weak neck musculature, immature brain myelination, and a soft brain with high water content.
- Nonaccidental injury to the head or brain is the most common cause of death related to child abuse.
- Premature babies or babies with congenital defects are at higher risk of abuse.
- The most common mechanism of inflicted injury involves violent shaking.
- Repetitive acceleration-deceleration forces cause subdural bleeding due to shearing of bridging veins and coup-contrecoup injury when impacting the skull.
- Subdural hemorrhage can manifest as seizures, increasing head circumference, bulging/tense anterior fontanelle, papilledema, and altered mental status.
- Shaking causes vitreoretinal traction and retinal hemorrhages, a virtually pathognomonic finding for abusive head trauma.
- Child abuse should be suspected when the mechanism of injury is inconsistent with the child's developmental stage.
- Rolling is typically achieved at 4-6 months; this patient "fell after rolling," but isn't old enough to roll.
- A noncontrast CT scan of the head is important to evaluate for intracranial injury.
- A skeletal survey should be done to identify occult fractures.
- Hospitalization and child protective services contacting are required to ensure the child's safety.
- Abusive head trauma is the most common cause of death from child abuse.
- Repetitive acceleration-deceleration forces cause shearing of the subdural bridging veins and vitreoretinal traction, resulting in subdural and retinal hemorrhages.
Acute Subdural Hematoma Explanation
- An 80-year-old woman is brought in due to progressive confusion, generalized weakness, and unsteadiness.
- The patient had a right femoral fracture 4 months prior to hip surgery.
- She has been using a walker to ambulate since coming home from inpatient physical rehabilitation three weeks ago.
- No fever, chest pain, vomiting, diarrhea, or dysuria have occurred.
- The patient has hypertension, hyperlipidemia, coronary artery disease, transient ischemic attack, and persistent atrial fibrillation.
- Aspirin, warfarin, metoprolol, and a statin are among the medications the patient takes.
Acute Subdural Hematoma Statistics
- The temperature is 37.2 C (99 F), blood pressure is 140/90 mm Hg, the pulse is 72/min and irregular, and respirations are 14/min.
- CT scan reveals an acute subdural hematoma where traumatic shearing forces leads to slow bleeding into the subdural space.
- Tearing of the bridging veins causes an acute subdural hematoma.
- Cerebral atrophy (advanced age, alcohol use disorder) contributes to SDH as bridging veins must traverse further, increasing their susceptibility to tears.
- Use of anticoagulants increases bleeding risk.
- Gait instability and recent hip fracture raise suspicion for falls and traumatic head injury.
- Acute SDH symptoms develop gradually 1-2 days after the initial injury.
- Symptoms include impaired consciousness, confusion, intracranial hypertension - headache, nausea/vomiting.
- Noncontrast head CT scan typically shows a crescent-shaped hyperdensity that crosses suture lines.
- Conservative management treats small hematomas, while large ones with neurological deficits require urgent surgical evacuation.
- Subdural hematoma results from the rupture of bridging veins, most commonly from head trauma.
- Risk factors include advanced age, chronic alcoholism, and anticoagulant use.
- Acute subdural hematoma appears as a crescent-shaped hyperdensity that crosses suture lines.
Epidural Hematoma Explanation
- A 27-year-old man is brought in due to headache and lethargy.
- He returned from a bar altercation; he's experienced a worsening headache, vomited twice, and become progressively lethargic.
- His breath smells of alcohol. Somnolent on exam.
- He drinks 2-3 beers/day, smokes marijuana, and is 146/88 mm Hg with a pulse of 92/min.
- A biconvex hyperdensity on CT scan indicates an epidural hematoma and requires surgical intervention.
- Sphenoid bone trauma causes tearing of the middle meningeal artery.
- Patients lose consciousness then experience a lucid interval.
- Hematoma expansion leads to increased intracranial pressure.
- CT scans reveal a hyperdense biconvex lesion that doesn't cross suture lines.
Epidural Hematoma Details
- Epidural hematoma is most common in young adults due to traumatic head injury - assault, leads to tearing the middle meningeal artery and bleeding between the dura mater and overlying skull.
- Hematoma expansion leads to signs of increased intracranial pressure (headache, nausea/vomiting, altered mental status).
- CT scan of the head typically reveals a hyperdense biconvex lesion that does not cross suture lines.
- Patients with focal deficits or signs of intracranial hypertension require emergent neurosurgical hematoma evacuation because treatment delay may lead to death secondary to brain herniation.
- Close observation and serial CT scans may be appropriate in patients with an epidural hematoma without significant dysfunction. Intravenous mannitol is an osmotic diuretic that can reduce brain volume in patients with elevated intracranial pressure.
- Prothrombin complex concentrate infusion, containing 4 vitamin K-dependent clotting factors, is indicated for rapid reversal of anticoagulation in patients with intracranial hemorrhage.
- Vitamin B infusion, followed by intravenous glucose, is used to treat Wernicke encephalopathy.
Cryptococcal Meningitis
- A 42-year-old man with an HIV infection, who is nonadherent with antiretroviral therapy, presents with 3 weeks of increasing headache, vomiting, and lethargy.
- Temperature is 38.5 C (101.3 F), neck stiffness present, and CT scan shows moderate hydrocephalus and basilar meningeal enhancement, no mass lesions present and CD4 count is 400/mm³.
- Meningitis can be be caused by common bacterial pathogens like Streptococcus pneumoniae and Neisseria meningitidis.
- Cryptococcal meningitis is associated with use of immunosuppresant medication.
- Cryptococcus neoformans is inhaled and subsequently forms a lifelong latent infection in the lung.
- Most patients remain asymptomatic, but those with severe immunocompromise can develop reactivation in the CNS spread.
- Cryptococcus produces capsular proteins that clog cerebrospinal fluid outflow, leading to progressive symptoms of elevated intracranial pressure.
- Elevated opening pressure, lymphocytosis, mildly elevated white blood cell count, low glucose, and mildly elevated protein are characteristic lumbar puncture findings.
Cryptococcus, Herpes Virus, and Toxoplasma
- Severe immunosuppression increase risk for cryptococcal meningitis marked by a subacute headache, vomiting, and nuchal rigidity.
- Cerebrospinal fluid shows lymphocytosis, mildly elevated white blood cell count, mild protein elevation, and low glucose.
- Diagnostic confirmation requires identification of the encapsulated yeast in cerebrospinal fluid (India ink stain) or polysaccharide antigen testing.
- Herpes encephalitis has an acute fever, confusion, seizure, and/or neurological deficits; Herpes simplex type 1 attacks the temporal lobe in a retrograde fashion along the trigeminal nerve.
- Cerebrospinal fluid analysis typically shows significant red blood cells in Herpes simplex encephalitis.
- Toxoplasma encephalitis occurs with focal issues, and/or seizure, the head generally shows numerous ring-shaped lesions in the brain parenchyma usually seen in advanced AIDS cases.
Gabapentin
- A 68-year-old woman comes to the office with persistent right-sided chest pain, having burning pain on the right chest wall and back for several months.
- She had a transient rash in the same region prior to the onset of symptoms but no associated cough, dyspnea, or trauma.
- Medical history is notable for breast cancer treated with surgery and chemotherapy, as well as hypertension and type 2 diabetes mellitus.
- Temperature is 37.1 C (98.8 F) and blood pressure is 130/80 mm Hg. - Pulse is 82/min.
- Chest examination shows no skin rash, but there is a band-like area of hyperesthesia on the right side.
- Lung auscultation reveals prolonged expiration with no wheezes, heart sounds normal and the back examination shows no deformity or focal tenderness.
- Gabapentin therapy is best for management of this patient.
Arterial Dissection Specifics
- A 28-year-old woman presents because of left-sided headache and neck pain after skiing the day prior. The patient is has transient leg weakness.
- Temperature is 37.2 C (99 F), blood pressure is 134/86 mm Hg, and pulse is 90/min.
- Examination shows mild ptosis and miosis of the left eye with normal Funduscopic examination and no carotid bruit is present.
- Neurological examination is normal and shows normal motor strength and sensation bilaterally.
- Arterial dissection is the most likely diagnosis.
Brain Death Details
- A 60-year-old man brought to the emergency department unresponsive at the bottom of a stairwell.
- Upon arrival, the patient is hemodynamically stable but has a Glasgow coma score of 7 with no skull fractures or large hematoma.
- The patient is intubated for airway protection and mentation does not improve; diffuse axonal injury is the suspected.
- In diffuse axonal injury with brain death, deep tendon reflexes can be observed.
Cryptococcal Meningitis Details
- A 48-year-old man presents with 3 days of nausea and vomiting, and has also had increasingly severe headaches over the past 4 weeks.
- He has a history of a kidney transplant due to glomerulonephritis 2 years ago under immunosuppressants.
- On examination, the temperature is 38.2 C (100.7 F), the blood pressure is 140/90 mm Hg with a pulse of 70/min and a history of kidney transplant 2 years ago.
- Lumbar-puncture results: glucose is 25 mg/dL; protein is 110 mg/dL, white blood cell count is 70/mm³ (95% lymphocytes), and red blood cell count is 1/mm³.
- Cryptococcal infection is the most likely cause.
Transverse Myelitis Details
- A 62-year-old man presents due to 3 months of progressive unsteadiness and difficulty walking.
- He experiences transient sharp stabbing pain in back/lower limbs, involuntary dribbling of urine (no history of back injury), lives in rural Nigeria, smokes 1/2 pack cigarettes per day for 30 y, drinks 1-2 alcohol beverages daily.
- Bilateral knee/ankle and vibration/position sensations are impaired, gait is broad based, Pupils small, irregular and do not constrict to light, while pupils constrict to look at an examiners finger.
- Aqueous crystalline penicillin G is helpful in treatment.
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