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Old 10-10-2012
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Arrow Billy Step 1 Questions # 21

A 72-year-old woman trips on a toy truck left at the top of a flight of stairs by a grandchild and falls down the stairs. She
does not lose consciousness. About 36 hours later, she develops a headache and confusion and is taken to the
emergency department. On physical examination, she is conscious and has a scalp contusion on the occiput. What is the
most likely location of an intracranial hemorrhage in this patient?


□ (A) Pontine
□ (B) Subarachnoid
□ (C) Basal ganglia
□ (D) Epidural
□ (E) Subdural


A 45-year-old, previously healthy man has developed headaches over the past month. There are no remarkable
findings on physical examination. A cerebral angiogram shows a 7-mm saccular aneurysm at the trifurcation of the right
middle cerebral artery. Which of the following is most likely to result from this lesion?

□ (A) Epidural hematoma
□ (B) Subarachnoid hemorrhage
□ (C) Subdural hematoma
□ (D) Cerebellar tonsillar herniation
□ (E) Hydrocephalus
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Old 10-10-2012
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Q 1 □ (E) Subdural

Q 2 □ (B) Subarachnoid hemorrhage
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1) E----

2) B---rupture of berry aneurysm
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1)epidural
2)SAH
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Old 10-10-2012
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Default my answer :)

1 - (E) Subdural
2 - (B) Subarachnoid hemorrhage

Last edited by Casandra; 10-10-2012 at 10:30 AM.
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Quote:
Originally Posted by rupesh View Post
1)epidural
2)sah
sorry its subdural...
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Correct Answer Yes E and B are correct

***This patient has a subdural hematoma resulting from tearing of the bridging veins beneath the dura. These veins
are at risk of tearing with head trauma, particularly in elderly individuals, in whom some degree of cerebral atrophy may be
present. Pontine hemorrhages are likely to be Duret hemorrhages. Subarachnoid hemorrhage could occur in contusions
with trauma. Basal ganglia hemorrhages are most often associated with hypertension. Epidural hemorrhages are most
often preceded by a blow to the head that tears the middle meningeal artery; there is commonly a “lucid” interval between
an initial loss of consciousness occurring with trauma and the later accumulation of blood.




***Intracranial aneurysms are typically saccular and enlarge slowly over time. Aneurysms that grow to 4 to 7 mm are
at greatest risk of rupture. Rupture occurs into the subarachnoid space at the base of the brain, where the cerebral arterial
distribution originates around the circle of Willis, and where saccular aneurysms are most likely to arise. Epidural
hematomas arise from a tear of the middle meningeal artery, typically as a result of head trauma. Trauma also can cause a
tear of bridging veins that produces a subdural hematoma. Neither a berry aneurysm nor the bleeding that results is likely
to cause a mass effect and herniation. In some cases of survival after rupture of a berry aneurysm, a noncommunicating
hydrocephalus results from organization of the subarachnoid hemorrhage.
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1. Subdural
2. Subarachnoid hemorrhage.
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