ARJ
Forum Guru
Topics: 133
Posts: 792
|
A 42-year-old, right-handed man has had a history of progressive speech difficulties and right hemiparesis for 5 months. He has had progressively severe headaches for the past 2 months, which are worse in the mornings. At the time of admission, he is confused and vomiting, and has blurred vision, papilledema, and diplopia. Shortly thereafter, his blood pressure increases to 190/110 mm Hg, and he develops bradycardia. Which of the following is most likely the significance of the hypertension and the bradycardia?
a)The brain tumor has produced tentorial herniation
b)The brain tumor is pressing on the hypothalamus
c)The chronic subdural hematoma has ruptured
d)The genesis of his symptoms is aortic dissection
e) There is a near-terminal increase in intracranial pressure
___________________
"Live as if you were to die tomorrow. Learn as if you were to live forever." --Mahatma Gandhi
|
| drkpp
Forum Guru
Topics: 45
Posts: 882
|
e. looks like cushings triad
___________________
"Where there is a will there is a way!"
-Anonymous
|
| Renegade
Forum Elite
Topics: 18
Posts: 171
|
e) Indeed
___________________
«The desire to take medicine is perhaps the greatest feature which distinguishes man from animals.» W. Osler
|
| catmd
Forum Senior
Topics: 7
Posts: 129
|
This is a classic case of how I screw up the q's.
Yes -its E, and they're telling us that so going from there - I wonder hmmm, maybe its 1 step further, so it has to be Sx based - so maybe A? 
|
| lucky
Forum Guru
Topics: 23
Posts: 505
|
A...
|
| Diego Casali
Forum Elite
Topics: 7
Posts: 232
|
I think the correct answer is E, because tentorial herniation would cause a more dramatic and rapid course.
|
| chemamr
Moderator and PGY1
Topics: 703
Posts: 4,441
|
i agree with E.
___________________
Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
|
| ARJ
Forum Guru
Topics: 133
Posts: 792
|
The correct answer is
E. The clinical picture is that of a brain tumor with increased intracranial pressure. However, the development of hypertension and bradycardia (Cushing's reflex) signifies that the brain has run out of compensatory mechanisms to minimize the intracranial pressure elevation generated by increased intracranial volume. When that point is reached, brain perfusion suffers and death is imminent. Choices A and B correctly identify the disease as a brain tumor, but assign an incorrect meaning to the hemodynamic changes. Tentorial herniation would lead to respiratory arrest. Pressure on the hypothalamus is not the reason for the Cushing's reflex. Choice C makes a wrong diagnosis. Chronic subdural hematomas are seen in very old or alcoholic patients, where they press on the cortex-but do not "rupture" and create a sudden catastrophe in that fashion. Aortic dissection (choice D) happens to hypertensive patients, but what they get is chest and back pain, not a long-standing neurologic picture as depicted here.
___________________
"Live as if you were to die tomorrow. Learn as if you were to live forever." --Mahatma Gandhi
|
| chemamr
Moderator and PGY1
Topics: 703
Posts: 4,441
|
 good.
___________________
Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
|
|
| |
| | | | | | | | | |
