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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Ochuko}}
|QuestionAuthor={{Ochuko}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
Line 20: Line 20:
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Neurology
|SubCategory=Neurology
|Prompt=A 38-year old male presents to the emergency room with a history of headache, decreasing loss of consciousness, difficulty with maintaining balance and progressive memory loss. 3-weeks prior to presentation, he was involved in a motor vehicle accident. CT scan of the head was ordered which revealed a crescent-shaped hemorrhage that crosses the suture lines. Which of the following mechanisms is involved in this patient’s symptoms?
|Prompt=A 38-year-old male presents to the emergency room with complaints of a headache, difficulty maintaining balance, and progressive memory loss. Three weeks prior to presentation, he was involved in a motor vehicle accident. During examination the man appears alert and oriented to his identity, but not to the current location or date. A CT scan of the head demonstrates a crescent-shaped hemorrhage crossing the suture lines. A rupture in which of the following structures is the most likely cause of this patient’s symptoms?
|Explanation=The patient in this vignette is presenting with [[subdural hematoma]], which occurs as a result of the rupture of bridging veins (Choice C). It is seen in elderly persons, alcoholics, blunt trauma and [[shaken baby syndrome]] (predisposing factors include [[brain atrophy]], shaking, [[whiplash]] injuries). CT scan of the head would show crescent-shaped hemorrhage that crosses the suture lines with the gyri preserved because pressure is equally distributed.
|Explanation=The patient in this senario presents with symptoms  suggestive of [[subdural hematoma]], which occurs as a result of the rupture of the bridging veins. It is ofetn observed in elderly individuals, alcoholics, blunt trauma patients, and individuals suffering from [[shaken baby syndrome]]. A CT scan of the head would demonstrate a crescent-shaped hemorrhage crossing the suture lines. The gyri would be preserved because pressure is equally distributed due to the relatively gradual accumulation of blood.


Educational Objective
Educational Objective


[[Subdural hematoma]] occurs as a result of rupture of bridging veins
[[Subdural hematoma]] results from the rupture of the bridging veins.


Reference: First AID for the USMLE Step 1 2011 Pgs 405-406
Reference: First AID for the USMLE Step 1 2011 Pgs 405-406


|AnswerA=Rupture of the middle meningeal artery
|AnswerA=Rupture of the middle meningeal artery
|AnswerAExp=Incorrect. Rupture of the [[middle meningeal artery]] occurs with [[epidural hematoma]]
|AnswerAExp= Rupture of the [[middle meningeal artery]] occurs with [[epidural hematoma]]
|AnswerB=Rupture of an [[aneurysm]]
|AnswerB=Rupture of an aneurysm
|AnswerBExp=Incorrect. Rupture of an aneurysm occurs in [[subarachnoid hemorrhage]] (usually berry aneurysm in [[Marfan’s syndrome]], [[Ehlers-Danlos syndrome]], [[polycystic kidney disease|Adult polycystic kidney disease]]) or an [[arteriovenous malformation]]
|AnswerBExp= Rupture of an [[aneurysm]] occurs in [[subarachnoid hemorrhage]], which may occur as a complication of [[Marfan’s syndrome]], [[Ehlers-Danlos syndrome]], [[polycystic kidney disease|adult polycystic kidney disease]], or [[arteriovenous malformation]].
|AnswerC=Rupture of [[bridging veins]]
|AnswerC=Rupture of bridging veins
|AnswerCExp=Correct. See explanation
|AnswerCExp= See explanation
|AnswerD=Rupture of anterior communicating arteries
|AnswerD=Rupture of the anterior communicating artery
|AnswerDExp=Incorrect. Rupture of anterior communicating arteries cause visual field defects
|AnswerDExp=  Rupture of the [[anterior communicating artery]] typically causes [[visual field defects]] in patients.
|AnswerE=Rupture of posterior communicating arteries
|AnswerE=Rupture of the posterior communicating artery
|AnswerEExp=Incorrect. Rupture of posterior communicating arteries causes [[oculomotor nerve palsy|CN III palsy]]
|AnswerEExp= Rupture of the [[posterior communicating artery]] typically causes [[oculomotor nerve palsy|CN III palsy]] in patients.
|RightAnswer=C
|RightAnswer=C
|Approved=Yes
|Approved=Yes
}}
}}

Revision as of 15:06, 2 July 2014

 
Author [[PageAuthor::Ogheneochuko Ajari, MB.BS, MS [1] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Neurology
Prompt [[Prompt::A 38-year-old male presents to the emergency room with complaints of a headache, difficulty maintaining balance, and progressive memory loss. Three weeks prior to presentation, he was involved in a motor vehicle accident. During examination the man appears alert and oriented to his identity, but not to the current location or date. A CT scan of the head demonstrates a crescent-shaped hemorrhage crossing the suture lines. A rupture in which of the following structures is the most likely cause of this patient’s symptoms?]]
Answer A AnswerA::Rupture of the middle meningeal artery
Answer A Explanation [[AnswerAExp::Rupture of the middle meningeal artery occurs with epidural hematoma]]
Answer B AnswerB::Rupture of an aneurysm
Answer B Explanation [[AnswerBExp::Rupture of an aneurysm occurs in subarachnoid hemorrhage, which may occur as a complication of Marfan’s syndrome, Ehlers-Danlos syndrome, adult polycystic kidney disease, or arteriovenous malformation.]]
Answer C AnswerC::Rupture of bridging veins
Answer C Explanation AnswerCExp::See explanation
Answer D AnswerD::Rupture of the anterior communicating artery
Answer D Explanation [[AnswerDExp::Rupture of the anterior communicating artery typically causes visual field defects in patients.]]
Answer E AnswerE::Rupture of the posterior communicating artery
Answer E Explanation [[AnswerEExp::Rupture of the posterior communicating artery typically causes CN III palsy in patients.]]
Right Answer RightAnswer::C
Explanation [[Explanation::The patient in this senario presents with symptoms suggestive of subdural hematoma, which occurs as a result of the rupture of the bridging veins. It is ofetn observed in elderly individuals, alcoholics, blunt trauma patients, and individuals suffering from shaken baby syndrome. A CT scan of the head would demonstrate a crescent-shaped hemorrhage crossing the suture lines. The gyri would be preserved because pressure is equally distributed due to the relatively gradual accumulation of blood.

Educational Objective

Subdural hematoma results from the rupture of the bridging veins.

Reference: First AID for the USMLE Step 1 2011 Pgs 405-406
Educational Objective:
References: ]]

Approved Approved::Yes
Keyword
Linked Question Linked::
Order in Linked Questions LinkedOrder::