NCC Related Links

NCC Blogspot  |   NCC Dropmark-Text  |   NCC Dropmark  |   NCC 4shared  |   NCC 4shared PDF  |   NCC Killexams-Blog  |   NCC  |   NCC  |   NCC RSS Feed  |   NCC  |   NCC   |   NCC  |   NCC   |   NCC Youtube  |   NCC  |   NCC  |  
Download Killexams NCC exam Cheatsheet PDF - Killexams

party is over! Time to study and bypass the examination.

NCC exam papers | NCC Latest Questions | NCC assessment test sample | NCC questions and answers | NCC brain dumps -

NCC - Certified in NeuroCritical Care (ABEM) - Dump Information

Vendor : Certification-Board
Exam Code : NCC
Exam Name : Certified in NeuroCritical Care (ABEM)
Questions and Answers : 726 Q & A
Updated On : Click to Check Update
PDF Download Mirror : NCC Brain Dump
Get Full Version : Pass4sure NCC Full Version

It is great ideal to prepare NCC exam with real exam questions.

There have been many approaches for me to reach my goal excursion spot of high score within the NCC but I used to be no longer having the Great in that. So, I did the excellent factor by taking region on-line NCC observe help of the Killexams mistakenly and determined that this mistake was a sweet one to be remembered for an extended time. I had scored nicely in my NCC exam program and that is all due to the Killexams exercise exam which became online.

Where can I find NCC dumps of real test questions?

My planning for the exam NCC was incorrect and subjects seemed tough for me as nicely. As a snappy reference, I depended on the questions and answers by way of Killexams and it delivered what I wished. tons oblige to the Killexams for the assistance. To the point, in method of this aide became not tough to seize for me as nicely. I surely retained all that I should. A score of 92% became agreeable, contrasting with my 1-week war.

I am very happy with this NCC study guide.

I am thankful to Killexams for their mock test on NCC. I could pass the exam comfortably. Thanks again. I have also taken a mock test from you for my other exams. I am finding it very useful and am confident of passing this exam by attaining more than 85%. Your question bank is very useful and the explanations are also very good. I will give you 4-star marks.

Feeling difficulty in passing NCC exam? Q&A bank is here.

Before discovering this great Killexams, I used to be effective about the capabilities of the net. As soon as I made an account here I observed a whole new worldwide and that was the beginning of my successful streak. That lets you get prepared for my NCC exams, I used to be given quite a few test questions/answers and a difficult and fast pattern to test which became very precise and entire. This assisted me in conducting fulfillment in my NCC exam which ends up an excellent feat. Thanks a lot for that.

Shortest question are protected in NCC question bank.

I pass in my NCC exam and that was not a simple pass but a great one that I could tell anyone with proud steam filled in my lungs as I had got 89% marks in my NCC exam from studying from Killexams.

these NCC actual test questions works within the actual take a look at.

I handed, and Greatly completely satisfied to document that Killexams adheres to the claims they make. They provide actual exam questions and the finding out engine works flawlessly. The bundle includes the whole thing they promise, and their customer support works well (I had to get in touch with them for the motive that first, my online rate would not go through, but it turned out to be my fault). Anyhow, this is an amazing product, much higher than I had predicted. I passed NCC exam with nearly top marks, something I concept I was able to. Thank you.

No more struggle required to pass NCC exam.

After a few days of NCC practice test with Killexams set, I passed the NCC exam. I have to admit, I am relieved to depart it in the back of, yet happy that I located Killexams to help me get through this exam. The questions and answers they encompass in the package deal are correct. The answers are right, and the questions had been taken from the actual NCC exam, and I have given them while taking the exam. It made matters much easier, and I was given marks fairly better than I had hoped for.

amazed to peer NCC real exam questions!

thanks, Killexams for complete help through offering this questions bank. I scored 78% in NCC exam.

Pleasant experience with Q&A, pass with high score.

After 2 times taking my exam and failed, I heard about Killexams Guarantee. Then I bought NCC Questions Answers. The online exam simulator helped me to train to solve questions in time. I simulated this test many times and this helps me to keep the focus on questions on exam day. Now I am an IT Certified! Thanks!

Where can I find NCC Latest dumps questions?

You need to ace your online NCC exams I have a first-class and easy manner of this and that is Killexams and its NCC exam examples papers which can be an actual picture of the final test of NCC exam tests. My marks in the very last check are 95%. Killexams is a product for those who usually want to move on with their life and want to do something extraordinary. NCC trial test has the potential to beautify your confidence level.

See more Certification-Board dumps


Latest Exams added on Killexams

1Y0-312 Question Bank | 2V0-21.19D objectives | 2V0-31.20 exam collection | 2V0-41.20 by examtut | ACLS elearningexams | AI-900 visual cert exam | ASTQB-CMT Question Answer Bank | C2070-987 mock exam | C2070-994 exam fee | C2090-558 sparknotes | CFA-Level-II pass4sure | CLSSMBB self test | GMAT-Verbal certification guide | LSAT-Logical-Reasoning official cert guide | LSAT-reading-comprehension exambraindumps | MB-500 cert guide | Scrum-Master-Certified free e-book | SPLK-3003 actual test | 300-515 material pdf | 300-915 exam prep | 1Y0-403 pdf-archive | SY0-601 lab manual | DES-1241 online tyari | DES-1D12 test engine | DEA-5TT1 difficulty | FML-5.3.8 downloads | NSE8-811 study guide | HPE2-E72 testinside | HPE0-S47 dumps pdf | C1000-010 simulation questions | ATA exam dumps | PL-100 test prep | PL-200 results | PL-400 test questions | OG0-061 free download | VMCE2020 pdf-archive | 1Z0-997-20 exam objectives | 1Z0-1072-20 blog | 1Z0-931 kit | 1Z0-1080-20 academy | 1Z0-072 exam guide | 1Z0-082 Questions Bank | 1Z0-083 vce exam simulator | 1Z0-1046 training tools | 1Z0-1047 certification guide | 1Z0-1048 made easy | 1Z0-340 case study | 1Z0-632 boot camp | 1Z0-815 exambraindumps | 1Z0-816 official certification guide | 1Z0-928 exam objectives | 1Z0-933 Sample exam | 1Z0-958 Questions Bank | 1Z0-983 tutorial | 1Z0-988 syllabus | 1Z0-995 study tools | 1Z0-996 training tips | 5V0-33.19 Question Answer Bank | 5V0-34.19 guide | C1000-019 test inside | C1000-022 new questions | C9510-052 study guide pdf | HP2-H88 study guide | HP2-N49 official cert guide library pdf | HP2-Z36 cert guide | HPE0-S57 is hard | HPE6-A27 new topics | P9560-043 download | 100-490 sybex pdf | 143-085 kaplan test | 143-425 study tools | 150-130 full version | 150-820 pass tricks | 170-010 examsokay | 200-201 exam prep | 200-901 studies | 2V0-21.20 free e-book | 2V0-61.20 pass-guide | 300-535 exam questions & answers | 300-710 visual cert exam | 300-715 questions & answers | 300-720 updated questions | 300-725 pearson vue | 300-730 exam papers | 300-735 questions answers pdf | 300-820 book download | 300-835 amazon | 500-440 exam cost | 600-660 cheat sheet pdf | 75940X study guide | 76940X amazon | AD0-E308 questions and answers pdf | AZ-104 simulation questions | AZ-303 blueprint | AZ-304 test questions | CFR-310 Sample exam | CCSK sybex | CTFL-2018 new questions | CV1-003 test questions | CWNA-108 questions & answers | DA-100 exam dumps | DES-5121 sparknotes | DES-5221 dump | DP-300 actualtests | DP-900 free pdf | EADA105 training tools | EADE105 study guide | IAPP-CIPM Question Answer Bank | IAPP-CIPP-E dumps in pdf | IIBA-AAC exam cost | iSAQB-CPSA-F exam prep | JN0-103 questions & answers | JN0-334 answers | JN0-648 download | Magento-Certified-Professional-Cloud-Developer simulator | MCPA-Level-1 official answers | MO-201 official cert guide library | MS-203 exam tricks | MS-600 Sample Test Questions | NS0-193 study guide pdf | NS0-591 elearningexams | NSE4_FGT-6.2 exam | NSE5_FMG-6.0 download | NSE7_SAC-6 practice test | Nutanix-NCP exam dumps | PEGAPCSSA80V1_2019 free pdf | SAA-C02 mock exam | Salesforce.Field-Service-Lightning-Consultant nbcot exam prep | SPLK-1002 simulator | 2V0-21-19-PSE network simulator | SPLK-3001 answers | CSBA q and a questions | Servicenow-PR000370 sybex | Servicenow-CIS-VR dump | Servicenow-CIS-SAM self test | Servicenow-CIS-RC official answers | Servicenow-CIS-ITSM free book | Servicenow-CIS-HR best study techniques | Servicenow-CIS-EM sybex | Servicenow-CIS-CSM sparknotes | Servicenow-CAD download | Scrum-PSM-II book pdf | Salesforce-Certified-Sales-Cloud-Consultant correct answers | Salesforce-Certified-Marketing-Cloud-Email-Specialist dumps pdf | Salesforce-Certified-Marketing-Cloud-Consultant objectives | Salesforce-Certified-Identity-and-Access-Management-Designer dumps pdf | Salesforce-Certified-Community-Cloud-Consultant testinside | Salesforce-Certified-B2C-Commerce-Developer test inside | Salesforce-Certified-Advanced-Administrator elearningexams | QSSA2018 vce exam simulator | PEGAPCRSA80V1_2019 passing score | PEGAPCDC80V1 Question Answer Bank | 1Z0-1068 Sample Study guide | MCIA-Level-1 testking pdf | MCD-ASSOC kindle | ASVAB-Assembling-Objects book download | ASVAB-Paragraph-comp exam success | ASVAB-General-Science boson practice | ASVAB-Mathematics-Knowledge study island | ASVAB-Electronic-Info dumps free download pdf | ASVAB-Automotive-and-Shop download | ASVAB-Mechanical-Comp study island | ASVAB-Arithmetic-Reasoning pdf download | ASVAB-Word-Knowledge self test | MB-901 study tools | MB-700 Sample exam | MB-600 pdf study guide | MB-400 Sample Question and Answer | AZ-220 accurate test | AZ-120 cheat sheets | Magento-2-CAD exam papers | 701-100 Questions Bank | 101-500 exam fee | ITIL-Practitioner training tips | C1000-026 quiz questions | C1000-012 examcollection | C1000-003 full version | C1000-002 exam | IAPP-CIPT passguide | HPE2-W05 aio testking | HPE2-T35 Sample Study guide | HPE2-E70 amazon | HPE2-CP02 passing skills | HPE0-V14 q and a questions | HPE0-S58 exam objectives | NSE7_EFW-6.2 sparknotes | NSE7_ATP-2.5 exam papers | 212-89 new topics | CAU201 exambraindumps | 1Y0-204 cheat sheet pdf | AD0-E301 exam success | 1Z0-1085-20 blueprint | 1Z0-1084-20 quiz questions | TB0-123 accurate answers | WorkKeys results | TEAS-V6 pass4sure download | SCS-C01 training tips | RPFT quick reference | PL-900 amazon | MS-700 passing score | HESI-A2 exam prep | Google-AVA book pdf | Google-ASA is hard | Google-AMA Sample Question and Answer | GCED Sample Question and Answer | GASF practice questions | CRT-450 pass guarantee | CRT-251 self test | CRT-160 sybex | CLTD frame relay | CCRA cert guide | AZ-204 premium vce file | AZ-202 official cert guide library pdf | ASSET network simulator | ACE-A1.2 free ebook | AACD dumps pdf | 98-388 sybex pdf | PCNSE-PANOS-9 is hard | NSE7_EFW-6.0 study help | 200-301 questions and answers | Watchguard-Essentials new questions | TCRN cert guide | T1-GR1 visual cert exam | SVC-19A training videos | SPLK-2002 sparknotes | SPLK-1001 free answers | RE18 nbcot exam prep | RACP aio downloader | QSDA2018 exam voucher | QSBA2018 pdf download | PEGACRSA80V1 free dumps | PEGACPDC74V1 Sample exam | PCNSA blog | PCCSA training tools | NRP boson practice | NLN-PAX pdf | NCC book download | NAB-NHA official cert guide pdf | Mulesoft-CD updated questions | MLS-C01 free e-book | LFCS free book | HPE6-A71 examcollection | HPE6-A70 pass4sure download | HPE6-A68 download | HPE6-A67 case study | HPE6-A49 trainsignal | HPE6-A48 official cert guide library | H31-611 test engine | Gsuite pdf-archive | Google-PDE camp | Google-PCSE questions answers pdf | Google-PCNE mock | Google-PCD online test | FSLCC Sample Question and Answer | ECSAv10 pdf download | DVA-C01 pass-guaranteed | DP-201 exam cram | DOP-C01 test prep online | DEV-450 official cert guide library | DES-6332 examcollections | DES-6321 Question Bank | DES-4421 Quiz | DES-1423 aio testking | DEA-1TT4 cheat sheet | CWT-100 pass4sure | CWDP-303 test-king | CSLE exam answers | CLO-002 exam success | CLF-C01 sparknotes | CIMAPRO17-BA2-X1-ENG test prep | CIMAPRO15-E03-X1-ENG official cert guide | CHAD Sample Test Questions | CCSP visual cert exam | CBSA visual cert exam | CBDH amazon | CBDE accurate test | CBBF free dumps | CAMS exam engine | C2040-986 lab questions | BDS-C00 exam voucher | AWS-CDBS free answers | AWS-CASBS sybex pdf | ARA01 pass tricks | APSCA difficulty | APD01 official cert guide library pdf | ANS-C00 exam tricks | AI-100 best study techniques | AD0-E452 camp | AD0-E106 testking | AD0-E104 study guide | AD0-E103 cheat sheets | AD0-E102 new questions | AD0-300 quiz questions | AD01 examcollections | ACSCE-5X quick reference | ACP-600 exam engine | ACP-100 test engine | ACA-Cloud1 exam tricks | ABPN-VNE free download | ABFM free book | ABCTE sam learning | 9A0-412 practice quiz | 840-450 official answers | 77-727 simulation questions | 77-725 questions & answers | 5V0-62.19 aio downloader | 5V0-61.19 certification guide | 5V0-21.19 nbcot exam prep | 500-215 official cert guide library | 4A0-M05 free test engine | 4A0-C01 notes | 350-901 exam cost | 350-801 study guide pdf | 350-701 nbcot exam prep | 350-601 official cert guide library pdf | 350-501 guaranteed success | 350-401 sybex | 300-920 study guide pdf | 300-910 examcollections | 300-815 questions & answers | 300-810 test-king | 300-635 pearson vue | 300-625 vce download | 300-620 boson practice | 300-615 actualtests | 300-610 sparknotes | 300-510 simulator download | 300-435 examcollection | 300-430 test prep online | 300-425 free test engine | 300-420 kit | 300-415 exam success | 300-410 simulator | 2V0-41.19 exam | 2V0-31.19 pdf download | 1Z0-1072 cheat sheets | 1Z0-1050 Sample Test Questions | MS-500 vce download | TMSTE test inside | ServiceNow-CSA killtest | SDM_2002001050 dumps in pdf | PEGACSSA74V1 cheat sheet | NS0-002 vce free | JN0-348 exam tips | ITIL-4-FOUNDATION test inside | CCCP-001 cheat sheets | AZ-500 quick reference | ANVE practice test | 50-695 mock exam | 3M00030A online test | 2V0-51-19 study help | 1Y0-440 pdf | 102-500 questions & answers with explanations | SIAMF pass4sure download | QV12BA Sample exam | PSM-I practice test | PR000005 lab manual | Platform-App-Builder how many questions | PDII bootcamp | PCIP3-0 pass4sure download | MB-330 study tools | MB-300 pdf study guide | MB-220 certkingdom | HPE0-J50 cert guide | H19-301 sybex pdf | Google-ACE dumps pdf | DES-9131 free book | DES-2T13 premium vce file | DES-1B31 troytec | CTFL-Foundation pass tips | C1000-004 Question Bank | 700-751 blueprint | 5V0-32-19 accurate test | 4A0-N02 online test | 2V0-61-19 Sample exam | 1Z0-927 exam tips | 050-6201-ARCHERASC01 simulation questions | XK0-004 new questions | SPLK-1003 dumps | PSAT-RW certificationking | P2090-095 test inside | MS-900 Question Bank | MB-320 pdf download | MB-310 new questions | MB-240 notes | MB-230 pdf download | MB-210 exambraindumps | HPE0-S56 syllabus | HPE0-S55 dumps in pdf | H19-307 dump | GRE-Verbal guaranteed success | GRE-Quantitative practice questions | C4040-100 testking | C2090-616 free e-book | 78200X exam answers | 2V0-21-19D amazon | 250-440 | HPE2-E71 exambraindumps | PEGAPCSA80V1_2019 pearson vue | PEGACPMC74V1 kaplan test | PEGACPBA74V1 correct answers | NS0-509 questions & answers | NS0-182 academy | NS0-160 simulator download | MB-200 free pdf | HPE2-CP04 passleader | HPE0-S54 answers | HPE0-S50 syllabus pdf | H13-523 lab kit | DP-200 is percent of | DES-3611 simulator | DCA free dumps | CTFL_Syll2018 dumps pdf | AZ-103 exam cram | 830-01 accurate test | 700-651 lab kit | 700-150 correct answers | 500-230 examcollection | 4A0-N01 passleader | 352-011 exam papers | 2V0-21-19 boson practice | 1Z0-1023 free pdf | 1Z0-1008 quick reference | 1Z0-1007 kindle | 1Z0-1006 questions and answers pdf | 1Z0-1004 exam tricks | 1Z0-1002 study guide pdf | 1Z0-1001 quick reference | TTA1 pass-guide | PEGACSA74V1 blueprint | NS0-300 how many questions | MS-101 study guide | JN0-220 transcender | HPE2-W02 kickass | HP2-H84 accurate questions | HP2-H80 visual cert exam | HP2-H78 free dumps | E20-893 testinside | DES-1B21 exam pdf | ATTA exam leader | ATM flash cards | 5V0-31-19 aio testking | 2V0-602PSE case study | 2V0-51-18 simulation questions | 2V0-01-19 questions & answers with explanations | 1Z0-975 q and a questions | 1Z0-956 certkingdom | 1Z0-930 actual test pdf | 1Z0-1013 sybex pdf | 1Z0-1012 Sample Test | 1Z0-1011 dumps | 1Z0-1010 kit | 1Z0-1005 pass score | 156-315-80 passing skills | 010-160 accurate test | SVC-16A blueprint | PRINCE2-Re-Registration official cert guide library | NSE8-810 study guide | NSE5_FAZ-6-0 exam collection | MS-301 actual test | MS-300 exam questions & answers | MS-201 download | MS-200 online test | MS-100 exam cost | MD-101 official certification guide | MD-100 pass4sure download | MAC-16A answers | MA0-107 discounted sale | JN0-1101 blueprint | HPE0-J58 ebook download | H31-523 quick reference | H31-211 pass4sure dumps | H13-629 actual test | H13-612 training videos | H13-611 cheat sheet | H13-511 official answers | H12-711 material pdf | H12-311 exam time | H12-223 aio testking | H12-222 answers | Google-PCA passleader | FC0-U61 cheat sheet | DP-100 kindle | DES-4121 vce free | DEE-1421 troytec | DEA-2TT3 actual test pdf | CWAP-403 boson practice | CCE-CCC exam cram | CAU302 pass4sure dumps | C2150-610 syllabus | C2090-101 simulator download | AZ-900 studies | AZ-400 prometric exam | AZ-203 updated questions | AWS-CSS free dumps | AWS-CSAP study tools | AWS-CSAA-2019 book pdf | 7495X free ebook | 7492X testinside | 7392X latest dumps | 72200X pass guarantee | 71200X official cert guide library | 500-901 Sample exam | 500-470 discounted sale | 3V0-752 guide | 3V0-732 examsking | 312-50v10 pass4sure | 2V0-622PSE passing score | 2V0-01.19 pearson vue | 250-437 home lab | 220-1002 premium vce file | 220-1001 getfreedumps | 1Z0-972 simulator download | 1Z0-926 Question Answer Bank | 1Z0-888 training videos | 1Z0-1028 exam dumps | 1Z0-1026 guide | 1Z0-1024 lab manual | 1Z0-1021 sybex pdf | 1Z0-1019 sybex pdf | 1Z0-1018 certkingdom | 1Z0-1017 practice questions | 1Z0-1016 test engine | 1Z0-1015 vce files | 1Z0-1014 examcollections | 1Z0-1009 pdf-archive | 1Z0-1000 visual cert exam | 1Z0-074 actual test | 156-115.80 exam cram | 500-490 pass score | NSE4_FGT-6-0 syllabus | PCAP-31-02 testinside | JN0-1301 sparknotes | HPE6-A07 official cert guide | HPE0-J55 passing skills | DEA-64T1 blueprint | DEA-41T1 objectives | CCSPA download | CAU301 exam success | 7497X premium vce file | 3V00290A vce download | 3314 exam questions & answers | 3313 official cert guide library | 3312 case study | 250-441 exam | 1Z0-980 guide | 1Z0-936 free dumps | 156-727-77 camp | PEGACPBA73V1 official cert guide | NS0-513 Sample Test | NS0-181 pass tips | NS0-159 mock exam | ML0-320 full version | MB6-898 study guide pdf | JN0-662 academy | HPE6-A47 Question Bank | HPE0-J57 exam pdf | HP2-H67 free answers | HP2-H65 academy | FortiSandbox vce files | AZ-301 material pdf | AZ-300 sybex pdf | A2040-918 questions and answers pdf | 1Z0-987 syllabus pdf | 1Z0-973 study guide | 1Z0-967 ebook | 1Z0-950 free book | 1Z0-935 practice test | 1Z0-900 quick reference | 1Z0-346 objectives | 1Z0-344 examsking | 1Z0-324 notes | 1Y0-340 prometric exam | WPT-R official cert guide | WHNP book pdf | VACC exam tips | TEAS-N questions answers pdf | RDN questions answers pdf | PET vce exam simulator | PCCN examsking | PCCE study material | PANRE syllabus | PACE lab questions | OCS how many questions | NSCA-CPT Sample Questions | NREMT-PTE simulator download | NREMT-NRP download | NRA-FPM book download | NNAAP-NA blueprint | NE-BC pass4sure download | NCPT MCQ | NCMA-CMA exam engine | NCIDQ-CID aio downloader | NCEES-PE study guide pdf | NCEES-FE book pdf | NCCT-TSC Question Answer Bank | NCCT-ICS exam engine | NBDE-II passcertification | NBDE-I kit | NBCC-NCC amazon | NAPLEX material pdf | MSNCB kickass | MHAP exam pdf | LCDC exam | LCAC nbcot exam prep | IFSEA-CFM practice questions | IBCLC accurate answers | GPTS is percent of | FSMC academy | FNS test engine | ESPA-EST dumps in pdf | DTR official cert guide pdf | DSST-HRM exam answers | CBCP accurate test | DHORT guaranteed success | DAT cheat sheet | CVPM exam cost | CRNE case study | CPM exam fee | CPCE study material | COMLEX-USA flashcards pdf | CNSC cheat sheet | CGRN studies | CFSW amazon | CDM mock | CDCA-ADEX dumps free download pdf | CCP study island | CCN study guide | CCI study guide | BMAT new topics | BCNS-CNS blueprint | AXELOS-MSP pearson vue | APMLE self test | ANP-BC pdf study guide | ANCC-MSN exam leader | ANCC-CVNC passguide | AHIMA-CCS pdf download | AEMT pass4sure dumps | ACSM-GEI study island | ACNP exam papers | ACF-CCP notes | ABEM-EMC mock | AAMA-CMA pass4sure | AACN-CMC free ebook | CPA-AUD blueprint | CPA-REG flash cards | PT0-001 lab questions | DES-1721 network simulator | CV0-002 home lab | C9560-517 exam success | C9550-413 aio testking | C5050-380 official answers | C2210-422 free book | C2010-530 full version | 9A0-411 aio downloader | 98-383 braindump | 70-537 actual test pdf | 500-325 Sample Questions | 202-450 dumps pdf | 1Z0-986 lab manual | 1Z0-974 free ebook | 1Z0-934 new topics | 1Z0-628 case study | VCS-316 questions & answers | NCIDQ examcollections | MBLEX accurate questions | LEED-GA kaplan test | IAHCSMM-CRCST certkingdom | HQT-4210 ebook | HPE6-A42 Question Bank | HP2-H62 examsking | HCE-5420 network simulator | E20-575 exam cram | NBSTSA-CST passing score | CDCS-001 free test engine | C5050-384 practice test | C2070-582 MCQ | C2010-825 actual test pdf | A2040-921 testinside | A2040-910 questions answers pdf | 7765X best study techniques | 700-901 MCQ | 700-551 vce exam simulator | 250-430 pass guarantee | 1Z0-853 exam leader | 1Z0-581 exam success | 1Z0-545 troytec | 1Y0-402 Sample Test | 1D0-621 testking pdf | 156-215-80 study | HPE0-S48 ebook download | JN0-410 Sample exam | C2090-735 practice test | C2090-603 home lab | 7241X exam | 7141X official cert guide pdf | 700-105 sparknotes | 500-710 Sample Question and Answer | 200-401 lab questions | 1Z0-477 study material | 090-077 free e-book | VCS-256 lab workbook | HPE2-T34 aio testking | HPE2-K43 dump | HCE-5710 Sample Question and Answer | E20-585 exam engine | CAS-003 sybex pdf | 9A0-410 training tools | 98-382 discounted sale | 98-381 pass4sure dumps | 810-440 test prep online | 700-265 pass-guide | 700-020 flash cards | 70-779 pass tips | 70-745 frame relay | 500-551 exam papers | 500-301 latest dumps | 3V0-624 actual test | 300-100 testinside | 1Z0-968 actualtests | 1Z0-447 by examtut | 1Z0-439 download | 1Z0-414 Sample Test | 156-915-80 exam tricks | VCS-413 vce download | VCS-275 examsokay | VCS-274 academic edition | PCNSE passing skills | N10-007 Question Bank | MB6-897 training videos | ITEC-Massage actual test pdf | HPE2-E69 prometric exam | HPE2-E55 | HPE0-S52 exam time | HPE0-J78 exam leader | FTCE Sample Questions | Firefighter passguide | CSWIP exam cram | CPT trainsignal | APA-CPP official certification guide | CPFA discounted sale | CPAT official cert guide pdf | CCC questions & answers | CAT-340 boot camp | IAAP-CAP amazon | C2150-609 official cert guide library | C2090-320 answers | BCB-Analyst simulation questions | 7491X exam prep | 7391X download | 70-705 recommended book | 500-701 troytec | 500-651 exam guide | 201-450 number of questions | 1Z0-932 syllabus | 1V0-701 examcollections | ACMA-6.4 mock exam | ACMA-6.3 exam leader | VCS-257 training tips | SPHR exam voucher | SDM-2002001040 frame relay | SDM-2002001030 Question Bank | S10-110 elearningexams | PEGACLSA_6.2V2 flash cards | PDM-2002001060 Sample Study guide | PCAT correct answers | P2090-027 blog | NSE4-5-4 training videos | NCS-20022101010 certkingdom | NCLEX-RN MCQ | NCLEX-PN exam | MB6-894 free book | JN0-411 dumps free download pdf | JN0-361 dumps pdf | ITILFND Sample Questions | IIA-CIA-Part3 mock | IIA-CIA-Part2 exam success | IIA-CIA-Part1 study island | HPE6-A45 real-exams | HPE6-A43 flash cards | HPE2-Z40 actual test | HPE0-S51 questions and answers | HP2-B129 notes | Hadoop-PR000007 premium vce file | H12-261 real-exams | FCNSP.V5 exam success | E20-920 simulator download | E20-307 latest dumps | DEV-401 mock | CWNA-107 actual test | CTAL-TM_Syll2012 exam success | CTAL-TA_Syll2012 visual cert exam | CPIM-MPR results | CPD-001 test questions | CoreSpringV3.2 exam time | C9530-519 passleader | C9060-528 exam pdf | C9060-521 dumps pdf | C9030-644 questions and answers pdf | C9020-667 pdf download | C9020-662 case study | C2180-275 vce download | C2180-273 pearson vue | C2150-630 flash cards | C2140-823 troytec | C2090-623 full version | C2070-588 transcender | C2070-586 questions & answers | C2070-585 getfreedumps | BAGUILD-CBA-LVL1-100 pass tricks | 70-778 sam learning | 70-768 boot camp | 70-767 difficulty | 600-211 getfreedumps | 600-210 examcollection | 412-79v8 dumps pdf | 3203 pass score | 312-49v9 guide | 3101 exam prep | 3100 cheat sheets | 2D00056A blog | 1Z0-985 frame relay | 1Z0-982 boson practice | 1Z0-970 dumps pdf | 1Z0-969 exambraindumps | 1Z0-966 online tyari | 1Z0-962 exam questions & answers | 1Z0-499 dumps free download pdf | 1Z0-348 free pdf | 1Z0-325 exam tricks | 1Z0-320 questions & answers with explanations | 1Z0-161 amazon | 1Z0-148 free download | 1Z0-134 recommended book | 1Z0-070 official cert guide library | 1Y0-203 questions & answers | 156-915.77 official cert guide library pdf | 156-727.77 book download | 156-315.77 pass-guide | 156-315.65 number of questions | 156-215.65 Sample Test Questions | 156-115.77 pdf study guide | 050-v5x-CAARCHER01 sybex | 050-80-CASECURID01 questions & answers | 002-ARXTroubleshoot online test | SY0-501 braindump | VCS-323 is percent of | VCS-322 questions & answers | T7 dumps pdf | NS0-505 examsking | M9550-752 download | JN0-647 objectives | JN0-634 flash cards | JN0-347 case study | JN0-333 exam success | HPE6-A44 download | FAR Sample Test Questions | DES-1D11 Question Bank | CEMAP-1 questions & answers | C9560-515 practice questions | C9560-040 trainsignal | C9530-001 exam papers | C9510-418 actual test pdf | C9050-041 Sample exam | C9020-668 testking pdf | C9020-563 pearson vue | C8 exam | C2150-620 studies | ADM211 vce exam simulator | 9A0-383 exam objectives | 7691X pdf study guide | 7595X free pdf | 6210 dumps pdf | 250-428 cheat sheet | 200-710 Sample Test Questions | 1Z0-976 exam collection | 1Z0-971 exam cost | 1Z0-964 exam questions & answers | 1Z0-961 Answers Bank | 1Z0-960 questions & answers | 1Z0-595 exam fee | 1Z0-588 study tools | 1Z0-449 actualtests | 1Z0-349 trainsignal | 1Z0-339 exam questions & answers | 1Y0-311 test-king | 1Y0-240 aio testking | 1Y0-230 pdf download | 156-215-77 study guide pdf | 412-79v9 kickass | IELTS free pdf | VCS-412 actual test | VCS-409 mock exam | VCS-371 ebook | VCS-352 guide | VCS-319 pdf download | VCS-318 testinside | VCS-310 camp | VCS-277 study | VCS-276 accurate answers | VCS-271 Question Bank | VCS-255 sybex pdf | VCS-253 syllabus | VCS-252 study tools | VCS-220 study help | S10-210 official cert guide | PPM-001 aio testking | PK0-004 updated questions | NS0-507 free questions | NS0-506 free questions | NS0-191 new questions | NS0-180 pearson vue | NS0-158 Questions Bank | LCP-001 network simulator | JN0-680 exam engine | HPE6-A41 guide | HPE6-A29 test prep | HPE6-A15 premium vce file | HPE2-Z39 questions & answers | HPE2-T27 passguide | HPE0-S22 Question Bank | HPE0-J80 pass4sure download | HPE0-J79 guaranteed success | HP2-Z34 exam pdf | HP2-H32 syllabus | HP2-B149 Questions Bank | HP2-B148 flash cards | HP2-B144 premium vce file | HC-224 pdf download | H12-211 killtest | E20-375 exam fee | C9520-421 Question Answer Bank | C9060-511 exambraindumps | C5050-300 troytec | BEC test questions | AHM-540 vce free | A2090-719 exam voucher | 9A0-803 Questions Bank | 9A0-702 exam questions & answers | 9A0-602 study guide | 9A0-394 test questions | 9A0-392 examsking | 9A0-382 cheat sheet | 9A0-045 questions & answers with explanations | 98-368 study material | 7591X pass tricks | 700-802 testking | 700-295 recommended book | 70-744 blueprint | 70-357 visual cert exam | 62-193 dumps | 501-01 cheat sheet | 500-290 | 500-265 pearson vue | 303-200 kickass | 2V0-642 recommended book | 2U00210A Sample Test Questions | 1Z0-965 exam success | 1Z0-963 exam time | 1Z0-500 full version | 1Z0-493 exam | 1Z0-468 flashcards pdf | 1Z0-416 boson practice | 1Z0-342 academy | 1Z0-338 actual test | 1Z0-321 troytec | HPE0-S46 test questions | HPE0-S37 simulator download | HPE0-J77 pass tricks | HPE0-J76 exam questions & answers | HPE0-J75 passing score | CWAP-402 exam guide | C2090-625 actual test pdf | 9A0-367 simulation questions | 7693X aio testking | 7593X vce download | 70-764 exam dumps | 500-052 simulator download | 1Z0-443 answers | 1Z0-347 official certification guide | MA0-103 actual test pdf | JN0-1100 dumps in pdf | HPE2-Z38 simulator | E20-526 academic edition | CS0-001 lab manual | 9A0-381 elearningexams | 7750X exam leader | 7304 flashcards pdf | 70-742 test engine | 1Z0-404 free pdf | 156-730 download | MB2-716 pass tips | HPE2-W01 cheat sheet | HPE2-E68 guide | HPE2-E67 visual cert exam | 9A0-395 exam cost | 9A0-393 Answers Bank | 70-741 dumps in pdf | 210-255 passguide | 1Z0-337 vce files | 1Z0-330 syllabus | NSE8 answers | HPE2-T22 examcollections | FSDEV visual cert exam | C9520-403 exam leader | C9510-669 guaranteed success | C2150-463 study guide | C2090-621 | C2090-600 pass4sure download | 7230X pass4sure | 7220X official certification guide | 7130X new topics | 70-740 best study techniques | 202-400 exam papers | 201-400 examcollection | 1Z0-160 exam dumps | P5050-031 real-exams | OMG-OCRES-A300 study guide | NSE6 trainsignal | MA0-104 vce free | JN0-661 downloads | JN0-346 aio downloader | JN0-1330 flashcards pdf | E20-624 actual test pdf | E20-562 Sample Test | CPIM-BSP study island | C9520-929 lab workbook | C9520-928 Quiz | C9520-923 mock | C9520-911 cheat sheet | C9510-819 lab kit | C9050-549 examsokay | C9050-548 download | C9050-042 certification guide | C9010-262 training tips | C2090-136 pdf-archive | C2010-555 questions answers pdf | 9A0-409 exam time | 70-765 pdf-archive | 500-210 material pdf | 500-205 quick reference | 210-250 new topics | 1Z0-453 best study techniques | PEGACSA72V1 lab manual | M2150-756 official certification guide | JN0-1300 passing score | HPE2-T30 test-king | C9560-574 official cert guide pdf | C9560-568 self test | C9560-507 exam dumps | C9560-505 exam | C9560-503 Sample Study guide | C9550-605 bootcamp | C9520-423 kit | C9010-250 downloads | C8060-220 practice questions | C5050-287 network simulator | ASVAB pdf study guide | 7893X guaranteed success | 70-762 online tyari | 70-761 training videos | 70-743 dumps | 70-339 troytec | 600-455 kaplan test | 3C00120A simulation questions | 1Z0-479 questions and answers | 1Z0-066 accurate answers | TM12 visual cert exam | TA12 sybex | PR000007 passing skills | P9510-020 amazon | P9050-005 free pdf | P8060-002 exam answers | P8060-001 academy | P8010-088 pass4sure dumps | P8010-034 pass score | P8010-005 questions & answers with explanations | P8010-004 braindump | P6040-025 boot camp | P6040-017 study guide | P2180-089 official cert guide library | P2170-035 braindump | P2170-033 pdf download | P2140-022 testking pdf | P2140-020 sybex pdf | P2090-086 home lab | P2090-080 vce download | P2090-076 test questions | P2090-068 Question Bank | P2090-046 mock exam | P2090-045 best study techniques | P2090-011 objectives | P2090-010 test questions | P2070-072 training tips | P2070-053 ebook | P2065-037 blueprint | P2065-016 exam cost | P2065-013 dump | P2050-028 test inside | P2050-006 made easy | P2040-060 kaplan test | P2020-007 download | OG0-021 Sample Test Questions | NSE7 test questions | MSC-331 study tools | MSC-321 material pdf | M9560-760 test-king | M9560-727 pass guarantee | M9560-670 exam prep | M9560-231 MCQ | M9510-726 real-exams | M9510-664 cheat sheet pdf | M9510-648 certificationking | M9060-719 difficulty | M9060-616 passguide | M8060-730 syllabus pdf | M8060-655 vce files | M8010-246 exam fee | M8010-241 testking | M8010-238 official certification guide | M6040-520 pass tips | M6040-420 new questions | M6040-419 testinside | M2180-651 study guide pdf | M2140-726 questions & answers | M2140-649 study guide | M2140-648 recommended book | M2090-643 kickass | M2090-618 exam pdf | M2090-234 online test | M2080-663 exam answers | M2065-741 study tools | M2050-243 sybex pdf | M2020-645 downloads | M2020-620 notes | M2020-229 training tips | M2010-760 questions answers pdf | M2010-719 self test | ITILSC-OSA exam guide | HP5-Z02D notes | HP5-H09D pass-guaranteed | HP5-H07D free download | HP5-H03D exam cost | HP5-B05D vce free | HP2-N52 simulation questions | HP2-N43 Sample Test | HP2-K41 exam questions & answers | HP2-K39 actual test | HP2-H38 exam questions & answers | HP2-H37 free pdf | HP2-H30 prometric exam | HP0-M74 Question Answer Bank | HP0-M101 by examtut | HH0-350 testking | C9560-510 exam cost | C9550-400 is hard | C9060-518 discounted sale | C9010-030 free e-book | C7010-010 passing skills | C2180-279 free pdf | C2180-183 pdf download | C2150-200 test inside | C2140-820 download | A2040-951 sam learning | A2010-652 pearson vue | A2010-572 killtest | 499-01 questions and answers pdf | Wonderlic simulator | 250-412 book download | 250-411 Questions Bank | 250-410 training tips | 250-405 kaplan test | 250-272 blueprint | 250-254 test inside | PEGACDA71V1 network simulator | ACE free book | 1Z0-448 sam learning | 1Z0-435 examcollection | 1Z0-400 testinside | 1Z0-028 test questions | 77-420 killtest | 70-345 testking | NCLEX Sample Test | NBRC trainsignal | CNS questions answers pdf | 304-200 quiz questions | PCM certkingdom | P8010-003 examsokay | P2170-749 Sample Test Questions | P2170-037 pass tips | P2170-036 cheat sheets | P2090-054 actual test | P2080-088 pass guarantee | P2080-034 flashcards pdf | P2065-749 free pdf | P2060-017 pass-guide | P2060-002 training tips | P2050-007 exam questions & answers | P2050-005 dumps pdf | P2050-004 Sample Test | P2050-003 material pdf | M9510-747 test inside | M8060-729 transcender | M8010-242 exam engine | M6040-427 aio testking | M5050-716 questions answers pdf | M2150-810 latest dumps | M2150-753 training tips | M2150-728 accurate test | M2090-732 study guide | M2090-626 exam tricks | M2090-615 amazon | M2080-713 Sample Study guide | M2080-241 exam prep | M2065-659 free questions | M2065-647 cheat sheets | M2050-655 free questions | M2050-242 exam tips | M2040-724 studies | M2040-641 pass score | M2035-725 mock | M2010-649 sparknotes | M2010-616 sam learning | C9560-658 studies | C9560-023 objectives | C9550-273 q and a questions | C9530-404 visual cert exam | C9520-427 questions answers pdf | C9510-401 kickass | C9510-317 passcertification | C9060-509 study | C9030-634 discounted sale | C9030-633 Sample Question and Answer | C9020-971 practice quiz | C9020-970 new topics | C9020-461 free test engine | C9010-252 certkingdom | C9010-022 q and a questions | C8010-726 official cert guide | C8010-725 examcollection | C8010-241 actual test pdf | C8010-240 exam questions & answers | C5050-285 Sample Test | C5050-284 download | C5050-280 made easy | C2180-410 study help | C2150-508 exam questions & answers | C2090-930 simulator | C2090-645 dumps in pdf | C2090-642 download | C2090-180 study guide | C2090-013 accurate answers | C2090-011 killtest | C2040-985 guide | C2040-958 vce exam simulator | C2010-940 q and a questions | C2010-654 Sample Test | C2010-653 testking | C2010-517 answers | C2010-024 exam questions & answers | BAS-004 recommended book | A6040-752 exam | A4120-784 download | A2180-607 number of questions | A2160-667 test prep online | A2090-558 quick reference | A2090-421 dumps | A2040-986 self test | A2040-913 is percent of | A2040-441 official answers | A2040-440 simulator | A2040-412 syllabus | A2040-405 aio testking | A2040-403 objectives | A2010-599 pearson vue | A2010-578 passguide | A2010-573 bootcamp | A2010-564 troytec | A2010-538 dumps pdf | A2010-502 premium vce file | 000-198 study | 000-052 official cert guide pdf | HP3-F18 exam dumps | HP3-C36 simulator download | HP3-C33 questions & answers | HP3-C29 study tools | HP2-H40 exam questions & answers | HP2-H31 mock exam | HP0-Y52 pass tricks | HP0-M77 ebook | HH0-380 pass tricks | 106 pdf download | E20-368 how many questions | SK0-004 made easy | 1Y0-371 pass tricks | 700-703 dumps pdf | CA-Real-Estate study guide pdf | AND-403 full version | AND-402 exam time | GED exam tricks | 9A0-365 vce download | 9A0-351 tutorial | TEAS exam cost | COMPASS official cert guide library pdf | PMI-002 guide | SSAT Sample Study guide | 70-333 actual test | QIA actual test pdf | Property-and-Casualty free questions | PDDM killtest | PARCC pass score | HH0-300 guaranteed success |

See more dumps on Killexams

000-208 | CCRN | 1Z0-1007 | 000-797 | 000-200 | DVA-C01 | CAT-241 | E20-535 | C2090-619 | 4A0-106 | 5V0-21.19 | 000-990 | HP0-S18 | IC3-3 | CTFL-UK | 202-450 | 050-565 | 250-371 | 648-244 | 000-884 | 000-M46 | 1Z0-402 | HP0-J40 | C2090-461 | 000-224 | HP2-B88 | C4060-156 | LSAT-Logical-Reasoning | C9010-250 | HP2-H36 | CTEL | HP0-438 | EADE105 | C9560-515 | BCP-420 | 00M-608 | 000-M646 | DES-1721 | Google-ACE | HP0-M98 | 000-255 | 000-719 | UM0-401 | A2040-407 | FC0-U61 | PCNSA | 000-050 | HP2-H18 | A2010-577 | 000-417 |

NCC Questions and Answers


Question: 710

A 55-year-old man, admitted with a Hunt and Hess grade 4aneurysmal subarachnoid hemorrhage (SAH), is now post bleed day5 with increasing Transcranial Doppler (TCD) velocities. Meanarterial pressure (MAP) is 76 mmHg on norepinephrine 12mcg/min, up from 5 mcg/min 24 hours earlier, intracranial pressure(ICP) is 12 mmHg, and heart rate (HR) is 110/min with sinusvolume control mechanical ventilation receiving 7 mL/kg tidalvolume (TV) with positive end-expiratory pressure (PEEP) of 10White blood cell (WBC) count is 11,000 with a new infiltrate onchest x-ray (CXR); and serum creatinine has increased to 1.5mg/dL. Fluid balance over the past 24 hours is 2 L positive withgood urine output. In addition to sending blood cultures, lactate, andstarting antibiotics, how can volume status be assessed to determinewhether additional fluid is needed for adequate resuscitation?

  1. Bolus 2 L normal saline (NS) over 2 hours and assess change in

  2. Perform a straight leg raise and assess for change in cardiac

  3. Place a Swan-Ganz catheter given the presence of shock and

  4. Measure inferior vena cava size change during inspiration and

  5. Insert arterial line and measure pulse pressure or stroke volume

G. mmHArterial blood gas (ABG) reveals a PaO2/FiO2 ratio of 250.

Answer: B Explanation:

Our patient is in septic shock, which requires timely acquisition of cultures, lactic acid, initiating antibiotics, and fluid resuscitation. This question is focused on how to best determine whether a patient in shock has been adequately resuscitatedùa critical question, since too little fluid leads to inadequate preload, reduced cardiac output (CO) and oxygen delivery, and consequently tissue hypoperfusion. Conversely, excessive volume loading, without further increase in CO, would lead to hemodilution and tissue edema. Fluid overload has been associated with worse outcomes in critically ill patients, and current guidelines recommend frequent assessment for ongoing need for resuscitation prior to fluid administration. Fluid responsiveness can be assessed by several methods. Traditional static measures of cardiac preload, such as central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) are unreliable for predicting fluid responsiveness. Dynamic measures of cardiac preload, such as stroke volume variation (SVV) and pulse pressure variability (PPV) require an arterial line, and are excellent measures of volume responsiveness in shock patients - with some notable exceptions: spontaneous respiration; tidal volume (TV) <8 mL/kg; PEEP >5; low lung compliance (i.e., ARDS); and when arrhythmias are present. Our patient was spontaneously breathing, limiting the diagnostic accuracy of SVV/PPV. Variation in inferior vena caval size during mechanical ventilation, as measured by echocardiography, is another means of assessing fluid responsiveness, but seems to be less sensitive and specific than SVV/PPV, with similar limitations. A third technique involves an ôautotransfusion,ö by passively raising the legs to 40 degrees in a supine patient, which has been shown to be a sensitive and specific assessment for volume responsiveness, potentially even in spontaneously breathing patients, during low-tidal ventilation, and with cardiac arrhythmia.

Question: 711

An 18-year-old man admitted to the hospital with a gunshot woundto the head and intractable intracranial hypertension is being deescalatedfrom hyperosmolar therapy with hypertonic saline andpotassium is 2.0 mEq/L, despite having received approximately 120mEq of potassium chloride in replacement that day, and the urineoutput

has been consistently greater than 200 mL/hour. Additionalpertinent labs include Na 153 mEq/L, Mg 1.5 mEq/L, and HCO3 20mEq/L. You notice a change on the telemetry monitor and order aabnormality?

  1. Acute myocardial infarction (MI)

  2. Acute pulmonary embolism

  3. Hypokalemia

  4. Acidosis

  5. Hypothermia

G. stat ECWhat is the likely cause of this

Answer: C Explanation:

These ECG changes are typically seen with severe refractory hypokalemia. The earliest ECG changes associated with hypokalemia are a decrease in T-wave amplitude followed by a ST segment depression and T-wave inversions. Subsequently, the PR interval may be prolonged with an increase in amplitude of the P wave. U waves (a positive deflection after the T wave) may be seen and in severe hypokalemia may fuse with the T wave to form giant U waves as seen in the ECG. A pseudo-prolonged QT interval may be seen, which is actually a QU interval in the absence of a T wave. The most common cause of hypokalemia is renal losses after diuretic use (more commonly thiazide than loop or osmotic diuretics), especially if two diuretics acting on different parts of the tubular system are used. Patients who develop secondary hypoaldosteronism from liver disease, congestive heart failure (CHF), or nephrotic syndrome are also at risk. Antibiotics such as penicillins and aminoglycosides can promote potassium loss. In the neurocritical care setting, patients receiving mannitol or hypertonic saline infusions have been noted to develop hypokalemia because of the diuretic effect and as a consequence of the high-sodium load reaching the collecting ducts. For this reason some centers use potassium-sparing diuretics in conjunction with mannitol to avoid symptomatic hypokalemia in the setting of intracranial pressure (ICP) management. Hypokalemia can be refractory if concomitant hypomagnesaemia is not corrected. The exact etiology of this is not known, but it may be multifactorial. Low intracellular magnesium levels may increase potassium wasting from the collecting tubules, especially in the setting of additional factors such as an increase in distal sodium delivery. ECG changes in hypomagnesemia include an increased PR and QT interval, widened QRS complex, and flattened T wave. The findings can be identical to those seen in hypokalemia; however, in this case, the patientí»s potassium level is much lower than his magnesium level and, given the refractory nature of his disease, hypokalemia is the more likely cause. Hypothermia at 35íÒC (95íÒF) is associated with sinus tachycardia. As the core body temperature drops further (<90íÒF or 32íÒC), sinus bradycardia with prolongation of PR interval, QRS widening, and QT interval are seen. Osborn waves (an upward deflection after the QRS complex) are seen below 86íÒF or 30íÒC.

Question: 712

A 44-year-old morbidly obese woman with hypertension anddiabetes is found slumped over in a bathroom stall. At the scene, herblood pressure (BP) is documented at 180/90 with a pulse of 78; herblood sugar is 180 mmol/L. CT scan of the head is shown. What isthe likely cause of this patientÆs findings?

  1. Hypertensive intracerebral hemorrhage (ICH)

  2. Embolic stroke with hemorrhagic conversion

  3. Venous sinus thrombosis

  4. Aneurysmal subarachnoid hemorrhage (SAH)

  5. Hemorrhagic encephalitis

Answer: D


This axial CT scan of the head shows an intraparenchymal hemorrhage (IPH) with a sylvian SAH and a small subdural hematoma (SDH), with the outline of an aneurysm visible lateral to the IPH. Approximately 20% of patients with aneurysmal rupture have associated IPH, occurring more commonly in patients with anterior communicating artery (AComm), distal anterior cerebral artery, and distal middle cerebral artery (MCA) aneurysms. These patients present with callosal, interhemispheric, and sylvian/temporal hematomas. In addition, patients may have concurrent intraventricular hemorrhage (IVH) and SDH. Rarely, patients may present with IPH, IVH, or SDH without any evidence of SAH. In these cases, a history of thunderclap headache, absence of risk factors for IPH or IVH, and absence of a history of trauma should raise the suspicion of a saccular aneurysm. Likely causes of the absence of SAH are the location of the dome of the aneurysm close to the ventricular system or brain parenchyma and delayed presentation after the hemorrhage, with radiographic resolution of subarachnoid blood. Another theory is that the IPH/IVH may represent a rebleed after the subarachnoid space has been scarred down by a sentinel hemorrhage.

Question: 713

A 29-year-old C5ûC6 quadriplegic patient is being prepared fortransfer to a rehabilitation facility when you are paged for with thecondition?

  1. Permanent pacemaker

  2. PRN intravenous (IV) atropine

  3. PO albuterol

  4. PO theophylline

  5. All of the above

G. following findinWhat is an appropriate long-term therapy for this

Answer: E Explanation:

Patients with acute spinal cord injury suffer a myriad of complications of which pulmonary and cardiac are the most common. Among the cardiac complications, shock and hypotension occur early and are usually the reason for ICU admission in the first week after injury. Sinus bradycardia, dysrhythmia, and cardiac arrest can occur subsequently, usually within the first 14 days after injury. Acute spinal cord injury above T6 can disrupt the descending sympathetic pathways to the intermediolateral cell column in the T1-L2 spinal cord. This results in loss of supraspinal sympathetic control and unopposed parasympathetic activity in the respiratory and cardiac systems in quadriplegic patients, making them prone to prolonged episodes of bradycardia, pauses, and intermittent heart blocks, especially when suctioned or turned. Atropine should be readily available for patients with bradycardia, and

0.5 to 1 mg should be administered when symptomatic or prophylactically before suctioning. Oral albuterol and theophylline can be used to increase resting heart rate, although there are no randomized trials to support this. Some patients with significant heart block or recurrent cardiac arrests may require a permanent pacemaker.

Question: 714 Answer: C


The history of ovarian cancer and the diffuse leptomeningeal enhancement are suggestive of meningeal carcinomatosis. Meningeal carcinomatosis is seen in 1% to 5% of patients with solid tumors (commonly breast, nonsmall-cell lung cancer, and melanoma), 5% to 15% of patients with leukemia/lymphoma (leukemic/lymphomatous meningitis), and 1% to 2% of patients with primary brain tumors. Neurologic symptoms

usually localize to several regions of the neuraxis, with those involving the spinal cord and cauda equina being most common, followed by cranial neuropathies and hemispheric dysfunction. Patients often present with signs of hydrocephalus and elevated intracranial pressures (ICP). Diagnosis is made by having a high index of suspicion, meningeal enhancement (often most prominent in the basal meninges, dorsal spinal column, and cauda equina), cerebrospinal fluid (CSF) monocytosis, and isolating tumor cells in CSF on cytology. Although the latter is the gold standard, tumor cells are isolated in only 50% of samples on the first LP, with the yield increasing to 80% on the second puncture. There is no added benefit of subsequent LPs. Treatment is mostly palliative, with median survival of 2 to 3 months. Whole brain radiation therapy and intrathecal chemotherapy are the mainstays of treatment and may prevent further neurologic deterioration and improvement in quality of life. Supportive treatments such as antiepileptic medications, pain medications, and occasionally corticosteroids in patients with concomitant parenchymal disease should be prescribed. Millerû Fisher syndrome is a demyelinating cranial and peripheral neuropathy, which is a variant of GuillainûBarrÚ syndrome (GBS) and is defined by a triad of areflexia, ophthalmoplegia, and ataxia. Patients classically do not have signs of encephalitis or encephalopathy. Anti-GQ1b antibodies are present in 90% of patients. Bickerstaff brainstem encephalitis presents with ataxia, ophthalmoplegia, hyperreflexia, and alteration of consciousness. Hyperintense lesions are seen in the midbrain, pons, and medulla on MRI. A significant number of patients have evidence of concurrent axonal GBS, suggesting that this may be another variant of the disease. The progression of symptoms and MRI findings preclude pontine infarction, and the EEG does not support a diagnosis of NCSE.

Question: 715

A 67-year-old woman was transferred from an outside facility withoutside hospital with complaints of nausea, vomiting, ataxia, andprogressive lethargy. The patient had a history of ovarian cancer inremission for 3 years and was otherwise healthy. CT scan and MRIblood cell (WBC) count of 15 (40% N, 20% L, and 40% M), redblood cell (RBC) count 250, glucose 40, and protein 100. Allbacterial and viral cultures and polymerase chain reactions (PCRs)were negative, and she was empirically treated with acyclovir. Uponyour evaluation, the patient was comatose with sluggish pupillaryresponse, dysconjugate gaze, absent oculocephalic reflexes,extensor posturing bilaterally, and brisk reflexes. She was breathingrepeated and showed WBC 18 (100% M), RBC 50, glucose 28, andprotein 150. Serum glucose was 150 mg/dL. EEG revealedgeneralized delta and theta activity without rhythmicity. Brain MRIwith contrast is shown on the right. What is the most likely cause ofthe patientÆs condition?

  1. MillerûFisher syndrome

  2. Bickerstaff brainstem encephalitis

  3. Meningeal carcinomatosis

  4. Pontine infarction

  5. Nonconvulsive status epilepticus (NCSE)

Answer: C Explanation:

The history of ovarian cancer and the diffuse leptomeningeal enhancement are suggestive of meningeal carcinomatosis. Meningeal carcinomatosis is seen in 1% to 5% of patients with solid tumors (commonly breast, nonsmall-cell lung cancer, and melanoma), 5% to 15% of patients with leukemia/lymphoma (leukemic/lymphomatous meningitis), and 1% to 2% of patients with primary brain tumors. Neurologic symptoms usually localize to several regions of the neuraxis, with those involving the spinal cord and cauda equina being most common, followed by cranial neuropathies and hemispheric dysfunction. Patients often present with signs of hydrocephalus and elevated intracranial pressures (ICP). Diagnosis is made by having a high index of suspicion, meningeal enhancement (often most prominent in the basal meninges, dorsal spinal column, and cauda equina), cerebrospinal fluid (CSF) monocytosis, and isolating tumor cells in CSF on cytology. Although the latter is the gold standard, tumor cells are isolated in only 50% of samples on the first LP, with the yield increasing to 80% on the second puncture. There is no added benefit of subsequent LPs. Treatment is mostly palliative, with median survival of 2 to 3 months. Whole brain radiation therapy and intrathecal chemotherapy are the mainstays of

treatment and may prevent further neurologic deterioration and improvement in quality of life. Supportive treatments such as antiepileptic medications, pain medications, and occasionally corticosteroids in patients with concomitant parenchymal disease should be prescribed. Millerû Fisher syndrome is a demyelinating cranial and peripheral neuropathy, which is a variant of GuillainûBarrÚ syndrome (GBS) and is defined by a triad of areflexia, ophthalmoplegia, and ataxia. Patients classically do not have signs of encephalitis or encephalopathy. Anti-GQ1b antibodies are present in 90% of patients. Bickerstaff brainstem encephalitis presents with ataxia, ophthalmoplegia, hyperreflexia, and alteration of consciousness. Hyperintense lesions are seen in the midbrain, pons, and medulla on MRI. A significant number of patients have evidence of concurrent axonal GBS, suggesting that this may be another variant of the disease. The progression of symptoms and MRI findings preclude pontine infarction, and the EEG does not support a diagnosis of NCSE.

Question: 716

A 60-year-old patient with diabetes and hypertension is transferredto your ICU from another facility, where he was being treated forurosepsis. The patient has been on stable, low-dose vasopressors for4 days, is on antibiotics, and appears adequately volumenot received nutrition since his admission to the hospital 5 days agobecause he was on vasopressors. You would:

  1. Insert a feeding tube and advance to full dose tube feeds despite

  2. Order total parenteral nutrition (TPN)

  3. Order peripheral parenteral nutrition (PPN)

  4. Start a dextrose solutionùit should provide enough calories!

  5. Start trophic feeds through the gut at 10 to 20 mL/hour while he

Answer: A Explanation:

Initiation of enteral nutrition (EN) in critically ill patients is not always clear cut. It is preferable to use EN in critically ill patients as it reduces infectious complications, promotes enterocyte health while maintaining a strong mucosal barrier, and has a lesser stress response than parenteral nutrition (PN). However, there is concern that initiating EN in a patient with hemodynamic compromise and possible splanchnic vasoconstriction may promote nonocclusive mucosal ischemia (NOMI) due to increased oxygen demand. Turza et al. recommend a four-stage approach to initiating EN in patients requiring vasopressors: a. Evaluate the patientÆs medical and nutritional history. Patients with multiple vascular risk factors may be predisposed to NOMI, while those with poor nutritional response or high metabolic demand will benefit from early nutrition. b. Evaluate the current physiologic state.

Low-dose, nonescalating vasopressors in patients who are volume resuscitated and able to maintain a mean arterial pressure (MAP) greater than 60 should not deter the initiation of EN. Alternately, patients with dropping urine output, worsening lactate levels, and base deficit and those requiring frequent transfusions may not be able to tolerate EN. c. Establish gastrointestinal (GI) access and pick appropriate tube feeds. The use of formulas with lower osmolarity (<700 mOsm) and fiber content and simpler sugars will reduce metabolic demands, improve transit time, and reduce dysmotility, thereby alleviating factors which may result in the bacterial overgrowth that worsens NOMI. d. Postinitiation monitoring includes serial abdominal examinations and gastric residual checks. Laboratory monitoring of lactate, white blood cell counts, and hemoglobin levels or radiologic testing may be performed if there is concern for ileus. At times, a combination of trophic EN and supplemental PN is adopted as an intuitive compromise. This has been shown to increase the risk of nosocomial infections in a retrospective review of trauma patients.

Question: 717

A 40-year-old woman is admitted to the hospital after witnessedcardiac arrest for 20 minutes. Bystanders performed CPR untilwas initiated after admission to the hospital, and the patient wasnoted to have frequent

myoclonic jerks during rewarming.Brainstem reflexes were intact and the patient had flexor posturingto painful stimulation. MRI brain revealed scattered diffusionweightedimaging changes in the cortex but no damage to the deepstructures. EEG was performed and is shown in the following

  1. Have a family discussion regarding irreversible brain damage

  2. Load with an antiepileptic agent until myoclonic jerks stop since

  3. Continue EEG monitoring and titrate antiepileptic agents until

  4. Load with antiepileptic drugs until clinical myoclonus stops and

  5. Recool the patient and rewarm more slowly next time

Answer: C Explanation:

The EEG is consistent with postanoxic status epilepticus (PSE). Although this diagnosis usually portends a poor prognosis, the administration of therapeutic hypothermia (TH) to postcardiac arrest patients has made the prediction of outcomes based on American Academy of Neurology (AAN) criteria more difficult. In a prospective study by Rossetti et al., three clinical variables were demonstrated to have higher false-positive rates compared to the AAN guidelines: incomplete brainstem reflexes, myoclonus, and absent motor responses to pain. Early lack of reactivity on continuous EEG, prolonged periods of discontinuity, epileptiform discharges or seizures, and absent cortical responses on somatosensory evoked potentials (SSEP) were strongly associated with mortality. PSE is independently associated with a poor outcome after anoxic injury. However, in the presence of brainstem reflexes, SSEP responses, and EEG reactivity can have a favorable outcome if the condition is treated as status epilepticus (SE).

Question: 718

A 60-year-old woman with a history of hypertension presented witha cerebellar intraparenchymal hemorrhage (IPH), fourth ventricleintraventricular hemorrhage (IVH), hydrocephalus with partialbrainstem dysfunction, and somnolence on examination. She wasemergently taken for surgical decompression and did well. Aconventional angiogram was subsequently performed and is shownin the following images. Your next steps in management include allof the following, except:

  1. Wean external ventricular drain (EVD) and tightly control blood

  2. Use intrathecal tissue plasminogen activator (tPA) to allow quick

  3. Take a detailed family history

  4. Send genetic testing

  5. Continue outpatient, staged management of this condition

Answer: B Explanation:

The patient has multiple arteriovenous malformations (AVMs) warranting a detailed family history and genetic workup. Intrathecal tPA is contraindicated in this setting. Intracranial vascular malformations include developmental venous anomalies (DVA), capillary telangiectasias, AVM, and cavernous malformations, each of which have different natural histories and treatment options. ò Capillary telangiectasias are usually angiographically occult lesions, detected incidentally on contrast-enhanced MRI or CT scans, and are rarely symptomatic. They are benign, thin-walled capillaries surrounded by normal brain parenchyma, do not need treatment or follow-up, and account for 4% to 12% of all vascular malformations. De novo development has been reported. ò DVA also known as venous angiomas are congenitally enlarged, thickened, hyalinized venous vessels draining normal brain tissue. They are the most common intracranial vascular malformation, with a prevalence of

2.5%, discovered mostly incidentally and often associated with cavernous malformations. A causative link between the two has been suggested, with DVAs being a precursor to cavernous malformations. DVAs can be detected on MRI, CT scan, and angiogram as a single dilated vein or caput medusa. They usually have a benign clinical course with low morbidity and mortality and do not warrant treatment. ò AVMs are a collection of abnormal blood vessels, comprising arteries, veins, and an intervening collection of abnormal vessels called the nidus. They are congenital lesions with an incidence of 1 per 100,000, often presenting as an intracerebral hemorrhage (ICH) in the third to fourth decade. The bleeding risk varies according to size, location, draining pattern, and so on. Magnetic resonance angiography (MRA) and CT angiography (CTA) can both visualize AVMs; however, conventional angiography remains the gold standard for diagnoses, formulation, and implementation of a treatment plan which may include a combination of surgery, embolization, and radiation therapy. ò Cavernous malformations are acquired or congenital lesions formed by endothelium-lined vascular spaces without intervening brain parenchyma. They can be seen on CT and MRI as ôpopcornö-shaped dystrophic calcifications or hemosiderin deposits from prior hemorrhages. They are angiographically occult and most commonly present with seizures. Treatment is not always warranted, but surgical resection is often necessary if associated with recurrent hemorrhages or intractable epilepsy. ò Dural arteriovenous fistulas are malformations located in the meninges fed by dural arteries and drained by dural or leptomeningeal venous channels. The most common location is the transverse sinus. They can develop after trauma, venous thrombosis, or spontaneously, and account for 10% to 15% of all cranial malformations. Clinical presentation includes headache, neurologic deficits, bruits, and hemorrhage, with a cortical drainage pattern consistent with more aggressive behavior. Sixvessel cerebral angiogram remains the gold standard in diagnosing a fistula. Treatment includes endovascular or surgical interventions, with surgery being the more definitive approach.

Question: 719

A 35-year-old, 2 days postpartum woman had sudden onset of thethe ED was 180/90, and she was somnolent but had a nonfocalneurologic examination. Opening pressure was normal on lumbarpuncture (LP), and cerebrospinal fluid (CSF) was clear with normalchemistries and cell count. Imaging studies are shown in thefollowing images. What is the most likely diagnosis?

  1. Eclampsia/preeclampsia

  2. Posterior reversible encephalopathy syndrome (PRES)

  3. Venous sinus thrombosis

  4. Reversible cerebral vasoconstriction syndrome (RCVS)

  5. SheehanÆs syndrome

Answer: D Explanation:

RCVS unifies a group of disorders with similar clinical and radiographic characteristics, such as CallûFleming syndrome, benign angiopathy of the central nervous system (CNS), migrainous angiitis, drug-induced cerebral angiopathy (selective serotonin reuptake inhibitors [SSRIs], marijuana), and postpartum angiopathy (hormonal changes, serotonergic surge). Typically, patients present with a thunderclap headache with or without focal neurologic signs, normal CSF analysis without evidence of CNS inflammation, exclusion of other causes of sudden severe headache (aneurysm or vascular abnormalities), and presence of segmental cerebral arterial vasoconstriction on catheter, CT, or magnetic resonance angiography (MRA), which resolves within 12 weeks. Cortical (nonaneurysmal) subarachnoid hemorrhage (SAH) is the most common radiographic finding. The gold standard for diagnosis is detecting the presence and subsequent resolution of segmental vasoconstriction on conventional angiography. In most cases the vascular changes resolve without treatment. Calcium channel blockers (nimodipine, verapamil), glucocorticoids, and intravenous (IV) magnesium have been tried with limited success. Although the course is usually benign, severe vasospasm has been reported resulting in transient ischemic attacks (TIAs), seizures, and ischemic and hemorrhagic infarctions. Intraarterial milrinone and verapamil as well as angioplasty have been attempted with some success in severe or refractory cases. Preeclampsia is defined as pregnancy-induced hypertension with proteinuria, but there is no information about urine studies in this case and the condition is not

associated with the imaging findings of cerebral vasoconstriction. Eclampsia, a life-threatening condition occurring in pregnancy or early puerperium, is the occurrence of a tonicûclonic seizure in the setting of preeclampsia. Treatment includes IV magnesium to a goal of 4 to 7 mEq/L (4û6 g IV loading dose, then 1û2 g/hour), BP control with IV hydralazine or labetalol, and emergent termination of pregnancy. If the patient continues to have seizures, the dose of magnesium may be increased (with close observation for respiratory failure or heart block). IV anticonvulsants and mechanical ventilation can be initiated in refractory cases. PRES is characterized by headache, confusion, seizures, and visual loss with acute subcortical and cortical edema on MRI. Although classically seen in the parietooccipital lobes, brainstem, and cerebellum, the edema can extend as far anteriorly as the temporal and frontal lobes. PRES can be seen in the setting of malignant hypertension, eclampsia, hypercalcemia, and due to drugs such as tacrolimus and cyclosporine. SheehanÆs syndrome, or postpartum pituitary necrosis, is a complication of postpartum hypovolemic shock resulting in panhypopituitarism. The most common presenting symptom is agalactorrhea.

Question: 720

An 18-year-old G1P0 woman presented with a severe headachebehind her right ear, followed by a left-sided tingling sensation andmonitoring and treatment while she continues to have frequentcomplex partial seizures. On examination, she is awake, butsomnolent with left-sided hemiparesis. Imaging studies are shown

  1. Eclampsia/preeclampsia

  2. Posterior reversible encephalopathy syndrome (PRES)

  3. Cerebral venous sinus thrombosis (CVST)

  4. Reversible cerebral vasoconstriction syndrome (RCVS)

  5. SheehanÆs syndrome

Answer: C Explanation:

CVST is a rare disorder affecting 3 to 4 adults per million annually. With the increasing use of oral contraceptives (OCP) in the past few decades, the disease has become more prevalent in adult women of child-bearing age with an almost sixfold increase in the risk of CVST among OCP users. This is followed by patients with inherited thrombophilia, hypercoagulability associated with pregnancy and puerperium, and head and neck infections. Presentation is varied and dependent on the location and extent of venous involvement. Headache is a ubiquitous presenting complaint, accompanied by seizures in 47% and paresis in 43% of patients. The majority of patients have an indolent course with symptoms developing over days to months. Rarely, they may resemble an arterial infarction but with a waxing and waning course. Focal edema and infarctions are often seen when cortical veins are involved. Larger infarctions and hemorrhages are associated with worsening mental status and coma. Abnormal signal change in the venous sinus on MRI with concomitant loss of flow on magnetic resonance venography (MRV) is diagnostic. Treatment includes systemic anticoagulation with weight-based low molecular weight heparin or unfractionated heparin with transition to vitamin K antagonists to a goal International Normalized Ratio (INR) of 2 to 3 for 3 to 6 months. Patients with a history of deep vein thrombosis (DVT) or recurrent CVST will need indefinite treatment. Intraparenchymal hemorrhage (IPH) is not a contraindication to anticoagulation in this population. Local administration of endovascular thrombolysis has been reported, but there is insufficient efficacy or safety data available to justify its utility in patients who are not refractory to systemic anticoagulation. Decompressive hemicraniectomy can be performed in the setting of malignant cerebral edema with reasonable outcomes. Over 80% of the patients have favorable recovery. Mortality of 7% to 13% is seen within the first month, usually due to cerebral edema in the acute phase or due to underlying cause on subsequent follow-up.

Question: 721

A 65-year-old alcoholic with traumatic brain injury (TBI), bifrontalcontusions, and right-sided epidural hematoma

with midline shiftand uncal herniation is admitted to your ICU. After initialdecompression, intracranial pressure (ICP) remained within normallimits. Four days postoperatively, the patient is now off all sedationwithdraws on the right, and flexes on the left. What is the cause of hispoor mental status?

  1. Bifrontal injury

  2. Diffuse axonal injury

  3. Persistent effects of midline shift after initial injury

  4. Nonconvulsive status epilepticus (NCSE)

  5. All of the above

Answer: E Explanation:

The patient has suffered a severe head injury with multiple contusions, cerebral edema, and herniation. Individually, each of these conditions can result in a persistent comatose state. In addition, the patient is having nonconvulsive focal seizures, which may be contributing to the encephalopathy. The growing recognition of nonconvulsive seizures (NCS) in the critically ill population and the need for treatment has been a topic of debate in recent years. Are these seizures a cause of the encephalopathy or simply a manifestation of the dying brain? Similarly, should they be aggressively treated with the hope of resolution of coma or are they a hallmark of irreversible brain injury and a poor prognostic sign? Although case reports supporting both arguments exist, these questions are yet to be answered in a randomized controlled trial. Additionally, many reports of NCSE lump together patients who are delirious with patients who are deeply comatose in the setting of NCS, making it all the more difficult to establish prognosis. Until the availability of further evidence, the best way to approach these situations is to look at the entire clinical picture. Aggressive treatment, with its risks, may be warranted if the clinical picture looks worse than can be explained by the level of injury. Similarly, in the setting of a devastating injury, administration of further sedatives to treat focal NCSE may not be worthwhile.

Question: 722

A 46-year-old man is admitted to your ICU after facial assault witha penetrating object through his orbit. You are called to the bedsideon postop day 1 after removal of the object because the patient is insevere pain. Upon your examination, the eye is swollen, injected,movements are difficult to assess because of pain. He has lightperception on visual acuity, which is unchanged from the time ofpresentation. What is the most likely diagnosis?

  1. Orbital cellulitis

  2. Orbital hematoma

  3. Cavernous sinus thrombosis

  4. Carotid-cavernous fistula (CCF)

  5. Orbital compartment syndrome

G. and pulsatinThe pupil is minimally reactive and extraocular

Answer: D Explanation:

The patient has a CCF, which is an abnormal communication between the arterial and venous blood within the cavernous sinus and is characterized by pain, chemosis, pulsatile proptosis, ocular bruit, and progressive vision loss. The most common form of CCF is a direct communication between the internal carotid artery (ICA) and cavernous sinus (type A) usually as a result of trauma (young males) or aneurysm rupture (older women). Traumatic CCFs are the most common type, accounting for 75% of all CCFs, and occur in 0.2% of all head trauma and 4% of basilar skull fractures. Conventional angiogram is the gold standard for diagnosis. Endovascular

transvenous embolization of the fistula while maintaining patency of the ICA is the mainstay of treatment, with greater than 80% cure rates at 1 year. Symptoms of chemosis and proptosis usually resolve within hours to days of intervention, while cranial nerve (CN) palsies may persist for a few weeks. Visual loss may or may not be reversed depending on the degree of blindness at presentation and the underlying cause. Cavernous sinus thrombosis is a close differential diagnosis and usually presents with ptosis, chemosis, proptosis, CN palsies, vision loss, and a dilated, sluggishly reactive pupil. The most common etiology is infectious with direct spread from the nose, sinuses, or teeth. Diagnosis is made by clinical findings, MRI, and magnetic resonance venography (MRV), and treatment includes intravenous (IV) antibiotics and close monitoring for complications such as meningitis, vision loss, sepsis, or septic emboli. Orbital cellulitis is a bacterial infection of the tissues surrounding the eye, including eyelids, eyebrows, and cheeks, resulting in swelling of the eyelids, pain with eye movements, fever, and decreased vision if not treated promptly. Orbital hematomas can be preseptal or postseptal. Preseptal hemorrhages are usually posttraumatic and benign, resulting in extensive ecchymoses of the eyelids. Postseptal hemorrhages may occur due to trauma, surgical intervention, arteriovenous malformations, or bleeding diathesis, among other causes, and can lead to orbital compartment syndrome with increase in intraocular pressures and vision loss from orbital nerve compression.

Question: 723

A 78-year-old man with a history of hypertension, hyperlipidemia,and mild hearing loss is brought to the hospital by ambulance after amotor vehicle accident. He is intubated in the ED for airwayprotection and undergoes massive blood transfusion forhemorrhagic shock. He is admitted to the ICU. Which of thefollowing reduces the risk of delirium in the ICU?

  1. Benzodiazepine-induced coma

  2. Mechanical ventilation

  3. Polytrauma

  4. Metabolic acidosis

  5. Sedation with dexmedetomidine

Answer: E Explanation:

A systematic review identified eleven risk factors for developing delirium in the ICU. These included age, dementia, hypertension, poly-trauma, emergency surgery prior to ICU admission, sedative-induced coma, delirium on the day prior, use of mechanical ventilation, metabolic acidosis, multi-organ failure and APACHE II score. Factors that were clearly associated with reduction in delirium were dexmedetomidine. It is unclear if this was a physiological effect of the drugs itself or because dexmedetomidine use was associated with less benzodiazepine use.

Question: 724

A 65-year-old man with a history of hypertension andhyperlipidemia is found down at home by his son at 6 p.m. after hedoes not show up at his granddaughterÆs birthday. He was last seenvital signs are blood pressure (BP) 178/92 mmHg, heart rate (HR)examination, the HR is irregularly irregular. He is awake butaphasic with right lower facial droop and flaccid right arm. Hisinitial National Institutes of Health Stroke Scale (NIHSS) score is18. A noncontrast CT scan of the brain shows loss of grey-whitematter differentiation in the left frontal lobe and hypoattenuation ofCT angiogram of the head shows an occlusion of the first segmentof the middle cerebral artery (MCA); and perfusion CT estimates aninfarct size of 28 mL. At baseline, the patient is independent withnext step in management?

  1. Start aspirin 325 mg. Patient is not eligible for either intravenous

  2. Initiate IV thrombolysis with alteplase based on neuroimaging

  3. Proceed with endovascular thrombectomy based on mismatch

  4. Initiate IV thrombolysis with alteplase followed by endovascular

  5. Need to calculate the ratio of the volume of ischemic tissues on

Answer: C Explanation:

The patient is out of 4.5-hour time window for IV thrombolysis. However, he is a candidate for endovascular thrombectomy based on the recent DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo (DAWN) trial. In this trial, patients with occlusion of the intracranial internal carotid artery (ICA) or proximal middle cerebral artery (MCA) who had last been known to be well 6 to 24 hours earlier and showed evidence of salvageable brain tissue were randomly assigned to thrombectomy plus standard care (the thrombectomy group) or to standard care alone (the control group). Enrolled patients had good premorbid baseline defined as modified Rankin scale (mRS), 0 to 1. Infarct volume was assessed on diffusion-weighted imaging (DWI) sequence of brain MRI or perfusion CT scan using the automated RAPID software. Presence of salvageable brain tissue was based on a mismatch between severity of their neurological deficits and the volume of infarcted brain, and not the ratio of the volume of ischemic tissue at risk to infarct volume: DAWN trial measured ôutility-weighted mRSö at 90 days as the primary outcome. In contrast to mRS, a lower score in ôutilityweighted mRSö indicates a better outcome (ranges from 0 = death to 10 = no deficits). At 90 days, the ôutility-weighted mRSö was 5.5 for the thrombectomy group compared to 3.4 in the control group, and 49% of patients in the thrombectomy group achieved functional independence versus only 13% in the control group. These translate to number-to-treat (NTT) of 2 and 2.8 for less disability and functional independence at 90 days, respectively. Rate of procedurerelated complications was very low. Serious adverse events including mortality and stroke-related death at 90 days as well as and symptomatic intracerebral hemorrhage (ICH) were similar between the two groups.

Question: 725

A 72-year-old woman with a past medical history of diabetes,hypertension, hyperlipidemia, and atrial fibrillation on warfarinpresents to the ED with a new severe dysarthria, left-sidedweakness, and neglect (National Institutes of Health Stroke Scale[NIHSS] score 17). Her vital signs are blood pressure (BP) 169/83mmHg, heart rate (HR) 87/min, respiratory rate (RR) 18/min, and1.3. She was last seen 12 hours prior to presentation. MRI of thebrain shows an acute stroke in the territory of the right middlecerebral artery (MCA) without evidence of intracranial hemorrhage.Infarct volume on diffusion-weighted imaging (DWI) is measured48 mL; and volume of ischemic tissue on MRI perfusion scan iscalculated as 110 mL. Magnetic resonance angiography (MRA)treatment for her stroke?

  1. Start intravenous (IV) alteplase infusion based on clear evidence

  2. Start heparin drip with a goal partial thromboplastin time (PTT)

  3. Start warfarin for secondary stroke prevention

  4. Immediate endovascular thrombectomy

  5. Start aspirin 325 mg

Answer: D Explanation:

The patient is not a candidate for IV alteplase as she presents out of 4.5-hour treatment time window. However, she is a candidate for endovascular thrombectomy. In DEFUSE 3 trial, patients 6 to 16 hours after they were last known to be well who had a proximal MCA or internal carotid artery (ICA) occlusion, an initial infarct size of less

than 70 mL, and a ratio of the volume of ischemic tissue on perfusion imaging to infarct volume of 1.8 or more were randomly assigned to thrombectomy plus standard medical therapy (thrombectomy group) or standard medical therapy alone (control group). Thrombectomy was associated with better functional outcomes (odds ratio, 2.77) and lower mortality (14% vs. 26% in the control group) without a difference in symptomatic intracranial hemorrhage or serious adverse events.

Question: 726

A 70-year-old man is admitted to the neurointensive care unit foraneurysmal subarachnoid hemorrhage (SAH). He is intubated onmechanical ventilation. On day 3 of admission, he develops septicshock. He is fluid resuscitated and broad-spectrum antibiotics withearly and aggressive treatment, 12 hours later, he remainshemodynamically unstable necessitating escalating doses ofnorepinephrine (>1 mg per hour) to maintain a systolic blooddecrease vasopressor requirement and mortality in septic shock?

  1. Switch antibiotics to linezolid plus meropenem

  2. Add vasopressin infusion

  3. Add intravenous (IV) infusion of hydrocortisone 200 mg per day

  4. Add oral fludrocortisone 50 mcg daily

  5. Add IV hydrocortisone 50 mg 4 times a day plus fludrocortisone

G. pressure (SBP) >90 mmHWhich intervention has been shown to

Answer: E Explanation:

Two recent trials (ADRENAL and APROCCHSS) studied the effects of adjunctive glucocorticoid therapy and glucocorticoid + mineralocorticoid therapy in patients with septic shock. In the former study, 3,800 patients with septic shock who were undergoing mechanical ventilation were randomized to receive hydrocortisone (at a dose of 200 mg per day) or placebo for 7 days (or until death or discharge from the ICU). Although patients in the hydrocortisone group had faster resolution of shock (3 days vs. 4 days in the control group), no significant between-group difference was found in mortality. In APROCCHSS, the effect of hydrocortisone plus fludrocortisone in patients with septic shock was compared to the placebo. Mortality was significantly lower in the hydrocortisone-plus-fludrocortisone group than in the placebo group at ICU and hospital discharge, and at 90 and 180 days. In addition, hydrocortisone plus fludrocortisone therapy increased the number of vasopressorfree and organ-failure-free days without increasing the rate of serious adverse events except for hyperglycemia.

Certification-Board NCC Exam (Certified in NeuroCritical Care (ABEM)) Detailed Information

NCC answers | NCC free pdf | NCC pdf download | NCC test questions | NCC practice questions | NCC results | NCC academy | NCC pearson vue | NCC exam papers | NCC exam time | NCC study guide | NCC study island | NCC case study | NCC studies | NCC guide | NCC study | NCC exam | NCC dump | NCC cheat sheet | NCC cheat sheets | NCC cheat sheet pdf | NCC pdf download | NCC download | NCC downloads | NCC pdf | NCC free pdf | NCC test prep | NCC bootcamp | NCC boot camp | NCC study tools | NCC camp | NCC quiz questions | NCC sparknotes | NCC notes | NCC actual test | NCC questions & answers | NCC answers | NCC amazon | NCC questions answers pdf | NCC actual test | NCC academic edition | NCC actual test pdf | NCC exam questions & answers | NCC exam answers | NCC braindump | NCC book pdf | NCC book download | NCC blueprint | NCC blog | NCC by examtut | NCC dumps | NCC dumps pdf | NCC study guide | NCC exam cost | NCC dumps pdf | NCC download | NCC difficulty | NCC download | NCC dumps pdf | NCC dumps free download pdf | NCC pdf download | NCC pass4sure download | NCC download | NCC exam cost | NCC exam dumps | NCC exam fee | NCC exam questions & answers | NCC ebook | NCC exam voucher | NCC exam cram | NCC exam pdf | NCC ebook download | NCC flash cards | NCC frame relay | NCC flashcards pdf | NCC free download | NCC free dumps | NCC free ebook | NCC study guide | NCC study guide pdf | NCC exam guide | NCC certification guide | NCC cert guide | NCC how many questions | NCC home lab | NCC is hard | NCC dumps in pdf | NCC is percent of | NCC killtest | NCC kickass | NCC kit | NCC kindle | NCC lab kit | NCC latest dumps | NCC lab manual | NCC lab workbook | NCC lab questions | NCC mock | NCC mock exam | NCC material pdf | NCC study material | NCC network simulator | NCC new topics | NCC simulator download | NCC number of questions | NCC new questions | NCC official cert guide pdf | NCC objectives | NCC official cert guide | NCC official cert guide library | NCC official cert guide library pdf | NCC official certification guide | NCC online test | NCC passing score | NCC premium vce file | NCC pass4sure | NCC practice questions | NCC practice test | NCC pdf study guide | NCC pass4sure dumps | NCC questions & answers with explanations | NCC questions & answers | NCC questions answers pdf | NCC questions and answers | NCC quick reference | NCC questions and answers pdf | NCC exam questions & answers | NCC recommended book | NCC syllabus | NCC study guide pdf | NCC simulator | NCC simulation questions | NCC syllabus pdf | NCC sybex | NCC sybex pdf | NCC testking | NCC testking pdf | NCC training videos | NCC trainsignal | NCC tutorial | NCC vce files | NCC vce download | NCC vce free | NCC examcollection | NCC exam prep | NCC pass-guaranteed | NCC exam engine | NCC test engine | NCC test questions | NCC pass guarantee | NCC prometric exam | NCC pearson vue | NCC exam cram | NCC study help | NCC correct answers | NCC pass score | NCC passguide | NCC pass-guide | NCC test-king | NCC official answers | NCC cert guide | NCC exam success | NCC training tools | NCC training tips | NCC pass tips | NCC pass tricks | NCC exam tips | NCC exam tricks | NCC exam leader | NCC transcender | NCC visual cert exam | NCC exam collection | NCC examcollection | NCC exam objectives | NCC passing skills | NCC free questions | NCC free answers | NCC free pdf | NCC free test engine | NCC free book | NCC free e-book | NCC accurate questions | NCC accurate test | NCC accurate answers | NCC practice quiz | NCC Quiz | NCC MCQ | NCC made easy | NCC discounted sale | NCC boson practice | NCC guaranteed success | NCC self test | NCC kaplan test | NCC troytec | NCC sam learning | NCC q and a questions | NCC aio downloader | NCC vce exam simulator | NCC nbcot exam prep | NCC online tyari | NCC test prep online | NCC aio testking | NCC best study techniques | NCC Question Bank | NCC Question Bank | NCC Questions Bank | NCC Question Answer Bank | NCC Answers Bank | NCC Sample Questions | NCC Sample Question and Answer | NCC Sample Test | NCC Sample Test | NCC Sample Test Questions | NCC Sample exam | NCC Sample Study guide | NCC full version | NCC updated questions | NCC test inside | NCC testinside | NCC elearningexams | NCC passleader | NCC examcollections | NCC exambraindumps | NCC certkingdom | NCC pdf-archive | NCC passcertification | NCC examsokay | NCC getfreedumps | NCC real-exams | NCC actualtests | NCC certificationking | NCC examsking |

Free PDF Download


Free Download NCC PDF Dumps
Free Download Killexams Certification Exam Dumps
Killexams Certification Exam Questions and Answers - amongtheway
Killexams Exam Study Notes, study guides -
Killexams Certification Exam Questions and Answers -
Killexams Exam Study Notes, study guides -
Killexams Certification Exam Questions and Answers - Puntotecnia
Killexams Exam Study Notes, study guides - Puntotecnia
Killexams Certification Exam Questions and Answers
Killexams Exam Study Notes, study guides
Killexams Certification Exam Questions and Answers and Study Notes
Killexams Exam Study Notes, study guides, QA
Killexams Exam Study Notes
Killexams Certification Exam Study Notes
Killexams Certification Exam Study Notes
Killexams Certification Exam Study Notes
Download Hottest Killexams Certification Exams - CSCPK
Here you will find Real Exam Questions and Answers of every exam -
Study notes to cover complete exam syllabus -
Killexams Exams Download Links -
Killexams Study Guides and Exam Simulator -
Killexams Study Guides and Exam Simulator -
Killexams Study Guides and Exam Simulator - (c) 2017-2021