COMMON DIAGNOSIS AND MANAGEMENT IN
ACUTE CARE PRACTICUM EXAM PAPER 2026
QUESTIONS AND ANSWERS GRADED A+
◉ Indications of lumbar puncture Answer: CSF sample for
examination; pressure measurements (NPH); reduction in CSF
pressure:; -infections; -SAH; -Inflammatory conditions; -MS; -
carcinomatosis; Spinal anesthetics, antitumor agents, antibiotics;
radio-opaque substance radioactive agent:; -cryptococcal
meningitis; -hydrocephalus with communication between all
ventricles; -pseudotumor cerebri; -drug administration; Imaging; -
myelography; -radionuclide cisternography
◉ Contraindications of performing LP Answer: • Increased risk of
fatal cerebellar or transtentorial herniation; • Coagulopathy; •
Infection over puncture site; • Spinal block requiring sample above
lesion
◉ Common complications of lumbar puncture Answer: -Sciatic pain
during needle insertion; -Slowing of fluid removal (elevate patient
head)
◉ How is chronic meningitis diagnosed? Answer: On LP/CSF
analysis or contrast MRI/CT showing leakage into meninges.
Meningeal biopsy if CSF not diagnostic.
,◉ Differentials for chronic meningitis Answer: -Partially treated
suppurative meningitis; -Paranmeningeal infection; -Mycobacterium
TB; -Lyme; -Syphilis; -HIV; -HSV; -Malignancy; -SLE; -Behcet's
◉ Indications for swallow evaluation Answer: -Hx of dysphasia; -
Observed dysphasia; -Suspected aspiration; -Decreased oral intake; -
Parenteral/enteral feeding
◉ Medicare coverage of hospice Answer: • Prognosis of six months
or less if illness runs normal course; • Falls under Medicare Part A
◉ Three common causes of acute ischemic stroke Answer: 1- Anoxic
injury; 2- Thrombosis in situ; 3- Thrombotic embolism
◉ In ischemic stroke, what area of damage is irreversible? Answer:
Tissue death at occluded artery (infarction core)
◉ Penumbra Answer: Area around infarct, salvageable if blood flow
restored
◉ Risk factors for ischemic stroke Answer: -Advanced age; -HTN
,◉ More risk factors for ischemic stroke Answer: -HLD, DM, oral
contraceptives, obesity, prior TIAs, tobacco, MI, alcohol, sedentary
lifestyle, sickle cell, stimulant drugs, family hx CVA, cardiac
abnormalities
◉ Subjective signs of ischemic stroke Answer: -Decreased LOC,
dysarthria, facial droop, aphasia, diplopia, visual deficits, sensory
deficits, ataxia, hemiparesis, vertigo
◉ Critical timeline info for CVA Answer: "Last known well"
◉ BE FAST Answer: Balance, Eyes, Face, Arms, Speech, Time
◉ ACA Answer: Anterior cerebral artery
◉ MCA Answer: Middle cerebral artery
◉ PCA Answer: Posterior cerebral artery
◉ Objective symptoms of ACA stroke Answer: -Urinary
incontinence; -Speech perseveration; -Disinhibition; -Gait apraxia; -
Primitive reflexes; -Altered mental status; -Impaired judgment; -
Contralateral leg>arm weakness
, ◉ Objective symptoms of MCA stroke Answer: -Gaze preference; -
Agnosia; -Ipsilateral hemianopsia; -Contralateral
hemiparesis/hypesthesia
◉ Objective symptoms of PCA stroke Answer: -Impaired memory; -
Cortical blindness; -Altered mental status; -Contralateral
homonymous hemianopsia; -Visual agnosia
◉ Visual agnosia Answer: Inability to recognize objects
◉ Contralateral homonymous hemianopsia Answer: Loss of vision in
contralateral visual field
◉ Contralateral hypesthesia Answer: Decreased touch perception on
one side
◉ Agnosia Answer: Inability to recognize familiar objects
◉ DDx for ischemic stroke Answer: -Drug toxicity; -Brain tumors; -
Hypertensive encephalopathy; -Conversion disorder
◉ Conversion disorder Answer: Somatoform disorder with real
symptoms and no physiological basis
ACUTE CARE PRACTICUM EXAM PAPER 2026
QUESTIONS AND ANSWERS GRADED A+
◉ Indications of lumbar puncture Answer: CSF sample for
examination; pressure measurements (NPH); reduction in CSF
pressure:; -infections; -SAH; -Inflammatory conditions; -MS; -
carcinomatosis; Spinal anesthetics, antitumor agents, antibiotics;
radio-opaque substance radioactive agent:; -cryptococcal
meningitis; -hydrocephalus with communication between all
ventricles; -pseudotumor cerebri; -drug administration; Imaging; -
myelography; -radionuclide cisternography
◉ Contraindications of performing LP Answer: • Increased risk of
fatal cerebellar or transtentorial herniation; • Coagulopathy; •
Infection over puncture site; • Spinal block requiring sample above
lesion
◉ Common complications of lumbar puncture Answer: -Sciatic pain
during needle insertion; -Slowing of fluid removal (elevate patient
head)
◉ How is chronic meningitis diagnosed? Answer: On LP/CSF
analysis or contrast MRI/CT showing leakage into meninges.
Meningeal biopsy if CSF not diagnostic.
,◉ Differentials for chronic meningitis Answer: -Partially treated
suppurative meningitis; -Paranmeningeal infection; -Mycobacterium
TB; -Lyme; -Syphilis; -HIV; -HSV; -Malignancy; -SLE; -Behcet's
◉ Indications for swallow evaluation Answer: -Hx of dysphasia; -
Observed dysphasia; -Suspected aspiration; -Decreased oral intake; -
Parenteral/enteral feeding
◉ Medicare coverage of hospice Answer: • Prognosis of six months
or less if illness runs normal course; • Falls under Medicare Part A
◉ Three common causes of acute ischemic stroke Answer: 1- Anoxic
injury; 2- Thrombosis in situ; 3- Thrombotic embolism
◉ In ischemic stroke, what area of damage is irreversible? Answer:
Tissue death at occluded artery (infarction core)
◉ Penumbra Answer: Area around infarct, salvageable if blood flow
restored
◉ Risk factors for ischemic stroke Answer: -Advanced age; -HTN
,◉ More risk factors for ischemic stroke Answer: -HLD, DM, oral
contraceptives, obesity, prior TIAs, tobacco, MI, alcohol, sedentary
lifestyle, sickle cell, stimulant drugs, family hx CVA, cardiac
abnormalities
◉ Subjective signs of ischemic stroke Answer: -Decreased LOC,
dysarthria, facial droop, aphasia, diplopia, visual deficits, sensory
deficits, ataxia, hemiparesis, vertigo
◉ Critical timeline info for CVA Answer: "Last known well"
◉ BE FAST Answer: Balance, Eyes, Face, Arms, Speech, Time
◉ ACA Answer: Anterior cerebral artery
◉ MCA Answer: Middle cerebral artery
◉ PCA Answer: Posterior cerebral artery
◉ Objective symptoms of ACA stroke Answer: -Urinary
incontinence; -Speech perseveration; -Disinhibition; -Gait apraxia; -
Primitive reflexes; -Altered mental status; -Impaired judgment; -
Contralateral leg>arm weakness
, ◉ Objective symptoms of MCA stroke Answer: -Gaze preference; -
Agnosia; -Ipsilateral hemianopsia; -Contralateral
hemiparesis/hypesthesia
◉ Objective symptoms of PCA stroke Answer: -Impaired memory; -
Cortical blindness; -Altered mental status; -Contralateral
homonymous hemianopsia; -Visual agnosia
◉ Visual agnosia Answer: Inability to recognize objects
◉ Contralateral homonymous hemianopsia Answer: Loss of vision in
contralateral visual field
◉ Contralateral hypesthesia Answer: Decreased touch perception on
one side
◉ Agnosia Answer: Inability to recognize familiar objects
◉ DDx for ischemic stroke Answer: -Drug toxicity; -Brain tumors; -
Hypertensive encephalopathy; -Conversion disorder
◉ Conversion disorder Answer: Somatoform disorder with real
symptoms and no physiological basis
