Rosh Emergency Medicine Practice Test

An 82-year-old man presents with altered mental status and a prior fall. The CT scan reveals a specific type of hemorrhage. What is the likely diagnosis?

1. Epidural hematoma

2. Left cortical infarction

3. Subarachnoid hemorrhage

4. Subdural hematoma

The correct answer is: Subdural hematoma

The diagnosis of a subdural hematoma is particularly likely in an elderly patient presenting with altered mental status after a fall. In this age group, the brain may undergo atrophic changes, which can lead to increased stretching of the bridging veins. A fall, even if minor, can result in a shearing force that ultimately tears these veins, leading to the accumulation of blood in the subdural space. Subdural hematomas can develop relatively slowly, contributing to a gradual change in mental status, which often mirrors the symptoms seen in this patient. The CT scan typically shows a crescent-shaped collection of blood that conforms to the surface of the brain. The history of a prior fall and the altered mental status align well with the typical presentation of a subdural hematoma in older adults. In contrast, an epidural hematoma usually presents with a lucid interval following the injury and is often a result of trauma to the temporal region, leading to arterial bleeding. A left cortical infarction would imply an acute stroke resulting from an obstruction of blood flow, which would present differently than a hemorrhage. Subarachnoid hemorrhage often presents with a sudden, severe headache and may or may not demonstrate significant changes on a CT scan immediately. The