Four days about targets: one you buy with clot, one that came from an uncontrolled series and stood for thirty years, one where the laboratory cannot help you, and one where the harm arrives most of a day after the mistake.
01
What this is
no new material
**No new material. Harder questions.**
This week was about numbers and what stands behind them. Reversal buys haemostasis and pays in thrombosis. A spinal cord perfusion target that everyone taught turned out to rest on a small uncontrolled series, and was revised not because benefit was disproved but because harms were finally counted on the same page. In hyponatraemia the laboratory values are identical in two conditions whose treatments are opposites. And the hypertensive surge at extubation produces a haemorrhage a median of twenty-one hours later.
Three of the four ask you to hold a number and its provenance at the same time. That is the habit this level has been building since day 02.
Answer first, then read. Checking the day before answering turns retrieval
practice into rereading, and the two feel identical while you are doing them.
03
The questions
9 of 10 application or analysis
Item 1Analysis Neuro 1 · Week 4
A patient on a factor Xa inhibitor has an intracerebral haemorrhage. Andexanet alfa is given. What has been bought, and at what price?
Item 2Analysis Neuro 1 · Week 4
For three decades the teaching in acute spinal cord injury was a MAP above 85 to 90 for seven days. Where did that number come from, and what replaced it?
Item 3Application Neuro 1 · Week 4
Why does the revised spinal cord perfusion guidance include an upper limit as well as a lower one?
Item 4Analysis Neuro 1 · Week 4
A patient six days after subarachnoid haemorrhage has a sodium of 127, urine sodium 55, urine osmolality 480 and serum osmolality 265. What do those four values establish?
Item 5Application Neuro 1 · Week 4
A patient with subarachnoid haemorrhage, a falling sodium, a high urine output and a negative fluid balance is placed on a 1000 mL daily fluid restriction. What is the risk?
Item 6Recall Neuro 1 · Week 4
What are the correction limits for chronic hyponatraemia in this curriculum, and how do they apply?
Item 7Analysis Neuro 1 · Week 4
Why is a hypertensive surge at emergence from craniotomy more dangerous than the same surge in a general surgical patient?
Item 8Analysis Neuro 1 · Week 4
Postoperative intracranial haemorrhage after craniotomy occurred at a median of 21 hours, interquartile range 4 to 52, with pre-haemorrhage hypertension in the first 12 hours carrying an odds ratio of 4.6. What does the timing imply for practice?
Item 9Application Neuro 1 · Week 4
A patient on apixaban has an intracerebral haemorrhage in a United States hospital in 2026. Which agent do you actually reach for, and why?
Item 10Analysis Neuro 1 · Week 4
What do the spinal cord perfusion target and the ICP threshold have in common as examples?