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1
Q

Osler Weber Rendu

A

Hereditary hemorrhagic telangiectasia
- mucocutaneous telangiectasias
- AVMs
- Mutations that involve signaling of TGF-beta
- bevacizumab being used as investigation treatment

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2
Q

Wyburn Mason Syndrome

A

Multiple AVMs predominantly affecting face and brain

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3
Q

Spetzler Martin grade

A
  • size (<3, 3-6, >6cm)
  • Venous drainage (superficial vs deep)
  • Eloquence (yes vs no)
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4
Q

AVM rupture risk

A

2.2%/year unruptured, 4.5% ruptured

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5
Q

ICH score

A

GCS 3-4 (2), 5-12 (1), 13-15 (0)
Age greater than or equal to 80 (1)
Volume greater than or equal to 30 (1)
Intraventricular (1)
Infratentorial (1)

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6
Q

Heparin reversal

A

20mg protamine

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7
Q

Coumadin reversal

A

Kcenter (4 factor prothrombin complex concentrate), FFP, vitamin K

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8
Q

Dabigatran (pradaxa) reversal

A

Idarucizumab

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9
Q

Hypercoagulable workup

A

Antithrombin
Protein C
Protein S
Factor V Leiden
Prothrombin mutations
Lupus anticoagulant
Anticardiolipin

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10
Q

NASCET

A

Endarterectomy, death or disabling stroke at 2 years, symptomatic patients

90-99% 26% ARR
>70% 17% ARR
50-69% 7% ARR

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11
Q

CREST

A

Stent vs CEA, asymptomatic and symptomatic
More perioperative strokes with stenting
More MIs with CEA

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12
Q

ACAS

A

Asymptomatic, CEA, stroke or death at 3 years
>60% stenosis 6% ARR
Greater in med

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13
Q

tPA dosing

A

0.9mg/kg, 10% over 1 min, rest over 1 hr

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14
Q

Spinous process avulsion

A

Hyperflexion

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15
Q

Clay shoveler’s fracture

A

C7 spinous process avulsion (sudden contraction of trapezius muscles)

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16
Q

Teardrop fracture

A

Fracture of anterior inferior vertebral body
Hyperflexion + axial loading
Unstable with concomitant disruption of ALL
Usually accompanied by retrolisthesis of anterior vertebral body

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17
Q

Avulsion fracture

A

Anterior inferior vertebral body without malalignment
Hyperextension
Usually stable (without PLL injury)

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18
Q

Quadrangular fracture

A

C spine fracture obliquely through vertebral body from anterior superior margin to inferior endplate
Flexion + compression + axial loading
Assess ligamentous structure to determine stability

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19
Q

Wedge fracture

A

Fracture of >50% of vertebral body without disruption of anulus or posterior ligament. (C spine)
Flexion + compression
Stable

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20
Q

Burst fracture

A

Flexion + compression + axial loading
Unstable, disruption of anterior and middle column
ALL and PLL disrupted

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21
Q

Subluxation spine

A

C spine
Distraction + flexion
Accompanied by fracture or disruption of at least 1 facet joint
Anterior translation >3.5mm or angulation >11 degrees indicates mechanical instability

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22
Q

C spine facet fracture

A

Extension + compression + rotation
Unstable

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23
Q

Traumatic spondylolisthesis

A

Anterior displacement of vertebral body as a result of single and/or bipedicular fracture and/or pars interarticularis
Extension + axial loading
Unstable

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24
Q

Type 2 dens fracture prognostic factors

A

Age >65
Angulation
Displacement/distraction
Posterior displacement of dens
Displacement in >1 plane
Delay in diagnosis

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25
Q

Dens fracture mechanism

A

Horizontal shear and compression

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26
Q

C1 screws

A

Lateral mass
Entry point: half way between junction of posterior arch and inferior posterior part of C1 lateral mass
5-10 degrees medial
Parallel to C1 posterior arch
Palpate medial border
3.5mm diameter, 18-30mm length

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27
Q

C2 screws

A

Pars
Pedicle
Intralaminar

Pedicle:
Starting point in superior medial quadrant of C2 inferior articular process
20 degrees medial, 20 degrees cephalad
3.5mm screw, 30-35mm length

Pars:
starting point 3mm rostral and lateral to inferior/medial inferior articular process
20-30 degrees medial, toward anterior ring of C1

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28
Q

Hangman’s fracture

A

Bilateral fracture of C2 pars/pedicle
Hyperextension + axial loading

Look for vert injury

Effendi classification:
Type 1: hairline fracture without angulation or displacement
Type 2: anterolisthesis C2 on C3
Type 3: type 2 + C2 body angulated

External immobilization for patients without neurologic injury and with anatomic alignment

C2/3 ACDF
C1 and C3 posterior fusion (+/- skip C2)

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29
Q

Thoracolumbar burst

A

Axial loading, +/- flexion

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30
Q

Chance fracture

A

Fracture through middle and posterior columns (pedicles and vertebral body)
Can be ligamentous only – splaying of spinous processes
Flexion distraction

Can trial bracing in poor operative candidates/those without ligamentous injury
Posterior fusion

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31
Q

Cervical jumped facets

A

Flexion/distraction/rotation
CTA to assess verts

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32
Q

Lateral mass screws

A

Starting point: 1mm medial to center (medial and inferior, aim to superolateral corner)
30 degrees lateral (lay against spinous process)
20 degrees superior (parallel to spinous process)

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33
Q

Atlanto axial dislocation/AOD

A

Basion dens interval (BDI) >10mm in adults or >12mm in children
Condylar gap: occipital condyl to superior articular facet of atlas >2mm in adults or >5mm in children

Type 1: anterior displacement of occiput with respect to atlas
Type 2: Vertical displacement of occiput
Type 3: posterior occiput displacement

Posterior fusion if reducible

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34
Q

Basilar invagination

A

Mcrae’s line: basion to opisthion, dens should not cross
Wackenheim’s clivus-canal line: line along clivus, dens should not cross
Fischgold’s digastric line: connects digastric notches, distance <10mm between this and middle of AA joint suggests BI
Fischgold’s bimastoid line: connects mastoid tips, AA joint should not cross

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35
Q

Radiation resistant tumors

A

Triple negative breast
Renal
NSCLC
Melanoma
Colon

36
Q

Spinal ependymomas

A

Myxopapillary: grade 1, lumbar cistern
Cellular: grade 2, from ependymal lining
Anaplastic: grade 3

37
Q

Ankylosing spondylitis

A

HLA B27
Sulfasalazine, methotrexate, TNF alpha antagonists

38
Q

NF1

A

Neurofibromas
MPNST

39
Q

NF2

A

Vestibular schwannomas
Meningiomas
Chromosome 22 (merlin)

40
Q

Acoustic approaches

A

Retrosig: chance of hearing preservation, good for tumors in CPA with limited extension into IAC

Translab: no hearing preservation, allows access to lateral recess of IAC and identification of facial nerve at labyrinthine segment to help preserve

Middle fossa: best hearing preservation, posterior fossa extension <0.5-1cm

41
Q

Cystic tumors

A

Metastasis
Hemangioblastoma – goal remove enhancing nodule
Glioma (juvenile pilocytic astrocytoma)

42
Q

Von Hippel Lindau

A

Hemangioblastoma
Pheochromocytoma

43
Q

Pituitary labs

A

Prolactin, TSH, Free T4, FSH, LH, ACTH, cortisol, IGF-1, GH, testosterone, estradiol

44
Q

Adamantimomatous craniopharyngioma

A

WHO grade 1
Children

45
Q

Papillary craniopharyngioma

A

Adults
BRAF

46
Q

GBM mutations

A

Primary: EGFR amplification, PTEN mutations
Secondary: TP53 mutations
MGMT promotor methylation: associated with greater response to temozolomide

47
Q

Stupp protocol

A

Radiation: 60Gy in 30 fractions over 6 weeks (M-F x 6 wks)
Temozolomide: during radiation 75mg/square meter bsa 7 days/week
Adjuvant: 6 cycles of 150-200mg/ square meter BSA for 5 days/28

48
Q

Oligodendroglioma genetics

A

1p/19q codeletion – more sensitive to radiation and alkylating chemotherapy

49
Q

Anaplastic oligodendroglioma chemo

A

Temozolamide
PCV (procarbazine, lomustine, vincristine)

50
Q

WHO grade 1 gliomas

A

Pilocytic astrocytoma
Subependymal giant cell astrocytoma

51
Q

WHO grade 2 gliomas

A

Pilomyxoid astrocytoma
Pleomorphic xanthoastrocytoma
Fibrillary/protoplasmic/gemistocytic astrocytoma
Oligodendroglioma
Oligoastrocytoma
Ganglioglioma
Gangliocytoma
Dysembryoplastic neuroepithelial tumors

52
Q

NF1

A

Low grade gliomas more common

53
Q

Most common brain metastases

A

Lung, breast
Of those with melanoma ~70% have brain mets

54
Q

Radiation sensitive cancers

A

SCLC
Breast
Lymphoma
Multiple myeloma

55
Q

Brain abscess organisms

A

Direct extension: strep milleri
Hematogenous: Strep viridans
Trauma: Staph aureus, staph epi

56
Q

Pediatric posterior fossa tumors

A

Ependymoma
Medulloblastoma
Pilocytic astrocytoma
AT/RT
PNET

57
Q

Ependymoma types

A

Grade 1: subependymoma, myxopapillary
Grade 2: papillary, clear cell, tanycytic, mixed
Grade 3: analplastic

58
Q

Myxopapillary ependymoma

A

Grade 1, filum terminale/conus

59
Q

Clear cell ependymoma

A

Pediatric
Supratentorial

60
Q

Tanycytic ependymoma

A

Grade 2, ventricular

61
Q

Anaplastic ependymoma

A

Grade 3

62
Q

Ependymoma genetics

A

NF2
Loss of 12 or 14q
High expression of HOX genes

63
Q

STN neural firing

A

20-50Hz

64
Q

GPI neural firing

A

60-100Hz

65
Q

STN side effects

A

Paresthesias: lemniscal pathway, posterior
Dysarthria: lateral, internal capsule
Contralateral gaze deviation: CN III nucleus medial

66
Q

GPI side effects

A

Dysarthria/contractions: capsule, medial
Scintillations/phosphenes: optic tract inferior

67
Q

Spasticity scale

A

Modified Ashworth

68
Q

Baclofen overdose

A

Physostigmine

69
Q

Disconnection syndrome

A

Mutism
Apraxia
Hemiparesis
Ideomotor apraxia

70
Q

Intrathecal pain pump meds

A

Approved: morphine, baclofen, ziconotide
Off label: mixed opioids and local anesthetics, other neuropathic agents

71
Q

Progressive multifocal leukoencephalopathy

A

JC virus
Treat HIV

72
Q

MS serum markers

A

anti-myelin oligodendrocytic protein and anti-myelin basic protein

73
Q

ALS gene

A

SOD1
D90A

74
Q

Guillan Barre syndrome diagnosis

A

EMG: abnormal H reflex, low amplitude/prolonged F-waves, distal latencies prolonged by >150% UNL, temporal dispersion of CMAP, slow conduction velocity, within 3 weeks demyelination
Anti-ganglioside antibodies” GQ1b, GT1b, GM1, Ga1Nac-GD1a
CSF with protein cytological dissociation (albuminocytologic dissociation –elevated protein, not elevated WBC)
MRI L spine with contrast with diffuse nerve root enhancement

75
Q

Neuromyelitis optica antibodies

A

NMO-IgG, anti-AQP4

76
Q

Status protocol

A

ABCs, labs (Na, etc)
Thiamine 100mg
Dextrose 50cc D50
Vitamin B6 100mg (neonate)

Meds:
Ativan 2mg/min (max 0.1mg/kg) with 1 min between doses
Fosphenytoin (20mg/kg at 150mg/min)
Keppra (60mg/kg)
(vs Depakote (20mg/kg))
intubate
Pentobarb (10mg/kg over 30min load, maintenance 2mg/kg/hr for burst suppression

77
Q

Transverse myelitis CSF

A

IgG
Pleocytosis
Elevated protein
+/- oligoclonal bands, increased IgG index, 14-33 protein, IL-6, non-specific enolase, myelin basic protein, S-100 protein

78
Q

Peroneal nerve

A

Dorsiflexion
EHL
Foot eversion

79
Q

Froment’s sign

A

Thumb interphalangeal flexion when trying to hold paper between thumb/index finger (ulnar weakness)

80
Q

Wartenberg’s sign

A

Little finger abducted (unopposed extensor digiti minimi due to palmar interosseous weakness; ulnar weakness)

81
Q

Anterior interosseous syndrome

A

Branch of median 6cm distal to elbow
Weakness of: flexor digitorum profundus (index and middle), flexor pollicis longus.
No sensory branches
“O” sign
Often compressed at tendinous arch of the sublimis muscle (FDS)

82
Q

Nerve transfers for shoulder function

A

Distal spinal accessory to suprascapular
Triceps branches of radial nerve to axillary nerve

83
Q

Nerve transfer elbow flexion

A

Motor median to musculocutaneous

84
Q

Oberlin procedure

A

Ulnar (wrist flexion fasicle) to biceps motor branch of musculocutaneous (to brachialis)

85
Q

Lumbar foramen borders

A

Anterior: disk, superior/inferior endplates of vertebral bodies
Posterior: supior/inferior articular processes/facet joint
Superior/inferior: pedicles

86
Q

Neurocysticercosis

A

Praziquantel
Albendazole

87
Q

Toxoplasmosis

A

Pyrimethamine and sulfadiazine, folinic acid

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