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Case Review Questions Flashcards

1
Q

What are the diagnostic criteria for NF-2?

A
  1. Bilateral vestibular schwannoma.
  2. Family history of NF-2 (first degree relative) plus unilateral VS.
  3. Family history of NF-2 plus two of the following: meningioma, schwannoma (nonvestibular), glioma, neurofibroma, juvenile posterior subcapsular lenticular cataract, or opacity.
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2
Q

What is the 50/50 rule for serviceable hearing?

A
  1. A pure tone (PTA) showing values of < 50 dB and speech discrimination with recognition of > 50% indicate serviceable hearing.
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3
Q

Differential diagnosis for intraventricular lesions?

A

CENTRAL MS

  1. Choroid plexus papilloma or carcinoma, colloid cyst, central neurocytoma, cavernoma.
  2. Ependymoma, epidermoid/dermoid.
  3. Neurocytoma.
  4. Teratoma, tuber.
  5. “Rule out” infection.
  6. Astrocytoma, AVM, aneurysm, abscess.
  7. Lipoma, lymphoma.
  8. Mets, meningioma.
  9. Subependymoma, SEGA.
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4
Q

Which neurocutaneous syndrome is associated with SEGAs?

A
  1. Tuberous sclerosis.
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5
Q

What are some complications that can be seen with transcallosal approaches to the lateral ventricles?

A
  1. Weakness.
  2. Akinetic mutism.
  3. Memory deficits.
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6
Q

Which vein does the thalamostriate vein empty into?

A
  1. Internal cerebral vein.
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7
Q

What are some findings associated with Sturge-Weber?

A
  1. Port wine stain (usually affecting V1).
  2. Leptomeningeal angiomas.
  3. Seizures.
  4. Hemiparesis.
  5. MR or learning disability.
  6. Glaucoma.
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8
Q

What are some indications for hemispherectomy?

A
  1. Intractable epilepsy with unilateral hemisphere damage.
  2. Congenital hemiplegia.
  3. Chronic encephalitis.
  4. Hemimegalencephaly.
  5. Sturge-Weber syndrome.
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9
Q

What lab abnormality can be seen with hemangioblastomas?

A
  1. Polycythemia.
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10
Q

Genetic mutation seen in NF-1?

A
  1. NF1 gene mutation on chrom. 17.
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11
Q

Genetic mutation seen in NF-2?

A
  1. NF2 gene mutation on chrom. 22.
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12
Q

Genetic mutation seen in tuberous sclerosis?

A
  1. TSC1 and TSC2 gene mutations on chrom. 9 and 16.
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13
Q

Genetic mutation seen in VHL?

A
  1. VHL gene mutation on chrom. 3P.
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14
Q

What are the 3 main types of spinal AVMs?

A
  1. Dural AV fistula.
  2. Perimedullary fistula.
  3. Intramedullary AVMs.
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15
Q

Pathophysiology of dural AV fistulas.

A
  1. Lesion consists of a small AV fistula within or just beneath the dura at the point where a feeding radicular artery enters the dura at the nerve root sleeve.
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16
Q

How do dural AV fistulas cause neurologic deficits?

A
  1. AV fistulas are low flow lesions resulting in venous hypertension and decreased spinal cord perfusion.
17
Q

Pathophysiology of perimedullary fistulas.

A
  1. Located intradurally but in the extramedullary space.

2. Characterized by a single shunt without a nidus.

18
Q

Indications to operate on GSWs to the head?

A
  1. Favorable GCS.
  2. Debridement of devitalized tissue or bone fragments.
  3. Evacuation of hematomas.
  4. Separation of intracranial component from air sinuses.
19
Q

Contraindications for surgery in GSWs to the head?

A
  1. Bullet traveling across the midline.
  2. Bullet traveling across ventricles.
  3. Bullets traveling across more than one contiguous lobe of the brain.
20
Q

Symptoms of Foster-Kennedy syndrome.

A
  1. Anosmia.
  2. Unilateral optic atrophy.
  3. Contralateral papilledema.
21
Q

What are the main features distinguishing olfactory groove meningiomas from tuberculum sellae meningiomas.

A
  1. The location of the chiasm.
  2. The optic nerves and optic chiasm are located inferolateral to the tumor with olfactory groove meningiomas.
  3. The optic nerves and chiasm are located superolateral to the tumor in tuberculum sellae meningiomas.
22
Q

Describe Chiari type 1.

A
  1. Shallow posterior fossa.
  2. Tonsillar descent down to the level of C1-C2 junction.
  3. Posterior compression of the cervical spinal cord.
23
Q

Describe Chiari type 2.

A
  1. Shallow posterior fossa.
  2. Descent of the cerebellar hemispheres, vermis and tonsils to the upper cervical spinal cord.
  3. Posterior compression of the brainstem and cervical spinal cord.
24
Q

Describe Chiari type 3.

A
  1. Shallow posterior fossa.
  2. Tonsillar herniation.
  3. Brainstem and cervical spinal cord compression.
  4. Occipital encephalocele.
25
Q

Location and function of the principal sensory nucleus of CN V.

A
  1. Located in the upper pons.

2. Conveys tactile and pressure senses from the face.

26
Q

Location and function of the mesencephalic nucleus of CN V.

A
  1. Located near the central gray matter of the upper 4th ventricle.
  2. Conveys pressure and kinesthetic senses from the teeth, hard palate, and jaw.
27
Q

Location and function of the spinal trigeminal nucleus of CN V.

A
  1. Extends from the upper cervical spine to the midpons.
  2. Divided into 3 parts (pars caudalis, pars interpolaris, and pars oralis) which convey sensation of pain and temperature from different parts of the face.
28
Q

Function of the motor nucleus of CN V.

A
  1. Relays fibers to the muscles of mastication and plays part in the jaw jerk reflex.
29
Q

Which vessel is the most common culprit of in trigeminal neuralgia?

A
  1. Superior cerebellar artery.
30
Q

What is the definition of moyamoya disease?

A
  1. Progressive occlusion of terminal ICAs, ACAs or MCAs.

2. Profuse lenticulostriate collateral formation (moyamoya vessels) at the base of the brain.

31
Q

Clinical presentations of moyamoya in children?

A
  1. Ischemic symptoms in 80%.
  2. Epilepsy in 5%.
  3. ICH in 2.5%.
  4. Other symptoms in 12.5% (headache, movement disorders, or mix of symptoms).
32
Q

What are some factors associated with moyamoya?

A
  1. Asian ethnicity.
  2. NF-1.
  3. Radiation for optic or hypothalamic pathway gliomas.
  4. Down syndrome.
  5. Renal artery stenosis.
  6. Thalassemia and sickle cell anemia.
33
Q

Direct revascularization procedures for moyamoya?

A
  1. Superficial temporal artery to MCA bypass.
34
Q

Indirect revascularization procedures for moyamoya?

A
  1. EDAS: encephaloduroarterosynagniosis.
  2. EMS: encephalomyosynangiosis.
  3. EDAMS: encephaloduraarteriomyosynangiosis.
  4. Modified EDAS (pial synangiosis).
35
Q

Why are vagal nerve stimulators contraindicated ont he right vagal nerve?

A
  1. The right vagal nerve innervates the SA node in more than 60% and stimulation will result in asystole.
36
Q

What are common side effects of vagal nerve stimulators?

A
  1. Cough.
  2. Hoarseness.
  3. Throat pain.

NS (25 decks)

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