Clin Med: Neuro III

Question 1

Mass effect

Answer 1

some encroachment upon the ventricles of the brain (causing some deformity of the ventricles)

Question 2

Midline shift

Answer 2

pushes the brain over (ex: hematoma or mass)

Question 3

Both mass effect & midline shift are generally associated with…

Answer 3

neurological abnormality w/ the patient

Question 52

Glasgow Coma Scale (GCS) severity levels

Answer 52

• Mild (13-15)
• Moderate (9-12)
• Severe (<8)

Question 53

GCS: Eye opening response

Answer 53

4. Spontaneously
5. To speech
6. To pain
7. No response

Question 54

GCS: Verbal response

Answer 54

5. Oriented to time, person, & place
6. Confused
7. Inappropriate words
8. Incomprehensible sounds
9. No response

Question 55

GCS: Motor response

Answer 55

6. Obeys command
7. Moves to localized pain
8. Flex to withdraw from pain
9. Abnormal flexion
10. Abnormal extension
11. No response

Question 57

Canadian CT: Exclusion Criteria

Answer 57

• age < 16yo
• Pt on blood thinners
• seizure after injury

Question 58

Canadian CT: High Risk Criteria

Answer 58

• GCS <15 at 2hrs post-injury
• ?? open or depressed skull frax
• Sign of basilar skull frax?
• > /= 2 episodes of vomiting
• > /= 65 years

Question 59

What are signs of a basilar skill frax?

Answer 59

• Hemotympanum
• racoon eyes
• Battle’s sign
• CSF oto-/rhinorrhea

Question 60

Canadian CT: Medium Risk Criteria

Answer 60

• retrograde amnesia >/= 30 mins
• “Dangerous” mechanism

Question 61

Concussion admission if:

Answer 61

• GCS < 15 after imaging
• CT scan is indicated, but is not available
• persistent worrisome signs, such as vomiting, severe HA, intoxication, other injuries, meningeal signs, or CSF leak

Question 62

C4 injury causes

Answer 62

tetraplegia

Question 63

C6 injury causes

Answer 63

tetraplegia

Question 64

T6 injury causes

Answer 64

paraplegia

Question 65

L1 injury causes

Answer 65

paraplegia

Question 66

When closed intervention used in spinal cord injuries?

Answer 66

Only for cervical spine fracture with subluxation

Question 69

What level spinal injury are highest risk of death?

Answer 69

C1-C3

Question 70

Complete Spinal Cord Injury

Answer 70

complete loss of motor & sensory function below the SCI

Question 71

Central Cord Syndrome is usually what type of injury?

Answer 71

hyperextension injury

Question 72

Central cord syndrome: classic patient

Answer 72

elderly w/ underlying spinal stenosis or osteophytes

Question 73

Central cord syndrome: S/S

Answer 73

Greater motor impairment in upper body vs lower body, sensory loss in lower body variable

Question 74

Central cord syndrome: Prognosis

Answer 74

Prognosis good, though full recovery is rare

Question 75

Anterior cord syndrome is usually what type of injury?

Answer 75

flexion injury of the cervical region

Question 76

Anterior cord syndrome: classic patient

Answer 76

Younger pts, due to dislocation or subluxation, from flexion injuries

Question 77

Anterior cord syndrome: S/S

Answer 77

Motor paralysis and loss of pain/temp sensation (LE>UE)

Question 78

Anterior cord syndrome: Prognosis

Answer 78

Only 10-20% chance of motor recovery

Question 79

Brown Sequard Syndrome is usually what type of injury?

Answer 79

penetrating trauma

Question 80

Brown Sequard Syndrome: S/S

Answer 80

• Contralateral loss of pain, temp, light touch
• Ipsilateral loss of motor function, vibration, proprioception

Question 81

Brown Sequard Syndrome: Prognosis

Answer 81

Excellent prognosis, most regain full function