Clinical assessment of neurosurgical patient Flashcards

1
Q

Give examples of different people you can take a history from

A

the person, bystander, family member, paramedic, the notes?

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2
Q

3 main things to do on an obtunded patient?

A

ABC
GCS
pupils

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3
Q

CPP=

A

MAP-ICP

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4
Q

What can uncal herniation lead to and why?

A

permanently dilated pupil

uncus squeezed under tentorium presses on brainstem (midbrain) and on cranial nerves

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5
Q

What is cushings response and the 3 parts

A

compensate for rising ICP

raised blood pressure, bradycardia, apnea

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6
Q

Observations of non communicative patient

A

posture, focal lack of eye movement, neglect of part of face or body, eye movements

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7
Q

What else would you assess in a non communicative patient?

A

speech

MMS - confused

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8
Q

What can you assess in a communicative patient of neurological function? (split into 3 parts)

A

cranial eg which lobe, cerebellum, cranial nerves
spinal eg radiculopathy, myelopathy, which level
spinal nerve

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9
Q

2 MRI techniques to view neurological function

A

functional MRI and tractography

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10
Q

List some parts of the frontal lobe and their function

A

precentral gyrus - voluntary control of movements
pars opecularis+triangularis - speech
higher order - restraint, initiative, order

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11
Q

Examining frontal lobe

A
inspection eg urinary catheter 
UMN signs 
pronator drift 
saccadic eye movements 
speech
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12
Q

2 tests for restraint eg socially acceptable language

A

go/no go tests

stroop test

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13
Q

Supplementary motor cortex signs of dysfunction

A

lack of motivation
apathy
depression
abulia

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14
Q

Abulia

A

Inability to act decisively

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15
Q

Ways to examine language

A
hearing 
fluency eg brocas 
aphasia 
repetition 
3 step command 
baby hippopotamus 
orofacial movement eg ppp,ttt,mmm
reading and writing
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16
Q

Parietal lobe functions

A
body image representation 
visuospatial awareness
language - wernickes 
multimodality assimilation 
numeracy
17
Q

Astereoagnosia

A

Inability to identify an object by touch of the hand without visual input

18
Q

dysgraphaesthesia

A

Form of agnosia - inability to interpret sensations

19
Q

Examining parietal lobe

A

ideomotor apraxia, ideational apraxia, dressing apraxia, loss of spatial awareness, hemineglect

20
Q

Temporal lobe functions

A

process auditory input
language
encoding long term memory - hippocampus
emotion - amygdala

21
Q

Examining occipital lobe

A

Visual fields

22
Q

Cerebellum - DANISHP

A
Dysdiadochokinesia 
ataxia 
nystagmus 
inattention tremor 
slurred speech 
hypotonia 
past pointing
23
Q

Radiculopathy signs

A

unilateral, single myotome and dermatome - LMN

24
Q

Peripheral nerve signs

A

unilateral, motor and sensory - LMN

25
Q

Myelopathy signs

A

bilateral, motor and sensory, UMN

26
Q

Peripheral neuropathy - body parts to remember?

A

stocking and glove

27
Q

Where does a myelopathy happen (level) and why?

A

mostly cervical and thoracic as not much cord at lumbar region

28
Q

Long tract signs of myelopathy

A

clonus, upgoing plantars, proprioception

29
Q

What is Hoffman sign?

A

flexion of ipsilateral thumb

30
Q

Example of cause of myelopathy and radiculopathy

A

myelopathy - herniated disc

radiculopathy - mass