Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery/ER Fall 2013 > ER- Head > Flashcards

ER- Head Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

etiology of TBI

A

alcohol and drugs 70% of the time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

leading cause of morbidity and mortality following trauma

A

head injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

patient lost consciousness, what must you do?

A

CT their head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

TBI management

A

GCS, thorough neuro exam, CT head, drug screeen, maintain C-spine precautions. Consult- trauma, neurosurgery, opthalmology, plastic surgery, and speech therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Primary and secondary brain injuries

A

concussion-compression, sudden deceleration, rotational acceleration, systemic insults, intracranial insults, and cerebral ischemia-reperfusion injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

sudden deceleration can result in what kind of hematoma?

A

subdural hematoma- tearing of bridging veins on the side opposite the area of impact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

most imp factor in generating parenchymal tears

A

rotational acceleration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is though to be responsible for loss of consciousness with head trauma?

A

brain stem movement at the time of impact- (brain stem controls respiration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what kind of injury would result in hypotension, decreased end organ perfusion, systolic BP less than 90 mmHg, anemia, electrolyte disturbances, hypoglycemia or hyperglycemia, and hyperthermia?

A

systemic injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

prolonged elevation in ICP a/w

A

poor outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Patient presents with acute subdural hematoma. What is mortality rate if operation occurs more than 4 hours after injury vs. less than 4 hours after injury?

A

90% mortality rate if operation MORE than 4 hours after injury, compared to 30% mortality rate if less than 4 hours after injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what occurs in cerebral ischemia-reperfusion injury

A

transmembrane shift of sodium and calcium INTO cell and potassium OUT of cell, oxygen radical formation, lipid peroxidation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

should you take a major scalp laceration seriouslY?

A

YES, can cause hemorrhagic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

should you take trivial scalp injury seeriously?

A

YES, may overlie a penetrating skull injury that can cause meningitis or brain abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

if laceration plus skull fracture-

A

neuro consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

if isolated laceration-

A

fix and discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Skull fracture types

A

stellate- occur with more force. Depressed fractures- still more force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

most skull fractures are…

A

linear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

basilar skull fracture can cause…

A

injury to cranial nerves. If fracture extends to paranasal sinuses or mastoid air cells, can cause CSF leak and meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

“racoon eyes” seen in

A

basilar skull fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

penetrating skull injuries are at risk to develop

A

meningitis or brain abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is prone to laceration type injury?

A

pontomedullary juction following hyperextension of the head on the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

concussion=

A

transient loss of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

concussion may result from..

A

temporary dysfunction of cortical hemispheric neurons bilaterally OR reticular activating system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

difference between concussion and contusion

A

concussion= little of no apparent tissue damage. contusion= tissue injury with capillary damage and interstitial hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

classifications of contusion

A

coup, intermediate, and contrecoup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

contusion can produce neurologic deficit d/t tissue injury, but more often exert their major effect as…

A

a nidus for hemorrhage, swelling, or post-traumatic epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What can mark Diffuse axonal injury?

A

petechial hemorrhages at the interface of gray and white matter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

preferred scan for Diffuse axonal injury?

A

MRI , but can also see on CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

diffuse axonal injury triad of damage involving:

A

corpus callosum, dorsal lateral quadrant of the midbrain, microscopic damage within the subcortical white matter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

diffuse axonal injury result from

A

strain-shear forces in deceleration or rotational acceleration injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

difference between intracerebral hemorrhage vs. contusion

A

contusion- rupture of capillaries. intracerebral hemorrhage-rupturing of blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

management of small vs. large intracerebral hemorrhage

A

small-non-surgical, control ICP, maintain perfusion. large- surgical decompression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

types of intracranial hematomas

A

intracerebral hematomas, subdural, epedural hematomas, subarachnoid hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

epidural hematoma- rupture of

A

middle meningeal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

subdural hematoma- damage to

A

cortical bridging veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

subarachnoid hemorrhage- damage to

A

saccular aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

tx of subdural hematoma

A

acute- craniotomy. chronic- burr hole evacuation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

tx of epidural hematma

A

emergency craniotomy and evacuation, IV mannitol and hyperventilation to PCO2 of 25-30 mmHg to buy some time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

difference in subdural and epidural appearance radiographically?

A

subdural- crescent shaped. epidural- lens shape

41
Q

epidural hematoma usually a/w

A

temporal bone fracture

42
Q

How to decrease ICP in ER?

A

IV mannitol and hyperventilation to PCO2 of 25-30 mmHg, elevate head of bed

43
Q

patient presents with concussion accident followed by period of lucidity, followed by headaches, loss of consciousness again, and progressive neurologic deterioration

A

epidural hematoma

44
Q

effects of mannitol in managing cerebral blood flow

A

given as bolus- increases intravascular volume, SBP, CPP

45
Q

what happens if mannitol given too rapidly?

A

can cause hypotension

46
Q

hyperventilation in managing cerebral blood flow

A

reduces ICP by constricting pial and cerebral arterioles, causes alkylosis

47
Q

herniation of medulla through foramen magnum

A

cushing response

48
Q

herniation of cerebellar tonsils through foramen magnum

A

further brain stem compression and medullary ischemia

49
Q

herniation of medial portion of temporal lobe

A

midbrain compression, LOC, decerebrate rigidity

50
Q

herniation of cerebellum upward through tentorial hiatus

A

bilateral decerebrate rigidity

51
Q

clinical sign seen when herniation has occured through foramen magnum?

A

ICP falls very fast, to 0

52
Q

control of agitation and seizures

A

avoid electrolyte imbalance, hypoxia, fever. sedatives, paralytics, dilantin, diazepam

53
Q

third leading cause of death worldwide

A

cva

54
Q

CVA etiology

A

brain ischemia from hypoperfusion as a result of ischemia (thromboembolic- occlusion of vessel), hemorrhage, or systemic hypotension

55
Q

ischemic stroke can occur as a result of

A

carotid circulation obstruction, vertebrobasilar obstruction, lacunar infarction

56
Q

carotid artery circulation obstruction causing ischemic stroke may be caused by

A

either cardiac (a. fib, rheumatic heart disese, infectious endocarditis) or vascular (giant cell arteritis, SLE) cause

57
Q

what has higher risk of early mortality and reinfarction - cerebral infarction or lacunar infarc?

A

cerebral infarction

58
Q

patient presents with CVA and you are trying to determine the source- ischemic or hemorrhagic. presentation includes contralateral pure motor or sensory deficit, ipsilateral ataxia with crural paresis, dysarthria with clumsiness of hand

A

lacunar infarct causing ischemic stroke

59
Q

prognosis of lacunar infarct

A

good- recovery in 4-6 weeks

60
Q

what kind of hemorrhagic stoke can HTN cause?

A

intraparenchymal hemorrhage

61
Q

HTN can cause microaneurysms most commonly in..

A

basal ganglia

62
Q

“worse headache in my life”

A

subarachnoid hemorrhage caused by AVM’s, saccular aneurysm rupture

63
Q

indication for promp surgical decompression

A

cerebellar hemorrhage

64
Q

ischemic stroke tx

A

tpa 0.9 mg/kg. 10% given over 10 minutes. remaining given over 1 hour. give within 3-4.5 hours

65
Q

berry aneursyms grade I-5

A

I- Neurologically intact, HA. II- HA, CN involvement. III- decreased LOC. IV-stupor. V- coma, brainstem involvement

66
Q

tx of hemorrhagic stroke

A

supportive/conservative tx. mannitol and elvate head to decrease intracranial pressure. If SBP over 220, lower wtih IV labetolol to range of 170-200 mmHg. CPP maintained between 70-90 mmHg

67
Q

when to consider carotic endarterectomy

A

in stoke patients who have nearly recovered but have carotid artery stenosis more than 70% in ipsilateral carotid a

68
Q

how to prevent second stroke or MI from occuring after first stroke?

A

preventative therapy includes statins, antiplatelet therapy with ASA and dipyridamole, or clopidogrel

69
Q

prognosis for CVA

A

survival for ischemic infarcts is beter than for hemorrhagic

70
Q

BP management in hemorrhagic stroke

A

should not be brought down to normal in first 2 weeks after stroke. if SBP over 220, then lower to 170-200 with IV labetolol

71
Q

correlation between stroke and TIA

A

risk of stroke highest in the 48 hours after TIA and declines to baseline by 3 months

72
Q

TIA cuased by

A

emboli, cardiac or vascular

73
Q

patient presents with vertigo, diplopia, weakness and numbness on ALTERNATING sides of body

A

TIA in vertebrobasilar distribution

74
Q

patient presents with weakness and sensory deficits on contralateral side, amaruosis fugax if opthalmic artery involved

A

TIA in carotid distribution

75
Q

gold standard in diagnosing TIA

A

Standard arteriography. can also do CT/MRI of head to r/o small CVA and tumor, carotid duplex ultrasonography

76
Q

Hospital if the following TIA symptos:

A

within 48 hours of attack, attacks are crescendo, symptoms lasting more than 1 hour, symptomatic carotid stenosis, KNOWN cardiac source, or hypercoagulable state

77
Q

Patient with TIA, do a standark arteriography that shows high -grade stenosis. next course of action?

A

surgery or stenting indicated

78
Q

when is medical tx indicated in TIA

A

if poor surgical candidate or if vascular disease is extensive or vertebrobasilar

79
Q

medical tx for TIA that is cardiac source-

A

warfarin INR 2-3. If Warfarin CI, then ASA 325 mg/day

80
Q

medical tx for TIA that is non-cardiac source

A

Warfarin or ASA (used alone or with dipyridamole). clopidogrel

81
Q

symptoms and signs of infectious meningitis

A

HA, fever, neck and back stiffness, kernig and brudzinski’s sign positive, sensory disturbance, and CSF abnormalities

82
Q

organisms responsible in purulent meningitis

A

18-50: s. pneumonia, Neiseeria meningitis. over 50- listeria, gram negatives

83
Q

dx and tx in purulent meningitis

A

dx- gram stain or culture of CSF. Tx- Vanco and cefotaxime or ampicillin

84
Q

aseptic meningitis cause

A

viral usually- HSV

85
Q

defining feature of aseptic meningitis

A

benign and self limited course

86
Q

aseptic meningitis can resemble___ on CSF exam

A

partially treated bacterial meningitis

87
Q

drug induced aseptic meningitis caused by

A

NSAIDS, sulfonamids, solid organ transplant agents

88
Q

CSF examination on non-infectious meningeal irritation

A

pleocytosis, increased protein, low or normal glucose

89
Q

organisms in health care associated meningitis

A

pseudomonas, staph, coag negative staph

90
Q

encephalitis causes

A

viral- herpesvirus, arbovirus, rabies virus, flavivirus

91
Q

CSF with RBC’s=

A

HSV encephalitis

92
Q

diagnosis of encephalitis

A

CT head and LP. CSF may be normal or show lymphocytes

93
Q

classic triad CNS infection

A

fever, stiff neck, altered mental status

94
Q

nearly all patients with bacterial meningitis have 2 of the following

A

FEVER, STIFF NECK, ALTERED MENTAL STATUS, HEADACHE

95
Q

if patient has papilledema, seizures of focal neurologic findings, do CT before LP to r/o

A

intracranial mass lesions

96
Q

dx CNS infection

A

CBC, blood culture, LP, CSF analysis, CXR, latex agglutination test

97
Q

tx meningitis

A

abx given prior to LP, LP should be done within 4 hours of abx start. Dexamethasone also given with first abx (most effective when causative agent is strep). to decrease ICP- mannitol, hyperventilation, ventriculostomy catheter placement

98
Q

heache behind 1 eye, a/w drinking. treated with oxygen.WANDER.

A

CLUSTER ha

99
Q

bilateral headache, have stress

A

tension ha

Surgery/ER Fall 2013 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions