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Neuro Surgery > Exam I > Flashcards

Exam I Flashcards

1
Q

coronal suture joins

A

frontal and parietal

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2
Q

sagittal suture joins

A

two parietal bones

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3
Q

lambdoid suture joins

A

occipital and parietal

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4
Q

squamous suture joins

A

parietal and temporal

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5
Q

CN II examination

A
  • pupillary reflex
  • VF
  • VA
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6
Q

CN V examination

A
  • cotton wisp
  • corneal reflex
  • mastication
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7
Q

CN VII examination

A
  • facial expression

- taste ant 2/3 of tongue

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8
Q

CN IX (glossopharyngeal) exam

A
  • gag reflex
  • swallow
  • posterior 1/3 taste
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9
Q

major switchboard for brain

A

thalamus

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10
Q

controls motor function/initiation of actions

A

basal ganglia

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11
Q

essential for memory and learning facts

A

hippocampus

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12
Q

maintains homeostasis, circadian rhythm, autonomic control

A

hypothalamus

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13
Q

main brain artery that comes off of vertebral arteries

A

basilar

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14
Q

things to consider for a physical exam on a neurp pt?

A
  • GCS is comatose

- perform a full system PE on ICU pts

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15
Q

eyes opening response

A

4-opens sponataneously
3-to speech
2-to pain
1-none

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16
Q

verbal response

A 
5-oriented to time, place, person
4-confused, disoriented
3-inappropriate words
2-incomprehensible sounds
1-none
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17
Q

motor response

A 
6-obeys command
5-moves toward pain
4-moves away from pain
3-abnormal flexion
2-abnormal extension
1-none
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18
Q

pt presents with rhino/otorhhea after trauama, think

A

CSF leak

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19
Q

when should you perform imaging on a neuro emergency pt?

A

ALWAYS, regardless of injury severity

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20
Q

best initial imaging modality in acute setting

A

CT

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21
Q

most sensitive test

A

MRI, technically the best but takes too long

-use this for cauda equina first line though

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22
Q

Monroe-Kelly doctrine

A

3 things in brain that can elevate intracranial pressure

  • blood
  • brain
  • CSF
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23
Q

HA and vomiting favors which type of stroke?

A
  • SAH

- ICH

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24
Q

Arterial bleed between skull & dura

A

epidural hemorrhage, MCC skull fx impacting the middle meningeal artery

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25
Q

clinical course of epidural hemorrhage

A

injury—-brief LOC—-lucid state—coma

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26
Q

what will an epidural hemorrhage show on CT?

A
  • lens/convex shape, does not cross suture line
  • temporal bone fx
  • midline shift
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27
Q

how to manage epidural hemorrhage

A
  • craniotomy w/evacuation of hemorrhage If clot thickness is greater than 10mm or if midline shift is greater than 5mm
  • change in pupil size
  • GCS <9
  • observation if small (Q1 neuro checks for 24-72 hrs)
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28
Q

Venous bleed MC* between dura & arachnoid (tearing of bridging veins. MC seen in elderly

A

subdural hematoma, MC blunt trauma often causes bleeding on other side of injury “contre-coup”.

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29
Q

what will a subdural hemorrhage show on CT?

A
  • CONCAVE (Crescent-shaped) MAY cross suture line

- midline shift

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30
Q

Arterial bleed between arachnoid & pia mater

A

subarachnoid hemorrhage, MC from berry aneurysm or AVM

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31
Q

clinical signs of SAH?

A
  • thunderclap HA, worst of life

- meningeal signs (photophobia, neck pain, NV)

32
Q

how to dx SAH?

A
  • CT first

- if negative, do a LP (xanthochromia (RBC’s), ↑CSF pressure & no focal neuro sx)

33
Q

how to manage SAH?

A
  • bed rest
  • stool softener
  • phenytoin seizure prophylaxis
  • anti anxiety
  • possible lower BP
34
Q

how do people get intraparenchymal hemorrhages

A
  • HTN

- AVM

35
Q

when should you not perform a LP?

A

intracerebral hemorrhage, may cause herniation

36
Q

how to manage intracerebral hemmorhage

A

supportive

  • anticonvulsants
  • steroids for edema
37
Q

clinical manifestation of basilar fx

A

Battle sign

Racoon Eyes

Hemotympanum

Rhinorrhea/
Otorrhea (CSF)

38
Q

normal ICP?

A

15mmHg

>20 needs tx

39
Q

idiopathic intracranial HTN

A

aka pseudotumor cerebri

  • increased ICP with no other cause of increased ICP found on CT/MRI
  • MC in obese women
40
Q

clinical signs of pseudotumor cerebri

A
  • HA worse with straining
  • N/V, tinnitus, photophobia
  • can lead to blindness (increased cup:disk)
41
Q

how to dx pseudotumor cerebri

A
  • papilledema on slit lamp
  • CT to r/o mass then do a LP
  • LP would show increased opening pressure
42
Q

how to manage pseudotumor cerebri

A

-acetazolamide

MOA: carbonic anhydrase inhibitor

43
Q

dead cells lyse and release intracellular contents resulting in edema. BBB remains intact
Seen in strokes

A

cytotoxic cerebral edema

44
Q

BBB compromised due to release of VEGF from neoplastic cells allowing new vessels to grow
Seen in brain tumors

A

vasogenic cerebral edema

Decadron is effective treatment to stop secretion of VEGF

45
Q

this type of cerebral edema is from HTN, capillary leakage

A

hydrostatic

46
Q

this type of cerebral edema results from serum hyponatremia resulting in pulling of sodium from brain and resultant edema

A

osmotic

47
Q

this type of cerebral edema is seen in hydrocephalus

A

interstitial,brain saturated with CSF

48
Q

clinical signs of elevated ICP

A
  • HA, NV
  • cushing’s triad:bradycardiam, dyspnea, HTN
  • herniation
  • blown pupil on ipsilateral side of herniation
  • decerebrate posture
49
Q

medulla herniation will result in

A
  • irregular or no breathing
  • midposition, fixed pupils
  • absent vestibulocular reflex
  • absent motor reponse
50
Q

midbrain/ upper pons herniation will result in

A
  • hyperventilatin of Cheyne-stokes
  • midposition, fixed pupils
  • absent or abduction of vestibuloocular reflex
  • decerebrate or no movement
51
Q

most sensitive way to assess ICP

A

invasive ICP monitor, ventricle
can treat as well
20% risk of infection

52
Q

when are invasive ICP monitors contraindicated?

A
  • awake and responsive
  • GCS >9
  • DIC
  • uncorrected coagulopathy
53
Q

bolt monitor

A

goes into subarachnoid space, dura must be punctured

54
Q

thin fiber optic cable is placed into the

A

intraparenchymal area, 3 mmHg variation

55
Q

how to manage increased ICP?

A
  • sedation/paralysis
  • control BP
  • hyperventilate to reduce CO2 to reduce cerebral blood flow to reduce ICP (from vasoconstriction)
  • mannitol (expands plasma volume to draw fluid out of brain tissue)
  • hypertonic saline
56
Q

meds to avoid in neurosx

A
  • anti platelet
  • anti coag
  • PCN (Decrease seizure threshold)
57
Q

good anti-seizure med

A

-valproic acid, divalproex sodium
MOA-↑ GABA effects (↑CNS inhibition), inhibits glutamate/NMDA receptor-mediated neuronal excitation
SE-pancreatitis, hepatotoxicity

58
Q

another good anti-seizure med

A

-phenytoin
MOA: Stabilizes neuronal membranes (limits firing of action potentials by blocking Na-dependent channels) causing CNS depression (related to barbiturates)
-used for seizure prophylaxis and after benzos for status epilepticus
S/E: rash (erythema mutliforme/SJS), gingival hyperplasia,hypotension, arrhythmias

59
Q

best benzo for seizures

A

lorazepam
MOA: potentiates GABA-mediated CNS inhibition
1st line for status epilepticus
flumenazil is the reversal agent, monitor BP

60
Q

phenobarbitol

A

MOA: binds to GABA receptor potentiating GABA-mediated CNS inhibition

Ind: Status epilepticus p phenytoin if status epilepticus persistent, febrile sz in children

SE: Depression, osteoporosis, irritability

61
Q

anti coag reversal agents

A

Fresh frozen plasma, Prothrombin
Vitamin K
Protamine Sulfate
start if INR is 5

62
Q

anti platelet reversal agents

A

Platelet infusion

DDAVP

63
Q

important points when considering brain death

A
  • make sure cause is irreversible
  • assess brain stem reflexes (calorics, gag, pupils)
  • Apnea test (brain will cause a reflex breath when CO2 levels rise too high) CO2 >60
64
Q

calorics interpretation

A

eye looks towards cold water

away from warm water

65
Q

positive apnea test

A

pCO2 > 60 or increase of 20 over a normal baseline with no respiratory effort

66
Q

MC SEEN AFTER BURST FRACTURES OF VERTEBRAL BODIES ESP WITH FLEXION INJURIES*

Motor deficits: Lower extremity
Sensory deficits: temp and pain in LE

A

anterior cord syndrome

67
Q

MC SEEN WITH HYPEREXTENSION INJURIES*

Motor deficits: upper extremity* esp distal extremities
(HANDS)*

Sensory deficits: Loss of Temp and pain* classically in a
shawl distribution*(in upper extremities)

A

central cord syndrome

68
Q

MC SEEN AFTER PENETRATION INJURIES*

ipsilateral deficits:
Motor, vibration and proprioception*

contralateral deficits:
Loss of Temp and pain*
(usually 2 levels below injury)

A

Brown Sequard syndrome

69
Q

how to manage the various cord syndromes

A

Removal of structures that are increasing the pressure on that specific portion of the spine. +/- Laminectomy

70
Q

burst fracture-Jefferson

A

C1, can cause anterior cord syndrome

71
Q

Hangman’s fx (pedicle)

A

C2- Axis- Hyperextension injury

72
Q

odontoid fxs occure from

A

falling on face

type 2 unstable is the MC

73
Q

Fx due to forced flexion of cervical spine

A

anterior wedge fx

74
Q

Due to severe flexion injuries leading to the collision of the above vertebral body with the one below it.

A

flexion teardrop fx

  • may present w/anterior cord syndrome
  • Anterior displacement of a Wedge shaped fragment
75
Q

Due to extension injuries of the neck, classically seen with diving accidents

A

extension teardrop fx

  • may present w/central cord syndrome
  • triangular shaped fragment
76
Q

Spinous process fracture- due to neck flexion in MVA

A

clay shoveler’s fx

77
Q

how to manage unstable cervical fxs

A

halo-vest immobilization

Neuro Surgery (1 decks)

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