General surgery: Neurology

Question 1

What are early signs of local anesthetic toxicity?

Answer 1

Tinnitus, perioral/tongue numbness, metallic taste, blurred vision, muscle twitches, drowsiness

Question 2

What nerve can be easily damaged in thyroid surgery and lead to hoarseness?

Answer 2

Recurrent laryngeal nerve injury

Question 3

Patient will present as → a 44-year-old female who arrives at the emergency room with a stiff neck, photophobia, and severe headache that began while she was just sitting down to enjoy a box of Kentucky Fried Chicken. She states her symptoms came on immediately and she is in severe distress. This is the worst headache of her life

Answer 3

subarachnoid hemorrhage

Question 4

Sudden, severe (often excruciating) headache in the absence of focal neurologic symptoms; the classic description is “the worst headache of my life” but may also be more subtle.

Answer 4

subarachnoid hemorrhage

Question 5

what is the initial investigational modality for suspected SAH?

Answer 5

Noncontrast head CT

Question 6

What do you do if you perform a CT scan and is negative but there is still a high clinical suspicion for SAH?

Answer 6

lumbar puncture

Question 7

what would an LP reveal in the setting of SAH?

Answer 7

elevated opening pressures and xanthochromia/blood

Question 8

what accounts for about 75% of nontraumatic cases of SAD and has a mortality rate of 50%?

Answer 8

Ruptured saccular (berry) aneurysm

Question 9

Patient will present as → a 74-year-old female who is being treated for mild hypertension. She is found at home with right hemiparesis and brought to the emergency department. Her daughter states that the patient fell in her kitchen 2 days ago, but had no complaints at that time. She did state that her mother sounded a little confused this morning. The patient’s left pupil is dilated. CT shows crescent shaped, concave hyperdensity.

Answer 9

subdural hematoma

Question 10

CT will show a crescent-shaped, concave hyperdensity that extends across suture lines

Answer 10

subdural hematoma

Question 11

This may occur d/t a laceration of the middle meningeal artery and typically presents with a lucid interval followed by sudden LOC

Answer 11

Epidural hematoma

Question 12

Patient will present as → a 24-year-old snowboarder strikes a tree and was not wearing a helmet. He loses consciousness for several minutes but later regains consciousness and reports feeling fine. Several hours later his neurological state decompensates acutely. His CT scan demonstrates a lens-shaped, biconvex hyperdensity that does not cross the suture lines.

Answer 12

Epidural hematoma

Question 13

Classic finding on CT is lenticular, unilateral convexity, usually in the temporal region

Answer 13

Epidural hematoma