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EANS > Högst möjliga tentafrågor > Flashcards

Högst möjliga tentafrågor Flashcards

1
Q

What is causing the most common intractable temporal lobe EP?

A

Mesial temporal sclerosis

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2
Q

What three extremely important features are kept in the dorsal hippocampus?

A
  • spatial memory
  • verbal memory
  • learning conceptual information
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3
Q

What is Lennox Gastaut syndrome?

A
  • Childhood drop attacks
  • Then tonic clonic seizures and mental retardation
  • Seizures often polymorphic and difficult to treat, sometimes 50/day.
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4
Q

Name 2 treatments for Lennox Gastaut syndrome?

A
  • Valproic acid - 50%
  • Corpus Callostomy!
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5
Q

What syndrome is associated to hypsarrytmia and jacknife spasm?

A

West syndrome

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6
Q

What type of special EEG show huge spike/waves and slow wave associated with muscle artifacts.

A

Hypsarrytmia

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7
Q

What is typical for abscence “seizures”?

A
  • NO postictal confusion
  • Aura is rare
  • EEG show spike and wave EXACTLY 3/s
  • May be induced by hyperventilation for 2-3 min.
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8
Q
A
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9
Q

What types of tumours are included in the tumour group “Ependymomas”?

A
  • Supratentorial ependymoma
  • Supratentorial ependymoma (ZFTA or YAP1 fusion-positive)
  • Posterior fossa ependymoma
  • Posterior fossa ependymoma (PFA or PFB group)
  • Pinal ependymoma
  • Spinal ependymoma, MYCN amplified
  • Myxopapillary ependymoma
  • Subependymoma
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10
Q

What does “IDH1/2” mutation stand for?

A

Isocitrate dehydrogenase

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11
Q

What does “MAPK” stand for?

A

Mitogen-activated protein kinase pathway

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12
Q

What does “MGMT” stand for?

A

methylation O6-methylguanine DNA methyltransferase

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13
Q

In what glioma type/s is “Loss of chromosome 1p and 19q (loss of heterozygosity) (1p/19q codeletion)” clinically relevant?

A
  • Prerequisite for the diagnosis of oligodendroglioma
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14
Q

Why should CSF and serum be measured for certain markers when a pineal tumor is found?

A

Alpha fetoprotein and beta human chorionic gonadotropin are pathognomonic for certain germ cell tumors.

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15
Q

What is different about spinal astrocytoma?

A
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16
Q

Which is the only high grade circumscribed astrocytic glioma?

A

high-grade astrocytoma with piloid features: not graded but poor prognosis.

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17
Q
A

Apart from the relatively common tumor types such as diffuse midline glioma, H3 K27-altered or pilocytic astrocytoma, other types of tumors in these categories are rare and the prevalence is not clearly established yet.

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18
Q

What is the most likely tumor?
A child with a nonenhancing expansile pontine mass

A

Typical imaging features and appropriate clinical settings suggesting
high-probability of
*diffuse midline glioma, H3 K27-altered!

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19
Q

What is the most likely tumor?
a child with cystic mass with enhancing mural nodule in the
cerebellum.

A

High probability of pilocytic
astrocytoma.

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20
Q

NF1 is closely realted to one type of astrocytoma. Which?

A

pilocytic astrocytoma, especially affecting the optical nerve.

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21
Q

What tumor?
A continuously enlarging enhancing mass near the foramen Monro in a patient with tuberous sclerosis ?

A

Suggesting subependymal giant cell tumor [SEGA]

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22
Q

The common locations of each type of tumors in pediatric
diffuse low-grade gliomas and circumscribed gliomas?

A

low grade gliomas - causing EP and situated in temporal lobe.

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23
Q

Diffuse hemispheric glioma, H3 G34-mutant, is a newly included tumor type in the 2021 WHO classification. how is it defined?

A

This tumor type is defined as an infiltrative hemispheric tumor with missense mutation of the H3-3A gene and predominantly found in adolescents and young adults.30 Diffuse hemispheric glioma, H3 G34-mutant corresponds to CNS WHO grade 4, regardless of the presence or absence of necrosis or microvascular proliferation.

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24
Q

What is the prognosis of H3G34 mutated pediatric diffuse hemispheric glioma in relation to the H3K27 altered diffuse MIDLINE glioma?

A

The prognosis of diffuse hemispheric glioma, H3 G34-mutant is poor but shows a longer overall survival (median: 18.0 months) than diffuse midline glioma, H3 K27-altered.3

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25
Q

HOw old are patients with pilocytic astrocytoma?

A

Pilocytic astrocytoma is most common during the first two decades of life and accounts for 17.6% of all childhood primary brain tumors. However, it also accounts for up to 1.5% of adult brain tumors.

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26
Q

Where are pilocytic astrocytomas localised?

A

Pilocytic astrocytoma usually arises from the cerebellum, but it can also occur in the supratentorial compartment including the optic nerve and chiasm, hypothalamus, cerebral hemispheres, or ventricles.58 Supratentorial location is more common in adults, up to 47.8% in a recent meta-analysis

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27
Q

What grade is pilocytic astrocytoma?

A

grade II

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28
Q

What is Ketoconazole and what is it used for?

A

An antifungal agent. Block adrenal steroid synthesis. Used for ACTH secreting tumors (Cushings disease)

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29
Q

how does carboplatin work?

A

chelation via intrastrand crosslink

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30
Q

What is bevacizumab - Avastin?

A

anti-VEGF antibody.

31
Q

Which is the only pituitary tumor treated medically and not surgically?

A

Prolactinoma

32
Q

What is the first line choice of treatment of Prolactinomas?

A

DA-AGONIST - Bromocriptine or Cabergoline.
obs inhibitory pathway

33
Q

What does PCV stand for?

A

P-Procarbazine
C-CCNU = Lomustine
V-Vincristine

34
Q

What is Ketoconazole and what is it used for?

A

An antifungal agent. Block adrenal steroid synthesis. Used for ACTH secreting tumors (Cushings disease)

35
Q

SCS - “functional indications”

A
  • bladderdysfunction
  • dystonia
  • spastic hemiparesis
36
Q

Intracranial ablative procedures for pain

A
  • Cingulotomy bilaterally
  • stereotactic mesencephalotomy - for unilateral head, neck, face and UE pain.
37
Q

When is DREZ indicated?

A

he dorsal root entry zone (DREZ) lesioning procedure is a treatment for severe pain caused by nerves that have been torn away (avulsed) from the spinal cord or, less commonly, by spinal cord injury. DREZ lesioning may be appropriate when nonoperative pain therapies have not provided relief.

38
Q

choice for unilateral pain, head, neck, UE

A

*DBS
*stereotactic mesencephalotomy
(trigeminus kompression)

39
Q

What is comissural myelotomy?

A

Midline or commissural myelotomy is a procedure in which the decussating fibers of the spinothalamic tract are interrupted as they cross in the anterior white commissure of the spinal cord.

40
Q

When is cordotomy used?

A

for unilateral aching pain below nipple (C5) in a terminally ill patient

41
Q

Var kan SCS placeras?

A
  • alltid epiduralt
    *från C1-C5 o nedåt.
42
Q

Effect av SCS C1-2 placering?

A

neck, schoulder or arm.

43
Q

What are the two ways to introduce electrodes in SCS?

A
  • Tuohy needles, inserted via puncture
  • Paddles, inserted via laminotomy.
44
Q

How is the effect/success of an SCS determined?

A

ALWAYS several day trial period with an external generator before the patient fill out a VAS.
Success= more than 50% pain reduction.

45
Q

DBS: for deafferentation pain syndromes

A
  • sensory thalamus: VPM or VPL
    For chronic neuropathic pain, 40-50% reduction in 20-60% of patients.
46
Q

DBS: for nociceptive pain syndromes

A

PVG (perivenricular grey matter)
PAG (periaqueductal grey matter)

Response rate about 20%

47
Q

DREZ lesion

A

laminectomy over involved segments.
Microscope. Find rootlets above and below.
Lesions created IPSILATERAL to the avulsed nerve root/s.
Radiofrequency current -75 degreeds celsius 15s per lesion (or knife blade).

48
Q

What is cordotomy?

A

Interruption of lateral spinothalamic tract fibers in the SC.

49
Q

How much painrelief is needed in an intrathecal vs an epidural administration?

A

5-10 x more in intrathecal.

50
Q

hur länge kan man förvänta sig effekt av en intrathecal eller epidural smärtpump?

A

upp till ett år. Alltså ej för kronisk smärta.

51
Q

According to Patric Blomstedt and Marwan Hariz, which are the two preferred targets for DBS in Parkinsons disease?

A
  1. The subthalamic nucleus
  2. Globus Pallidus interna
52
Q

Which is the ONE absolute preferred target for Parkinssons disease and why is it not always ok to use?

A

The STN - Subthalamic nucleus.
Not always ok if the pt is too old, with cognitive decline or relevant depression. The patient cannot either have medically resistant axial symptoms, such as balance and gait disturbance.

53
Q

Which are the preferred targets for tremors?

A

sites in Thalamus, such as zona inserta and Vim.

54
Q

What is the most common side effect of DBS regardless of brain target?

A

Dysarthria

55
Q

shunt or ETV?

A
  1. AGE?
    under 1 mo -0%
    1 - 6 mo -10%
    6mo-1year - 20%
    1y - 10 y - 40%
    over 10 y - 50%
  2. Type of hcph?
    * post infectious - 0%
    * MMC, non-tectal tumor, post IVH - 20%
    * aq-stenosis, tectal tumor - 30%
  3. Previous shunt?
    yes - 0%
    no - 10%
56
Q

The ETV success score is validated for predicting chance of success 6 months after ETV surgery. What does it mean to score 40% or less on the scale?

A

It means a very low chance of success.

57
Q

What does it mean to have a score over 80% in the ETV success score?

A

A better chance to succeed with ETV than shunting from the outset.

58
Q

What 2 nerves from the median nerve needs to be looked out for?

A
  1. Palmar cutaneous branch.
  2. Recurrent motor branch to the thumb.
59
Q

Elecrtrodiagnostic criteria for the ulnar neuropathy at the elbow?

A

Not all criteria need to be present and a needle EMG is not needed.
* Absolute MN conduction velocity under 50m/s from elbow to above elbow.
* Drop of conduction velocity with more than 10m/s in the underarm compared to above elbow.
* Amplitude of compound motor action potential normally decreases by distance, but a drop of more than 20% is abnormal.

mer sägs men detta är core.

60
Q

What is a pancoast tumor?

A

most often due to bronchogenic ca.
Situated close to the brachial plexus
* Atrophy of hand muscles
* Horner syndrome
Radiating pain.

61
Q

How can preganglionic injuries be differentiated from postganglionic?

A

-proximal or distal to the dorsal root ganglion-
Pre ganglionic:
* horner syndrome
* Wing scapula - long thoracic nerve injury –serratus anterior
* Rhomboid paralysis - dorsal scapular nerve
* PSeudomeningocele on MRI associated to root avulsion and associated neuropathic pain.

EMG - cannot be done until 3 weeks after injury to get a any findings.

62
Q

What does EMG find to suggest preganglionic injury?

A
  • Denervation potentials in paraspinal muscles due to loss of neural input. The posterior ramus of of the spinal nerve originates just distal to the dorsal root ganglion.
  • Normal sensory nerve action potential - SNAP- preganglionic injuries leave the dorsal ganglion sensory bodies and the distal axon intact. A normal SNAP can therefore be recorded proximally EVEN IN AN ANESTHETIC REGION!
63
Q

What is a surgical option for birth upper plexus injuries (C5-7)

A

Nerve transfer if no antigravity in deltoid, bicep or tricep at 3 mo age.

64
Q

How to reach sphenoid sinus to pack in case of CSF leak?

A
  • incise dura over tuberculum sella, drill through bone to reach sphenoid sinus, remove mucosa and pack inferiorly. Use fat!
65
Q

How to treat known CSF leaks into sphenoid sinus?

A
  1. LP 2 times a day or continous lumbar drainage.
  2. if more than 3 days, repack sphenoid sinus and pterygoid recessses.
  3. if more than 5 days, LP-shunt. (R/O obstructive hcph)

alt - intradural approach to medial aspect of middle cranial fossa
alt2. consider transnasal sellar injection of fibrin glue under local anesthesia.

66
Q

Successrate for pt w spontaneous intracranial hypotension?

A

70-75% w blood patch.

67
Q

what is a Torkildsen shunt?

A

a ventriculocisternal shunt

68
Q

What vasculature is the donor for a VA shunt?

A

jugular vein to superior vena cava.

69
Q

what is the risk of seizure after shuntplacement?

A

5.5% first year. 1.1% 3rd.

70
Q

When does a suboccipital pseudomeningocele need operation?

A
  • leak
  • threathening the integrity of the incision
  • cosmetic deformity
  • causing symtoms
71
Q

what is trendelenburg position?

A

Straight body, head kept under heartlevel and feet above.

72
Q

Supine position

A

on the back

73
Q

How many pt w HIV/AIDS get neurologic symtoms?

A

40-60%

74
Q

What are the 5 most common focal CNS lesions caused by -correlated to AIDS?

A
  • Toxoplasmosis - Toxoplasma Gondhii
  • primary CNS lymphoma.
  • progressive multifocal leukoencephalopathy - viral
  • Cryptococcal abscesses (more commonly manifest as meningitis)
    *TB

EANS (31 decks)

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