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AMBOSS (BA) > Nervous system-Surgery > Flashcards

Nervous system-Surgery Flashcards

1
Q

58M, burning pain in his neck and arms for a year, , MVA 3years ago, UE weak, absent reflexes. No pain or temperature sensation on chest and bilateral upper arm. Dx?

A

Syringomyelia post trauma due to whiplash-type injury to the neck- shows central cord syndrome (anterior horn compression)

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2
Q

Loss of vibration and proprioception in lower extremity. Dx?

A

Tabes dorsalis (tertiary syphyilis)

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3
Q

Most common complication after subarachnoidal hemorrhage (SAH)? and Preventative?

A 
Cerebral ischemia 
Oral nimodipine (CCB) to prevent vasospasm
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4
Q

6MO, intermittent eye crossing, an asymmetric corneal light reflex, positive cover test. Dx?Tx?

A
  • Strabismus

- Patching the healthy eye or blurring it with cycloplegia eye drops (cyclopentolate)

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5
Q

Most brain tumors that present with seizures are located in

A

supratentorial

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6
Q

Compression of adjacent white matter and/or a rim of CSF around the tumor (CSF appears hyper intense on T2 weighted imaging) indicated the location of the tumor to be? the most common tumor is?

A

extra-axial (external to the brain parenchyma)

Meningiomas

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7
Q

26M, with agitation and confusion after vacation in caves, who refused to drink any liquids, moderate amount of drool, combative. Dx? Prevention?

A

encephalitic Rabies

Immunoglobulin and vaccination administration

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8
Q

qualification for urgent surgical evacuation of SDH (3)

A
  1. evidence of moderate to severe cognitive impairment
  2. Subdural hematoma > or = 10mm
  3. Midline shift > or = 5mm on brain scan
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9
Q

NSIM for bruit on the right side of the neck? Dx?

A

-Carotid artery stenosis
-Ultrasonography of the neck (noninvasive)
Digital subtraction angiography of the neck (golden standard for visualizing the carotid artery- invasive and costly- SE 4% TIA or stroke)-NOT first line

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10
Q

31M, tingling, pain, numbness on R hand, works as hardscaper, reproduced symptoms when his hand is held above his head for 2 minutes. Dx? to confirm do?

A

Carpal tunnel syndrome (CTS), nerve conduction studies

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11
Q

Sensorineural hearing loss, tinnitus and vertigo

A

Meniere’s disease

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12
Q

unilateral hearing loss, + Rinner test and

lateralization to the normal ear (weber test)

A

Acoustic neuroma (Tumor in the cerebelloponitine angle) Schwann cells in the internal auditory meatus

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13
Q

low HR, hypertension, irregular respiration after TBI

A

Cushing’s triad (HTN, Brady & irregular respiration) due to increased ICP, causing increased CPP

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14
Q

hypotension, decreased unilateral breath sounds, distended neck veins, tracheal deviation and tachycardia is

A

tension pneumothorax

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15
Q

The two spinal cord areas and their response to loss in that are supplied by the anterior spinal artery are

A
  1. Descending corticospinal tract fibers -bilateral flaccid paralysis and loss of DTRs
  2. Ascending spinothalmic tract - bilateral pain/temp sensation loss
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16
Q
  • R side hemiparalysis
  • R side loss of proprioception, tactile discrimination & vibratory sense
  • L side loss of pain and temperature sensation
A

Brown-Sequard syndrome- trauma to spinal cord (hemisection of the R side)

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17
Q

Pain on the foot when pressure is applied between the metatarsal heads with audible click
Tapping on the affected area causes pain that shoots into the second and third digits. Dx? Cause?

A
  • Intermetatarsal neuroma (Morton’s neuroma)- caused by entrapment or enlargement of one of the plantar digital nerves
    + Tinel’s and Mulder’s sign
    -from high-heeled footwear
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18
Q

hyperventilation causes ______, using _____ law

A

vasoconstriction (for Increased ICP)

Poiseuille’s law (small radius causes decrease in blood flow)

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19
Q

Level of management for pt with mild carpal tunnel syndrome (CTS)

A
  • Volar splinting
  • local glucocorticoid injection (triamcinolone)
  • for sever surgical decompression of median nerve
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20
Q

Cushing triad (Brady, irregular respiration, HTN) and ipsilateral oculomotor palsy indicates

A

Tentorial (uncle) herniation

21
Q

ipsilateral R uncus herniation progresses to displace midbrain and comprising the left cerebral peduncle that contains ______ causing ______ process called

A

left corticospinal tract-across the tentorium causing ipsilateral (R sided) hemiparesis and UMN signs, Kernohan phenomenon (false localizing syndrome)

22
Q

Bitten by a raccoon on a pt who have received rabies vaccine, NSIM?

A

Rabies vaccination

23
Q

Bitten by a raccoon on a pt who have NOT received rabies vaccine, NSIM?

A

Rabies immunoglobulin and vaccine

24
Q

the cause for 80% of non-traumatic subarachnoid hemorrhages are

A

Ruptured saccular aneurysms

25
Q

The cause of 10% non-traumatic subarachinoid hemorrhages are

A

intracranial arteriovenous malformation

26
Q

CT scan with diffuse hemorrhage at the base of the brain

A

ruptured saccular aneurysms

27
Q

CT with foci of calcification and hyper attenuating vascular channels

A

Arteriovenous malformations

28
Q

1st line of tx for epidural hematoma

A
  • Urgent craniotomy

- 2nd line is perform burr hole evacuation (place with limited neurosurgeons, can be done by general surgeon)

29
Q

Bilateral periorbital ecchymosis (Raccoon eyes) and CSF rhinorrhea is

A

Basilar skull fracture involving anterior cranial fossa

30
Q

Retroauricular ecchymosis (battle sign) and otorrhea

A

Basilar skull fracture involving petrous part of the temporal bone

31
Q

Retinal pallor indicates

A

ischemia

32
Q

Sudden loss of vision and an afferent pupillary defect , retinal pallor and cherry-red spot in foveal region, narrow retinal vessels with a cattle-truck appearance is

A

Central retinal artery occlusion

33
Q

Sudden, painless, transient monocular loss of vision with discoloration along the retinal arterial supply on fundoscopy. Dx? NSIM?

A

retinal artery occlusion , carotid duplex ultrasonography

34
Q

1st line of Tx for trigeminal neuralgia & epilepsy

A

Carbamazepine

35
Q

Pt with clean, minor wound with unknown immunization hx. NSIM?

A

administer Tdap

36
Q

Pt with not clean or not minor wound with unknown immunization hx. NSIM?

A

Admisniter Tdap with TIG (Tetanus prophylaxis after injury)

37
Q

Sudden painless decreased vision in one eye with flashes of light and floaters after a cataract surgery indicates

A

pathology in the posterior segment of the eyeball- retinal detachment

38
Q

“Rising wall” or “dark curtain” across the field of vision is

A

Retinal detachement

39
Q

Bitten by neighbor’s dog, who behaves normal. NSIM?

A

Observe dog for 10 days-

normal- no postexposure prophylaxis (PEP)

40
Q

Bitten by neighbor’s dog, who behaves abnormal. NSIM?

A

Start PEP for pt, test dog if negative- prophylaxis discontinue

41
Q

R side temporal headache, conjunctival swelling, anterior bulging of the left eye, right sided purulent nasal discharge and nasal congestion , fever and leukocytosis. Dx? Tx?

A

Cavernous sinus thrombosis (late complication of paranasal sinus or facial infections), subcutaneous enoxaparin, aggressive abx therapy (vancomycin with 3rd or 4th generation cephalosporin)

42
Q

Pt taking metronidazole should avoid

A

alcohol consumption because it causes disulfiram-like reaction

43
Q

When do you perform urea beach test for H.Pylori infection treatment?

A

at least 4 weeks after completing the abx and PPI therapy

44
Q

Best treatment of bleeding aneurysm (SAH) who is hemodynamically stable

A

surgical clipping

45
Q

Best treatment of bleeding aneurysm (SAH) who is hemodynamically unstable (increased risk of cerebral herniation)

A

decompressive craniectomy

46
Q

The most common anterior mediastinal mass is ___ and what test used?

A

Thymoma- common in myasthenia graves (acetylcholine receptor antibody detection)

47
Q

Meniere’s disease is

A

reduced resorption of endolymph leads to the accumulation of fluid in the endolyphatic sac

48
Q

Weber test lateralization to the left ear on meunière disease, hearing loss in what ear?

A

Right ear hearing loss

AMBOSS (BA) (9 decks)

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