Nervous system-Surgery Flashcards
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?
Syringomyelia post trauma due to whiplash-type injury to the neck- shows central cord syndrome (anterior horn compression)
Loss of vibration and proprioception in lower extremity. Dx?
Tabes dorsalis (tertiary syphyilis)
Most common complication after subarachnoidal hemorrhage (SAH)? and Preventative?
Cerebral ischemia Oral nimodipine (CCB) to prevent vasospasm
6MO, intermittent eye crossing, an asymmetric corneal light reflex, positive cover test. Dx?Tx?
- Strabismus
- Patching the healthy eye or blurring it with cycloplegia eye drops (cyclopentolate)
Most brain tumors that present with seizures are located in
supratentorial
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?
extra-axial (external to the brain parenchyma)
Meningiomas
26M, with agitation and confusion after vacation in caves, who refused to drink any liquids, moderate amount of drool, combative. Dx? Prevention?
encephalitic Rabies
Immunoglobulin and vaccination administration
qualification for urgent surgical evacuation of SDH (3)
- evidence of moderate to severe cognitive impairment
- Subdural hematoma > or = 10mm
- Midline shift > or = 5mm on brain scan
NSIM for bruit on the right side of the neck? Dx?
-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
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?
Carpal tunnel syndrome (CTS), nerve conduction studies
Sensorineural hearing loss, tinnitus and vertigo
Meniere’s disease
unilateral hearing loss, + Rinner test and
lateralization to the normal ear (weber test)
Acoustic neuroma (Tumor in the cerebelloponitine angle) Schwann cells in the internal auditory meatus
low HR, hypertension, irregular respiration after TBI
Cushing’s triad (HTN, Brady & irregular respiration) due to increased ICP, causing increased CPP
hypotension, decreased unilateral breath sounds, distended neck veins, tracheal deviation and tachycardia is
tension pneumothorax
The two spinal cord areas and their response to loss in that are supplied by the anterior spinal artery are
- Descending corticospinal tract fibers -bilateral flaccid paralysis and loss of DTRs
- Ascending spinothalmic tract - bilateral pain/temp sensation loss
- R side hemiparalysis
- R side loss of proprioception, tactile discrimination & vibratory sense
- L side loss of pain and temperature sensation
Brown-Sequard syndrome- trauma to spinal cord (hemisection of the R side)
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?
- 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
hyperventilation causes ______, using _____ law
vasoconstriction (for Increased ICP)
Poiseuille’s law (small radius causes decrease in blood flow)
Level of management for pt with mild carpal tunnel syndrome (CTS)
- Volar splinting
- local glucocorticoid injection (triamcinolone)
- for sever surgical decompression of median nerve
Cushing triad (Brady, irregular respiration, HTN) and ipsilateral oculomotor palsy indicates
Tentorial (uncle) herniation
ipsilateral R uncus herniation progresses to displace midbrain and comprising the left cerebral peduncle that contains ______ causing ______ process called
left corticospinal tract-across the tentorium causing ipsilateral (R sided) hemiparesis and UMN signs, Kernohan phenomenon (false localizing syndrome)
Bitten by a raccoon on a pt who have received rabies vaccine, NSIM?
Rabies vaccination
Bitten by a raccoon on a pt who have NOT received rabies vaccine, NSIM?
Rabies immunoglobulin and vaccine
the cause for 80% of non-traumatic subarachnoid hemorrhages are
Ruptured saccular aneurysms
The cause of 10% non-traumatic subarachinoid hemorrhages are
intracranial arteriovenous malformation
CT scan with diffuse hemorrhage at the base of the brain
ruptured saccular aneurysms
CT with foci of calcification and hyper attenuating vascular channels
Arteriovenous malformations
1st line of tx for epidural hematoma
- Urgent craniotomy
- 2nd line is perform burr hole evacuation (place with limited neurosurgeons, can be done by general surgeon)
Bilateral periorbital ecchymosis (Raccoon eyes) and CSF rhinorrhea is
Basilar skull fracture involving anterior cranial fossa
Retroauricular ecchymosis (battle sign) and otorrhea
Basilar skull fracture involving petrous part of the temporal bone
Retinal pallor indicates
ischemia
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
Central retinal artery occlusion
Sudden, painless, transient monocular loss of vision with discoloration along the retinal arterial supply on fundoscopy. Dx? NSIM?
retinal artery occlusion , carotid duplex ultrasonography
1st line of Tx for trigeminal neuralgia & epilepsy
Carbamazepine
Pt with clean, minor wound with unknown immunization hx. NSIM?
administer Tdap
Pt with not clean or not minor wound with unknown immunization hx. NSIM?
Admisniter Tdap with TIG (Tetanus prophylaxis after injury)
Sudden painless decreased vision in one eye with flashes of light and floaters after a cataract surgery indicates
pathology in the posterior segment of the eyeball- retinal detachment
“Rising wall” or “dark curtain” across the field of vision is
Retinal detachement
Bitten by neighbor’s dog, who behaves normal. NSIM?
Observe dog for 10 days-
normal- no postexposure prophylaxis (PEP)
Bitten by neighbor’s dog, who behaves abnormal. NSIM?
Start PEP for pt, test dog if negative- prophylaxis discontinue
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?
Cavernous sinus thrombosis (late complication of paranasal sinus or facial infections), subcutaneous enoxaparin, aggressive abx therapy (vancomycin with 3rd or 4th generation cephalosporin)
Pt taking metronidazole should avoid
alcohol consumption because it causes disulfiram-like reaction
When do you perform urea beach test for H.Pylori infection treatment?
at least 4 weeks after completing the abx and PPI therapy
Best treatment of bleeding aneurysm (SAH) who is hemodynamically stable
surgical clipping
Best treatment of bleeding aneurysm (SAH) who is hemodynamically unstable (increased risk of cerebral herniation)
decompressive craniectomy
The most common anterior mediastinal mass is ___ and what test used?
Thymoma- common in myasthenia graves (acetylcholine receptor antibody detection)
Meniere’s disease is
reduced resorption of endolymph leads to the accumulation of fluid in the endolyphatic sac
Weber test lateralization to the left ear on meunière disease, hearing loss in what ear?
Right ear hearing loss
