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EOR - Surgery > Neurology > Flashcards

Neurology Flashcards

1
Q

6 early sx of local anesthetic toxicity

A

tinnitus
perioral/tongue numbness
metallic taste
blurred vision
muscle twitches
drowsiness

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2
Q

perioperative vision loss is very rare, but is associated w. what surgeries (3)

A

cardiac
spine
head/neck

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3
Q

mcc of post op ocular injury

A

corneal abrasion

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4
Q

3 mcc of permanent perioperative vision loss

A

CRAO
ischemic optic neuropathy
cerebral vision loss

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5
Q

most frequent clinical presentation of perioperative vision loss

A

ischemic optic neuropathy

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6
Q

rf for perioperative vision loss (9)

A

long surgeries
excessive blood loss
hypotn
anemia
hypoxia
excessive IVF
vasoconstricting agents
elevated venous pressure
head positioning

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7
Q

3 causes of post op transient blurring of vision

A

ocular ointments
excessive drying
corneal trauma

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8
Q

4 causes of complete or partial perioperative visual loss

A

surgical trauma
embolic events
anemia
hypotn

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9
Q

ischemia or poor circulation to the short posterior ciliary blood vessels that supply the front or anterior portion of the optic nerve

A

anterior ischemic optic neuropathy (AION)

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10
Q

2 sx of AION

A

painless abrupt vision loss
optic disc pallor/swelling

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11
Q

life threatening condition caused by sudden hemorrhage or infarction w.in the pituitary gland

A

pituitary apoplexy

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12
Q

transient perioperative visual loss after absorption of glycine solution

A

glycine induced visual loss

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13
Q

rf for glycine induced vision loss

A

TURP

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14
Q

sx of AION

A

starts in one eye -> then affects both eyes

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15
Q

major rf for AION

A

hypotn

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16
Q

what n is easily damaged in thyroid surgery leading to hoarseness

A

recurrent laryngeal

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17
Q

7 causes of aphasia

A

CVA - mc
MS
ICH
migraine
carotid dz
recurrent laryngeal n damage
apraxia of speech (AOS)

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18
Q

motor speech disorder resulting from neurological injury of the motor component of the motor speech system

A

dysarthria

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19
Q

causes of dysarthria (lots!)

A

TBI
CVA
parkinson’s
ALS
MS
huntington’s
wilson’s dz
drowning
central pontine myelinolysis
brain tumor
cereral palsy
guillain barre
hypothermia
lyme
stroke
intracranial htn (pseudotumor cerebri)
tay-sachs

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20
Q

what is ICH

A

bleeding into brain parenchyma

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21
Q

mcc of ICH

A

htn/atherosclerosis dz

also: coagulopathies, AVMs, amyloid angiopathy, tumor, trauma

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22
Q

mc location for ICH

A

basal ganglia -> putamen

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23
Q

6 sx of ICH

A

coma
contralateral hemiplegia
hemisensory deficits
lateral gaze
aphasia
homonymous hemianopsia

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24
Q

surgical indications for ICH (2)

A

CN III palsy
progressive alteration of consciousness

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25
4 syndromes associated w. spinal cord injury
anterior cord central cord complete cord brown sequard (hemisection(
26
sx of anterior cord syndrome
loss of pain/temp below the level of injury preserved proprioception/vibration
27
sx of central cord syndrome
loss of pain/temp at the level of injury preserved proprioception/vibration
28
sx of complete cord transection
reduced sensation caudally no sensation below the injury urinary retention/bladder distension
29
sx of brown sequard/hemisection
-loss of proproception/vibration on the side of injury -loss of pain/temp on the opposite side of injury and a few levels below the injury
30
2 types of sensory neuropathies
distal sensory/stocking glove axonal
31
causes of axonal neuropathies (lots!)
DM etoh B12 syphilis HIV lyme uremia chemo vasculitis paraneoplastic amyloidosis
32
excruciating HA in the absence of focal neuro findings
SAH
33
2 PE findings of SAH
elevated bp fever
34
sx of a herald bleed
less severe/atypical HA focal neuro signs *usually precedes severe SAH by 1-3 weeks*
35
pathophys of SAH
**ruptured cerebral aneurysm (mc)** OR AVM -> bleeding into CSF of subarachnoid space
36
mcc of SAH
berry aneurysm
37
mc age for SAH
60-70
38
4 rf for SAH
smoking htn hypercholesterolemia etoh
39
gs dx for SAH
noncontrast CT
40
order of dx imaging for SAH
1. noncontrast CT 2. LP - if CT neg and high suspicion for SAH 3. cerebral angiography once stable - look for additional aneurysms 4. EEG
41
2 LP findings of SAH
elevated opening pressure grossly bloody fluid
42
SAH bleeding occurs btw the _ and _ layers
arachnoid pia
43
supportive tx for SAH aims to
prevent elevated arterial pressure -> prevent re-rupture of affected vessel
44
tx for SAH
manage htn avoid hypotn **clip vs wrap aneurysm** embolectomy via catheter
45
tx for vasospasm caused by SAH
nimodipine
46
causes of SAH (3)
**trauma - mc** ruptured aneurysm AVM
47
saccular outpouching of vessels in the COW, usually at bifurcations
berry aneurysm
48
mc location for SAH
1. anterior communicating a 2. posterior communicating a 3. middle cerebral a
49
what 2 conditions increases risk of berry aneurysm
polycystic kidney dz marfans
50
mc location for AVMs
supratentorial
51
mcc of sdh
trauma
52
hallmark hpi for sdh
elderly pt w. hx of multiple falls presents w. neuro sx
53
sdh result from inury to what brain structure
bridging veins
54
classification of sdh
acute: sx w.in 48 hr of injury subacute: sx w.in 3-14 days of injury chronic: sx after >/= 2 weeks
55
chronic sdh are commonly seen in what pt pop
alcoholics
56
2 hallmark findings of sdh
AMS focal neuro sx
57
what shape does sdh bleeding appear on a CT
crescent/concave
58
what is this showing
sdh
59
path of bleeding: sdh vs epidural hematoma
sdh: may cross suture line epidural: does not cross suture line
60
tx for sdh based on severity
small/mild sx: obs, +/- repeat imaging severe: burr holes vs craniotomy vs craniectomy
61
7 rf for atherosclerosis
**smoking** **dm** male fam hx hld htn advanced age
62
2 conditions associated w. atherosclerosis
pad cad
63
if symptomatic, atherosclerosis commonly presents w. (5)
amaurosis fugax unilateral m weakness/paresthesia dizziness tinnitus aphasia
64
carotid bruit is typically heard at what % stenosis
60-70
65
dx for atherosclerosis
1. duplex US 2. angiography (MRI vs CT)
66
classification of stenosis
moderate: 50% severe: 70%
67
management of atherosclerosis (4)
smoking cessation asa vs clopidogrel vs both statins for all endarterectomy vs stenting
68
2 indications for revascularization
stenosis > 70% TIA/stroke
69
what type of revascularization is first line
endarterectomy (cea)
70
what is RIND
reversible ischemic neuro deficit basically a TIA but lasts 24-72 hr
71
gs invasive method to evaluate carotid dz
angiogram/arteriogram
72
indication for CEA in asymptomatic vs symptomatic pt
asymptomatic: > 60% symptomatic: > 50%
73
complication of CEA
stroke
74
microemboli to retinal arterioles seen as bright defects
hollenhorst plaque
75
hallmark presentation of epidural hematoma
injury -> transient loc -> lucid perior -> increasing drowsiness, HA, unilateral/contralateral weakness
76
mcc of epidural hematoma
traumatic ICH
77
epidural hematomas are mc caused by tearing of the _ a
middle meningeal
78
the middle meningeal a passes thru the _ of the _ bone
foramen spinosum sphenoid
79
epidural hematoma causes bleeding between the _ and the _
dura skull
80
CT findings of epidural hematoma bleeding
lenticular/lens shaped unilateral convexity temporal region
81
what is this showing
epidural hematoma
82
tx for epidural hematoma
craniotomy bp control
83
how is increased intracerebral pressure managed w. epidural hematoma (4)
mannitol hyperventilate steroids ventricular shunt
84
how does trauma lead to epidural hematoma
skull fx -> bone fragments lacerate meningeal a
85
mc sign of epidural hematoma
ipsilateral blown pupil
86
indications for craniotomy w. epidural hematoma
symptomatic > 1 cm

EOR - Surgery (13 decks)

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