Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EOR General Surgery > Neurology (5%) > Flashcards

Neurology (5%) Flashcards

1
Q

Risk factors for carotid disease

A

HTN
DM
Smoking
Hypercholeseterolemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A pt with carotid disease may have a history of:

A

Stroke
TIA
Focal motor deficits, weakness, clumsiness, expressive or cognitive aphasia
May be reversible neurological deficits or fixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Treatment for carotid artery dissection

A

Anticoagulation for 3-6 mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Signs/Symptoms of carotid disease

A 
Amaurosis Fugax (transient monocular blindness)
Hollenhorst Plaques (found in retinal exam - evidence of previous emboli)
Carotid bruit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Amaurosis Fugax

A

Seen in carotid disease
Transient monocular blindness
Usually described as a shade being pulled down in front of pt’s eye
Due to occlusion of a branch of the ophthalmic artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Diagnosis for carotid disease

A
  1. Carotid duplex screening

2. MRA (magnetic resonance angiogram) - best for degree of stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of carotid disease

A
  1. Antiplatelet therapy with aspirin to prevent neurologic events
  2. Endarterectomy (if indicated)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Indications for endarterectomy

A
  1. > 75% stenosis
  2. > 70% stenosis and symptomatic
  3. Bilateral dz and symptomatic
  4. > 50% stenosis with recurrent TIAs despite aspirin therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Major complications of endarterectomy

A

MI (major cause of death post-procedure)

Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mechanism behind subarachnoid hemorrhage

A

Berry aneurysm rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Signs/Symptoms of subarachnoid hemorrhage

A 
Thunderclap H/A (worst of my life)
\+/- unilateral, occipital area
\+/- LOC, N/V
May have meningeal sx: stiff neck, photophobia, delirium
Usually no focal neurological deficits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Diagnosis of subarachnoid hemorrhage

A
  1. CT first
  2. If CT negative, perform LP (looking for blood, increased pressure)
  3. 4-vessel angiography after confirmed SAH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of subarachnoid hemorrhage

A
  1. Supportive: bed rest, stool softeners, lower ICP
  2. Surgical coiling or clipping
  3. +/- BP lowering (Nicardipine, Nimodipine, Labetalol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mechanism behind subdural hematoma

A

Tearing of cortical bridging veins

Seen most commonly in the elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most common cause of subdural hematoma

A

Blunt trauma - often causes contrecoup bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Signs/Symptoms of subdural hematoma

A

Varies

May have focal neurological symptoms

17
Q

Diagnosis of subdural hematoma

A

CT (concave crescent shaped bleed)

Bleeding can cross suture lines

18
Q

Management of subdural hematoma

A

Hematoma evacuation vs. supportive

Evacuation if massive or > 5 mm midline shift

19
Q

Mechanism behind epidural hematoma

A

Middle meningeal artery

Most common after temporal bone fracture

20
Q

Signs/Symptoms of epidural hematoma

A

Brief LOC, lucid interval, coma
Headache, N/V, focal neuro sx, rhinorrhea (CSF fluid)
CN III palsy if tentorial herniation

21
Q

Diagnosis of epidural hematoma

A
  1. CT (convex lens shaped bleed)

Will not cross suture lines, usually in temporal area

22
Q

Management of epidural hematoma

A

+/- herniation if not evacuated early
Observation if small
If increased ICP: mannitol, hyperventilation, head elevation +/- shunt

23
Q

80% of all strokes are __________, and are due to ________, ________, or ______ _________

A

Ischemic
Emboli
Thombus
Systemic hypoperfusion

24
Q

Signs/Symptoms of stroke

A

Abrupt onset of neurological abnormalities
Facial paresis
Arm drift/weakness
Abnormal speech

25
Q

Signs/Symptoms of hemorrhagic stroke

A

Headache
LOC
N/V

26
Q

Diagnostic testing of stroke

A
  1. Non-contrast CT to r/o hemorrhage
  2. LP if negative but still suspicious
  3. MRI - localize extent of infarction (after 24 hrs)
27
Q

Other tests for stroke to r/o other dz:

A
  1. Glucose - r/o hypoglycemia
  2. O2 sats
  3. EKG - r/o arrhythmia
  4. CBC
  5. Cardiac enzymes - r/o infarction
  6. PT/PTT
28
Q

All patients who present within ______ hours of symptom onset should be offered TPA (ischemic stroke)

A

4.5 hours

29
Q

All presents who present after 4.5 hour window for ischemic stroke should be given:

A

Aspirin

30
Q

Patients who have ___________________ should not be given TPA

A

Rapidly improving stroke symptoms

31
Q

In ischemic stroke, blood pressure should be lowered in the case of:

A
  1. Malignant hypertension
  2. Myocardial ischemia
  3. BP > 185/110 and if TPA will be administered
32
Q

Indications for mechanical thrombectomy in ischemic stroke

A

Occlusion of proximal anterior circulation
No hemorrhage present
Can be done w/n 6 hours

33
Q

Treatment for hemorrhagic stroke

A

BP therapy - goal is 160/90
Labetalol and nicardipine are 1st line
If pt on anticoagulants, give reversal agent
Surgical removal or hemorrhage should be done if hemorrhage is > 3 cm in diameter or if patient is deteriorating

34
Q

Ischemic Stroke Interventions:

A
  1. ASA within 48 hours
  2. Pneumatic compression stockings or heparin for VTE prophylaxis
  3. Statin therapy
  4. Smoking cessation
35
Q

Long Term Antiplatelet Therapy after ischemic stroke

A

Aspirin, clopidogrel, or aspirin-dipyridamole

If patient was previously on aspirin - switch to clopidogrel or add dipyridamole

36
Q

After stroke management (diagnostic modalities):

A
  1. Echocardiogram - look for clot
  2. EKG/Holter monitor - r/o AFib/arrhythmia
  3. Carotid duplex US - r/o stenosis
  4. Duplex Ultrasound, CTA or MRA or head/neck arteries - look for clot

EOR General Surgery (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions