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Surgery EOR > Neurology (Alice) > Flashcards

Neurology (Alice) 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
Q

4 syndromes associated w. spinal cord injury

A

anterior cord
central cord
complete cord
brown sequard (hemisection(

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26
Q

sx of anterior cord syndrome

A

loss of pain/temp below the level of injury
preserved proprioception/vibration

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27
Q

sx of central cord syndrome

A

loss of pain/temp at the level of injury
preserved proprioception/vibration

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28
Q

sx of complete cord transection

A

reduced sensation caudally
no sensation below the injury
urinary retention/bladder distension

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29
Q

sx of brown sequard/hemisection

A

-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

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30
Q

2 types of sensory neuropathies

A

distal sensory/stocking glove
axonal

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31
Q

causes of axonal neuropathies (lots!)

A

DM
etoh
B12
syphilis
HIV
lyme
uremia
chemo
vasculitis
paraneoplastic
amyloidosis

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32
Q

excruciating HA in the absence of focal neuro findings

A

SAH

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33
Q

2 PE findings of SAH

A

elevated bp
fever

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34
Q

sx of a herald bleed

A

less severe/atypical HA
focal neuro signs

usually precedes severe SAH by 1-3 weeks

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35
Q

pathophys of SAH

A

ruptured cerebral aneurysm (mc) OR AVM -> bleeding into CSF of subarachnoid space

36
Q

mcc of SAH

A

berry aneurysm

37
Q

mc age for SAH

A

60-70

38
Q

4 rf for SAH

A

smoking
htn
hypercholesterolemia
etoh

39
Q

gs dx for SAH

A

noncontrast CT

40
Q

order of dx imaging for SAH

A
  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
Q

2 LP findings of SAH

A

elevated opening pressure
grossly bloody fluid

42
Q

SAH bleeding occurs btw the _ and _ layers

A

arachnoid
pia

43
Q

supportive tx for SAH aims to

A

prevent elevated arterial pressure ->
prevent re-rupture of affected vessel

44
Q

tx for SAH

A

manage htn
avoid hypotn
clip vs wrap aneurysm
embolectomy via catheter

45
Q

tx for vasospasm caused by SAH

A

nimodipine

46
Q

causes of SAH (3)

A

trauma - mc
ruptured aneurysm
AVM

47
Q

saccular outpouching of vessels in the COW, usually at bifurcations

A

berry aneurysm

48
Q

mc location for SAH

A
  1. anterior communicating a
  2. posterior communicating a
  3. middle cerebral a
49
Q

what 2 conditions increases risk of berry aneurysm

A

polycystic kidney dz
marfans

50
Q

mc location for AVMs

A

supratentorial

51
Q

mcc of sdh

A

trauma

52
Q

hallmark hpi for sdh

A

elderly pt w. hx of multiple falls
presents w. neuro sx

53
Q

sdh result from inury to what brain structure

A

bridging veins

54
Q

classification of sdh

A

acute: sx w.in 48 hr of injury
subacute: sx w.in 3-14 days of injury
chronic: sx after >/= 2 weeks

55
Q

chronic sdh are commonly seen in what pt pop

A

alcoholics

56
Q

2 hallmark findings of sdh

A

AMS
focal neuro sx

57
Q

what shape does sdh bleeding appear on a CT

A

crescent/concave

58
Q

what is this showing

A

sdh

59
Q

path of bleeding: sdh vs epidural hematoma

A

sdh: may cross suture line
epidural: does not cross suture line

60
Q

tx for sdh based on severity

A

small/mild sx: obs, +/- repeat imaging
severe: burr holes vs craniotomy vs craniectomy

61
Q

7 rf for atherosclerosis

A

smoking
dm
male
fam hx
hld
htn
advanced age

62
Q

2 conditions associated w. atherosclerosis

A

pad
cad

63
Q

if symptomatic, atherosclerosis commonly presents w. (5)

A

amaurosis fugax
unilateral m weakness/paresthesia
dizziness
tinnitus
aphasia

64
Q

carotid bruit is typically heard at what % stenosis

A

60-70

65
Q

dx for atherosclerosis

A
  1. duplex US
  2. angiography (MRI vs CT)
66
Q

classification of stenosis

A

moderate: 50%
severe: 70%

67
Q

management of atherosclerosis (4)

A

smoking cessation
asa vs clopidogrel vs both
statins for all
endarterectomy vs stenting

68
Q

2 indications for revascularization

A

stenosis > 70%
TIA/stroke

69
Q

what type of revascularization is first line

A

endarterectomy (cea)

70
Q

what is RIND

A

reversible ischemic neuro deficit
basically a TIA but lasts 24-72 hr

71
Q

gs invasive method to evaluate carotid dz

A

angiogram/arteriogram

72
Q

indication for CEA in asymptomatic vs symptomatic pt

A

asymptomatic: > 60%
symptomatic: > 50%

73
Q

complication of CEA

A

stroke

74
Q

microemboli to retinal arterioles seen as bright defects

A

hollenhorst plaque

75
Q

hallmark presentation of epidural hematoma

A

injury -> transient loc -> lucid perior -> increasing drowsiness, HA, unilateral/contralateral weakness

76
Q

mcc of epidural hematoma

A

traumatic ICH

77
Q

epidural hematomas are mc caused by tearing of the _ a

A

middle meningeal

78
Q

the middle meningeal a passes thru the _ of the _ bone

A

foramen spinosum
sphenoid

79
Q

epidural hematoma causes bleeding between the _ and the _

A

dura
skull

80
Q

CT findings of epidural hematoma bleeding

A

lenticular/lens shaped
unilateral convexity
temporal region

81
Q

what is this showing

A

epidural hematoma

82
Q

tx for epidural hematoma

A

craniotomy
bp control

83
Q

how is increased intracerebral pressure managed w. epidural hematoma (4)

A

mannitol
hyperventilate
steroids
ventricular shunt

84
Q

how does trauma lead to epidural hematoma

A

skull fx -> bone fragments lacerate meningeal a

85
Q

mc sign of epidural hematoma

A

ipsilateral blown pupil

86
Q

indications for craniotomy w. epidural hematoma

A

symptomatic
> 1 cm

Surgery EOR (17 decks)

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