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Neurology and Orthopedic Flashcards

1
Q

Broca’s area function

A

Posterior part of anterior lobe, responsible for speech motor function.

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2
Q

Wernicke’s area function

A

Located in the temporal lobe, responsible for speech comprehension.

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3
Q

Pituitary adenoma treatment after XRT and in shock

A

Pituitary apoplexy; treatment is steroids.

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4
Q

Neuropraxia definition

A

No axonal injury; temporary loss of function, motor more than sensory; ex foot falling asleep.

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5
Q

Axonotmesis definition

A

Disruption of axon with preservation of myelin sheath; nerve must regenerate to improve= = Wallerian degeneration

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6
Q

Neurotmesis definition

A

Disruption of both axon and myelin sheath; whole nerve is disrupted and may need surgery for recovery. worst form

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7
Q

Most common cause of subarachnoid hemorrhage

A

Trauma is the most common cause; second is rupture of berry aneurysm.

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8
Q

Subarachnoid hemorrhage treatment

A

Prevent rebleed (open clip, endovascular coil), prevent vasospasm with CCB, nimodipine.

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9
Q

Asymptomatic cerebral aneurysm treatment

A

If < 1 cm, treatment is to leave alone.

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10
Q

Neurogenic shock injury level

A

Occurs only in injury above T5.

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11
Q

Brown-Sequard syndrome characteristics

A

MCC is penetrating injury; ipsilateral motor and proprioception loss, contralateral pain and temperature loss below the lesion. 90% recover to ambulation

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12
Q

Anterior Cord Syndrome cause

A

MCC is vascular injury to anterior spinal artery; loss of motor, pain, and temperature below the level of injury.

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13
Q

Central Cord Syndrome cause

A

MCC is hyperextension of the cervical spine; bilateral loss of motor and sensation in upper extremities, lower extremities spared. Cape-like distribution.

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14
Q

Spinothalamic tract function

A

Transmits pain and temperature sensory neurons; will be contralateral. (dorsal=afferent)

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15
Q

Corticospinal tract function
Rubrospinal tract

A

Responsible for motor function.
Ventral

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16
Q

Dorsal nerve roots function

A

Afferent sensory.

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17
Q

Ventral nerve roots function

A

Efferent motor.

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18
Q

Most common primary brain tumor in adults

A

Glioma, subtype Astrocytoma.

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19
Q

Most common brain tumor in children

A

Medulloblastoma.

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20
Q

Most common metastasis to brain in children

A

Neuroblastoma.

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21
Q

Acoustic neuroma origin

A

Arises from CN VIII at the cerebellopontine angle; symptoms include hearing loss, unsteady gait, vertigo, N/V. Tx: surgery

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22
Q

Spine tumor characteristics

A

Most are benign; #1 is neurofibroma.

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23
Q

Intradural vs. extradural tumors

A

Intradural tumors are more likely to be benign; extradural tumors are more likely to be malignant.

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24
Q

Paraganglioma

A

Check for metanephrines in urine.

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25
Q

Palmar and axillary hyperhidrosis treatment

A

First use anti-perspirant for 3 months; if affecting lifestyle, consider T2-T4 sympathectomy.
-AVOID T1: Will cause Horner’s syndrome

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26
Q

Complication of sympathectomy for hyperhidrosis

A

Most common complication is compensatory sweating in lower extremities or abdomen.

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27
Q

Nerve of Kuntz significance

A

Accessory pathway between T1 and T2; can cause refractory palmar sweating after sympathectomy. Make sure to coagulate nerve of kuntz on the bottom of the 2nd rib

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28
Q

Complex regional pain syndrome progression

A

Reflex sympathetic dystrophy –> Causalgia; severe burning in limb caused by injury to peripheral nerve. Usually after trauma, amputation (PHANTOM pain), frostbite, surgery

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29
Q

Complex regional pain syndrome treatment

A

Gabapentin and amitriptyline; TENS; sympathectomy only if pain is dramatically relieved by nerve blocks.

  • NOT USED FOR DIABETIC ULCERS
  • Location of sympathectomy depends on location of pain
  • Unresectable pancreatic CA causing pain  lumbar sympathectomy
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30
Q

Salter-Harris fracture types III, IV, and V

A

Cross the epiphyseal plate and can affect the growth plate of the bone; need ORIF.

I and II = closed reduction

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31
Q

Fractures that result in non-union

A

Clavicle and 5th metatarsal (Jones fracture).

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32
Q

Biggest risk factor for non-union

A

Smoking.

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33
Q

Metaphysis, diaphysis, epiphysis definition

A

Metaphysis: has epiphyseal growth plate; diaphysis is the mid portion; epiphysis is the round end of long bone.

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34
Q

Superior gluteal nerve function

A

Hip abduction.

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35
Q

Inferior gluteal nerve function

A

Hip extension.

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36
Q

Femoral nerve function

A

Knee extension, hip flexion.

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37
Q

Obturator nerve function

A

Hip adduction.

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38
Q

Knee dislocation management

A

If ABI is >0.9 and pulse is good, just observe; if < 0.9 or weak pulse, then CT angio; if no pulse, OR.

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39
Q

Cervical nerve roots exit pattern

A

Exit at the level above the corresponding vertebra, except for C8, which exits below.

All others exit BELOW corresponding vertebra e.g. L5 nerve root exits below L5 vertebra in the L5/S1 space

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40
Q

Nerve root compression in herniations

A

The nerve root that gets compressed is the one that exits the foramen below the herniated disc. E.g. L4/L5 herniation causes L5 compression

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41
Q

L1-L3 nerve root function

A

Hip flexion
Compression= weak hip flexion.

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42
Q

L4 nerve compression symptoms

A

Weak knee extension (quadriceps) and weak patellar reflex.

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43
Q

L5 nerve compression symptoms

A

Weak dorsiflexion (foot drop) and decreased sensation in the big toe web space.

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44
Q

S1 nerve compression symptoms

A

Weak plantarflexion, weak Achilles reflex, and decreased sensation of lateral foot.

45
Q

MRI indication for nerve issues

A

Need MRI if neuro deficit; conservative management for 6 weeks, if fails, consider discectomy.

46
Q

Brachial plexus nerve roots

A

C5-T1.

47
Q

Ulnar nerve function

A

Wrist flexion
Fingers abduction. Intrinsic muscle of hand palmar interossei, palmaris brevis, and hypothenar eminence
Sensory to ALL OF 5th and ½ of 4th digit
Injury leads to claw hand  cubital tunnel syndrome at elbow
MC nerve associated with neurogenic thoracic outlet syndrome

48
Q

Median nerve function

A

Motor to thumb apposition, OK sign, flexes fingers; sensory to 1-4 digits only on palm.

49
Q

Radial nerve function

A

Motor for wrist extension, finger extension, thumb extension, triceps; NO HAND muscles, sensory to 1-4 digits only on back of hand.

50
Q

Axillary nerve function

A

Motor to deltoid (abduction).

51
Q

Musculocutaneous nerve function

A

Motor to biceps, brachialis, and coracobrachialis.

52
Q

Radial artery supply
Radial nerve roots

A

Radial artery: supplies the deep palmar arch.
Radial nerve roots - on superior portion of brachial plexus

53
Q

Ulnar artery supply
Ulnar nerve roots

A

Ulnar artery: Supplies the superficial palmar arch, the main supply to the hand.
Ulnar nerve roots – on inferior portion of brachial plexus

54
Q

Anterior shoulder dislocation

A

90% of cases; risk of axillary nerve injury; treatment is closed reduction.

55
Q

Posterior shoulder dislocation cause

A

Occurs after seizures; risk of axillary artery injury; treatment is closed reduction.

56
Q

Acromioclavicular separation management

A

Treatment is a sling; risk of brachial plexus and subclavian vessel injury.

57
Q

Scapula fracture management

A

Sling unless glenoid fossa involved, then internal fixation.

58
Q

Proximal humerus fracture management

A

Non-displaced requires a sling; displaced or comminuted requires ORIF. Risk of axillary nerve injury

59
Q

Midshaft humerus fracture management

A

Almost all require a sling; surgery only for failed reduction or neurovascular symptoms. Risk of radial nerve injury: weak wrist extension and finger extension

60
Q

Supracondylar humeral fracture management

A

Adults require ORIF; children and non-displaced require closed reduction; unless displaced, then closed reduction with internal fixation with Kirschner wire

-Risk of Volmann’s contracture (forearm compartment syndrome) – anterior interosseous artery. Median nerve most affected. Tx: forearm fasciotomy

61
Q

Monteggia fracture definition

A

Proximal ulnar fracture and radial head dislocation; requires ORIF.

62
Q

Colles fracture characteristics

A

Most common fracture in children; occurs from a fall on an outstretched hand; distal radius fracture with possible distal ulnar dislocation; requires closed reduction.

63
Q

Combined radial and ulnar fracture management

A

Requires ORIF; in children, closed reduction.

64
Q

Greenstick fracture definition

A

Fracture in young, soft bone; buckling of the cortex; common in children with distal radius fracture; treatment is cast for 3 weeks.

65
Q

Scaphoid fracture characteristics

A

(wrist fracture, perilunate wrist fx)
MC carpal bone fracture, MC fx in wrist. Tenderness in snuffbox. Can have negative xray initially

66
Q

Scaphoid fracture management

A

Negative x-ray requires all patients to get a spica cast to elbow; follow up x-ray in 2 weeks; non-displaced scaphoid or lunate fracture requires spica cast for 6-8 weeks; displaced scaphoid or lunate requires ORIF.

67
Q

Dupuytren’s contracture association

A

Associated with DM and ETOH; proliferation of palmar fascia; inability to extend fingers, especially 4th and 5th digits.

68
Q

Dupuytren’s contracture treatment

A

NSAIDs, steroids, and surgery for refractory cases (excise palmar fascia).

69
Q

Trigger finger definition

A

Tenosynovitis of flexor tendon that catches at MCP, preventing finger extension.

70
Q

Trigger finger treatment

A

Splint, steroid injection, or split tendon at MCP joint if fails.

71
Q

Suppurative tenosynovitis definition

A

Infection along the flexor tendon sheath, often after trauma or bite.

72
Q

Suppurative tenosynovitis symptoms

A

Four classic symptoms: tendon sheath tenderness, pain with passive motion, swelling along sheath, and flexed finger.

73
Q

Suppurative tenosynovitis treatment

A

Midaxial longitudinal incision and drainage; avoid lateral incision due to nerves.

74
Q

Rotator cuff components

A

Supraspinatus, infraspinatus, teres minor, and subscapularis.

75
Q

Rotator cuff injury management

A

Acute treatment is a sling; surgical repair if patients need to retain high level of activity or ADLs are affected.

76
Q

Flexor tendon sheath injury management

A

No surgery if < 60% laceration; if greater, requires surgery; repair in < 2 weeks.

77
Q

Paronychia definition

A

Infection where skin and nail meet; can progress to under nail bed.

78
Q

Paronychia treatment

A

Local wound care if no abscess; if abscess, requires incision and drainage.

79
Q

Felon definition

A

Abscess of terminal finger.

80
Q

Felon treatment

A

Incision over tip of finger, along the center.

81
Q

Posterior hip dislocation characteristics

A

90% of cases; thigh is internally rotated and adducted; risk of sciatic nerve injury.

82
Q

Posterior hip dislocation treatment

A

Closed reduction.

83
Q

Anterior hip dislocation characteristics

A

Thigh is abducted and externally rotated; risk of femoral artery injury.

84
Q

Anterior hip dislocation treatment

A

Same as posterior, closed reduction.

85
Q

Femoral shaft fracture management in children < 6

A

Requires spica cast.

86
Q

Lateral knee trauma structures involved

A

Anterior cruciate, posterior cruciate, medial collateral ligament, and medial meniscus.

87
Q

ACL injury diagnosis

A

Positive anterior drawer test; MRI confirms diagnosis.

88
Q

ACL injury treatment

A

Reconstruction with patellar tendon or hamstring tendon if knee instability.

89
Q

Patellar fracture management

A

Long leg cast unless comminuted, then requires internal fixation.

90
Q

Ankle fracture management

A

Most require cast; unless bi- or trimalleolar, then requires ORIF.

91
Q

Plantaris muscle rupture management

A

below popliteal fossa -> no repair

92
Q

Metatarsal fracture management

A

Cast or immobilization for 6 weeks.

93
Q

Calcaneus fracture management

A

Cast and immobilization if non-displaced; if displaced, requires ORIF.

94
Q

Talus fracture management

A

Closed reduction for most; if severely displaced, requires ORIF.

95
Q

Foot drop definition

A

Inability to dorsiflex; common peroneal nerve injury.

  • lithotomy position
  • after crossing legs for long period
  • Fibular head fracture
96
Q

Foot drop treatment

A

Foot brace.

97
Q

Unicameral bone cyst characteristics

A

Painless, causes pathological fractures; cyst contains high level of cytokines that resorb bone.

98
Q

Unicameral bone cyst treatment in young kids

A

Intraosseous injection of methylprednisolone.

99
Q

Unicameral bone cyst treatment in adults

A

Curettage and bone grafting.

100
Q

Most common bone tumor origin

A

Metastasis from breast.

101
Q

Bone tumor treatment with impending fracture

A

ORIF with bone tumor and >50% cortical involvement, then XRT.

102
Q

Most common primary malignant bone tumor

A

Multiple myeloma.

103
Q

Most common bony tumor overall

A

Osteochondroma.

104
Q

Most common malignant bone tumor in adults

A

Osteosarcoma; most common around knee, 80% in young < 20.

105
Q

Osteosarcoma X-ray finding

A

Codman triangle.

106
Q

Osteosarcoma treatment

A

Limb sparing resection; consider pre-op chemo-XRT.

107
Q

Ewing sarcoma characteristics

A

Most common in adolescents; painful swelling; onion skin appearance on X-ray.

108
Q

Ewing sarcoma most common location

A

Diaphysis of femur.

109
Q

Ewing sarcoma treatment

A

Chemo-RAD is the mainstay of treatment, +/- resection.

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