NeuroSurg

Question 1

Provide 3 symptoms of a brain tumor causing high ICP

Answer 1

1) Headache (worse in morning)
2) Blurred Vision
3) projectile vomiting

Question 2

What is the importance, work-up, and treatment for TIAs

Answer 2

1) predictor of stroke
2) work-up is duplex scan
3) treatment is carotid endarterectomy

Question 3

How do you work-up ischemic stroke (1) and what is the best treatment (2)?

Answer 3

1) CT scan to confirm not hemorrhagic

2) tPA within 3 hours

Question 4

What clinical sign increases the suspicion of a subarachnoid bleed from an intracranial aneurysm?

Answer 4

Thunderclap headache

Question 5

What is the most common type brain cancer in an adult

Answer 5

Glioma

Question 6

What is the most malignant intracranial tumor in an adult

Answer 6

Glioblastoma multiform

Question 7

What medical treatment is provided to reduce ICP in brain tumors?

Answer 7

high-dose dexamethasone

Question 8

Name two clinical side effects of prolactinomas and provide the medical treatment

Answer 8

1) amenorrhea and galactorrhea in young women

2) Bromocriptine

Question 9

Name 4 sequelae of acromegaly

Answer 9

1) large hands, feet, tongue, jaw
2) hypertension
3) DM
4) headache

Question 10

What is the physical finding for a pineal gland tumor

Answer 10

Sunset eyes (loss of upper gaze)

Question 11

What is the most common type of brain tumor in children and describe its clinical presentation

Answer 11

1) Medulloblastoma

2) cerebellar symptoms including truncal ataxia

Question 12

What is the clinical sign ependymoma

Answer 12

knee-chest position (to open flow of CSF)

Question 13

What is the treatment for tic douloureux

Answer 13

trigeminal neuralgia is treated with anticonvulsants (carbamazapine)

Question 14

What does a GCS score of 4+6+5 indicate

Answer 14

1) eyes: spontaneous opening
2) Motor: Obeys commands
3) Verbal: Oriented

Question 15

What does a GCS score of 3+5+4 indicate

Answer 15

1) eyes: to speech
2) motor: localizes pain
3) Verbal: confused conversation

Question 16

What does a GCS score of 2+4+3 indicate

Answer 16

1) eyes: to pain
2) motor: withdraws from pain
3) verbal: inappropriate words

Question 17

What does a GCS score of 1+3+2 indicate

Answer 17

1) eyes: none
2) motor: decorticate posture (abnormal flexion)
3) verbal: incomprehensible sounds

Question 18

What does a GCS score of 1+2+1 indicate

Answer 18

1) eyes: none
2) motor: decerebrate posture (extension)
3) verbal: none

Question 19

What does a CGS score of 1+1+1 indicate

Answer 19

1) eyes: none
2) motor: no response
3) verbal: none

Question 20

What is the most important principle in dealing with a severe closed head inury

Answer 20

Avoidance of secondary injury

Question 21

When should you intubate a patient with a severe closed head injury

Answer 21

GCS of 8 or less

Question 22

How should patients with severe head injury and localizing signs be treated in an adequately fluid resuscitated patient

Answer 22

Hypoventilate (reduce intracranial blood volume) and mannitol (decrease blood volume and edema in brain)

Question 23

How does an epidural hematoma appear on CT and what artery is most commonly involved

Answer 23

Biconvex appearance, middle meningeal artery

Question 24

What causes subdural hematoma

Answer 24

Tearing of bridging veins (more common in elderly)

Question 25

A blown pupil is associated with a mass effect on which side (ipsilateral or contralateral)

Answer 25

Ipsilateral

Question 26

When should carotid endarterectomy be considered?

Answer 26

> 70% occlusion and symptomatic

Question 27

If following Duplex, the grade of stenosis is in question in the carotid artery, what confirmatory modality can be used

Answer 27

MR angiogram, CT angiogram

Question 28

What are the most common site for disc hernias and what are some common symtpoms (3)

Answer 28

L4-5 and L5-S1

SSx: back pain radiating down legs, aggravation by coughing/sneezing/straining, relieved by lying flat

Question 29

Describe cauda equina syndrome (3)

Answer 29

1) mechanical compression of cauda equina
2) loss of bladder and bowel function
3) paresthesia in legs and saddle region

Question 30

What is appropriate treatment for prolapsed nucleus pulposus with mild to moderate symptoms

Answer 30

bed rest, heat/ice, NSAIDs