Neurosurgery

Question 1

what does the sensory spinocerebellar pathway do?

Answer 1

sends information about unconscious proprioception to the cerebellum for posture and movement of upper and lower limbs

Question 2

what does the vestibulospinal tract do?

Answer 2

exerts posture via extensors for legs and flexors for arms

Question 3

which spinal tract increases tone?

Answer 3

reticulospinal tract via the pontine reflex response

Question 4

which spinal tract decreases tone?

Answer 4

reticulospinal tract via the medullary tract

Question 5

knee reflex nerves

Answer 5

L3/4 femoral

Question 6

biceps reflex nerves

Answer 6

C5/6 musculocutaneous

Question 7

triceps reflex nerves

Answer 7

C7/8 radial

Question 8

ankle reflex nerves

Answer 8

S1/2 tibial

Question 9

what type of cartilage is the annulus fibrosus made of?

Answer 9

fibrocartilage

Question 10

three directions of prolapse for the nucleus pulposis

Answer 10

1. paramedian (posterolateral)
2. extraforaminal (far lateral)
3. central/ medial herniation

Question 11

paramedian prolapse

Answer 11

compresses tranversing nerve

herniation at L4/5 causes damage to L5 as nerve root exits below level

Question 12

extraforminal (far lateral) proalpse

Answer 12

compresses exiting nerve

herniation at L4/5 causes L4 damage

Question 13

central/ medial prolapse

Answer 13

lumbar stenosis or if large enough can cause cauda equina

Question 14

what is a radiculopathy?

Answer 14

dysfunction of a nerve root causing a dermatomal sensory deficit with weakness of the muscle groups supplied by that nerve
LMN

Question 15

what is a myelopathy?

Answer 15

UMN signs more predominant in lower limbs before progressing to upper limbs

Question 16

presentation of neurogenic claudication

Answer 16

leg weakness
tingling
numbness
normal pulses

Question 17

cause of anterior cord syndrome

Answer 17

cord infarction by anterior spinal artery

Question 18

presentation of spinal shock

Answer 18

flaccid areflexic paralysis

Question 19

three components of the cerebellum

Answer 19

1. vestibulocerebellum
2. spinocerebellum
3. cerebrocerebellum

Question 20

role of the vestibulocerebellum

Answer 20

balance and coordination of vestibulo-ocular reflexes

Question 21

role of the spinocerebellum

Answer 21

maintains muscle tone and participates in posture and gait

Question 22

role of the cerebrocerebellum

Answer 22

voluntary motor movement

Question 23

presentation of thalamic infarction

Answer 23

hemiparesis
spontaneous pain
hemichorea
severe impairment of consciousness

Question 24

appearance of glioblastoma multiforme

Answer 24

butterfly

Question 25

appearance of oligodendroglioma

Answer 25

toothpaste

Question 26

where do meningiomas originate from?

Answer 26

arachnoidal cap cells within arachnoid membrane

Question 27

what are associations with meningiomas

Answer 27

NF2 | childhood radiation

Question 28

what are haemangioblastomas?

Answer 28

benign cystic vascular tumours in posterior fossa leading to cerebellar dysfunction and raised ICP

Question 29

which are haemangioblastomas associated with?

Answer 29

VHL

Question 30

diagnosis of AVM

Answer 30

catheter angiography | CTA

Question 31

management of AVM

Answer 31

excision | radiosurgery

Question 32

what is a cavernous malformation?

Answer 32

benign vascular lesion in sinusiodal spaces

Question 33

types of aneurysms

Answer 33

berry/saccular fusiform (hypertension associated) mycotic

Question 34

diagnosis of SAH

Answer 34

CT > LP > CTA or angiogram

Question 35

grading scale for SAH

Answer 35

Fisher's grading scale

Question 36

grades in Fisher's scale

Answer 36

grade 1= no blood seen on CT grade 2= diffuse or vertical layers <1mm grade 3= diffuse clot and/or vertical layer >1mm

Question 37

what ischaemic penumbra?

Answer 37

early ischaemic stroke there is an area not functioning but has reversible damage atm

Question 38

pupillary light reflex pathwya

Answer 38

CNII > optic tract > ipsilateral pretectal nucleus of midbrain > bilateral EWN > CNIII > ciliary ganglion > parasympathetic via short ciliary nerve > ciliary muscle and sphincter pupillae

Question 39

what is neuromyelitis optica (Devic's disease)?

Answer 39

bilateral severe optic neuritis and transverse myelitis in 3 or more vertebral columns (muscle weakness, increased tone and spasm)

Question 40

antibody in Devic's disease?

Answer 40

IgG Ab against astrocystic aquaporin 4

Question 41

what causes ptosis in Horner's?

Answer 41

muller muscle dysfunction

Question 42

define anisocoria

Answer 42

unequal pupil size

Question 43

what is Adie's pupil?

Answer 43

loss of postganglionic parasympathetic innervation of the iris sphincter and ciliary muscle

Question 44

presentation of Adie's pupil

Answer 44

large pupil with blurring of near vision | absent light reflex

Question 45

what does Holmes-Adie syndrome present with?

Answer 45

Adie's pupil | diminished tendon reflexes of the lower limb +/- orthostatic hypotension

Question 46

diagnosis of Adie's pupil

Answer 46

topical pilocarpine will cause an Adie's pupil to constrict

Question 47

what is Weber's syndrome?

Answer 47

form of stroke affecting the ventral midbrain

Question 48

presentation of Weber's syndrome

Answer 48

ipsilateral 3rd nerve palsy with contralateral hemiparesis

Question 49

what is Benedikt's syndrome?

Answer 49

form of stroke affecting the dorsal midbrain

Question 50

presentation of Benedikts syndrome

Answer 50

ipsilateral 3rd nerve palsy with contralateral tremor, ataxia or chorea

Question 51

what is the cogan lid twitch?

Answer 51

brief upshoot of lid elicited by patient looking down then up {myasthenia gravis)

Question 52

what is the ice test?

Answer 52

ptosis improves after applying ice for 2 minutes

Question 53

clinical investigations for myasthenia gravis

Answer 53

antibodies EMG muscle biopsy imaging for thymoma

Question 54

what is the genetic inheritance of myotonic dystrophy?

Answer 54

AD trinucleotide repeat on chromosome 19

Question 55

presentation of myotonic dystrophy

Answer 55

``` delayed muscle relaxation and wasting christmas tree cataract (early onset) ptosis hypermetropia ophthalmoplegia ```

Question 56

what is benign essential blepharospasm?

Answer 56

bilateral idiopathic condition with idiopathic contraction of orbicularis oculi

Question 57

management of benign essential blepharospasm

Answer 57

artificial tears | botox

Question 58

what structures are damaged to cause decorticate posturing?

Answer 58

cerebrum internal capsule thalamus

Question 59

which spinal tracts take over in decorticate posturing?

Answer 59

lateral CST is disrupted so rubrospinal tract causes abnormal flexion in upper limbs and reticulospinal extension of legs

Question 60

what structures are damaged to cause decerebrate posturing?

Answer 60

level below the red nucleus of the midbrain

Question 61

what spinal tracts cause decorticate posturing?

Answer 61

reticulospinal tract causes whole body extension

Question 62

what does CSF flow through to get from the lateral to the 3rd ventircle?

Answer 62

foramen of Munro (intraventricular foramen)

Question 63

what does CSF flow through to get to the 4th ventricle?

Answer 63

aqueduct of Sylvius

Question 64

what does uncal herniation cause?

Answer 64

pupillary dilatation due to involvement of oculomotor nerve and contralateral hemiparesis

Question 65

what does subfalcine hernaiton cause?

Answer 65

compression of anterior cerebral artery causing weakness in lower extremities

Question 66

what does tonsillar herniation cause?

Answer 66

medullary compression

Question 67

what does central herniation of the brainstem cause?

Answer 67

diplopia (6th nerve palsy) | brainstem dysfunction

Question 68

in the spinal which part of the dura exists?

Answer 68

only the meningeal part

Question 69

management of normal pressure hydrocephalus?

Answer 69

VP shunt

Question 70

what are chiari malformations?

Answer 70

congenital or acquired conditions of the hindbrain affecting CSF circulation through the foramen magnum

Question 71

chiari I malformation

Answer 71

caudal displacement of cerebellar tonsils, may be associated with syringomyelia

Question 72

presentation of chiari I malformation

Answer 72

HA (coughing, suboccipital pain, neck extension) downbeat nystagmus central cord symptoms ataxic gait

Question 73

chiari II malformation (Arnold-Chiari)

Answer 73

displacement of cerebellum and medulla below foramen magnum with herniation of the 4th ventricle

Question 74

what is chairi II associated with?

Answer 74

spina bifida

Question 75

which nerve root is extensor hallucis longus specific for?

Answer 75

L5

Question 76

what does an upgoing plantar indicate?

Answer 76

lesion not below L1/2 (cervical myelopathy)

Question 77

presentation of cervical myelopathy

Answer 77

jump at night/ sitting in char upgoing plantars off legs

Question 78

test in cervical myelopathy

Answer 78

Hoffman's

Question 79

management of cervical myelopathy

Answer 79

``` physio collar corticosteroid injections pain relief surgery (foot drop more urgent + progression) ```

Question 80

types of gait

Answer 80

1. spastic 2. high stepping gait 3. hemiplegic gait 4. festinant gait 5. shuffling gait

Question 81

when is spastic gait present?

Answer 81

unilateral in cervical myelopathy | diplegic and scissoring in cerebral palsy

Question 82

what causes high stepping gait?

Answer 82

foot drop (L5) disc prolapse front of shoe scuffed

Question 83

what causes hemiplegic gait?

Answer 83

stroke

Question 84

what muscles are involved in hemiplegic gait?

Answer 84

flexors strong in upper limb | extensors in lower limb

Question 85

which condition has a festinant gait?

Answer 85

PD

Question 86

which condition has a shuffling gait?

Answer 86

normal pressure hydrocephalus