Neurosurgery

Question 0

Most common cause of TIA (2)

Answer 0

High grade stenosis of internal carotid

Ulcerated plaque at carotid bifurcation

Question 1

Sudden loss of neurologic function
No headache
Resolve spontaneously leaving no sequela

Answer 1

Transient ischemic attack

Question 2

Workup after TIA

Tx if lesions found

Answer 2

Duplex study
Carotid endarterectomy
Filter, angioplasty, stenting

Question 3

Sudden onset of neurologic deficits
No headache
Deficits present for > 24 h
Dx, tx?

Answer 3

Ischemic stroke
CT scan
Rehabilitation, tPA for very early strokes (within 90 minutes) after hemorrhage ruled out, vascular workup to predict future stroke risk

Question 4

Uncontrolled hypertensive
Sudden severe headache, then neurologic deficits
Dx Tx?

Answer 4

Hemorrhagic stroke
CT scan
Control hypertension, rehabilitation

Question 5

Sudden severe headache
Sometimes no neurological deficits
May return with same symptoms and deficits a week later
May show meningeal irritation or nuchal rigidity
Dx Tx?

Answer 5

Subarachnoid bleed from intracranial aneurysm
CT scan, spinal tap, arteriogram
Clipping of aneurysm or endovascular coiling

Question 6

Progressively increasing headache over months
Worse in morning
Signs of increased ICP
Dx, tx?

Answer 6

Brain tumor
MRI preferred
Surgical removal, treat ICP with dexamethasone

Question 7

What is Cushing’s reflex

Answer 7

Bradycardia with hypertension

Question 8

Inappropriate behavior
Optic nerve atrophy
Papilledema
Anosmia

Answer 8

Base of frontal lobe tumor

Question 9

Young, short for age
Bitemporal hemianopsia
Calcified lesion above sella turcica

Answer 9

Craniopharyngioma

Question 10

Amenorrhea, galactorrhea

Dx tx?

Answer 10

Prolactinoma
MRI of sella turcica, r/o pregnancy, hypothyroid, get prolactin level

Bromocriptine or transnasal,trans-sphenoidal surgical removal

Question 11

HTN, DM, sweaty hands, headache
Hats, wedding bands no longer fit
Dx tx?

Answer 11

Acromegaly
Pituitary MRI, determine somatomedin C
Surgical removal or radiation

Question 12

H/x pituitary tumor
Severe headache
Deterioration of vision, pallor of optic nerves
Dx tx?

Answer 12

Pituitary apoplexy
MRI or CT
Steroid, hormone replacement

Question 13

Loss of upper gaze

Parinaud syndrome

Answer 13

Pineal gland tumor

Question 14

Child in knee-chest position

Cerebellar symptoms- ataxia, stumbling

Answer 14

Posterior fossa tumor

Question 15

1-2 weeks tumor symptoms
Fever
Commonly recent otitis media or mastoiditis
Dx tx?

Answer 15

Brain abscess
CT
Surgical resection

Question 16

Sharp shooting pain in face
Usually with trigger zone
Older patients
Dx tx?

Answer 16

Trigeminal neuralgia
MRI to r/o lesion
Anticonvulsants or radiofrequency ablation

Question 17

H/x crushing injury 3 months ago
Constant burning pain made worse by touching
Cold cyanotic and moist
Dx tx?

Answer 17

Reflex sympathetic dystrophy
Successful sympathetic block diagnostic
Surgical sympathectomy