Neurosurgery

Question 1

what level does the spinal cord end?

Answer 1

L1 (called conus medullaris)

Question 2

what can cause cauda equina?

Answer 2

disc herniation
disc prolapse
tumours
trauma
spinal stenosis

Question 3

features of cauda equina?

Answer 3

poor anal tone
saddle anaesthesia
paralysis
sensory loss
weakness
back pain 
urinary retention/incontinence

Question 4

Ix for cauda equina?

Answer 4

PR

MRI

Question 5

Tx for cauda equina?

Answer 5

laminectomy
IV steroids
(+ radiotherapy if malignancy caused)

Question 6

cause of a SAH?

Answer 6

rupture of a berry aneurysm OR AVMs

often occur at bifurcations in the circle of willis

Question 7

risk factors for SAH?

Answer 7

FHx
smoking 
alcohol
HT
PKD

Question 8

features of a SAH?

Answer 8

thunderclap headache
vomiting 
neck pain
photophobia
focal neuro defecit

Question 9

what ophthalmology sign can be seen in a SAH? what is the cause?

Answer 9

CNIII palsy (down and out)
dilated pupil 

caused by a posterior communicating artery aneurysm until proved otherwise

Question 10

what is the triad of symptoms that make up meningism?

Answer 10

neck stiffness
headache
photophobia

Question 11

Ix for SAH?

Answer 11

CT head

LP

Question 12

Tx for SAH?

Answer 12

nimidopine

endovascular coil/clipping

Question 13

what endocrine abnormality can SAH cause?

Answer 13

SIADH
check Na (will be low as water being retained)

Question 14

causes of spinal stenosis?

Answer 14

disc herniation
tumour
osteophytes

Question 15

causes of sciatica?

Answer 15

disk prolapse

disc herniation

Question 16

if there is a L3/4 prolapse, what symptoms result?

Answer 16

pain to ankle

reduced knee jerk

Question 17

if there is a L4/5 prolapse, what symptoms result?

Answer 17

pain to dorsum of foot

Question 18

if there is a L5/S1 prolapse, what symptoms result?

Answer 18

pain to sole of foot

Question 19

what are the sciatic nerve roots?

Answer 19

L4-S3

Question 20

features of sciatica?

Answer 20

leg pain >back
shooting 
radicular (not below knee)
worse on stretch/standing 
relieved when lying with knee bent

Question 21

features of spinal stenosis?

Answer 21

back > leg
brought on by walking
claudication distance
cycle without pain

Question 22

Tx for lumbar back pain?

Answer 22

NSAID + PPI
baclofen 
amitryptillin/gabapentin 
opiates acutely 
physio

laminectomy (back pain often worse after)

Question 23

what happens in an extra dural haematoma? causes?

Answer 23

rupture of vessels in dura

in region of middle meningeal artery (temporal bone)

Question 24

features of extra dural haematoma?

Answer 24

trauma

lucid interval

Question 25

Ix and Tx for extra dural haematoma?

Answer 25

lemon on CT

surgery

Question 26

what types of intradural haemorrhages can occur?

Answer 26

SAH
intracerebral
subdural

Question 27

what happens in a sub dural haematoma? causes?

Answer 27

blood between dura and arachnoid pools
due to disruption of the bridging veins

elderly
HT
falls
anticoag

Question 28

features of sub dural haematoma?

Answer 28

symptoms fluctuate 
drowsy
headaches
vomiting 
confused

Question 29

Ix and Tx for sub dural haematoma?

Answer 29

banana on CT

surgery

Question 30

what nerve causes the knee jerk reflex?

Answer 30

L3/4

Question 31

what nerve causes the ankle jerk reflex?

Answer 31

S1/2

Question 32

what nerve causes the biceps reflex?

Answer 32

C5/6

Question 33

what nerve causes the triceps reflex?

Answer 33

C7/8