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neurology 1 > Neurosurgery - Brain Haemorrhage > Flashcards

Neurosurgery - Brain Haemorrhage Flashcards

1
Q

at which point do saccular aneurysms usually occur

a.straight vessels
b.unbranched vessels
c.branched vessels
d.branching points

A

d.branching points

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2
Q

localised dilations of blood vessel walls

A

saccular aneurysms

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3
Q

what is the fundus of a saccular aneurysm composed of

a.adventitia and media
b.adventitia and intima
c. media and intima

A

b.adventitia and intima

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4
Q

thunderclap headache, vomiting, neck stiffness , photophobia and seizure /loss of consciousness indicates what

a.meningitis
b.migraine
c.unruptured brain aneurysm
d.ruptured brain aneurysm

A

d.ruptured brain aneurysm

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5
Q

examinations for ruptured brain aneurysm

A

Glasgow coma scale
Pupils
fundoscopy
peripheral nervous system

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6
Q

which of these is not a risk factor for brain aneurysm

a,smoking
b.hypertension
c.alcohol excess
d.strong family history
e.obesity

A

e.obesity

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7
Q

what initially is done to diagnose a ruptured brain aneurysm

a. CT brain
b.x RAY
c.MRI
d.ECG
e.EEG

A

a. CT brain

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8
Q

if the CT is negative following suspected ruptured brain aneurysm what is done

a.EEG
b.ECG
c.Bloods
D.lumbar puncture

A

D.lumbar puncture

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9
Q

a lumbar puncture should be done how long after a stroke due to suspected ruptured brain aneurysm

a.<1 hr
b.>5 hrs
c.>8 hrs
d.>12 hrs

A

d.>12 hrs

RBC lysis, HB released and metabolised to oxyHb and bilirubin
– Bilirubin is only formed in vivo and appears after 10hours

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10
Q

where is the ilaic crest

a.L1
b.L2
c.L3
d.L4

A

d.L4

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11
Q

where is a lumbar puncture usually done between

a. L1 -L2
b.L2-L3
c.L3-L4

A

c.L3-L4

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12
Q

which of these structures does a lumbar puncture needle NOT penetrate

a.supraspinous ligament
b. interspinous ligaments
c.ligamentum flavum
d.posterior longitudinal

A

d.posterior longitudinal

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13
Q

which of these structures does a lumbar puncture needle NOT penetrate

a.supraspinous ligament
b. interspinous ligaments
c.ligamentum flavum
d.anterior longitudinal

A

d.anterior longitudinal

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14
Q

a lumbar puncture sample should be sent to the lab

a.urgently
b.with other samples
c.after 12 hours
d.after light exposure

A

a.urgently

PROTECT FROM LIGHT
avoid lysis of RB forming oxy Hb

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15
Q

which of these contraindicates a patient against LP

a.recent stroke
b.hypertension
c.obesity
d.caogulopathy

A

d.caogulopathy

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16
Q

true or false lumbar puncture should be done on a patient with focal neurology and abnormal concious level in whom brain imaging is unknown

a. true
b.false

A

b.false

contraindicated

eg posterior fossa mass or lateral mass effect on brain imaging casuing displacement of midbrain/ cerebral hemispheres

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17
Q

which of these contraindicates a patient against LP

a.recent stroke
b.hypertension
c.obesity
d.local infection at puncture site

A

d.local infection at puncture site

18
Q

if a SAH is confirmed what should be done next

a.CT brain
b.LP
c.CTA
d.CA

A

c.CTA

CT angiography

then CA - Catheter angiogram if necessary (x rays of heart)

19
Q

catheter insertion into artery in leg/groin tube guided into head and into aneurysm and platinum coils used to fill aneurysm so blood can no longer enter it

a.coiling
b.clipping

A

a.coiling

20
Q

what drug is given to reduce the chances of secondary cerebral ischameia after an SAH

a.amlodipine
b.nimodipine
c.phenytoin
d.promethazine

A

b.nimodipine

21
Q

death , stroke, bleeding and seizure are side effects of which SAH treatment

a.coiling
b.clipping

A

b.clipping

22
Q

a cut in the scalp and small removal of bone (craniotomy) to allow for a small metal clip to be fitted around the base of the aneurysm to seal it shut describes which SAH treatment

a.coiling
b.clipping

A

b.clipping

23
Q

subarachnoid haemorrhage is graded on what scale

a.GCS
b.GRACE
c.GOLD
d.WFNS

A

d.WFNS

world federation of neurological symptoms

combines glasgow coma scale and neurological symptoms

24
Q

what is given to prevent hypervolaemia and decrease risk of vasospasm post SAH

a.50ml/hr normal saline
b.125 ml/hr normal saline
c.200ml/hr normal saline

A

b.125 ml/hr normal saline

25
Q

initial rescue measures for vasospasm folllowing SAH

a.nimodipine
b.125ml/hr saline
c.hypertensive therapy
d.chemical angiolasty with nimodipine
e.bolus iv saline/colloid

A

e.bolus iv saline/colloid
c.hypertensive therapy
d.chemical angiolasty with nimodipine

26
Q

main complication of subarachnoid haemorrhages

a.cerebral ischaemia
b.hydrocephalus
c.seizures
d.low sodium
e.ECG changes
d.pulmonary oedema and pneumonia

A

a.cerebral ischaemia

ECG changes mimic MI as troponin rises

27
Q

when is screening for intracranial aneurysm offered

a.one first degree relative
b.2+ first degree relatives
c.2+ first degree relatives and 1+ second degree relatives

A

b.2+ first degree relatives

8% risk of aneurysm

28
Q

what is used to predict risk of rupture of Intracranial aneurysm

a.WFNS
b.QRISK
c,GCS
d.PHASES
e.GRACE

A

d.PHASES

29
Q

which of these is not a predictor of aneurysm rupture

a.age
b.hypertension
c.aneurysm size
d.smoking
e.location

A

d.smoking

30
Q

tangled fistulous connections between arteries and veins , centred on a nest (nidus) , vascular mass replaces the capillary bed where shunting occurs

A

aterio venous malformation

31
Q

what is the main treatment for AVM

a.lifestyle changes
b.drugs
c.surgery

A

c.surgery

32
Q

treatment for AVM radiation induced endothelial damage with smooth muscle proliferation occluding vessel lumen

A

stereotactic radiosurgery

33
Q

which of these is not a complication of stereotactic radiosurgery

a.cerebral infarction
b.radiation necrosis
c.bleeding
d.seizures

A

a.cerebral infarction

34
Q

main cause of intracranial haemorrhages

a.hypertension
b.vascular lesions
c.coagulation disorders
e.vasculitis

A

a.hypertension

35
Q

dural AV fistula between the cavernous part of the internal carotid artery and the cavernous sinus or its venous outflow

a.SAH
b.Arterio venous malformation
c.carotid cavernous fistula

A

c.carotid cavernous fistula

36
Q

orbital bruit, exopthalmos (bulging eyeballs) and pulsatile tinnitus what does this indicate

a.SAH
b.Arterio venous malformation
c.carotid cavernous fistula

A

c.carotid cavernous fistula

37
Q

how is carotid cavernous fistula treated

a. nimodipine
b.125ml/hr saline
c.surgery
d.coiling
e.endovascular treatment

A

e.endovascular treatment

38
Q

possible causes of thunderclap headache

A

SAH
migraine
ice pick
trigeminal neuralgia
cluster
tension

ischaemic stroke , venous sinus thrombosis

pituitary apoplexy

carotid dissection

meningitis

brain tumour

39
Q

what is the main reason to treat a ruptured aneurysm early

a.prevent rebleed
b.prevent hydrocephalus
c.prevent vasospasm
d.prevent seizure

A

a.prevent rebleed

40
Q

which of the following is not a risk factor for SAH

a.aaaa
b.smoking
c.hypertension
d.polycystic kidney disease

A

a.aaaa

neurology 1 (44 decks)

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