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Surgery Clerkship - De Virgilio > Summary of Essentials - Ch. 24-29 (Neuro/MSK) > Flashcards

Summary of Essentials - Ch. 24-29 (Neuro/MSK) Flashcards

1
Q

First step in assessing a suspected spinal cord injury?

A

Thorough neurological exam

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2
Q

Presentation (spinal cord injury) - no motor and sensory function below the level of the injury

A

Complete spinal cord injury

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3
Q

Presentation (spinal cord injury) - some residual motor and/or sensory function below the level of the injury

A

Incomplete spinal cord injury

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4
Q

Role of the lateral corticospinal tract?

A

Movement of the ipsilateral limbs and body

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5
Q

Clinical effects of a lesion of the lateral corticospinal tract?

A

Ipsilateral paresis at and below the level of the lesion

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6
Q

Role of the dorsal column medial lemniscus tract?

A

Fine touch, vibration, conscious proprioception

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7
Q

Clinical effects of a lesion of the dorsal column medial lemniscus tract?

A

Ipsilateral loss of fine touch, vibration, and proprioception at and below the level of the lesion

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8
Q

Role of the spinothalamic tract?

A

Pain, temperature

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9
Q

Clinical effects of a lesion of the spinothalamic tract?

A

Contralateral loss of pain and temperature at and bleow the level of the lesion

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10
Q

Presentation - contralateral loss of pain and temperature sensation 1-2 levels below the lesion, ipsilateral hemiparesis and diminished dorsal column sensation below the level of the lesion

A

Brown-Sequard hemisection (loss of half of the spinal column)

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11
Q

Presentation - sensory-motor dissociation, intact fine touch, vibration, proprioception

A

Complete occlusion of anterior spinal artery (anterior cord syndrome) - associated with abnormal aortic surgery)

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12
Q

Presentation - weakness, upper extremities > lower extremities in the setting of a hyperextension injury in individuals 50+ y/p

A

Central cord syndrome

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13
Q

Presentation - temporary, concussive-like syndrome associated with flaccid paralysis below the level of injury with loss of all reflexes, as well as urinary and rectal tone

A

Spinal shock

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14
Q

What is neurogenic shock?

A

Hemodynamic state wherein sympathetic outflow through the spinal cord has been disrupted, resulting in vasodilation, bradycardia, and dangerous hypotension

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15
Q

Work-up of suspected C-spine injury (discuss utility of XR, CT, MRI)

A

X-ray - AP, lateral, and odontoid (open-mouth)

CT - vertebral fractures, hematomas or disk fragments in the spinal canal

MRI - injury to the spinal cord itself in patients with neuro deficits

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16
Q

Detect abnormalities in patients with SCIWORA (SC injury without radiographic abnormality)?

A

MRI

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17
Q

Management of C-Spine injury?

A
  1. Rigid cervical collar on a spine board
  2. Early closed reduction with tongs or halo traction devices for awake patients with obvious subluxation on imaging causing spinal cord compression
  3. IV fluids
  4. Vasopressors (phenylephrine or dopamine) if neurogenic shock
  5. Foley catheter
  6. Stool softeners
  7. VTE PPX
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18
Q

Complication of exposure of the anterior cervical spine?

A

Injury to the recurrent laryngeal nerve (hoarseness, risk of aspiration)

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19
Q

Initial H&P in a patient with LOC following head trauma?

A

Confusion, LOC, decreased level of consciousness, amnesia

GCS

CN exam

Sensory/motor exam

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20
Q

Define severe TBI based on GCS?

A

8 or less

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21
Q

GCS Scoring (3 categories)

A
  1. Eye opening response (4 points)
  2. Verbal Response (5 points)
  3. Motor response (6 points)

4 eyes
Jackson 5
V6 engine

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22
Q

GCS Scoring (eye opening response)

A

4 Spontaneous
3 Opens to command
2 Opens to pain
1 None

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23
Q

GCS scoring (verbal response)

A 
5 Oriented
4 Confused speech
3 Inappropriate words
2 Incomprehensible
1 None
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24
Q

GCS scoring (motor response)

A 
6 Follows commands
5 Localizes pain
4 Withdraws to pain
3 Flexion
2 Extension
1 None
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25
Racoon's eyes (periorbital ecchymoses) and Battle's sign (postauricular ecchymoses) are signs of ___.
Basilar skull fracture
26
Presentation - HTN, bradycardia, respiratory irregularity
Cushing's triad -> intracranial HTN
27
Presentation - blown pupil, contralateral hemiparesis
Uncal herniation
28
Most common source of epidural hematoma?
Laceration of the middle meningeal artery
29
Cause of subdural hematoma?
Rupture of the bridging veins
30
Cause of diffuse axonal injury?
Stretching of axons between gray and white matter
31
Cause of concussion?
Disruption of inflow and outflow tracks from RAS
32
Cause of contusion?
Hemorrhage within the brain parenchyma
33
Cause of subarachnoid hemorrhage?
Accumulation of blood in subarachnoid space
34
First step in all trauma?
ABCs
35
When should you intubate in the setting of TBI?
GCS of 8 or less
36
Once the patient's airway is protected, what should be done in a patient with LOC following head trauma?
STAT non-contrast head CT Coagulopathy should b esought and corrected ICP monitoring for select patients with moderate to severe TBI
37
An ICP >___ should be treated aggressively. Options?
20 ``` Elevate the head of bed Intubate and paralyze Mild hyperventilation (avoid prolonged hyperventilation) Mannitol Hypertonic saline Control pyrexia/therapeutic hypothermia Barbiturate coma ```
38
Who should get a craniotomy with hematoma evacuation?
1. Epidural hematomas >30 mL in volume or causing >10 mm midline shift 2. Acute subdural hematomas >5 mm in thickness or causing >10 mm shift 3. Decompressive craniectomy 4. Persistent several intracranial hypertension despite medical management
39
Criteria for brain death?
GCS of 3 while not hypoxic, normotensive, euthermic, not on sedatives/paralytics No CN reflexes No respiratory effort during an apnea test
40
Presentation - respiratory symptoms, neurological changes, and reddish-brown petechial rash 24-72 hours after leg injury?
Fat embolism syndrome
41
Presentation - radial nerve injury, wrist drop?
Humeral shaft fracture
42
What is unique about managing open fractures?
Communicates with environment, requires special treatment to prevent infection
43
Dx fractures?
1. Thorough secondary survey to avoid missing additional fractures 2. Radiographs of joint above and below all fractures seen on XR 3. If femoral fracture, always evaluate for femoral neck fracture
44
What constitutes an open fracture?
Any soft tissue wounds in conjunction with a fracture
45
Management of open femoral fracture?
1. ABX coverage (first-generation cephalosporin +/- AG) 2. Manage within 6 hours 3. Irrigate/debride 4. External fixation for immediate and temporary control if unstable 5. Internal fixation for definitive
46
Management of closed femoral fracture?
1. Manage within 2-12 hours with intramedullary nailing to reduce risk of fat emoblism syndrome
47
Presentation - acute trauma to knee with anterior knee laxity?
ACL injury
48
In a patient with acute trauma to the knee who can bear weight, what is less likely?
Fracture
49
___ knee injuries present with immediate swelling; ___ injuries have delayed swelling.
Ligament; meniscal
50
Presentation - non-contact twisting, forced hyperextension, or impact to extended knee; audible pop during acute sports-related injury involving an awkward landing to twisting
ACL injury
51
In a patient with a likely ACL injury, how can meniscal or MCL injuries be ruled out?
MCL will have + valgus stress test LCL injury wil have +varus stress test Meniscal injury will have +McMurray test
52
What is the unhappy triad?
MCL ACL Medial meniscus
53
Presentation - posteriorly directed force on a flexed knee, posterior drawer test
PCL injury
54
Presentation - acute twisting or degenerative tear (elderly), clicking or locking, joint line tenderness, +McMurray test
Meniscal injury
55
Work-up knee injury?
Radiographs to look for fracture, alignment or deformity, infection, and tumor MRI for confirmation
56
General management of knee injury?
Individualized Exhaust conservative options first - Rest, Ice, Compress, Elevate Consider non-operative management for elderly and low-demand patients Surgery for reconstruction, NOT repair
57
Which knee injuries should be treated conservatively?
MCL/LCL, meniscal tears Operative meniscal repair - younger patients with reparable tears, older patients with mechanical symptoms who do not respond to conservative treatment
58
Presentation - obese, adolescent male aged 10-16 y/o presenting with groin pain, painful limp, externally rotated hip, not irritable (patient allows ROM)
Slipped capital femoral epiphysis
59
Pathophysiology and predisposing factors of SCFE?
Excess loading across the physis causes slippage of the head on the neck of the femur Endocrine disorders, osteodystrophy, hypothyroid/hypopituitarism
60
Work-up for SCFE?
Dx - AP and/or frog lateral view of the hip with displacement of proximal femoral epiphysis on metaphysis R/o emergent septic arthritis
61
Management of SCFE?
Admit for urgent in situ surgical pinning of the hip with a single screw Short period of protected weight bearing with crutches
62
Presentation - sensory dysesthesias in the median nerve distribution (3 1/2 radial digits volarly and dorsal tips), dropping things, worse at night, job/activity involving repetitive movements of the hand/wrist. Thenar atrophy, +Phalen maneuver, Tinel sign
Carpal tunnel syndrome
63
Dx carpal tunnel syndrome?
Clinical If equivocal -> EMG/NCS R/o spinal disease with MRI and medical neuropathies with lab testing as indicated based on H&P
64
Management of carpal tunnel syndrome?
NSAIDs, wrist splinting, carpal tunnel injection Surgical release if failure of conservative treatment or muscle involvement (thenar wasting) present
65
When is carpal tunnel an emergency?
Acute syndrome after acute fracture or dislocation
66
What should not be overlooked when suspecting carpal tunnel?
Myopathy, Pancoast tumor, treatable peripheral neuropathy (syphilis, HIV, vitamin deficiency, heavy metal toxicity, cancer, rheum condition, DM, thyroid disease, etc.)

Surgery Clerkship - De Virgilio (9 decks)

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