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Pediatrics 3B > Surgery 3B - Neurosurgery > Flashcards

Surgery 3B - Neurosurgery Flashcards

1
Q

Uncal Herniation

A

Opposite lower extremity weakness

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2
Q

Upward herniation

A

Posterior fossa pathology

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3
Q

Tonsillar herniation

A

Cardiorespiratory impairment

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4
Q

Central Transtentorial herniation

A

Pinpoint pupils

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5
Q

Subfalcine herniation

A

Opposite upper/lower ext weakness

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6
Q

Skull X ray

A

Rapid and almost universally available

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7
Q

CT Scan

A

Access vascular pathology of brain and spine

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8
Q

Cranial MRI

A

Superior Brain/Spinal tissue resolution

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9
Q

Cerebral Angiography

A

Evaluates hemorrhagic stroke/trauma

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10
Q

EMG-NCV

A

Peripheral nerve integrity

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11
Q

Catheter inserted into frontal horn of lateral ventricle, also used for CSF drainage

A

EVD

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12
Q

Normal ICP range

A

110-120 mmH2O (5-10 mmHg)

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13
Q

Increased ICP

A

> 200 mmH2O (15 mmHg)

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14
Q

Volume of blood

A

120 mL

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15
Q

Volume of CSF

A

120 mL

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16
Q

Cushing Triad

A

Sys HPN,
Bradycardia
Resp irregularities

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17
Q

Example of primary (impact damage) brain injury

A

Cortical contusions
Diffuse white matter lesions
Laceration

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18
Q

Thalamic bleed

A

Hemiplegia/hemiparesis

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19
Q

Pontine bleed

A

Total paralysis

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20
Q

Cerebellar bleed

A

Repeated vomiting

Conjugate stare

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21
Q

Putaminal bleed

A

Face sags

Slurred speech

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22
Q

Lobar bleed

A

Depends on area affected

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23
Q

Bivex lentiform shape on CT

A

Epidural hematoma

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24
Q

Respects cranial sutures line

A

Epidural hematoma

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25
Q

Bright crescent shape by CT

A

Acute subdural hematoma

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26
Q

Hypodense crescent shape by CT

A

Chronic subdural hematoma

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27
Q

Spherical hyperdense intra-axial shape by CT

A

?

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28
Q

Abnormally dilated arteries and veins w/o intervening capillary bed

A

AVM

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29
Q

Most common primary intra-axial CNS neoplasm in adults

A

Astrocytoma

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30
Q

Metastatic tumors of the brain least likely extra-cranial source is

A

Melanoma

More likely lungs, breast, colon, kidney

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31
Q

Calcifications and hemorrhage on CT or MRI suggest diagnosis of

A

Oligo-dendro-glioma

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32
Q

Most common intra-dural, intra-medullary spinal tumor

A

Ependymoma

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33
Q

Loss of motor control and proprioception ipsilaterally

A

Brown Sequard

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34
Q

Upper extemities worse than lower extremities weakness

A

Central cord syndrome

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35
Q

Total loss of sensory, motor, nociception and proprioception bilaterally

A

Functional cord transection

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36
Q

Loss of bilateral proprioception and thermoception

A

Posterior cord syndrome

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37
Q

Best dx imaging for trauma

A

CT w/contrast

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38
Q

Communicating type of hydrocephalus are as follows except

  • meningitis
  • arachnoiditis
  • subarachnoid hemorrhage
  • aqueductal stenosis
  • none
A

Aqueductal stenosis

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39
Q

CSF production /day

A

500cc/day

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40
Q

Masses higher up in the hemisphere can pass the cingulate gyrus causing what type of herniation

A

Subfalcine herniation

Opposite upper/lower ext weakness

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41
Q

Primary source of energy in the brain

A

Glucose

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42
Q

True of brain abscess

A

Manifest as cerebritis early
Ring enhancing lesion on CT contrast
Congenital cyanotic heart dse is a risk factor

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43
Q

Composted of cystic vascular spaces lined by single layer of endothelial cells

A

Cavernous malformation

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44
Q

Increased ICP can be 2’ to ff except

  • Sagittal Sinus thrombosis
  • Hypoventilation
  • Hypocarbia
  • Hypercarbia
A

Hypo-carbia

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45
Q

Cerebral blood flow

A

50ml/100g of brain/min

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46
Q

50 m, sudden severe headache w/assocaited nuchal rigidity. Afebrile and heache refractory to analgesics.

A

Brain abscess

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47
Q

Most common cause of communicating hydrocephalus

A

Meningitis (ex TB infection)

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48
Q

MCC Lateral ventricle tumor

A

subependymal giant cell astrocytoma

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49
Q

Lucid interval after falling, consider

A

Epidural hematoma

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50
Q

Diagnostic procedure in Epidural hematoma (lucid interval)

A

CT scan w/o contrast

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51
Q

Battle sign

A

Discoloration over the mastoid

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52
Q

Intra-dural extra-medullary spinal cord tumors

A

Schwannoma
Meningioma
(NOT astro)

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53
Q

MCC spontaneous intra-cerebral hematoma in 1st two decades of life

A

AVM

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54
Q

MC spinal cord tumor in intra-dural, extramedullary region w/predilection in thoracic region

A

Schwannoma ?

Astrocytoma ?

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55
Q

Unequal weakness of all ext more profound in lower and some form of sacral sparring

A

Central cord

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56
Q

MCC congenital hydrocephalus

A

Aqueductal stenosis

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57
Q

Subdural hematomas are located b/t

A

Dura and arachnoid

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58
Q

Epidural hematomas are located b/t

A

Bone and dura

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59
Q

MCC of subarachnoid hemorrhage in general

A

Intracerebral hemorrhage

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60
Q

MC intra-cranial tumor (adult)

A

Metastasis

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61
Q

Pediatric pt. w/gain unsteadiness and intention tremors

A

Medulloblastoma

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62
Q

Glucose consumption in the brain

A

60 mg/min

63
Q

Pathologic condition where excessive CSF is collected in the cranial cavity

A

Hydrocephalus

64
Q

68 F w/bleed
Extends to pain
No verbal output
Opens eye to pain

A

GCS 5

65
Q

Hx of mauling
Obeys
Confused
Opens eye spontaneously

A

GCS 14

66
Q 
5 M 
Hx of fall 
Withdraws to pain
Inappropriate words 
Opens eye to pain
A

GCS 9

67
Q 
18 M 
Hx bike accident
Flexes to pain 
Moans 
No eye opening
A

GCS 6

68
Q

Pt w/stroke
localizes
Confused
Opens eye to pain

A

GCS 11

69
Q

Cerebral blood flow

A

50cc/kg/min

70
Q

Coma

A

< 20 mg glucose

71
Q

Brain blood volume

A

120 mL

72
Q

Cerebral O2 consumption

A

45-50cc/min

73
Q

Glucose consumption

A

25% of body/60mg/min

74
Q

Ant cerebral artery stroke

A

Contralateral limb weakness

75
Q

Middle cerebral artery stroke

A

Aphasia expected

76
Q

Post cerebral artery stroke

A

Homonymous hemianopsia

77
Q

PICA stroke

A

Nystagmus and ataxia are prominent

78
Q

Pontine stroke

A

Total paralysis

79
Q

Brain abscess w/TOF

A

Fronto-parietal abscess

80
Q

Chronic otitis media

A

Temporal abscess

81
Q

Recurrent frontal sinusitis

A

Frontal abscess

82
Q

Odontogenic source

A

Basifrontal abscess

83
Q

Chronic mastoiditis

A

Cerebellar abscess

84
Q

Usually appears in majority of brain tumor patients, exacerbated by changes of posture, usually predominates in early morning upon waking up

A

Headache

85
Q

Dandy walker malformation

A

Posterior fossa cyst

86
Q

Communicating hydrocephalus type

A

Post-meningitis hydrocephalus

87
Q

Non-communicating hydrocephalus example

A

Aqueductal stenosis

88
Q

Vascular malformation w/nidus arterial feeder and draining vein

A

AVM

89
Q

Vascular malformation containing several sinusoidal vascular spaces

A

Cavernous malformation

90
Q

Possible complication of ethmoidal sinusitis via contiguous route

A

Frontal lobe abscess

91
Q

Pt w/TOF might develop a hematogenous route of cerebral abscess

A

Fronto-patietal convexity abscess

92
Q

Chronic otitis media predisposes to

A

Temporal or cerebellar abscess

93
Q

Extradural spinal turmor

A

Metastatic

94
Q

Example of Intradural extramedullary spinal tumor

A

Meningioma

95
Q

Metastasis

A

Extra-dural extra-medullary spine tumor

96
Q

Ependymoma

A

Intra-dural intra-medullary spine tumor

97
Q

Schwannoma

A

Intra-dural extra-medullary spine tumor

98
Q

Hyperdense crescent shape on CT

A

Acute subdural hematoma

99
Q

Hypodense crescent shape on CT

A

Chronic subdural hematoma

100
Q

Cerebellar bleed

A

hydrocephalus

101
Q

Pontine bleed

A

Hemiparesis w/poor outcome

102
Q

Lobar bleed

A

Focal deficits based on location

103
Q

Thalamic bleed

A

contralateral hemi-sensory loss

104
Q

Basal ganglia bleed

A

contralateral weakness

105
Q

Aneurysm

A

Neck and sac

106
Q

Cavernous malformation

A

Not seen in angiography w/mass-like sinusoidal vessels

107
Q

Venous malformation

A

No arterial supply

108
Q

Capillary telangiectasia

A

Benign and low incidence of bleeding, see in autopsy

109
Q

AVM

A

Needs embolization, Sx, radiation or combination

110
Q

Cerebral hemispheres (telencephalon)

A

cerebral cortex
basal ganglia
hippocampus

111
Q

frontal lobes

A 
Executive fxn
Decision making 
Speech 
Restrain of emotion
Origin of CST
112
Q

Parietal lobes

A

Sensory cortex

Bounded by occipital lobe posteriorly

113
Q

Temporal lobes

A

Amygdala

Lowe optic radiation (Meyer’s loops)

114
Q

T/F
Hippocampus = memory
Amygdala = emotion
Lower optic radiation = visual pathways

A

All True

115
Q

Brainstem

A

Midbrain
Pons
Medulla

116
Q

Cerebellum arises from dorsal aspect of the brainstem

A

integrates somatosensory, vestibular and motor info for coordination and timing of movement

117
Q

Pineal tumor big enough to press on the posterior midbrain compromising CSF passage thru aqueduct

A

Lateral ventricles enlarge

118
Q

Paired spinal nerves exit the spinal cord

A

7 cervical vertebral bodies

119
Q

L2-L4 spinal nerves intersect in the lumbrosacral plexus and divide to form the main nerve branches to the leg

A

Common peroneal
Tibial
Femoral

120
Q

CT

A

Acute hematoma appear white or hyperdense

INvasive procedure for plain cranial CT scan

121
Q

T/F
MRI = excellent imaging of soft tissue in head and spine

Transarterial catheter-based angiography remains gold STD for vascular pathology of brain and spine

Acute nerve injury after 28 days is ideal timing for EMG NCV

A

TRUE

122
Q

Pressure volume curve of ICP

A

Arbitrary point volume and pressure are directly proportional

123
Q

Brain death

A

Confirmed absence of CBF

EEG documentation necessary

124
Q

Multiple injured vehicular accident patient who is unconscious

A

presumed to have spine injury
lateral cervical xray done by turning pt laterally like a log
treated acc to ABC for multiple injured persons

125
Q

Peripheral nerve injuries
Neuroproxia
Axonotmesis
Neurotmesis

A

Neuroproxia - temporary failure of nerve fxn
Axonotmesis - disruption of axons and myelin. Endoneurium intact
Neurotmesis - disruption of axons and endoneural tubes

126
Q

Erh’s palsy

A

C5 C6 components of brachial plexus

Glemohumeral dislocation

127
Q

Klumple’s palsy

A

Injury to C8 T1 components of brachial plexus

Claw hand deformity

128
Q

Cerebrovascular dse

A

DM, cholesterol, BP, smoking = risk factors

Basal ganglia is most common site of IC hemorrhage

129
Q

Acute epidural hematoma

A

Biconvex hyperdense lesion

130
Q

Brain tumors

A

Meningiomas are beign and rarely malignant

131
Q

GCS

A

Stimuli at nailbed or supraorbital
low score = lower sensorium
3 = poorest prognosis

132
Q

Acute epidural hematoma

A

Lucid interval
High assoc ofskull patient
Not always Sx

133
Q

Lumbar puncture after ruptured cerebral aneurysm

A

spinal fluid primarily dominant RBC

134
Q

Corticospinal tract fibers at the right half of midbrain passed thru the

A

right posterior limb of int capsule

135
Q

Motor cortex is

A

Covered by parietal bones

Pre-central gyrus

136
Q

Corticospinal tract

A

UMN
includes anterior hron cells of the cervical spine
Modulates the spinal arch

137
Q

CST at thoracic cord level if from the right motor cortex

A

located at the left posterior quadrant

138
Q

Pain and temp from left big toes at the thoracic cord

A

Right anterior quadrant

139
Q

Occipital lobe L infaction

A

R hemianopsia

140
Q

CN attached to brainstem

A

occulomotor

141
Q

Spinal cord

  • starts at F magnum
  • Anchored in spinal cancal by nervous structure dentate
  • Ends at approx lower level of L1
A

True

142
Q

Spine

A

7 Cervical Vertebrae
8 Cervical Roots
One coccygeal nerve root/side

143
Q

L2-L4

A

Lumbrosacral plexus
Mixed Nerves
Common peroneal, tibeal, femoral

144
Q

Spinal cord division

A

Ant - pain, temp, motor

Post - position and vibratory

145
Q

X ray of cervical spine

A

cross table for unconscious pt

146
Q

CT

A

detects Acute hemorrhage
xray radiation
generally used w/contrast for pt w/metal in orbit or pacemaker (not able to use MRI)

147
Q

Electromyography and Nerve conduction

A

NC records velocity and amplitude of nerve action potential

148
Q

Invasive IC pressure monitoring

A

external ventricular drain
intra-parencymal fiberoptic pressure transducer
brain tissue oxygen sensors

149
Q

Intracranial pressure/volume curve

A

maintain pressure in early stage

150
Q

Recurrent frontal sinusitis

A

Frontal abscess

151
Q

Temporal abscess

A

Chronic otitis media

152
Q

Odontogenic source

A

Basifrontal abscess

153
Q

Mastoiditis

A

Cerebellar abscess

Pediatrics 3B (12 decks)

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