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Neurosurgery > Test > Flashcards

Test Flashcards

1
Q

Most common brain tumor?

A

Metastasis

(Lung, breast, melanoma, renal cell)

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2
Q

Most common HIV/AIDS related tumor?

A

Lymphoma

(EBV, crosses the midline)

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3
Q

5 yo with solitary mass in cerebellum. What is the most likely diagnosis?

A

Pilocytic astrocytoma (most common)

features:

  • “hairlike” processes
  • frequently contain BRAF mutation
  • positive for GFAP (cuz they are glial tumors)
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4
Q

What is the average survival of GBM s/p surgery and CRT?

A

12 - 14 months

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5
Q

What is the most common primary systemic cancer with synchronous brain mets?

A

lung cancer

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6
Q

From what cells are meningiomas derived?

A

Arachnoid cap (meningeal cells)

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7
Q

A patient presents with status epilepticus with a newly diagnosed brain tumor in the ED. What medication should be avoided?

A

decadron (dexamethasone)

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8
Q

patient presents following a motor vehicle crash. 3 days into his hospital course he develops an ICP of 45 with decreased pupil response. A head CT shows multifocal hemorrhage and sulci effacement. What is the treatment?

A

decompressive craniotomy

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9
Q

A patient has a head injury. What should be given for EARLY seizure (within first week after injury) prophylaxis? What should be given for LATE seizure prophylaxis?

A

EARLY = Dilantin (phenytoin)

Dilantin (phenytoin) does not help with LATE seizures

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10
Q

A 75 yo man presents with abnormal gain, dementia, and urinary incontinence. Lumbar puncture reveals a normal opening pressure. Imaging (MRI preferable but CT can be used) reveals enlarged ventricles. What is the diagnosis?

A

Normal-pressure hydrocephalus

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11
Q

Of the following, which is NOT a treatment for elevated ICP?

1) Hypoventilation
2) Hypertonic saline
3) Mannitol
4) Elevate head of bed
5) Drain ventricles
6) Hyperventilation

A

1) Hypoventilation

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12
Q

A 7 yo present with a 3 week history of vomiting and difficulty walking. MRI reveals a tumor of the 4th ventricle. What is the most likely diagnosis?

A

meduloblastoma

(although pilocytic astrocytomas are the most common, the rapid progression of symptoms suggest a meduloblastoma)

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13
Q

An 80 yo man fell from ground level and hit his head resulting in a subdural hemorrhage. He is currently on warfarin with an INR of 2.5. Which of the following is not a reversal agent?

1) Vitamin A
2) FFP
3) Prothrombin
4) Vitamin K
5) Cessation of medication

A

1) Vitamin A

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14
Q

A patient with HTN and T2DM presents with L-sided weakness and facial droop. What imaging modality should you start with?

A

noncontrast head CT

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15
Q

What medications should be avoided in individuals with Parkinson’s?

A

Avoid antipsychotics as they are dopamine antagonists

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16
Q

Are EEGs for new onset seizures helpful without seizure during assessment?

A

yes

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17
Q

A patient has acutely elevated ICP. Can you give them D5W?

A

NO! Hypotonic fluids will only worsen the ICP

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18
Q

Noncontrast CT shows a right-sided crescent shaped hyperdensity. What is the diagnosis?

A

subdural hematoma

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19
Q

A 15 yo gymnast presents with lower back pain without radiculopathy. Imaging reveals bilateral pars intraarticular defect, with normal L5-S1 alignment. What is the diagnosis?

A

Spondylolysis

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20
Q

A 30 yp cashier presents with 3 months of progressive neck pain, weakness, increased reflexes, and parasthesias of hands. What is the diagnosis?

A

cervical myelopathy

(UMN, bilateral, progressive)

Caused by compression of the spinal cord in the cervical region

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21
Q

A patient presents with a non-specific pituitary tumor. In gerneral, what treatment should you avoid? What are better options?

A

AVOID = temporal excision

GOOD = transphenoidal excision, transcranial, radiotherapy, antisecretory agents

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22
Q

A 52 yo patient presents with tinnitus, vertigo, and hearing loss. What is the diagnosis?

A

Vestibular schwannoma

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23
Q

A 32 yo man presents following a motor vehicle crash with loss of sensation from the chest down and inability to move bilateral legs. What is the next best step?

A

IV fluids and/or O2 therapy and/or catheter

Patient presumably has spinal shock. Spinal shock can lower blood pressure and hypoventilation which can increase the extent of neurological impairment. In addition, bladder overdistention can result from spinal shock

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24
Q

70 yo man presents with months of slurred speech, difficulty walking, fasiculations/atrophy, and increased reflexes. What is the diagnosis?

A

ALS

ALS has both upper and lower motor neuron damage

25
Q

18 yo man presents with CN VII injury secondary to a temporal bone fracture (see anatomy picture). How would his symptom(s) present?

A

inability to close ipsilateral eye

26
Q

A patient has a right-sided tumor and presents with back pain and right sided-foot drop. What muscles are affected?

A

anterior compartment muscles:

  • anterior tibialis
  • extensor hallucis longus
  • extensor digitorum longus
  • fibularis tertius
27
Q

What are the symptom(s) of a subarachnoid hemorrhage?

A

thunderclap headache

28
Q

What is the cause of hydrocephalus in the picture?

A

Aquedectal stenosis

SOR = supraoptic recess
IR = infundibular recess
PR = pineal recess
29
Q

A patient presents with urinary incontinence, lower back pain, lower extremity weakness, and absent ankle reflexes. What is the diagnosis?

A

cauda equina syndrome (LMN deficit)

30
Q

Migrains are associated with all of the following EXCEPT:

1) Head pain worse with standing
2) Headache
3) Nausea
4) Vomiting
5) Family history

A
31
Q

A patient hits his head. Physical exam reveals one dilated pupil. Which side is the expanding lesion?

A

ipsilateral side

32
Q

Patient presents with a brainstem cavernous malformation (cavernous malformations are clusters of abnormal, tiny blood vessels and larger, stretched-out, thin-walled blood vessels filled with blood and located in the brain) causing abducens palsy (CN VI). How would the patient present?

A

inability to abduct the eye

33
Q

What is going on here (know it or don’t question)

A

calcified pineal gland

34
Q

What is a normal adult intracranial pressure?

A

<20 mmHg

35
Q

A patient presents with bilateral hand weakness after a fall. CT C-spine reveals hyperextension injury. What is the diagnosis?

A

central cord syndrome

36
Q

What are subarachnoid hemorrhages commonly misdiagnosed as?

A

Migraines

37
Q

What are the symptoms of trigeminal neuralgia?

A

Intermittent shock-like sensations with extreme unilateral face pain

38
Q

What is the treatment for trigeminal neuralgia?

A

carbamazepine

39
Q

What is a good migraine prophylaxis?

A

topiramate

40
Q

Which of the following diseases does NOT have upper motor neuron findings?

1) Spinal transection
2) Myasthenia gravis
3) Multiple sclerosis
4) ALS

A

Myasthenia gravis

41
Q

A patient gets a head CT which reveals hyperdensity in the left basal ganglia. What is the likely diagnosis?

A

Intraparenchymal hemorrhage (IPH)

42
Q

Which of the following indicates upper motor neuron damage?

1) Hyperreflexia
2) Hyporeflexia

A

Hyperreflexia

43
Q

40 yo man presents with urinary symptoms and weakness. 18 years ago he experienced painful vision loss that resolved. What is the diagnosis?

A

Multiple sclerosis

44
Q

A 65 yo man with a history of alcohol abuse presents with tonic clonic seizures. Should you get an MRI?

A

No. Seizures are liekly due to alcohol withdrawal. Give benzos

45
Q

A patient has an acute migraine. Should you administer phenobarbitol?

A

no

46
Q

What are the red flag symptoms in headaches?

A

SNOOP

S = systemic symptoms

N = neurologic symptoms

O = abrupt onsent (thunderclap)

O = Older than 65

P = positional/papilledema/progression (worse)

47
Q

Cordotomy relieves intractable pain. However, patients that undergo this procedure will likely develop what type of neurological symptoms?

A

unilateral loss of pain and temperature below the surgical level

48
Q

CT shows lens shaped right side hyperdensity. What is the diagnosis?

A

epidural hematoma

49
Q

A patient develops a right-sided epidural hematoma. Would you see left pupil dilation?

A

no. If a transtentorial herniation occurs, you would see a right-sided herniation

50
Q

What is the treatment for an epidural hematoma?

A

decompressive hemicraniotomy

51
Q

What type of fluids should you avoid with epidural hematomas?

A

1/2 normal saline

52
Q

A 62 yo female presents with slurred speech, right-sided faial droop, right sided weakeness. Head CT was unremarkable. What is the next step?

A

Ask about contraindications to tPA. If none, administer tPA

53
Q

True or falseL Lamictal is useful in status epulepticus due to rapid IV infusion?

A

False, use benzos first

54
Q

Prolonged phenytoin use cases all of the following EXCEPT:

1) Osteoporosis
2) Neuropathy
3) Hyperostosis (excessive bone growth)
4) Blood dyscrasias (blood disorders)

A

NO: Hyperostosis (excessive bone growth)

YES: osteoporosis, neuropathy, blood dyscrasia (megaloblastic anemia, DRESS)

55
Q

True of false: A patient can be discharged immediately status post aneurysmal SAH coiling/clipping

A

False

Must observe them as there is a risk for vasospasm and hydrocephalus

56
Q

How do you calculate cerebral perfusion pressure?

A

MAP - ICP

57
Q

What are features of brown sequard syndrome?

A

loss of motor and proprioception on ipsilateral side with loss of pain and temperature on the contralateral side

58
Q

Glasgow coma scale categories and points

A

eye opening
EYES mnemonic

Verbal response
VOWEL mnemonic

Motor response
OLD BEN mnemonic

Neurosurgery (1 decks)

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