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Neuro Surgery > Exam I > Flashcards

Exam I Flashcards

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1
Q

coronal suture joins

A

frontal and parietal

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2
Q

sagittal suture joins

A

two parietal bones

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3
Q

lambdoid suture joins

A

occipital and parietal

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4
Q

squamous suture joins

A

parietal and temporal

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5
Q

CN II examination

A
  • pupillary reflex
  • VF
  • VA
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6
Q

CN V examination

A
  • cotton wisp
  • corneal reflex
  • mastication
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7
Q

CN VII examination

A
  • facial expression

- taste ant 2/3 of tongue

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8
Q

CN IX (glossopharyngeal) exam

A
  • gag reflex
  • swallow
  • posterior 1/3 taste
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9
Q

major switchboard for brain

A

thalamus

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10
Q

controls motor function/initiation of actions

A

basal ganglia

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11
Q

essential for memory and learning facts

A

hippocampus

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12
Q

maintains homeostasis, circadian rhythm, autonomic control

A

hypothalamus

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13
Q

main brain artery that comes off of vertebral arteries

A

basilar

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14
Q

things to consider for a physical exam on a neurp pt?

A
  • GCS is comatose

- perform a full system PE on ICU pts

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15
Q

eyes opening response

A

4-opens sponataneously
3-to speech
2-to pain
1-none

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16
Q

verbal response

A 
5-oriented to time, place, person
4-confused, disoriented
3-inappropriate words
2-incomprehensible sounds
1-none
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17
Q

motor response

A 
6-obeys command
5-moves toward pain
4-moves away from pain
3-abnormal flexion
2-abnormal extension
1-none
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18
Q

pt presents with rhino/otorhhea after trauama, think

A

CSF leak

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19
Q

when should you perform imaging on a neuro emergency pt?

A

ALWAYS, regardless of injury severity

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20
Q

best initial imaging modality in acute setting

A

CT

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21
Q

most sensitive test

A

MRI, technically the best but takes too long

-use this for cauda equina first line though

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22
Q

Monroe-Kelly doctrine

A

3 things in brain that can elevate intracranial pressure

  • blood
  • brain
  • CSF
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23
Q

HA and vomiting favors which type of stroke?

A
  • SAH

- ICH

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24
Q

Arterial bleed between skull & dura

A

epidural hemorrhage, MCC skull fx impacting the middle meningeal artery

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25
clinical course of epidural hemorrhage
injury----brief LOC----lucid state---coma
26
what will an epidural hemorrhage show on CT?
- lens/convex shape, does not cross suture line - temporal bone fx - midline shift
27
how to manage epidural hemorrhage
- craniotomy w/evacuation of hemorrhage If clot thickness is greater than 10mm or if midline shift is greater than 5mm - change in pupil size - GCS <9 - observation if small (Q1 neuro checks for 24-72 hrs)
28
Venous bleed MC* between dura & arachnoid (tearing of bridging veins. MC seen in elderly
subdural hematoma, MC blunt trauma often causes bleeding on other side of injury “contre-coup”.
29
what will a subdural hemorrhage show on CT?
- CONCAVE (Crescent-shaped) *MAY cross suture line* | - midline shift
30
Arterial bleed between arachnoid & pia mater
subarachnoid hemorrhage, MC from berry aneurysm or AVM
31
clinical signs of SAH?
- thunderclap HA, worst of life | - meningeal signs (photophobia, neck pain, NV)
32
how to dx SAH?
- CT first | - if negative, do a LP (xanthochromia (RBC’s)*, ↑CSF pressure & no focal neuro sx*)
33
how to manage SAH?
- bed rest - stool softener - phenytoin seizure prophylaxis - anti anxiety - possible lower BP
34
how do people get intraparenchymal hemorrhages
- HTN | - AVM
35
when should you not perform a LP?
intracerebral hemorrhage, may cause herniation
36
how to manage intracerebral hemmorhage
supportive - anticonvulsants - steroids for edema
37
clinical manifestation of basilar fx
Battle sign Racoon Eyes Hemotympanum Rhinorrhea/ Otorrhea (CSF)
38
normal ICP?
15mmHg | >20 needs tx
39
idiopathic intracranial HTN
aka pseudotumor cerebri - increased ICP with no other cause of increased ICP found on CT/MRI - MC in obese women
40
clinical signs of pseudotumor cerebri
- HA worse with straining - N/V, tinnitus, photophobia - can lead to blindness (increased cup:disk)
41
how to dx pseudotumor cerebri
- papilledema on slit lamp - CT to r/o mass then do a LP - LP would show increased opening pressure
42
how to manage pseudotumor cerebri
-acetazolamide | MOA: carbonic anhydrase inhibitor
43
dead cells lyse and release intracellular contents resulting in edema. BBB remains intact Seen in strokes
cytotoxic cerebral edema
44
BBB compromised due to release of VEGF from neoplastic cells allowing new vessels to grow Seen in brain tumors
vasogenic cerebral edema | Decadron is effective treatment to stop secretion of VEGF
45
this type of cerebral edema is from HTN, capillary leakage
hydrostatic
46
this type of cerebral edema results from serum hyponatremia resulting in pulling of sodium from brain and resultant edema
osmotic
47
this type of cerebral edema is seen in hydrocephalus
interstitial,brain saturated with CSF
48
clinical signs of elevated ICP
- HA, NV - cushing's triad:bradycardiam, dyspnea, HTN - herniation - blown pupil on ipsilateral side of herniation - decerebrate posture
49
medulla herniation will result in
- irregular or no breathing - midposition, fixed pupils - absent vestibulocular reflex - absent motor reponse
50
midbrain/ upper pons herniation will result in
- hyperventilatin of Cheyne-stokes - midposition, fixed pupils - absent or abduction of vestibuloocular reflex - decerebrate or no movement
51
most sensitive way to assess ICP
invasive ICP monitor, ventricle can treat as well 20% risk of infection
52
when are invasive ICP monitors contraindicated?
- awake and responsive - GCS >9 - DIC - uncorrected coagulopathy
53
bolt monitor
goes into subarachnoid space, dura must be punctured
54
thin fiber optic cable is placed into the
intraparenchymal area, 3 mmHg variation
55
how to manage increased ICP?
- sedation/paralysis - control BP - hyperventilate to reduce CO2 to reduce cerebral blood flow to reduce ICP (from vasoconstriction) - mannitol (expands plasma volume to draw fluid out of brain tissue) - hypertonic saline
56
meds to avoid in neurosx
- anti platelet - anti coag - PCN (Decrease seizure threshold)
57
good anti-seizure med
-valproic acid, divalproex sodium MOA-↑ GABA effects (↑CNS inhibition), inhibits glutamate/NMDA receptor-mediated neuronal excitation SE-pancreatitis, hepatotoxicity
58
another good anti-seizure med
-phenytoin MOA: Stabilizes neuronal membranes (limits firing of action potentials by blocking Na-dependent channels) causing CNS depression (related to barbiturates) -used for seizure prophylaxis and after benzos for status epilepticus S/E: rash (erythema mutliforme/SJS), gingival hyperplasia,hypotension, arrhythmias
59
best benzo for seizures
lorazepam MOA: potentiates GABA-mediated CNS inhibition 1st line for status epilepticus flumenazil is the reversal agent, monitor BP
60
phenobarbitol
MOA: binds to GABA receptor potentiating GABA-mediated CNS inhibition Ind: Status epilepticus p phenytoin if status epilepticus persistent, febrile sz in children SE: Depression, osteoporosis, irritability
61
anti coag reversal agents
Fresh frozen plasma, Prothrombin Vitamin K Protamine Sulfate start if INR is 5
62
anti platelet reversal agents
Platelet infusion | DDAVP
63
important points when considering brain death
- make sure cause is irreversible - assess brain stem reflexes (calorics, gag, pupils) - Apnea test (brain will cause a reflex breath when CO2 levels rise too high) CO2 >60
64
calorics interpretation
eye looks towards cold water | away from warm water
65
positive apnea test
pCO2 > 60 or increase of 20 over a normal baseline with no respiratory effort
66
MC SEEN AFTER BURST FRACTURES OF VERTEBRAL BODIES ESP WITH FLEXION INJURIES* Motor deficits: Lower extremity Sensory deficits: temp and pain in LE
anterior cord syndrome
67
MC SEEN WITH HYPEREXTENSION INJURIES* Motor deficits: upper extremity* esp distal extremities (HANDS)* Sensory deficits: Loss of Temp and pain* classically in a shawl distribution*(in upper extremities)
central cord syndrome
68
MC SEEN AFTER PENETRATION INJURIES* ipsilateral deficits: Motor, vibration and proprioception* contralateral deficits: Loss of Temp and pain* (usually 2 levels below injury)
Brown Sequard syndrome
69
how to manage the various cord syndromes
Removal of structures that are increasing the pressure on that specific portion of the spine. +/- Laminectomy
70
burst fracture-Jefferson
C1, can cause anterior cord syndrome
71
Hangman's fx (pedicle)
C2- Axis- Hyperextension injury
72
odontoid fxs occure from
falling on face | type 2 unstable is the MC
73
Fx due to forced flexion of cervical spine
anterior wedge fx
74
Due to severe flexion injuries leading to the collision of the above vertebral body with the one below it.
flexion teardrop fx - may present w/anterior cord syndrome - Anterior displacement of a Wedge shaped fragment
75
Due to extension injuries of the neck, classically seen with diving accidents
extension teardrop fx - may present w/central cord syndrome - triangular shaped fragment
76
Spinous process fracture- due to neck flexion in MVA
clay shoveler's fx
77
how to manage unstable cervical fxs
halo-vest immobilization

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