Pretest Neuro

Question 1

What does Glasgow coma scale measure?

Answer 1

Severity of head trauma

Question 2

Glasgow coma scale (point distribution)

Answer 2

• Eye opening: 4 points
• Verbal response: 5 points (“T” if intubated)
• Motor response: 6 points

Question 3

Glasgow coma scale (stratification based on points)

Answer 3

3 = completely unresponsive
15 = fully oriented
8 or less = severe TBI
9-12 = moderate TBI
13-15 = mild TBI

Question 4

Cerebral perfusion pressure (calc, NL)

Answer 4

MAP - ICP

greater than 70 mmHg

Question 5

NL ICP

Answer 5

less than 20 mmHg

Question 6

Methods of reducing ICP (x5)

Answer 6

• Reverse Trendelenburg
• Mannitol
• Short-acting sedatives
• Prevention of hypoventilation/hypercarbia
• Prevention of hypovolemia/hypotension

Question 7

GBM tumor (derivation)

Answer 7

Malignant degeneration of an astrocytoma or anaplastic astrocytoma

Question 8

GBM tumor (CT/MRI 4)

Answer 8

• Hypodense central necrosis
• Peripheral ring enhancement
• Surrounding edema
• Mass effect

Question 9

GBM tumor (mgmt)

Answer 9

• Resection

- External beam radiation

Question 10

MC etiology of hypodense lesion with ringlike contrast enhancement

Answer 10

Metastatic brain tumor

Question 11

What kind of patients are susceptible to toxoplasmosis?

Answer 11

Immunocompromised

Question 12

What kind of skull fxs require surgical intervention?

Answer 12

• Depressed: elevate

- Compound: clean and close

Question 13

CSF leak: rhinorrhea or otorrhea (mgmt)

Answer 13

• Observe

- Surgical repair of dura if more than 2wks

Question 14

Two general types of pituitary adenomas

Answer 14

• Functional

- Non-Functional

Question 15

Functional pituitary adenoma (pathologies 3)

Answer 15

• PRL: amenorrhea, galactorrhea
• GH: gigantism, acromegaly
• ACTH: Cushing disease

Question 16

Frontal craniotomy vs trans-sphenoidal approach for pituitary adenomas (determining factor)

Answer 16

Suprasellar extension

Question 17

Epidural hematoma (skull site, vessel, lesion shape, surgical approach)

Answer 17

• Temporal region
• Middle meningeal artery
• Biconvex
• Craniectomy

Question 18

Initial medical mgmt in SAH

Answer 18

• Counteract vasospasm
• BP control
• Anticonvulsant therapy

Question 19

Physiologic response to acute rise in ICP

Answer 19

Cushing triad:

• Irregular respirations (hypoperfusion of brainstem)
• HTN (decreased perfusion of cerebrum)
• Bradycardia (decreased perfusion of cerebrum)

Question 20

Benign schwannomas (tx)

Answer 20

Excision

Question 21

Intracranial schwannomas (sxs 3)

Answer 21

• Hearing loss
• Tinnitus
• Vertigo

Question 22

Peripheral nerve tumors (5)

Answer 22

• Chemodectomas
• Ganglioneuromas
• Schwannomas
• Neuroblastomas
• Pheochromocytomas

Question 23

Craniopharyngiomas (mgmt)

Answer 23

• Subfrontal or trans-sphenoidal excision

- Adjuvant radiotherapy w/ subtotal resections

Question 24

Cerebral contusions (definition, mc sites)

Answer 24

• Bruises of neural parenchyma

- Orbital surfaces of frontal lobes, anterior portion of temporal lobes

Question 25

Meningiomas (derivation)

Answer 25

Arachnoid layer

Question 26

Meningiomas (tx)

Answer 26

Excision

Question 27

Brain abscess (dx)

Answer 27

CT/MRI with contrast

Question 28

Brain abscess (mechanism of infection)

Answer 28

- Contiguous spread | - Hematogenous spread

Question 29

Brain abscess (mgmt 3)

Answer 29

- ABXs - Relief of mass effect by aspiration (not surgery) - Tx underlying cause

Question 30

Subdural hematomas (vessels, lesion shape, surgical approach)

Answer 30

- Bridging veins, venous sinuses - Concave - Drain hematoma through Burr hole