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Surgery Clerkship - De Virgilio COPY > 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
Q

Racoon’s eyes (periorbital ecchymoses) and Battle’s sign (postauricular ecchymoses) are signs of ___.

A

Basilar skull fracture

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26
Q

Presentation - HTN, bradycardia, respiratory irregularity

A

Cushing’s triad -> intracranial HTN

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27
Q

Presentation - blown pupil, contralateral hemiparesis

A

Uncal herniation

28
Q

Most common source of epidural hematoma?

A

Laceration of the middle meningeal artery

29
Q

Cause of subdural hematoma?

A

Rupture of the bridging veins

30
Q

Cause of diffuse axonal injury?

A

Stretching of axons between gray and white matter

31
Q

Cause of concussion?

A

Disruption of inflow and outflow tracks from RAS

32
Q

Cause of contusion?

A

Hemorrhage within the brain parenchyma

33
Q

Cause of subarachnoid hemorrhage?

A

Accumulation of blood in subarachnoid space

34
Q

First step in all trauma?

A

ABCs

35
Q

When should you intubate in the setting of TBI?

A

GCS of 8 or less

36
Q

Once the patient’s airway is protected, what should be done in a patient with LOC following head trauma?

A

STAT non-contrast head CT
Coagulopathy should b esought and corrected
ICP monitoring for select patients with moderate to severe TBI

37
Q

An ICP >___ should be treated aggressively. Options?

A

20

Elevate the head of bed
Intubate and paralyze
Mild hyperventilation (avoid prolonged hyperventilation)
Mannitol
Hypertonic saline
Control pyrexia/therapeutic hypothermia
Barbiturate coma
38
Q

Who should get a craniotomy with hematoma evacuation?

A
  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
Q

Criteria for brain death?

A

GCS of 3 while not hypoxic, normotensive, euthermic, not on sedatives/paralytics
No CN reflexes
No respiratory effort during an apnea test

40
Q

Presentation - respiratory symptoms, neurological changes, and reddish-brown petechial rash 24-72 hours after leg injury?

A

Fat embolism syndrome

41
Q

Presentation - radial nerve injury, wrist drop?

A

Humeral shaft fracture

42
Q

What is unique about managing open fractures?

A

Communicates with environment, requires special treatment to prevent infection

43
Q

Dx fractures?

A
  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
Q

What constitutes an open fracture?

A

Any soft tissue wounds in conjunction with a fracture

45
Q

Management of open femoral fracture?

A
  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
Q

Management of closed femoral fracture?

A
  1. Manage within 2-12 hours with intramedullary nailing to reduce risk of fat emoblism syndrome
47
Q

Presentation - acute trauma to knee with anterior knee laxity?

A

ACL injury

48
Q

In a patient with acute trauma to the knee who can bear weight, what is less likely?

A

Fracture

49
Q

___ knee injuries present with immediate swelling; ___ injuries have delayed swelling.

A

Ligament; meniscal

50
Q

Presentation - non-contact twisting, forced hyperextension, or impact to extended knee; audible pop during acute sports-related injury involving an awkward landing to twisting

A

ACL injury

51
Q

In a patient with a likely ACL injury, how can meniscal or MCL injuries be ruled out?

A

MCL will have + valgus stress test
LCL injury wil have +varus stress test
Meniscal injury will have +McMurray test

52
Q

What is the unhappy triad?

A

MCL
ACL
Medial meniscus

53
Q

Presentation - posteriorly directed force on a flexed knee, posterior drawer test

A

PCL injury

54
Q

Presentation - acute twisting or degenerative tear (elderly), clicking or locking, joint line tenderness, +McMurray test

A

Meniscal injury

55
Q

Work-up knee injury?

A

Radiographs to look for fracture, alignment or deformity, infection, and tumor

MRI for confirmation

56
Q

General management of knee injury?

A

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
Q

Which knee injuries should be treated conservatively?

A

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
Q

Presentation - obese, adolescent male aged 10-16 y/o presenting with groin pain, painful limp, externally rotated hip, not irritable (patient allows ROM)

A

Slipped capital femoral epiphysis

59
Q

Pathophysiology and predisposing factors of SCFE?

A

Excess loading across the physis causes slippage of the head on the neck of the femur

Endocrine disorders, osteodystrophy, hypothyroid/hypopituitarism

60
Q

Work-up for SCFE?

A

Dx - AP and/or frog lateral view of the hip with displacement of proximal femoral epiphysis on metaphysis

R/o emergent septic arthritis

61
Q

Management of SCFE?

A

Admit for urgent in situ surgical pinning of the hip with a single screw
Short period of protected weight bearing with crutches

62
Q

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

A

Carpal tunnel syndrome

63
Q

Dx carpal tunnel syndrome?

A

Clinical
If equivocal -> EMG/NCS
R/o spinal disease with MRI and medical neuropathies with lab testing as indicated based on H&P

64
Q

Management of carpal tunnel syndrome?

A

NSAIDs, wrist splinting, carpal tunnel injection

Surgical release if failure of conservative treatment or muscle involvement (thenar wasting) present

65
Q

When is carpal tunnel an emergency?

A

Acute syndrome after acute fracture or dislocation

66
Q

What should not be overlooked when suspecting carpal tunnel?

A

Myopathy, Pancoast tumor, treatable peripheral neuropathy (syphilis, HIV, vitamin deficiency, heavy metal toxicity, cancer, rheum condition, DM, thyroid disease, etc.)

Surgery Clerkship - De Virgilio COPY (9 decks)

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