NEUROSURG - LE1 (SAMPLEX)

Mamatay nalang

• In general, steroids is most effective in pathologies with this type of cerebral edema

Vasogenic edema

• The pathogenesis behind this type of cerebral edema is increased brain water due to impairment of CSF absorption. An example is obstructive hydrocephalus.

Interstitial hydrocephalic/hydrostatic edema

• The total volume of CSF that is found in an adult CNS at a given prior in time is around

150cc

• Found in the lateral, third, and fourth ventricles, this structure produces CSF through ultrafiltration process.

Choroid plexus

• The Monroe-Kellie doctrine states that the cranial vault is a rigid structure that contains these three components:

brain, blood, csf

• Because it has the longest intracranial course, this cranial nerve can cause a false localizing sign during episodes of increased intracranial pressure.

CN VI

• It is the most common type of cerebral herniations. In severe cases, may cause impaired levels of sensorium, urinary incontinence, and weakness of contralateral lower extremity.

Subfalcine herniation

• The diagnosis of brain death is primarily clinical and consists of the following essential findings EXCEPT:

No palpable pulse

• Clinical documentation of brain stem reflexes includes the following EXCEPT:

Abdominal reflex

• A 24 y/o male was rushed to the emergency room after a motorcycle accident. A cervical CT scan was done which showed a C3C4 fracture dislocation. MMTs of both upper and lower extremities were 3/5. This patient has an ASIA impairment scale of:

asia grade D

• Which of the following conditions can increase the mortality of traumatic brain injury (TBI)?

older age

• This pattern of spine injury is a pure axial compression injury causing failure of the anterior and middle columns.

burst fracture

• This is a spinal condition that is characterized by paralysis, hypotonia, and areflexia. It is temporary and should last approximately for about 24-72 hours only

spinal shock

• This type of incomplete spinal cord syndrome presents with weaker upper extremities compared to lower extremities. Patients have a variable degree of sensory loss and most of the time will not require surgery

central cord syndrome

• The following are acceptable immobilization devices used in patients with cervical cord injury EXCEPT:

soft cervical collar

• A 78 y/o male has a history of repeated falls. You want to rule out an intracranial traumatic hemorrhage. The best diagnostic imaging to request is:

cranial ct scan plain

• Which among the following is NOT a standard recommendation for management of patients with spinal cord injury (SCI)?

steroids

• It is defined as a transient post-traumatic loss of consciousness with normal neurologic examination. Its acute clinical symptoms largely represent a functional disturbance rather than a structural injury.

concussion

• which of the skull fractures would require surgical intervention?

depressed fracture resulting to a focal neurologic deficit

• In managing a multiply injured patient, injury to this organ/system should be given the topmost priority

abdomen

• In the newly revised GCS 40, application of painful stimuli is NOT recommended in this area.

sternum

• The most common injury to the cervical spine is

flexion and flexion-rotation

• This type of intracranial hemorrhage is frequently due to tearing of bridging vein between the cerebral cortex and the draining sinuses

subdural hematoma

• Which of the following pathologies is an example of secondary brain damage?

meningitis

• To rule out an odontoid fracture using a plain radiograph, this view is obtained

open mouth view

• This type of incomplete spinal cord syndrome presents with loss of motor function as well as loss of pain and temperature below the level of the lesion. It has the worst prognosis among the different incomplete cord syndromes.

anterior cord syndrome

• A 21 y/o female was ran over by a jeepney at Dapitan. She fell on the sidewalk and was rushed to UST emergency room. Upon initial examination, she had stable vital signs with intact brainstem reflexes. Upon applying pressure on her trapezius, she would open her eyes and moan. She would also localize to the stimulus by grabbing your arms. What is her GCS score?

9

• This type of cerebral herniation produces a syndrome which consists of progressively impaired consciousness, dilated ipsilateral pupil, and contralateral hemiplegia

uncal herniation

• This is a burst fracture of the ring of the atlas from a direct vertical blow to the head.

jefferson’s fracture

• Which of the following is true regarding subacute subdural hematoma?

consistency is composed of clotted and fluid blood

• It is an innocuously appearing form of spinal dysraphism usually described as a superficial stroma of an epithelium lining that can extend intraspinally.

dermal sinus

• This is an example of communicating type of hydrocephalus:

meningitis

• This type of craniosynostosis exhibits abnormal closure of the metopic sutures which results in a pointed forehead with a midline ridge

trigoncephaly

• All of the following are used to determine a diagnosis of hydrocephalus by cranial imaging except;

third ventricle dilation

• The most common symptomatic finding in patients diagnosed with tethered cord is

gait difficulty

• The most common organism isolated in patients diagnosed with shunt infection is:

s epidermidis

• Which among the following pathologies is an example of under absorption of CSF that can lead to hydrocephalus?

venous sinus thrombosis

• This type of craniosynostosis is more common in females and accounts for 20-30% of all cases of craniosynostosis. It is commonly associated with Crouzon’s and Apert’s syndrome.

coronal synostosis

• Type of Chiari malformation that describes herniation of the cerebellar verns, medulla, and 4th ventricle into the foramen magnum

type 2

• This syndrome of neural tube defect (NTD) has open neural groove with no leptomeninges, vertebral arch or skin covering.

spina bifida aperta

• A 65 y/o female with hypertensive bleed was admitted in the neuro ICU and was hooked to the ICP monitor. ICP reading was 30 mmHg and the BP is 130/70. The Cerebral Perfusion pressure is:

60mmhg

• This type of cerebral edema is caused by swelling of the neurons and failure of ATPase Na channels (failure of membrane transport)

cytotoxic edema

• This type of brain herniation produces a syndrome which includes progressively impaired consciousness, dilated ipsilateral pupil, and contralateral hemiplegia

uncal herniation

• The components of Cushing’s triad which may be observed in cases of increased intracranial pressure are the following:

hypertension, bradycardia, and irregular respiration

• Under normal conditions, the average rate of CSF that is produced per day by an adult brain is around

500cc

• This type of incomplete spinal cord injury results from hyperextension injury in athletes and in elderly patients with preexisting cervical spondylysis. There is disproportionately greater motor deficit in the upper extremities than lower extremities. There is also the presence of sacral sparing

central cord syndrome

• The diagnostic imaging of choice for patients with traumatic brain injury is:

plain CT scan

• A 74-y/o male fell from the stairs hitting his head. He was brought to the ER with the following vital signs: BP 170/100, CR 55/min, RR 12/min, T 38C. He has no eye opening and no verbal output. Upon applying sternal rub, his right arm localizes but his left arm decorticates. What is the patient’s GCS score?

7

• A 47y/o female was hit by a car while on her way to work. She was immediately rushed to the emergency room where initial resuscitation was done. Vital signs were as follows: BP 150/60 CR 110 RR 14 T37C. She was disoriented and upon eliciting pain, she would withdraw and open her eyes. What Is her GCS score?

10

• The usual source of bleeding in this type of traumatic brain injury are bridging veins

subdural hematoma

• Type of diastematomyelia that presents as 2 hemicords each with its own central canal and dural tube.

Type I

• An innocuously appearing form of spinal dysraphism that is made up of a superficial stroma of epithelium that extends intraspinally

Dermal sinus

• A congenital anomaly where the cerebral tonsils descend below the foramen magnum and produces a mixture of cerebellar signs, lower cranial nerve palsies and upper cervical cord symptoms.

chiari malformation

• Who among the following health care professionals can perform a clinical brain death examination?

Neurologist, neurosurgeon, or intensivist

• A 75y.o. Male was admitted to the ICU after suffering from a hypertensive hemorrhage. The following VS were recorded. BP 180/90 CR 80/min RR 16/min T 37C. An ICP monitor was attached to the patient and the reading was 20 mmhg. What is the cerebral perfusion pressure (CPP) of the patient?

100mmHg

• The total amount of CSF that is produced by the
choroid plexus in an adult brain per day is approximately:

500cc

• Which of the following cranial nerve palsy is considered a false localizing sign?

CN VI

• A 5-month baby girl was admitted at the PICU because of TB meningitis. A cranial MRI was done which showed hydrocephalus and evidence of transependymal seepage of CSF. based on the imaging findings, the type of cerebral edema that is most likely involved is:

Interstitial hydrocephalic/hydrostatic edema

• In a normal brain with good compensatory reserve, you would expect the following:

high compliance, low elastance

• Among the different types of ICP monitors, an intraventricular catheter has the advantage of:

ICP measurement and therapeutic drainage

• The most significant factor that determines Cerebral Blood Flow at any given time is the:

cerebral perfusion pressure

• This type of cerebral herniation patients may experience weakness of the contralateral lower extremity only.

subfalcine herniation

• Which among the different type of skull fractures can be observed and treated conservatively?

linear fracture extending from frontal bone up to the occipital bone

• A 19 y.o. Boxer suffered a 3rd round knockout loss on his fight. He never had loss of consciousness but could not recall the last few seconds of the fight. Based on the Colorado Concussion grading system, the patient is:

Grade 2

• This type of traumatic hemorrhage is lenticular in shape as seen in a CT or MRI scan. The typical story is triphasic, wherein a mild head injury leads to a transient alteration in consciousness followed by a lucid interval and eventually ends up with deterioration of sensorium.

acute epidural hematoma

• A 23 y.o. Male carpenter fell from the roof of a 2 - story house he was repairing. He was rushed to UST ER where he underwent initial resuscitation. Since you are suspecting a TBI, the best cranial imaging for this patient is:

plain CT scan

• An acute subdural hematoma will appear on a cranial CT scan as:

biconvex lens limited by suture lines (lenticular)

• This type of brain herniation presents with a syndrome that consists of progressively impaired consciousness, dilated ipsilateral pupil, and contralateral hemiplegia

uncal herniation

• Mt. Fuji sign is an imaging finding that is seen in patients with:

tension pneumocephalus

• The most frequent cause of TBI in young adults is

motor vehicular accident

• Which of the following is an example of primary brain injury?

skull fracture, subarachnoid hemorrhage, diffuse axonal injury

• In a patient with multiple traumatic injuries, priority of assessment should be given to:

abdominal injury

• Bleeding from an acute epidural hematoma usually comes from this vessel

middle meningeal artery

• A 32y.o. Female was involved in a motor vehicular accident where she suffered a whiplash injury. Upon examination, she was notes to be weak in all extremities. She can lift both her arms and legs against gravity. Based on the manual muscle testing her strength grade is:

Grade 3

• This type of spinal cord syndrome presents with ipsilateral loss of motor function and position sense. It also presents with contralateral loss of pain and temperature

brown-sequard syndrome

• Cushing’s triad is the classic presentation of
intracranial hypertension. It consists of the following components:

hypertension, bradycardia, and irregular respiration

• This type of shock is characterized by paralysis, hypotonia, and areflexia. It usually lasts for about 24-72hrs up to 1-2 weeks.

spinal shock

• The most consistent finding in patients with cauda equina syndrome is:

urinary retention

• This type of incomplete spinal cord injury results from hyperextension injury in athletes and in elderly patients with preexisting cervical spondylosis. There is disproportionately greater motor deficit in the upper extremities than lower extremities. There is also presence of sacral sparing.

central cord syndrome

• To rule out an odontoid fracture using a plain radiograph, this view is obtained.

open mouth view

• This medical cerebral decompressant has shown to have NO beneficial effects in patients with TBI

anti-epileptic meds

• A 22-y/o male construction worker fell from the 3rd floor of a building. He was brought to the ER. Upon examination of extremities, sensory is intact, majority of muscles below the neurological level of injury have a muscle grade of 3 and above. The ASIA score of this patient is:

asia grade D

• Post traumatic seizures are seizures occurring within how many days after trauma?

<7 days post-injury

• This type of fracture is characterized by bilateral fracture of the pars interarticularis of C2 which results from sudden extension forces of the neck.

hangman’s fracture (C2)

• This segment is most commonly involved in traumatic spinal injury.

Cervical (C5-C6)

• According to Canadian C-spine rule, this set of patients need to undergo a cervical imaging.

• This type of traumatic intracranial hematoma presens as crescent shape in CT scan and MRI that may cross suture lines but not dural attachments

subdural hematoma

• This type of spinal cord syndrome presents as complete loss of motor, pain, and temperature below the injury but retains proprioception and vibration sense.

anterior cord syndrome

• An 82y.o. Male was rushed to the emergency room after an unwitnessed fall. Upon initial assessment, he was able to open his eyes to sound and was able to utter words. He was also able to stick out his tongue when asked to. What is the patient’s GCS score?

12

• A 44y.o. Female pedestrian was runover by a truck. She sustained a TBI and was GCS 9 when she was examined at the eR. Her TBI is classified as:

moderate

• This pattern of spine fracture is characterized by

Moderate
failure of the anterior, middle, and posterior columns caused by flexion-distraction, shear, or compression forces.