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pestana Neurosurgery and trauma

Terms in this set (100)

Acute epidural hematoma
ct scan
A 14-year-old boy is hit over the right side of the head with a baseball bat. He loses consciousness for a few minutes, but recovers promptly and continues to play. One hour later he is found unconscious in the locker room. His right pupil is fixed and dilated.

what is it?
how diagnosed?
acute subdural > epidural hematoma
ct scan + cervical check
A 32-year-old male is involved in a head-on, high-speed automobile collision. He is unconscious at the site, regains consciousness briefly during the ambulance ride and arrives at the E.R. in deep coma, with a fixed, dilated right pupil.

what is it?
how diagnosed?
emergency decompression craniotomy
treatment for acute epidural hematoma?
emergency decompression craniotomy
treatment for acute subdural hematoma?
good
fatal
prognosis for acute EPIDURAL hematoma treated within hours? delayed by hours?
poor b/c brain injury
prognosis for ACUTE subdural hematoma in which patient is in a deep coma?
chronic subdural venous hematoma
ct scan
A 77-year-old man becomes "senile" over a period of three or four weeks. He used to be active and managed all of his financial affairs. Now he stares at the wall, barely talks and sleeps most of the day. His daughter recalls that he fell from a horse about a week before the mental changes began.

what is it?
how diagnosed?
decompression craniotomy
treatment for chronic subdural venous hematoma
good
prognosis for chronic subdural venous hematoma treated by craniotomy
skull base fracture
ct scan + cervical check
A car hits a pedestrian. He arrives in the ER in coma. He has...(raccoon eyes... or clear fluid dripping from the nose...or clear fluid dripping from the ear...or ecchymosis behind the ear)...

what is it?
how diagnosed?
neurosurgery consult + ab
treatment for skull base fracture
extracranial blood loss
A 45-year-old man is involved in a high-speed automobile collision. He arrives at the ER in coma, with fixed dilated pupils. He has multiple other injuries (extremities, etc). His blood pressure is 70 over 50, with a feeble pulse at a rate of 130. What is responsible for his vitals: an intracranial process or extracranial?
hypovolemic shock
A 22-year-old gang member arrives in the E.R. with multiple guns shot wounds to the ABDOMEN. He is diaphoretic, pale, cold, shivering, anxious, asking for a blanket and a drink of water. His blood pressure is 60 over 40. His pulse rate is 150, barely perceptible.

What is it?
explore lap (blood control)
large bore iv
foley catheter
IV AB
sequence of management of hypovolemic shock if OR is available
large bore iv
foley catheter
IV AB
explore lap (blood control)
sequence of management of hypovolemic shock if OR is not immediately available
dxd chest/abdomen
hypovolemic shock
pericardial tamponade
tension pneumothorax
A 22-year-old gang member arrives in the E.R. with multiple gun shot wounds to the CHEST AND ABDOMEN. He is diaphoretic, pale, cold, shivering, anxious, asking for a blanket and a drink of water. His blood pressure is 60 over 40. His pulse rate is 150, barely perceptible.

What is it?
Distended neck veins
high cvp
A 22-year-old gang member arrives in the E.R. with multiple gun shot wounds to the CHEST AND ABDOMEN. He is diaphoretic, pale, cold, shivering, anxious, asking for a blanket and a drink of water. His blood pressure is 60 over 40. His pulse rate is 150, barely perceptible.

What additional signs indicate a pericardial tamponade or tension pneumothorax but not hypovolemic shock?
respiratory distress
tracheal deviation
hemithorax breath sound absence
hemithorax percussion hyperresonance
A 22-year-old gang member arrives in the E.R. with multiple gun shot wounds to the CHEST AND ABDOMEN. He is diaphoretic, pale, cold, shivering, anxious, asking for a blanket and a drink of water. His blood pressure is 60 over 40. His pulse rate is 150, barely perceptible.

What additional signs would ID tension pneumothorax but not pericardial tamponade or hypovolemic shock?
pericardial tamponade
clinically
A 22-year-old gang member arrives in the E.R. with multiple guns shot wounds to the chest and abdomen. He is diaphoretic, cold, shivering, anxious, asking for a blanket and a drink of water. His blood pressure is 60 over 40. His pule rate is 150, barely perceptible. He has big distended veins in his neck and forehead. He is breathing OK, has bilateral breath sounds and no tracheal deviation.

What is it?
how diagnosed?
pericardial window
thoracotomy
explore lap
treatment sequence of SUSPECTED pericardial tamponade
no
A gunshot wound to the precordial area with signs of pericardial tamponade. Need a pericardial window be performed before thoracotomy?
tension pneumothorax
clinically
A 22-year-old gang member arrives in the E.R. with multiple gun shot wounds to the chest and abdomen. He has labored breathing is cyanotic, diaphoretic, cold and shivering. His blood pressure is 60 over 40. His pulse rate is 150, barely perceptible. He is in respiratory distress, has big distended veins in his neck and forehead, his trachea is deviated to the left, and the right side of his chest is tympantic, with no breath sounds.

What is it?
how diagnosed?
large bore pleural iv
chest tube
explore lap
treatment sequence for tension pneumothorax
cardiogenic shock per mi
High CVP
EKG
Cardiac Enzymes
A 72 year old man who lives alone calls 911 saying that he has severe chest pain. He cannot give a coherent history when picked up by the EMT, and on arrival at the ER he is cold and diaphoretic and his blood pressure is 80 over 65. He has an irregular, feeble pulse at a rate of 130. His neck and forehead veins are distended and he is short of breath.

what is it?
how diagnosed?
TIA per left carotid artery
angiogram
carotid endarterectomy
A 62 year old right handed man has transient episodes of weakness in the right hand, blurred vision, and difficulty expressing himself. There is not associated headache, the episodes last about 5 or 10 minutes at the most, and they resolve spontaneously. Funduscopic examination reveals highly refractile crystals in the left retinal artery.

What is it?
how diagnosed?
treatment?
TIA per vertebral artery
aortic arch angiogram
vascular surgery
A 61 year old man presents with a one year history of episodes of vertigo, diplepia, blurred vision, disarthria and instability of gait. The episodes last several minutes, have no associated headache and leave not neurological sequela.

What is it?
how diagnosed?
treatment?
Vasoocclusive CVA stroke
ct scan
rehab
A 60 year old diabetic male presents with abrupt onset of right third nerve paralysis and contralateral hemiparesis. There was NO ASSOCIATED HEADACHE. The patient is alert, but has the neurological deficits mentioned.

What is it?
how diagnosed?
treatment?
Hemorrhagic CVA stroke
ct scan
rehab
A 64 year old black man complains of a VERY SEVERE HEADACHE of sudden onset and then lapses into a coma. Past medical history reveals untreated hypertension and examination reveals a stuporous man with profound weakness in the left extremities.

What is it?
how diagnosed?
treatment?
subarachnoid hemorrhage via
intracranial aneurysm
CT scan
angiogram
surgical clip
A 39 year old lady presents to the ER with a history of a severe headache of sudden onset that she says is different and worse than any headache she has ever had before. She is given pain medication and sent home. She improves over the next few days, but ten days after the initial visit she again gets a sudden, severe and singular diffuse headache and she returns to the ER. This time she has some nuchal rigidity on physical exam.

what is it?
how diagnosed?
treatment?
brain tumor per silent area
MRI
CT scan
A 31 year old nursing student developed persistent headaches that began approximately 4 months ago, have been gradually increasing in intensity and are worse in the mornings. For the past three weeks, she has been having projectile vomiting. Thinking that she may need new glasses, she seeks help from her optometrist, who discovers that she has bilateral papilledema.

What is it?
how diagnosed?
mannitol
hyperventilation
high dose dexamethasone=decadron
What measures should be taken to lower ICP while a brain tumor patient is awaiting surgery?
brain tumor per non silent area
mri
ct scan
A 42 year old right handed man has a history of progressive speech difficulties and right hemiparesis for five months. He has had progressively severe headaches for the last two months. At the time of admission he is confused, vomiting, has blurred vision, papilledema and diplopia. Shortly thereafter his blood pressure goes up to 190 over 110, and he develops bradychardia.

What is it?
how diagnosed?
non silent is emergency surgery
what is the difference in management of a brain tumor in a silent vs non silent area?
craniopharyngioma
mri
pituitary surgery
A 12 year old boy is short for his age, has bitemporal hemianopsia and has a calcified lesion above the sella in X-Rays of the head.

what is it?
how diagnosed?
treatment?
prolactinoma
measure prolactin
mri
A 23 year old nun presents with a history of amenorrhea and galactorrhea of six months duration. She is very concerned that other may think that she is pregnant, and she vehemently denies such a possibility.

what is it?
how diagnosed?
trans nasal/sphenoidal surgery
bromocriptine
treatment for operable prolactinoma?
treatment for inoperable prolactinoma?
acromegaly
measure gh
mri
pituitary surgery
A 44 year old man is referred for treatment of hypertension. His physical appearance is impressive: he has big, fat, sweaty hands; large jaw and thick lips, large tongue and huge feet. He is also found to have a touch of diabetes. In further questioning he admits to headaches and he produces pictures of himself taken several years ago, where he looks strikingly different.

what is it?
how diagnosed?
treatment?
cushing disease via pituitary microadenoma
AM/PM cortisol
dexamethasone suppression test
sella mri
pituitary surgery
A 15 year old girl has gained weight and become "ugly". She shows a picture of herself a year ago, where she was a lovely young lady. Now she has a hairy, red, round face full of pimples; her neck has a posterior hump and her supraclavicular areas are round and convex. She has a fat trunk and thin extremities. She has mild diabetes and hypertension.

What is it?
how diagnosed?
treatment?
nelson syndrome via pituitary microadenoma
A 55 year old lady is involved in a minor traffic accident where her car was hit sideways by another car that she "did not see" at an intersection. When she is tested further it is recognized that she has bitemporal hemianopsia. Ten years ago she had bilateral adrenalectomies for Cushing's disease.

What is it?
frontal lobe brain tumor
A 42 year old man has been fired from his job because of inappropriate behavior. For the past two months he has gradually developed very severe, "explosive" headaches that are located on the right side, above the eye. Neurologic exam shows optic nerve atrophy on the right, papilledema on the left and anosmia.

what is it?
Foster Kennedy syndrome
The frontal lobe has to do with behavior and social graces, and is near the optic nerve and the olphactory nerve. A tumor in this region causes the associated deficits and is known as what?
pineal tumor parinaud syndrome
mri
neurosurgery
A 32 year old man complains of progressive, severe generalized headaches, that began three months ago, are worse in the mornings and lately have been accompanied by projectile vomiting. He has lost his upper gaze and he exhibits the physical finding known as "sunset eyes".

What is it?
how diagnosed?
treatment?
pineal tumor parinaud syndrome
upper gaze paralysis?
posterior fossa tumor
A six year old boy has been stumbling around the house and complaining of severe morning headaches for the past several months. While waiting in the office to be seen, he assumes the knee-chest position as he holds his head. Neurological exam demonstrates truncal ataxia.

What is it?
knee chest position
child with posterior fossa tumor alleviates his high icp symptoms (headache, etc)
brain abscess
ct scan
drainage
A 23 year old man develops severe headache, seizures and projectile vomiting over a period of two weeks. He has low grade fever, and was recently treated for acute otitis media and mastoiditis.

what is it?
how diagnosed?
treatment?
brown sequard
An 18 year old street fighter gets stabbed in the back, just to the right of the midline. He has paralysis and loss of proprioception distal to the injury on the right side, and loss of pain perception distal to the injury on the left side.

What is it?
anterior cord syndrome
A patient involved in a car accident sustains a burst fracture of the vertebral bodies. He develops loss of motor function and loss of pain and temperature sensation on both sides distal to the injury, while showing preservation of vibratory sense and position sense.

what is it?
central cord syndrome
An elderly man is involved in a rear end automobile collision where he hyperextends his neck. He develops paralysis and burning pain of both upper extremities while maintaining good motor function in his legs.

what is it?
high dose methylprednisolone
Acute management common to all the cord syndromes due to trauma
high dose dexamethasone=decadron
spinal cord tumor steroid treatment
compression
via fracture
via spinal cord metastasis
A 52 year old lady has constant, severe back pain for two weeks. While working on her yard, she suddenly falls and can not get up again. When brought to the hospital she is paralyzed below the waist. Two years ago she had a mastectomy for cancer of the breast.

what is it?
mri
best imaging modality for spinal cord
lumbar disk herniation
A 45 year old male gives a history of aching back pin for several months. He has been told that he had muscle spasms, and was given analgesics and muscle relaxants. He comes in now because of the sudden onset of very severe back pain that came on when he tried to lift a heavy object. The pain is "like an electrical shock that shoots down his leg", and it prevents him from ambulating. He keeps the affected leg flexed. Straight leg raising test gives excruciating pain..

What is it?
45
l4-l5
l5-s1
lumbar disk herniation peak age of incidence?
whick disks?
mri
bedrest
progressive weakness
sphincter deficit
image modality for lumbar disk herniation?
most common treatment modality?
what makes it a surgical case?
cauda equina neurogenic claudication
mri
surgical decompression
A 79 year old man complains of leg pain brought about by walking and relieved by rest. On further questioning it is ascertained that he has to sit down or bend over for the pain to go away. Standing at rest will not do it. Furthermore, he can exercise for long periods of time if he is "hunched over", such as riding a bike or pushing a shopping cart. He has normal pulses in his legs.

what is it?
how diagnosed?
treatment?
tic doloreux trigeminal neuralgia
mri to rule out lesions
anticonvulsants
A 60 year old man complains of extremely severe, sharp, shooting, "like a bolt of lighting", pain in his face which is brought about by touching a specific area, and which lasts about 60 seconds. His neurological exam is normal, but it is noted that part of his face is unshaven, because he fears to touch that area.

what is it?
how diagnosed?
treatment?
causalgia reflex sympathetic dystrophy
sympathetic block
sympathectomy
good
Several months after sustaining a crushing injury of his arm, a patient complains bitterly about constant, burning, agonizing pain that does not respond to the usual analgesic medications. The pain is aggravated by the slightest stimulation of the area. The arm is cold, cyanotic and moist.

what is it?
how diagnosed?
treatment?
prognosis?
vasomotor shock
vasoconstrictors
A 17 year old girl is stun by a swarm of bees...or a man of whatever age breaks out with hives after a penicillin infection...or a patient undergoing surgery under spinal anesthetic...eventually develop BP of 75 over 25, pulse rate of 150, but they look warm and flus rather than pale and cold. CVP is low.

what is it?
treatment?
tension pneumothorax
upper pleural cavity chest tube
25-year-old man is stabbed in the right chest. He is moderately short of breath, has stable vital signs. No breath sounds on the right. Resonant to percussion.

what is it?
treatment?
hemothorax
xray
base pleural cavity chest tube
A 25-year-old man is stabbed in the right chest. He is moderately short of breath, has stale vital signs. No breath sounds on at the base on the right chest, faint distant breath sounds at the apex. Dull to percussion.

what is it?
how diagnosed?
treatment?
no
high chest tube drainage volume
intercostal
Hemothoraces emanate from the parenchyma. These are low pressure bleeds. Is an exploratory laparotomy needed in most cases? What dictates when an explore lap + ligation is needed? what vessel?
hemo-pneumothorax
chest tube
A 25-year-old man is stabbed in the right chest. He is moderately short of breath, has stable vital signs. No breath sounds on the right. Resonant to percussion at the apex of the right chest, dull at the base. Chest X-Ray shows one single, large air-fluid level.

what is it?
treatment?
tension pneumothorax
broken rib
chest tube
widened mediastinum via aorta rupture
A 33-year-old lady is involved in a high-speed automobile collision. She arrives at the E.R. gasping for breath, cyanotic at the lips, with flaring nostrils. There are bruises over both sides of the chest, and tenderness suggestive of multiple fractured ribs. Blood pressure is 60 over 45. Pulse rate 160, feeble. She has distended neck and forehead veins, is diaphoretic. Left hemithorax has no breath sounds, is tympanitic to percussion.

what is it?
what is causing the penetrating trauma?
best next step: chest tube or xray?
what is an a xray intented to rule out in this case?
flail chest
oxygen
A 54-year-old lady crashes her car against a telephone pole at high speed. On arrival at the E.R. she is in moderate respiratory distress. She has multiple bruises over the chest, and multiple site of point tenderness over the ribs. X-Rays show multiple rib fractures on both sides. On closer observation it is noted that a segment of the chest wall on the left side caves in when she inhales, and bulges out when she exhales.

what is it?
treatment?
pulmonary contusion
what is the major cause of morbidity in flail chest?
pulmonary contusion
fluid restriction
diuretics
respiratory support
A 54-year-old lady crashes her car against a telephone pole at high speed. On arrival at the E.R. she is breathing well. She has multiple bruises over the chest and multiple sites of point tenderness over the ribs. X-Rays show multiple rib fractures on both sides, but the lung parenchyma is clear and both lungs are expanded. Two days later her lungs "white out" on X-Rays and se is in respiratory distress.

what is it?
treatment?
sternal fracture
A 54-year-old lady crashes her car against a telephone pole at high speed. On arrival at the E.R. she is breathing well. She has multiple bruises over the chest, and is exquisitely tender over the sternum at a point where there is a crunching feeling of crepitation elicited by palpation.

what is it?
heart
aorta
CT scan
TE echo
what structures must be examined in a sternal fracture?
how is this done?
diaphragm rupture
surgery
A 53-year-old man is involved in a high-speed automobile collision. He has moderate respiratory distress. Physical exam shows no breath sounds over the entire left chest. Percussion is unremarkable. Chest X-Ray shows air fluid levels in the left chest.

what is it?
treatment?
left
liver on right
what side is a diaphragm rupture always on?
why?
aorta rupture
arteriogram
emergency surgery
A motorcycle daredevil attempts to jump over the 12 fountains in front of Caesar's Palace Hotel in Las Vegas. As he leaves the ramp at very high speed his motorcycle turns sideways and he hits the retaining wall at the other end, literally like a rag doll. At the Er. he is found to be remarkably stable, although he has multiple extremity fractures. A chest X-Ray shows fracture of the left first rib and widened mediastinum.

what is it?
how diagnosed?
treatment
trachea/main bronchus rupture
xray
fiberoptic bronchoscopy
surgery
A 34-year-old lady suffers severe blunt trauma in a car accident. She has multiple injuries to her extremities, has head trauma and has a pneumothorax on the left. Shortly after initial examination it is noted that she is developing progressive subcutaneous emphysema all over her upper chest and lower neck.

what is it?
how diagnosed?
treatment?
25%
4.5L
what % blood loss = hypovolemic shock?
how much total blood is in an average sized adult?
peritoneal lavage
sonogram
A patient is going into hypovolemic shock and will die in the time it takes to get a ct scan. What imaging devices should be used to locate the bleed?
large bore iv
foley catheter
ab
explore lap
A 19 year old gang member is shot in the abdomen with a 38 caliber revolver. The entry wound is in the epigastrium, to the left of the midline. The bullet is lodged in the psoas muscle on the right. He is hemodynamically stable, the abdomen is moderately tender.

what is the best next step?
nipple line
no
Where does the abdomen begin superiorly? Does the chest end here?
both
A penetrating wound at the nipple should be treated as thoracic, abdominal or both?
explore lap
What is the initial procedure in all abdominal penetrating trauma wounds?
ruptured spleen
A 27 year old intoxicated man smashes his car against a tree. He is tender over the left lower chest wall. Chest X-Ray shows fractures of the 8th, 9th and 10th ribs on the left. He has a blood pressure of 85 over 68 and a pulse rate of 128.

what is it most likely?
explore lap
A 31 year old lady smashes her car against a wall. She has multiple injuries including upper and lower extremity fractures. Her blood pressure is 75 over 55, with a pulse rate of 110. On physical exam she has a tender abdomen, with guarding and rebound on all quadrants.

What is the best diagnostic step?
bladder vs urethra
retrograde urethrogram
A patient involved in a high speed automobile collision has multiple injuries, including a pelvic fracture. On physical exam there is blood in the meatus.

where is the injury?
best next step: foley or retrograde urethrogram
posterior urethra
retrograde urethrogram
suprapubic catheter
surgery after 6 months
A 19 year old male is involved in a severe automobile accident. Among many other injuries he has a pelvic fracture. He has blood in the meatus, scrotal hematoma and the sensation that he wants to urinate but can not do it. Rectal exam shows a "high riding prostate".

where is the injury?
how diagnosed?
management?
anterior
posterior
Urethral injury that is repair immediately?
Urethral injury that is repaired after 6 months?
bladder
retrograde cystogram
A patient involved in a high speed automobile collision has multiple injuries, including a pelvic fracture. Insertion of a Foley catheter shows that there is gross hematuria.

where is the injury?
how diagnosed?
kidney
ct scan
A patient involved in a high speed automobile collision has multiple injuries, including rib fractures and abdominal contusions. Insertion of a Foley catheter shows that there is gross hematuria, and retrograde cystogram is normal.

where is the injury?
how diagnosed?
renal pedicle avulsion
exsanguination
a traumatic injury to the kidney is surgically repair when what is present?
congenital anomaly
sonogram
A pediatric patient has microhematuria after minor trauma. What is this possibly indicative of? How diagnosed?
sonogram
scrotum rupture
A 14 year old boy slides down a banister, not realizing that there is a big knob at the end of it. He smashes the scrotum and comes in to the E.R. with a scrotal hematoma the size of a grapefruit.

What is the next step?
What are you looking for?
profusion water irrigation
ER in 30 minutes
You get a phone call from a frantic mother. Her 7 year old girl spilled Drano all over her arms and legs. You can hear the girl screaming in pain in the background.

What should you tell the mother to do?
debridement
myoglobinuria
Electrical burns are alway much deeper than they appear.

What is the surgical management?
What is a major complication of this type of injury?
bronchoscopy
respiratory support
What is the diagnostic step for respiratory burns? What is the management?
distal circulatory compromise
A patient has suffered third degree burns to both of his arms when his shirt caught on fire while lighting the back yard barbecue. The burned areas are dry, white, leatherly anesthetic, and circumferential all around arms and forearms.

what sign warrants escharotomy?
silver sulfadiazine
bacitracin
sulfamyelon
AB treatment for most burns? Facial? Cartilage/Thick eschar (deep penetration)?
3rd degree
anesthetic
burn that is white, leathery? Is it painful or anesthetic?
2nd degree
painful
burn that is moist, blistered? Is it painful or anesthetic?
recirculated edema
Burn patient, Patient was well resuscitated, had good hemodynamic parameters but required a lot of fluid. On the third day he starts to pee out a storm. What is the source?
early excision and graft
A 42 year old lady drops her hot iron on her lap while doing the laundry. She comes in with the shape of the iron clearly delineated on her upper thigh. The area is white, dry, leatherly, anesthetic.

What is the best approach to this particular case?
yes
Is surgical exploration warranted with human bite injury?
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