Surgery EOR Exam (PAEA Blueprint) - Complete Solutions (Answered) If patient is supine, PNA most commonly involves which lobe____if supine or
... [Show More] _________if patient is sitting/semirecumbant. RUL, RLL If a patient presents with slurred speech, what neurological problem is in your d/d? CVA or brain tumor If your patient presents with a motor and/or sensory loss, what is your imaging study of choice? CT scan -- test of choice to evaluate cervical spine Signs of ___are upon auscultation of the carotid and subclavian arteries -- reveals audible bruit in the neck. What is the diagnostic study of choice? carotid disease; Doppler ultrasound A ______is head trauma results in blood below the arachnoid membrane and above the pia. Most often supratentorial (contains the cerebrum). Subarachnoid hemorrhage What are the three most common causes of subarachnoid hemorrhage? 1 - trauma 2 - ruptured berry aneurysms 3 - AVM - arteriovenous malformations A ______is a secular outpouching of vessels in the circle of willis, usually at bifurcations). berry aneurysm A _____is a congenital abnormality of the vasculature with connections between arterial and venous circulations without interposed capillary network. AVM - arteriovenous malformations How does a patient with a SAH present? "worst headache of my life" -- positive Kernig and Brudzinski sign What is the difference between nuchal rigidity, Kernig's, and Brudzinski's signs? nuchal rigidity - neck stiffness when bending neck forward Kernig's - inability to straighten the leg when the hip is flexed at a 90 degree angle Brudzinski's - when the examiner flexes the patient's neck, knees, and hips at the same time What is part of the work-up of SAH? CT scan and arteriogram (to look for aneurysms or AVMs) The most common cause of morbidity and mortality with a SAH is _____. vasospasm -- other complications are brain edema (increased ICP) and rebleeding What is the treatment for SAH? --Nimodipine CCB for vasospasm --surgical metal clipping for aneurysm (alternative is balloon occlusion or coil embolization) --AVM: pre op embolization -- for surgically inaccessible lesions, radiosurgery A ______is bleeding into the brain parenchyma. Prognosis poor. Dx w CT. intracerebral hemorrhage These are _____indications for intracerebral hemorrhage are CNIII palsy (oculomotor nerve) and progressive alteration of consciousness. 2/3 present with coma, lateral gaze preference, aphasia, homonymous hemianopsia. Surgical ______is blood collection under the dura. Caused by tearing of "bridging" veins that pass through the space between. The cortical surface and the dural venous sinuses or injury to the brain surface with resultant bleeding from cortical vessels. Subdural hemorrhage What are the CT finding of a subdural hemorrhage? Treatment? CT findings = curved, crescent shaped hematoma (sUbdural = cUrved) Treatment = reduce mass effect usually by craniotomy with clot evacuation A ________is a collection of blood between the skull and dura. Usually in association with skull fracture as bone fragments lacerate meningeal arteries. What artery is most commonly affected? epidural hematoma; middle meningeal artery What are the CT findings with epidural hematoma? lenticular or LENS shaped hematoma (Epidural = lEnticular) What are the s/s of basilar skull fracture? raccoon eyes and battle's sign, hemotypanum, CSF rhinorrhea/otorrhea What are the surgical indications for brain tumors? establishing a tissue diagnosis, relief of increased ICP, relief of neurologic dysfunction caused by tissue compression, attempt to cure in the setting of localized tumor What is the #1 and #2 most common intracranial tumor in adults? #1 - glioblastoma ("Greatest Brain Tumor Malignancy") #2 - meningiomas Some risk factors of _______are radiation exposure, neurofibromatosis 2, and female sex. Meningiomas What are the most common brain tumors in children? medulloblastomas, astrocytomas, ependymonomas Cerebellar astrocytomas - peak age between 5 & 9 years old. In 75% of cases, they are completely _____. Resectable Medulloblastoma - peak age 3-7 yo. Most common location is cerebellar vermis in children With pituitary tumors, the most common is a ____. The most common presentation is bitemporal hemianopsia (lateral visual fields blind). Medical tx = bromocriptine. Surgical tx = transsphenoidal resection. Prolactinoma Explain the Glasgow Coma Score. Eyes 4 - opens spontaneously 3 - opens to voice 2 - opens to pain 1 - none Verbal 5 - normal conversation 4 - disoriented conversation 3 - words, incoherent 2 - incomprehensible sounds 1 - none Motor 6 - normal 5 - localizes to pain 4 - withdraws from pain 3 - decorticate posturing 2 - decerebrate posturing 1 – none Most edema (causes - CHF, meds, pregnancy, cirrhosis, kidney dz, lymphatic deficiency, lower extremity vein injury or weakness) is treatment with _____. Home remedies are elevation, movement, massage etc. Diuretics Causes of orthostatic hypotension dehydration, heart conditions, endocrine (addisons disease, hypoglycemia, DM), nervous system disorders (Parkinsons, multiple system atrophy, Lewy body dementia, pure autonomic failure, amyloidosis), meds (diuretics, alpha blockers, beta blockers, CCB, ACE inhibitors, nitrates) What is the treatment for urinary retention? foley catheter Dysuria: Pain starting at the start of urination may indicate ____pathology, whereas pain occurring at the end of micturition is usually of _____origin. urethral; bladder origin _______is more than 2x/night of voiding. Nocturia Urinary frequency during the day wo nocturia is usually related to _______. Nocturia without frequency may occur in ____ patient in whom intravascular volume and urine output increase when supine. Also, renal concentrating ability decreases with age; therefore urine production in the geriatric patient ________. anxiety; CHF; increases at night GU pain is usually associated with either ____or____. urinary tract obstruction or inflammation The source of GU pain: inflammation is most severe when it involves the _____of a GU organ. Do tumors in the GU tract cause pain? parenchyma (inflammation of hollow organs produces discomfort); usually not painful unless they produce obstruction -- also a late manifestation _____pain is caused by acute distention of the capsule and located on the back and can radiate across the flank anteriorly. Pain is steady. Obstruction fluctuates in intensity. Renal ______pain is acute and secondary to obstruction. Can be located around McBurney's point or lower vesicle irritability including frequency, urgency, and suprapubic discomfort. Ureteral ______pain is produced either by overdistention of the bladder as a result of acute urinary retention or by inflammation. Inflammatory conditions usually produce intermittent pain. Vesicle _______pain is usually secondary to inflammation with secondary edema and distention of the prostatic capsule. Pain is poorly localized -- frequency associated with irritative sx such as frequency, dysuria, and in prostatic edema Prostatic ______pain primarily arises from w/in the scrotum and is usually secondary to acute epididymitis, torsion, or testicular appendices. Testicular ________is usually related to noninflammatory conditions such as a hydrocele, varicocele, and pain is characterized as dull, heavy sensation in testes that does not radiate. Chronic scrotal pain [Show Less]