STATION 1
Hydrocephalus (a) Give three clinical features of hydrocephalus (3) (b) Give two common causes of communicating hydrocephalus
(2)
STATION 2
Spina Bifida (a) List signs suggestive of spina bifida occulta (3)
(b) List two other congenital anomalies associated with spina bifida (2)
STATION 1 & STATION 2
Station 1
• A) 1. Children with open fontanels – Bulging anterior fontanel
– Splayed sutures
– Distended scalp veins
– Craniofascial disproportion
– Macrocrania
2. Adults and older kids: headache that gets progressively worse
Vomit
Papiledema
Change in LOC
ophthalmoplegia
• B. Meningitis + SAH (d/t aneurysm rupture)
Station 2
A. Skin lesions in midline
– Dimple
– Sinus tract
– Hemangioma
– Tuft of hair
– Hyperpigmentation
• B. Chiari Malformation and Hydrocephalus
• Syringomylia
• Intellectual impairment
STATION 3
Trauma Resuscitation
A. Describe principles of resuscitation in primary survey of a polytrauma patient
(3)
B. List two factors associated with poor prognosis in a head injured patient
(2)
• A. According to ATLS principles:
B. 1. BP < 90mmHg
2. PO2 < 60mmHg
(gekry uit neursurg lesing 4de jaar)
Jana van Niekerk se:
> Abn pupils, No reflexes, low GCS
Primary Survey
Prim Clinical Survey: Airway, breathing, circulation, disability, exposure, fracture Primary radiological survey: C-spine (lateral, CXR, PXR)
STATION 4
• Severe Head Injury
(a) What are the clinical features of base of skull
fracture? (4)
(b) What is the diagnosis
on the CT scan shown below (1)
• A. Depends on if is anterior or middle cranial fossa # – Anterior fossa: racoon eyes, CSF rhinorrhea, subconjunctival hemorrhage (entire eye), asomnia
– Middle fossa: Battle sign, CSF otorrhea , Facial nerve palsy, heamotympanum
• B. Extradural haematoma
STATION 5
• Space Occupying Lesions
(a) Describe signs of raised intracranial pressure (3)
(b) Give two examples of primary brain tumours (2)
• A. 1. H/A – progressive as tumor SOL increases
• 2. Vomiting
• 3. 4. Seizures
• 4. Change in LOC – e.g. drowsiness
• 5. FND depending on the region involved
• 6. Papilledema
• B. 1. Astrocytoma
• 2. Meningioma
RANDOM IF ASK TO INTERPRET SCAN ALWAYS STATE FOLLOWING IN ANSWER:
1. Location
2. Density
3. Ring enhancement
4. Centre of lesion
5. Mass effect – midline shift or ventricle compression
Station 1
• 1) What is the diagnosis? (2)
• 2) What is the treatment
of choice for the above (1)
• 3) List 3 complications associated with your treatment above
(2)
• A. Communicating hydrocephalus
• B. VP shunt (ventricular peritoneal)
• C. 1.Infection (shunt, peritonitis, meningitis)
• 2. Blocking of shunt
• 3. Migration of shunt
• 4. Convulsions
• 5. Over drainage
Station 2
• 1) What is the diagnosis?
(2)
• 2) What will you do if this lesion ruptures?
(3)
• A. Spina Bifida Aperta - Myelomenigocele
• B. – Normal Neonatal Resus
– Cover with transparent non-adherent semi-permeable dressing • Gelanet
• Gauze
• Opsite
– Nurse Prone
– Keep nappy open – Px feces and urine getting into lesion
– Get urgent neurosurgery consult – must be repaired surgically within 36hr
– Antibiotics
– Multidisciplinary approach to Rx
Station 3 (No slide)
• 1) Define shock (2)
• 2) What clinical parameters will suggest adequate resuscitation (3)
• A. Shock – Circulatory failure resulting in inadequate organ perfusion.
– SBP <90mmHg
– Tachycardia
– Cold clammy extreminities
– Decreased capillary refill
– oligouria
• B.
– 1. Normalize BP and Urine Output
• Urine output > 0.5 ml/kg/hour
– 2. Central venous pressure SO2 >70%
– 3. Normalize pH, BE and Lactate
(antw uit Dr Shapiro se lesing)
Station 4
• 1) Interpret the scan below
(3)
• 2) What surgical treatment would you recommend?
(2)
• A. Intracerebral bleed with associated SDH (Burst Lobe)
• B. Craniotomy for drainage of hematoma??
Station 5
• 1) Describe the lesion on the
scan.
(2)
• 2) How do you think this patient presented?
(3)
• A. Lesion located in midline anteriorly – frontal lobes
• Various densities – hyperdense (white) outline compared to hypodense (black) inner lesion
• Ring enhancement
• Mass effect – compression of ventricles
• B. Headache, vomiting,, seizures, change in LOC, papiledema
STATION 1 Patient had hydrocephalus due to meningitis. He had a VP shunt inserted.
Give 5 complications of VP shunt (5)
• A.
• 1.Infection (shunt, peritonitis, meningitis)
• 2. Blocking of shunt (obstruction)
• 3. Over drainage
• 4. Migration of shunt
• 5. Seizures (d/t gloisis)
STATION 1
1. What is the lesion?
2. What is the cause of the lesion?
3. Which vessels is the likely source?
4. A dilated pupil is in most cases ipsilateral to the lesion (True/False)
5. What is the definitive treatment?
5 Marks
• 1. Extra dural haematoma
• 2. Laceration of blood vessel (usu middle meningeal artery) following trauma
• 3. Middle meningeal artery
• 4. True
• 5. Craniotomy and drainage of haematoma.
STATION 2
1. What is the diagnosis?
2. List three causes
3. What is the most common definitive treatment option.
5 Marks
• 1. Hydrocephalus – communicating (sien prof se lesing vir similar prentjie)
• 2. – Meningitis
– SAH (d/t aneurysm rupture)
– Choroid plexus papiloma
– IVH
• 3. VP-shunt
STATION 3
1. What is the diagnosis?
2. List four clinical features.
5 Marks
• 1. Myelomeningocele (spina bifida aperta)
• 2.
• Neural elements protrude through vertebral defect
• Lined by meninges
• Associated with irreversible neurological deficit
Depends on spinal level
Includes weakness, flaccidity, spasticity, wasting, sensory level – in this child > LL signs
STATION 4
1. What is the diagnosis?
2. What is the most common complication if not treated?
3. List three indications for tracheal intubation.
5 Marks
• 1. Depressed Skull fracture (vault)
• 2. Infection
• 3. (Jana van Niekerk se opsommings) GCS ≤ 8
Poor oxygenation and ventilation
Severe work of breathing
Soft tissue swelling in neck
Massive facial #
Inhalation burns
STATION 5
1. List 5 clinical features of this lesion.
5 Marks
Headache
Vomiting
Seizures
Change in level of consciousness – e.g. drowsiness
FND – frontal lobes involved e.g. motor weakness
Describe scan: (extra vraag)
• Frontal lesion well circumscribed, crosses midline
• Ring enhancement
• Centre is hypodense and homogenous
• Mass effect – compression of ventricles
STATION 2
• NO SLIDE
• (a) What are the features of myelomeningocoele (2)
• (b) List 3 other congenital defects associated with spina bifida (3)
• Neural elements protrude through vertebral defect
• Lined by meninges
• Associated with irreversible neurological deficit
Depends on level of lesion
Includes weakness, flaccidity, spasticity, wasting, sensory level
• B:
– Chiari 2 malformation
– Hydrocephalus – 90% need a shunt!!
– Syringomyelia
– Intellectual impairment
STATION 3
NO SLIDE
• (a) What are the primary radiological survey/imaging required (3)
• (b) What fluid would you use for resuscitation and why? (2)
A: Primary Survey
• Prim Clinical Survey:
• Airway, breathing, circulation, disability, exposure, fracture
• Primary radiological survey:
• C-spine (lateral, CXR, PXR)
• B: Initial Fluid: Crystalloid – Ringers Lactate (2L) – good resus fluid (isotonic to plasma with similar electrolyte content) but short intravascular half life – Run fast, after this blood should ideally be available for further resus
– * if not can alternate between colloids (voluven) and crystalloid (RL)
STATION 4
• Patient was assaulted with a sharp object and sustained laceration with brain injury.
• (a) What is the diagnosis? (2)
• (b) How will you treat the patient?
(3)
• A. Skull fracture of vault (linear? Depressed?)
• B. ATLS priniciples – Airway: Px hypoxia
– Breathing: prevent hypoxia
– Circulation: Px hypotension
Clean wound + suture closed
Refer to Neurosurgery!!!
Station 5
Mr X, 56 years old, presented with seizures and progressive weakness on the left side of the body. Describe/interpret the scan (5)
• 1. Check date, pt name, scan orientation – check from outside to inside taking into account all structures. I will focus on the lesion:
• Located on the Right (frontal and parietal???)
• Not cross midline.
• No mass effect visible on this specific section.
• Tumor has various densities and not homogenous on enhancement
• Ring enhancement present???