Tuesday, October 29, 2013

1. Shortcut neuro exam for a patient with a LEFT frontal lobe lesion that you're worried about getting larger: key to understanding is that this area is important for language (close to Broca's). So test language production by talking to them, asking them to ID objects (hold up a pen, ask if they can name what it is and what it does), ask them to repeat a phrase.
2. Shortcut neuro exam for RIGHT frontal lobe lesion: there isn't one. Generally, R frontal lesions will not produce symptoms unless they are large enough to create mass-effect problems (i.e. L sided weakness from compression of M1 on the R side), i.e. extremely large. Smaller frontal lesions can produce seizures, but this is not specific to R frontal.
3. During brain surgery where you're utilizing somatosensory evoked potentials, (e.g.  if you're operating on the spinal cord you want to check peripheral innervation, near the brainstem you want to check cranial nerves) do not use potent inhaled gases because they dampen the potentials. Use propofol and fentanyl.
4. Pulmonary AVMs can allow the passage of clots (+/- infected) through the lungs into the systemic circulation, esp brain. They are associated with significant (>10%) rates of stroke, TIA, and brain abscess. One way to diagnose them is to see late-onset of bubbles in echo.
5. Elevated CK/rhabdo: Hydrate aggressively & alkalinize the urine by adding bicarb to the IV fluids. Theoretically, alkalinization prevents the breakdown of myoglobin into nephrotoxic metabolites, and also to reduce crystallization of uric acid in the tubules.
6. DDx for pulsatile tinnitus:
-Vascular malformation in the ear: AVM, aberrant vessel
-Increased flow through ear: anemia, hyperthyroid
-Increased pressure transduction into the middle ear: superior canal dehiscence
7. Mass that has low signal (i.e. darker than CSF, which is bright white) on T2- meningioma or lymphoma.
8. Three categories of otitis media;
-Acute otitis media: can be recurrent or persistent
-Otitis media with effusion
-Chronic otitis media: implies tympanic perforation with chronic drainage
9. Indications for ear tubes:
-Recurrent otitis media, defined strictly as 6+ episodes of AOM in one year, 4+ episodes of AOM for two years, 3+ episodes of AOM for 3 years
-Complicated AOM (i.e. mastoiditis)
-AOM refractory to antibiotic treatment
10. Ear tubes 
-May or may not reduce the incidence of AOM, but AOM with ear tubes is much less painful than AOM without ear tubes
-If you have tubes, you get ear-drop administered antibiotics which can result in MICs in the 1000s, very effective treatment.

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