Advanced | Critical Care and Neurocritical Care Anesthesia

Question 1

This is the temperature threshold that produces progressive thermal injury to the metabolically active brain cells, blood-brain barrier, and vascular endothelium:

A. between 39°C and 40°C
B. between 35°C and 40°C
C. between 33°C and 35°C
D. between 32°C and 38°C

Answer 1

A. between 39°C and 40°C

Fever occurs with an incidence of up to 70% in brain injured patients. The degree and duration of early hyperthermia are closely correlated with a higher morbidity and mortality after neurologic injury

Question 2

A 30 year old patient came in with moderate to severe headache and nuchal rigidity. You immediately suspect SAH and devised a comprehensive anesthetic plan. The symptoms presented by the patient corresponds to which grade in Hunt and Hess Grading System:

A. Grade I
B. Grade IIIA
C. Grade II
D. Grade IV
E. Grade IIIB

Answer 2

C. Grade II

The Hunt and Hess Scale describes the severity of subarachnoid hemorrhages and is used as an outcome predictor

Question 3

Based on the current guideline, a Hunt and Hess grade of IV would have a survival rate of:

A. 5%
B. 10%
C. 50%
D. 20%

Answer 3

D. 20%

Check the numbers.:)

Grade Percent Survival

Grade 1 —-> 70
Grade 2 —-> 60
Grade 3 —-> 50
————————
Grade 4 —–> 20
Grade 5 —–> 10

Question 4

The term ‘cerebral steal’ refers to a situation that occurs in the brain when:

A. Blood flow has resumed after a period of ischemia

B. Blood flow is directed from a normal region of the brain to an ischemic region

C. Vasoparalysis exists with hypercarbia

D. The Robin Hood phenomenon exists

Answer 4

C. Vasoparalysis exists with hypercarbia

Question 5

One hour after induction of anesthesia for a posterior fossa craniotomy using opioid, relaxant, and nitrous oxide, the brain begins to protrude through the dura. The most effective measure to decrease intracranial pressure is to:

A. administer additional opioid
B. decrease PaCO2 from 25 to 15 mmHg
C. drain cerebrospinal fluid
D. discontinue nitrous oxide
E. induce hypotension

Answer 5

C. Drain cerebrospinal fluid

Question 6

Intravenous administration of mannitol during a craniotomy:

(A) decreases intracranial pressure relative to dosage
(B) hastens excretion of pancuronium
(C) induces metabolic alkalosis
(D) produces a sustained increase in intravascular volume
(E) requires an intact blood-brain barrier to decrease brain water

Answer 6

(E) requires an intact blood-brain barrier to decrease brain water

Mannitol decreases intracranial pressure by increasing plasma osmolarity, which draws water from tissues, including the brain, along an osmotic gradient.

Mannitol begins to exert an effect within 10 to 15 minutes, with a peak effect at 30 to 45 minutes and a duration of 6 hours.

An intact blood– brain barrier is necessary for the cerebral effects of mannitol. If the blood– brain barrier is not intact, mannitol may enter the brain, drawing fluid with
it and causing worsening of the cerebral edema.

STOELTING | Pharmacology 9th Edit

Question 7

For each 1° C decrease in body temperature, how much will cerebral
metabolic rate (CMRO2 ) be diminished?

A. 2%
B. 4%
C. 6%
D. 10%

Answer 7

C. 6%

Question 8

A 24-year-old carpenter is treated for a closed head injury sustained 3 days
earlier after falling from a roof. He has been hemodynamically stable. Despite
aggressive efforts to pharmacologically reduce ICP, he is now unconscious
and unresponsive to painful stimuli. All of the following are clinical criteria consistent with a diagnosis of brain death in this patient EXCEPT

A. Persistent apnea for 10 minutes
B. Absence of pupillary light reflex
C. Persistent spinal reflexes
D. Decorticate posturing

Answer 8

D. Decorticate posturing

The GCS score of 3 is included with brain death (score of 1 for Eye – does not open eyes; score of 1 for Verbal – makes no sounds; score of 1 for Motor – no movement). Decorticate posturing (upper extremities are flexed, lower extremities are extended) and the more severe decerebrate posturing (both arms and legs are extended with internal rotation) are signs of severe brain damage but are not consistent with the diagnosis of brain death

Question 9

The EEG begins to flatten during carotid endarterectomy when regional cerebral blood flow (in ml/min/100 g brain) decreases to:

A. 55
B. 45
C. 30
D. 20
E. 10

Answer 9

D. 20

Question 10

Which of the following interventions is MOST effective in preventing neurologic injury resulting from global cerebral ischemia?

(A) Induction of barbiturate coma prior to ischemia

(B) Maintenance of serum glucose concentration greater than 200 mg/dl prior to ischemia

(C) Induction of hypothermia to a core temperature of 15 degrees C prior to
ischemia

(D) Maintenance of PaCO2 less than 25 mmHg following ischemia

(E) Prevention of systemic hypertension following ischemia

Answer 10

(C) Induction of hypothermia to a core temperature of 15 degrees C prior to
ischemia