Advanced | Critical Care and Neurocritical Care Anesthesia Flashcards
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
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
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
C. Grade II
The Hunt and Hess Scale describes the severity of subarachnoid hemorrhages and is used as an outcome predictor
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%
D. 20%
Check the numbers.:)
Grade Percent Survival
Grade 1 —-> 70
Grade 2 —-> 60
Grade 3 —-> 50
————————
Grade 4 —–> 20
Grade 5 —–> 10
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
C. Vasoparalysis exists with hypercarbia
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
C. Drain cerebrospinal fluid
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
(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
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%
C. 6%
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
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
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
D. 20
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
(C) Induction of hypothermia to a core temperature of 15 degrees C prior to
ischemia
The sudden onset of pulmonary edema can be caused by each of the following EXCEPT
(A) rapid re-expansion of the lungs following pneumothorax
(B) upper airway obstruction
(C) oxygen toxicity
(D) rupture of mitral papillary muscle
(E) severe preeclampsia
(C) oxygen toxicity
What is the suggested temperature employed for Mild Therapeutic Hypothermia in ICU
33-35C
Which of the following hypotensive patients could potentially show
improvement in their hemodynamics with the administration of POSITIVE PRESSURE VENTILATION?
A. Large myocardial infarction in left anterior descending territory
B. Acute liver failure (ALF)
C. Acute pulmonary embolism
D. Induction of anesthesia
E. Sepsis
A. Large Myocardial Infarction in the LAD territory
Positive pressure ventilation can have significant hemodynamic effects through
changes in cardiac function and pulmonary vascular pressure. The overall effect on hemodynamic function depends on underlying pathology. An increase in
intrathoracic pressure reduces the gradient for venous return to the right heart and
therefore decreases right-sided preload. In patients with reduced preload due to
hypovolemia or decreased SVR (hemorrhage, sepsis, liver failure, anesthetic
agents), the addition of positive pressure ventilation will further decrease preload
and worsen hypotension. Increased alveolar pressure increases pulmonary vascular
resistance and therefore increases right heart afterload. In general, right-sided
cardiac output declines under positive pressure ventilation. Patients with pulmonary
hypertension and right ventricle (RV) failure (eg, acute PE) will therefore develop
worsening hemodynamics with positive pressure ventilation.
In contrast to the right heart, left heart function can improve with positive
pressure ventilation. Positive intrathoracic pressure decreases left ventricle (LV)
transmural pressure and wall tension according to the Law of Laplace. This in turn
reduces LV afterload. Assuming the LV preload is adequate, cardiac output may
improve due to reduced afterload. This becomes especially apparent in patients
with cardiogenic shock. LV failure should always be considered in the differential
of ventilator weaning failure.
Hemodynamic
Which of the following basic principles applied to all critical care patients, assuming initial surgical management are appropriate?
A. Head elevation more than 45 degrees
B. CPP <50 Torr
C. ICP <5 Torr
D. Mannitol, hyportonic saline
E. SaO2 ≥95%; PaCO2 35–40 Torr
E. SaO2 ≥95%; PaCO2 35–40 Torr
True or False
Administration of empiric broad-spectrum antibiotics within ONE HOUR of sepsis diagnosis is an essential component of the SEPSIS campaign.
TRUE
Administer empiric broad-spectrum antibiotics within 1 hour of sepsis diagnosis, and reassess appropriateness of antimicrobial therapy upon availability of microbiology results.
The primary 1st line vaso-pressor for sepsis:
NOREPINEPHRINE
The target MAP is > or = 65
The addition of Vasopressin is recommended when the Norepinephrine dose reaches 0.25 to 0.5 mg/kg/min
****TRUE
Vasopressin may be added at a fixed rate as an adjunct to norepinephrine, but should not be used alone. The addition of vasopressin is recommended instead of further norepinephrine dose escalation when the norepinephrine dose reaches 0.25–0.5 μg/kg/min
The target hgb in the absence of tissue hypoperfusion, CAD, or acute hemorrhage is:
A. <7 g/dL
B. >10 g/dL
C. 7-9 g/dL
D. < 8 g/dL
**C. 7-9 g/dL **
Target a hemoglobin of 7–9 g/dL in the absence of tissue hypoperfusion, coronary artery disease, or acute hemorrhage
The recommended duration per day when employing PRONE positioning among sepsis-induced ARDS patients is:
A. 24 hrs
B. at least 12 hrs
C. at least 8 hrs
D. less than 8 hrs
B . At least 12 hours
For patients with moderate-to-severe sepsis-induced ARDS, prone positioning for at least 12 hrs per day is recommended
Which of the following interventions is TRUE in the sespis campaign guideline?
A. Intensive Care Unit admission within the FIRST hour of diagnosis
B. Use bicarbonate to correct arterial pH <7.2 in the setting of acute kidney injury
C. Use of procalcitonin levels to decide when to start antimicrobial therapy.
D. Use of Pulmonary artery catheters to assess the acuteness of lung injury
B. Use bicarbonate to correct arterial pH <7.2 in the setting of acute kidney injury
The following are the predictors of poor outcome in TBI except:
A. Age > 45
B. Blood Glucose of > 1,800 mg/dL
C. Poor GCS
D. Poor pupillary reaction
E. Age > 60
A. Age > 45
A 74-year-old man presents for a femoral popliteal artery bypass procedure for peripheral limb ischaemia. Regarding its role in modifying his perioperative cardiovascular risk, clonidine
A. Haemodynamically stable in doses of 200 mcg
B. Reduces periop MI more than metoprolol
C. Increases risk of nonfatal cardiac arrest
D. Increases stroke risk
C. Increases risk of nonfatal cardiac arrest
58 year old patient with liver cirrhosis presents for liver transplantation. He will likely exhibit each of following hemodynamic changes EXCEPT?
A. ↓ cardiac output
B. ↓ Serum glucose concentration
C. ↓ Systemic vascular resistance
D. ↑ alveolar oxygen tension
A. ↓ cardiac output
