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A1 > APEX brain > Flashcards

APEX brain Flashcards

1
Q

Cells of the brain

A

All collectively known as Glial cells- they support neuronal function
Astrocytes- metabolic support to neurons, most abundant, repair after injury
Oligodendrocytes- speed up velocity of neuron/ form myelin sheath (compare to schwann cells in PNS)
Epidendymal cells- CSF production by forming the choroid plexus
Microglia- phagocytize debris
(Schwann- form the myelin sheath in peripheral nerves)

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2
Q

The cell bodies form ___, the axons form ___

A

grey matter
white matter

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3
Q

3 types of neurons in the CNS

A

Multipolar- most of the CNS
Pseudounipolar- dorsal root ganglion, cranial ganglion
Bipolar- retina, ear

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4
Q

Brain lobes and their function

A

Frontal- motor
Occipital- vision
Parietal- sensation
Temporal- audition

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5
Q

Parts of the temporal hemisphere

A

Wernickes- understand speech
Brocas- motor control of speech

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6
Q

4 areas of the brain (not lobes)

A

Cerebral hemispheres- frontal, parietal, occipital, temporal, cortex, hippocampus, amygdala, basal ganglia
diancephalon- thalamus, hypothalamus
Brain stem- midbrain, pons, RAS, medula
Cerebellum- archicerebellum, paleocerebellum, neocerebellum

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7
Q

The diancephalon contains

A

hypothalamus
Thalamus

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8
Q

3 parts of the brainstem

A

midbrain
pons
medulla oblongata

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9
Q

Where is the RAS

A

Brainstem
More specific- posterior region of the PONS

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10
Q
A
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11
Q
A
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12
Q

Cranial nerves

A

oh oh oh to touch and feel a girls vagina, ah heaven
some say marry money but my brother says big brains matter most
1 olfactory- smell
2 optic- vision
3 occulomotor- eye movement
4 trochlear- eye movement
5 trigeminal- sensation to face, chewing
6 abducens- eye side to side
7 facial- facial movement except chewing
8 vestibulocochlear- balance
9 glossopharyngeal- taste to posterior tongue
10 vagal- swallow
11 accessory- shoulder shrug
12 hypoglossal- tongue movement

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13
Q

Cranial nerves for eye movement

A

3,4,6

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14
Q

Branches of CN7

A

Facial
two zebras bit my carrot

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15
Q

Parasympathetic output is carried by ___

A

3,7,9,10

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16
Q

which cranial nerve is a part of the CNS

A

Optic is the only one

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17
Q

Site of CSF reabsorption

A

arachnoid villa

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18
Q

Foramen of monro

A

pathway between lateral and third ventricle

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19
Q

CSF volume, specific gravity, pressure, and rate of production

A

volume- 150ml, created at 30ml/hr
CSF pressure 5-15
SP GR 1.002- 1.009

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20
Q

2 types of hydrocephalus and the treatment

A

obstructive- most common
communicating hydrocephalus- decreased reabsorption or overproduction of csf (very rare)
Catheter to drain CSF
Ventriculoatrial shunt (brain to heart)
Ventriculoperitoneal shunt (brain to belly)

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21
Q

Critical threshold for global CBF

A

Normal is 50ml/100g tissue/min (AKA 15% of CO)
20- ischemia
15- complete cortical suppresion
<15- cell death

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22
Q

5 determinants of CBF

A

PaCO2
PaO2
CPP
Venous pressure
CMRO2

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23
Q

CMRO2

A

3-3.8ml/o2/100g tissue/min

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24
Q

What can decrease cmro2?

A

Hypothermia- decrease by 7% for every 1C
EEG suppression occurs at 20C, we use 32C for mild hypothermia
halogenated agents
propofol
etomidate
barbituates

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25
Q

What can increase CMRO2?

A

Hyperthermia (above 42 will destroy neurons and denature proteins)
Ketamine
Seizures
N2O

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26
Q

CPP formula, when does it autoregulate

A

MAP-ICP (or CPP, whichever is higher)
50-150 or MAP 60-160

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27
Q

What will interfere with cerebral autoregulation?

A

Intracranial tumor
Head trauma
Volatile anesthetics

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28
Q

In regards to PaCO2, when is CBF maximally dilated and constricted?

A

Dilated- 80
Constricted- 25

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29
Q

What can cause steal phenomena?

A

Max vasodilation
Hypercapnia
Hypoventilation
Vasodilators

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30
Q

PaO2 below ___ will cause cerebral vasodilation

A

50

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31
Q

What can impair venous drainage from the brain?

A

Jugular compression from head position
Increased intrathoracic pressure from PEEP or coughin
Vena cava syndrome, vena cava thrombosis

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32
Q

For every 1 increase in PaCO2, CBF will increase by ___

A

1
Vice versa as well

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33
Q

Most common site of transtentorial herniation and S&S

A

Temporal uncus
Compresses CN3
Causing a fixed and dilated pupil

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34
Q

S&S intracranial HTN

A

headache
N/V
Papilledema
Pupil dilation/ non reactivity
Seizure
Coma
Focal defect

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35
Q

What is cushings triad

A

Sign of impending herniation
HTN
Brady (reflex)
Irregular respirations

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36
Q

PEEP will ___ ICP

A

increase
Reduces outflow out of the brain

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37
Q

ICP > ____ = intracranial hypertension

A

20

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38
Q

How can we reduce ICP

A

1 CBV reduction- hyperventilation, void hypoxemia, avoid dilators, allow for outflow
2 CSF reduction- drain via shunt, diamox and lasix
3 Cerebral mass reduction- tumor debulk or evacuation hematoma
4 Cerebral edema reduction- diuretics, steroids

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39
Q

In the setting of cerebral ischemia, excess glucose is converted to ___

A

Lactic acid

40
Q

Cerebral circulation can be divided into 2 circulations, ___ & ____. Venous circulation can also be divided into 2 circulations, ___ & ___.

A

Anterior/ posterior (converge at the circle of willis)
Superior sagittal sinus/ dural sinus (converge at the confluence of sinuses then exits via the paired jugular veins)

41
Q

TPA within

A

4.5 hours of SYMPTOM onset

42
Q

Draw the circle of willis

A
43
Q

Risk factors for a stroke

A

HTN (most important)
Smoking
DM
HLD
ETOH abuse
Elevated homocysteine

44
Q

___ is the first line agent for acute ischemic stroke

A

PO aspirin

45
Q

Embolectomy should be within ___

A

6 hours

46
Q

Target BP after an ischemic stroke

A

Below 185/110
HTN will support CPP
HOTN will worsen ischemia

47
Q

Management of cerebral vasospasm

A

Nimodipine increases collat flow
HCT 30% (hypervolemia/ hemodilution/ hypertension 30 above baseline)
Daily doppler exams

48
Q

Arterial bleeding usually occurs in the ___, while venous bleeding usually occurs in the ___.

A

Arterial SAH
Venous subdural

49
Q

SAH S&S

A

Bad headache
LOC
Focal defects
N/V
Photophobia
Fever

50
Q

Surgical repair of SAH should take place ___

A

First, prevent rebleeding and vasospasm
24-48 hours after the initial bleed

51
Q

Goal SBP for SAH surgery- open repair

A

120-150
High enough to feed collaterals, low enough to not cause a rebleed

52
Q

Cerebral vasospasm occurs in ___ patients and ___ following SAH

A

1 in 4
5-10 days

53
Q

The most common presentation of cerebral vasospasm

A

new neuro deficit / altered LOC

54
Q

If nimodipine fails, treatment is ___

A

Verapamil
Cardene
Milrinone
Balloon angioplasty

55
Q

Whos at risk for CSW? treatment?

A

Cerebral salt wasting- the brain releases natriuretic peptide and causes salt wasting by the kidneys
SAH patients
Isotonic fluids

56
Q

Gold standard for cerebral vasospasm diagnosis

A

Cerebral angiography

57
Q

Treatment for TBI on plavix

A

3% saline
Platelets
Recombinant 7a

58
Q

GCS measures ___

A

Eye opening 1-4
Verbal response 1-5
Motor response 1-6
Pupil reactivity -2-0

59
Q

Reversal of plavix and aspirin

A

Platelets

60
Q

Reversal of Warfarin

A

FFP
Recombinant 7a
PT concentrate

61
Q

For head injury, keep CPP ___

A

> 70

62
Q

Hypotonic solutions in the setting of TBI

A

Increase cerebral edema

63
Q

What meds are linked to poor outcomes in the setting of TBI?

A

Albumin
Glucose (unless hypoglycemic)
Steroids
Nitrous oxide

64
Q

Partial vs generalized seizure

A

Partial- localized to a particular cortical region
Generalized- both hemispheres

65
Q

A partial seizure can turn into a generalized seizure, this is called ____

A

Jacksonian March

66
Q

Treatment for GrandMa seizure

A

Prop
Diazepam
Thiopental
Vagal nerve stimulator
Resection of foci

67
Q

Treatment for status

A

Phenobarbital
Thiopental
Propofol
Phenytoin
Benzos
GA

68
Q

In the adult, new onset seizures are usually cause by ___ or ___

A

Brain lesion- tumor, trauma, CVA
Metabolic cause- hypoglycemia, drugs, withdrawal, infection

69
Q

Signs of a seizure under GA w/ inhalation agents

A

Tachy
HTN
Increased ETCO2
(Similar to MH?)

70
Q

IV agents that can induce seizures

A

Ketamine
Propofol (but its still a first line treatment)
LA reduce seizure threshold
Atracurium, cisatracurium metabolize to a proconvulsant
Etomidate doesnt, but it causes myoclonus

71
Q

3 anesthetic drugs that are used to locate seizure foci

A

Etomidate
Methohexital
Alfentanil

72
Q

Which anticonvulsant is excreted unchanged in the kidneys?

A

Gabapentin

73
Q

Pneumonic for seizure causes

A

VITAMIN D,E
Vascular/ bleed
Infection meningitis
Trauma
Autoimmune disease SLE
Metabolic hyponatremia high glucose
Idiopathi
Neoplasia (lesion)
Drugs/ toxins
Eclampsia

74
Q

Anticonvulsants/ MOA

A

Phenytoin NA blocker
Valproic acid NA blocker
Carbamazepine NA blocker
Gabapentinoids CA blocker alpha 2 delta subunit

75
Q

Phenytoin special comments

A

Resistance to NMB
0 order kinetic
Purple glove syndrome

76
Q

Valproic acid special comments

A

Slows phenytoin metabolism
Thrombocytopenia

77
Q

Which anticonvulsants will cause resistance to NMB?

A

Phenytoin
Carbamazepine

78
Q

S&S Alzheimers

A

Memory loss
Aprasia
Aphasia
Agnosia

79
Q

Treatment for alzheimers

A

Restore the concentration of acetylcholine via cholinesterase inhibitors;
Donepizil
Rivastigmine
Tacrine
Galantamine

80
Q

Key points of anesthetic management of alzheimers patients

A

Try to avoid MAC and regional
Short acting meds are best so patient can return to baseline ASAP
No perioperative sedation
Succ can be prolonged in theory
High PNS tone, so expect brady, syncope, n/v
Use glycco if needed bc it doesnt cross BBB

81
Q

Increased risk of Alzheimers if the patient has experienced ___

A

Multiple GAs before age 50

82
Q

Patho of alzheimers

A

Diffuse beta amyloid rich plaques and neurofibrillary tangles in the brain
Apoptosis, dysfunctional synapse

83
Q

Which halogenated agents increase beta amyloid production?

A

Halothane
Isoflurane

84
Q

What factors contribute to parkinsons disease?

A

Deceased dopamine in the basal ganglia
Increased ACH in the basal ganglia
Increased GABA in the thalamus

85
Q

Diagnosis for parkinsons

A

2 of 4;
1- pill roll tremor
2- skeletal muscle rigidity
3- postural instability
4- bradykinesia- slow movement

86
Q

Treatment for parkinsons

A

Carbidopa levodopa (levodopa is precursor for dopamine, carbidopa prevents levodopa metabolism)
selegiline (MAO-B inhibitor reduces dopamine metabolism
Others; DA, anticholinergics, amantadine, COMT inhibitors, hormone replacement

87
Q

Parkinsons patients are at risk for;

A

Autonomic instability
OH
Dysrhythmias
Aspiration

88
Q

When should carbidopa levodopa be administered?

A

The morning of surgery to prevent worsening of symptoms such as rigidity which can alter ventilation

89
Q

Which drugs are contraindicated in parkinsons?

A

Antidopaminergic drugs; reglan, butyrophenones (haldol, droperidol), and phenothiazines (promethazine)
They will exacerbate extrapyramidal symptoms

90
Q

What can treat acute parkinsons symptoms?

A

Anticholinergics
Benadryl for sedation and reduction of tremors

91
Q

Deep brain stimulation key points

A

For parkinsons
Drill a burr hole and insert electrodes
GABA agonists are avoided (prop, benzos)
Risk of VAE

92
Q

Ischemic optic neuropathy is most common after ____

A

Spinal surgery

93
Q

Different eye injuries

A

Corneal abrasion- 1-3 days usually until recovery, abx eye drops erythromycin/ tobramycin
IOP- most common after spinal surgery, ischemia of the optic nerve, occurs 24 hours later
Central retinal artery occlusion- cherry red macula, vessel issue

94
Q

Risk factors for central retinal artery occlusion

A

horseshoe headrest- most common
Improper head position
Better option is foam face pillow
N2O
Embolism

94
Q

Risk factors for IOP

A

Male
Obese
DM
HTN
Amoke
Old age
prone
Large blood loss
HOTN

95
Q

Ocular perfusion pressure formula

A

MAP- IOP

96
Q

Flow of CSF in the brain

A

Lets Forget And Flip
Lateral ventricles
Foramen of monro
Aqueduct of sylvius
Foramen of magendie

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