EXAM 1

Question 1

Autoregulation of cerebral blood flow remains nearly constant between a mean arterial pressure of about 70-150 mmHg. (T or F)

Answer 1

True

Question 2

Cerebral blood flow (CBF) is approximately:

Answer 2

40-50 ml/100g/min

Question 3

Agents that are useful in decreasing CMRO2 include all of the following EXCEPT

Answer 3

Ketamine

Question 4

Cerebral blood flow decreases about ________% for every 1 degree Celcius __________ in body temperature

Answer 4

7

decrease

Question 5

Which of the following reasons is the MOST IMPORTANT reason to avoid preoperative sedation in patients with suspected increased ICP?

Answer 5

sedation may cause hypoventilation leading to hypercarbia

Question 6

Which of the following describe functions of neuroglial cells?

Answer 6

all of the above are correct

Question 7

Determinants of cerebral blood flow include:

Answer 7

PaCO2

CPP

CMRO2

Question 8

All of the following are true about intracranial pressure EXCEPT:

Answer 8

normal ICP is 10 - 20 mmHg, and intracranial hypertension is a sustained ICP greater than 25-30

Question 9

Which of the following are maneuvers / interventions that can be used by the anesthetist to decrease intracranial volume and ICP?

Answer 9

administer corticosteroids

provide moderate hyperventilation

Question 10

A 55 year old patient presents to the operating room for emergent craniotomy. According to her husband, she has been complaining of a headache for about 6 months and he noticed she had increasing memory loss during that time. Over the last couple days, she has had worsening hemiplegia, a decline in cognitive function and is now aphasic. She experienced a seizure 30 minutes ago in the emergency department. She had a CT before being transported to the operating room. Even before reviewing the CT report, you suspect the patient has:

Answer 10

a symptomatic supratentorial space occupying lesion

Question 11

Which of the following statements is true regarding monitors to detect venous air embolus?

Answer 11

End-tidal nitrogen is specific to air AND detects air earlier than ETCO2

Question 12

A 72 year old woman prsents to the Emergency department with sudden onset, severe headache described as the worst headache of her life, nausea, vomiting, photophobia. There are focal neurological deficits on exam. As the patients is being taken to CT, you are called to accompany the patient in case of further deterioration in status and the likely trip to the operating room. You suspect that the pateint has suffered:

Answer 12

an intracranial hemorrhage

Question 13

Which of the following are indications for tracheal intubation in the head trauma patient?

Answer 13

a, b, and c

Question 14

Which of the following statements is TRUE regarding neurosurgical procedures in the sitting position?

Answer 14

Pressors may be required to maintain adequate blood pressure

Question 15

What is the cerebral perfusion pressure when the ICP = 12, CVP = 6, and the MAP = 114?

Answer 15

102

Question 16

Match the BIS values with the appropriate level of consciousness

Answer 16

60 - 70 Deep Sedation

40 - 60 General Anesthesia

70 - 80 light / moderate sedation

0 flat line EEG

Question 17

Risk factors, or contributing factors, for awareness under anesthesia include which of the following:

Answer 17

all of the above

Question 18

The Basilar artery and the middle cerebral artery are two of the vessels that compose the Circle of Willis. (T or F)

Answer 18

False

Question 19

Which of the following statements about cerebral oximetry is true?

Answer 19

cerebral oximetry decreases during cerebral ischemia due to increased oxygen extraction

Question 20

Volatile anesthetics increase the latency and decrease the amplitude of evoked potentials. (T or F)

Answer 20

True

Question 21

Somatosensory evoked potentials (SSEPs) measure the intactness of the _________ pathways.

Answer 21

Dorsal Column

Question 22

Because anesthetics can not affect SSEPs, it is not necessary for the anesthetist to communicate changes in the anesthetic to the electrophysiology monitor. (T or F)

Answer 22

False

Question 23

You are the anesthetist for a posterior discectomy and fusion at L1-5 in the prone position. The neuromonitor technician informs you that the SSEPs are decreased. Vital signs and anesthetic specifics are as follows:
BP 85/40 (preop was 135/62), HR 80 (baseline was 78), Spo2 98%, Cerebral oximeter 65 and 63 (baseline was 80 and 78), BIS/entropy 55.
FiO2 .6, ET Sevo 1.0, propofol 50 mcg/kg/min, remifentanil .025 mcg/kg/min.
Based on your knowledge of neuromonitoring and CBF, what would be the most appropriate intervention?

Answer 23

adminisiter a vasoporssor such as phenylephrine

Question 24

Brain stem auditory evoked potentials are most useful during which of the following types pf surgery?

Answer 24

transphenoidal or anterior fossa surgery

Question 25

Goals of anesthetic management of the patient having a carotid endarterectomy include:

Answer 25

all of the above

Question 26

Which of the following tests of nerve function correlates with the lowest percentage of Ach receptors that are occupied during the recovery from a nondepolarizing muscle relaxant?

Answer 26

head lift x 5 seconds

Question 27

Spinal anesthesia should be avoided in patients with multiple sclerosis becuse it exacerbates symptoms. (T or F)

Answer 27

True

Question 28

Based on your understanding of the pathophysiology of Duchenne's Muscular Dystrophy, which of the following should be conducted as part of the preoperative preparation of a patient with DMD?

Answer 28

ECG and echocardiography

Question 29

Choose all of the following statements that are TRUE:

Answer 29

Lambert-Eaton Myasthenic Syndrome is an autoimmune disorder classically occuring in patients with malignancies, especially of the lung. Succinylcholine should be avoided in patients with multiple sclerosis to avoid the risk of succhinylcholine-induced hyperkalemia which can result in a fatal cardiac arrhythmia. Patients with Duchenne's Muscular Dystrophy often exhibit slowed gastric emptying and weakened pharyngeal muscles, making them at risk for aspiration.

Question 30

Maintenance of normothermia in patients who have suffered complete spinal cord transection is important because:

Answer 30

they are likely to become poikilothermic below the level of the injury

Question 31

Which of the following conditions may mimic malignant hyperthermia?

Answer 31

pheochromocytoma neuroleptic malignant sydrome cocaine use hyperthermia

Question 32

A 30 kg child is in the operating room for an elective tonsillectomy and adenoidectomy. The child was anesthetized with propofol 100 mg and rocuronium 20 mg. Following intubation, maintenance of anesthesia is accomplished with sevoflurane and O2/air (FiO2 .60). Soon after the bed is turned, the HR rises from 110 to 160 and ETC02 rises to 78. An esophageal temperature probe is placed and the temperature is 39.8 degrees celcius. The anesthetist suspects malignant hyperthermia. What is the FIRST thing that the anesthetist should do?

Answer 32

discontinue all volatile anesthetic agents and hyperventilate with 100% O2

Question 33

Which of the following is the correct initial dose and maximum dose of dantrolene to be administered to a 60 kg patient suspected of having malignant hyperthermia?

Answer 33

150 mg initial dose, 600 mg maximum dose

Question 34

In patients who have suffered significant burn injuries, it is prudent to avoid succinylcholine for ____ months following the burn. (Please indicate your answer as a number not a word).

Answer 34

6

Question 35

When "reversing" the effects of a nondepolarizing muscle relaxant, anticholinergic medications are admistered with cholinesterase inhibitors to limit the muscarinic effects of the cholinesterase inhibitor. Examples of muscarinic side effects of cholinesterase inhibitors include all of the following EXCEPT

Answer 35

decreased salivation

Question 36

Please match the fasting status with the specific types of oral intake which is recommended prior to elective surgey and anesthesia.

Answer 36

at least 2 hours - clear liquids at least 4 hours - breast milk at least 6 hours - infant formula or light meal at least 8 hours - fried or fatty foods

Question 37

Because the infant's brain is proportionally larger relative to the cranial volume than that of an adult, their skull is less compliant and therefore, infants will demonstrate signs and symptoms associated with intracranial abnormalities much sooner than adults. (T or F)

Answer 37

False

Question 38

Cerebral autoregulation may be shifted to significantly lower values, ___________ mm Hg in infants, and acute hypotension may lead to cerebral ischemia, while acute hypertension may place the infant at risk of _______________.

Answer 38

20-60, intracranial hemorrhage

Question 39

Congenital heart defects may not be apparent immediately after birth; however, the defect may be manifested due to the effects of anesthetics or positive pressure ventilation. (T or F)

Answer 39

True

Question 40

Preoperative anxiolysis with midazolam should be avoided in pediatric patients presenting for neurosurgery because of the hypoventilation and resultant rise in ICP associated with this drug. (T or F)

Answer 40

False

Question 41

Which of the following is TRUE about the physiologic effects of patient positioning?

Answer 41

The lateral decubitus position results in a decreased compliance of the down-side lung

Question 42

Which of the following are true regarding introperative airway management in the infant and small child neurosurgical patient?

Answer 42

the ETT can kink during flexion of the head An improperly sized ETT can increase the risk of subglottic obstruction postoperatively airway management may be difficult in patients with craniofacial abnormalities

Question 43

All of the following are true about the neonate with a myelomeningocele EXCEPT:

Answer 43

Because there is little blood loss during surgical repair of a myelomeningocele, it is not necessary to have PRBCs available intraoperatively.

Question 44

Which of the following is TRUE about the anesthetic management of the infant undergoing surgery for craniosynostosis?

Answer 44

Significant blood loss should be anticipated and is more with an increased number of sutures involved

Question 45

Methods to lower ICP in children is the same as in adults and include elevation of the head, hyperventilation, and admistration of steroids and diuretics. (T or F)

Answer 45

True