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Principles 4 > EXAM 1 > Flashcards

EXAM 1 Flashcards

1
Q

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

A

True

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2
Q

Cerebral blood flow (CBF) is approximately:

A

40-50 ml/100g/min

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3
Q

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

A

Ketamine

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4
Q

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

A

7

decrease

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5
Q

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

A

sedation may cause hypoventilation leading to hypercarbia

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6
Q

Which of the following describe functions of neuroglial cells?

A

all of the above are correct

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7
Q

Determinants of cerebral blood flow include:

A

PaCO2

CPP

CMRO2

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8
Q

All of the following are true about intracranial pressure EXCEPT:

A

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

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9
Q

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

A

administer corticosteroids

provide moderate hyperventilation

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10
Q

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:

A

a symptomatic supratentorial space occupying lesion

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11
Q

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

A

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

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12
Q

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:

A

an intracranial hemorrhage

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13
Q

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

A

a, b, and c

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14
Q

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

A

Pressors may be required to maintain adequate blood pressure

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15
Q

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

A

102

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16
Q

Match the BIS values with the appropriate level of consciousness

A

60 - 70 Deep Sedation

40 - 60 General Anesthesia

70 - 80 light / moderate sedation

0 flat line EEG

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17
Q

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

A

all of the above

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18
Q

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

A

False

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19
Q

Which of the following statements about cerebral oximetry is true?

A

cerebral oximetry decreases during cerebral ischemia due to increased oxygen extraction

20
Q

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

A

True

21
Q

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

A

Dorsal Column

22
Q

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)

A

False

23
Q

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?

A

adminisiter a vasoporssor such as phenylephrine

24
Q

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

A

transphenoidal or anterior fossa surgery

25
Q

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

A

all of the above

26
Q

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?

A

head lift x 5 seconds

27
Q

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

A

True

28
Q

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?

A

ECG and echocardiography

29
Q

Choose all of the following statements that are TRUE:

A

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.

30
Q

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

A

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

31
Q

Which of the following conditions may mimic malignant hyperthermia?

A

pheochromocytoma

neuroleptic malignant sydrome

cocaine use

hyperthermia

32
Q

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?

A

discontinue all volatile anesthetic agents and hyperventilate with 100% O2

33
Q

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?

A

150 mg initial dose, 600 mg maximum dose

34
Q

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).

A

6

35
Q

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

A

decreased salivation

36
Q

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

A

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

37
Q

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)

A

False

38
Q

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 _______________.

A

20-60, intracranial hemorrhage

39
Q

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)

A

True

40
Q

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)

A

False

41
Q

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

A

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

42
Q

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

A

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

43
Q

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

A

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

44
Q

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

A

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

45
Q

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)

A

True

Principles 4 (20 decks)

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