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Principles 3 > Exam 1 Neuro 3 > Flashcards

Exam 1 Neuro 3 Flashcards

1
Q

How do seizures look like on an EEG?

A

Sharp, spiking waves

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2
Q

What do slow waves on an EEG indicate?

A

Tumor, stroke, anesthesia, seep sleep

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3
Q

What can interfere with an EEG?

A

Hypoglycemia, movement, bright lights, benzos, caffeine

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4
Q

What is burst suppression?

A

Quieting brain electrical activity(decrease CRMO2) to protect brain

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5
Q

How is burst suppression achieved?

A

Bolus of propofol

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6
Q

What is an epoch?

A

EEG signal over 5-10sec is analyzed

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7
Q

What frequencies dominate with deeper anesthesia?

A

Lower frequencies

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8
Q

What is a normal awake BIS value, what about general anesthesia?

A

85 – 100 & 40 – 60

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9
Q

What is the BIS value for burst suppression?

A

<20

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10
Q

What transient disorders (3) can cause seizures?

A

Hypoglycemia, hyponatremia, hyperthermia

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11
Q

What is atonic?

A

The risk of falling during a seizure

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12
Q

What are petit mal seizure S/S & who is more likely to have them?

A

Eyes roll back/staring. More common in kids

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13
Q

What is the MOA for antiseizure meds?

A

Reduce inward voltage-gated positive currents of Na+ & Ca2+

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14
Q

What antiseizure med increases GABA?

A

Valproate (valproic acid)

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15
Q

What seizure med decreases glutamate and aspartate?

A

Keppra

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16
Q

How does Keppra work?

A

Binds to SV2 (synaptic vesicle protein 2A to inhibit release of neurotransmitters

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17
Q

What should you consider when someone is on an older seizure medication?

A

Upregulation of CYP450, faster metabolism

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18
Q

What is a common dose for Keppra?

A

500 – 1,000mg IV

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19
Q

How does magnesium help with seizures?

A

It inhibits glutamate

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20
Q

What anesthetic drugs are not so good for seizure patients?

A
  • Etomidate (lowers seizure threshold) &
  • Meperidine (Demerol) d/t active metabolite normeperidine can cause seizures
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21
Q

What about ketamine and seizure patients?

A

Can be used but may be better if used with propofol or benzo

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22
Q

What is the treatment for status epilepticus?

A

Airway, ventilation, check hypoglycemia, antiepileptics, ABG, paralytics

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23
Q

Is MS inherited?

A

No

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24
Q

Where does MS cause most damage?

A

Axons in the CNS, some periphery

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25
When is the onset of MS?
After age 35, usually a slow progression
26
What is often the first sign of MS?
Visual disturbances
27
What are some treatments for MS?
- Steroids, - Interferon (cardiac toxic), - Azathioprine (immune suppressant), - methotrexate (immune suppressant)
28
What is the anesthetic management for MS?
- Preoxygenate (OSA common), - continue steroids, - stress dose steroids after induction, - continue MS meds on day of surgery, - steroids can have effects on CV system & liver
29
What do you consider with someone taking Baclofen?
- Increases sensitivity to NDMR’s. - Avoid Scc. - Use sugammadex as reversal
30
What is usually the first/hallmark sign of GBS?
-Pins and needles & numbness. - Starting in legs
31
What can precede GBS?
An infection
32
What drug must be avoided in GBS?
Succinylcholine
33
What are some S/S of GBS?
- BP fluctuations, - HTN with laryngoscopy, - hypotension with position changes or positive airway pressure, - resting tachycardia, - profuse diaphoresis, - orthostatic hypotension, - sudden death
34
What is the better anesthetic for someone with GBS?
- GETA d/t respiratory compromise & airway reflexes, - consider a-line, - use good judgement with NMDR’s
35
Who is more likely to need post-op ventilation, someone with GBS or MS?
GBS
36
What happens with Parkinson’s?
- Loss of dopaminergic fibers from basal ganglia, - decreased NE production, - Lewy bodies
37
What is the single most important risk factor for Parkinson’s?
Age
38
What is the Triad of Parkinson’s?
Tremors, Rigidity, Akinesia
39
What muscles are affected first in Parkinson’s & what does it look like?
- Proximal neck muscles. - Loose arm swinging
40
When are Parkinson’s tremors more prominent?
During rest
41
What is the treatment goal of Parkinson’s?
- Decrease effects of acetylcholine & - increase dopamine in basal ganglia
42
What anesthetic type would be better for someone with Alzheimer?
TIVA
43
What part of the brain is affected in Huntington’s?
Enlargement of lateral ventricles
44
What happens in ALS?
Degeneration of motor neurons → respiratory failure
45
What is destroyed in Myasthenia Gravis?
Post-synaptic Ach receptors at NMJ
46
What is the hallmark of MG?
Weakness & rapid exhaustion of voluntary muscles followed by partial recovery
47
What kind of tumor could cause MG?
Tumor on the thymus gland
48
What are the Dx of MG?
Blood test & EMG
49
What is the Tensilon test?
- Edrophonium, a short-acting anticholinesterase med. - Given with atropine. - Symptoms of MG should improve
50
What drug is usually given for MG?
Pyridostigmine or neostigmine
51
What is a cholinergic crisis?
Too much Ach or substance that mimics Ach
52
How do we know if someone with MG is in cholinergic crisis or myasthenic crisis?
- Give Edrophonium, if they improve then they are in MG crisis. - If they get worse then they are in cholinergic crisis.
53
Which crisis would have profound muscle weakness?
Cholinergic crisis
54
What medications are avoided in someone with MG?
Calcium channel blockers & magnesium
55
If muscle weakness is not treated well in MG, what can be added to help?
Immunosuppressors
56
What is plasmapheresis?
Removing antibodies from circulation. Is only temporary
57
What is the treatment of choice for most MG patients?
Thymectomy
58
What are anesthetic management for MG?
- High risk for aspiration, - extubate awake, - PPI, H2 blockers, Reglan, - continue MG meds, - sensitive to opioids & benzos, - very sensitive to NMDR, - sensitive to Scc, - use sugammadex
59
What happens in LEMS?
Antibodies directed against presynaptic calcium channels at NMJ
60
What muscles are more affected in LEMS vs MG?
Proximal muscles
61
What med are LEMS patients often resistant to?
NMDR’s
62
LEMS is often associated with what?
Small cell lung cancer
63
Which demyelinating disease does not have autonomic dysfunction?
Myasthenia gravis
64
Which disease has an incremental response with nerve stimulation?
LEMS

Principles 3 (3 decks)

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