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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
Q

When is the onset of MS?

A

After age 35, usually a slow progression

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26
Q

What is often the first sign of MS?

A

Visual disturbances

27
Q

What are some treatments for MS?

A
  • Steroids,
  • Interferon (cardiac toxic),
  • Azathioprine (immune suppressant),
  • methotrexate (immune suppressant)
28
Q

What is the anesthetic management for MS?

A
  • 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
Q

What do you consider with someone taking Baclofen?

A
  • Increases sensitivity to NDMR’s.
  • Avoid Scc.
  • Use sugammadex as reversal
30
Q

What is usually the first/hallmark sign of GBS?

A

-Pins and needles & numbness.
- Starting in legs

31
Q

What can precede GBS?

A

An infection

32
Q

What drug must be avoided in GBS?

A

Succinylcholine

33
Q

What are some S/S of GBS?

A
  • BP fluctuations,
  • HTN with laryngoscopy,
  • hypotension with position changes or positive airway pressure,
  • resting tachycardia,
  • profuse diaphoresis,
  • orthostatic hypotension,
  • sudden death
34
Q

What is the better anesthetic for someone with GBS?

A
  • GETA d/t respiratory compromise & airway reflexes,
  • consider a-line,
  • use good judgement with NMDR’s
35
Q

Who is more likely to need post-op ventilation, someone with GBS or MS?

A

GBS

36
Q

What happens with Parkinson’s?

A
  • Loss of dopaminergic fibers from basal ganglia,
  • decreased NE production,
  • Lewy bodies
37
Q

What is the single most important risk factor for Parkinson’s?

A

Age

38
Q

What is the Triad of Parkinson’s?

A

Tremors, Rigidity, Akinesia

39
Q

What muscles are affected first in Parkinson’s & what does it look like?

A
  • Proximal neck muscles.
  • Loose arm swinging
40
Q

When are Parkinson’s tremors more prominent?

A

During rest

41
Q

What is the treatment goal of Parkinson’s?

A
  • Decrease effects of acetylcholine &
  • increase dopamine in basal ganglia
42
Q

What anesthetic type would be better for someone with Alzheimer?

A

TIVA

43
Q

What part of the brain is affected in Huntington’s?

A

Enlargement of lateral ventricles

44
Q

What happens in ALS?

A

Degeneration of motor neurons → respiratory failure

45
Q

What is destroyed in Myasthenia Gravis?

A

Post-synaptic Ach receptors at NMJ

46
Q

What is the hallmark of MG?

A

Weakness & rapid exhaustion of voluntary muscles followed by partial recovery

47
Q

What kind of tumor could cause MG?

A

Tumor on the thymus gland

48
Q

What are the Dx of MG?

A

Blood test & EMG

49
Q

What is the Tensilon test?

A
  • Edrophonium, a short-acting anticholinesterase med.
  • Given with atropine.
  • Symptoms of MG should improve
50
Q

What drug is usually given for MG?

A

Pyridostigmine or neostigmine

51
Q

What is a cholinergic crisis?

A

Too much Ach or substance that mimics Ach

52
Q

How do we know if someone with MG is in cholinergic crisis or myasthenic crisis?

A
  • Give Edrophonium, if they improve then they are in MG crisis.
  • If they get worse then they are in cholinergic crisis.
53
Q

Which crisis would have profound muscle weakness?

A

Cholinergic crisis

54
Q

What medications are avoided in someone with MG?

A

Calcium channel blockers & magnesium

55
Q

If muscle weakness is not treated well in MG, what can be added to help?

A

Immunosuppressors

56
Q

What is plasmapheresis?

A

Removing antibodies from circulation. Is only temporary

57
Q

What is the treatment of choice for most MG patients?

A

Thymectomy

58
Q

What are anesthetic management for MG?

A
  • 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
Q

What happens in LEMS?

A

Antibodies directed against presynaptic calcium channels at NMJ

60
Q

What muscles are more affected in LEMS vs MG?

A

Proximal muscles

61
Q

What med are LEMS patients often resistant to?

A

NMDR’s

62
Q

LEMS is often associated with what?

A

Small cell lung cancer

63
Q

Which demyelinating disease does not have autonomic dysfunction?

A

Myasthenia gravis

64
Q

Which disease has an incremental response with nerve stimulation?

A

LEMS

Principles 3 (3 decks)

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