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KLowe Neuro > Exam 2 Review > Flashcards

Exam 2 Review Flashcards

1
Q

___ (upper/lower) motor neuron injuries can cause spastic paralysis

A

Upper motor neuron injuries

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2
Q

___ (upper/lower) motor neuron injuries are typically not associated with muscle atrophy (until later on in the disease)

A

Upper motor neuron injuries

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3
Q

___ (upper/lower) motor neuron injuries cause hyperreflexia

A

Upper motor neuron injuries

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4
Q

___ (upper/lower) motor neuron injuries cause flaccid paralysis

A

Lower motor neuron injuries

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5
Q

Lower motor neuron injuries ___ (are/are not) associated with muscle atrophy; cause ___reflexia (hypo/hyper)

A

Lower motor neuron injuries are NOT associated with muscle atrophy; cause hyporeflexia

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6
Q

Injuries above T___ will cause autonomic dysreflexia, neurogenic shock, and paralysis below the level of injury

A

Above T6

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7
Q

Autonomic dysreflexia and autonomic hyperreflexia are two terms that can be used interchangeably—T/F?

A

True… dysreflexia = hyperreflexia

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8
Q

Injuries above T6 can cause neurogenic shock, especially when the T___-T___ levels are damaged

A

T1-T4 levels—cardiac accelerators

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9
Q

Autonomic hyperreflexia = dangerously high ___; can be caused by T___ and above spinal cord injuries; can be precipitated by noxious stimuli ___ (above/below) the level of injury

A

Dangerously high BP; can be caused by T6 and above spinal cord injuries; can be precipitated by noxious stimuli below the level of injury

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10
Q

Cysto patients with spinal cord injuries are infamous for autonomic hyperreflexia—T/F?

A

True

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11
Q

Spinal cord transections above T6 will very frequently have autonomic hyperreflexia—T/F?

A

True

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12
Q

What nerves innervate the diaphragm?

A

C3-C5

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13
Q

C___-C___ injuries cause quadriplegia and need for mechanical ventilation

A

C1-C4 injuries

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14
Q

C___ and above injuries = difficulty clearing secretions

A

C5 and above injuries

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15
Q

Patients with C5 and above injuries will have difficulty clearing secretions, which indicates a need for mechanical ventilation—T/F?

A

True

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16
Q

___ (parasympathetic/sympathetic) nervous system = rest and digest

A

Parasympathetic nervous system

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17
Q

PNS originates in ___ and ___ areas of spinal cord and brainstem; uses ___ as the neurotransmitter

A

Cranial and sacral areas of spinal cord and brainstem; uses ACH as the neurotransmitter

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18
Q

___ (parasympathetic/sympathetic) nervous system = fight or flight

A

Sympathetic nervous system

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19
Q

SNS ___ (increases/decreases) HR and contractility; ___ (contracts/relaxes) the muscles of the airways, broncho___ (constricts/dilates)

A

Increases HR and contractility; relaxes the muscles of the airways, bronchodilates

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20
Q

Even though there are both alpha and beta receptors on the bronchioles, the bronchioles are dominated by ___ (alpha/beta) receptors, which cause smooth muscle ___ (contraction/relaxation)/broncho___ (constriction/dilation)

A

The bronchioles are dominated by beta receptors, which cause smooth muscle relaxation/bronchodilation

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21
Q

Alpha and beta receptors are both adrenergic receptors that are stimulated by the SNS—T/F?

A

True

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22
Q

The alpha receptors on the bronchioles play a major role in smooth muscle contraction and bronchoconstriction—T/F?

A

False—alpha receptors on the bronchioles play a very very MINOR role in smooth muscle contraction/bronchoconstriction

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23
Q

The bronchioles are dominated by beta receptors—T/F?

A

True

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24
Q

Except for glands, viscera, and the adrenal medulla, the receptors of the SNS are ___ and ___ receptors and are referred to as ___ receptors

A

The receptors of the SNS are alpha and beta receptors and are referred to as adrenergic receptors

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25
Q

Receptors of the PNS are ___, referred to as ___ receptors, and use ___ as a neurotransmitter

A

Receptors of the PNS are muscarinic, referred to as cholinergic receptors, and use ACH as a neurotransmitter

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26
Q

Alpha 1 = vaso___ and broncho___

A

Vasoconstriction and bronchoconstriction

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27
Q

Alpha 2 activation inhibits the release of ___

A

Norepi

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28
Q

What two medications are alpha 2 agonists?

A

Clonidine and precedex

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29
Q

Beta 1 receptors are present on the ___ (what organ?); ___ (increase/decrease) HR and contractility; ___ (increase/decrease) AV node conduction

A

Beta 1 receptors are present on the heart; increase HR and contractility; increase AV node conduction

30
Q

Beta 2 receptors = vaso___ (constriction/dilation); broncho___ (constriction/dilation)

A

Vasodilation; bronchoconstriction

31
Q

What receptors dominate when it comes to increasing BP?

A

Alpha 1 receptors

32
Q

What receptors relax the smooth muscles, specifically the uterus?

A

Beta 2 receptors

So a beta 2 agonist will relax the uterus

33
Q

Activation of muscarinic receptors ___ (increases/decreases) HR and contractility; causes broncho___ (constriction/dilation); vaso___ (constriction/dilation)

A

Activation of muscarinic receptors decreases HR and contractility; causes bronchoconstriction; vasodilation

34
Q

What is the captain of the autonomic nervous system?

A

Hypothalamus—controls autonomic NS

35
Q

The brainstem has control over ___ and ___ function

A

CV and pulmonary function

36
Q

Autonomic reflexes will suppress one branch of the ANS while activating the other branch—i.e.: when SNS is activated, PNS is inactivated and vice versa—T/F?

A

True

37
Q

Neurogenic shock causes loss of ___ tone

A

Neurogenic shock causes loss of vasomotor tone

38
Q

Loss of vasomotor tone = ___tension; causes diminished ___ (SNS/PNS) innervation of the heart which results in ___cardia

A

Hypotension; causes diminished SNS innervation of the heart which results in bradycardia

39
Q

Normal ICP = ___-___ mm Hg

A

5-15 mm Hg

40
Q

ICP is usually treated above ___ mm Hg

A

Above 20 mm Hg

41
Q

ICP can be affected by anesthetic meds and techniques—T/F?

A

True

42
Q

CSF accounts for ___-___% of intracranial volume

A

10-15%

43
Q

Choroid plexus produces ~___ ml of CSF per day

A

~500 ml of CSF per day

44
Q

Total volume of CSF at any one time = ___ ml

A

150 ml

45
Q

Cerebral edema can be caused by ischemic stroke, meningitis, or disruption of blood brain barrier—T/F?

A

True

46
Q

Cerebral blood flow accounts for ~___% of cardiac output and is tightly coupled to ___

A

Cerebral blood flow accounts for ~14% of cardiac output and is tightly coupled to CMRO2

47
Q

Cerebral blood flow is autoregulated between MAP of ___-___ mm Hg

A

60-160 mm Hg

48
Q

Autoregulation of CBF can be lost with ___osis, ___ia, and ___ anesthetics

A

Acidosis, hypoxia, and volatile anesthetics

49
Q

PaCO2 is a potent cerebral vaso___, has an approximately linear relationship to ___, and is a potent determinant of ___

A

Potent cerebral vasodilator, has an approximately linear relationship to CBF, and is a potent determinant of CBF

50
Q

Regarding PaO2–once PaO2 drops below ___ mm Hg, there is an increase in cerebral blood flow, even in the presence of ___capnia

A

Once PaO2 drops below 50 mm Hg, there is an increase in cerebral blood flow, even in the presence of hypocapnia

So, even if you are blowing off CO2 and keeping CBF/ICP down, if you allow the PaO2 to drop below 50, it doesn’t make a difference how much CO2 you are blowing off

51
Q

PaO2 of 50 mm Hg approximately equates to SaO2 of ___

A

SaO2 of low to mid 80s

52
Q

Don’t let patients with increased ICP O2 sat drop below ___

A

Mid 80s

53
Q

Volatile anesthetic agents ___ (increase/decrease) CBF; ___ (increase/decrease) CMRO2; and have a profound effect on ___ (motor/sensory) evoked potentials

A

Volatile anesthetic agents increase CBF; decrease CMRO2; and have a profound effect on motor evoked potentials

54
Q

Propofol and etomidate ___ (increase/decrease) CBF; ___ (increase/decrease) CMRO2

A

Decrease CBF; decrease CMRO2

55
Q

Ketamine ___ (increases/decreases) CBF; ___ (increases/decreases) CMRO2

A

Increases CBF; increases CMRO2

56
Q

Opioids alone have no direct effect on CBF—T/F?

A

True

However—if you give patients opioids any time BEFORE securing the airway (i.e.: during induction), they can suppress the respiratory drive, patient will become hypercarbic/hypoxic, which will then cause an increase in ICP…but opioids alone have no direct effect on CBF

57
Q

Benzos have minimal effect on CBF—T/F?

A

True

58
Q

Studies have shown that there is no clinically significant increase in CBF with the administration of succinylcholine—T/F?

A

True

59
Q

___ (somatosensory/motor) evoked potentials are exquisitely sensitive to inhalational agents

A

Motor evoked potentials

60
Q

Monitoring of MEPs requires the patient to NOT be paralyzed throughout the entire case—T/F?

A

True

61
Q

If MEPs are going to be monitored during a case, it is typically okay to paralyze the patient during induction—T/F?

A

True—just make sure you communicate with neurophysiology to know when they are going to want twitches back/begin monitoring MEPs so you don’t re-dose your paralytic

62
Q

Regarding evoked potentials—what (2) medications enhance the quality of SSEP signals?

A

Ketamine and etomidate

63
Q

What (2) medications attenuate (AKA reduce) the amplitude of all evoked potentials?

A

Propofol and thiopental

64
Q

Propofol and thiopental attenuate the amplitude of evoked potentials but do not obliterate them—T/F?

A

True

65
Q

Opioids, benzos, and precedex have negligible effects on the recording of evoked potentials—T/F?

A

True

66
Q

Inhalation agents, including nitrous oxide, generally have more depressant effects on evoked potential monitoring than do IV agents—T/F?

A

True

67
Q

Volatile agents can have profound influence on amplitude and latency of evoked potentials, both sensory and motor—T/F?

A

True

68
Q

Evoked potential signals are not obtainable under inhalation agents—T/F?

A

False—signals ARE obtainable under inhalation agents, but the anesthetic is typically kept at sub MAC doses to avoid degradations in the quality of signals

69
Q

Cerebral oximetry can be used in any procedure where there may be vascular compromise to the ___ from restriction of blood flow

A

Vascular compromise to the brain from restriction of blood flow

70
Q

___% decrease in cerebral oximetry is significant

A

20% decrease

71
Q

Cerebral oximetry can be used in any procedure where there may be vascular compromise to the brain from patient positioning—T/F?

A

True

KLowe Neuro (3 decks)

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