Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUNA 684 Advanced Pathophysiology > Exam IV: Neuro Diseases > Flashcards

Exam IV: Neuro Diseases Flashcards

1
Q

CEREBRAL BLOOD FLOW(CBF):
*autoregulated—normally
*___mL/100g brain tissue when CPP ___-___ mmHG
*is about 750 ml/min (___-___% of cardiac output)

A

50
50-150
15-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

CBF governed by:

A

Cerebral metabolic rate-CMRO2
Cerebral Perfusion Pressure-CPP
PaCo2 and O2 tension
Various medications
Intracranial abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cerebral Metabolic Rate-CMR

Rate of O2 consumption-3.0-3.8mL O2/100 g brain tissue/min and consumes ____% of total body oxygen

A

20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cerebral Metabolic Rate-CMR

Most used to generate ATP for ____ ____ activity

A

neuronal electrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cerebral Metabolic Rate-CMR

*High ____ _____ + low ____ _____ = unconsciousness in 10 sec if perfusion stopped
*If not restored in ___-___ min leads to ATP stores depleted causing cellular injury/death

A

O2 consumption
O2 reserve
3-8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cerebral Metabolic Rate-CMR

Decreased by _____ temps, anesth agents
Increased by _____ temps, seizures

A

lower
higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

CPP =

A

MAP - ICP (or CVP, whichever is greater)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CPP is normally ___-___ mmHg

A

60-110

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

if ICP increases, MAP must _____ to maintain CPP

A

increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

if MAP falls below 60 mmHg, CPP _______________

A

cant be maintained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Even with normal MAP, if ICP is ______, CPP (thus CBF) can change

A

> 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CPP less than 50 mmHg shows

A

slowing on EEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CPP 25-50 mmHg shows

A

flat EEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

CPP less than 25 mmHg leads to

A

possible irreversible brain damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Autoregulation b/t 50-150 mmHG (pressure dep beyond this)
Arterial constriction with ______ BP
Arterial dilation with ______ BP

A

increased
decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Normotensive, if CBF…
___mmHg - ischemia (nausea, dizziness)
___mmHG - vessels max constricted; fluid forced out of vessel causing cerebral edema

A

35
150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hypertensive
Autoregulation curve shifted _____
Chronic HTN-lower limit shift _____

A

right
upward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Auto regulation lost or impaired with:

A
  • intracranial tumors
  • vessels around tumor are acidotic
  • maximally dilated, now all pressure dependent
  • head trauma
  • volatile anesthetics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

_____ is the most important extrinsic factor

A

PaCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

change the PaCO2, change CBF, they are _____ _____

A

directly proportional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

CBF changes approx ___-___ ml/100 g/min per mmHg change in PaCO2.
The change is _____

A

1-2
immediate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Thought to be b/c of changes in ____ of ____ around walls of arterioles, all compensated after ____-____ hours of hypo or hypercapnia

A

pH of CSF
24-48

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Marked hyerventilation - PaCo2 < 20 shifts the curve to the ____, may have ____ changes

A

left
EEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

“The ability of hypocapnia to acutely decrease ____, ____, and _____ is fundamental to the practice of clinical neuroanesthesia.”

A

CBF, CBV, and ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

CBF not significantly effected by decrease in PaCo2—–until threshold of ____
Below threshold, +cerebral vasodilation and CBF increase; +hyper_____ and +hypo_____ have synergistic effects

A

50
hypercarbia
hypoxemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Hypocapnia= ____ _____ with RISKS

A

FINE LINE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Hypocapnia may be ____ ____ during craniotomy
Impact with TBI or intracranial hemorrhage ____

A

well tolerated
unclear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

CBF changes ___-___% per 1°C

A

5-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Hypothermia - decreases ____ & ____

A

CMR and CBF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Hyperthermia - increases _____ & _____

A

CMR and CBF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Lower Hct _____ viscosity, but also _____ O2 carrying capacity

A

decreases
decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Increased Hct increases viscosity, decreases _____

A

CBF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Studies suggest optimal Hct for cerebral O2 delivery = ___%

A

30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Blood Brain Barrier

unique vessels with junctions between endothelial cells that are nearly _____

A

fused

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

BBB is a _____ barrier for brain

A

lipid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

lipid soluble (CO2, O2, H2O, and most anesthetics) move across BBB _____

A

easily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

ionized/large molecular weight have _____ movement across BBB

A

restricted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

BBB is disrupted by:

A
  • severe HTN
  • strokes
  • trauma
  • tumors
  • infection
  • hypercapnia
  • hypoxia
  • sustained seizures

(fluid movement now dependent on hydrostatic pressure not osmotic gradient)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

CSF major fxn:

A

protect CNS against trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

CSF formed by ____ _____ of cerebral ventricles (mostly _____)

A

choroid plexuses
lateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

CSF produced 2 ways

A
  1. ultrafiltration and secretion by the cells of the choroid plexus
  2. passage of water, electrolytes, and other things across the BBB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q
  1. CSF is produced by the ____ ____ in the ventricles
A

choroid plexuses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q
  1. CSF is produced by the choroid plexus in the ventricles
  2. CSF flows through the _____ _____ from the 3rd to the 4th ventricle
A

cerebral aqueduct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q
  1. CSF is produced by the choroid plexus in the ventricles
  2. CSF flows through the cerebral aqueduct from the 3rd to the 4th ventricle
  3. CSF flows into the subarachnoid space by the _____ and _____ _____ also into the spinal canal
A

lateral and medial aperatures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q
  1. CSF is produced by the choroid plexus in the ventricles
  2. CSF flows through the cerebral aqueduct from the 3rd to the 4th ventricle
  3. CSF flows into the subarachnoid space by the lateral and medial apertures also into the spinal canal
  4. CSF removes _____ and provides _____ from within subarachnoid space
A

waste
bouyancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q
  1. CSF is produced by the choroid plexus in the ventricles
  2. CSF flows through the cerebral aqueduct from the 3rd to the 4th ventricle
  3. CSF flows into the subarachnoid space by the lateral and medial apertures also into the spinal canal
  4. CSF removes waste and provides buoyancy from within subarachnoid space
  5. Excess CSF will be ______ by the _____ ____ which will drain in tho the ____ _____ sinus
A

absorbed
arachnoid villi
superior sagittal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Adults: produce ___ mL/hr (500 ml/d) ____ mL is total CSF volume

A

21
150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

LATERAL VENTRICLES
Intraventricular foramina of Monro
3rd Ventricle
Cerebral aqueduct of Sylvius
4th Ventricle
Foramen of Magendie &
Foramina of Luschka
Cisterna Magna
Subarachnoid space
Circulates around the brain & spinal cord
Absorbed into arachnoid granulations

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

cranial vault is _____

A

rigid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

vault is made up of 3 things

A

brain - 80%
blood - 12%
CSF - 8%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

if one thing in the cranial vault increases, another must ________

A

decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

ICP usually ____ mmHg or less - measured in the ____ ventricles or over the cerebral _____

A

10
lateral
cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Monro-Kellie Doctrine:

A

Any increase in one compartment must be offset by an equal reduction in another to avoid increases in ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

ICP reduction mechanisms:

A
  • increased CSF absorption
  • decreased CSF production
  • decrease in total CBV (mostly venous)
  • brain stem herniation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

normal ICP

A

5-10 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

mild increase in ICP

A

20-30 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

moderate increase in ICP

A

30-40 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

severe increase in ICP

A

> 40 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

CBV increases ___ ml/100 g of brain per 1 mmHg ↑ PaCo2

A

.05

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Blood pressure effects of CBV dependent on _______ of ______

A

autoregulation of CBF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

if increase in ICP is sustained, can lead to ______

A

herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

4 types of herniation

A
  1. cingulate gyrus under the falx cerebri (subfalcine herniation)
  2. uncinate gyrus through the tentorium cerebelli (transtentorial herniation)
  3. cerebellar tonsils through the foramen magnum
  4. transcalvarial - any area beneath a defect in the skull
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

subfalcine herniation leads to compression of anterior cerebral artery causing a _____ ____

A

midline shift

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

______ brainstem compression leads to altered consciousness, gaze defects, ocular reflex defect, hemodynamic and resp failure and then _____

A

transtentorial
death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

*If _____ herniation (medial portion of temporal lobe), oculomotor nerve dysfun

A

uncal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

S&S - pupil ______, ptosis, lat deviation of _____ eye and then death

A

dilatation
affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

S&S - indicates ______ dysfunction—cardio and resp dysfunction and leading to death

A

medullary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

ICP

HA, nausea, vomiting, pupillary dilation, blurred vision (CNII)a, inability to adduct (____) or abduct (____)eye
Focal neurological deficits and unsteady gait
Decreased consciousness, seizures, coma
Cushing’s Triad: irregular _____, _____, _____

A

CNIII
CNVI
respiration, ↑ BP,↓HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

ICP Dx:

A

symptoms, CT or MRI, or direct measurement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

_______ - helpful to measure, removal of CSF, and CSF sent to lab for analysis

A

Ventriculostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

mean ICP should remain below _____

A

15 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

dramatic increase in ICP leads to ______ and ______ change

A

hyperventilation and LOC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

causes of increased ICP

A
  • Tumor -Due to size, Indirectly b/c of edema in surrounding tissue, Causing obstruction of CSF flow out (tumor in 3rd vent)
  • Intracranial hematomas (a lot like tumor)
  • Blood in CSF (subarachnoid hemorrhage)
  • Infection (meningitis, encephalitis)
  • Aqueductal stenosis - congenital narrowing of cerebral aqueduct connecting 3rd and 4th ventricles
  • Sz disorder seen in 1/3 of these patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Decreasing ICP

elevate HOB ___-___ degrees above heart

A

15-30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Decreasing ICP

head neutral if possible, dont compress _____

A

jugulars

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Decreasing ICP

hyperventilation - maintain PaCO2 ___-____ mmHg, effects diminish in 6-12 hours, rebound increases in ICP can be problematic

A

30-35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Decreasing ICP

drain _____

A

CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Decreasing ICP

hypo_____

A

thermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Decreasing ICP

______ drugs - avoid sig hypovolemia, Mannitol 20% 0.25gm/kg, IV

A

hyperosmotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Decreasing ICP

c_______

A

corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Decreasing ICP

cerebral vasoconstrictors - ______, _____

A

barbs, prop

82
Q

Decreasing ICP

HTN control - ______, _______, keep MAP _____

A

labetalol, nicardipine
> 70

83
Q

Seizure Disorder

Abnormal _____ _____ activity in the brain
___% of population experience seizure in lifetime
Epilepsy-true disorder; recurrent seizures

A

synchronized electrical
2

84
Q

underlying mechanisms for seizure disorder: (3)

A

Loss of inhibitory activity
Enhanced release of excitatory amino acids
Enhanced neuronal firing due to voltage mediated Ca+ current

85
Q

precipitants to seizures:

A
  • Genetic predisposition (low sz threshold)
  • Brain trauma or tumor
  • Infection/febrile illness
  • Hypoxia
  • Drug overdose or withdrawal
  • Fatigue/stress
  • Methohexital (small doses)
  • Ketamine
  • Demerol
  • Metabolic defects (Na+, hypo: mag, Ca+, or glycemia, alkalosis)
86
Q

_____ –also called _____
Manifested by motor, sensory, autonomic or psych symptoms
Complex sz - impairment of consciousness

A

PARTIAL
Focal

87
Q

GENERALIZED
______ ______ electrical activity—no local onset
May or may NOT have abnormal _____ activity, loss of consciousness, etc

A

Bilaterally symmetric
motor

88
Q

Petit Mal - (absence sz) -

A

transient lapse in consciousness

89
Q

Grand Mal - (tonic clonic) - ______ common, loss of consciousness followed by clonic and tonic motor activity

A

most

90
Q

STATUS EPLEPTICUS: prolonged partial or general sz ______ recovery between attacks; _______ _______

A

without
MEDICAL EMERGENCY

91
Q

Seizure Disorder Management

PreOp eval-focus on ____, ____ of sz, and medications

A

cause, type

92
Q

Seizure Disorder Management

antiepileptic drugs - ______ ______

A

Antiepileptic drugs-continue throughout

93
Q

Seizure Disorder Management

Even partial sz can progress to generalized - major risks assoc with _____, ______, ______

A

injury, aspiration, hypoxemia

94
Q

Seizure Disorder Management

PRIORITIES

A

airway and oxygenation

95
Q

Seizure Disorder Management

AVOID

A
  • ketamine
  • methohexital
  • demerol
  • atra/cisatracurium (in large doses d/t metabolites)
96
Q

Seizure Disorder Management

expect hepatic enzyme ______, probably will _____ dose of NMB

A

induction
increase

97
Q

Seizure Disorder Management

terminate seizure with:

A

propofol 50 - 100 mg
dilantin 500 - 1000 mg slowly
benzos - midazolam - 1 - 5 mg

98
Q

Most common disorder involving motor tracts of extrapyramidal system (controlled by basal ganglia and cerebellum)

A

parkinsons disease (PD)

99
Q

PD affects 3% of _____ _____

A

elderly americans

100
Q

primary PD

A

degenerative disorder of substantia nigra; interferes with dopamine pathways to basal ganglia

101
Q

primary PD onset

A

after 50

102
Q

primary PD etiology

A

unknown

103
Q

PD hereditary pattern

A

none

104
Q

secondary PD

A

d/t trauma, drugs, infection, toxins (usually reversible)

105
Q

Parkinson’s Disease-PD

Principle feature: degeneration of ________ pathways (inhibitory) and relative excess of ________ activity (excitatory)

A

dopaminergic
cholinergic

106
Q

Parkinson’s Disease-PD

classic signs (cogwheel rigidity)
- ____ _____ tremor - rhythmic, usually at rest, usually disappear with voluntary movement; pill rolling tremor
- _______—1st appears in neck muscles; arm swinging, infrequent blinking
- _______ of facial muscles
- Often oily skin, seborrhea, diaphragmatic spasms, dementia and depression
- Eventually includes muscles of ______ and _____
- Upper airway involvement may _____ airflow

A

Skeletal muscle
Rigidity
Akinesia
chewing and swallowing
restrict

107
Q

Tx of PD

Goal is to ↑concentration of ______ in basal ganglia OR to decrease effects of _____

A

dopamine
ACh

108
Q

Tx of PD

_______-_______ precursor (Sinemet, Parcopa) - assoc with dyskinesias, confusion, HA, hallucinations

A

Levodopa-dopamine

109
Q

Tx of PD

increase myocardial _______

A

contractility

110
Q

Tx of PD

_______ hypotension

A

orthostatic

111
Q

Tx of PD

Decarboxylase inhibitor - prevents conversion of levodopa to dopamine in _____ to optimize conversion in _____ (Duopa)

A

periphery
CNS

112
Q

Tx of PD

anti______

A

anticholinergics

113
Q

Surgical Tx of PD

Deep brain stimulation- stimulates various nuclei in _____ ______ to relieve/help with tremor

A

basal ganglia

114
Q

Surgical Tx of PD

______ - rigid head frame, MRI, burr hole, electrode advanced

A

AWAKE

115
Q

Surgical Tx of PD

______ position (risk of air embolism)

A

sitting

116
Q

Surgical Tx of PD

opioids (sparingly) and _______ BEST; diphenhydramine

A

dexmedetomidine

117
Q

Surgical Tx of PD

avoid ____ and ____ bc alter recordings of nuclei thus stimulation of appropriate place

A

propofol and benzos

118
Q

Surgical Tx of PD

avoid over_____

A

oversedation

119
Q

Anesthetic Implications-PD

_____ PD meds perioperatively

A

continue

120
Q

Anesthetic Implications-PD

response to NDMR

A

generally normal

121
Q

Anesthetic Implications-PD

rare reports of increased ____ with SCh

A

potassium

122
Q

Anesthetic Implications-PD

avoid ketamine - _____ response

A

SNS

123
Q

Anesthetic Implications-PD

Predisposed to rigidity related to ______

A

opioids

124
Q

Anesthetic Implications-PD

avoid dopamine antagonists such as:

A
  • metoclopramide
  • phenothiazines (compazine, thorazine)
  • butyrophenones (haldol, droperidol)
125
Q

Most common neurodegenerative dz responsible for 40-80% dementia cases

A

Alzheimer’s Dz

126
Q

Alzheimer’s Dz

cause:

A

unknown

127
Q

Alzheimer’s Dz

characterized by ____ ____ in intellectual function (____ years). Memory, judgement, decision making, emotional lability.

A

slow decline
5+

128
Q

Alzheimer’s Dz

late signs

A

EPS, apraxias, aphasia

129
Q

Alzheimer’s Dz

marked _____ atrophy with _____ enlargement

A

corticol
ventricular

130
Q

Alzheimer’s Dz

_____ response to many of our drugs along with loss of ____ matter

A

altered
gray

131
Q

AD Pathophysiology

Proteins in the neurons become twisted and distorted “_______ triangle”

A

neurofibrillary

132
Q

AD Pathophysiology

“Senile plaques” deposit. This disrupts impulse transmission…especially in the _____ ______ and ______

A

cerebral cortex and hippocampus

133
Q

Anesthesia Considerations with AD are ________

A

COMPLICATED

134
Q

Anesthesia Considerations with AD

New onset of temporary impairment frequent after anesthesia-lasts ___-___ days following

A

1-3

135
Q

Anesthesia Considerations with AD

Consent—

A

must have from someone legally able to provide

136
Q

Anesthesia Considerations with AD

Central anticholinergics (_____/_____) - add to confusion; use ______ (doesn’t cross BBB) if anticholinergic needed

A

atropine/scop
glycopyrrolate

137
Q

Anesthesia Considerations with AD

Many studies have shown neuronal injury and cell death is related to _____ _____—much debate related to GA and elderly and pediatrics

A

anesthetic agents

138
Q

Anesthesia Considerations with AD

bottom line

A

slow, gentle, careful

139
Q

Anesthesia Considerations with AD

____ contraindications to regional or GA….but consider how you will provide anxiolysis and potential side effects

A

No

140
Q

Reversible demyelination at random and multiple sites in the brain and spinal cord

A

Multiple Sclerosis

141
Q

Multiple Sclerosis

Much inflammation which eventually causes _____ - gliosis

A

scarring

142
Q

Multiple Sclerosis

_______ initiated by a virus??

A

autoimmune

143
Q

MS - primarily affects females ___-___ years old 2:1

A

20-40

144
Q

MS - unpredictable course of _____/______

A

attack/remission

145
Q

MS - 50% require help with walking within ____ years of diagnosis

A

15

146
Q

Considerations with MS

____ or ____ can confirm

A

CSF or MRI

147
Q

Considerations with MS

remyelination is limited - ____ ____ ____

A

may not occur

148
Q

Considerations with MS

Conduction ____ still occur across demyelinated axons, but affected by many things—including _____

A

CAN
temperature

149
Q

Considerations with MS

Tx-focused on tx symptoms and stopping disease process
Effect of sx is _____
_____ _____ procedures during exacerbation

A

unpredictable
NO elective

150
Q

Considerations with MS

Peripheral nerve blocks ____ - MS is CNS disorder

A

ok

151
Q

Considerations with MS

____ _____ problems with GA

A

no specific

152
Q

Considerations with MS

if paresis or paralysis - NO ____

A

sux

153
Q

Considerations with MS

symptoms may _____ perioperatively - ASSESS

A

worsen

154
Q

Neurodegenerative, rapidly progressive of both upper and lower motor neurons

A

ALS-Amyotrophic Lateral Sclerosis(Lou Gehrig’s Dz)

155
Q

ALS-Amyotrophic Lateral Sclerosis(Lou Gehrig’s Dz)

No specific known cause—some have ____ _____
Usually present in ____ or _____—muscular weakness, atrophy, fasciculation, spasticity
__-__ years—progresses to all skeletal muscles and vent failure

A

gene deformity
50’s or 60’s
2-3

156
Q

ALS-Amyotrophic Lateral Sclerosis(Lou Gehrig’s Dz)

susceptible to _____
anesthesia focus - ____ ____

A

aspiration
resp care

157
Q

ALS-Amyotrophic Lateral Sclerosis(Lou Gehrig’s Dz)

no _____ bc of hyperkalemia risk

A

anectine

158
Q

Guillain –Barre’ Syndrome

Affects 1-4/100,000
____ onset—paralysis, areflexia, paresthesias
____ _____ paralysis is common

A

Sudden
Respiratory muscle

159
Q

Guillain –Barre’ Syndrome

Seems to be immunologic rx against ____ _____ of _____ nerves
Weakness or paralysis starts in the ____ and spreads cephalad over several days

A

myelin sheath of peripheral
legs

160
Q

Guillain –Barre’ Syndrome

multiple types (3)

A

Acute inflammatory dymelinating polyneuropathy-75%
Acute motor axonal neuropathy
Acute motor AND sensory axonal neuropathy

161
Q

GBS

Peak disability ___-___ days, recovery in weeks to months
Usually follows URI or GI infections
Associated with _____ dz

A

10-14
Hodgkin’s

162
Q

GBS

Complication of ____
Some respond to ______
Prognosis is good—although 10% die of complications and 10% have lifelong comps

A

HIV
plasmapheresis

163
Q

GBS

ANS is labile +resp insufficiency
No ____
Regional anesthesia is _____

A

anectine
controversial

164
Q

GBS Clinical Manifestations

Resp paralysis - 25% require _____ _____

A

mechanical ventilation

165
Q

GBS Clinical Manifestations

Autonomic dysfunction is common:

A

Wide changes in BP
Profuse diaphoresis
Gastroparesis
Tachycardia
Dysrhythmias

166
Q

GBS Clinical Manifestations

Bulbar involvement-45-75%
_____ _____ weakness

A

pharyngeal muscle

167
Q

GBS-Anesthesia Implications

A

Prepare for and anticipate dysrhythmias and autonomic instability
Hypotension with position change or small blood loss
Exaggerated HTN with laryngoscopy
Anectine is contraindicated
Possible post op ventilation
Regional anesthesia is controversial

168
Q

Cerebral Vascular Accident (CVA)

Cerebral perfusion is interrupted, depriving brain of ____ and _____

A

O2 and glucose

169
Q

Cerebral Vascular Accident (CVA)

creates cycle - cell hypoxia causes edema, edema causes activation of _____ _____ acids, that creates free radicals causing an influx of _____

A

excitatory amino acids
Ca++

170
Q

Perioperative Stroke

Overall risk with GA < ____
Risk with GA + hx of CVDz= _____
Mortality rate after intraoperative stroke- ____

A

.4%
.4-3%
25%

171
Q

Most common surgery related to CVA (2)

A

Open heart procedure for valve disease
Surgery on the thoracic aorta

172
Q

risk factors for CVA

A
  • HTN
  • Diabetes
  • Cigarette smoking
  • Drug abuse
  • Age >75
  • CADz
  • Hyperlipidemia
  • Atrial fib
  • Heredity
    PRIOR STROKE OR Hx of TIA
173
Q

classification of CVA - _____ or _____

A

hemorrhagic or ischemic

174
Q

ischemic CVAs (3)

A
  • thrombotic
  • embolic
  • global hypoperfusion
175
Q

CVA-Hemorrhagic

Most common cause is ____ (60-80%)
Other causes: ruptured aneurysm, AV malformation, bleeding into tumor, coag defect
____ usually associated with this type of stroke

A

HTN
HA

176
Q

CVA-Thrombotic

Arterial occlusion caused by thrombi in _____ or _____ vessels
Assoc with: atherosclerosis, diabetes, hypercoags, dehydration, arteritis, polycythemia vera, hypertension
Typically evolves over _____ to ____s

A

carotid or cerebral
minutes to hours

177
Q

CVA-Embolic

Fragments break from thrombi formed ______ the brain
Associated with atrial fib, endocarditis, valve prosthesis, carotid dz, valvular and aortic surgery
Less common: ____, _____, or _____ emboli
Often lodge in the ____ ____ ____

A

outside
air, fat, or tumor
middle cerebral artery (MCA)

178
Q

Thrombotic or Embolic Stroke

IV fibrinolytic tx within ___ ____ of onset of symptoms

A

3 hours

179
Q

Thrombotic or Embolic Stroke

Do NOT give ____, ____, or ____ until CAT scan has ruled out an intracranial hemorrhage

A

ASA, heparin, or tPA

180
Q

Thrombotic or Embolic Stroke

No fibrinolytic Rx: (4)

A
  • Hx or evidence of bleed
  • Known AVM, aneurysm, or neoplasm
  • Platelet count <100,ooo or INR >1.7
  • Stroke, neurosurgery, or head trauma within the past 3 months
181
Q

CVA-Anesthetic Implications

____ ____ before discontinuing antiplatelet and anticoags before surgery

A

Neuro consult

182
Q

CVA-Anesthetic Implications

Resistance to NMB in ____ ____

A

paretic limb

183
Q

CVA-Anesthetic Implications

Monitor TOF in _____ _____

A

nonparetic limb

184
Q

CVA-Anesthetic Implications

avoid ____

A

sux

185
Q

CVA-Anesthetic Implications

____ may be safer for some procedures (Hip fx)

A

RA

186
Q

CVA-Anesthetic Implications

Post CVA, area of infarct:
Loss of ______
Loss of ____ responsiveness
Loss of _____ integrity

A

autoregulation
CO2
BBB

187
Q

CVA-Anesthetic Implications

Keep BP slightly higher than normal in the hypertensive patient
*____ ____ in autoreg curve

A

right shift

188
Q

Cerebrovascular Dz

Typically have hx of ____ or _____
Risk of stroke ↑ with ____ and _____ of procedure

A

TIA or stroke
age and type

189
Q

Cerebrovascular Dz

Asymptomatic ____ _____ —up to 4% in those <40

A

carotid bruits

190
Q

Cerebrovascular Dz

Those at greatest risk :

A

open heart procedures with valvular dz, CADz with ascending aortic atherosclerosis, and diseases of thoracic aorta

191
Q

Cerebrovascular Dz

All due to _____ (air, clots, debris)

A

embolism

192
Q

Cerebrovascular Dz

Non cardiac surgery-risk assoc with _____/_____

A

hyper/hypotension

193
Q

CVAs and HTN

A
  • Hemorrhagic stroke due to intercerebral bleed
  • Sustained HTN causes BBB breakdown
  • Pulse pressures >80 mmHg leads to endothelial injury thus hypoperfusion or embolism
  • Blood flow abnormalities-resolve in 2 weeks
  • BBB and CO2 responsiveness-takes 4 weeks to heal
  • Emergency: hemorrhage, cardiac sources emboli, symptomatic carotid dz
194
Q

CVAs and HoTN

A
  • watershed infarcts
195
Q

CVA management

  • Neuro and CV eval—no ____ _____ in those with TIA’s that haven’t been evaluated
  • Most have comorbidities (HTN, renal dz, diabetes, hyperlipidemia, etc)
  • Many on long term ______ or ______ ______
A

elective surgery
coumadin or antiplatelet therapy

196
Q

may see CVA pts for:

A
  • Removal of emboli
  • CEA
  • Endovascular procedures
  • Hematoma evac
  • Decompressive craniotomy
    (Arterial line, have iv vasodilators and β blockers ready)
197
Q

Spinal Cord Disorders

Numerous types: (5)

A
  • Tumors
  • Abscess
  • Spinal stenosis
  • Fractures (vertebral)
  • Degenerative disc disease
198
Q

SC disorders divided up into ____, _____, _____ and/or _____ issues

A

cervical, thoracic, lumbar, and/or sacral

199
Q

Symptoms of SCD

Loss of _____
Weakness or paralysis of extremities
Reflex changes (_____ or _____)
Bladder or bowel incontinence
Back pain
______ spasms

A

sensation
hyper or hypo
Muscle

200
Q

SCD - DX by:

A

DX by MRI/CT, Xray, myelogram

201
Q

Causes of Spinal Cord Disorders

A

Trauma (fall, MVA, diving, trampoline, GSW, etc.)
Infection/abscess
Autoimmune disorders

202
Q

SCD AIs:

  • Airway-neutral intubation, possible obstruction/edema, recurrent laryngeal damage
  • Positioning issues/injuries
  • Cardiovascular issues: reflex bradycardia, arrhythmias, hyper and hypotension
  • Respiratory issues-ventilation, ? Paralysis, need for post op ventilation
    ?pneumonia
  • Potential loss-blood and CSF
A

NUNA 684 Advanced Pathophysiology (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions