Neuro

Question 1

Anaesthetic drugs that increase CBF

Answer 1

Volatile (halothane> iso and des >sevo)
Nitrous
Ketamine

Question 2

Anaesthetic drugs that reduce CBF

Answer 2

Propofol 
Thiopentone 
Etomidate 
Dexmed
Benzodiazepines
Barbiturates 

Opiods- dose and agent specific
Morphine does not effect CBF

Question 3

Anaesthetic drugs that increase the cerebral metabolic rate

Answer 3

Ketamine

Question 4

MRI causes alignment of atoms with ODD number of protons and neutrons in patient

Answer 4

True

Question 5

Parameters after brain injury include map/pa02/glucose

Answer 5

Map > 80
Pao2 >13
Glucose 6-10

Question 6

EVD is safest way to monitor ICP T/F

Answer 6

False - evd is gold standard but associated with haemorrhage and infection

Question 7

CPP =

Answer 7

CPP = map -icp (+cvp)

Question 8

Normal ICP

ICP in head injury to treat

Answer 8

Normal ICP 5-15mmhg

Head injury treat ICP >20

Question 9

Medullary coning may present with what symptoms

Answer 9

Medullary coning presents with decorticating posturing, respiratory depression and bradycardia

Question 10

Presentations of macroadenoma

Answer 10

Visual changes ie bitemporal hemianopia
Headache
CN palsies ie loss of smell

Question 11

Presentations of micro adenomas

Answer 11

Endocrine abnormalities

Coincidental finding

Question 12

Describe short sync then test

Answer 12

Short synacthen test is to assess adrenal response to strep (ie cortisol response to acth)

Synthetic acth given, cortisol levels taken baseline 30 and 60 mins

Should double or be more than 480nmol/l

If not evidence of adrenal insufficiency

Question 13

Perio operative mamagement if low short synacthen

Answer 13

Adrenal insufficiency so give 
IV hydrocortisone 
IV fluids 
Monitor glucose 
Monitor electrolytes

Question 14

Post op complications of tea sphenoid alcohol surgery

Answer 14

Persistent csf leak 
Epistaxis 
CN injury 
Cerebral ischaemia 
Vascular injury 
Infection
apoplexy

Question 15

Neuro endocrine disorders after pituitary surgery

Answer 15

Adrenal insufficiency
Siadh
DI

Question 16

Non surgical treatments of acromegaly

Answer 16

Dopamine agonists ie bromlcriptine carbergoline

Somatostatin analogues is octreotide

GH receptor antagonists

Radiation

Question 17

Procedures to prone for

Answer 17

Scoliosis 
Posterior craniotomy 
Ultra low bowel resection 
Achilles
Ankle 
Ercp

Question 18

Physiological effects of prone

Answer 18

Cardiovascular

Increased svr 
Reduced preload 
Reduced stroke volume 
Increased heart rate 
Reduced co 
Increased CVP 

Resp

Increased FRC
Better vq matching

Question 19

Risks of prone position

Answer 19

Eye damage 
Airway loss
Oropharyngeal odema 
Aspiration 
Direct pressure 
Peripheral nerve damage 
AVN 
Abdominal compartment syndrome

Question 20

Indications for awake craniotomy

Answer 20

Tumours near eloquent brain cortex
Epilepsy surgery
DBS

Question 21

Contraindications to awake craniotomy

Answer 21

Patient refusal 
lA allergy 
Inability to lie still 
I inability to cooperate ie confusion 
Language barrier 
Hearing or visual impairment 
OSA 
Inability to lie flat

Question 22

Scalp block

Answer 22

Calculate volumes and make sure communicate with surgeons

Supratrochlear v1 
Supraorbital 
Zygomaticotemporal 
Auriculotemporal 
Lesser occipital 
Greater occipital 
Great auricular

Question 23

Intraoperative problems with awake craniotomy

Answer 23

Airway - obstruction aspiration LMA issues
Breathing - hypoxia hypercarbia
Circulation - Brady tachy hypotension hypertension
Disability - confusion agitation LAST
Anaesthetic technique - pain inadequate sedation
Surgery - vae seizures brain swelling