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SEE Exam Review > Neuro > Flashcards

Neuro Flashcards

1
Q

What is CN I and the function?

A

Olfactory Nerve

Smell

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2
Q

What is CN II and its function?

A

Optic Nerve

Vision

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3
Q

What is CN III and its function

A

Occulomotor

Adduction of the eye and pupillary constriction

Superior Rectus
Interior Rectus
Medial Rectus
Inferior Oblique

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4
Q

What does the superior rectus muscle do?

A

Allows eye to look up

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5
Q

What does the Medial rectus muscle do?

A

look medially
Adduction

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6
Q

What does the inferior rectus do?

A

Eye Looks down

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7
Q

What does the Inferior oblique do?

A

Looks out and up

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8
Q

What is CN IV and its functioN?

A

Trochlear Nerve

Eye movements (superior oblique)

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9
Q

What does the superior oblique muscle do/

A

Eye looks down and in

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10
Q

What is CN V and its function?

A

Trigeminal Nerve

Chewing, Mastication, Facial sensory

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11
Q

What is CN VI and its function?

A

Lateral rectus
Abduction of eye (LR6, SO4)

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12
Q

What is CN VII and its function?

A

Motor of Facial muscles
Taste to anterior 2/3 of tongue

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13
Q

What is CN VIII and its function?

A

Vestibulocochlear

Hearing
Balance

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14
Q

What is CN IX?

A

Glossopharyngeal Nerve

Taste to Posterior 1/3 of tongue
Carotid and Sinus AF

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15
Q

What is CN X and what is it responsible for?

A

Parasympathetic innervation (efferent)
Decrease HR

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16
Q

What is CN XI and what is its function?

A

Spinal Accessory

Motor control of the larynx and pharynx
Also in control of shrugging shoulders

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17
Q

What is CN XII and what is its function?

A

Hypoglossal

Tongue muscles

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18
Q

What is the equation for Cerebral blood flow?

A

Cerebral perfusion pressure/cerebral vascular resistance

approx 750 mL (50 ml/100g/min)

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19
Q

What is the equation for CPP?

A

MAP - ICP (or RAP)

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20
Q

How do you determine to use RAP or ICP?

A

Use the higher one

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21
Q

How much glucose does the brain consume?

A

5mg/100g/min

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22
Q

In a non-ischemic brain, what happens during cerebral steal?

A

Increased blood flow and increased vessel diameter

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23
Q

In a non-ischemic brain, what happens during inverse steal?

A

Decreased blood flow and decreased vessel diameter

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24
Q

In an ischemic brain, what happens during cerebral steal?

A

Decreased blood flow
Vessel diameter is already maxed out

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25
Q

In an ischemic brain, what happens during inverse steal?

A

Increased blood flow

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26
Q

If you increase CO2 or give a vasodilator, what happens in the cerebral steal scenario?

A

Increases steal

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27
Q

If you hyperventilate a patient undergoing cerebral steal, what happens?

A

Inverse steal and returns to normal

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28
Q

What is the occulocardiac reflex?

A

Afferent pathway - CN V
Efferent pathway - CN X

triggers by traction of the extraoccular muscles –>
- MEDIAL RECTUS
- Occular manipulation
- Manual pressure on the eye

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29
Q

What are the EKG manifestations of the occulocardiac reflex?

A

Decreased HR
Junctional rhythm
PVCs

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30
Q

How do you treat/block the occulocardic reflex?

A

Anti-muscarinic meds
Retrobulbar block
IA

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31
Q

What is normal ICP?

A

5-15

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32
Q

What ICP shows focal ischemia?

A

25-55 mmHg

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33
Q

What ICP shows global ischemia?

A

> 55 mmHG

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34
Q

What is the IC volume made up of in the brain?

A

80% brain matter and intracellular H2O
12% blood
8% CSF

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35
Q

What are the three ICP waveforms?

A

A - plateau waves, found in pts with Increased ICP
B
C

36
Q

What are the 12 s/sx of Increased ICP?

A

Headache
N/V
Blurred vision
unilateral pupil deviation
papilledema
CN III paralysis
CN VI paralysis
HTN
Bradycardia
Irregular respirations
Altered LOC
Seizures

37
Q

What is Cushing’s triad?

A

HTN
Bradycardia
Irregular Respirations

38
Q

How do you treat increased ICP

A

Hyperventilate to PaCo2 25-30
Elevate HOB to 30
Control BP
Administer Mannitol or Lasix
Give Steroids
Restrict fluids
Administer cerebral vasoconstrictor
Cool pt to 34C for cerebral protection

39
Q

How much mannitol do you give for elevated ICPs?

A

0.25-1 g/kg

40
Q

What is decorticate posturing?

A

Above the cerebellum injury

Flexion of the upper and extension of the lower

41
Q

What is decerebrate posturing?

A

Injury to the brainstem

Extension of arms and legs
Arched body

42
Q

What is held in the anterior cranial fossa?

A

Frontal lobe

43
Q

What is held in the middle anterior cranial fossa?

A

Temporal lobe

44
Q

What is held in the posterior cranial fossa?

A

Brainstem and Cerebellum

45
Q

When does the anterior fontanelle close?

A

18 months

46
Q

When do the posterior and anterolateral fontanelles close?

A

2 months

47
Q

When do the posterolateral fontanelles close?

A

2 years

48
Q

What is the specific gravity of CSF?

A

1.003 - 1.009

49
Q

What is an example of a hyperbaric solution to CSF?

A

D10 (dextrose)

50
Q

What is a hyperbaric solution to CSF?

A

NS
Sterile H2O

51
Q

How many mL of CSF Form in an hour? In a day?

A

20-30 mL in 1H

500-700 ml/day

52
Q

Where is CSF formed?

A

Choroid Plexus

53
Q

Where is the choroid plexus located?

A

Temporal horn of lateral ventricles
Posterior portion of the third ventricle
Roof of the fourth ventricle

54
Q

Where is the CSF reabsorbed

A

Arachnoid villi mostly
Also in the spinal villi and lymphatics

55
Q

What is the total volume of CSF held in the brain and spinal column at once?

A

150 ml

56
Q

Where is the most common CSF obstruction?

A

Aqueduct of Sylivus

57
Q

How does CSF Flow?

A

Choroid plexus
Lateral Ventricles
Foramen of Monroe
Third Ventricle
Aqueduct of sylvius
Fourth Ventricle
Into
- Foramen Luschka
- Foramen Magendie
SA Space
Brain
Arachnoid Villi

58
Q

What are the four factors governing passage across the BBB

A

Size –> Smaller crosses easier
Charge – ions do not cross
Lipid solubility –> increased lipid solubility = easier time crossing
Degree of protein binding
- water and gases cross
- H2Osoluble drugs do not cross

59
Q

What four electrolyte disorders decrease seizure threshold?

A

(increased seizure activity)

Hypocalcemia
Hypomagnesemia
Hyponatremia
Hypernatremia

60
Q

What conditions are likely to decrease seziure threshold?

A

hypoglycemia
alkalosis

61
Q

What opioid is most likely to cause seizures?

A

Demerol

62
Q

What two meds together can cause seizures?

A

Ketamine
Aminophylline

63
Q

What happens in acute spinal shock?

A

HYPOTENSION due to sympathetic blockade
BRADYCARDIA due to blockade of cardiac accelerators

64
Q

What level is autonomic hyper-reflexia located at in the spinal column?

A

T5 or T6

65
Q

What is triple H therapy?

A

Hypervolemia (>10 mmHg)
Hypertension (SBP 160-200 mmHg)
Hemodilution (Hct 33%)

66
Q

When might you see a cerebral vasospasm?

A

4-12 days post op /post injury

67
Q

What are some s/sx of a vasospasm?

A

Worsening H/A
Confusion
HTN

68
Q

What medication is used to treat vasospasm?

A

Nimodipine

69
Q

What is a wake up test and why is ti used?

A

used to test the motor tracts of the brain

Monitors the anterior (ventral) spinal cord –> supplied by the anterior spinal arteries

70
Q

What are some complications associated with a wake up test?

A

Recall
Extubation
Dislodgement of Spinal instrumentation
VAE from spontaneous ventilation

71
Q

What medications do you want to avoid in Parkinson’s pts?

A

Reglan
Compazine
Droperidal
ALl meds that decrease dopamine!

72
Q

if you suspect a VAE, what should you do?

A

Doppler at RA 3rd -6th ICS, Right of sternum to look for wheel hill murmur

Notify surgeon to flood the field
Turn off N2O
Administer 100% FiO2
Aspirate Central venous catheter to remove air
Increased CVP (VALSALVA MANEUVAR)
CV drugs to support circulation
Bilateral jugular vein compressionm
PEEP applied
Left lateral decubitus with 15 degree head down to sit

73
Q

What makes up the circle of willis?

A

R?L internal carotid arteries
Basilar and vertebral arteries

74
Q

What is the delta brain wave?

A

Delta wave is the highest amplitude wave

found in sleeping adults, abnormal in awake adults

75
Q

What is the theta brain wave?

A

Lesser amplitude than delta but more than higher than alpha and beta

76
Q

What is the Beta brain wave

A

Alert but relaxed brain state
Eyes closed

Higher in amplitude than the alpha wave

77
Q

What is the alpha brain wave?

A

Low amplitude, made by frontal head movement

business activity

78
Q

When might you see variations in the beta waves?

A

if given propofol or benzodiazepines

79
Q

With surgical stimulation or light anesthesia, what brain waves might you see?

A

Increased high frequency waves
Low voltage activity

80
Q

With GA, what brain waves might you see?

A

Decreased Alpha and beta,

increased low frequency theta and delta waves

81
Q

What inhalation agents can attenuate epileptic activity?

A

Sevo & Enflurane

82
Q

What meds are used for burst suppression>

A

Propofol
Barbiturates
Etomidate

83
Q

What medications DO NOT produce a change in latency and amplitude?

A

Ketamine
Opioids
Etomidate

84
Q

Where is the sensory portion of the spinal cord?

A

Afferent side – Dorsal Horn (posterior portion)

S-sensory
A- afferent
D- dorsal horn

85
Q

Where is the motor portion of the spinal cord?

A

Efferent side, anterior portion, ventral horn

86
Q

What does SSEPs monitor?

A

Monitor the dorsal horn – posterior portion

TELLS US ABOUT THE POSTERIOR SPINAL ARTERIES

87
Q

For the sensory

A

SEE Exam Review (3 decks)

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