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DSouza 2015 > Neuro > Flashcards

Neuro Flashcards

1
Q

Depolarization of nerve is due to the … of Na … the cell

However depolarization of SA node is due to the entry of … into pacemaker cell

A

Entry of Na into cell

Ca

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2
Q

The concentration of Cl, Mg, and PCO2 is higher/lower in CSF compared to the plasma concentration?

A

Higher

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3
Q

During ECT treatment there is initial parasympathetic stimulation followed by sympathetic stimulation. Initial arrhythmias is … followed by ….

A

Bradycardia then tachycardia

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4
Q

The purpose of using succinylcholine during ECT treatment is to ….

A

Avoid fractures during seizure activity

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5
Q

Drugs increases seizure duration of ECT?

A

Etomidate, Caffeine, Aminophylline

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6
Q

Drugs decreases seizures duration of ECT duration?

A

Thiopental, propofol, midazam, lidocaine, diltiazem, esmolol

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7
Q

I’m a patient with failed prior ECT treatment, due to shorter seizure duration, …. should be used

A

Etomidate

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8
Q

Propfol and thiopental effect on seizure

A

Decreases its duration and increases threshold

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9
Q

Ketamine and lidocaine effect on seizure duration

A

Decreases its duration

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10
Q

Etomidate effect on seizure

A

Prolongs it’s duration

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11
Q

Absolute CI for ECT

A

Pheochromocytoma

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12
Q

Relative CI for ECT

A

Pregnancy
Cardiac conduction defects
Aortic and cerebral aneurysm
Recent CVA

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13
Q

Is AICD CI for ECT?

A

No. It should be deactivated prior to ECT and interrogation done after ECT ttx

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14
Q

Most sensitive evoked potential to anesthetic

A

VEP

VEP > MEP > SSEP > BAEP

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15
Q

Most resistance evoked potential to anesthetic

A

Brain stem Auditory evoked potential

BAEP

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16
Q

Thiopental + propofol + isoflurane effect on SSEP amplitude…. and it …. SSEP latency

A

They decrease amplitude and increase latency

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17
Q

…. unique in increasing both amplitude and latency of the SSEP

A

Etomidate

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18
Q

Ketamine and N2O increases or decreases SSEP amplitude and it latency

A

Both effect amplitude only.

Ketamine increases it

N2O decreases it

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19
Q

Persistent vegetative state vs coma?

A

If ptn can be partially aroused -> vegetative

Cannot aroused with painful stimuli, light/sound -> coma

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20
Q

Brain death causes absent cortical and brain stem function, however … are active

A

Spinal reflexes

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21
Q

Choice of treating bradycardia in brain dead ptn?

A

Direct acting drugs (isoproterenol, epi). And pacing

The indirect (atropine) ineffective

22
Q

Most common abnormality in brain dead patients?

A

HyperNa from DI

23
Q

EEG waves of awake? Relax state? And sleep?

A

Beta -> awake
Alpha -> relaxed
Theta -> sleep and anesthesia

Delta -> Deep anesthesia

24
Q

Burst suppression on EEG waves is the goal of …. administration and overdose of those meds will causes … on EEG

A

Barbiturates/ propfol

Avoid the electrical silence EEG

25
Q

Signs of cerebral ischemia on EEG

A 
Slowing waves (theta and delta)
Changes in spectral edge
Burst suppression 
Loss of evoked potentials 
Isoelectric EEG
26
Q

What dose slowing of spectral edge frequency on EEG hints for?

A

Cerebral ischemia

Deepening anesthesia

27
Q

Spike and dome activity on EEG?

A

Epileptic activity

28
Q

So N2O increases CMRO2 which leads to increase CBF and propfol/thiopental dose the opposite. What about isoflurane?

A

decreases CMRO2 but increases CBF

29
Q

Decreases PaO2 has no effect on CBF until it reaches …. below this level CBF increases

A

60 mmHg below this a steep increase in CBF

30
Q

PaCO2 curve become flat below …. and above …. on CBF/pressure curve.

In between an increase in each PaCO2 causes increase CBF by …/100gm of the brain tissue

A

Below 25 mmHg and above 100 mmHg a flat line

1 mmHg PaCO2 increase causes increase of 1mL/100 g of brain tissue (2% increase)

31
Q

Normal CBF …/100gm of brain tissue

…% of CO

… mL per minute

A

50 mL

15%

750 mL

32
Q

CMRO2 is ~ …/ 100gm of brain tissue

A

3-4 mL

33
Q

The organ that consumes highest amount of O2 per fm:tissue is ….

A

Myocardium

34
Q

… has the highest blood flow per gm of the tissue

A

Carotid body

35
Q

…. circulation is not auto regulated

A

Uterine

36
Q

CBF auto regulation shifted to right in …. and left in ….

A

Chronic HTN

Neonates and they have narrow range of MAP

37
Q

Isoflurane produces …. waves on EEG at … MAC

A

Isoelectric at 2 MAC

38
Q

The best measure for ICP control during resection of Supranational tumor is …. and maintaining…. and avoiding ….?

A

Mannitol and maintaining normocarbia. Avoiding hyperventilating to not further decreasing CBF to compromised brain tissue area???

39
Q

Complications of hypertonic mannitol?

A

Volume expansion
Hyperosmolality
HypoNa

Likely occur in RF or large doses

40
Q

The goal of anesthetic during clipping of intracranial aneurysm?

A

Maintenance of CPP and transmural pressure gradient (TMPG)

Sudden increase in MAP or decrease in ICP will change in TMPG and will make aneurysm vulnerable for rupture

41
Q

When is the optimal time to unclamped the lumber drain during intracranial aneurysm repair?

A

After surgeon opens the dura.

If it’s unclamped before a sudden decrease in ICP May result in change in TMPG and the aneurysm rupture

42
Q

DI vs SIADH vs cerebral salt wasting

A

Differentiated by Volume status and serum Na

DI hypovolemia + hyperNa

SIADH hypervolemia + hypoNa

CSW. Down down both hypoV hypoNa

43
Q

During posterior fossa craniotomy, the pressure transducer should be zeroed at the level of

A

External auditory meatus

44
Q

… most sensitive method to detect Air embolism and …. is second most sensitive

A

TEE

Percordial doppler

45
Q

The risk of air embolism is higher in …. and … positions

A

Sitting and reverse trendelenburg

46
Q

During air embolism the …, …, … falls as there is decreased perfusion through the lung

A

EtCO2, N2O, nitrogen

47
Q

The tip of multiorifice CVP catheter to aspirate air in air embolism situation should be ..

A

2 cm below SVC-RA junction

48
Q

Management of air embolism?

A

Flood the surgical field with normal saline. Compress the internal jugular.

Place in left lateral decubitus, trendelenburg to prevent the embolism to go to RV into plum artery

49
Q

A bradycardia results from stimulation of … during post fossa craniotomy and best managed by …

A

vasomotor center

Stop stimulation

50
Q

Bradycardia during squint surgery due to stimulation of

A

Occlucardiac reflex

51
Q

Oculocardiac reflex pathway ophthalmic division of trigeminal (… and …) -> … ganglion -> … ganglion -> vagus nerve.

A

ophthalmic division of trigeminal (long and short ciliary nerves) -> ciliary ganglion -> Gasserian ganglion -> vagus nerve.

DSouza 2015 (21 decks)

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