Neuro Final Flashcards
The brain receives approximately ______ of the cardiac output, yet makes up only 2% of total body weight.
15
Increased carbon dioxide levels cause ______ in the cerebral vessels.
vasodilation and increased blood flow
The vertebral arteries arise from the _____ and join to form the _____ artery.
subclavian artery; basilar
the cerebrum, Broca’s area is found in the _____ and is the _____ center.
frontal lobe
speech production
What is the nerve root for the rectal sphincter?
S2-4
The optic nerve is cranial nerve _____ .
II (2)
The sympathetic nervous system neurons arise from which segments of the spinal cord?
T1-L3 (thoracolumbar)
When stimulated, the sympathetic nervous system ____ viscera and skin vasculature and _____ the coronary arteries?
dilates; constricts
Supratentorial structures include:
lateral ventricles
third ventricle
What neurotransmitters are released at the preganglionic and the postganglionic fibers in the parasympathetic nervous system?
• ACh, ACh
Neurons that release ACh are said to be which of the following?
• Cholinergic
Neurons that release NE are said to be which of the following?
• Adrenergic
Cholinergic receptors can be subdivided into _____ at _____ receptors
• Muscarinic; nicotinic
Beta 1 agonists affect which tissues(s) with what effect?
• Cardiac muscle fibers; increase force and rate of contraction
The anatomical origins of the sympathetic nervous system come from which of the following?
• Thoracic and lumbar areas (thoracolumbar)
The anatomical origins of the parasympathetic nervous system come from which of the following?
• Brain stem and sacral areas of spinal cord (craniosacral)
What is the major inhibitory neurotransmitter in the brain?
• Gamma-aminobutyric acid (GABA)
Which nerve fibers carry sharp pain?
• Type-A delta fibers
Which nerve fibers carry dull pain?
• C fibers
What is the correct anatomical order of the ventricular system in which CSF is produced and circulated
• Choroid Plexus → Aqueduct of Monroe → Third Ventricle → Aqueduct of Sylvius → Fourth Ventricle → Subarachnoid space of spinal cord → Arachnoid villi (CM3S4 sub villi)
Decreased levels of dopamine in the brain are associated with what disease?
• Parkinson’s disease
Which of the following is NOT a goal of therapy to arrest or slow down the effects of Parkinson’s disease?
• Increase cholinergic activity
. Parkinson’s disease is a degeneration of which part of the CNS
• Basal ganglia
Which of the following are features seen in Parkinson’s disease?
a. Bradykinesia
b. Muscle rigidity
c. Disorientation, dementia
d. Tremor
e. ALL OF THE ABOVE
Which of the following is NOT a therapy for the treatment of Parkinson’s disease?
• Selective serotonin reuptake inhibitor (SSRIs)
. Brain stem auditory evoked potentials test the integrity of which cranial nerve?
• VIII
Somatosensory evoked potentials (SSEP) test the integrity of which of the following?
• Dorsal spinal column
Which of the following correctly lists the sensitivity of evoked potentials to anesthesia from least sensitivity to most sensitive?
• BAER, SSEP, VEP
For SSEP monitoring, the stimulating electrodes are placed _____ and the response is recorded _____.
• At a peripheral nerve; at the cerebral cortex
Which of the following are treatment modalities for MS?
- Plasmapheresis
- Baclofen
- Benzodiazepines
- Monoclonal antibodies
Which of the following statements are true regarding MS?
- detailed documentation of preexisting neurological deficits is important
- Regional anesthesia may offer advantages to patients with cognitive dysfunction.
- MS is through to be an inflammatory immune disease.
Myasthenia gravis signs and symptoms can be exacerbated by which of the following?
• Hypokalemia
Which muscles are unaffected by myasthenia gravis?
- Cardiac
* Smooth
Which anesthetic pharmaceutical regimen is recommended for patient with myasthenia gravis
• smaller than normal dose of anectine
How long should an anticholinesterase medication be held before elective surgical procedures in a patient with myasthenia gravis
• 6 hours
All of the following statements are true regarding myasthenia gravis, except?
• Edrophonium is the anticholinesterase drug most often used to treat MG
. TRUE or FALSE: When planning an anesthetic for a patient with MS, it is acceptable to use a full dose of succinylcholine.
False
. Normal CPP is which of the following?
80-100
. A _____ linear change in cerebral blood flow occurs with 1C change in temperature.
7%
What is the normal ICP?
0-15
. All of the following are possible site of brain herniation, except?
• choroid plexus into a lateral ventricle
ICP and CPP are
• inversely related
What are the signs and symptoms of Cushing’s triad?
- Hypertension
- Bradycardia
- irregular respirations
TRUE or FALSE: If the volume of one of the constituents of the intracranial cavity increases, a reciprocal decrease must occur in the volume of one or all of the other factors.
True
Which of the following is the most common cause of a subarachnoid hemorrhage?
• rupture of a saccular aneurysm
Which of the following is the most typical complaint of sign of a patient presenting with an acute subarachnoid hemorrhage?
• sudden, severe headache
Following a subarachnoid hemorrhage, a potential vasospasm may be prevented, or the risk of permanent neurological deficits reduced, by early delivery of “triple H” therapy. What does this therapy include?
• hypertension, hypervolemic, hemodilution
Autonomic dysreflexia or hyperreflexia is a potentially life-threatening medical emergency that can occur in association with spinal cord injury at or above which vertebrae?
• T6
Usual causes of autonomic dysreflexia (AD) include which of the following? (choose two that apply)
- distended bladder
* impacted bowel
Signs and symptoms common in a patient experiencing autonomic dysreflexia include which three of the following?
- very high blood pressure and vasoconstriction below the transection
- possible myocardial infarction and pulmonary edema
- bradycardia and vasodilation above the transection
Overactivity of the sympathetic nervous system is common with transection at _____ or above, but is unusual with injuries below _____.
• T5; T10
TRUE or FALSE: Regional anesthesia and deep general anesthesia are ineffective in preventing autonomic hyperreflexia.
False
Injuries above the _____ level may require a ventilator for the person to breathe.
• C4-C5
Following a motor vehicle accident, a 25-year-old male patient is brought to the operating room for repair of facial lacerations and fractures, and abdominal exploration. The patient is extremely micrognathic and weighs 150 kg (330 pounds). Acceptable techniques for securing the airway include
• Awake fiberoptic intubation
An 18-year-old patient is brought to the intensive care unit after sustaining a cervical spine injury and quadriplegia during a motor vehicle accident. In the first 24 hours after the injury, the patient is at risk for
• Hypothermia, hypotension, pulmonary edema
A 72-year-old patient undergoing resection of an astrocytoma in the sitting position suddenly develops hypotension. Air is heard on the precordial Doppler ultrasound. Each of the following therapeutic maneuvers to treat VAE is appropriate EXCEPT
• Implement positive end-expiratory pressure (PEEP)
A 13-year-old boy is anesthetized with 0.5% isoflurane, 50% N2O, and fentanyl for scoliosis repair. Somatosensory evoked potentials (SSEP) monitoring is conducted during the procedure. Which of the following structures is NOT involved in conveyance of the stimulus from the posterior tibial nerve to the cerebral cortex?
• Corticospinal tract
Calculate cerebral perfusion pressure from the following data: Blood pressure (BP) 100/70, heart rate (HR) 65 beats/min, central venous pressure (CVP) 20 mm Hg, ICP 15 mm Hg
• 65 mm Hg
Which of the following is LEAST likely to impair CBF autoregulation
• Nitrous oxide 50%
A 62-year-old patient is scheduled to undergo resection of a frontal lobe intracranial tumor under general anesthesia. Preoperatively, the patient is alert and oriented, and has no focal neurologic deficits. Within what range should PaCO2 be maintained?
• 25 and 30 mm Hg
Select the FALSE statement concerning autonomic hyperreflexia.
• Propranolol is effective in treating hypertension associated with autonomic hyperreflexia
Which of the following is the most sensitive means of detecting venous air embolism (VAE)?
• Transesophageal echocardiography
. Hydromyelia can be defined as what?
• Abnormal widening of the central canal of the spinal cord
Intracranial hypertension is defined as a sustained increase in intracranial pressure (ICP) above
• 15 mm Hg
. By what percentage does cerebral blood flow (CBF) change for each mm Hg increase in PaCO2?
2%
The CBF autoregulatory curve is shifted to the right by
• Chronic hypertension
Therapy that is useful in the treatment of cerebral vasospasm includes all of the following EXCEPT
• Diuretics
Which of the following pharmacologic agents would have the LEAST effect on transcranial motor evoked potentials (MEPs)?
• Diazepam
. A 2-year-old child is anesthetized for resection of a posterior fossa tumor. Preoperatively, the patient is lethargic and disoriented. Which of the following is most likely to adversely alter ICP?
• 5% dextrose in water
. A 14-year-old girl with severe scoliosis is to undergo spine surgery. Anesthesia is maintained with fentanyl, N2O 50% in O2, vecuronium, and isoflurane. Neurologic function of the spinal cord is monitored by SSEPs. In reference to the SSEP waveform, spinal cord ischemia would be manifested as
• Decreased amplitude and increased latency
Select the TRUE statement concerning administration of glucose-containing solutions to the patient with a closed head injury versus a patient with a spinal cord injury.
• Glucose-containing solutions are contraindicated in both patient groups
The afferent input for somatosensory evoked potentials (SSEPs) is carried through which spinal cord tract?
• Dorsal columns
The term luxury perfusion refers to a situation that occurs in the brain when
• Vasoparalysis exists
The part of the brain that controls coordination and balance is the
• Cerebellum
The Frontal lobe of the brain is located deep to the frontal bone of the skull and plays an integral role in
• Decision making, reasoning, and personality*
- Adduction of the eye (medial rectus); pupil size
- Moves eyes; Abduction of eye (lateral rectus)
- Moves eyes
- III Oculomotor
- VI Abducens
- IV Trochlear
Which descending spinal tracts are the pathways concerned with voluntary, discrete, skilled movements, especially those of the distal parts of the limbs?
• Corticospinal tracts
. At what cerebral blood flow (CBF) does cerebral ischemia become apparent on the EEG?
• 20 ml/100gm/min
T/F In the healthy patient, cerebral autoregulation is effective over a range of mean arterial pressures (MAP) 60-160 mmHg
True
During craniotomy for tumor removal, the arterial pressure transducer should be level with the patient’s:
Ear
The clear cause of multiple sclerosis remains unkwnown, thought_________ may be important factors
• Environmental viruses and genetics
Which of the following regarding multiple sclerosis is true
• The rate of relapse decreases during pregnancy
What connects the two hemispheres of the brain?
• Corpus callosum*
For sensory evoked potentials, the stimulating electrodes are placed ____________ and the detecting electrodes are placed ___________.
• Peripherally, centrally*
Release of neurotransmitter requires the entry of what substance into the nerve terminal?
Calcium
At resting potential the ion concentration inside and outside of the neuron is such that _____ ions are most abundant on the outside of the cell while _____ ions are most abundant on the inside of the cell.
• Sodium outside / Potassium inside
Which type of neuroglia cell help regulate the composition of CSF?
• Ependymal
The _____ are the type neuroglia cells that provide the myelin sheath in the central nervous system
• Oligodenrocytes
Myelin sheath on the outside of many neurons in the peripheral nervous system are constructed by _____.
• Schwann Calls
The most rapid maneuver available for lowering ICP in a patient with a large intracranial mass is?
• Hyperventilation to 25 mm Hg PaCO2
Who is at the greatest risk for developing Duchene’s Muscular Dystrophy?
• Young boys
. All of the following statements are true regarding the Dorsal-Lemniscal Tract except:
• The primary afferent fiber enters the dorsal cord, divides, and ascends or descends 1-3 segments in the tract of Lissauer*
The major source of blood (75%) supply to the spinal cord is the:
• Anterior Spinal Artery
the most common neurotransmitter in the body is _____.
• Acetylcholine
Which of these ascending spinal tract neurons will decussate
• Second order*
The Glasgow comma scale evaluates?
• Level of Consciousness
Which of these is true when a neuron is at rest
The inside of the cell is more negative than the outside at rest (has a resting membrane potentially of about -70mV), Na+ is abundant outside the cell; K+ is abundant inside the cell
When provided with a pain stimulus, your patient flexes and adducts both arms. The response characterizes?
Decorticate posture
Amytrophic lateral sclerosis is correctly defined as
- Motor neuron disease
- Rapidly progressive disorder of both upper and lower motor neurons
Signs of hydrocephalus?
- Headache
- Difficulty in remaining awake or waking up
- Loss balance
- Loss of bladder control
- Impaired vision
- Decline in memory, concentration
CMRO2 is decreased by what?
- Isoflurane
- Hypothermia
- Anesthesia
