Neuroanesthesi

Question 1

1. A patient presenting for resection of a small parietal meningioma has a preoperative INR of 1.5. What is the likellhood that the transfusion of 2 units of FFP would normalize her INR?
   A. 50%
   B. 25%
   C. <5%
   D. 75%
   E. 95%

Answer 1

C. <5%

Abdei-Wahab prospectively audited all FFP transfusions for an INR of 1.1-1.85 at Mamusetts General Hospital over 13 months (324 transfus100s had the necessary follow up data). Transfusion of FFP resulted in normalization of PT-INR values in 0.8% of patients and decreased the INR halfway to noonalization in 15% of patients. Interestingly, !here was no significant relationship between pretransfusion INR and likelihood of achieving 50 percent cooedion of the INR after FFP transfusion There was no dose-respoose effect, and increasing amounts of FFP did not appear to result in larger decrements in INR. Median decrease in INR was 0.07.

Question 2

2. During the creation of a burr hole for a deep brain stimulator, an awake, sedated patient develops the sudden onset of coughing, hypotension, and hypoxia. The clinical presentation suggest which of the following complications:
   A. Intracranial hemorrhage
   B. Aspiration pneumonia
   C. Air embolism
   D. Tension pneumocephalus

Answer 2

C. Air embolism

During creation of the burr hole In awake patients, sudden vigorous coughing may be a sign of venous air embolism. Other signs are unexplained hypoxia and hypotension. Early detection may be possible with precordial Doppler monitoring. The overall incidence of venous air embolism as detected by a precordial Doppler uTirasound has been reported to be4.5%. Hooper et al. in their small study of 21 patients noted 1 venous air embolism (1 of 221ead Insertions), and the important predictors were patient positioning and the occurrence of coughing.

Question 3

3. In a Nationwide lnpatient Sample, the most common cause of perioperative visual loss (POVL) In 465,345 patients undergolng spinal fusion was:

A Anterior ischemic optic neuropathy
B Corneal abrasion
C Cortical blindness
D Posterior ischemic optic neuropathy
E. Retinal vascular occlusion

Answer 3

C Cortical blindness

The most cause of POVL after spinal fusion is cortical blindness. The prevalence an spinal fusion is 3.09/10,000 cases. While the precise cause is unknown, risk factors include male gender, age less than 18 years, anemia, and requirement for blood transfusion. Theoretical risk factors also include prone position and intraoperative hypotension.

Question 4

4. In a 2009 study of 5.6 million patients who underwent the principal procedures of knee arthroplasty, cholecystostomy, hip/femur surgical treatment, spinal fusion, appendectomy, colorectal resection, laminectomy without fusion, coronary artery bypass grafting, and cardiac valve procedures from 1996 to 2005, cardiac and spinal fusion surgery had the highest rates of POVL. The national estimate in cardiac surgery was 8.64/10000.
 The American society of Anesthesiologists (ASA) class is designed to estimate what parameter:

A. Patient physical status
B. Age maximum of surgery
C. Tolerable blood loss
D. Surgical risk
E. Operative mortality

Answer 4

A. Patient physical status

Question 5

5. The use of Intensive Insulin therapy to reduce blood glucose In critically Ill patients with aneurismal subarachnoid hemorrhage has teen associated with an increase In the Incidence of what complication?
   A. Myocardial ischemia and Infarction
   B. Hypoglycemic episodes
   C. All-cause in-hospit31 mortality
   D. seizures
   E. Surgical site infection

Answer 5

B. Hypoglycemic episodes

Question 6

6. What is the BEST estimate of blood volume in a thirteen month old child weighing 10 kilograms?
   A. 700 ml
   B. 1000 ml
   c. 800 ml
   D 9OOml
   E. 600 ml

Answer 6

A. 700 ml

Question 7

7. What is the maximal reduction in the cerebral metabolic requirement for oxygen (CMR02) achievable exclusively through the use of high-dose barbiturates?

A. 50%
B. 25%
C.15%
D. 75%
E. 90%

Answer 7

A. 50%

Question 8

8. What is the most concerning side effect or dexmedetomidine Infusion In ICU patients?
   A. Inhibition or the locus ceruleus
   B. Bradycardia
   c Systolic hypertension
   D. Respiratory depression
   E. Intracranial hypertension

Answer 8

B. Bradycardia

Question 9

9. Which anesthetic agent is least likely to precipitate EEG evidence or seizure activity?
   A Lidocaine
   B. Isoflurane
   C. Enflurane
   D. Propofol
   E. Sevoflurane

Answer 9

B. Isoflurane