Neuroanesthesia

Question 1

According to the American Society of Anesthesiologists (ASA)
grading system to estimate anesthetic risk for various condi-
tions, a patient with severe systemic disease that is a constant threat to life will be assigned which ASA class?
● A. I
● B. II
● C. III
● D. IV
● E. V

Answer 1

D. IV

Question 2

Regarding the importance of temperature control in neuroanesthesia, for each 1°C drop in patient’s temperature, the cerebral metabolic rate of oxygen (CMRO2) decreases by about what amount?
● A. 1%
● B. 7%
● C. 11%
● D. 15%
● E. 20%

Answer 2

B. 7%

Question 3

CO2 is the most potent cerebral vasodilator; hyperventilation reduces PaCO2 (hypocapnea). The goal for safe neurological surgery is generally end tidal CO2 (ETCO2) of what?
● A. 20–25 mmHg
● B. 25–30 mmHg
● C. 30–35 mmHg
● D. 35–40 mmHg
● E. > 45 mmHg

Answer 3

B. 25–30 mmHg

Question 4

Regarding drugs used in neuroanesthesia, which of the following is associated with development of tension pneumocephalus?
● A. Nitrous oxide
● B. Propofol
● C. Etomidate
● D. Barbiturates
● E. Ketamine

Answer 4

A. Nitrous oxide

Question 5

Most barbiturates are anticonvulsants except which of the following?
● A. Phenobarbital
● B. Pentobarbital
● C. Sodium thiopental
● D. Primidone
● E. Methohexital

Answer 5

E. Methohexital

Question 6

Regarding remifentanil, which statement is false?
● A. Reduces intracranial pressure
● B. Reduces cerebral blood volume
● C. Increases CMRO2
● D. Large doses can be neurotoxic to limbic system
● E. Can be used in awake craniotomy

Answer 6

C. Increases CMRO2

Question 7

Dexmedetomidine (Precedex®) is used for control of hypertension postoperatively, as well as for its sedating qualities during awake craniotomy either alone or in conjunction with propofol. It is an agonist for which of the following?
● A. Alpha 1 receptors
● B. Alpha 2 receptors
● C. Beta receptors
● D. Beta 2 receptors
● E. Beta 3 receptors

Answer 7

B. Alpha 2 receptors

Question 8

Regarding paralytics for intubation, which of the following is an intermediate-acting, aminosteroid, nondepolarizing muscle relaxant agent approved for rapid sequence intubation?
● A. Succinylcholine
● B. Lidocaine
● C. Rocuronium
● D. Cisatracurium
● E. Etomidate

Answer 8

C. Rocuronium

Question 9

Which of the following is the ideal modality regarding anesthesia issues related to intraoperative evoked potential (EPs) monitoring?
● A. Total intravenous anesthesia
● B. Intermittent boluses are preferred over continuous infusion
● C. Nitrous/narcotic is the first choice
● D. Monitoring of temperature and blood pressure changes is not mandatory as these do not affect the potentials
● E. Halothane is the ideal inhalational drug

Answer 9

A. Total intravenous anesthesia

Question 10

Malignant hyperthermia is a hypermetabolic state of skeletal muscle due to idiopathic block of calcium re-entry into sarcoplasmic reticulum. Which of the following is the earliest possible sign?
● A. Increased end tidal pCO2
● B. Bradycardia
● C. Metabolic alkalosis on arterial blood gas analysis
● D. Decreased myoglobin levels
● E. Decreased CPK levels

Answer 10

A. Increased end tidal pCO2

Question 11

Parameters of primary relevance to neurosurgical surgery that can be modulated by anesthesiologist which play a primary role in control of intracranial pressure (ICP) and cerebral metabolic requirements of nutrients include all of the following except?
● A. Blood pressure which affects cerebral perfusion pressure (CPP)
● B. Jugular venous pressure
● C. Arterial CO2 tension
● D. Body temperature
● E. Elevating hematocrit

Answer 11

E. Elevating hematocrit

Question 12

Nitrous oxide (N2O) is an inhalational anesthetic agent which is 34 times more soluble in blood as compared to nitrogen. When N2O comes out of blood into the airtight cranial cavity it can produce tension pneumocephalus. Which of the following are steps that can be used to reduce chances of tension pneumocephalus while using N2O in patients?
● A. Filling the cranial cavity with fluid while doing closure
● B. Doing the operation in more supine position
● C. Turning off N2O 10 minutes prior to completion of dural closure
● D. All of the above
● E. Aspirating air with needle while doing closure

Answer 12

D. All of the above

Question 13

Etomidate is an intravenous anesthetic agent which should be avoided in patients with what?
● A. Liver disease
● B. Renal disease
● C. High blood pressure
● D. Respiratory difficulty
● E. All of the above

Answer 13

B. Renal disease

Question 14

Ketamine is usually not used in neurosurgical patients because of its which side effect?
● A. Respiratory depression
● B. Bradycardia
● C. Low blood pressure
● D. Increase in intracranial pressure
● E. All of the above

Answer 14

D. Increase in intracranial pressure

Question 15

Which of the following are disadvantages of using narcotics in neurosurgical patients?
● A. May cause hypotension by histamine release
● B. May cause cerebrovascular vasodilation which can cause increased ICP
● C. Can cause confusion in renal insufficient patient
● D. Can cause confusion in hepatic insufficient patient
● E. All of the above

Answer 15

E. All of the above

Question 16

Following are the useful characteristics of propofol which make it more suitable for use in neurosurgical patients except?
● A. Reduces cerebral metabolism, cerebral blood flow, and intracranial pressure
● B. It is a cerebral protectant
● C. Short half-life makes it useful for use in awake craniotomy
● D. Produces isoelectric EEG
● E. All of the above

Answer 16

D. Produces isoelectric EEG

Question 16

Which of following is an alpha 2 adrenergic receptor agonist which is used for control of hypertension in postoperative patients and for sedation during awake craniotomy?
● A. Dexmedetomidine (Precede)
● B. Esmolol
● C. Lidocaine
● D. Propofol
● E. None of the above

Answer 16

A. Dexmedetomidine (Precede)

Question 17

Paralytics should not be given until it has been determined that the patient can be ventilated manually unless what?
● A. The patient has cervical spine injury
● B. The patient has brain tumor
● C. Treating the patient with laryngospasm
● D. When treating the patient with botulism
● E. None of the above

Answer 17

C. Treating the patient with laryngospasm

Question 18

For inhalational anesthetic agent, maximum alveolar concentration (MAC) of drug should ideally be what?
● A. More than 1
● B. Less than 0.5
● C. More than 1.5
● D. Less than 2
● E. Exactly 1

Answer 18

B. Less than 0.5

Question 19

A patient developed elevated body temperature (> 44 degrees Celsius or 113 degrees Fahrenheit) after giving succinylcholine during induction of anesthesia. It is a malignant hypertension due to idiopathic block of calcium re-entry into the sarcoplasmic reticulum. Which of the following is treatment for this condition?
● A. Eliminating offending agent and hyperventilation
● B. Giving dantrolene sodium with surface and cavity cooling
● C. Giving bicarbonate with IV insulin and glucose
● D. Giving procainamide and diuretics
● E. All of the above

Answer 19

E. All of the above