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Advanced Principles C > Neuroanesthesia Pt. 1 (Exam I) > Flashcards

Neuroanesthesia Pt. 1 (Exam I) Flashcards

1
Q

List off the cranial nerves in order.

A
  1. Olfactory
  2. Optic
  3. Oculomotor
  4. Trochlear
  5. Trigeminal
  6. Abducens
  7. Facial
  8. Vestibulocochlear
  9. Glossopharyngeal
  10. Vagus
  11. Accessory
  12. Hypoglossal
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2
Q

For Cranial Nerve I, what is the:

Nerve type?
Function?

A

Nerve Type: Sensory
Function: Smell

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3
Q

For Cranial Nerve II, what is the:

Nerve type?
Function?

A

Nerve Type: Sensory
Function: Vision

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4
Q

For Cranial Nerve III, what is the:

Nerve type?
Function?

A

Nerve Type: Motor
Function: Majority of Eye movement

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5
Q

For Cranial Nerve IV, what is the:

Nerve type?
Function?

A

Nerve Type: Motor
Function: Eyeball Adduction

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6
Q

For Cranial Nerve V, what is the:

Nerve type?
Function?

A

Nerve Type: Motor & Sensory
Function: Facial sensation & chewing

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7
Q

For Cranial Nerve VI, what is the:

Nerve type?
Function?

A

Nerve Type: Motor
Function: Eyeball Abduction

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8
Q

For Cranial Nerve VII, what is the:

Nerve type?
Function?

A

Nerve Type: Motor & Sensory
Function: Facial Expression & Taste

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9
Q

For Cranial Nerve VIII, what is the:

Nerve type?
Function?

A

Nerve Type: Sensory
Function: Hearing & Balance

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10
Q

For Cranial Nerve IX, what is the:

Nerve type?
Function?

A

Nerve Type: Motor & Sensory
Function: Taste & gag reflex

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11
Q

For Cranial Nerve X, what is the:

Nerve type?
Function?

A

Nerve Type: Sensory & Motor
Function: Parasympathetic Innervation & gag reflex

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12
Q

For Cranial Nerve XI, what is the:

Nerve type?
Function?

A

Nerve Type: Motor
Function: Shoulder Shrug

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13
Q

For Cranial Nerve XII, what is the:

Nerve type?
Function?

A

Nerve Type: Motor
Function: Swallowing & Speech

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14
Q

Which two cranial nerve share control over the gag reflex?

A

CN 9 & 10 (Glossopharyngeal & Vagus)

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15
Q

Differentiate the functions of the temporal & parietal lobes of the brain.

A
  • Temporal: Understanding language, memory, & hearing.
  • Parietal: Speech & words, sense of touch, spatial perception.
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16
Q

Which type of glial cell is only found in the PNS?

A

Schwann cells

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17
Q

What are the types of glial cells?

A
  • Astrocytes
  • Oligodendrocytes
  • Microglia
  • Ependymal cells
  • Schwann cells

All of these provide protection & support.

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18
Q

Which glial cells regulate the blood brain barrier?

A

Astrocytes

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19
Q

Which glial cells produced myelin?

A
  • Oligodendrocytes (CNS)
  • Schwann cells (PNS)
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20
Q

Which glial cells are heavily involved in the immunofunction of the brain?

A

Microglia

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21
Q

Which glial cells secrete CSF?

A

Ependymal cells

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22
Q

Where is acetycholine seen as a neurotransmitter?

A
  • PNS neuromuscular junctions
  • CNS
  • Most neurons of autonomic nervous system (preganglionic SNS & PSNS)
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23
Q

What type of ACh receptors are located at the NMJ?

A

Nicotinic

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24
Q

What type of ACh receptors are located in the PSNS?

A

Muscarinic

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25
Q

What type of ACh receptors are located in the CNS?

A

Muscarinic & Nicotinic

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26
Q

Which anitcholinesterase is used to treat myasthenia gravis?

A

Pyridostigmine

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27
Q

What acronym is used for cholinergic toxicity?

A

Salivation
Lacrimation
Urination
Diaphoresis
GI Upset (diarrhea)
Emesis

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28
Q

What drugs are used to treat anticholinesterase toxicity?

A
  • Atropine
  • Pralidoxime
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29
Q

What drug class is used to treat Dementia, Alzheimer’s, and Parkinson’s disease?

How does this work?

A

Acetylcholinesterase Inhibitors (rivastigmine, donepizil, etc.)

↑ ACh availability in the CNS thus improving neuron to neuron communication.

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30
Q

What is the major excitatory neurotransmitter of the CNS?

A

Glutamate

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31
Q

Excessive activation of glutaminergic synapses leads to excessive influx of what ion?

What conditions does this present as?

A
  • Ca⁺⁺
  • Parkinson’s, Huntington’s, Alzheimer’s
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32
Q

What amino acid is the precursor to dopamine?

A

Tyrosine

Phenylalanine was mentioned in lecture but this is incorrect.

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33
Q

Dopamine’s effects in the CNS are generally _____ in nature.

A

inhibitory

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34
Q

Where are dopaminergic neurons located in the brain?

A
  • Between substantia nigra & caudate nucleus/putamen
  • In Limbic system, retinas, & olfactory system.

Limbic = Reward system.

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35
Q

Outside the CNS, dopamine exhibits paracrine effects. What does this mean?

A

Acts as a hormone on nearby cells.

  • Inhibits NE release
  • ↑ Na⁺ excretion
  • ↓ insulin secretion
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36
Q

Degeneration of dopaminergic neurons occurs with _____ disease.

A

Parkinson’s.

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37
Q

Why is carbidopa given in conjunction with levodopa for Parkinson’s?

A

Prevents early conversion of levodopa to dopamine ensuring proper drug concentrations in the brain.

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38
Q

Why is levodopa given instead of dopamine for Parkinson’s?

A

Dopamine cannot cross the BBB

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39
Q

Why should Reglan and Droperidol be avoided in patients with Parkinson’s?

A

They antagonize dopamine

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40
Q

Which Dopamine antagonists are utilized for N/V?

A
  • Droperidol
  • Metoclopramide
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41
Q

Where is epinephrine utilized as a neurotransmitter in the CNS?

A
  • Medulla Oblongata
  • Pons
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42
Q

Where is norepinephrine utilized as a NT in the CNS?

A
  • Locus Coeruleus
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43
Q

Where are norepinephrine and epinephrine used as NT’s in the PNS?

A
  • SNS Ganglia
  • Postganglionic SNS neurons
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44
Q

What is serotonin synthesized from?

A

Tryptophan

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45
Q

Where is most of the body’s serotonin produced?

A

GI Tract by enterochromaffin cells

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46
Q

Where is serotonin located in the brain?

A

Pons & medulla

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47
Q

What are the coagulation aspects of serotonin?

A
  • Stored in platelets
  • Released during clot formation (promotes wound healing)
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48
Q

What does serotonin do to blood vessels in a pathologic state?

A

Vasoconstricts

(HTN, atherosclerosis)

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49
Q

What does serotonin do to blood vessels in a physiologic state?

A

Vasodilates (via NO release)

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50
Q

What NT, released by the gut, causes nausea?

A

Serotonin

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51
Q

What type of drugs are paroxetine and sertraline?

A

SSRI’s

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52
Q

What type of drug is venlafaxine?

A

SNRI

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53
Q

Which serotonin antagonist is used to treat N/V?

A

Ondansetron

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54
Q

Besides the CNS, what organ system has large amounts of GABA?
Why is this?

A
  • Pancreas
  • GABA inhibits glucagon secretion
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55
Q

What arteries provide blood flow to the entirety of the brain?

A
  • 2 Common Carotid Arteries
  • 2 Vertebral Arteries
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56
Q

The internal carotid artery bifurcates to become the….

A

Anterior & Middle Cerebral Arteries

(ACA & MCA)

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57
Q

The vertebral arteries join to form the ______ artery, which then divides into the ______ _______ arteries.

A

Basilar

Posterior Cerebral

58
Q

What vessels merge to form the circle of Willis?

A
  • ACA’s
  • MCA’s
  • PCA’s
59
Q

What is the order of perfusing arteries that occurs after the Circle of Willis?

Superficial to deep

A
  1. Pial Arteries (cover surface of brain)
  2. Penetrating Arteries
  3. Intracerebral arterioles
  4. Capillaries
60
Q

Is the circle of willis a high or low resistance vascular formation?

A

Low Resistance

61
Q

How many anterior communicating arteries of the Circle of Willis are there?

A

1

62
Q

How many Posterior communicating arteries of the Circle of Willis are there?

A

2

63
Q

Circle of Willis Picture

A
64
Q

What anatomic structure is located at the blue area in the picture below?

A

Locus Coeruleus

65
Q

What structure is indicated by 1 in the figure below?

A

Anterior Cerebral Artery

66
Q

What structure is indicated by 2 in the figure below?

A

Anterior Communicating Artery (ACOM)

67
Q

What structure is indicated by 3 in the figure below?

A

Middle Cerebral Artery

68
Q

What structure is indicated by 4 in the figure below?

A

Posterior Communicating Artery (PCOM)

69
Q

What structure is indicated by 5 in the figure below?

A

Posterior Cerebral Artery

70
Q

What structure is indicated by 6 in the figure below?

A

Basilar Artery

71
Q

What structure is indicated by 7 in the figure below?

A

Vertebral Artery

72
Q

What structure is indicated by 8 in the figure below?

A

Internal Carotid Artery

73
Q

What is the most prominent venous sinus of the superficial venous system of the brain?

A

Superior Sagittal Sinus

74
Q

What are the vascular structures of the superficial venous system of the brain?

A
  • Superior Sagittal Sinus
  • Transverse Sinus
  • Cavernous Sinus
75
Q

What are the vascular structures of the deep venous system of the brain?

A
  • Great Cerebral Vein
  • Inferior Sagittal Sinus
  • Straight Sinus
76
Q

Where do the superficial and deep venous systems of the brain meet?

A

Confluence of Sinuses (They then drain out into the Internal Jugular Vein)

77
Q

Internal jugular vein drainage is always symmetric between both veins. T/F?

A

False

78
Q

The brain is 2% of the body’s total weight but consumes _____% of CO.

A

15 - 20%

79
Q

The average weight of a human brain is ______ grams.

A

~ 1400 grams

80
Q

What is the average cerebral blood flow of a human adult?

A

50 mL / 100g of brain tissue / min

81
Q

Where does the brain store glucose?

A

It does not!

(Cerebral glucose requirement is very important).

82
Q

At what cerebral blood flow would be expect to see impairment and EEG slowing?

A

< 20 - 30 mL / 100g / min

83
Q

At what cerebral blood flow would be expect to see an isoelectric EEG?

A

15 - 20 mL / 100g / min

84
Q

At what cerebral blood flow would be expect to see irreversible brain damage?

A

≤ 10 mL / 100g / min

85
Q

CPP = ?

A

CPP = MAP - ICP

86
Q

What are the 3 subsets of cerebral autoregulation?

A
  • Myogenic
  • Neurogenic
  • Metabolic
87
Q

What is the cerebral autoregulation MAP window?

A

~ 60 - 140 mmHg

88
Q

What occurs to the cerebral autoregulation curve in a patient with chronic hypertension?

A

The curve shifts to the right

89
Q

Cerebral arterioles ___ when CPP is down.

A

Dilate

90
Q

Cerebral arterioles ______ when CPP is high.

A

Constrict

91
Q

Local Dilation/Constriction of cerebral arterioles is the _____ facet of cerebral autoregulation.

A

myogenic

92
Q

What is the neurogenic aspect of cerebral autoregulation?

A

SNS innervation of large cerebral arteries and the release of vasoactive neurotransmitters.

93
Q

Between MAP, myogenic control, metabolic requirements, and neurogenic control, which of these is the weakest factor in cerebral autoregulation?

A

Neurogenic

94
Q

What are the four factors that make up the metabolic facet of cerebral autoregulation?

A
  • pH (CO₂ & H⁺)
  • O₂ concentration
  • CMRO₂
  • Astrocytes
95
Q

What is the CMRO₂ of the brain in a resting state?

A

3mL of O₂ / 100g / min

96
Q

What is the CMRO₂ of a 1500g brain at a resting state?

A

3 mL O₂ x 15 = 45 mL O₂ per min

97
Q

Systemic hypoxia causes cerebral vaso_______.

A

vasodilation

98
Q

What is the term for cerebral blood flow matching CMRO₂?

A

Neurovascular coupling

99
Q

For each 1°C drop in temperature, CMRO₂ decreases by _____.

A

6 - 7 %

100
Q

Hyperthermia will increase CMRO₂ up until ___°C, then CMRO₂ decreases due to metabolic dysfunction.

A

42°C

101
Q

Severe hypoglycemia will have what effect on CBF? What about CMRO₂?

A

↓BG = ↑CBF
↑CBF = ↑CMRO₂

Brain will try to compensate for low BG by increasing CBF thus ↑CMRO₂.

102
Q

Severe blood glucose occurs at less than ____ mg/dL.

A

36

103
Q

What is the mechanism for increased CO₂ resulting in cerebral vasodilation?

A

↑CO₂ combines with H₂O in blood.
↓
Carbonic acid (H₂CO₃) forms
↓
H₂CO₃ dissociates into H⁺ & HCO₃⁻
↓
H⁺ & HCO₃⁻ cause vasodilation

104
Q

CBF is ________ proportional to PaCO₂.

A

Directly

105
Q

What are the primary functions of astrocytes?

A
  • Provide support & nutrition to neurons
  • Regulate neuroinflammation
  • Antioxidant responses
106
Q

What is the mechanism for astrocyte mediated vasodilation?

A
  • Glutaminergic neurons stimulate astrocytes
    ↓
    Astrocyte has ↑ CO₂
    ↓
    Astrocyte releases NO
    ↓
    local vasodilation
107
Q

What effect will N₂O have on cerebral blood flow?

A

N₂O = minor ↑CBF
N₂O + VAA = More ↑CBF

108
Q

Ketamine is a potent cerebral _________.

A

vasodilator

109
Q

What is the Robinhood effect?

A

Reverse Steal Effect

↓ cerebrovascular response to CO₂ resulting in:
- Healthy brain tissue is vasoconstricted
- Ischemic areas get vasodilated (and thus more blood flow).

110
Q

What drug class exhibits the Robinhood Effect?

A

Barbiturates

111
Q

Differentiate the Robinhood Effect & Circulatory Steal?

A
  • Robinhood = vasoconstricted healthy areas and vasodilated (more CBF) to ischemic areas.
  • Circulatory Steal = Vasodilation everywhere
112
Q

Which artery is indicated by 7 in the figure below?

A

Anterior Spinal Artery

113
Q

Which artery is indicated by the star in the figure below?

A

Artery of Adamkiewicz

114
Q

Which artery is indicated by 6 in the figure below?

A

Posterior Spinal Arteries (2)

115
Q

The anterior spinal artery runs from the ______ cephalically to the _______ caudally.

A

Foramen magnum to the filum terminale

116
Q

Where does the anterior spinal artery originate from?

A

The vertebral artery

117
Q

What artery supplies the anterior ⅔ of the spinal cord?

A

Anterior spinal artery

118
Q

What artery supplies the posterior ⅓ of the spinal cord?

A

Posterior Spinal Arteries

119
Q

What arteries feed the posterior spinal arteries?

A

Radicular & medullary arteries at each spinal level

120
Q

The Artery of Adamkiewicz is the largest what?

A

Largest anterior medullary segmental artery

121
Q

Spinal segmental arteries branch off of the _____.

A

aorta

122
Q

The Artery of Adamkiewicz most commonly originates from where?

A

Left side of the aorta around the T9 - T12 levels.

123
Q

What is the significance of the Artery of Adamkiewicz?

A

Provides major blood supply to the anterior thoracolumbar spinal cord.

124
Q

What usually remains intact if the Artery of Adamkiewicz is damaged?

A

Sensory functions of the spinal cord.

Motor typically damaged.

125
Q

What is Tethered Cord Syndrome?

A

Syndrome where spinal cord is attached to spinal column and stretching may cause injury.

126
Q

What structure is indicated by 1 below?

A

Anterior Communicating Artery

127
Q

What structure is indicated by 2 below?

A

Internal Carotid Artery (Left)

128
Q

What structure is indicated by 3 below? What large artery precedes this one?

A
  • Middle Cerebral Artery
  • Internal Carotid Artery
129
Q

What structures are indicated by 4 below?

A

Posterior Communicating Arteries

130
Q

What structure is indicated by 7 below?

A

Superior Cerebellar Artery

131
Q

What structure is indicated by 8 below? On which structure does this artery sit? What two arteries converge to form this one?

A
  • Basilar Artery
  • Pons
  • Left and Right Vertebral Arteries
132
Q

What structure is indicated by 11 below? What is the importance of this structure? Where does this structure sit?

A
  • The Right Vertebral Artery
  • This structure perfuses the posterior of the brain
  • The two vertebral arteries sit on the brainstem
133
Q

What structure is indicated by 12 below?

A

PosteroInferior Cerebellar Artery

134
Q

What structure is indicated by 13 below?

A

AnteroInferior Cerebellar Artery

135
Q

What structure is indicated by 15 below?

A

Precommunicating (P1) of the Posterior Cerebral Artery

136
Q

What structure is indicated by 16 below?

A

Postcommunicating (P2) of the Posterior Cerebral Artery

137
Q

What structure is indicated by 17 below?

A

Precommunicating (A1) of the Anterior Cerebral Artery

138
Q

What structure is indicated by 18 below?

A

Postcommunicating (A2) of the Anterior Cerebral Artery

139
Q

What structure is indicated by 19 below? What makes up this artery? Where does its blood flow come from?

A
  • Anterior Cerebral Artery
  • A1 and A2
  • Middle Cerebral Artery
140
Q

What structure is indicated by 1 below?

A

Superior Cerebellar Artery

141
Q

What structure is indicated by 2 below?

A

Basilar Artery

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