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Health Assessment Exam 3 > Neurological Disorder In Anesthesia (Part 2) > Flashcards

Neurological Disorder In Anesthesia (Part 2) Flashcards

1
Q

Name the Disease of these (7) common symptoms
* ↑ICP
* Papilledema
* Headache
* AMS
* Mobility impairment
* Vomiting
* Autonomic dysfunction
* Seizures

A

Brain Tumors

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2
Q

The mass effects of any tumor can cause

A
  • neurological deficits
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3
Q

Name the (2) Types of Brain Tumors

A
  • Primary
  • Metastatic
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4
Q

Name the most common CNS glial cell

A

Astrocytes

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5
Q

The (4) Types of Astrocytoma are _______, _________ astricytomas, _____________ astrocytomas and ____________ Multiforms.

A
  • Gliomas
  • Pilocyctic astrocytomas
  • Anaplastic astrocytomas
  • Glioblastoma Multiforms
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6
Q

_________ are primary tumors, least aggressive and are found in young adults w/ new onset seizures.

A

Gliomas

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7
Q

__________ Astrocytomas are found in children and young adults, are mostly benign with good outcomes if resectable.

A

Pilocyctic Astrocytomas

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8
Q

________ Astrocytoma are poorly differentiated and usually evolve into Glioblastoma Multiform.

A

Anaplastic Astrocytoma.

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9
Q

_________ _____________ has a high mortality, requires surgical debulking and chemo. Life expectancy is usually weeks, even with treatment.

A

Glioblastoma Multiform

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10
Q

Name (4) Brain Tumors

A
  • Meningiomas
  • Pituitary Adenomas
  • Acoustic Neuromas
  • Metastatic Carcinomas
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11
Q

____________ are usually benign, arise from dura or archnoid tissue and has a good prognosis w/ surgical resection.

A

Meningiomas

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12
Q

________ ________ are noncancerous. Transphenoidal or open craniotomy for removal is curative.

A

Pituitary Adenomas

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13
Q

_____________________ are benign schwannomas and involve vestibular components of CN VIII within the auditory canal. Has a good prognsis with resection and radiation.

A

Acoustic Neuromas

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14
Q

________ __________ vary widely in origin and symptoms and has less favorable outcomes.

A

Metastatic Carcinomas

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15
Q

Radiation and Chemotherapy for Brain Tumors can cause

A
  • letharygy
  • AMS
  • Neurological effects
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16
Q

Patient’s with Brain Tumors are on place on steroids to minimize _________ ____________

A
  • cerebral edema
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17
Q

______ is used to reduce intracranial volume and pressure in patients with Brain Tumors

A

Mannitol

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18
Q

Anticonvulsants are ______ used in Anesthesia for Brain Tumors d/t _________ lesions closer to ________ cortex.

A
  • very common
  • supratentorial lesions, closer to motor cortex
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19
Q

Name the (2) types of Strokes

A
  • Ischemic
  • Hemorrhagic
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20
Q

Globally, ________ is the leading cause of death and disability

A

Stroke

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21
Q

Blood is supplied to the brain by the:

A
  • internal carotid arteries
  • Vertebral arteries
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22
Q

The internal carotid arteries and verebral arteries join on the _________ surface of the brain to form the ______ ______ _____, which provides __________ circulation to multiple areas of the brain

A
  • inferior
  • Circle of Willis
  • Collateral
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23
Q

An occlussion of this artery causes contralateral leg weakness.

A

Anterior Cerebral Artery

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24
Q

An Occlussion of this artery causes:
* Contralateral hemipharesis defict (face and arm more than leg)
* Aphasia
* Contralateral visual field defect

A

Middle Cerebral Artery

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25
Q

Occlussion of this Artery causes:
* Contralateral visual field defect
* Contralateral hemiparesis

A

Posterior Cerebral Artery

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26
Q

Occlussion to these arteries cause:
* Contralateral hemiparesis
* Contralateral hemisensory deficits

A
  • Penetrating Arteries
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27
Q

Occlussion to this artery causes:
* Oculomotor deficits
and/or
* ataxia w/ crossed sensory and motor deficits

A
  • Basilar Artery
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28
Q

Occlussion of this Artery causes:
* Lower cranial nerve deficits
and/or
* ataxia with crossed sensory deficits

A

Vertebral Artery

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29
Q

_________ stroke is an occulsion of a vessel that supplies a region of brain resulting in cellular ischemia

A

Ischemic Stroke

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30
Q

_________________ is a sudden focal vascular neurologic deficit that resolves within 24 hours

A

Transient Ischemic Stroke

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31
Q

__/__ of pts who experience a TIA will subsequently suffer a stroke

A

1/3

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32
Q

What is the goal time from Stroke Prognosis to the onset of thrombolytic intervention?

A

90 minutes

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33
Q

If a stroke is suspected, a STAT ___-_____ _____ is needed to distinguish between ischemic stroke and intracerebral hemorrhage.

A
  • non-contrast CT
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34
Q

Causes of Ischemic Strokes are categorized according to the TOAST classification into 5 groups:

A
  • Large artery occlussion
  • Small vessel occlussion
  • Cardioaortic embolic
  • other etiology
  • Undetermined Etiology
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35
Q

Carotid Stenosis is an example of what TOAST classification

A

Large Artery Occlussion

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36
Q

Lacunar Stroke is an example of what TOAST classification

A

Small vessel occlussion

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37
Q

Emboli from atrial fibrillation is an example of what TOAST classification

A

Carioaortic embolic

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38
Q

Stroke due to hypercoagulation states or vasculaopathies is an example of what TOAST classification

A

Other etiology

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39
Q

PO aspirin in the most common recommended intial treatement for

A

Acute ischemic stroke

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40
Q

IV ___ ____ _____ (___) is used when specific criteria is met and must be intiated within a limited time window

A

Tissue Plasminogen activator (TPA)

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41
Q

_______ _________ have been used to stent vessels and remove clots.

A

Thrombectomy devices

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42
Q

This intervention showed little benefit as they were time-consuming and carry a risk of creating fragemented embolization.

A

Thrombectomy devices

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43
Q

This treatement for CVAs is performed in intervential radiology (IR), allowing for angiographic assessment and radiographic guidance during administration of thrombolytics or thrombectomy.

A

Revascularization

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44
Q

Patient’s with ______ _______ frequently have CV risks including HTN, DM, CAD, Afib, and valvular diseases that could impact __________ drug choices and hemodynamic goals

A
  • ischemic stroke
  • vasoactive
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45
Q

This type of stroke results from bleeding inside the cranaial vault, in turn, impairs perfusion of the brain

A
  • Acute hemorrhagic stroke
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46
Q

Hemorrhagic stroke is ___x more likely to cause death than ischemic stroke.

A

4

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47
Q

The 2 most reliable predictators of outcome for a Hemorrhagic CVA are:

A
  • Estimated Blood Loss
  • Change in LOC
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48
Q

Subtypes of Hemorrhagic strokes are defined base on……

A
  • location of the blood
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49
Q

Hemmorrhagic stroke with blood in the brain is called____________ hemorrhage.

A

intraparenchymal hemorrhage

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50
Q

Hemorrhagic CVA with blood in the epidural, subdural and subarachnoid spaces are called

A
  • epidural, subdural and subarachnoid hematoma/hemorrhage
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51
Q

Hemorrhagic stroke with blood in the ventricular system is called _________ hemorrhage and usually occues with other _________ strokes,

A
  • intraventricular hemorrhage
  • hemorrhagic strokes
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52
Q

Treatment of a hemorrhagic stroke that is centered around reduction in ICP, blood pressure control, seizure procautions and vigilant monitoring is known as

A

Conservative treatments

53
Q

This treatment for a Hemorrhagic CVA involves evacuation of the hematoma

A

Surgical

54
Q

Continuation of Intubation of a Hemorrhagic CVA depends on_________ stability.

A

cardiopulmonary stability

55
Q

If you prescribes a new anticoagulant for CVA prophylaxis, when can the patient have an elective surgery?

A

3 months

56
Q

You need to consult ______ to establish protocol for anticoagulants for CVA prophylaxis

A

prescriber

57
Q

High Risk patient for a CVA that pause their long acting anticoagulants (warfarin) will need to take ______ ________ to bridge the gap.

A
  • Shorting acting anticoagulant
  • LMWH
  • Unfractionated heparin
58
Q

If you plan to do Regional Anesthesia on a patient for a planned procedure who is taking anticoagulants, what should you do?

A
  • Plan for the patient to d/c anticoag for a sufficent time to safely perform the block.
59
Q

Name (4) specific inquires for patients with CVA pre-op.

A
  • Headaches
  • tinnitus
  • vision/memory loss
  • bathroom issues
60
Q

Vascular disease, embolic (a-fib, prosthetic valve, right-to-left shunt/PFO) are all examples of Root causes of _____ .

A

Root causes of CVA

61
Q

Name the imaging required for surgery on patient with a CVA

A
  • Carotid U/S
  • CT/MRI head and neck
  • echocardiogram
62
Q

What vascular access do you need to have established before starting surgery on a patient with Cerebrovascular disease

A
  • A-line
  • 2 IVs
  • CVC
63
Q

T/F: Majority of aneurysms are diagnosised before rupture

A
  • False
64
Q

Only __/__ of aneurysm patients have symptoms before rupture

A

1/3

65
Q

Headache, photophobia, confusion, hemiparesis and coma are all symptoms of a cerebral _________.

A

cerebral aneurysm.

66
Q

HTN, smoking, female and oral contraceptives are all Risk factors for

A

Cerebral aneurysms

67
Q

Diagnosis of a Cerebral Aneurysm requires..

A
  • CT/angio
  • MRI
  • Lumbar puncture w/ CSF analysis if rupture suspected
68
Q

For best outcomes, interventions for Cerebral Aneurysms should be preformed within ___ hours of rupture

A

72 hours

69
Q

Name the medication to control BP for cerebral aneuysms

A

Mannitol

70
Q

Name the (3) surgical treatments for Cerebral Aneurysms

A
  • coiling
  • stenting
  • trapping/bypass
71
Q

What specialty needs to be on standby in case of intra-op rupture/SAH?

A

Neurosurgeon

72
Q

Risk for vasospam Post-SAH can last for __ - ___ days

A

3-15 days

73
Q

____ _____ triggers inflammatory mediators, which reduces nitric oxide availability and increase ________-1, leading to vasoconstriction.

A
  • Free Hemoglobin
  • endothelin
74
Q

Triple H therapy for Post-SAH Vasospams

A
  • hypertension
  • Hypervolemia
  • Hemodilution
75
Q

To avoid complications of Hypervolemia ,_____ is the intial treatment for Post-SAH Vasospasm

A

Hypertension

76
Q

Interventional treatments such as ______ ______ and direct injection of ________ can relieve Post-SAH spasm

A
  • balloon dilation
  • direct injection of vasodilators
77
Q

________ _________ is an arterial to venous connections without intervening capillaries. Creates an area of high flow, low resistance shunting.

A

Arteriovenous Malformations (AVM)

78
Q

T/F: Ateriovenous Malformations are through to be congenital

A

True

79
Q

Symptoms of Arteriovenous Malformations (AVM) is throught to range from _______ -effects to _________.

A
  • mass effects to hemorrhage
80
Q

Majority of AVMs are ________

A

supratentorial

81
Q

Treatment of AVMs include_______, angio-guided _______ and ______ resection.

A
  • radiation
  • angio-guided embolization
  • surgical resection
82
Q

Name the treatment of AVM that has the highest mortality

A

Surgical resection

83
Q

Before AVM surgery, you need to establish:

A
  • BP control –mannitol
  • seizure prophylaxis
  • CVC or Lg bore IVs
  • A-line
84
Q

_______ ______ abnormalities are often hereditary, and the disease process may be diffuse or confined to specific neuronal structurs

A

Congenital Brain Abnormalities

85
Q

This congenital brain abnormality is congenital displacement of cerebellum.

A

Chiari malformation

86
Q

There are how many types of Chiari Malformation

A

4

87
Q

This type of Chiari Malformation is characterized by downward displacement of cerebellum.

A

Type 1

88
Q

This type of Chiari Malformation is characterized by downward displacement of cerebellar vermis often associated with myelomeningocele.

A

Type 2: Arnold Chiari

89
Q

This type of Chiari Malformation is: Rare; occipital encephalocele w/ downward cerebellar displacement

A

Type 3

90
Q

This type of Chiari Malformation is:
* not compatible with life
* cerebellar hypolasia without displacement of posterior fossa contents

A

Type 4

91
Q

Symptoms of Chiari Malformation include _____ extending to shoulders/arms, ______ disturbances, ataxia and hydrocephalus.

A
  • headache extending to shoulder/arms
  • visual disturbances
  • ataxia
  • hydrocephalus
92
Q

Treatment for Chiari malformation is Surgical _____________.

A

Surgical Decompression

93
Q

Pre-anesthesia Chiari Malformation considerations include:
* __________ to ↓ICP
* Lg bore IV x__
* CVC
* ________

A
  • Hyperventilate to ↓ICP
  • Lg bore IV x2
  • CVC
  • A-line
94
Q

__________ _________ is an autosomal dominant disease causing benign hematomas, angiofibromas and other malformations that can occur anywhere in the body

A

Tuberous Sclerosis

95
Q

Tuberous Sclerosis can cause ______tumors and giant cell _________ in the brain.

A
  • cortical tumors
  • giant cell astrocytomas
96
Q

Co-existing tumors of the face, oropharynx, heart, lungs, liver and kidneys with this Congenital Brain Abnormality

A

Tuberous Sclerosis

97
Q

Patients with Tuberous Sclerosis present with ______ retardation and ________ disorders.

A
  • mental retardation
  • seizures disorders
98
Q

Airway compromise and cardiac/kidney involvement are some anesthesia considerations for ______ _______.

A

Tuberous Sclerosis

99
Q

This is an autosomal dominant disease with benign tumors of the CNS, eyes, adrenal, pancreas and kidneys.

A

Von-Hippel- Lindau Disease

100
Q

Von Hippel-Lindau disease may present with

A

pheochromocytoma

101
Q

What would limit Neuraxial anesthesia in patients with Von Hipple-Lindau Disease

A

co-existing spinal cord tumor

102
Q

Name the (3) types of Neurofibromatosis

A
  • Type 1
  • Type 2
  • Schwannomatosis (rare)
103
Q

Anesthesia consideration for ________ include increased scoliosis, possibility of pheochromocytoma, ICP, and airway issues

A

Neurofibromatosis

104
Q

T/F: Neurofibromatosis patients are good candiates for Neuraxial anesthesia.

A
  • False
  • Avoid NA d/t high likelihood of spinal tumors
105
Q

_______ is a disorder of CSF accumulation, causing increased ICP, that results in ventricular dilation.

A

Hydrocephalus

106
Q

Accumulation of CSF in Hydrocephalus is due to

A
  • an imbalance between CSF production and absorption
107
Q

_____ can be congenital or acquired d/t meningitis, tumors, head injuries, or strokes

A

Hydrocephalus

108
Q

Name the treatments for Hydrocephalus

A
  • diuretics - controversial in children
  • serial lumbar punctures - temporary
  • VP shunt/Endoscopic third ventriculostomy (ETV)
109
Q

This is placed in the ventricle of the brain and empties into peritoneum to treat Hydrocephalus

A

VP Shunt

110
Q

This is a catheter placed into the lateral ventricle that drains into the perironeal space, right atrium or more rarely into pleural space to treat Hydrocephalus.

A
  • ETV
111
Q

Shunt malfunction most frequently occurs in the ______ year of placement.

A

first

112
Q

These can be categorized by:
* penetrating
* non-penetrating
* d/o breech of dura

A

Traumatic Brain Injury (TBI)

113
Q

Primary Injury of a TBI occurs as a result of __________.

A
  • as a result of time
114
Q

______ injuries of a TBI can include: neuroinglammation, cerebral edema, hypoxia, anemia, electrolyte imbalances, and neurologic shock.

A

Secondary

115
Q

________ is required in severe TBI w/ GSC <9, AW trauma and respiratory distress

A

Intubation

116
Q

With TBIs, mild __________ can control increased ICP

A

mild hyperventilation

117
Q

Name the imaging that needs to be obtained ASAP for TBIs

A
  • CT head/neck
118
Q

T/F: You can delay emergent surgery for TBI for complete Pre-Op testing

A

False

119
Q

C-spine stabilization, adequate IV access, CVC, A-line, and uncrossed blood are Anesthetic considerations for_______.

A

TBI

120
Q

T/F: You can place an NGT/OGT for potential basal skull fractures

A

False

121
Q

Intra-Op considerations for TBIs

A
  • I-stat labs
  • Pressors
  • BiCarb
  • Calcium
  • Blood Products
122
Q

_______ is defined as transient, paroxysomal, synchronous discharge of neurons in the brain.

A

Seizures

123
Q

To cure seizures, you have to treat the ______ _________.

A

treat the underlying condition

124
Q

Hypoglycemia, hyponatremia, hyperthermia and intoxication are _______ abnormalties that can cause seizures.

A
  • transcient abnormalities
125
Q

______ is defined as recurrent seizures d/t congentital or acquired factors

A

Epilepsy

126
Q

_______ drugs decrease neuronal excitability/enhance inhibition

A

Antiepileptic

127
Q

What medication do you want onboard before incision in patients with seizure disorders?

A

Anti-seizures drugs

128
Q

Phenytoins, Tegretol, Barbituates are enzyme - ________.

A

inducers

129
Q

What needs to be applies when intubating (RSI) patient’s post-seizure?

A

cricoid pressure

Health Assessment Exam 3 (5 decks)

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