Neurology

Question 1

Intracerebral Bleed Incidence Associated with

Answer 1

HTN, anticoagulation therapy or coagulopathy, drug and alcohol abuse, neoplasia, amyloid angiopathy, infection

Question 2

aneurysm etiologies

Answer 2

trauma, inflammation, atherosclerosis, congenital, peak age 35-50

Question 3

ischemic stroke risk factors

Answer 3

increasing age, underlying atherosclerotic disease, hx TIA’s, associated with CV disease

Question 4

patients at risk for stroke anesthetic implications

Answer 4

control DM, HTN, coagulation therapy

Question 5

SAH risk factors

Answer 5

HTN, DM, CAD

Question 6

oligodendrocytes

Answer 6

form myelin around CNS axons (schwann cell in PNS)

Question 7

astrocytes

Answer 7

help regulate composition of ISF in CNS, provide glucose to and remove ammonia from neurons
-repair after neuronal injury and maintain metabolic environment

Question 8

microglia cells

Answer 8

specialized macrophages that phagocytize neuronal cells

Question 9

CSF emptying

Answer 9

from saggital sinus to superior jugular vein to SVC

Question 10

CSF pathway

Answer 10

made in ependymal cells in lateral and 3rd ventricle, then goes to 4th ventricles, then foramen of magendie, then cerebellar versus spinal pathway

Question 11

which artery carries 80% of blood to the brain

Answer 11

MCA

Question 12

susceptibility to aneurysm formation

Answer 12

structural abnormalities, genetics, atherosclerosis, HTN, coarctation of aorta, connective tissue DO’s

Question 13

where are most AVM’s

Answer 13

75% supratentorial

Question 14

3rd leading cause of death in US

Answer 14

ischemic stroke

Question 15

thrombus formations associated with these risk factors

Answer 15

atherosclerosis, hyper coagulation, sickle cell disease, polycythemia vera, decreased BF

Question 16

TBI: extradural hematoma

Answer 16

usually arterial source of bleeding, can lead to herniation because bleed is compressing veins

Question 17

TBI: subdural hematoma

Answer 17

usually torn bridging vein or venous sinus, increased ICP compresses tear, can lead to herniation

Question 18

TBI: intracerebral bleed

Answer 18

small blood vessel trauma- shearing or penetration. increased ICP and brain compression, brain edema. dont have effect on CSF movement like the others

Question 19

what can predispose to seizures

Answer 19

hyperthermia, hypoxia, hypoglycemia, hyponatremia, repeated sensory stimulation, sleep phases

Question 20

tonic phase of seizures

Answer 20

muscle contraction/increased muscle tone. occurs when neuronal excitation spreads to subcortical, thalamic, and brainstem areas

Question 21

clonic phase

Answer 21

alternating muscle contraction and relaxation. this is essentially periodic interruption of tonic phase. occurs when inhibitory neurons (in cortex, thalamus, and basal ganglia) begin to inhibit neuronal (cortical) excitation

Question 22

seizure risk factors

Answer 22

genetic-idiopathic
genetic predisposition for disorder associated with DiGeorge syndrome- hypoparathyroidism and hypocalcemia
tumor, trauma, infection, fever
sah, stroke damage
metabolic origin (fever, uremia, hypoxemia, hyperglycemia, hyponatramia, hypocalcemia)
hypoxia, hyperventilation (resp alkalosis)
drugs or alcohol OD or withdrawal
fatigue or stress
excessive sensory stimuli

Question 23

cytotoxic edema

Answer 23

ischemia induced neuronal ion influx that facilitates cell swelling. no net increase in fluid, brain ISF goes to ICF

Question 24

vasogenic edema

Answer 24

ischemia- damages endothelial cells, BBB breakdown in 2-3 days, BBB breach means plasma protein moves into ISF

Question 25

hydrostatic edema

Answer 25

cerebral auto regulation disrupted, CBF increased, capillary hydrostatic pressure increased

Question 26

osmotic edema

Answer 26

dilution of blood, pressure decreases, more plasma volume goes to brain interstitium ex)liver failure, lack of albumin

Question 27

interstitial edema

Answer 27

transependymal movement of CSF to interstitium from ventricles

Question 28

communicating hydrocephalus

Answer 28

no CSF absorption at saggital sinus, extraventricular

Question 29

non communicating

Answer 29

intraventricular

Question 30

Parkinsons Pathophysiology

Answer 30

DA at SN inhibits GABA so movement can occur, but there is less dopamine being released to inhibit GABA at the substantial niagra and allow for movement.
Ach modulates GABA neurons, so Ach exacerbates parkinsons since the cholinergic and dopaminergic receptor balance is screwed. Usually, Ach inhibit DA input to the GABA neurons, so now Ach transmission is favored. This is why anticholinergic meds may help.

Question 31

Alzheimers pathophysiologu

Answer 31

extracellular neuritic plaques that contain amyloid protein and deform the synaptic terminal, and you lose you Ach NT. most prominent in hippocampus (memory, navigation)

Question 32

alzheimers risk factors

Answer 32

genetic, chronic HTN, head injury, female, TIA

Question 33

sx of cross clamping

Answer 33

preload increases because its a reduced container, SVR increases, RAAS and catecholamines

Question 34

each segment of the SC will receive blood from how many anterior and how many posterior spinal arteries that stem from which artery

Answer 34

1 anterior
2 posterior
stem from vertebral artery

Question 35

tx if hypotension occurs when you unclamp from cross clamping

Answer 35

partial or complete re application of cross clamp recommended

Question 36

possible reasons for ALS

Answer 36

heavy metal exposure, glutamate excitotoxicity, oxidant stress, hereditary component

Question 37

MD anesthesia risks

Answer 37

acute respiratory depression, rhabdomyolysis, hyperkalemic cardiac arrest (esp c succ), heart failure/arrhythmias

Question 38

scoliosis associated with increased risk of

Answer 38

mitral valve prolapse, pulmonary resistance, pulmonary hypertension