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Neuro Test 4 > Prodigy > Flashcards

Prodigy Flashcards

1
Q

Which of the following are symptoms associated with autonomic hyperreflexia? (select two)

A: Hypertension
B: Hypotension
C: Tachycardia
D: Bradycardia

A

AD

The hallmark cardiovascular symptoms of autonomic hyperreflexia are severe hypertension and bradycardia.

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2
Q

A patient with autonomic hyperreflexia will exhibit (select two)

A: Vasoconstriction above the level of spinal cord injury
B: Vasodilation below the level of spinal cord injury
C: Vasoconstriction below the level of spinal cord injury
D: Vasodilation above the level of spinal cord injury

A

CD

When a patient experiences autonomic hyperreflexia, a reflex dilation of the tissues ABOVE the level of the spinal cord injury will occur to help offset the sudden increase in blood pressure due to vasoconstriction below the level of the lesion. Patients may experience nasal stuffiness as a result of this effect.

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3
Q

Increased afferent impulses from the glossopharyngeal and vagus nerves inhibit the peripheral sympathetic nervous system resulting in: (select two)

A: vasoconstriction
B: increased vagal tone
C: tachycardia
D: vasodilation

A

BD

Increased afferent impulses from the glossopharyngeal and vagus nerves inhibit peripheral SNS vascular tone resulting in vasodilation. Vagal tone is increased resulting in bradycardia.

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4
Q

Which of the following drugs should be avoided in patients with Parkinson’s disease?

A: Fentanyl
B: Droperidol
C: Ketorolac
D: Desflurane

A

B

Because Parkinson’s disease results in decreased dopamine levels in the basal ganglia, butyrophenones such as droperidol, which can antagonize the effects of dopamine in the basal ganglia, can exacerbate symptoms

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5
Q

Which meningeal layer is thin and is in direct contact with the outer surface of the spinal cord?

A: Pia mater
B: Dura mater
C: Arachnoid mater
D: Conus medullaris

A

A

The pia mater is the innermost meningeal layer. It is thin and lies in direct contact with the outer surface of the spinal cord.

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6
Q

Which of the following effects is not a symptom of autonomic hyperreflexia?

A: Hypertension
B: Nasal stuffiness
C: Pulmonary edema
D: Polyuria

A

D

The hallmark symptoms of autonomic hyperreflexia are hypertension and bradycardia. It may also be accompanied by blurred vision, loss of consciousness, seizures, cardiac dysrhythmias, and pulmonary edema. When a patient experiences autonomic hyperreflexia, a reflex dilation of the tissues ABOVE the level of the spinal cord injury will occur to help offset the sudden increase in blood pressure. Patients may experience nasal stuffiness as a result of this effect.

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7
Q

Select two dopamine antagonists to be avoided for patients with Parkinson’s disease.

A: Droperidol
B: Ondansetron
C: Metoclopramide
D: Dexamethasone

A

AC

Dopamine antagonists (phenothiazines, droperidol, and metoclopramide) should be avoided in patients with Parkinson’s disease.

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8
Q

Which of the following illustrates a correct understanding of the anesthestic management of the patient with cerebral palsy? (select two)

A: Baclofen should be discontinued at least 12 hours prior to surgery
B: The patient is at severe risk for gastric aspiration
C: Patients with cerebral palsy are more at risk for hypothermia
D: Hyperkalemia due to succinylcholine administration is a serious risk

A

BC

Even though they may suffer muscle weakness and spasticity, patients with cerebral palsy do not have an exaggerated hyperkalemic response to succinylcholine, nor are they more susceptible to malignant hyperthermia.They are susceptible of hypothermia and require close temperature monitoring. Abrupt discontinuation of baclofen can result in withdrawal symptoms such as itching, confusion, hallucinations, and seizures. Gastric reflux is often severe enough that surgery to correct it is necessary.

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9
Q

Patients taking levodopa for the treatment of Parkinson’s disease may exhibit (select two)

A: dyskinesias
B: orthostatic hypotension
C: decreased risk for nausea and vomiting
D: decreased cardiac contractility

A

AB

Levodopa is a precursor to dopamine. It is combined with a decarboxylase inhibitor to prevent the peripheral conversion of levodopa to dopamine and increase levels in the central nervous system. Side effects include dyskinesias (in over 80% of patients after one year of treatment), hallucinations, paranoia, and mania. Increases in cardiac contractility and heart rate occur. Orthostatic hypotension is also common in these individuals and levodopa therapy may result in nausea and vomiting as a result of stimulation of the chemoreceptor trigger zone.

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10
Q

Which of the following represents a primary aim of the treatment of Parkinson’s disease?

A: Increasing the amount of dopamine in the basal ganglia
B: Increasing the neuronal effects of acetylcholine
C: Increasing the amount of serotonin in the neuronal synapse
D: Preventing systemic hypertension

A

A

Treatment of Parkinson’s disease is aimed at increasing the amount of dopamine in the basal ganglia or suppressing the neuronal effects of acetylcholine.

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11
Q

Select two characteristic features of patients with Parkinson’s disease.

A: Resting tremor
B: Scissor gait
C: Tachykinesia
D: Cogwheel rigidity of extremities

A

AD

Features characteristic of Parkinson’s disease include: resting tremor, cogwheel rigidity of extremities, bradykinesia, shuffling gait, stooped posture, and facial immobility.

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12
Q

In which cranial nerves are parasympathetic nervous system preganglionic fibers found?

A: II, VI, IX, X
B: III, VII, IX, X
C: IV, VI, X, XI
D: V, VI, IX, X

A

B

Preganglionic fibers are located in cranial nerves III, VII, IX, and X.

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13
Q

On preoperative examination of a patient with Parkinson’s disease, you find that he is taking levodopa. Considering that you are planning a general anesthetic, you should

A: Discontinue the levodopa 24 hours prior to surgery
B: Discontinue the levodopa 12 hours prior to surgery
C: Continue the levodopa as scheduled
D: Increase the dose of levodopa

A

C

Levodopa has a relatively short half-life and interruption of administration of the drug can result in abrupt loss of therapeutic effect within 6 to 12 hours resulting in skeletal muscle rigidity which can interfere with ventilation. Therefore, it is recommended that levodopa be continued as prescribed.

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14
Q

Parkinson’s disease is associated with

A: A decrease in dopamine levels in the basal ganglia
B: A decrease in dopamine levels in the cerebellum
C: An increase in dopamine levels in the basal ganglia
D: An increase in dopamine levels in the cerebellum

A

A

Parkinson’s disease is associated with a loss of dopaminergic fibers and subsequently, decreased dopamine levels in the basal ganglia. The result is unopposed action of acetylcholine and a decrease in the inhibition of the extrapyramidal motor system.

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15
Q

What is the most effective anesthetic for preventing autonomic hyperreflexia and providing pain relief in a laboring parturient?

A: Pudendal block
B: Epidural block
C: Spinal block
D: Intravenous meperidine as the sole anesthetic

A

C

Epidural anesthesia has been reported to be effective in preventing autonomic hyperreflexia from occurring due to uterine contractions, but, because epidurals may spare the sacral segments, spinal anesthesia is more protective.

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16
Q

What is the primary area for relay of afferent chemoreceptor and baroreceptor information from the vagus and glossopharyngeal nerves?

A: Pons
B: Hypothalamus
C: Nucleus tractus solitarius
D: White ramus

A

C

Located within the medulla, the nucleus tractus solitarius is the main area responsible for relaying afferent chemoreceptor and baroreceptor information from the vagus and glossopharyngeal nerves.

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17
Q

What agent would be the most appropriate to have on hand to treat autonomic hyperreflexia should it occur during an anesthetic?

A: Nitroprusside
B: Esmolol
C: Metoprolol
D: Norepinephrine

A

A
Vasodilators with a short half-life (such as sodium nitroprusside) should be available to treat the sudden onset of systemic hypertension in patients with autonomic hyperreflexia.

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18
Q

You are evaluating a patient with cerebral palsy for general anesthesia. You know that this patient has a significantly increased risk for

A: malignant hyperthermia
B: gastric reflux
C: hyperkalemic response to succinylcholine
D: intraoperative cardiac arrest due to hypertrophic cardiomyopathy

A

B
Patients with cerebral palsy have an increased incidence of reflux and weak pharyngeal and laryngeal muscles. Gastric reflux is often severe enough in patients with cerebral palsy that surgery to correct it is necessary. Even though they may suffer muscle weakness and spasticity, patients with cerebral palsy do not have an exaggerated hyperkalemic response to succinylcholine, nor are they more susceptible to malignant hyperthermia.

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19
Q

Which of the following is true regarding patients with cerebral palsy?

A: Baclofen should be discontinued at least 6 hours prior to surgery
B: LMA use is preferred to reduce the risk of bronchospasm
C: Deep extubation is preferred to reduce the risk of delirium on emergence
D: MAC is decreased

A

D
Patients with cerebral palsy have an increased incidence of reflux and weak pharyngeal and laryngeal muscles. Tracheal extubation may need to be delayed until the patient is fully awake and airway reflexes return. Abrupt discontinuation of baclofen can result in withdrawal symptoms such as itching, confusion, hallucinations, and seizures. MAC is generally decreased and emergence times are longer.

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20
Q

Autonomic hyperreflexia would most likely produce

A: cutaneous vasoconstriction above the spinal cord lesion
B: apnea
C: hypotension
D: vasoconstriction below the spinal cord lesion

A

D
When a patient experiences autonomic hyperreflexia, a reflex dilation of the tissues ABOVE the level of the spinal cord injury will occur to help offset the sudden increase in blood pressure caused by the unopposed vasoconstriction below the spinal cord lesion.

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21
Q

Which of the Rexed laminae are located in the dorsal horn of the spinal cord?

A: Lamina VI
B: Lamina VII
C: Lamina VIII
D: Lamina IX

A

A
Rexed laminae I through laminae VI are located in the dorsal horn of the spinal column. Laminae VII, VIII, and IX comprise the ventral horn.

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22
Q

Which drug regimen is used in the treatment of muscle spasticity in patients with cerebral palsy?

A: Acetaminophen
B: Rocuronium
C: Droperidol
D: Dantrolene

A

D

and includes medicines such as dantrolene, Botox injections, and baclofen.

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23
Q

Which of the following cranial nerves provides both a motor and a sensory component?

A: Abducens
B: Trochlear
C: Trigeminal
D: Optic

A

C
The olfactory, optic, and vestibulocochlear nerves are sensory only. The oculomotor, trochlear, abducens, spinal accessory, and hypoglossal nerves are motor only. The trigeminal, facial, glossopharyngeal, and vagus are both sensory and motor.

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24
Q

Which of the Rexed laminae are found in the dorsal horn of the spinal column? The ventral horn?

A

Rexed laminae I through laminae VI are located in the dorsal horn of the spinal column. Laminae VII, VIII, and IX comprise the ventral horn.

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25
Q

Which cranial nerves are sensory only? Which are motor only? Which have both sensory and motor function?

A

The olfactory, optic, and vestibulocochlear nerves are sensory only. The oculomotor, trochlear, abducens, spinal accessory, and hypoglossal nerves are motor only. The trigeminal, facial, glossopharyngeal, and vagus are both sensory and motor.

26
Q

What is the pathologic process that results in the neuronal degradation associated with Alzheimer’s disease?

A

Deposition of amyloid beta peptides produces neuritic plaques and neurofibrillatory tangles that result in disruption of neurotransmitter function and the death of neurons.

27
Q

What test is diagnostic of Alzheimer’s disease?

A

Although computed tomography may demonstrate ventricular dilation and cortical atrophy and positive emission tomography may exhibit areas of decreased cerebral blood flow, only postmortem examination of the brain tissue is definitively diagnostic of Alzheimer’s.

28
Q

What is the standard medical treatment for patients with Alzheimer’s disease?

A

Cholinesterase inhibitors such as rivastigmine, donepazil, and galantamine are the standard medical treatments for Alzheimer’s disease. Memantine, and NMDA receptor antagonist has also shown some efficacy.

29
Q

What are the side effects of the most common drugs used to treat Alzheimer’s?

A

Acetylcholinesterase inhibitors are the most common treatment and may result in nausea, vomiting, bradycardia, syncope, and fatigue.

30
Q

What are the anesthetic management implications for the patient with Alzheimer’s disease?

A

Preoperative sedation is usually avoided because it may aggravate dementia and precipitate postoperative confusion.

31
Q

How would you expect a patient with Alzheimer’s to respond to succinylcholine?

A

Patients taking acetylcholinesterase inhibitors may have a prolonged duration of action with succinylcholine.

32
Q

How would you expect a patient with Alzheimer’s disease to respond to muscle relaxants?

A

They will exhibit a resistance to nondepolarizing muscle relaxants due to the use of acetylcholinesterase inhibiting drugs as part of their medical management. They will also exhibit a longer duration of action with succinylcholine.

33
Q

If you need to administer an anticholinergic to a patient with Alzheimer’s disease, which one is preferred and why?

A

Glycopyrrolate is preferred because it doesn’t cross the blood-brain barrier. Atropine and scopolamine may result in increased confusion.

34
Q

What are of the spine is mostly commonly involved in acute spinal cord injury?

A

The cervical spine because it is more mobile, specifically C7 vertebra

35
Q

Where do the fibers that innervate the diaphragm originate?

A

C3, C4, and C5 nerve roots

36
Q

An injury at or above what level can result in severe bradycardia and hypotension?

A

T6, because the cardioaccelatory fibers originate between T1 and T5

37
Q

What are the symptoms of acute spinal cord injury?

A

Below the level of injury, the patient will exhibit flaccid paralysis, total absence of sensation, and loss of temperature regulation and spinal cord reflexes.

38
Q

How long can spinal shock last?

A

1 to 3 weeks

39
Q

In patients with spinal shock, why are their extremities warm and pink?

A

Spinal shock disrupts the compensatory vasoconstrictive response

40
Q

Can succinylcholine be used with spinal cord injury?

A

In the first 24 hours it is safe to use. Following that, new exntrajunctional nicotinic receptors begin to form that could result in life-threatening hyperkalemia from Sux.

41
Q

When is the risk greatest for life-threatening hyperkalemia with SCI?

A

The first 6 months after injury.

42
Q

What are the symptoms of spinal shock?

A

Decreased blood pressure due to loss of preload (there is significant dilation of the capacitance vessels). If the injury is at or above T1-T4, the loss of sympathetic innervation to the heart can result in bradycardia.

43
Q

What is autonomic hyperreflexia?

A

Autonomic hyperreflexia may appear after spinal shock has resolved and represents the return of spinal cord reflexes. It is a massive sympathetic discharge that occurs in response to a cutaneous or visceral stimulation below the level of transection. In normal patients, the sympathetic activity that results from this stimulation is overridden by inhibitory impulses from higher central nervous system centers. In the spinal cord injured patient, the sympathetic outflow is isolated from the inhibitory feedback loop and the sympathetic discharge is unopposed.

44
Q

What are the signs of autonomic dysreflexia?

A

Hypertension, seizures, MI, pulmonary edema, renal injury, and intracranial bleeding.

45
Q

With what spinal cord injury levels is autonomic hyperreflexia most common?

A

About 85% of patients with a spinal cord injury above T6 will exhibit autonomic hyperreflexia, but it is uncommon in patients with lesions below T10.

46
Q

What types of stimuli may precipitate autonomic hyperreflexia?

A

Visceral or cutaneous stimulation below the level of the lesion, or distention of the bladder or rectum,

47
Q

What precautions can you take to prevent or treat autonomic hyperreflexia during the perioperative period?

A

Don’t allow stimulation from surgical incision or other manipulation to occur before adequate general or regional anesthesia has been established. Have immediate access to short-acting vasodilators such as nitroprusside to treat sudden, severe hypertension. Monitor the patient closely in the recovery area as autonomic hyperreflexia may not occur until the effects of anesthetic drugs wear off.

48
Q

How can autonomic hyperreflexia be prevented in a parturient with a chronic spinal cord injury undergoing childbirth?

A

The use of neuraxial anesthesia has been reported to prevent autonomic hyperreflexia in response to labor contractions. Epidural anesthesia is less effective than spinal anesthesia in this scenario as it can spare sacral segments that can be involved in autonomic hyperreflexia.

49
Q

Will topical anesthesia prevent autonomic hyperreflexia from occurring in patients undergoing bladder procedures such as cystoscopy? Why or why not?

A

No. Topical anesthesia does not affect the nerves that detect bladder distention which can precipitate autonomic hyperreflexia.

50
Q

How do patients with acute and chronic spinal cord injury respond to succinylcholine?

A

Because of the risk for severe hyperkalemia following the administration of succinylcholine, especially during the first six months after the injury, it should be avoided in all patients with spinal cord injury for the rest of their life. Some practitioners will utilize succinylcholine during the first 24 hours as upregulation of extrajunctional receptors probably has not had time to occur yet.

51
Q

Why is it important to closely manage hydration status in a patient with spinal cord injury?

A

Patients with a spinal cord injury may have difficulty maintaining ventricular filling pressures due to the loss of venous return from the cord transection.

52
Q

In what patient population does autonomic hyperreflexia occur?

A

It occurs in patients who have experienced spinal shock and appears in conjunction with the return of spinal reflexes.

53
Q

What are the hallmark cardiovascular symptoms of autonomic hyperreflexia?

A

Severe hypertension and reflex bradycardia. It may also be accompanied by blurred vision, loss of consciousness, seizures, cardiac dysrhythmias, and pulmonary edema.

54
Q

What factors can trigger autonomic hyperreflexia?

A

It can be triggered by cutaneous stimulation such as surgical incision or visceral stimulation such as distention of the bladder or rectum.

55
Q

How is the incidence of autonomic hyperreflexia related to the level of the spinal cord injury?

A

About 85% of patients with an injury above T6 will suffer from autonomic hyperreflexia, but it is unlikely to occur at all in patients with a lesion below T10.

56
Q

What are methods of preventing autonomic hyperreflexia?

A

The goal is to prevent the triggering event from initiating the reflex by deep general anesthesia, neuraxial anesthesia, or regional anesthesia.

57
Q

Will an epidural prevent autonomic hyperreflexia from occurring in a laboring parturient with a T6 injury?

A

Epidural anesthesia has been reported to be effective in preventing autonomic hyperreflexia from occurring due to uterine contractions, but, because epidurals may spare the sacral segments, spinal anesthesia is more protective.

58
Q

What is the treatment for autonomic hyperreflexia if it occurs?

A

Vasodilators with a short half-life (such as sodium nitroprusside) should be available to treat the sudden onset of systemic hypertension.

59
Q

What symptoms may be seen in a patient who is awake and experiences autonomic hyperreflexia?

A

Severe headache and blurred vision may occur due to severe hypertension and nasal stuffiness may occur due to reflexive cutaneous vasodilation.

60
Q

What is reflexive cutaneous vasodilation and how does it relate to autonomic hyperreflexia?

A

When a patient experiences autonomic hyperreflexia, a reflex dilation of the tissues ABOVE the level of the spinal cord injury will occur to help offset the sudden increase in blood pressure. Patients may experience nasal stuffiness as a result of this effect.

Neuro Test 4 (3 decks)

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