QUIZ 3 Flashcards
The trigeminal nerve is primarily responsible for motor innervation of the face ?
T/F
False- sensory
Which of the following is most concerning following microvascular decompression?
A. Hearing loss
B.PONV
C.Headache
D. Visual Impairment
B.PONV
Which of the following is/are intraoperative measures to reduce brain volume and promote brain relaxation ?
A.Mannitol administration
B. Controlled Ventilation to maintain ETCO2 < 30mmHg
C. Placement of lumbar drain
D.All the above
D. All the above
Cushing’s Triad is associated with with of the following ?
A.Hypotension, bradycardia, and respiratory patter change
B. Hypertension, bradycardia, and respiratory pattern change
C. Follows a significant decrease in ICP
D. An ominous sign related to an increase in ICP
E. Both B & D
F. All the above
E. Both B & D
Which one of the following statements is true regarding anesthetic technique or intracranial tumors?
A.Ketamine is the induction agent of choice
B. If patient shows a significant increase in ICP, it is imperative to decrease the patients BP
C. Mannitol and 3% NaCl can be given to decrease ICP
D. Head pin placement is not painful
C. Mannitol and 3% NaCl can be given to decrease ICP
A patient with an elevated ICP and midline shift due to intracranial tumor has fixed and dilated pupil, what is the cause of the pupillary change?
A.Blood brain barrier has been compromised
B. Oculomotor Nerve (III) is being compromised
C. Direct stimulation of the brain stem
D. Vagus Nerve (X) has been dissected
B. Oculomotor nerve (III) is being compressed
1.Intravenous administration of mannitol during a craniotomy
A.decreases intracranial pressure relative to dosage
B. hastens excretion of pancuronium
C. induces metabolic alkalosis
D.produces a sustained increase in intravascular volume
E.requires an intact blood-brain barrier to decrease cerebral Fluid
E. Requires an intact blood brain barrier to decrease cerebral fluid
2.All of the following are true regarding noxious stimuli associated with craniotomy under general anesthesia EXCEPT:
A.Application of the Mayfield pin head holder may lead to undesirable increases in ICP
B.Efforts to blunt the hemodynamic response to direct laryngoscopy can help protect patients from dangerous increase in transmural pressure (TMP) and mean arterial pressure (MAP) during craniotomy for aneurysm clipping
C.There is some evidence that skull blocks help to blunt the hemodynamic response to the craniotomy incision
D.Another noxious stimuli is the pain from resection of the brain itself
D. Another noxious stimuli is the pain from the resection of the brain itself
What are the predisposing factors for an intracranial aneurysm rupture ?
A.Tobacco Use B. ETOH C.Pregnancy D. HTN E. All the Above
E. All the above
1.What is the preferred crystalloid and colloid of choice when doing a cerebral coiling of SAH?
A. Normal Saline and Albumin
B. Albumin and Lactated Ringers
C. Hetastarch and Normal Saline
D. None of the above
A. Normal Saline and Albumin
2.True or false? Alcoholism is not a risk factor for subarachnoid hemorrhage.
False
3.What is a bigger risk associated with coiling compared to clipping to treat cerebral aneurysm?
A. Late Re-bleeding
B. Hypotension
C. Death or dependency
D. All of the above
A. Late Re-bleeding
What is the most common indication for a VP shunt?
a. Pseudotumor cerebri
b. Hydrocephalus
c. Subarachnoid Cyst
d. Dandy- Walker Malformation
B. Hydrocephalus
Your patient has increased ICP, what induction agent would be use to decrease cerebral blood volume?
a. Propofol
b. Etomidate
c. Dexmedetomidine
d. Ketamine
A. propofol
During a VP shunt procedure where is the incision(s) made?
a. Neck (subgaleal)
b. Cranium
c. Abdominal
d. All of the above
D. All of the above
Which of the following should be avoided in a Duchenne’s muscular dystrophy patient?
A. Propofol
B. Rocuronium
C. Succinylcholine
D. Fentanyl
C. Succinylcholine
Duchenne’s Muscular Dystrophy is associated with the absence of which of the following proteins?
A. Albumin
B. Dystrophin
C. Actin
D. Elastin
B. Dystrophin
Which of the following are the most common causes of death in Duchenne’s Muscular
Dystrophy (select 2 that apply)?
A. Renal Insufficiency
B. Cardiomyopathy
C. Stroke
D. Respiratory Insufficiency
B.Cardiomyopathy
D. Respiratory Insufficiency
Patients with myasthenia gravis will be (choose 2)
a. Resistant to rocuronium
b. Resistant to succinylcholine
c. Sensitive to succinylcholine
d. Sensitive to rocuronium
B. Resistant to succinylcholine
D. Sensitive to Rocuronium
What is the earliest sign/symptom of myasthenia gravis?
a. Dyspnea with exertion
b. Diplopia/ptosis
c. Difficulty walking
d. Dysphagia
B. Diploplia/ptosis
Myasthenia gravis occurs when antibodies attack the ________ neuromuscular junction, leading to ________.
a. Muscarinic; muscle weakness
b. Nicotinic Acetylcholine; muscle weakness
c. Dopaminergic; muscle contraction
d. Nicotinic Acetylcholine; muscle contraction
B. Nicotinic Acetylcholine, muscle weakness
1) Succinylcholine is the drug of choice for induction of a patient with ALS.
a. True
b. False
False
ALS is believed to be attributed to:
a. A mutation in the antioxidant superoxide dismutase-1 (SOD1)
b. A malfunction of the ryanodine receptor
c. A tick-born illness
d. Lack of sleep during anesthesia school
A. A mutation in the antioxidant superoxide dismutase-1 (SOD1)
Symptoms of ALS include:
a. Progressive weakening and atrophy of an extremity
b. Pseudobulbar effects
c. Dyspnea
d. All of the above
D. All of the above
Which of the following would NOT exclude a patient from having an awake craniotomy for tumor resection?
a. A 73-year-old female who is uncooperative and confused b. A cooperative 50-year-old woman with a Class I Mallampati airway assessment c. A 46-year-old male with a history of drug and alcohol abuse d. An otherwise healthy 24 year old football player with a history of violent emergence from anesthesia
B. A cooperative 50-year old woman with a class I Mallampati airway assessment
Which of the following are considered stages of an awake craniotomy procedure?
a. Preparation and pinning b. Cortical mapping c. resection and closure d. All of the above
D. All of the above
If a patient exhibits seizure activity during brain mapping, and it does not spontaneously resolve, which of the following are appropriate interventions?
a. Apply iced saline directly to the brain b. Administer IV midazolam and IV Levetiracetam c .Resedate the patient and secure the airway d. All of the above
D. All of the above
Which type of pituitary tumor secretes hormones?
A. Non-functional
B. Functional
Functional
A patient with a GH secreting tumor may exhibit what?
A. Small mandible, small tongue that complicate airway management as well as hypotension
B. Hypertrophy of the tongue and other airway features that complicate airway management as well as HTN
C. Normal airway and normal BP with no concerns
D. None of the above
B. Hypertrophy of the tongue and other airway features that complicate airway management as well as HTN
3.A Valasalva maneuver may be used during this surgery to?
A. Help visualize the tumor
B. Check for a CSF leak
C. All of the above
D. None of the above
C. All of the above
1.What position will be utilized for Cervicocranial Decompression surgery when there is coexisting Myelomeningocele?
a) Supine
b) Lateral
c) Sitting
d) Prone
D. Prone
- What may be necessary in order to correct hypotension that is unresponsive to fluids and vasopressors in a patient with Chiari Malformation that is in the prone position?
a) Albumin administration
b) Conversion to supine position
c) Conversion to lateral position
d) Central line insertion
B. Conversion to supine position
- What is the incidence of coexisting Type II Arnold Chiari Malformation when Myelomeningocele is present?
a) 50%
b) 22%
c) 10%
d) 95%
D. 95%
1.Which of the following is the safest mode of ventilation to prevent barotrauma in the anesthetized patient undergoing a proned cervical spine surgery?
A. Pressure Support
B. Volume Control Ventilation
C. Pressure Control Ventilation
D. The patient should be manually bagged during the case
C. Pressure Control Ventilation
2.Which of the following are risk factors for post-operative vision loss? (Select 3)
A. Female B. Obesity C. Use of a Jackson Frame D. Large Blood Loss E. Use of Colloids F. IOP less than 40 mmHg
B.Obesity
D. Large blood loss
E. Use of Colloids
- You are the CRNA for an obese patient about to undergo an ACDF (Anterior Cervical Discectomy and Fusion your patient has a mouth opening of 3cm, and a Mallampati score of 3. What is your anesthetic plan?
A. Don’t worry about the airway, you can just MAC him
B. Smaller LMA will fit
C. General anesthesia ramp the patient and intubate using a MAC 3 blade
D. General anesthesia, ramp the patient, and intubate using a fiberoptic due to the potential of a difficult airway.
D. General anesthesia, ramp the patient, and intubate using fiberoptic due to the potential difficult airway
1.MS is characterized as an autoimmune neurological disease where the immune system mainly attacks which part of the CNS?
◦A. The myelin
◦B. The oligodendrocytes
◦C. The nerve itself
◦D. All of the above
D. All of the above
A MS patient has complaints of neurological symptoms that have completely resolved for 3 years. The patient recently had a UTI and the symptoms came back but then completely resolved again. This is an example of?
◦A. Primary progressive MS
◦B. Secondary progressive MS
◦C. Relapsing-Remitting MS
◦D. Temporary neurological demyelinating MS
C. Relapsing- Remitting MS
Post operatively your patient with MS is complaining of partial vision loss in both eyes, numbness and tingling of the lower legs, and is having uncontrolled tremors. What is the most likely reason the patient is experiencing these symptoms?
◦A. You performed an RSI induction using succinylcholine
◦B. This was a prone case, you were unable to do frequent pressure checks due to location of the surgical field and you noticed when the case was over the prone pillow was incorrectly placed.
◦C. You left the bair hugger on for the entire case. Your bladder temp probe started at 36.5 and went up to 37.9
◦D. You didn’t do the pre-op assessment so you assume this is normal for the patient. You use an alias when giving report in the PACU just in case, then quickly leave the hospital- hopefully making it seem like you were never there
C. You left the air hugger on for the entire case. Your bladder temp probe started at 36.5 and went up to 37.9
How long should Parkinson’s medications be held before surgery?
a. 48 hours
b. 24 hours
c. 8 hours
d. Should be given up to the time of surgery
D. Should be given up to the time of surgery
Which medication will have a prolonged effect if a Parkinson’s patient is on an mao inhibitor?
a. Ephedrine
b. Propofol
c. Rocuronium
d. Epinephrine
A. Ephedrine
What can decrease your chances of Parkinson’s disease?
a. Vegetarian diet
b. Smoking and caffeine intake
c. Rigorous exercise
d. None of the above
B.Smoking and caffeine intake
What is the most common risk factor for developing a posterior fossa tumor?
A. Smoking
B. Atherosclerosis
C. Family Hx
D. There are no identifiable risk factors
D. There are no identifiable risk factors
What complication is commonly associated with craniotomies in the sitting position?
A. VAE
B. Urine retention
C. Pressure ulcer
D. MI
A. VAE
What is the most sensitive non-invasive indicator for detecting VAE’s?
A. EtCO2
B. SaO2
C. Tachycardia
D. Precordial doppler
D. Precordial doppler
Where do you keep the patients MAP at post-clipping?
A. 60-65
B. 80 - 100
C. 110-120
D. No need to control MAP
B. 80-100
2.Pre-operatively for Cerebral Emboli, the patient is to be kept in a controlled hypotensive state, True or False?
False
What is a good neuroprotective drug for induction?
A. Ketamine
B. Potassium
C. Etomidate
D. Diphenhydramine
C. Etomidate
- Which drug should be avoided with induction for a patient with a history of Guillain Barre Syndrome?
A. Rocuronium
B. Cisatracurium
C. Ketamine
D. Succinylcholine
D. Succinylcholine
Which is true regarding the anesthetic management of a patient with Guillain Barre Syndrome?
A. Non-depolarizing muscle relaxants - may result in prolonged neuromuscular block
B. Continued ventilatory support may be needed in the post-op period (d/t intercostal muscle paralysis).
C. The dose-response relationship for vasopressors may be abnormal due to denervation. Patients may exhibit exaggerated responses to indirect acting vasopressors.
D. All of the above
D. All of the above
Which of the following are presenting symptoms of someone with Guillain Barre Syndrome?
A. Sudden onset of ascending skeletal muscle weakness or paralysis
B. Intercostal muscle paralysis
C. Dysautonomia/autonomic nervous system dysfunction
D. All of the above
D. All of the above
What is the longest duration is acceptable for a patient to be under DHCA?
a. 10 minutes
b. 30 minutes
c. 1 hour
d. 2 hours
B. 30 minutes
- T/F – Rewarming should be done as fast as possible, after DHCA?
False
Which site provides the most accurate “brain temperature”?
a. Oral
b. Bladder
c. Tympanic membrane
d. PAC
C. Tympanic Membrane
