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Apex Review > Brain 2 > Flashcards

Brain 2 Flashcards

1
Q

The ______ cushions the brain, provides buoyancy, and delivers optimal conditions for neurologic function.

A

cerebrospinal fluid

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2
Q

CSF is located in the

A

ventricles, cisterns, and subarachnoid space in the brain and spinal cord

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3
Q

The total CSF volume is

A

~150 mL

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4
Q

CSF is produced by the

A

choroid plexus (~30 mL/hr)

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5
Q

CSF is absorbed in the

A

arachnoid villi in the superior sagittal sinus

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6
Q

The blood brain barrier separates the

A

CSF from the plasma

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7
Q

The blood brain barrier becomes dysfunctional at sites of

A

tumor, injury, infection, or ischemia

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8
Q

The blood-brain barrier isn’t present at the _______, which explains how some drugs that can’t pass through the BBB can elicit N & V.

A

chemoreceptor trigger zone

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9
Q

The blood brain barrier is poorly developed in the

A

neonate

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10
Q

The specific gravity of CSF is

A

1.002-1.009

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11
Q

CSF pressure is

A

5-15 mmHg

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12
Q

Reabsorption of CSF is dependent on the pressure gradient between

A

the CSF and venous circulation

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13
Q

What is the mnemonic for CSF flow in the brain?

A

Love My 3 Silly 4 Lorn Magpies

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14
Q

Describe the mnemonic for CSF flow in the brain

A

Lateral ventricles
Monro (foramen)
3rd ventricle
Sylvius (aqueduct)
4th ventricle
Luschka
Magendie

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15
Q

_______ is the excessive accumulation of CSF in the brain.

A

Hydrocephalus

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16
Q

What are the two types of hydrocephalus?

A

obstructive
communicating

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17
Q

Describe obstructive hydrocephalus.

A

Obstruction to CSF flow in the ventricular system (most common)

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18
Q

Describe communicating hydrocephalus.

A

a. decreased CSF absorption by the arachnoid villi (e.g. intracranial hemorrhage)
b. Overproduction of CSF (very rare)

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19
Q

Surgical management for either type of hydrocephalus depends on the cause and can include

A

placing a catheter in the cerebral ventricles to drain CSF
placing a ventriculoatrial shunt (brain to heart)
or ventriculoperitoneal shunt (brain to belly)

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20
Q

Where in the brain is the blood-brain barrier NOT present?

A

chemoreceptor trigger zone
hypothalamus
pineal gland
posterior pituitary gland
choroid plexus

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21
Q

The 5 determinants of cerebral blood flow include:

A

cerebral metabolic rate for oxygen (CMRO2)
cerebral perfusion pressure
PaCO2
PaO2
Venous pressure

22
Q

The brain __________ to protect against blood pressure fluctuations that accompany everyday life.

A

autoregulates its blood flow

23
Q

Describe the relationship between cerebral blood flow and CMRO2

A

they are coupled
the greater the need for oxygen, the more blood flow there will be to satisfy this need

24
Q

CMRO2 is decreased by

A

hypothermia, halogenated anesthetics, propofol, etomidate, and barbiturates

25
Q

CMRO2 is increased by

A

hyperthermia, seizures, ketamine, and nitrous oxide

26
Q

Cerebral blood flow autoregulates between a cerebral perfusion pressure of

A

50-150 mmHg
in reality, not all patients have such a wide range of autoregulation

27
Q

There’s a risk of ________ when CPP is below the lower limit of autoregulation.

A

hypoperfusion

28
Q

There’s a risk of _______ and ________ when CPP is above the upper limit of autoregulation.

A

cerebral edema & hemorrhage

29
Q

A PaO2 below 50-60 mmHg causes

A

cerebral vasodilation and increases CBF

30
Q

A high venous pressure reduces _______ and increases ________

A

cerebral venous drainage; and increases cerebral volume

31
Q

What is the relationship between PaCO2 and CBF?

A

there is a linear relationship
will both go up or down together

32
Q

For every _______ increase in PaCO2, CBF will increase by

A

1 mmHg; 1-2 mL/100 g brain tissue/min.

33
Q

Maximal cerebral vasoconstriction occurs at a PaCO2 of

A

25 mmHg

34
Q

Maximal cerebral vasodilation occurs at a PaCO2 of

A

80-100 mmHg

35
Q

Cerebral blood flow is equal to

A

Cerebral perfusion pressure/cerebral vascular resistance

36
Q

At a cerebral blood flow of 20 mL/100 g tissue/min we see evidence of

A

ischemia

37
Q

At a CBF <15 mL/100 g tissue/min, we see

A

membrane failure and cell death

38
Q

Cerebral perfusion pressure is equal to

A

MAP-ICP

39
Q

Things that abolish or reduce the effectiveness of autoregulation include

A

intracranial tumor
head trauma
volatile anesthetics

40
Q

When PaO2 is above 60 mmHg, cerebral blood flow is

A

unaffected by PaO2

41
Q

Conditions that impair venous drainage include

A

jugular compression due to improper head positioning
increased intrathoracic pressure secondary to coughing or PEEP
vena cava thrombosis
vena cava syndrome

42
Q

A fixed and dilated pupil suggests herniation of the:
a. cingulate gyrus
b. choroid plexus
c. temporal uncus
d. cerebellar tonsils

A

C. temporal uncus

43
Q

The most common site of transtentorial herniation is at the

A

temporal uncus

44
Q

Normal ICP is

A

5-15 mmHg

45
Q

Intracranial hypertension occurs when ICP exceeds

A

20 mmHg

46
Q

Signs and symptoms of intracranial hypertension includes

A

headache, N/V, papilledema, focal neurologic deficit, decreased LOC, seizures, and coma

47
Q

Cushing’s triad is composed of

A

hypertension
bradycardia
irregular respirations
it is a sign of intracranial HTN

48
Q

Describe the Monro-Kellie hypothesis.

A

the brain, blood, and CSF exist in the confines of the cranium. an increase in one of these components must be countered with a decrease in one or both of the others or an increase in the pressure inside the cranium will occur

49
Q

Herniation at the temporal uncus applies pressure to the

A

oculomotor nerve (CN 3), making it ischemia; this manifests as a fixed and dilated pupil

50
Q

The gold standard of ICP measurement is

A

intraventricular catheter

51
Q

ICP measurement is indicated with a GCS score of

A

<7

Apex Review (224 decks)

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