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Board Prep > Module 6 Evoked Potentials And Pain Paths/CNS > Flashcards

Module 6 Evoked Potentials And Pain Paths/CNS Flashcards

1
Q

What tract is monitored by SSEPs

A

Dorsal Leminiscal is all sensory system: cuneatus and Gracillus tracts

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2
Q

Cuneatus and gracilis tracts of dorsal leminiscal system are located where in SC

What information do they carry

A

Posterior cord

Sensation of touch, pressure, and vibration

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3
Q

Pathway for dorsal leminiscal sensory system

A

Ascend on ipsilateral side and crossover in brainstem to thalamus and primary sensory cortex

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4
Q

General anesthetics produce sedation and hypnosis by

A

Depressing the RAS

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5
Q

What nerves are stimulated in SSEPs

A

Tibial, median, or ulnar nerves

SSEPs are recorded from the scalp

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6
Q

CN IX supplies

A

Glossopharyngeal nerve

Posterior 1/3 tongue
Vallecula
Anterior surface of epiglottis

Motor for deglutition (swallowing)

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7
Q

Cranial nerve controlling equilibrium

A

Vestibular branch of CN VIII

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8
Q

Motor innervation of tongue supplied by

A

CN XIII hypoglossal

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9
Q

What structure provides collateral blood flow to the brain if major blood vessel carrying blood to the brain becomes obstructed

A

Circle of Willis

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10
Q

Formula for CBF

A

CPP/CVR

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11
Q

CPP formula

A

MAP-ICP

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12
Q

Single most important determinant of CBF

A

PaCO2 when between 20-80mmHg

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13
Q

Effect of hypercarbia on CBF

A

CBF increased by hypercarbia

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14
Q

How does CBF change for each mmHg decrease in PaCO2

A

1 ml/100g/min

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15
Q

Cerebral metabolic rate decreases by how much for each degree Celsius drop in temperature

A

6-7% for each degree Celsius temperature drops

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16
Q

CBF is autoregulated over what MAP range

A

50-150 mmHg

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17
Q

What is normal ICP

A

15 mmHg

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18
Q

CSF volume

Total daily production/absorption

A

150ml

500-750 ml/day

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19
Q

What 2 areas of the brain have no BBB

A

Chemoreceptor trigger zone

Capillaries of choroid plexus

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20
Q

Autonomic hyperreflexia symptoms

A

Paroxysmal HTN

Bradycardia

Vasoconstriction below the lesion

Vasodilation above the lesion

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21
Q

4 Anesthetic concerns for MS patient

A

Neuraxial can exacerbate symptoms

Symptoms worsened by increased temperature

Corticosteroids may be needed

Succinylcholine can cause hyperkalemia

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22
Q

4 neurodegenerative diseases with high risk of aspiration pneumonitis

A

ALS

Huntinton’s chorea

Creutzfeldt-Jakob

Parkinson’s

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23
Q

Frequency for 4 brain waves

A

Delta 0-4 Hz
Theta 4-7 Hz
Alpha 8-12 Hz
Beta >12Hz

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24
Q

What happens to EEG waveforms when anesthetic depth increases

A

Increased amplitude and synchrony

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25
Q

What MAC correlates with isoelectric EEG

A

1.5-2.0 MAC

26
Q

How does N2O change EEG

A

Decrease in amplitude without change in latency

27
Q

Cell bodies of A delta and C fibers are found where

A

Dorsal root ganglion

28
Q

Major NTS released from A delta fibers is_____

Binds to which receptors

A

Glutamate

AMPA andNMDA

29
Q

Major NTS released from type C fibers is _____

Binds to what receptors

A

Substance P

NK-1 receptors

30
Q

Fast pain fibers are what type

Terminate where

A

A delta

Terminate Rexed’s lamina I and V

Second order neuron crosses to contralateral spinothalamic tract

31
Q

Slow pain fibers are what type

Terminate where

A

Type C

Terminate Rexed’s lamina II and III

Interneuron transmits to Rexed V and pass to the contralateral spinothalamic tract

32
Q

What is the function of the dorsolateral tract

A

Modulate pain

33
Q

Spinal analgesia is mediated by primarily what receptor

A

Mu2

34
Q

Supraspinal analgesia with mediated by what receptor

A

Mu1

35
Q

Modulation of pain pathway

A

Axons leave periventricular nuclei through periaquaductal gray matter. Then through lotus cerulean to Ralphe mangnus nucleaus down to medulla. Then out foramen magnum to spinal cord aka dorsolateral fasiculus

Ends in Enkephalins containing interneuron command to release enkephalins = decreased substance P

36
Q

Which receptor is responsible for supraspinal analgesia, decreased HR, euphoria and pruritis

A

Mu1

37
Q

Which opioid receptor is responsible for spinal analgesia, respiratory depression, and physical dependence

A

Mu2

38
Q

Which opioid receptor is responsible for dysphoria (sedation)

A

Kappa

39
Q

CSF circulation pathway

A

Choroid plexus - lateral ventricles - foramina of Munro - third ventricle - aqueduct of Sylvius - fourth ventricle - foramina of Lusaka or foramen of magendie - subarachnoid space of SC - brain - arachnoid villi

40
Q

What blood vessels supply the circle of Willis

A

Left and right internal carotid as well as basilar artery (supplied by vertebral arteries)

41
Q

Ketamine and N20 effect on CBF and cerebral metabolism

A

Increases both

42
Q

Blood supply to spinal cord

A

75% from one anterior spinal artery

25% from 2 posterior spinal arteries

Small segmental arteries

43
Q

Artery of Adamkiewicz significance

A

Enters vertebral canal mainly on left side in lower thoracic or upper lumbar region

Major source of blood to lower 2/3 spinal cord. Interruption can lead to paraplegia

44
Q

Decorticate rigidity cause

A

Damage to brain above cerebellum and brainstem (supratentorial)

45
Q

Decerebrate rigidity cause

A

Extensive damage to brainstem or cerebral lesions compressing thalamus and brainstem

46
Q

Cushings triad

A

Hypertension

Bradycardia

Irregular respirations

47
Q

What area of spinal cord is where transmission of pain impulses is modulated

A

Substantial gelatinosa

48
Q

What is the difference in complex regional pain syndrome type I and type II

A

In type II there is documents nerve injury

49
Q

What is the best time to initiate PCA

A

In PACU after initial pain level under control

50
Q

Epidural steroid injection for radiculopathy and back pain work how

A

Anti-inflammatory effect related to inhibition of phospholipase A2 (PLA2) activity

51
Q

Spinal cord stimulation is most effective for what type of pain

A

Neuropathic pain

52
Q

Medical management of CRPS

A

Physical Therapy

Membrane stabilizers (gabapentin)

TCAs

53
Q

What regional block may be indicated for circulatory insufficiency of upper extremity

A

Stellate ganglion block

54
Q

What is the most effective measure for pain associated with pancreatic CA

A

Celiac plexus block with alcohol or phenol

55
Q

During posterior fossa surgery bradycardia and hypertension develop. Why

A

Stimulation of trigeminal nerve due to pressure on brainstem (cushings reflex)

56
Q

During posterior fossa surgery bradycardia and hypotension develop. Why

A

Stimulation of glossopharyngeal or vagus nerve

57
Q

Standard treatment for cerebral vasospasm

A

Calcium channel blocker (nimodipine)

Triple H therapy (hypertensive, hypervolemic, hemodilutional)

58
Q

To reduce intracranial volume to give neurosurgeon more space to work in posterior fossa, ETCO2 should be kept where

A

25-30mmHg

Provides maximum intracranial decompression with minimal risk of cerebral ischemia

59
Q

What nerves carry the afferent and efferent action potentials in the oculocardiac reflex arc

A

Afferent- trigeminal (CNV)

Efferent- Vagus (CNX)

60
Q

What is the most frequent complication of retrobulbar block

A

Hemorrhage

61
Q

How does hypercarbia affect intraocular pressure

A

Hypercarbia increases IOP

62
Q

How long should N20 be avoided in a patient that had sulfur hexaflouride bubble

A

10 days

Board Prep (19 decks)

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