Exam 3 - Neuro

Question 1

Cerebral Perfusion Pressure (CPP) is calculated by:
A) CPP = MAP - ICP
B) CPP = CBF + ICP
C) CPP = MAP + CBF
D) CPP = ICP - MAP

Answer 1

Answer: A) CPP = MAP - ICP.
Rationale: CPP is the net pressure gradient causing cerebral blood flow to the brain (cerebral perfusion). It is calculated by subtracting the intracranial pressure (ICP) from the mean arterial pressure (MAP).

Question 2

Which of the following would likely cause an increase in cerebral blood flow?
A) Decreased arterial carbon dioxide (PaCO2)
B) Increased arterial carbon dioxide (PaCO2)
C) Decreased arterial oxygen (PaO2)
D) Both B and C

Answer 2

Answer: D) Both B and C.
Rationale: An increase in PaCO2 leads to cerebral vasodilation and increased blood flow. Additionally, a decrease in PaO2 below certain thresholds can also trigger cerebral vasodilation to increase blood flow and oxygen delivery.

Question 3

Autoregulation of cerebral blood flow ensures that the CBF remains constant over a range of:
A) 10-20 mmHg of mean arterial pressure
B) 20-40 mmHg of mean arterial pressure
C) 50-150 mmHg of mean arterial pressure
D) 150-200 mmHg of mean arterial pressure

Answer 3

Answer: C) 50-150 mmHg of mean arterial pressure.
Rationale: Cerebral autoregulation is a mechanism that maintains a relatively constant cerebral blood flow despite changes in systemic arterial pressure, usually within the range of 50-150 mmHg of mean arterial pressure.
CBF is approx 50 mL/100g brain tissue per minute
750mL/min

Question 4

What percentage of cardiac output (COP) is typically received by the brain?
A) 5%
B) 15%
C) 20%
D) 25%

Answer 4

Answer: B) 15%.
Rationale: The brain receives about 15% of cardiac output, which is a substantial amount considering its size relative to the rest of the body, reflecting its high metabolic demand.

Question 5

Which components are found within the intracranial vault?
A. Neural tissue, blood, and cerebrospinal fluid
B. Muscles, blood, and cerebrospinal fluid
C. Neural tissue, lymph, and synovial fluid
D. Bones, muscles, and neural tissue

Answer 5

Answer: A. Neural tissue, blood, and cerebrospinal fluid

Rationale: The intracranial vault contains neural tissue (including the brain and spinal cord), blood, and cerebrospinal fluid, which are all enclosed by the dura mater and bone.

Question 6

According to the Monroe-Kellie hypothesis, what occurs if there is an increase in one component of the intracranial volume?
A. Intracranial pressure will always increase.
B. It must be offset by a decrease in another component to prevent an elevated intracranial pressure.
C. The intracranial pressure decreases in a compensatory manner.
D. It does not affect the intracranial pressure.

Answer 6

Answer: B. It must be offset by a decrease in another component to prevent an elevated intracranial pressure.

Rationale: The Monroe-Kellie hypothesis suggests that because the total volume inside the cranial cavity is fixed, an increase in any one of the components—neural tissue, blood, or cerebrospinal fluid—must be compensated for by a decrease in volume of another component to maintain a normal intracranial pressure.

Question 7

What could be the result if homeostatic mechanisms fail to compensate for increased intracranial pressure?
A. Decreased mean arterial pressure
B. Increased cerebrospinal fluid production
C. Cerebral ischemia
D. Unchanged cerebral perfusion pressure

Answer 7

Answer: C. Cerebral ischemia

Rationale: Cerebral perfusion pressure is determined by the mean arterial pressure and intracranial pressure. Homeostatic mechanisms can increase mean arterial pressure to support cerebral perfusion pressure despite increases in intracranial pressure. However, if these compensatory mechanisms fail, it could lead to decreased blood flow to the brain, resulting in cerebral ischemia.

Question 8

Which meningeal structure separates the two cerebral hemispheres?
A. Falx cerebri
B. Tentorium cerebelli
C. Arachnoid mater
D. Pia mater

Answer 8

Answer: A. Falx cerebri

Rationale: The falx cerebri is a sickle-shaped fold of dura mater that descends vertically in the longitudinal fissure between the two cerebral hemispheres.

Question 9

The tentorium cerebelli is significant because it:
A. Divides the cerebrum from the cerebellum.
B. Protects the brainstem.
C. Is the primary site of cerebrospinal fluid production.
D. Contains the majority of the cerebral arteries.

Answer 9

Answer: A. Divides the cerebrum from the cerebellum.

Rationale: The tentorium cerebelli is an extension of the dura mater that separates the cerebrum from the cerebellum and marks the boundary between the supratentorial and infratentorial spaces.

Question 10

What is a potential consequence of localized increases in intracranial content?
A. Decreased mean arterial pressure.
B. Herniation of brain tissue into another compartment.
C. Reduced cerebrospinal fluid production.
D. Atrophy of the cerebral hemispheres.

Answer 10

Answer: B. Herniation of brain tissue into another compartment.

Rationale: An increase in the content of one region of the brain can cause a regional increase in intracranial pressure, leading to the herniation of brain tissue into another compartment, especially if the increase is significant or sudden.

Question 11

Herniation syndromes are categorized by:
A. The initial cause of increased intracranial pressure.
B. The patient’s age and medical history.
C. The specific type of brain tissue that is herniating.
D. The region of the brain that is affected.

Answer 11

Answer: D. The region of the brain that is affected.

Rationale: Herniation syndromes are classified based on the region of the brain affected by the herniation, which is important for diagnosis and management of the condition.

Question 12

What is a characteristic clinical manifestation of subfalcine herniation?
A. Ipsilateral oculomotor nerve dysfunction
B. Midline shift and compression of the anterior cerebral artery branches
C. Medullary dysfunction
D. Respiratory instability

Answer 12

Answer: B. Midline shift and compression of the anterior cerebral artery branches

Rationale: Subfalcine herniation occurs when there is a herniation of the cerebral hemispheric contents beneath the falx cerebri, which often leads to a midline shift and compression of the branches of the anterior cerebral artery.

Question 13

Uncal herniation, a subtype of transtentorial herniation, typically presents with:
A. Pupillary dilatation, ptosis, and lateral deviation of the affected eye
B. Bilateral oculomotor nerve palsy
C. Compression of the posterior cerebral artery branches
D. Decerebrate posturing

Answer 13

Answer: A. Pupillary dilatation, ptosis, and lateral deviation of the affected eye

Rationale: Uncal herniation occurs when the uncal region (medial portion of the temporal lobe) herniates over the tentorium cerebelli, leading to ipsilateral oculomotor nerve dysfunction, which can manifest as pupillary dilatation, ptosis, and lateral deviation of the affected eye. These symptoms reflect the involvement of cranial nerve III.

Question 14

Herniation of the cerebellar tonsils through the foramen magnum can lead to:
A. Oculomotor nerve palsy
B. Medullary dysfunction and cardiorespiratory instability
C. Bilateral ptosis
D. Coma without brainstem involvement

Answer 14

Answer: B. Medullary dysfunction and cardiorespiratory instability

Rationale: Herniation of the cerebellar tonsils into the foramen magnum can lead to compression of the brainstem, particularly the medulla oblongata, which is responsible for regulating vital functions. This compression can result in medullary dysfunction and cardiorespiratory instability, which are life-threatening conditions.

Question 15

Transtentorial herniation can result in all of the following EXCEPT:
A. Alteration in mental status (AMS)
B. Hemodynamic compromise
C. Respiratory compromise
D. Increased intracranial pressure without symptoms

Answer 15

Answer: D. Increased intracranial pressure without symptoms

Rationale: Transtentorial herniation results in herniation of the supratentorial contents past the tentorium cerebelli, leading to significant clinical symptoms including alteration in mental status, hemodynamic and respiratory compromise. It does not occur without symptoms; increased intracranial pressure in the context of herniation is associated with significant clinical manifestations.

Question 16

How do tumors typically lead to increased intracranial pressure (ICP)?
A. By secreting cerebrospinal fluid
B. By causing edema in surrounding brain tissue
C. By decreasing cerebral blood flow
D. By reducing cerebral metabolic demand

Answer 16

Answer: B. By causing edema in surrounding brain tissue

Rationale: Tumors can lead to increased ICP not only due to their size but also by causing edema in the surrounding brain tissue. Additionally, they can obstruct the flow of cerebrospinal fluid, particularly if they involve the third ventricle.

Question 17

Intracranial hematomas increase intracranial pressure in a manner similar to:
A. Ischemic strokes
B. Mass lesions
C. Encephalitis
D. Meningitis

Answer 17

Answer: B. Mass lesions

Rationale: Intracranial hematomas act like mass lesions, increasing ICP due to their volume and associated swelling. This is similar to the effect of tumors and other space-occupying lesions within the intracranial vault.

Question 18

Subarachnoid hemorrhage can exacerbate increased intracranial pressure through:
A. Increased cerebral metabolic rate
B. Obstruction of cerebrospinal fluid reabsorption
C. Hypersecretion of cerebrospinal fluid
D. Compression of the cerebral aqueduct

Answer 18

Answer: B. Obstruction of cerebrospinal fluid reabsorption

Rationale: Blood in the cerebrospinal fluid, as seen in subarachnoid hemorrhage, can lead to obstruction of CSF reabsorption, which can exacerbate increased ICP. Additionally, granulations from the inflammatory response can further impair CSF flow.

Question 19

Infections such as meningitis or encephalitis contribute to increased intracranial pressure primarily by:
A. Promoting cerebrospinal fluid production
B. Causing edema or obstruction of cerebrospinal fluid reabsorption
C. Inducing vasospasm of cerebral arteries
D. Decreasing blood-brain barrier integrity

Answer 19

Answer: B. Causing edema or obstruction of cerebrospinal fluid reabsorption

Rationale: Infections like meningitis or encephalitis can lead to increased ICP due to edema from inflammatory processes or by obstructing CSF reabsorption, often as a result of the inflammatory response within the subarachnoid space or the ventricular system.

Question 20

What is the rationale behind elevating the head to decrease intracranial pressure?
A. It reduces cerebrospinal fluid production.
B. It encourages jugular venous outflow.
C. It increases cerebral perfusion pressure.
D. It enhances cerebrospinal fluid absorption.

Answer 20

Answer: B. It encourages jugular venous outflow.

Rationale: Elevating the head of the bed is a non-pharmacological method used to facilitate venous drainage from the head, which can help reduce intracranial pressure.

Question 21

Hyperosmotic drugs decrease intracranial pressure by:
A. Reducing cerebral metabolic demand.
B. Increasing cerebrospinal fluid production.
C. Increasing osmolarity, drawing fluid across the blood-brain barrier.
D. Vasoconstriction of cerebral blood vessels.

Answer 21

Answer: C. Increasing osmolarity, drawing fluid across the blood-brain barrier.

Rationale: Hyperosmotic drugs, such as mannitol, work to reduce intracranial pressure by creating an osmotic gradient that draws fluid from the brain parenchyma, across the blood-brain barrier, into the bloodstream.

Question 22

Which medication can be used to decrease intracranial pressure by reducing cerebral metabolic oxygen consumption?
A. Antibiotics
B. Antiepileptics
C. Corticosteroids
D. Cerebral vasoconstricting anesthetics (e.g., propofol)

Answer 22

Answer: D. Cerebral vasoconstricting anesthetics (e.g., propofol)

Rationale: Cerebral vasoconstricting anesthetics like propofol can decrease cerebral metabolic oxygen consumption (CMRO2) and cerebral blood flow (CBF), which can contribute to a reduction in intracranial pressure.

Question 23

An external ventricular drain (EVD) is utilized in the management of increased ICP primarily to:
A. Monitor cerebral blood flow.
B. Drain cerebrospinal fluid.
C. Administer medications directly to the central nervous system.
D. Reduce cerebral edema through refrigeration.

Answer 23

Answer: B. Drain cerebrospinal fluid.

Rationale: An external ventricular drain is used to directly remove cerebrospinal fluid from the ventricular system to help manage increased intracranial pressure.

Question 24

What is the first step in conducting a neurological assessment for anesthesia planning?
A. Administering preoperative medications
B. Knowing the basic pathophysiology of neurological disorders
C. Reviewing the patients’ drug history
D. Deciding on the anesthetic plan

Answer 24

Answer: B. Knowing the basic pathophysiology of neurological disorders

Rationale: Understanding the basic pathophysiology of neurological disorders is essential as it guides the assessment of the patient’s history, symptoms, baseline neuro-deficits, and helps in the interpretation of imaging and neurologic test results, which are fundamental in planning anesthesia care.

Question 25

Why is it important to review a patient's current medications during a neurological assessment before anesthesia? A. To identify potential drug interactions with anesthesia B. To comply with hospital protocol C. To prepare the medication chart for surgery D. To educate the patient about their medications

Answer 25

Answer: A. To identify potential drug interactions with anesthesia Rationale: Reviewing a patient’s current medications is crucial to identify any potential interactions with anesthetic drugs, as well as to understand the patient's existing treatments which might affect perioperative management and anesthetic choices.

Question 26

What is the purpose of implementing preoperative measures in patients with neurological issues? A. To complete the required paperwork before surgery B. To optimize the patients' condition prior to anesthesia C. To ensure the patient has fasted appropriately D. To administer preoperative sedation

Answer 26

Answer: B. To optimize the patients' condition prior to anesthesia Rationale: Preoperative measures are often necessary to stabilize and optimize the patient’s condition before administering anesthesia, especially in those with neurological deficits. This may include adjusting medications, hydration status, or other interventions specific to the patient's neurological condition.

Question 27

When documenting a preoperative plan for a patient with a neurological condition, what is essential to include? A. Only the chosen anesthetic technique B. A detailed medical history irrelevant to the surgery C. The rationale for the chosen anesthetic plan D. An exhaustive list of all possible anesthetic drugs

Answer 27

Answer: C. The rationale for the chosen anesthetic plan Rationale: Providing clear documentation of the neurological assessment, including the rationale for the chosen anesthetic plan, is important for communication among the healthcare team and for medico-legal reasons. It should reflect the integration of the patient's history, current condition, risks, and benefits of the anesthetic options considered.

Question 28

Which patient demographic is more commonly diagnosed with Multiple Sclerosis (MS)? A. Males aged 50-70 B. Females aged 20-40 C. Females over the age of 60 D. Males in their teenage years

Answer 28

Answer: B. Females aged 20-40 Rationale: Multiple Sclerosis typically has an onset age between 20-40 years and is more prevalent in females.

Question 29

Which of the following is considered a trigger for exacerbation in patients with Multiple Sclerosis (MS)? A. Low-stress levels B. Cooler body temperatures C. The postpartum period D. Increased physical activity

Answer 29

Answer: C. The postpartum period Rationale: Triggers for periods of exacerbation in Multiple Sclerosis include stress, elevated temperatures, and the postpartum period. These can lead to a flare-up of symptoms.

Question 30

What is a common symptom of Multiple Sclerosis (MS) that varies based on the site of demyelination? A. Consistent pain in the lower extremities B. Motor weakness C. Uniform loss of vision in both eyes D. Steady cognitive decline

Answer 30

Answer: B. Motor weakness Rationale: The symptoms of Multiple Sclerosis vary based on the location of demyelination and can include motor weakness, sensory disorders, visual impairment, and autonomic instability. Motor weakness is particularly influenced by the site of the nerve damage.

Question 31

The management of Multiple Sclerosis (MS) often includes the use of: A. Corticosteroids and immune modulators B. Antibiotics and antivirals C. Antidepressants and mood stabilizers D. Chemotherapy and radiation therapy

Answer 31

Answer: A. Corticosteroids and immune modulators Rationale: While there is no cure for Multiple Sclerosis, management includes the use of corticosteroids to reduce inflammation during exacerbations and immune modulators to alter the course of the disease, along with targeted antibodies.

Question 32

In patients with Multiple Sclerosis undergoing surgery, why is temperature management considered critical? A. Increase in body temperature can precipitate an exacerbation of MS symptoms. B. Lower body temperature reduces the effectiveness of anesthetic agents. C. Higher body temperature increases the risk of intraoperative bleeding. D. Lower body temperature may prolong the duration of muscle relaxants.

Answer 32

Answer: A. Increase in body temperature can precipitate an exacerbation of MS symptoms. Rationale: Patients with MS can experience worsening of symptoms with increased body temperature, known as Uhthoff's phenomenon. Therefore, careful temperature management is essential to avoid triggering an exacerbation of MS symptoms.

Question 33

What is an important consideration when providing anesthesia to MS patients with a history of long-term steroid use? A. They should always be given supplemental oxygen. B. They may require a stress-dose of steroids due to adrenal suppression. C. They must be administered a lower dose of anesthetic agents. D. They should receive an increased dose of muscle relaxants.

Answer 33

Answer: B. They may require a stress-dose of steroids due to adrenal suppression. Rationale: Long-term steroid use can lead to adrenal suppression. Administering a stress-dose of steroids may be necessary for patients with MS who have been on long-term steroids to provide the body with sufficient cortisol to handle the stress of surgery.

Question 34

Why should succinylcholine be avoided in patients with Multiple Sclerosis? A. It may precipitate malignant hyperthermia. B. It can cause bradycardia and hypotension. C. It may induce hyperkalemia due to upregulated nicotinic acetylcholine receptors. D. It can result in prolonged paralysis post-operatively.

Answer 34

Answer: C. It may induce hyperkalemia due to upregulated nicotinic acetylcholine receptors. Rationale: In MS patients, there can be an upregulation of nicotinic acetylcholine receptors, which makes them more susceptible to the potassium-releasing effects of succinylcholine, potentially leading to hyperkalemia. Therefore, this drug is best avoided in these patients.

Question 35

What preoperative assessment is especially important in patients with MS who exhibit respiratory compromise? A. Electrocardiogram (ECG) B. Pulmonary function tests (PFTs) C. Complete metabolic panel (CMP) D. Echocardiogram (ECHO)

Answer 35

Answer: B. Pulmonary function tests (PFTs) Rationale: For MS patients with respiratory compromise, assessing respiratory function with pulmonary function tests is crucial to understanding the patient's baseline respiratory status and potential anesthetic risks, as well as to guide intraoperative and postoperative respiratory management.

Question 36

Myasthenia Gravis (MG) is characterized by muscle weakness that is: A. Persistent and unchanging throughout the day. B. Exacerbated with exercise and improves with rest. C. Unaffected by physical activity levels. D. Improved with exercise as muscles warm up.

Answer 36

Answer: B. Exacerbated with exercise and improves with rest. Rationale: MG is an autoimmune disorder where antibodies impair neurotransmission at the neuromuscular junction, leading to muscle weakness that worsens with exercise and improves with rest.

Question 37

Which cranial nerve involvement in Myasthenia Gravis (MG) can lead to respiratory insufficiency? A. Olfactory nerve involvement leading to smell deficits. B. Optic nerve involvement affecting vision. C. Bulbar involvement leading to laryngeal and pharyngeal muscle weakness. D. Trigeminal nerve involvement causing mastication difficulties.

Answer 37

Answer: C. Bulbar involvement leading to laryngeal and pharyngeal muscle weakness. Rationale: The bulbar muscles, when affected by MG, can lead to weakness of the laryngeal and pharyngeal muscles, resulting in difficulties with swallowing and the potential for respiratory insufficiency due to aspiration risks. glossopharyngeal nerve (CN IX), the vagus nerve (CN X), the accessory nerve (CN XI), and the hypoglossal nerve (CN XII).

Question 38

The treatment for Myasthenia Gravis (MG) commonly includes the use of: A. Acetylcholinesterase inhibitors to decrease the availability of acetylcholine. B. Acetylcholinesterase inhibitors to increase the availability of acetylcholine. C. Beta-blockers to manage cardiac symptoms. D. Anticholinergic drugs to reduce excessive muscle contractions.

Answer 38

Answer: B. Acetylcholinesterase inhibitors to increase the availability of acetylcholine. Rationale: Acetylcholinesterase inhibitors, such as Pyridostigmine, are used in the treatment of MG to inhibit the breakdown of acetylcholine, thereby increasing its availability and improving neuromuscular transmission.

Question 39

In the management of Myasthenia Gravis (MG), thymectomy is associated with: A. Worsening of symptoms in most patients. B. No change in symptoms for the majority of patients. C. Improvement in symptoms in about 90% of patients. D. Complete cure in all patients.

Answer 39

Answer: C. Improvement in symptoms in about 90% of patients. Rationale: Thymectomy, the surgical removal of the thymus gland, can lead to an improvement in symptoms for about 90% of patients with MG. Although not all patients will achieve remission, many will experience a reduction in their symptoms.

Question 40

Why is it important to reduce paralytic dosage in patients with Myasthenia Gravis (MG) during anesthesia? A. To minimize the risk of malignant hyperthermia. B. To avoid prolonged muscle weakness postoperatively. C. To reduce the chances of an allergic reaction to anesthetic drugs. D. To prevent the risk of intraoperative awareness.

Answer 40

Answer: B. To avoid prolonged muscle weakness postoperatively. (I DONT LIKE THIS SLIDE) Rationale: Patients with MG are particularly sensitive to neuromuscular blocking agents due to their pre-existing neuromuscular junction dysfunction. Reducing the dosage of paralytics can help prevent exacerbation of muscle weakness and respiratory compromise postoperatively.

Question 41

Acetylcholinesterase inhibitors used to treat MG can have an interaction with which types of drugs? A. Beta-blockers B. Local anesthetics, specifically esters C. Nonsteroidal anti-inflammatory drugs (NSAIDs) D. Antibiotics

Answer 41

Answer: B. Local anesthetics, specifically esters Rationale: Acetylcholinesterase inhibitors may prolong the action of succinylcholine and ester local anesthetics due to their mechanism of increasing acetylcholine at the neuromuscular junction, which can lead to prolonged neuromuscular blockade.

Question 42

In a patient with Myasthenia Gravis, the purpose of considering preoperative steroids is to: A. Provide analgesia. B. Manage the autoimmune process during surgery. C. Reduce inflammation related to the surgical procedure. D. Compensate for adrenal suppression in long-term steroid users.

Answer 42

Answer: D. Compensate for adrenal suppression in long-term steroid users. Rationale: Patients with MG who have been on long-term steroid therapy may have adrenal suppression. Considering preoperative steroids is important to prevent adrenal crisis during the stress of surgery.

Question 43

What is a crucial part of preoperative counseling for patients with Myasthenia Gravis? A. Warning about the potential for chronic pain postoperatively. B. Discussing the increased risk of needing postoperative respiratory support. C. Informing about the likelihood of extended hospital stay for observation. D. Advising on dietary restrictions post-surgery.

Answer 43

Answer: B. Discussing the increased risk of needing postoperative respiratory support. Rationale: Due to the potential for exacerbation of muscle weakness, patients with MG should be counseled about the increased risk of requiring postoperative respiratory support or ventilation until they have fully recovered from anesthesia.

Question 44

Eaton-Lambert Syndrome is often associated with which of the following conditions? A. Breast cancer B. Small cell lung carcinoma C. Lymphoma D. Prostate cancer

Answer 44

Answer: B. Small cell lung carcinoma Rationale: More than 60% of cases of Eaton-Lambert Syndrome are associated with small cell lung carcinoma. It is a paraneoplastic syndrome that can precede or coincide with the diagnosis of lung cancer.

Question 45

What is the primary mechanism by which Eaton-Lambert Syndrome reduces the efficacy of neuromuscular transmission? A. It enhances the degradation of acetylcholine in the synaptic cleft. B. It reduces calcium influx into the presynaptic terminals. C. It blocks the postsynaptic acetylcholine receptors. D. It increases the release of acetylcholine into the synaptic cleft.

Answer 45

Answer: B. It reduces calcium influx into the presynaptic terminals. Rationale: Eaton-Lambert Syndrome involves the development of autoantibodies against voltage-gated calcium channels, leading to reduced calcium influx into the presynaptic nerve terminals, which decreases the release of acetylcholine at the neuromuscular junction.

Question 46

Which medication is used in the treatment of Eaton-Lambert Syndrome to facilitate the release of acetylcholine at the neuromuscular junction? A. Acetylcholinesterase inhibitors B. Selective potassium channel blockers such as 3,4-diaminopyridine C. Beta-blockers D. Calcium channel blockers

Answer 46

Answer: B. Selective potassium channel blockers such as 3,4-diaminopyridine Rationale: Treatment for Eaton-Lambert Syndrome may include the use of selective potassium channel blockers like 3,4-diaminopyridine, which increases acetylcholine release and improves muscle strength.

Question 47

Lambert-Eaton syndrome is characterized by which of the following mechanisms? A. Excessive acetylcholine release at the neuromuscular junction. B. Antibodies against postsynaptic acetylcholine receptors. C. Antibodies against the presynaptic calcium channels of the neuromuscular junction. D. Degeneration of the presynaptic nerve terminals.

Answer 47

Answer: C. Antibodies against the presynaptic calcium channels of the neuromuscular junction. Rationale: Lambert-Eaton syndrome involves an autoimmune response where antibodies target the presynaptic calcium channels at the neuromuscular junction, leading to decreased acetylcholine release and impaired muscular transmission.

Question 48

The symptoms of Lambert-Eaton syndrome may improve with: A. Rest and inactivity. B. Cooling therapies such as cryotherapy. C. Repeated muscle use. D. Administration of calcium channel activators.

Answer 48

Answer: C. Repeated muscle use. Rationale: An atypical feature of Lambert-Eaton syndrome is that muscle strength may transiently improve with repeated use, known as 'facilitation,' which is opposite to the fatigue seen in myasthenia gravis.

Question 49

Patients with Eaton-Lambert Syndrome (ELS) exhibit increased sensitivity to which types of agents? A. Non-depolarizing neuromuscular blockers (ND-NMBs) and depolarizing neuromuscular blockers (D-NMBs) B. General anesthetics and benzodiazepines C. Local anesthetics and sedatives D. Anticholinesterase medications and antibiotics

Answer 49

Answer: A. Non-depolarizing neuromuscular blockers (ND-NMBs) and depolarizing neuromuscular blockers (D-NMBs) Rationale: Patients with ELS are very sensitive to both ND-NMBs and D-NMBs due to the pre-existing compromised neuromuscular transmission. They are significantly more sensitive to ND-NMBs compared to patients with Myasthenia Gravis (MG).

Question 50

What is a hallmark laboratory finding in Duchenne Muscular Dystrophy (DMD)? A. Decreased serum creatine kinase levels. B. Elevated serum creatine kinase levels. C. Elevated white blood cell count. D. Decreased hemoglobin levels.

Answer 50

Answer: B. Elevated serum creatine kinase levels. Rationale: Duchenne Muscular Dystrophy is characterized by elevated serum creatine kinase levels due to muscle wasting. Creatine kinase is released into the bloodstream when muscle fibers are damaged, which is a frequent occurrence in DMD.

Question 51

Duchenne Muscular Dystrophy primarily affects which population? A. Girls and boys equally, onset in teenage years. B. Only boys, typically with onset between 2-5 years of age. C. Only girls, onset usually in early childhood. D. Boys and girls with onset in infancy.

Answer 51

Answer: B. Only boys, typically with onset between 2-5 years of age. Rationale: DMD is an X-linked disorder and therefore primarily affects boys, with symptoms typically becoming apparent between 2-5 years of age.

Question 52

What is a common complication associated with the progression of Duchenne Muscular Dystrophy? A. Hypertension. B. Type II diabetes. C. Cardiopulmonary complications. D. Hyperthyroidism.

Answer 52

Answer: C. Cardiopulmonary complications. Rationale: Cardiopulmonary complications are a significant cause of morbidity and the most common cause of death in patients with DMD, as the disease progresses to affect cardiac and respiratory muscles.

Question 53

Why is Duchenne Muscular Dystrophy associated with skeletal changes such as kyphoscoliosis? A. Vitamin D deficiency. B. Genetic predisposition to bone deformities. C. Progressive muscle wasting leading to skeletal deformities. D. Overuse of affected muscles during physical therapy.

Answer 53

Answer: C. Progressive muscle wasting leading to skeletal deformities. Rationale: In DMD, progressive muscle wasting can lead to imbalances in muscle support around the spine and long bones, resulting in deformities such as kyphoscoliosis and long bone fragility.

Question 54

Why is it important to conduct a thorough cardiac evaluation, including an EKG and echocardiogram, in patients with Muscular Dystrophy before administering anesthesia? A. Most patients with Muscular Dystrophy have congenital heart defects. B. Muscular Dystrophy is commonly associated with the development of cardiomyopathy. C. Anesthesia can cause bradycardia, which is especially risky in these patients. D. Patients with Muscular Dystrophy are at a higher risk for developing myocardial infarction during surgery.

Answer 54

Answer: B. Muscular Dystrophy is commonly associated with the development of cardiomyopathy. Rationale: Due to the potential for cardiac involvement, including cardiomyopathy in patients with Muscular Dystrophy, a preoperative cardiac workup is essential to assess the heart's function and to tailor anesthetic management accordingly.

Question 55

What is a potential consequence of using succinylcholine (Succs) in patients with Muscular Dystrophy? A. It can lead to a hypermetabolic syndrome similar to malignant hyperthermia. B. It can cause an unexpected allergic reaction specific to MD patients. C. It will likely result in a prolonged duration of anesthesia. D. It has no significant side effects or consequences in MD patients.

Answer 55

Answer: A. It can lead to a hypermetabolic syndrome similar to malignant hyperthermia. Rationale: In patients with Muscular Dystrophy, the use of succinylcholine and volatile anesthetics can exacerbate muscle membrane instability and may trigger a hypermetabolic syndrome, with clinical features resembling malignant hyperthermia, which can be life-threatening.

Question 56

What anesthetic strategy is preferred for patients with Muscular Dystrophy to avoid cardiopulmonary complications- select all? A. Total Intravenous Anesthesia (TIVA) with low-dose rocuronium B. High-dose volatile anesthetics C. General anesthesia with high-dose non-depolarizing neuromuscular blockers D. Regional anesthesia (RA) over general anesthesia (GA)

Answer 56

Answer: A. A. Total Intravenous Anesthesia (TIVA) with low-dose rocuronium & D. Regional anesthesia (RA) over general anesthesia (GA) Rationale: Regional anesthesia is often preferred over general anesthesia for patients with Muscular Dystrophy to avoid triggering cardiopulmonary complications and to reduce the risk of malignant hyperthermia-like reactions.

Question 57

What preoperative laboratory test is crucial for evaluating the extent of muscle wasting in Muscular Dystrophy? A. Complete Blood Count (CBC) B. Creatine Kinase (CK) C. Blood Urea Nitrogen (BUN) D. Aspartate Aminotransferase (AST)

Answer 57

Answer: B. Creatine Kinase (CK) Rationale: Elevated serum creatine kinase levels are indicative of muscle wasting and are often found in patients with Muscular Dystrophy due to ongoing muscle damage. This test helps assess the severity of the disease.

Question 58

What is myotonia? A. A rapid onset of muscle weakness following activity. B. An inability of muscles to relax promptly after voluntary contraction. C. A type of muscular dystrophy affecting primarily the heart muscle. D. A genetic disorder leading to involuntary muscle contractions.

Answer 58

Answer: B. An inability of muscles to relax promptly after voluntary contraction. Rationale: Myotonia refers to a condition where there is a prolonged contraction or delayed relaxation of muscles following voluntary contraction, commonly seen in various muscle disorders including myotonic dystrophy.

Question 59

Which muscles are typically spared in Myotonia Congenita? A. Skeletal muscles B. Smooth and cardiac muscles C. Diaphragmatic muscles D. Facial muscles

Answer 59

Answer: B. Smooth and cardiac muscles Rationale: Myotonia Congenita is a milder form of myotonic disorder which typically involves the skeletal muscles, but spares the smooth and cardiac muscles.

Question 60

What percentage of patients with Myotonic Dystrophy are reported to have mitral valve prolapse (MVP)? A. 10% B. 20% C. 50% D. 75%

Answer 60

Answer: B. 20% Rationale: Myotonic Dystrophy can affect cardiac conduction and about 20% of individuals with this condition may have mitral valve prolapse. This has implications for anesthesia, particularly regarding cardiovascular stability.

Question 61

Central Core Disease is characterized by what primary symptom? A. Progressive muscle wasting in the face and hands B. Difficulty swallowing and speaking C. Proximal muscle weakness and scoliosis D. Prolonged muscle stiffness after exercise

Answer 61

Answer: C. Proximal muscle weakness and scoliosis Rationale: Central Core Disease is a rare genetic muscle disorder characterized by a deficiency in mitochondrial enzymes in core muscle cells, resulting in proximal muscle weakness and scoliosis.

Question 62

Why is the assessment of GI motility important before administering anesthesia to patients with myotonic conditions? A. To ensure proper nutrition before surgery. B. To gauge the risk of aspiration due to GI hypomotility. C. To determine the need for postoperative dietary restrictions. D. To assess the patient’s ability to metabolize oral medications.

Answer 62

Answer: B. To gauge the risk of aspiration due to GI hypomotility. Rationale: GI hypomotility can increase the risk of aspiration, a serious concern during anesthesia. Preoperative evaluation helps in planning for aspiration risk mitigation strategies.

Question 63

Succinylcholine is avoided in patients with myotonic conditions primarily because: A. It is less effective in these patients. B. It can cause prolonged muscle relaxation. C. It can trigger myotonic muscle contractions (fasciculations). D. It increases the risk of malignant hyperthermia.

Answer 63

Answer: C. It can trigger myotonic muscle contractions (fasciculations). Rationale: Succinylcholine may trigger myotonia, leading to prolonged and potentially severe muscle contractions, complicating intubation and ventilation.

Question 64

Pre-anesthetic endocrine assessment for patients with myotonic conditions often includes which of the following? A. Adrenal function tests. B. Thyroid and glucose level checks. C. Pituitary hormone profiling. D. Parathyroid hormone measurements.

Answer 64

Answer: B. Thyroid and glucose level checks. Rationale: There is a high incidence of endocrine abnormalities in myotonic conditions, particularly involving the thyroid and glucose levels, which can affect both anesthesia management and surgical outcomes.

Question 65

Why should patients with myotonic conditions be kept warm during the perioperative period? A. Cold exposure may decrease blood viscosity. B. Warmth provides comfort and reduces anxiety. C. Cold temperatures can exacerbate myotonic symptoms. D. Warm temperatures enhance the effect of anesthetics.

Answer 65

Answer: C. Cold temperatures can exacerbate myotonic symptoms. Rationale: Patients with myotonic conditions may experience worsening of myotonic symptoms when exposed to cold temperatures; hence, maintaining normothermia is crucial.

Question 66

What is the most common form of dementia, comprising approximately 70% of cases? A. Alzheimer's disease B. Vascular dementia C. Parkinson's disease-associated dementia D. Lewy body dementia

Answer 66

Answer: A. Alzheimer's disease Rationale: Alzheimer's disease is the most prevalent form of dementia, responsible for around 70% of cases.

Question 67

Why is regional anesthesia (RA) often preferred over general anesthesia (GA) in patients with dementia? A. RA completely eliminates the risk of postoperative cognitive dysfunction. B. GA has been shown to have no impact on patients with dementia. C. RA may reduce the requirement for opioids, which can exacerbate delirium. D. RA is faster to administer than GA.

Answer 67

Answer: C. RA may reduce the requirement for opioids, which can exacerbate delirium. Rationale: RA is preferred to minimize opioid requirements because opioids can increase the risk of postoperative delirium and worsen cognitive function in dementia patients.

Question 68

What factor should be considered when administering anesthetics to a patient with dementia who is on preoperative medications, including acetylcholinesterase inhibitors (AChE-I), MAOIs, or psychotropic medications? A. The risk of hypertension B. The possibility of reduced anesthetic requirements C. The potential for drug interactions affecting anesthetic depth D. The increased likelihood of allergic reactions

Answer 68

Answer: C. The potential for drug interactions affecting anesthetic depth Rationale: It is crucial to consider the potential interactions between the patient's preoperative medications, such as AChE-I, MAOIs, or psychotropic medications, and anesthetic agents, which can affect anesthetic depth and management.

Question 68

In the context of dementia, why is there a heightened risk of aspiration? A. Dementia patients are more likely to have a full stomach due to GI hypomotility. B. All dementia patients routinely receive tube feeding, which increases aspiration risk. C. Dementia is directly correlated with an increased production of stomach acid. D. Dementia affects the patient's ability to fast before surgery.

Answer 68

Answer: A. Dementia patients are more likely to have a full stomach due to GI hypomotility. Rationale: Dementia can be associated with GI hypomotility, which increases the risk of aspiration due to delayed gastric emptying, making it more likely that the patient has a full stomach at the time of surgery.

Question 69

What is the primary neurochemical imbalance in Parkinson's Disease? A. Overproduction of acetylcholine in the basal ganglia B. Deficiency of dopamine in the basal ganglia C. Excess of serotonin in the motor cortex D. Insufficient production of GABA in the thalamus

Answer 69

Answer: B. Deficiency of dopamine in the basal ganglia Rationale: Parkinson's Disease is characterized by the degeneration of dopaminergic fibers in the basal ganglia, leading to a deficiency of dopamine, which normally helps regulate motor function.

Question 70

Which of the following is a common motor symptom of Parkinson's Disease? A. Hyporeflexia B. Clonus C. Pill-rolling tremor D. Spasticity

Answer 70

Answer: C. Pill-rolling tremor Rationale: Parkinson's Disease is known for a specific type of tremor known as a "pill-rolling" tremor, along with other symptoms such as muscle rigidity and bradykinesia or akinesia.

Question 71

The treatment for Parkinson's Disease commonly includes which medication? A. Acetylcholinesterase inhibitors B. Levodopa C. Benzodiazepines D. Beta-blockers

Answer 71

Answer: B. Levodopa Rationale: Levodopa is commonly used in the treatment of Parkinson's Disease because it can cross the blood-brain barrier and is converted to dopamine within the brain, addressing the dopamine deficiency.

Question 72

What is a major non-motor symptom that may accompany Parkinson's Disease? A. Excessive sweating B. Depression and dementia C. Auditory hallucinations D. Olfactory hypersensitivity

Answer 72

Answer: B. Depression and dementia Rationale: Along with motor symptoms, Parkinson's Disease can also present with non-motor symptoms, including psychological changes such as depression and dementia.

Question 73

Why is it important to continue per os (PO) Levodopa in patients with Parkinson's Disease undergoing surgery? A. To maintain stable blood pressure during anesthesia. B. To prevent withdrawal symptoms such as nausea and vomiting. C. To avoid exacerbation of extrapyramidal symptoms such as chest wall rigidity. D. To reduce the risk of postoperative seizures.

Answer 73

Answer: C. To avoid exacerbation of extrapyramidal symptoms such as chest wall rigidity. Rationale: Continuation of Levodopa is crucial to maintain motor control and prevent exacerbation of Parkinson's symptoms, such as rigidity, which can complicate the management of anesthesia.

Question 74

Why should drugs like Reglan (metoclopramide), phenothiazines, and butyrophenones be avoided in patients with Parkinson's Disease? A. They can increase the risk of hypertension. B. They are known to cause renal impairment. C. They may exacerbate Parkinsonian symptoms. D. They can lead to excessive sedation when combined with anesthesia.

Answer 74

Answer: C. They may exacerbate Parkinsonian symptoms. Rationale: These drugs can exacerbate Parkinsonian symptoms because they act as dopamine receptor antagonists, which can worsen the dopaminergic imbalance in Parkinson's Disease.

Question 75

In the presence of a deep brain stimulator, why is the use of bipolar cautery recommended during surgery? A. It is more effective at controlling bleeding. B. It reduces the risk of thermal injury to surrounding tissues. C. It minimizes the risk of interference with the deep brain stimulator. D. It ensures the stimulator's battery life is conserved.

Answer 75

Answer: C. It minimizes the risk of interference with the deep brain stimulator. Rationale: Bipolar cautery is recommended because it reduces the scattering of electrical current, which could otherwise interact with the deep brain stimulator's function.

Question 76

What symptom is directly related to the increased intracranial pressure (ICP) caused by brain tumors? A. Seizures B. Autonomic dysfunction C. Headache D. Mobility impairment

Answer 76

Answer: C. Headache Rationale: Headaches are a common symptom associated with increased ICP due to brain tumors. The increased pressure within the skull can lead to stretching of the meninges or compression of intracranial structures, which often manifests as headaches.

Question 77

Which finding is a visual sign of increased intracranial pressure on ophthalmologic examination? A. Hemianopia B. Mydriasis C. Papilledema D. Cataract formation

Answer 77

Answer: C. Papilledema Rationale: Papilledema, or optic disc swelling, can be observed during an eye examination and is a sign of increased intracranial pressure, which may result from a mass effect of a brain tumor.

Question 78

Autonomic dysfunction as a symptom of brain tumors can result in which of the following? A. Precise movements of the hands B. Stabilization of blood pressure and heart rate C. Abnormalities in heart rate and blood pressure D. Improved respiratory function

Answer 78

Answer: C. Abnormalities in heart rate and blood pressure Rationale: Autonomic dysfunction in the context of brain tumors can lead to irregularities in the autonomic regulation of heart rate, blood pressure, and other involuntary bodily functions. This could be due to the tumor's impact on brain regions that control these functions.

Question 79

Which type of astrocytoma is most commonly associated with new onset seizures in young adults? A. Pilocytic astrocytomas B. Anaplastic astrocytomas C. Glioblastoma Multiforme D. Gliomas

Answer 79

Answer: D. Gliomas Rationale: Gliomas are primary tumors and the least aggressive form of astrocytomas, often found in young adults presenting with new-onset seizures.

Question 80

Pilocytic astrocytomas typically have the best prognosis if found in which patient population? A. Middle-aged adults B. Elderly patients C. Children and young adults D. All age groups equally

Answer 80

Answer: C. Children and young adults Rationale: Pilocytic astrocytomas are mostly benign and have good outcomes if resectable, particularly in children and young adults.

Question 81

What characterizes anaplastic astrocytomas? A. They are well-differentiated tumors with a slow growth rate. B. They are poorly differentiated and often progress to Glioblastoma Multiforme. C. They are often completely resectable with minimal recurrence. D. They are the most benign form of astrocytomas with no malignant potential.

Answer 81

Answer: B. They are poorly differentiated and often progress to Glioblastoma Multiforme. Rationale: Anaplastic astrocytomas are poorly differentiated tumors that often evolve into Glioblastoma Multiforme, which carries a worse prognosis.

Question 82

Glioblastoma Multiforme is known for its: A. High rate of cure with surgical intervention. B. High mortality rate and aggressive nature. C. Lack of symptoms until late stages of growth. D. Predominance in children under the age of 10.

Answer 82

Answer: B. High mortality rate and aggressive nature. Rationale: Glioblastoma Multiforme is a highly aggressive brain tumor with a poor prognosis, typically requiring extensive treatment including surgical debulking and chemotherapy. Life expectancy with this diagnosis is usually limited, even with aggressive treatment.

Question 83

Where do meningiomas typically originate from? A. Neural stem cells within the brain parenchyma. B. Dura or arachnoid tissue. C. The ventricles of the brain. D. The meninges covering the spinal cord.

Answer 83

Answer: B. Dura or arachnoid tissue. Rationale: Meningiomas arise from the meningeal layers of the brain, typically the dura or arachnoid tissue.

Question 84

What is the typical prognosis for patients with meningiomas following surgical resection? A. They often require additional treatments due to high recurrence rates. B. Prognosis is good with surgical resection. C. Surgery is usually palliative as these tumors are highly aggressive. D. Surgical resection has a high rate of mortality.

Answer 84

Answer: B. Prognosis is good with surgical resection. Rationale: Meningiomas are usually benign and often have a good prognosis following surgical resection.

Question 85

Which type of brain tumor is usually curative with transsphenoidal or open craniotomy for removal? A. Glioblastoma Multiforme B. Acoustic Neuroma C. Metastatic Carcinoma D. Pituitary Adenomas

Answer 85

Answer: D. Pituitary Adenomas Rationale: Pituitary adenomas are noncancerous and vary in subtypes, with removal through transsphenoidal surgery or open craniotomy often being curative.

Question 86

Acoustic neuromas are schwannomas involving which cranial nerve? A. Cranial Nerve II B. Cranial Nerve V C. Cranial Nerve VII D. Cranial Nerve VIII

Answer 86

Answer: D. Cranial Nerve VIII (Vestibular Nerve) Rationale: Acoustic neuromas are usually benign tumors that arise from the Schwann cells covering the vestibular component of Cranial Nerve VIII within the auditory canal. A. Cranial Nerve II (Optic Nerve) B. Cranial Nerve V (Trigeminal Nerve) C. Cranial Nerve VII (Facial Nerve)

Question 87

What is a general characteristic of outcomes for patients with metastatic carcinomas in the brain? A. They have a high likelihood of complete remission with treatment. B. Outcomes are generally less favorable compared to primary brain tumors. C. They respond well to radiation therapy, resulting in prolonged survival. D. They are less aggressive than primary brain tumors.

Answer 87

Answer: B. Outcomes are generally less favorable compared to primary brain tumors. Rationale: Metastatic carcinomas in the brain have varied origins and symptoms, and their outcomes are generally less favorable due to the widespread nature of the disease.

Question 88

Why are patients with brain tumors often prescribed steroids preoperatively? A. To boost overall energy levels before surgery. B. To reduce the risk of infection. C. To minimize cerebral edema. D. To increase appetite and nutritional status.

Answer 88

Answer: C. To minimize cerebral edema. Rationale: Steroids are commonly used in patients with brain tumors to minimize cerebral edema and reduce intracranial pressure. Monitoring glucose levels is essential as steroids can elevate blood sugar.

Question 89

What is the role of Mannitol in the pre-operative management of patients with brain tumors? A. It is used to calm the patient before surgery. B. It reduces intracranial volume and pressure. C. It enhances the effectiveness of anesthesia. D. It prevents postoperative infections.

Answer 89

Answer: B. It reduces intracranial volume and pressure. Rationale: Mannitol is an osmotic diuretic often used pre-operatively in patients with brain tumors to reduce intracranial volume and pressure, thereby minimizing the risk of herniation and facilitating safer surgical conditions.

Question 90

Anticonvulsants are commonly used in patients with which type of brain tumor lesions? A. Infratentorial lesions. B. Supratentorial lesions, closer to the motor cortex. C. Posterior fossa tumors. D. Tumors involving the cranial nerves.

Answer 90

Answer: B. Supratentorial lesions, closer to the motor cortex. Rationale: Anticonvulsants are frequently prescribed to patients with supratentorial lesions, especially when these lesions are close to the motor cortex, due to the increased risk of seizures associated with these tumor locations.

Question 91

Autonomic dysfunction in patients with brain tumors may manifest in what way during pre-anesthetic evaluation? A. Consistent bradycardia B. Stable blood pressure readings C. Labile heart rate and blood pressures D. Lowered body temperature

Answer 91

Answer: C. Labile heart rate and blood pressures Rationale: Autonomic dysfunction may be evidenced by fluctuations in heart rate and blood pressure, which can be observed during an EKG as part of pre-anesthetic assessments. This has implications for anesthetic management, as these patients may require more vigilant intraoperative monitoring and management of hemodynamic parameters.

Question 92

What is the most common type of stroke? A. Hemorrhagic stroke B. Ischemic stroke C. Embolic stroke D. Subarachnoid stroke

Answer 92

Answer: B. Ischemic stroke Rationale: Ischemic strokes, caused by the obstruction of blood flow to the brain, account for approximately 88% of stroke cases.

Question 93

The Circle of Willis is significant in stroke because: A. It is the most common site for the formation of aneurysms. B. It is the primary structure affected by ischemic stroke. C. It provides collateral circulation to the brain during the blockage of a major artery. D. It is where the majority of hemorrhagic strokes occur.

Answer 93

Answer: C. It provides collateral circulation to the brain during the blockage of a major artery. Rationale: The Circle of Willis is a ring of interconnected arteries at the base of the brain that can provide collateral circulation, potentially preserving brain tissue during the blockage of a primary artery.

Question 94

Stroke is the leading global cause of: A. Malpractice Suits B. Cancer C. Death and disability D. Respiratory disorders

Answer 94

Answer: C. Death and disability Rationale: Stroke represents a major cause of death and disability worldwide, impacting millions of people each year.

Question 95

Blood supply to the brain is primarily provided by: A. The aorta and its major branches B. The internal carotid arteries and vertebral arteries C. The jugular veins and subclavian arteries D. The external carotid arteries and basilar artery

Answer 95

Answer: B. The internal carotid arteries and vertebral arteries Rationale: The brain receives its blood supply from the internal carotid arteries and vertebral arteries, which contribute to the Circle of Willis and distribute blood throughout the cerebral structures.

Question 96

Aphasia, a deficit in language function, is most likely to occur with a stroke involving which artery? A. Anterior cerebral artery B. Middle cerebral artery C. Posterior cerebral artery D. Basilar artery

Answer 96

Answer: B. Middle cerebral artery Rationale: Aphasia typically occurs with a stroke affecting the dominant hemisphere, often due to occlusion of the middle cerebral artery, which supplies areas of the brain responsible for language.

Question 97

A stroke in the posterior cerebral artery would most likely result in: A. Contralateral leg weakness. B. Contralateral visual field defect. C. Lower cranial nerve deficits. D. Oculomotor deficits and/or ataxia.

Answer 97

Answer: B. Contralateral visual field defect. Rationale: The posterior cerebral artery supplies the occipital lobe, where the visual processing centers are located. Occlusion can lead to contralateral visual field defects.

Question 98

Occlusion of which artery is most likely to cause contralateral leg weakness? A. Middle cerebral artery B. Anterior cerebral artery C. Basilar artery D. Vertebral artery

Answer 98

Answer: B. Anterior cerebral artery Rationale: The anterior cerebral artery supplies the medial portion of the frontal lobe, which includes the primary motor cortex controlling the lower body, thus its occlusion often leads to contralateral leg weakness.

Question 99

Which cerebral artery when occluded can lead to ataxia with crossed sensory and motor deficits? A. Anterior cerebral artery B. Middle cerebral artery C. Basilar artery D. Vertebral artery

Answer 99

Answer: C.Basilar artery Rationale: The vertebral arteries, along with the basilar artery, supply the brainstem and cerebellum. Occlusion can cause ataxia with crossed sensory and motor deficits due to the unique brainstem crossing of the nerve tracts.

Question 100

What percentage of patients who experience a Transient Ischemic Attack (TIA) will subsequently suffer a stroke? A. 10% B. 33% C. 50% D. 75%

Answer 100

Answer: B. 33% Rationale: According to the slide, one-third of patients who experience a TIA will subsequently suffer a stroke.

Question 101

What is the recommended time frame for thrombolytic intervention after the onset of ischemic stroke symptoms for the best prognosis? A. Within 180 minutes B. Within 90 minutes C. Within 60 minutes D. Within 30 minutes

Answer 101

Answer: B. Within 90 minutes Rationale: The slide indicates that the prognosis of stroke differs due to the time from onset to thrombolytic intervention, and it is suggested that intervention should occur within 90 minutes for the best outcomes.

Question 102

The TOAST classification system categorizes ischemic strokes into several etiologies. Which category involves emboli from conditions such as atrial fibrillation? A. Large artery atherosclerosis B. Small vessel occlusion C. Cardioaortic embolic D. Other etiology

Answer 102

Answer: C. Cardioaortic embolic Rationale: Cardioaortic embolic strokes are often due to emboli from the heart, such as those that can occur with atrial fibrillation. Group 3

Question 103

A STAT non-contrast CT scan is imperative in a suspected stroke patient for which of the following reasons? A. To determine the patient's eligibility for physical therapy B. To distinguish between ischemic stroke and intracerebral hemorrhage C. To identify the presence of pre-existing conditions like tumors D. To assess the long-term prognosis of the patient

Answer 103

Answer: B. To distinguish between ischemic stroke and intracerebral hemorrhage Rationale: A non-contrast CT scan is essential in the acute setting to differentiate between ischemic and hemorrhagic stroke because the treatment for each type differs significantly.

Question 104

What is often the recommended initial treatment for acute ischemic stroke? A. Oral anticoagulants B. Oral Aspirin C. TPA D. Intracranial pressure reduction

Answer 104

Answer: B. Oral Aspirin Rationale: Aspirin is commonly recommended as an initial treatment for acute ischemic stroke due to its antiplatelet effects, which help to prevent further clot formation.

Question 105

Recombinant tissue plasminogen activator (TPA) is indicated for ischemic stroke under certain conditions. What is one critical factor in its administration? A. It must be administered within a limited time window after symptom onset. B. It can be administered regardless of the time of symptom onset. C. It is only effective for hemorrhagic stroke. D. It should be used concurrently with anticoagulants.

Answer 105

Answer: A. It must be administered within a limited time window after symptom onset. Rationale: TPA is most effective when administered within a specific time frame, typically within 3-4.5 hours from the onset of stroke symptoms, to improve outcomes and reduce the risk of complications.

Question 106

The main goal of revascularization procedures in ischemic stroke, such as angiographic assessment and thrombectomy, is to: A. Reduce inflammation in the brain. B. Repair damaged brain cells. C. Restore blood flow to the affected area of the brain. D. Prevent the occurrence of future strokes.

Answer 106

Answer: C. Restore blood flow to the affected area of the brain. Rationale: Revascularization procedures aim to restore blood flow to the brain regions affected by the ischemic stroke, which is crucial for saving brain tissue and improving functional recovery.

Question 107

When evaluating patients for ischemic stroke interventions, what cardiovascular risk factors must be taken into account due to their impact on treatment choices and hemodynamic goals? A. Hypertension (HTN), Diabetes Mellitus (DM), Coronary Artery Disease (CAD), Atrial Fibrillation (Afib) B. Hypercholesterolemia, history of smoking, obesity, sedentary lifestyle C. Previous stroke, family history of stroke, age, gender D. Peripheral artery disease, chronic kidney disease, migraine with aura, sleep apnea

Answer 107

Answer: A. Hypertension (HTN), Diabetes Mellitus (DM), Coronary Artery Disease (CAD), Atrial Fibrillation (Afib) Rationale: Patients with ischemic stroke frequently have cardiovascular risk factors such as hypertension, diabetes, coronary artery disease, and atrial fibrillation, which can influence treatment decisions and anesthetic management during procedures like thrombolytics or thrombectomy. Vasoactive drug choice

Question 108

Hemorrhagic stroke is how many times more likely to cause death compared to ischemic stroke? A. 2 times B. 3 times C. 4 times D. 5 times

Answer 108

Answer: C. 4 times Rationale: According to the slide, a hemorrhagic stroke is four times more likely to cause death than an ischemic stroke.

Question 109

What are the two most reliable predictors of outcome in a hemorrhagic stroke? A. Age of the patient and the size of the stroke B. Time of onset to treatment and the presence of comorbidities C. Estimated blood volume of the hemorrhage and change in the level of consciousness (LOC) D. Location of the hemorrhage and the patient's prior medical history

Answer 109

Answer: C. Estimated blood volume of the hemorrhage and change in the level of consciousness (LOC) Rationale: The two most reliable predictors of outcome for a hemorrhagic stroke are the estimated blood volume lost and the change in the patient's level of consciousness.

Question 110

A hemorrhage located within the ventricular system is known as what type of hemorrhage? A. Subarachnoid hemorrhage B. Intraventricular hemorrhage C. Subdural hemorrhage D. Epidural hemorrhage

Answer 110

Answer: B. Intraventricular hemorrhage Rationale: Blood located in the ventricular system is referred to as an intraventricular hemorrhage and usually occurs in conjunction with other types of hemorrhagic stroke

Question 111

Conservative treatment for hemorrhagic CVA primarily focuses on: A. Immediate surgical intervention B. Reduction of intracranial pressure (ICP), blood pressure control, seizure precautions, and vigilant monitoring C. Rehabilitation and physical therapy D. Prompt administration of thrombolytic medications

Answer 111

Answer: B. Reduction of intracranial pressure (ICP), blood pressure control, seizure precautions, and vigilant monitoring Rationale: Conservative treatment for hemorrhagic stroke centers on the reduction of intracranial pressure, controlling blood pressure, taking seizure precautions, and closely monitoring the patient. These measures aim to stabilize the patient and prevent further damage while evaluating for potential surgical intervention.

Question 112

What is the recommendation for elective cases in patients who have recently started a new anticoagulant for thrombus treatment? A. Proceed with elective cases as planned. B. Delay elective cases for at least 1 month. C. Delay elective cases for at least 3 months. D. Only proceed if INR levels are within the therapeutic range.

Answer 112

Answer: C. Delay elective cases for at least 3 months. Rationale: The slide indicates that no elective cases should be scheduled within 3 months of starting a new anticoagulant for thrombus treatment due to the risk of bleeding and potential thrombus destabilization.

Question 112

For patients at high risk for CVA who are pausing long-acting anticoagulants, such as Warfarin, what is a common bridging strategy? A. Starting a beta-blocker B. Administration of short-acting anticoagulants like low molecular weight heparin or intravenous unfractionated heparin C. No bridging is necessary; long-acting anticoagulants can be stopped and restarted post-procedure D. Immediate switch to a new oral anticoagulant

Answer 112

Answer: B. Administration of short-acting anticoagulants like low molecular weight heparin or intravenous unfractionated heparin Rationale: High-risk patients for CVA may require short-acting anticoagulants to bridge the gap when long-acting anticoagulants are paused to reduce the risk of clot formation while minimizing bleeding risks during procedures.

Question 113

When planning a regional anesthesia (RA) for a patient on anticoagulants, what is an important consideration? A. Discontinue anticoagulants for a sufficient time to safely perform the block B. Proceed with regional anesthesia regardless of anticoagulation status C. Only use local anesthesia as it does not interact with anticoagulants D. Increase the dose of anticoagulants to prevent clot formation during surgery

Answer 113

Answer: A. Discontinue anticoagulants for a sufficient time to safely perform the block Rationale: Regional anesthesia requires careful planning in patients on anticoagulants. Discontinuing anticoagulants for an appropriate duration before the procedure is crucial to reduce the risk of bleeding and hematoma formation.

Question 114

Why is close monitoring of coagulation status required in patients with cerebrovascular disease who are on anticoagulant therapy? A. To ensure that blood glucose levels remain stable B. To monitor for potential renal impairment C. To adjust for appropriate anticoagulation levels and minimize the risk of bleeding D. To detect any potential allergic reactions to the anticoagulant medication

Answer 114

Answer: C. To adjust for appropriate anticoagulation levels and minimize the risk of bleeding Rationale: Close monitoring of coagulation status is necessary to maintain the delicate balance between preventing clot formation and minimizing the risk of excessive bleeding, which can be particularly challenging in patients with cerebrovascular disease.

Question 115

What is a key assessment in the pre-operative evaluation of a patient with cerebrovascular disease? A. Assessing for symptoms of urinary tract infection B. Checking for skin integrity and signs of bedsores C. Evaluating the patient's orientation, pupil response, and bilateral limb strength D. Reviewing the patient's dietary preferences and nutritional status

Answer 115

Answer: C. Evaluating the patient's orientation, pupil response, and bilateral limb strength Rationale: The slide emphasizes the importance of assessing neurological status, including orientation (cognitive function), pupils (cranial nerve function), and strength in the limbs (motor function), which could be impacted by cerebrovascular disease.

Question 116

When preparing for surgery in a patient with a history of cerebrovascular accidents (CVA), what specific type of imaging might be necessary to investigate potential sources of embolic strokes? A. Chest X-ray B. Abdominal ultrasound C. Carotid ultrasound and echocardiogram D. Pelvic MRI

Answer 116

Answer: C. Carotid ultrasound and echocardiogram Rationale: A carotid ultrasound can reveal vascular disease that may cause or contribute to a stroke, and an echocardiogram can identify cardiac sources of emboli, such as atrial fibrillation or a prosthetic valve.

Question 117

Which of the following vascular access methods is indicated in the slide for a pre-operative cerebrovascular disease patient? A. Peripheral intravenous (IV) access only B. Central venous catheter (CVC) only C. Arterial line (A-line), 2 IVs and/or central venous catheter (CVC) D. No vascular access is typically needed

Answer 117

Answer: C. Arterial line (A-line), 2IVs and/or central venous catheter (CVC) Rationale: For patients with cerebrovascular disease, particularly in complex surgical cases, establishing an arterial line for continuous blood pressure monitoring and blood sampling, as well as a central venous catheter for central venous pressure monitoring and medication administration, may be indicated.

Question 118

What laboratory tests are typically included in the pre-operative evaluation for a patient with cerebrovascular disease? A. Complete blood count (CBC), basic metabolic panel (BMP), possible type and crossmatch (T & C) B. Liver function tests (LFTs) only C. Hormone panel including thyroid function D. Genetic testing for clotting disorders

Answer 118

Answer: A. Complete blood count (CBC), basic metabolic panel (BMP), possible type and crossmatch (T & C) Rationale: The slide indicates that CBC and BMP are standard lab tests required pre-operatively to assess overall health, electrolyte balance, and renal function. A type and crossmatch may also be conducted to prepare for potential blood transfusions during surgery.

Question 118

What fraction of patients with cerebral aneurysms experience symptoms before rupture? A. One third B. One half C. Two thirds D. None

Answer 118

Answer: A. One third Rationale: The slide notes that only one third of patients with cerebral aneurysms show symptoms before a rupture occurs.

Question 119

What is the goal of administering mannitol in the pre-anesthesia phase for a patient with a cerebral aneurysm? A. To provide analgesia B. To control seizures C. To reduce intracranial pressure and avoid rupture D. To promote diuresis

Answer 119

Answer: C. To reduce intracranial pressure and avoid rupture Rationale: Mannitol is used pre-operatively in patients with cerebral aneurysms to control blood pressure and reduce intracranial pressure, which can help prevent aneurysm rupture. also on seizure prophylaxis

Question 120

When is the best time for intervention after a cerebral aneurysm rupture for optimal outcomes? A. Within 24 hours B. Within 72 hours C. Within 1 week D. Timing of intervention is not critical for outcomes

Answer 120

Answer: B. Within 72 hours Rationale: Intervention for a cerebral aneurysm is most effective when performed within 72 hours of rupture for the best patient outcomes.

Question 121

Which of the following are potential surgical treatments for cerebral aneurysms? A. Antibiotic therapy B. Coiling, stenting, trapping/bypass C. Craniotomy only D. Stereotactic radiosurgery

Answer 121

Answer: B. Coiling, stenting, trapping/bypass Rationale: Surgical treatments for cerebral aneurysms include procedures like coiling, stenting, or a trapping/bypass procedure, particularly for large aneurysms.

Question 122

When is the risk for vasospasm highest after a subarachnoid hemorrhage (SAH)? A. Immediately following SAH B. 1-2 days post-SAH C. 3-15 days post-SAH D. 1 month post-SAH

Answer 122

Answer: C. 3-15 days post-SAH Rationale: The risk for vasospasm is particularly high from 3 to 15 days following a subarachnoid hemorrhage, which requires close monitoring and management during this critical period.

Question 123

What is the primary goal of Triple H therapy in the management of post-SAH vasospasms? A. To relieve headache pain B. To reduce intracranial pressure C. To manage hypertension, hypervolemia, and hemodilution D. To prevent secondary infections

Answer 123

Answer: C. To manage hypertension, hypervolemia, and hemodilution Rationale: Triple H therapy, which stands for Hypertension, Hypervolemia, and Hemodilution, is aimed at improving cerebral blood flow and preventing ischemic injury due to vasospasm after a subarachnoid hemorrhage.

Question 124

Which therapeutic strategy is considered the initial main treatment to avoid complications of hypervolemia in post-SAH vasospasm management? A. Administration of diuretics B. Implementation of hypertension management C. Immediate surgical intervention D. Administration of anti-inflammatory medication

Answer 124

Answer: B. Implementation of hypertension management Rationale: The initial main treatment to avoid complications of hypervolemia, including increased intracranial pressure, is the management of hypertension to ensure adequate cerebral perfusion while avoiding fluid overload.

Question 125

What kind of interventional treatments may be employed to relieve vasospasms after a subarachnoid hemorrhage? A. Balloon dilation and direct injection of vasodilators B. Administration of oral anticoagulants C. Continuous lumbar drainage D. Intravenous administration of beta-blockers

Answer 125

Answer: A. Balloon dilation and direct injection of vasodilators Rationale: Interventional treatments for vasospasm after a subarachnoid hemorrhage may include endovascular procedures such as balloon dilation to mechanically open constricted vessels and direct injection of vasodilators to relax the blood vessel walls.

Question 126

Arteriovenous malformations (AVMs) create an area of abnormal connection between arteries and veins that results in which of the following hemodynamic changes? A. High flow, high resistance shunting B. High flow, low resistance shunting C. Low flow, high resistance shunting D. Low flow, low resistance shunting

Answer 126

Answer: B. High flow, low resistance shunting Rationale: AVMs create an area of high flow, low resistance shunting due to the absence of intervening capillaries, leading to direct arterial-to-venous connections.

Question 127

Where are the majority of arteriovenous malformations located within the brain? A. Infratentorial B. Supratentorial C. Brainstem D. Cerebellum

Answer 127

Answer: B. Supratentorial Rationale: The majority of arteriovenous malformations are found in the supratentorial region of the brain, which includes the cerebral hemispheres above the tentorium cerebelli.

Question 128

Pre-anesthesia management for a patient with an AVM includes which of the following? A. Blood pressure control, mannitol administration, seizure prophylaxis B. Increased intracranial pressure management with hyperventilation C. Immediate correction of coagulopathies D. Induction of hypothermia to reduce metabolic demand

Answer 128

Answer: A. Blood pressure control, mannitol administration, seizure prophylaxis Rationale: Pre-anesthesia considerations for patients with an AVM include blood pressure control to prevent hemorrhage, mannitol to reduce intracranial pressure, and seizure prophylaxis due to the increased risk of seizures.

Question 129

In patients with AVMs, what type of imaging is commonly used for diagnosis? A. Plain X-ray B. Echocardiogram C. Angiogram and MRI D. PET scan

Answer 129

Answer: C. Angiogram and MRI Rationale: Angiograms provide a detailed view of the blood vessels and are used alongside MRI to diagnose arteriovenous malformations and understand their architecture and impact on surrounding brain tissue.

Question 130

According to the Spetzler-Martin Grading System, an AVM located in an eloquent area of the brain is assigned how many points? A. 0 points B. 1 point C. 2 points D. 3 points

Answer 130

Answer: B. 1 point Rationale: The grading system assigns 1 point to an AVM that is located in an eloquent (functionally significant) area of the brain.

Question 131

What is the expected rate of patients with no postoperative neurologic deficit if an AVM is graded at 3 points? A. 100% B. 95% C. 84% D. 73%

Answer 131

Answer: C. 84% Rationale: According to the provided outcome table, an AVM with a Spetzler-Martin grade of 3 points corresponds to an 84% chance of the patient having no postoperative neurologic deficit.

Question 132

In the Spetzler-Martin Grading System, what is the nidus size threshold for assigning 2 points? A. Small (<3 cm) B. Medium (3-6 cm) C. Large (>6 cm) D. The size does not affect the point system

Answer 132

Answer: B. Medium (3-6 cm) Rationale: The grading system assigns 2 points for a medium-sized nidus, which is defined as being between 3-6 cm.

Question 133

How does the pattern of venous drainage affect the grading of an AVM in the Spetzler-Martin system? A. Superficial only drainage is assigned 0 points. B. Deep only or deep and superficial drainage is assigned 0 points. C. Superficial only drainage is assigned 1 point. D. Deep only or deep and superficial drainage is assigned 1 point.

Answer 133

Answer: D. Deep only or deep and superficial drainage is assigned 1 point. Rationale: The grading system assigns 1 point if the pattern of venous drainage is deep or involves both deep and superficial veins. Superficial only drainage does not add any points to the grading.

Question 134

Which type of Chiari Malformation is associated with myelomeningocele and is the most common? A. Type 1 B. Type 2 (Arnold Chiari) C. Type 3 D. Type 4

Answer 134

Answer: B. Type 2 (Arnold Chiari) Rationale: Type 2 Chiari Malformation, also known as Arnold Chiari, involves the downward displacement of the cerebellar vermis and is commonly associated with myelomeningocele. It is stated as the most common type of Chiari Malformation.

Question 135

What is the primary treatment for symptomatic Chiari Malformation? A. Pharmacologic management with pain relievers B. Physical therapy and exercise C. Surgical decompression D. Lifetime anticoagulation

Answer 135

Answer: C. Surgical decompression Rationale: The mainstay treatment for symptomatic Chiari Malformation, particularly when significant neurological symptoms are present, is surgical decompression to relieve pressure on the cerebellum and spinal cord.

Question 136

In preparing a patient with Chiari Malformation for anesthesia, what might be an important consideration? A. Patients may need to hyperventilate to reduce intracranial pressure B. Only oral intubation is indicated C. Spinal anesthesia is the preferred method D. Blood thinners are administered pre-operatively to prevent clots

Answer 136

Answer: A. Patients may need to hyperventilate to reduce intracranial pressure Rationale: Pre-anesthesia considerations for a patient with Chiari Malformation may include strategies like hyperventilation to reduce intracranial pressure. Additionally, establishing sufficient venous access with large bore IVs or a central venous catheter and an arterial line for invasive monitoring may be indicated.

Question 137

Chiari Malformation Type 4 is characterized by what feature? A. Downward displacement of the cerebellum B. Cerebellar hypoplasia without displacement of posterior fossa contents C. Occipital encephalocele with downward cerebellar displacement D. Association with hydrocephalus

Answer 137

Answer: B. Cerebellar hypoplasia without displacement of posterior fossa contents Rationale: Type 4 Chiari Malformation is characterized by cerebellar hypoplasia without displacement of posterior fossa contents. It is also noted on the slide that this type is not compatible with life.

Question 138

Tuberous Sclerosis is also known by which other name? A. Sturge-Weber Syndrome B. Von Hippel-Lindau Disease C. Bourneville Disease D. Neurofibromatosis

Answer 138

Answer: C. Bourneville Disease Rationale: Tuberous Sclerosis is also known as Bourneville Disease. It is an autosomal dominant condition characterized by the growth of numerous benign tumors in many parts of the body.

Question 139

Which organ systems are commonly involved in Tuberous Sclerosis, requiring particular consideration during anesthesia? A. Central nervous system and gastrointestinal system B. Respiratory and endocrine systems C. Face, oropharynx, heart, lungs, liver, and kidneys D. Skeletal and muscular systems

Answer 139

Answer: C. Face, oropharynx, heart, lungs, liver, and kidneys Rationale: Tuberous Sclerosis often involves co-existing tumors in various organ systems including the face, oropharynx, heart, lungs, liver, and kidneys. Anesthesia considerations must take into account the potential for airway compromise and cardiac or kidney involvement due to these tumors.

Question 140

What type of lesions are associated with the brain in Tuberous Sclerosis? A. Meningiomas B. Pituitary adenomas C. Cortical tumors and giant-cell astrocytomas D. Glioblastomas

Answer 140

Answer: C. Cortical tumors and giant-cell astrocytomas Rationale: Brain lesions associated with Tuberous Sclerosis include cortical tumors and subependymal giant-cell astrocytomas (SEGAs), which can cause complications such as seizures.

Question 141

When planning anesthesia for a patient with Tuberous Sclerosis, what are the key concerns? A. Only allergic reactions to anesthetic agents B. Airway compromise and involvement of cardiac and kidney systems C. Strict avoidance of any IV medication D. Ensuring the patient remains ambulatory post-operation

Answer 141

Answer: B. Airway compromise and involvement of cardiac and kidney systems Rationale: Anesthesia consideration for patients with Tuberous Sclerosis must include potential airway compromise due to oropharyngeal tumors and the involvement of the cardiac and kidney systems, which may be affected by the disease and could impact anesthesia management and patient safety.

Question 142

Von Hippel-Lindau (VHL) Disease is inherited in which manner? A. Autosomal recessive B. Autosomal dominant C. X-linked recessive D. X-linked dominant

Answer 142

Answer: B. Autosomal dominant Rationale: Von Hippel-Lindau (VHL) Disease is inherited in an autosomal dominant manner, meaning that a single copy of the mutated gene in each cell is sufficient to cause the disorder.

Question 143

Which of the following organs or systems is commonly affected by benign tumors in individuals with VHL Disease? A. Liver and spleen B. Lungs and heart C. Central nervous system, eyes, adrenals, pancreas, and kidneys D. Musculoskeletal system and skin

Answer 143

Answer: C. Central nervous system, eyes, adrenals, pancreas, and kidneys Rationale: Benign tumors associated with VHL Disease commonly affect the central nervous system, eyes, adrenals, pancreas, and kidneys, leading to various clinical manifestations.

Question 144

What additional condition may individuals with VHL Disease present with? A. Multiple sclerosis B. Pheochromocytoma C. Cystic fibrosis D. Hypothyroidism

Answer 144

Answer: B. Pheochromocytoma Rationale: Individuals with VHL Disease may present with pheochromocytoma, which is a tumor of the adrenal gland that can lead to excessive secretion of catecholamines and episodic hypertension.

Question 145

What anesthesia considerations are important for patients with VHL Disease who present with pheochromocytoma? A. Monitoring for bradycardia B. Administering intravenous fluids liberally C. Taking precautions to avoid exaggerated hypertension D. Administering high-dose opioids for pain management

Answer 145

Answer: C. Taking precautions to avoid exaggerated hypertension Rationale: Anesthesia considerations for patients with VHL Disease who present with pheochromocytoma include taking precautions to avoid exaggerated hypertension, as these patients may be particularly sensitive to stimuli that can trigger hypertensive crises.

Question 146

What may limit the use of neuraxial anesthesia in individuals with VHL (Von Hippel-Lindau )Disease? A. Renal impairment B. Hepatic dysfunction C. Co-existing spinal cord tumor D. Allergic reactions to local anesthetics

Answer 146

Answer: C. Co-existing spinal cord tumor Rationale: The presence of a co-existing spinal cord tumor may limit the use of neuraxial anesthesia in individuals with VHL Disease due to concerns about potential compression of the spinal cord and neurological complications.

Question 147

Neurofibromatosis is inherited in which manner? A. Autosomal recessive B. Autosomal dominant C. X-linked recessive D. X-linked dominant

Answer 147

Answer: B. Autosomal dominant Rationale: Neurofibromatosis is inherited in an autosomal dominant manner, meaning that a single copy of the mutated gene in each cell is sufficient to cause the disorder.

Question 148

Which type of Neurofibromatosis is the most common? A. Type 1 B. Type 2 C. Schwannomatosis D. Type 3

Answer 148

Answer: A. Type 1 Rationale: Type 1 Neurofibromatosis is the most common form of the disorder, accounting for the majority of cases.

Question 149

What is a common anesthesia consideration for patients with Neurofibromatosis? A. Hypovolemia management B. Management of hyperthyroidism C. Management of increased intracranial pressure (ICP) D. Administration of muscle relaxants

Answer 149

Answer: C. Management of increased intracranial pressure (ICP) -Anesthesia considerations account for increased ICP, airway issues, scoliosis, possibility of pheochromocytoma Rationale: Anesthesia considerations for patients with Neurofibromatosis often include management of increased intracranial pressure (ICP) due to the risk of neurofibromas in the central nervous system.

Question 150

Why might neuraxial anesthesia be avoided in patients with Neurofibromatosis? A. Risk of allergic reactions to local anesthetics B. Risk of spinal cord compression due to tumors C. Risk of postoperative delirium D. Incompatibility with other medications

Answer 150

Answer: B. Risk of spinal cord compression due to tumors Rationale: Neuraxial anesthesia may be avoided in patients with Neurofibromatosis due to the risk of spinal cord compression from the presence of spinal tumors associated with the disorder.

Question 150

Hydrocephalus is characterized by which of the following? A. Accumulation of blood in the brain ventricles B. Excessive production of cerebrospinal fluid (CSF) C. Imbalance between CSF production and absorption D. Blockage or obstruction in the flow of CSF

Answer 150

Answer: C. Imbalance between CSF production and absorption

Question 151

Which of the following is NOT a potential cause of acquired hydrocephalus? A. Meningitis B. Brain tumors C. Head injury D. Congenital heart disease

Answer 151

Answer: D. Congenital heart disease Rationale: Acquired hydrocephalus can result from conditions such as meningitis, brain tumors, head injury, or stroke, but not from congenital heart disease.

Question 152

What is the main treatment modality for hydrocephalus? A. Diuretics to decrease CSF production B. Serial lumbar punctures for CSF drainage C. Surgical intervention D. Antibiotics to treat underlying infection

Answer 152

Answer: A. Tx mainly consists of diuretics (furosemide & acetazolamide decrease CSF production)  although this remains controversial in children Rationale: OTHER cases of hydrocephalus require surgical treatment, which may involve ventriculoperitoneal (VP) shunt placement or endoscopic third ventriculostomy (ETV).

Question 153

When does shunt malfunction most frequently occur? A. Within the first month of placement B. Within the first year of placement C. After 5 years of placement D. Shunt malfunction is rare and occurs randomly

Answer 153

Answer: B. Within the first year of placement Rationale: Shunt malfunction most frequently occurs within the first year of placement, with a relatively high failure rate during this period.

Question 154

Traumatic brain injury (TBI) can be categorized into which of the following types based on the breach of the dura? A. Closed and open B. Mild and severe C. Primary and secondary D. Acute and chronic

Answer 154

Answer: A. Closed and open Rationale: Traumatic brain injury (TBI) can be categorized as either closed (non-penetrating) or open (penetrating), based on whether there is a breach of the dura mater.

Question 155

Which scale is commonly used to categorize the severity of traumatic brain injury (TBI)? A. Glasgow-Coma Scale (GCS) B. Modified Rankin Scale C. NIH Stroke Scale D. Rancho Los Amigos Scale

Answer 155

Answer: A. Glasgow-Coma Scale (GCS) Rationale: The severity of traumatic brain injury (TBI) is commonly categorized using the Glasgow-Coma Scale (GCS), which assesses eye, verbal, and motor responses.

Question 156

In cases of severe traumatic brain injury (TBI), when is intubation typically required? A. GCS < 15 B. GCS < 10 C. GCS < 9 D. GCS > 5

Answer 156

Answer: C. GCS < 9 Rationale: Intubation is typically required in cases of severe traumatic brain injury (TBI) when the Glasgow-Coma Scale (GCS) score is less than 9.

Question 157

(TBI)

Answer 157

Secondary injuries: neuroinflammation, cerebral edema,        hypoxia, anemia, electrolyte imbalances, and neurogenic shock Secondary is more serious then the primary injury Refrain from NGT/OGT –potential for basal skull fx Intra-op ISTAT labs, Pressors, Bicarb, Calcium, & Blood products

Question 158

Which of the following best defines a seizure? A. A chronic neurological condition characterized by recurrent episodes of abnormal electrical activity in the brain B. A transient, paroxysmal, synchronous discharge of neurons in the brain C. A sudden loss of consciousness without any apparent cause D. A progressive degenerative disorder affecting motor function and cognition

Answer 158

Answer: B. A transient, paroxysmal, synchronous discharge of neurons in the brain Rationale: A seizure is defined as a transient, paroxysmal, synchronous discharge of neurons in the brain, leading to abnormal electrical activity.

Question 159

Which of the following drugs are enzyme-inducers and may require higher doses of hepatically-cleared medications? A. Benzodiazepines B. Opioids C. Antiepileptic drugs like Phenytoin and Tegretol D. Local anesthetics

Answer 159

Answer: C. Antiepileptic drugs like Phenytoin and Tegretol Phenytoin, Tegretol, Barbiturates are enzyme-inducers Likely require higher doses of hepatically-cleared medications May be called to intubate post-seizure→ RSI w/cricoid pressure