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

Module 6 Evoked Potentials And Pain Paths/CNS Flashcards

(62 cards)

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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
What MAC correlates with isoelectric EEG
1.5-2.0 MAC
26
How does N2O change EEG
Decrease in amplitude without change in latency
27
Cell bodies of A delta and C fibers are found where
Dorsal root ganglion
28
Major NTS released from A delta fibers is_____ Binds to which receptors
Glutamate AMPA andNMDA
29
Major NTS released from type C fibers is _____ | Binds to what receptors
Substance P NK-1 receptors
30
Fast pain fibers are what type Terminate where
A delta Terminate Rexed’s lamina I and V Second order neuron crosses to contralateral spinothalamic tract
31
Slow pain fibers are what type Terminate where
Type C Terminate Rexed’s lamina II and III Interneuron transmits to Rexed V and pass to the contralateral spinothalamic tract
32
What is the function of the dorsolateral tract
Modulate pain
33
Spinal analgesia is mediated by primarily what receptor
Mu2
34
Supraspinal analgesia with mediated by what receptor
Mu1
35
Modulation of pain pathway
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
Which receptor is responsible for supraspinal analgesia, decreased HR, euphoria and pruritis
Mu1
37
Which opioid receptor is responsible for spinal analgesia, respiratory depression, and physical dependence
Mu2
38
Which opioid receptor is responsible for dysphoria (sedation)
Kappa
39
CSF circulation pathway
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
What blood vessels supply the circle of Willis
Left and right internal carotid as well as basilar artery (supplied by vertebral arteries)
41
Ketamine and N20 effect on CBF and cerebral metabolism
Increases both
42
Blood supply to spinal cord
75% from one anterior spinal artery 25% from 2 posterior spinal arteries Small segmental arteries
43
Artery of Adamkiewicz significance
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
Decorticate rigidity cause
Damage to brain above cerebellum and brainstem (supratentorial)
45
Decerebrate rigidity cause
Extensive damage to brainstem or cerebral lesions compressing thalamus and brainstem
46
Cushings triad
Hypertension Bradycardia Irregular respirations
47
What area of spinal cord is where transmission of pain impulses is modulated
Substantial gelatinosa
48
What is the difference in complex regional pain syndrome type I and type II
In type II there is documents nerve injury
49
What is the best time to initiate PCA
In PACU after initial pain level under control
50
Epidural steroid injection for radiculopathy and back pain work how
Anti-inflammatory effect related to inhibition of phospholipase A2 (PLA2) activity
51
Spinal cord stimulation is most effective for what type of pain
Neuropathic pain
52
Medical management of CRPS
Physical Therapy Membrane stabilizers (gabapentin) TCAs
53
What regional block may be indicated for circulatory insufficiency of upper extremity
Stellate ganglion block
54
What is the most effective measure for pain associated with pancreatic CA
Celiac plexus block with alcohol or phenol
55
During posterior fossa surgery bradycardia and hypertension develop. Why
Stimulation of trigeminal nerve due to pressure on brainstem (cushings reflex)
56
During posterior fossa surgery bradycardia and hypotension develop. Why
Stimulation of glossopharyngeal or vagus nerve
57
Standard treatment for cerebral vasospasm
Calcium channel blocker (nimodipine) Triple H therapy (hypertensive, hypervolemic, hemodilutional)
58
To reduce intracranial volume to give neurosurgeon more space to work in posterior fossa, ETCO2 should be kept where
25-30mmHg Provides maximum intracranial decompression with minimal risk of cerebral ischemia
59
What nerves carry the afferent and efferent action potentials in the oculocardiac reflex arc
Afferent- trigeminal (CNV) Efferent- Vagus (CNX)
60
What is the most frequent complication of retrobulbar block
Hemorrhage
61
How does hypercarbia affect intraocular pressure
Hypercarbia increases IOP
62
How long should N20 be avoided in a patient that had sulfur hexaflouride bubble
10 days

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