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SEE Exam Review > Neuro > Flashcards

Neuro Flashcards

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1
Q

What is CN I and the function?

A

Olfactory Nerve

Smell

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2
Q

What is CN II and its function?

A

Optic Nerve

Vision

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3
Q

What is CN III and its function

A

Occulomotor

Adduction of the eye and pupillary constriction

Superior Rectus
Interior Rectus
Medial Rectus
Inferior Oblique

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4
Q

What does the superior rectus muscle do?

A

Allows eye to look up

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5
Q

What does the Medial rectus muscle do?

A

look medially
Adduction

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6
Q

What does the inferior rectus do?

A

Eye Looks down

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7
Q

What does the Inferior oblique do?

A

Looks out and up

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8
Q

What is CN IV and its functioN?

A

Trochlear Nerve

Eye movements (superior oblique)

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9
Q

What does the superior oblique muscle do/

A

Eye looks down and in

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10
Q

What is CN V and its function?

A

Trigeminal Nerve

Chewing, Mastication, Facial sensory

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11
Q

What is CN VI and its function?

A

Lateral rectus
Abduction of eye (LR6, SO4)

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12
Q

What is CN VII and its function?

A

Motor of Facial muscles
Taste to anterior 2/3 of tongue

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13
Q

What is CN VIII and its function?

A

Vestibulocochlear

Hearing
Balance

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14
Q

What is CN IX?

A

Glossopharyngeal Nerve

Taste to Posterior 1/3 of tongue
Carotid and Sinus AF

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15
Q

What is CN X and what is it responsible for?

A

Parasympathetic innervation (efferent)
Decrease HR

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16
Q

What is CN XI and what is its function?

A

Spinal Accessory

Motor control of the larynx and pharynx
Also in control of shrugging shoulders

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17
Q

What is CN XII and what is its function?

A

Hypoglossal

Tongue muscles

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18
Q

What is the equation for Cerebral blood flow?

A

Cerebral perfusion pressure/cerebral vascular resistance

approx 750 mL (50 ml/100g/min)

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19
Q

What is the equation for CPP?

A

MAP - ICP (or RAP)

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20
Q

How do you determine to use RAP or ICP?

A

Use the higher one

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21
Q

How much glucose does the brain consume?

A

5mg/100g/min

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22
Q

In a non-ischemic brain, what happens during cerebral steal?

A

Increased blood flow and increased vessel diameter

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23
Q

In a non-ischemic brain, what happens during inverse steal?

A

Decreased blood flow and decreased vessel diameter

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24
Q

In an ischemic brain, what happens during cerebral steal?

A

Decreased blood flow
Vessel diameter is already maxed out

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25
In an ischemic brain, what happens during inverse steal?
Increased blood flow
26
If you increase CO2 or give a vasodilator, what happens in the cerebral steal scenario?
Increases steal
27
If you hyperventilate a patient undergoing cerebral steal, what happens?
Inverse steal and returns to normal
28
What is the occulocardiac reflex?
Afferent pathway - CN V Efferent pathway - CN X triggers by traction of the extraoccular muscles --> - MEDIAL RECTUS - Occular manipulation - Manual pressure on the eye
29
What are the EKG manifestations of the occulocardiac reflex?
Decreased HR Junctional rhythm PVCs
30
How do you treat/block the occulocardic reflex?
Anti-muscarinic meds Retrobulbar block IA
31
What is normal ICP?
5-15
32
What ICP shows focal ischemia?
25-55 mmHg
33
What ICP shows global ischemia?
>55 mmHG
34
What is the IC volume made up of in the brain?
80% brain matter and intracellular H2O 12% blood 8% CSF
35
What are the three ICP waveforms?
A - plateau waves, found in pts with Increased ICP B C
36
What are the 12 s/sx of Increased ICP?
Headache N/V Blurred vision unilateral pupil deviation papilledema CN III paralysis CN VI paralysis HTN Bradycardia Irregular respirations Altered LOC Seizures
37
What is Cushing's triad?
HTN Bradycardia Irregular Respirations
38
How do you treat increased ICP
Hyperventilate to PaCo2 25-30 Elevate HOB to 30 Control BP Administer Mannitol or Lasix Give Steroids Restrict fluids Administer cerebral vasoconstrictor Cool pt to 34C for cerebral protection
39
How much mannitol do you give for elevated ICPs?
0.25-1 g/kg
40
What is decorticate posturing?
Above the cerebellum injury Flexion of the upper and extension of the lower
41
What is decerebrate posturing?
Injury to the brainstem Extension of arms and legs Arched body
42
What is held in the anterior cranial fossa?
Frontal lobe
43
What is held in the middle anterior cranial fossa?
Temporal lobe
44
What is held in the posterior cranial fossa?
Brainstem and Cerebellum
45
When does the anterior fontanelle close?
18 months
46
When do the posterior and anterolateral fontanelles close?
2 months
47
When do the posterolateral fontanelles close?
2 years
48
What is the specific gravity of CSF?
1.003 - 1.009
49
What is an example of a hyperbaric solution to CSF?
D10 (dextrose)
50
What is a hyperbaric solution to CSF?
NS Sterile H2O
51
How many mL of CSF Form in an hour? In a day?
20-30 mL in 1H 500-700 ml/day
52
Where is CSF formed?
Choroid Plexus
53
Where is the choroid plexus located?
Temporal horn of lateral ventricles Posterior portion of the third ventricle Roof of the fourth ventricle
54
Where is the CSF reabsorbed
Arachnoid villi mostly Also in the spinal villi and lymphatics
55
What is the total volume of CSF held in the brain and spinal column at once?
150 ml
56
Where is the most common CSF obstruction?
Aqueduct of Sylivus
57
How does CSF Flow?
Choroid plexus Lateral Ventricles Foramen of Monroe Third Ventricle Aqueduct of sylvius Fourth Ventricle Into - Foramen Luschka - Foramen Magendie SA Space Brain Arachnoid Villi
58
What are the four factors governing passage across the BBB
Size --> Smaller crosses easier Charge -- ions do not cross Lipid solubility --> increased lipid solubility = easier time crossing Degree of protein binding - water and gases cross - H2Osoluble drugs do not cross
59
What four electrolyte disorders decrease seizure threshold?
(increased seizure activity) Hypocalcemia Hypomagnesemia Hyponatremia Hypernatremia
60
What conditions are likely to decrease seziure threshold?
hypoglycemia alkalosis
61
What opioid is most likely to cause seizures?
Demerol
62
What two meds together can cause seizures?
Ketamine Aminophylline
63
What happens in acute spinal shock?
HYPOTENSION due to sympathetic blockade BRADYCARDIA due to blockade of cardiac accelerators
64
What level is autonomic hyper-reflexia located at in the spinal column?
T5 or T6
65
What is triple H therapy?
Hypervolemia (>10 mmHg) Hypertension (SBP 160-200 mmHg) Hemodilution (Hct 33%)
66
When might you see a cerebral vasospasm?
4-12 days post op /post injury
67
What are some s/sx of a vasospasm?
Worsening H/A Confusion HTN
68
What medication is used to treat vasospasm?
Nimodipine
69
What is a wake up test and why is ti used?
used to test the motor tracts of the brain Monitors the anterior (ventral) spinal cord --> supplied by the anterior spinal arteries
70
What are some complications associated with a wake up test?
Recall Extubation Dislodgement of Spinal instrumentation VAE from spontaneous ventilation
71
What medications do you want to avoid in Parkinson's pts?
Reglan Compazine Droperidal ALl meds that decrease dopamine!
72
if you suspect a VAE, what should you do?
Doppler at RA 3rd -6th ICS, Right of sternum to look for wheel hill murmur Notify surgeon to flood the field Turn off N2O Administer 100% FiO2 Aspirate Central venous catheter to remove air Increased CVP (VALSALVA MANEUVAR) CV drugs to support circulation Bilateral jugular vein compressionm PEEP applied Left lateral decubitus with 15 degree head down to sit
73
What makes up the circle of willis?
R?L internal carotid arteries Basilar and vertebral arteries
74
What is the delta brain wave?
Delta wave is the highest amplitude wave found in sleeping adults, abnormal in awake adults
75
What is the theta brain wave?
Lesser amplitude than delta but more than higher than alpha and beta
76
What is the Beta brain wave
Alert but relaxed brain state Eyes closed Higher in amplitude than the alpha wave
77
What is the alpha brain wave?
Low amplitude, made by frontal head movement business activity
78
When might you see variations in the beta waves?
if given propofol or benzodiazepines
79
With surgical stimulation or light anesthesia, what brain waves might you see?
Increased high frequency waves Low voltage activity
80
With GA, what brain waves might you see?
Decreased Alpha and beta, increased low frequency theta and delta waves
81
What inhalation agents can attenuate epileptic activity?
Sevo & Enflurane
82
What meds are used for burst suppression>
Propofol Barbiturates Etomidate
83
What medications DO NOT produce a change in latency and amplitude?
Ketamine Opioids Etomidate
84
Where is the sensory portion of the spinal cord?
Afferent side -- Dorsal Horn (posterior portion) S-sensory A- afferent D- dorsal horn
85
Where is the motor portion of the spinal cord?
Efferent side, anterior portion, ventral horn
86
What does SSEPs monitor?
Monitor the dorsal horn -- posterior portion TELLS US ABOUT THE POSTERIOR SPINAL ARTERIES
87
For the sensory

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