neuro final Flashcards
(26 cards)
Following clipping of an anterior communicating artery aneurysm, a 59-year-old man is admitted to the intensive care unit (ICU). Serum sodium is 115 mEq/L,24-hour urine sodium collection is 350 mmol (normalrange 40-117 mmol/24 hr), and central venous pressure (CVP) is 1 cm H2O. The MOST likely cause ofthese findings is
A. Tubular necrosis
B. Diabetes insipidus
C. Cerebral salt-wasting syndrome
D. Syndrome of inappropriate antidiuretic hormone
(SIADH)
C. Cerebral salt-wasting syndrome
Intracranial hypertension is defined as a sustained increase in intracranial pressure (ICP) above
A. 5 mm Hg
B. 15 mm Hg
C. 25 mm Hg
D. 40 mm Hg
B. 15 mm Hg
Calculate cerebral perfusion pressure from the following data: blood pressure (BP) 100/70, heart rate (HR) 65 beats/min, and ICP 15 mm Hg.
A. 60 mm Hg
B. 65 mm Hg
C. 70 mm Hg
D. 75 mm Hg
B. 65 mm Hg
The afferent input for somatosensory evoked potentials (SSEPs) is carried through which spinal cord
tract?
A. Spinocerebellar
B. Spinothalamic
C. Dorsal columns
D. Corticospinal
C. Dorsal columns
By what percentage does cerebral blood flow (CBF)
change for each mm Hg increase in Paco2?
A. 1%
B. 2%
C. 7%
D. 10%
B. 2%
Which of the following intravenous anesthetics is contraindicated in patients with intracranial hypertension?
A. Propofol
B. Fentanyl
C. Ketamine
D. All are acceptable
C. Ketamine
The term luxury perfusion refers to a situation that occurs in the brain when
A. Blood flow has resumed after a period of ischemia
B. Blood flow is directed from a normal region of the brain to an ischemic region
C. Vasoparalysis exists
D. The Robin Hood phenomenon exists
C. Vasoparalysis exists
A 62-year-old patient is scheduled to undergo resection of a frontal lobe intracranial tumor under general anesthesia. Preoperatively, the patient is alert and oriented, and has no focal neurologic deficits. Within what range should Paco2 be maintained during
surgery?
A. 15 and 20 mm Hg
B. 20 and 25 mm Hg
C. 25 and 30 mm Hg
D. 40 and 45 mm Hg
C. 25 and 30 mm Hg
A 2-year-old child is anesthetized for resection of a
posterior fossa tumor. Preoperatively, the patient is
lethargic and disoriented. Which of the following is
MOST likely to adversely alter ICP?
A. 5% Dextrose in water
B. Normal saline
C. Lactated Ringer solution
D. 5% Albumin
A. 5% Dextrose in water
A 22-year-old patient is anesthetized for resection of
a temporal lobe tumor. Preoperatively, he is lethargic
and confused. After induction of general anesthesia,
which of the following would be the MOST appro-
priate drug to control systemic arterial blood pressure
during direct laryngoscopy and tracheal intubation?
A. Esmolol
B. Nitroprusside
C. Hydralazine
D. Isoflurane
A. Esmolol
Normal global CBF is
A. 25 mL/100 g/min
B. 50 mL/100 g/min
C. 75 mL/100 g/min
D. 100 mL/100 g/min
B. 50 mL/100 g/min
The lower and upper mean arterial blood pressure
limits of CBF autoregulation are, respectively,
A. 25 and 125 mm Hg
B. 25 and 200 mm Hg
C. 40 and 250 mm Hg
D. 60 and 160 mm Hg
D. 60 and 160 mm Hg
How much will CBF increase in a patient whose
Paco2 is increased from 35 to 45 mm Hg?
A. There is no relationship between Paco2 and CBF
B. 10 mL/100 g/min
C. 20 mL/100 g/min
D. 40 mL/100 g/min
B. 10 mL/100 g/min
Select the FALSE statement concerning autonomic
hyperreflexia.
A. Distention of a hollow viscus below the level of
the spinal cord transection can elicit autonomic
hyperreflexia
B. Up to 85% of patients with a spinal cord transection above the T6 dermatome will exhibit
autonomic hyperreflexia under general anesthesia
C. Propranolol is effective in treating hypertension
associated with autonomic hyperreflexia
D. Spinal anesthesia is effective in preventing auto-
nomic hyperreflexia
C. Propranolol is effective in treating hypertension
associated with autonomic hyperreflexia
What is the normal cerebral metabolic rate for oxygen
(CMRO2) per minute?
A. 0.5 mL/100 g brain tissue
B. 2.0 mL/100 g brain tissue
C. 3.5 mL/100 g brain tissue
D. 7.5 mL/100 g brain tissue
C. 3.5 mL/100 g brain tissue
A 14-year-old girl with severe scoliosis is to undergo spine surgery. Anesthesia is maintained with fentanyl, N2O 50% in O2, vecuronium, and isoflurane. Neurologic function of the spinal cord is monitored by SSEPs. In reference to the SSEP waveform, spinal cord ischemia would be manifested as
A. Increased amplitude and increased latency
B. Decreased amplitude and increased latency
C. Decreased amplitude and decreased latency
D. Increased amplitude and decreased latency
B. Decreased amplitude and increased latency
For each 1° C decrease in body temperature, how
much will CMRO2 be diminished?
A. 3%
B. 5%
C. 6%
D. 10%
C. 6%
A 24-year-old carpenter is treated for a closed head injury sustained 3 days earlier after falling from a roof. He has been hemodynamically stable. Despite aggressive efforts to pharmacologically reduce ICP, he is now unconscious and unresponsive to painful stimuli. All of the following are clinical criteria consistent with a diagnosis of brain death in this patient EXCEPT
A. Persistent apnea for 10 minutes
B. Absence of pupillary light reflex
C. Persistent spinal reflexes
D. Decorticate posturing
D. Decorticate posturing
Which of the following is the MOST sensitive means
of detecting venous air embolism (VAE)?
A. Electroencephalography (EEG)
B. Pulmonary artery catheter
C. Transesophageal echocardiography
D. Right atrial catheterization
C. Transesophageal echocardiography
When intracranial hypertension exists, the main compensatory mechanism from the body is
A. Increased absorption of cerebrospinal fluid (CSF)
at the intracranial arachnoid villi
B. Increased absorption of CSF in the spinal arachnoid villi
C. Shifting of CSF from intracranial to spinal sub-
arachnoid space
D. Reduction of cerebral blood volume due to compression of intracranial arteries
C. Shifting of CSF from intracranial to spinal sub-
arachnoid space
Administration of vecuronium during spinal surgery may interfere with monitoring of
A. Dorsal columns
B. Corticospinal tract
C. Electrocorticography
D. Bispectral index
B. Corticospinal tract
what is the most common classification of cerebral palsy?
spastic
which is the most significant pre-natal risk factor for cerebral palsy?
preterm birth and low birth weight
T/F: NDNMBs are more potent in pts w cerebral palsy?
false
