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Neuro Test 2 > Prodigy Questions > Flashcards

Prodigy Questions Flashcards

1
Q

What is the normal cerebrospinal fluid pressure?

A

When lying in a horizontal position, the normal cerebrospinal fluid pressure is about 130 mm of water or 10 mmHg.

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2
Q

What are some common causes of increased cerebrospinal fluid pressure?

A

brain tumor can result in the decreased reabsorption of the CSF, which can result in an increased CSF pressure. Hemorrhage or infection are other potential causes as the appearance of red blood cells or white cells can obstruct the absorption channels in the arachnoid villi. Hydrocephalus is an inborn cause of increased CSF pressure.

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3
Q

What is the rate of formation of cerebrospinal fluid?

A

About 500 mL of CSF is formed each day. This translates into about 21 mL/hour.

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4
Q

Where in the brain are the choroid plexuses located? Which locations are associated with the greatest quantity of cerebrospinal fluid produced?

A

The choroid plexuses are located in the four ventricles. The ones located in the two lateral ventricles produce the greatest quantity of cerebrospinal fluid.

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5
Q

About how much cerebrospinal fluid is in the subarachnoid space at any given time?

A

About 150 mL

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6
Q

How does secretion of cerebrospinal fluid by the choroid plexus occur?

A

It is dependent upon the active transport of sodium through the epithelium of the choroid plexus. As the sodium is transported out, chloride is pulled outward as well because of its electrochemical attraction to sodium. The combination of sodium and chloride increases the osmotic pressure on the outside of the plexus which results in the osmosis of water through the plexus membrane. It is the fluid that forms the principal constituent of cerebrospinal fluid.

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7
Q

Where is the cerebrospinal fluid secreted and where is it absorbed?

A

Cerebrospinal fluid is secreted by the choroid plexus and absorbed by the arachnoid villi.

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8
Q

What percentage of cardiac output goes to the brain?

A

The brain only comprises about 2% of body mass but receives about 15% of the cardiac output.

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9
Q

What are the four arteries that supply blood to the brain?

A

The left and right carotid arteries and left and right vertebral arteries.

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10
Q

What is the normal cerebral blood flow?

A

The normal blood flow to the brain is about 50-65 milliliters per 100 grams of brain tissue per minute. This amounts to about 750-900 milliliters/minute in the average adult.

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11
Q

About what percent of the cardiac output does the brain receive?

A

About 15 percent of the cardiac output goes to the brain, or about 50 mL/100g/min

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12
Q

What are evoked potentials?

A

Electrical potentials that are measured in response to some type of stimulus. The purpose is to improve or preserve neurologic structures that are at risk, and to also prevent damage that is irreversible.

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13
Q

What is the purpose of SSEP’s?

A

SSEP’s monitor various neural structures along the central and peripheral somatosensory pathways.

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14
Q

How is the stimulation for SSEP’s created?

A

Through electrical stimulation of peripheral nerves

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15
Q

How does carbon dioxide affect cerebral blood flow?

A

Hypocapnia decreases cerebral blood flow. This effect usually lasts for about 4-6 hours. PaO2 has little effect on CBF until it reaches a tension of 50 mmHg at which point it dramatically increases CBF.

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16
Q

Are most strokes ischemic or hemorrhagic?

A

Most CVAs are ischemic in nature. Only about 10 percent are hemorrhagic.

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17
Q

How is blood glucose related to stroke outcomes?

A

Hyperglycemia is associated with poor outcomes in patients with ischemic stroke. Intravenous administration of glucose should be avoided in stroke patients

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18
Q

What is electroconvulsive therapy (ECT)?

A

ECT is the induction of a generalized seizure via electrodes placed on the cranium.

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19
Q

What psychiatric disorders is ECT used to treat?

A

Mania, affective disorders, and major depression disorders that are resistant to medical therapy.

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20
Q

What are the two most common causes of death related to electroconvulsive therapy?

A

Cardiac dysrhythmias and myocardial infarction are the two most common causes of death related to ECT treatment.

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21
Q

What are the anesthetic goals for ECT?

A

Provide airway support, prevent any recall of the procedure, and attenuate the hemodynamic response to ECT.

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22
Q

What type of anesthesia is administered for ECT?

A

General anesthesia is induced with an intravenous agent, succinylcholine is administered to provide muscle relaxation in preparation for the seizure, and positive-pressure ventilation by mask is performed via mask (or via ETT if the patient is at risk for aspiration).

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23
Q

Historically, what has been the preferred intravenous anesthetic agent for ECT? Why?

A

Methohexital is considered the gold standard induction agent for ECT. All intravenous anesthetics reduce seizure activity, but methohexital reduces it the least.

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24
Q

What are the hemodynamic effects of ECT?

A

ECT treatments result in stimulation of the autonomic nervous system resulting in a short-lived bradycardia followed by a surge in endogenous catecholamines causing potentially dangerous hypertension and tachycardia.

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25
Q

What is the minimum seizure duration recommended to ensure adequate antidepressant efficacy when performing electroconvulsive therapy?

A

Seizures often last several minutes and minimum seizure duration of 25 seconds is recommended to ensure adequate antidepressant efficacy.

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26
Q

What anesthetic agents do not produce a change in latency or amplitude in regards to SSEP’s?

A

Ketamine, etomidate, and opiates.

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27
Q

What are brainstem auditory evoked potentials and when are they used?

A

Brainstem auditory evoked potentials assess the integrity of the 8th cranial nerve and the auditory pathways above the pons and are best for monitoring during posterior fossa surgery.

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28
Q

Blood flow to the brain is provided by what arteries?

A

2 vertebral arteries, 2 carotid arteries, and collateral circulation is provided by the Circle of Willis. The circular pattern helps ensure even blood flow to the brain even if one side is impeded.

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29
Q

How do inhalational agents affect CBF?

A

Inhalational agents cause vasodilation in a dose-related fashion. At low doses, little to no change is seen, however with higher doses, CBF is increased.

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30
Q

The IV agents thiopental and propofol exert what effects on CMRO2 and CBF?

A

Thiopental and propofol reduce metabolism and cause cerebral vasoconstriction (lower CBF).

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31
Q

How does Ketamine affect cerebral blood flow and metabolism?

A

Ketamine increases both cerebral blood flow and metabolism.

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32
Q

What is the most common psychiatric disorder?

A

Depression

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33
Q

In order for ECT treatments to elicit a therapeutic effect, how long must the electrically-induced seizure last?

A

At least 25 seconds

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34
Q

Why is succinylcholine used during anesthesia for ECT?

A

To lessen the magnitude of skeletal muscle contractions and associated bone fractures that occur during seizure activity.

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35
Q

Are the cardiovascular side effects seen with ECT caused by stimulation of the sympathetic or parasympathetic nervous system?

A

Both. There is a 10-15 second stimulation of the parasympathetic nervous system in which bradycardia and hypotension occur, followed by hypertension and tachycardia that lasts for several minutes as a result of sympathetic nervous system activation.

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36
Q

List side effects associated with ECT.

A

Hypotension and bradycardia (caused by parasympathetic activation), tachycardia and hypertension (caused by sympathetic activation), increased intragastric pressure, increased ICP, increased IOP, an increase in cerebral blood flow, cardiac dysrhythmias

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37
Q

What is the disadvantage to the use of propofol during ECT?

A

It has anticonvulsant properties, thus reducing the duration of the induced seizure.

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38
Q

What is the most common long-term effect associated with the use of ECT?

A

Memory impairment

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39
Q

Why is methohexital the preferred induction drug used with ECT?

A

It has very little anticonvulsant effects, and it has a rapid onset and recovery. Because of difficulty getting barbiturates in the US, propfol is commonly used.

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40
Q

Which type of seizure is defined as two consecutive tonic-clonic seizures without regaining consciousness or seizure activity that is unabated for 30 minutes or more?

A

Status epilepticus is defined as two consecutive tonic-clonic seizures without the patient regaining consciousness in between or seizure activity that lasts for 30 solid minutes or more.

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41
Q

Where do partial seizures originate?

A

They originate from a localized segment of neurons in a single cerebral hemisphere.

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42
Q

From where do generalized seizures originate?

A

The originate in neurons in both cerebral hemispheres.

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43
Q

What is the Jacksonian March?

A

A partial seizure that evolves into a generalized seizure.

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44
Q

Which test is used to determine the location of seizure foci and describe its electrical properties?

A

Standard EEG

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45
Q

What is the method of choice for studying the brain structure of patients with epilepsy?

A

MRI

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46
Q

What is often used in conjunction with an EEG to document clinical and electrical seizure activity at the same time?

A

Videography

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47
Q

What is electrocorticography?

A

Electrocorticography is type of monitoring in which electrodes are placed surgically on the cerebral cortex. Seizure foci are more accurately determined and electrical events can be mapped in relation to brain anatomy.

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48
Q

What are the most common adverse effects associated with the use of antiepileptic drugs?

A

Dose-dependent neurotoxic effects and depression of cerebral function.

49
Q

What is a conservative surgical approach to seizures that do not respond to antiepileptic drug therapy?

A

Implantation of a left vagal nerve stimulator

50
Q

Why is the vagal nerve stimulator used to treat seizures placed on the left side?

A

Cardiac innervation is usually controlled by the right vagus nerve. Implantation on that side could result in severe dysrhythmias.

51
Q

Should glucose be administered to a patient in status epilepticus before a glucose level is determined?

A

No. Hyperglycemia could potentially exacerbate brain injury in an instance such as this.

52
Q

Name two considerations in the management of anesthesia in patients taking antiepileptic drugs.

A
  1. Antiepileptic drugs that cause enzyme induction can alter the pharmacodynamics and pharmacokinetics of anesthesia drugs and 2. There can be an additive effect between anesthetic drugs and antiepileptic drugs that produces excess sedation.
53
Q

What is the formula for cerebral perfusion pressure (CPP)?

A

CPP = MAP - ICP (or CVP if it’s higher than ICP)

54
Q 
Which of the following agents does not decrease CSF production?
DES
Acetazolamide
Corticosteroids
Furosemide
A

DES can increase CSF production.

55
Q 
Which of the following will decrease CSF production?
Etomoidate
Isoflurane 
Fentanyl
Meperidine
A

Etomidate
ISO - increases absorption
DES increases secretion
Fentanyl increases absorption

56
Q 
What is the normal tissue PO2 in the brain?
10-15 mmHg
20-25 mmHg
35-40 mmHg
70-90 mmHg
A

35-40 mmHg

57
Q 
Intracranial hypertension is defined as a sustained increased in intracranial pressure above:
A. 6-8 mmHg
	B. 10-15 mmHg
	C. 20-25 mmHg
	D. 35-40 mmHg
A

10-15 mmHg

58
Q 
Methods to decrease the intracranial pressure should be employed when there is a sustained increase in pressure to at least
10 cm H2O
10 mmHg
20 cm H2O
20 mmHg
A

20 mmHg

59
Q

at is the term for a seizure that continues for 30 minutes or more?

A

Status epilepticus

60
Q 
Wich of the following will decrease intracranial pressure?
Dexmedetomidine
Hyperventilation
Droperidol
Midazolam
A

Hyperventilation

61
Q 
In adults, how many milliliters of cerebrospinal fluid are produced each day?
20-30
100-200
300-400
500-750
A

In adults, about 21 ml/hour of CSF is produced by the choroid plexus of the cerebral ventricles every day. This will average around 500 mL a day.

62
Q 
Which of the following interventions will not help decrease intracranial pressure?
Ventriculostomy
Hypoventilation
Administration of mannitol
30 degree head-up position
A

Hypoventilation

63
Q 
Under normal conditions, the mechanism of autoregulation maintains constant cerebral blood flow over a range of mean arterial pressures from \_\_\_\_\_ to \_\_\_\_\_ mm Hg.
	A. 30-80
	B. 40-100
	C. 60-140
	D. 70-120
A

60-140

64
Q

RR: 24; ICP: 29 Calculate your answer in mm Hg to the nearest whole number.

A

98 mmHg

65
Q 
Which type of seizure is characterized by a sudden and brief loss of consciousness and postural tone?
A. Grand mal
	B. Petit mal
	C. Akinetic
	D. Status epilepticus
A

Akinetic

66
Q

Cerebrospinal fluid normally flows from the lateral ventricles to the third ventricle via the:

A

Foramen of Monroe

67
Q

Where is cerebrospinal fluid produced?

A

Choroid plexus

68
Q

Which meningeal layer is thin and is in direct contact with the outer surface of the spinal cord?

A

Pia mater

69
Q 
Which of the following values most accurately represents the normal average total cerebral blood flow?
A. 10% of cardiac output
	B. 50 mL/100g/min
	C. 1500 mL/min
	D. 20 mL/100g/min
A

50 mL/100g/min

70
Q

What is the approximate CSF volume (in mL)?

A

150 mL

71
Q

Which of the following statements regarding respiratory gas tension and cerebral blood flow (CBF) is true?
A. CBF decreases in response to hypocapnia
B. CBF is not related to carbon dioxide tension
C. CBF is directly proportional to PaO2 between tensions of 50 and 100 mmHg
D. PaO2 tension has no effect on CBF

A

CBF decreases in response to hypocapnia

72
Q 
A patient has been diagnosed with an ischemic stroke.  Which agent should be avoided in the care of this patient?
A. Glucose
	B. Labetolol
	C. Tissue plasminogen activator
	D. Heparin
A

Glucose

73
Q

Which of the following statements regarding cerebrospinal fluid is TRUE?
A. Total CSF volume is about 250 mL
B. CSF is produced by the cerebromedullary cistern
C. CSF is absorbed by arachnoid tissue over the cerebral hemispheres
D. CSF is produced at a rate of 120 cc/hour

A

CSF is absorbed by arachnoid tissue over the cerebral hemispheres

74
Q

Per hour how much CSF if produced?

A

21 mL/hr

75
Q

Which of the following statements regarding the formation of cerebrospinal fluid (CSF) is true?
. CSF passes into the fourth ventricle via the foramen of Monro
B. CSF is formed primarily by the choroid plexuses in the cerebromedullary cistern
C. Normal CSF production is about 50 mL a day
D. The total volume of CSF at any given time is about 140-150 mL

A

The total volume of CSF at any given time is about 140-150 mL

76
Q 
You are preparing to induce a patient with uncorrected hydrocephalus for placement of a ventriculoperitoneal shunt.  Which of the following agents would be least appropriate for this patient?
A. Spironolactone
	B. Isoflurane
	C. Desflurane
	D. Acetazolamide
A

DES

77
Q 
Select two factors that may increase the specific gravity of CSF.
	A. Hyperglycemia
	B. Uremia
	C. Hypoglycemia
	D. Jaundice
A

Hyperglycemia and uremia

78
Q

Which of the following represents a primary aim of the treatment of Parkinson’s disease?
A. Increasing the amount of dopamine in the basal ganglia
B. Increasing the neuronal effects of acetylcholine
C. Increasing the amount of serotonin in the neuronal synapse
D. Preventing systemic hypertension

A

Increasing the amount of dopamine in the basal ganglia

79
Q 
Which of the following will decrease intracranial pressure?
A. Dexmedetomidine
	B. Hyperventilation
	C. Droperidol
	D. Midazolam
A

Hyperventilation

80
Q

Parkinson’s disease is associated with
A. A decrease in dopamine levels in the basal ganglia
B. A decrease in dopamine levels in the cerebellum
C. An increase in dopamine levels in the basal ganglia
D. An increase in dopamine levels in the cerebellum

A

decrease in dopamine levels in the basal ganglia

81
Q 
What is the primary area for relay of afferent chemoreceptor and baroreceptor information from the vagus and glossopharyngeal nerves?
A. Pons
	B. Hypothalamus
	C. Nucleus tractus solitarius
	D. White ramus
A

Nucleus tractus solitarius

82
Q

APEX
Select the true statements regarding cerebral blood flow. (select 2).
Maximal cerebral vasoconstriction occurs when PaCO2 is 25 mmHg
The pH of the CSF around the arterioles controls the cerebral vascular resistance
A 1mmHg increase in PaCO2 increases CBF by 3-4mL/100g/min
Respiratory alkalosis increases CBF

A

Maximal cerebral vasoconstriction occurs when PaCO2 is 25 mmHg
The pH of the CSF around the arterioles controls the cerebral vascular resistance

83
Q

A Patient has a mAP of 95 mmHg, ICP of 15 mmHG and a CVP of 20 mmHg. Calculate the CPP.

A

75

84
Q

CSF is reabsorbed into the venous circulation via the:

A

Arachnoid villi

85
Q 
Order the flow from the aorta to the circle of willis (1-4)
Basilar artery
Subclavian artery
Vertebral artery
Posterior cerebral artery
A

Subclavian
Vertebral
Basilar
Posterior cerebral

86
Q 
Which spinal tract is monitored by somatosensory evoked potentials?
Dorsal column
Spinothalmic
Corticospinal
Vestibulospinal
A

Dorsal column

87
Q 
Loss of somatosensory evoked potentials during spinal fusion is most likely due to interruption of the:
posterior spinal artery
artery of Adamkiewicz
anterior spinal artery
azygous artery
A

posterior spinal artery

88
Q 
Prolonged thoracic aortic cross clamp time most likely to result in loss of: (select 2)
Bowel control
movement
sensation
proprioception
A

Bowel control

movement

89
Q

List the name and function of the 4 lobes of the cerebral cortex

A

Frontal - contains the motor cortex
Parietal - contains somatic sensory cortex
Occipital - contains vision cortex
Temporal - contains auditory cortex and speech centers
wernicke’s area = understanding speed
broca’s area = motor control of speech

90
Q

What is the function of CSF, and where is it located?

A

Cushions the brain, provides buoyancy, and delivers optimal conditions for neurologic function. It is located in the: ventricles (laterals, third and fourth), cisterns around the brain, subarachnoid space in the brain and spinal cord

91
Q

What regions of the brain are not protected by the BBB?

A

chemoreceptor trigger zone, posterior pituitary gland, pineal gland, choroid plexus, and parts of the hypothalamus

92
Q

What is the normal volume and specific gravity of CSF?

A

Volume 150 mL

SG 1.002-1.009

93
Q

Describe production, circulation, and absorption of CSF

A

Production: ependymal cells of the chorioid plexus at a rate of 30 mL/hr
Circulation: Lateral ventricles - Monroe - 3rd ventricle - aqueduct of sylvius - 4th ventricle - lusaka and magendie
Reabsorption: venous circulation via arachnoid villi in the superior sagittal sinus

94
Q

?Formula for cerebral blood flow?

A

CBF = CPP/cerebral vascular resistance

95
Q

What is the normal value for CMRO2? What factors causes it to increase? To decrease?

A

3.0-3.8 mL/100g/min
Increase: hyperthermia, seizures, ketamine, N2O
Decrease: hypothermia, halogenated anesthetics, propofol, etomidate, barbiturates

96
Q

What is the formula for CPP? What is normal?

A

CPP = MAP - ICP (or CVP whichever is higher)

50-150 mmHg

97
Q

What is the relationship between PaCO2 and CBF?

A

Linear

98
Q

What is the relationship between CMRO2 and CBF?

A

As a general rule things that increase the amount of O2 the brain uses tend to cause cerebral vasodilation

99
Q

What is normal ICP? What values are considered abnormal?

A

Normal is 5-15 mmHg

Cerebral hypertension ICP > 20 mmHg

100
Q

How does hyperventilation affect CBF?

A

Hyperventilation constricts the cerebral vessels, increases cerebral vascular resistance, decreasing CBF and decreasing ICP

101
Q

Describe the anterior and posterior circulation of the brain. Where do these pathways converge?

A

Anterior: aorta - internal carotids - circle of willis - cerebral hemispheres
Posterior: aorta - subclavian - vertebral a. - basilar a. - posterior fossa and cervical spinal cord.
Converge at the circle of willis

102
Q

What is the primary function of the circle of willis

A

to provide redundancy of blood flow to the brain

103
Q

What is the relationship between hyperglycemia and cerebral hypoxia?

A

During cerebral hypoxia, glucose is converted to lactic acid. Cerebral acidosis destroys brain tissue and is associated with worse outcomes.

104
Q

Describe the pathophysiology of Parkinson’s disease

A

The dopaminergic neurons in the basal ganglia are destroyed

105
Q

What arteries perfuse the spinal cord

A

1 anterior spinal artery
2 posterior spinal arteries
6-8 radicular arteries

106
Q

How much of the spinal cord is perfused by the anterior spinal artery?

A

2/3

107
Q

How much of the spinal cord is perfused by the posterior spinal arteries?

A

1/3

108
Q

What is the most important radicular artery? Which spinal segment does it typically enter the spinal cord?

A

Artery of Adamkiewicz

Most commonly originates between T11-T12

109
Q

What part of the spinal cord does the artery of Adamkiewicz supply?

A

Along with the anterior spinal artery, it supplies the anterior cord in the thoracolumbar region

110
Q 
Anesthesia Hub:
The EEG begins to flatten during carotid endarterectomy when regional cerebral blood flow (in ml/min/100 g brain) decreases to
(A) 55
(B) 45
(C) 30
(D) 20
(E) 10
A

20 mL/100g/min

111
Q 
The most important factor regulating blood flow to ischemic cerebral tissue is
(A) systolic blood pressure
(B) PaO2
(C) cerebral perfusion pressure
(D) PaCO2
(E) cerebral oxygen consumption
A

CPP

112
Q 
Which of the following drugs increases cerebral blood flow while decreasing cerebral metabolic rate?
(A) Etomidate
(B) Fentanyl
(C) Isoflurane
(D) Lidocaine
(E) Midazolam
A

Isoflurane

113
Q 
Cerebral blood flow is decreased by
(A) chronic respiratory acidosis
(B) hypoxia
(C) hypoglycemia
(D) polycythemia
(E) the postictal state
A

polycythemia

114
Q

Which of the following would be most likely to increase the duration of seizures during electroconvulsive therapy using a barbiturate and succinyleholine for general anesthesia?
A) Administration of atropine prior to therapy
(B) Changing to a benzodiazepine for induction
(C) Changing to etomidate for induction
(D) Adding phenytoin to preoperative medications
(E) Decreasing the dose of barbiturate used for induction

A

Decreasing the dose of barbiturate used for induction

115
Q

Brain stem auditory evoked potentials are most likely to be absent during which of the following?
(A) Anesthesia with 1.5 MAC isoflurane
(B) Barbiturate coma
(C) Hypotension to a mean arterial pressure of 50 mmHg
(D) Surgical retraction of the temporal lobe
(E) Surgical traction on the pons

A

Surgical traction on the pons

116
Q

Which of the following best explains the decreased effect of hyperventilation on cerebral blood flow when PaCO2 decreases below 20 mmHg?

(A) Maximal constriction of cerebral vessels
(B) Decreased cerebral perfusion pressure
(C) Decreased cerebral metabolic rate for oxygen
(D) Increased cardiac output
(E) Increased cerebrospinal fluid pressure

A

Maximal constriction of cerebral vessels

117
Q

Which of the following best reflects findings of inadequate cerebral perfusion during carotid cross clamping?

(A) Decreased frequency on EEG
(B) Increased latency of brain stem auditory evoked potentials
(C) Increased spectral edge frequency
(D) Jugular bulb oxygen tension of 27 mmHg
(E) Stump pressure of 50 mmHg

A

Decreased frequency on EEG

118
Q

Which of the following statements concerning brain stem auditory evoked responses is true?

(A) They monitor cortical function
(B) They are not affected by changes in PaCO2
(C) They are not affected by mild hypothermia (34°C)
(D) They are more resistant to anesthetic effects than somatosensory evoked responses
(E) They are abolished coincident with flattening of the EEG

A

They are more resistant to anesthetic effects than somatosensory evoked responses

119
Q

Each of the following statements about the blood supply of the spinal cord is true EXCEPT:

(A) The anterior spinal artery is made up of branches from the vertebral, intercostal, and iliac arteries
(B) The segmental blood supply of the cord depends upon the location of the arteria radicularis magna (Adamkiewicz)
(C) The posterior spinal arteries supply most of the spinal cord
(D) Obstruction of the inferior vena cava increases blood flow through the epidural venous plexus
(E) The spinal cord is supplied by one anterior spinal artery and two posterior spinal arteries

A

The posterior spinal arteries supply most of the spinal cord

Neuro Test 2 (4 decks)

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