Unit 7 - Neuro Flashcards
(160 cards)
1
Q
What is the primary role of neurons?
A
To receive and send information
2
Q
What constitutes grey matter in the CNS?
A
Cell bodies
3
Q
What constitutes white matter in the CNS?
A
Axons
4
Q
List the three types of neurons.
A
- Multipolar
- Pseudounipolar
- Bipolar
5
Q
What is the role of glial cells?
A
Support neuronal function by creating a healthy ionic environment, modulating nerve conduction, controlling reuptake of neurotransmitters, and repairing neurons following injury
6
Q
What connects the cerebral hemispheres?
A
The corpus callosum
7
Q
How many lobes are each cerebral hemisphere divided into?
A
Four
8
Q
What is the function of the frontal lobe?
A
Motor cortex
9
Q
What is the function of the parietal lobe?
A
Somatic sensory cortex
10
Q
What is the function of the occipital lobe?
A
Vision cortex
11
Q
What is the function of the temporal lobe?
A
Auditory cortex and speech centers
12
Q
What is the role of the hippocampus?
A
Memory and learning
13
Q
What does the amygdala respond to?
A
Emotion, appetite, pain, and stressors
14
Q
What is the function of the basal ganglia?
A
Fine control of movement
15
Q
What does the thalamus do?
A
Acts as a relay station that directs information to various cortical structures
16
Q
What is the primary neurohumoral organ?
A
Hypothalamus
17
Q
What are the functions of the midbrain?
A
Auditory and visual tracts
18
Q
What does the pons integrate?
A
Autonomic functions
19
Q
What does the Reticular Activating System control?
A
Consciousness, arousal, and sleep
20
Q
List the three parts of the cerebellum.
A
- Archicerebellum (Equilibrium)
- Paleocerebellum (Muscle tone)
- Neocerebellum (Voluntary muscle movement)
21
Q
What mnemonic helps remember cranial nerves?
A
On Occasion Our Trusty Truck Acts Funny Very Good Vehicle Any How
22
Q
What is the mnemonic for cranial nerve functions?
A
Some Say Marry Money But My Brother Says Bad Business to Marry Money
23
Q
What is Bell’s Palsy associated with?
A
CN 7 injury
24
Q
What cranial nerves are responsible for parasympathetic output?
A
- CN 3
- CN 7
- CN 9
- CN 10
25
What is the primary role of the vagus nerve?
Responsible for 75% of all parasympathetic activity
26
What is the role of cerebrospinal fluid (CSF)?
Cushions the brain, provides buoyancy, and delivers optimal conditions
27
Where is CSF located?
In the ventricles, cisterns, and subarachnoid space
28
What separates the CSF from the plasma?
Blood-brain barrier
29
What are tight junctions in the blood-brain barrier responsible for?
Restricting the passage of large molecules and ions
30
What is the normal volume of CSF?
~150 mL
31
What is the pressure range for normal CSF?
5-15 mmHg
32
How is CSF produced?
By ependymal cells of the choroid plexus at 30 mL/hr
33
What are the sites of CSF production and reabsorption?
* Site of production: Choroid plexus
* Site of reabsorption: Arachnoid villi in the superior sagittal sinus
34
What is hydrocephalus?
A condition involving obstruction to CSF flow or decreased absorption
35
What is the Monro-Kellie Hypothesis?
Pressure equilibrium between brain, blood, and CSF
36
What are the signs of increased intracranial pressure (ICP)?
* Headache
* Nausea/Vomiting
* Papilledema
* Pupil dilation
* Focal neurological deficit
* Seizure
* Coma
37
What is Cushing’s Triad?
* Hypertension
* Bradycardia
* Irregular respirations
38
What is a common site of transtentorial herniation?
At the temporal uncus
39
What is the gold standard for ICP measurement?
Intraventricular catheter
40
What is the effect of hyperventilation on CBF?
Causes vessels to constrict and decrease CBF
41
What are the major causes of morbidity in patients with subarachnoid hemorrhage (SAH)?
* Obstructive hydrocephalus
* Rebleeding
* Vasospasm
42
What is the primary cause of subarachnoid bleeding?
Aneurysm rupture
43
What is the most common sign of SAH?
An intense headache described as the 'worst headache of my life'
44
What is the treatment for cerebral salt-wasting syndrome?
Isotonic crystalloids
45
What should be avoided in the treatment of traumatic brain injury?
Corticosteroids
46
What is the function of the Circle of Willis?
Provide redundancy of blood flow to the brain
47
What is the main risk factor for ischemic stroke?
Hypertension
48
What is the time frame for administering tPA in ischemic stroke?
Within 4.5 hours of symptom onset
49
What is the role of elevated blood pressure in stroke management?
Supports CPP and cerebral oxygenation
50
What is the primary treatment for cerebral edema?
Diuretics
51
What is the result of increased transmural pressure in aneurysms?
Predisposes the aneurysm to rupture
52
What should intra-op SBP be maintained at during aneurysm clipping or coiling?
Between 120-150 mmHg
53
What are the signs of cerebral vasospasm?
New neurologic deficit or altered level of consciousness
54
What is the primary treatment for hypervolemia?
Fluid restriction
## Footnote
Hypervolemia is a condition characterized by an excess of fluid in the body.
55
What initial considerations should be taken for traumatic brain injury?
Stabilization of the cervical spine, airway protection, optimization of hemodynamics, cerebral protection
## Footnote
These considerations are crucial for managing head trauma effectively.
56
When is a head CT not needed in cases of head trauma?
No physical evidence of trauma above the clavicles, no headache, no N/V, no neurologic deficit, no impairment of short-term memory, no intoxication, no seizures, age < 60
## Footnote
N/V refers to nausea and vomiting.
57
What does the Glasgow Coma Scale assess?
Level of consciousness in a person
## Footnote
It evaluates eye, verbal, and motor responses.
58
What is a primary priority in managing traumatic brain injury?
Ensure ABCs (Airway, Breathing, Circulation)
## Footnote
This is critical for patient survival.
59
How can warfarin be reversed?
FFP, prothrombin complex concentrate, recombinant factor 7a
## Footnote
FFP stands for Fresh Frozen Plasma.
60
What is the target cerebral perfusion pressure (CPP) for anesthetic management?
CPP > 70 mmHg
## Footnote
This value is crucial for maintaining adequate cerebral blood flow.
61
Which solutions are avoided in cases of traumatic brain injury and why?
Hypotonic solutions; they increase cerebral edema
## Footnote
Cerebral edema can exacerbate brain injury.
62
What type of seizures is characterized by activity localized to a particular cortical region?
Partial seizures
## Footnote
These can progress to generalized seizures.
63
What are the key findings in Alzheimer's disease?
Development of beta-amyloid plaques and neurofibrillary tangles
## Footnote
These findings contribute to synaptic dysfunction and apoptosis.
64
What is the most common cause of dementia in patients 65 years and older?
Alzheimer's disease
## Footnote
It is a chronic degenerative condition of the CNS.
65
What is the primary treatment for Alzheimer's disease?
Restoring acetylcholine levels with drugs like Tacrine, Donepezil, Rivastigmine, Galantamine
## Footnote
These medications are palliative.
66
What are the cardinal signs of Parkinson’s disease?
Pill rolling, skeletal muscle rigidity, postural instability, bradykinesia
## Footnote
Diagnosis requires at least 2 of these signs.
67
What is the classic presentation of Beck's syndrome?
Flaccid paralysis of the lower extremities, bowel and bladder dysfunction, loss of temperature and pain sensation
## Footnote
This occurs due to anterior spinal artery syndrome.
68
What does the dorsal column-medial lemniscal system transmit?
Fine touch, proprioception, vibration, and pressure
## Footnote
It consists of large myelinated fibers.
69
What is the role of the anterior spinal artery?
Perfuses the anterior 2/3 of the spinal cord
## Footnote
It plays a critical role in supplying blood to motor pathways.
70
What is the main function of the corticospinal tract?
Voluntary fine motor control to the limbs and coordination of posture
## Footnote
It is also known as the pyramidal tract.
71
What characterizes neurogenic shock?
Hypotension, bradycardia, hypothermia with pink, warm extremities
## Footnote
This occurs due to sympathetic disruption below the injury level.
72
What is the significance of the Babinski sign?
Assesses the integrity of the corticospinal tract
## Footnote
A positive test indicates damage to the corticospinal tract.
73
What are common events that can cause autonomic hyperreflexia?
Stimulation of hollow organs, catheterization, surgery, bowel movement, cutaneous stimulation, childbirth
## Footnote
These trigger sympathetic reflex arcs leading to hypertension.
74
What is the effect of levodopa and carbidopa in Parkinson's treatment?
Increases dopamine levels in the CNS
## Footnote
Carbidopa prevents levodopa metabolism in the blood.
75
What is the most common cause of postoperative visual loss?
Ischemic optic neuropathy
## Footnote
It results from ischemia to the optic nerve.
76
What is the consequence of using nitrous oxide in patients with seizure disorders?
It should not be used
## Footnote
Nitrous oxide can increase the risk of seizures.
77
What can be a consequence of anterior spinal artery syndrome?
Loss of motor function below the injury level
## Footnote
Sensory function may be preserved due to posterior column involvement.
78
What is the function of the spinothalamic tract?
Transmits pain, temperature, crude touch, tickle, itch, and sexual sensation
## Footnote
It has slower conducting fibers compared to the dorsal column.
79
What events can cause autonomic hyperreflexia (AH)?
Stimulation of hollow organs, catheterization, surgery (cysto/colonoscopy), bowel movement, cutaneous stimulation, childbirth
## Footnote
These events can trigger autonomic hyperreflexia due to sympathetic reflex arcs in individuals with spinal cord injuries.
80
What are the key pathophysiological changes in autonomic hyperreflexia?
Hypertension and Bradycardia
## Footnote
These changes result from sympathetic reflex arcs triggered below the level of spinal cord injury.
81
What is the effect of spinal cord injury on vasoconstriction and vasodilation?
Profound vasoconstriction below the level of injury and vasodilation above the injury
## Footnote
This differential response can lead to symptoms such as nasal stuffiness due to reflex vasodilation.
82
What symptoms can hypertension cause in autonomic hyperreflexia?
Headache and blurred vision
## Footnote
These symptoms are common due to elevated blood pressure.
83
What are the potential complications of malignant hypertension?
Stroke, seizure, LV failure, dysrhythmias, pulmonary edema, and MI
## Footnote
Malignant hypertension can lead to severe cardiovascular events.
84
What is the best anesthetic management for autonomic hyperreflexia?
Prevent stimulation of affected areas, general or spinal anesthesia
## Footnote
This approach minimizes triggers for autonomic hyperreflexia during procedures.
85
What should be done to manage hypertension during anesthesia?
Remove stimulus, deepen anesthetic, rapid acting vasodilator (clevidipine, nifedipine, nitrates), hydralazine for persistent hypertension
## Footnote
Adding a positive chronotrope will worsen hypertension.
86
What is contraindicated in anesthetic management for autonomic hyperreflexia?
Succinylcholine
## Footnote
Succinylcholine can lead to severe complications in this context.
87
What is amyotrophic lateral sclerosis (ALS)?
A progressive degeneration of motor neurons in the corticospinal tract
## Footnote
The etiology of ALS is unknown, and it affects both upper and lower motor neurons.
88
What replaces the affected motor neurons in ALS?
Astrocytic gliosis
## Footnote
This process occurs as the disease progresses.
89
What are the signs and symptoms of upper motor neuron involvement in ALS?
Spasticity, hyperreflexia, and loss of coordination
## Footnote
These symptoms reflect the dysfunction of upper motor neurons.
90
What are the signs and symptoms of lower motor neuron involvement in ALS?
Muscle weakness, fasciculations, and atrophy
## Footnote
These symptoms indicate damage to lower motor neurons.
91
Where do symptoms of ALS often begin?
In the hands
## Footnote
This initial presentation can then spread to other parts of the body, including the tongue, pharynx, larynx, and chest.
92
What common cardiovascular issues are associated with ALS?
Orthostatic hypotension and resting tachycardia
## Footnote
These issues can complicate the clinical picture of ALS.
93
What is the most common cause of death in ALS?
Respiratory failure
## Footnote
This occurs due to weakness of respiratory muscles as the disease progresses.
94
What risk does succinylcholine pose in patients with ALS?
Lethal hyperkalemia
## Footnote
This occurs due to increased postjunctional receptors in ALS patients.
95
What increased sensitivity is observed in ALS patients regarding anesthesia?
Increased sensitivity to non-depolarizing blockers
## Footnote
This necessitates careful dosing and monitoring during procedures.
96
What complications arise from bulbar muscle dysfunction in ALS?
Increased risk of aspiration
## Footnote
This is due to difficulty in swallowing and protecting the airway.
97
What is a consideration for post-operative management in ALS patients?
Post-op mechanical ventilation
## Footnote
This may be necessary due to respiratory muscle weakness.
98
What is the pathophysiology of Myasthenia Gravis?
Autoimmune disease causing IgG antibodies to destroy POST-junctional, nicotinic, acetylcholine receptors
## Footnote
This leads to insufficient receptors to translate the extracellular signal into an intracellular response, resulting in skeletal muscle weakness.
99
What is a key feature of Myasthenia Gravis?
Skeletal muscle weakness that becomes worse throughout the day.
100
What surgical procedure can provide symptom relief in Myasthenia Gravis?
Thymectomy.
101
What are the earliest symptoms of Myasthenia Gravis?
Diplopia and ptosis.
102
What are some situations that can exacerbate Myasthenia Gravis symptoms?
* Pregnancy
* Infection
* Electrolyte abnormalities
* Surgical and psychological stress
* Aminoglycoside antibiotics
103
What is the first-line treatment for Myasthenia Gravis?
Oral Pyridostigmine.
104
What does the Tensilon test involve in Myasthenia Gravis?
Edrophonium (1-2 mg IV) is used; if weakness worsens, it indicates a cholinergic crisis; if it improves, it indicates a myasthenic crisis.
105
What is Eaton-Lambert Syndrome also known as?
Myasthenic Syndrome and Lambert-Eaton Myasthenic Syndrome (LEMS).
106
What is the pathophysiology of Eaton-Lambert Syndrome?
IgG-mediated destruction of presynaptic voltage-gated calcium channels at the PRE-synaptic nerve terminal.
107
How does Eaton-Lambert Syndrome affect muscle weakness throughout the day?
Weakness is generally worse in the morning and gets better throughout the day.
108
What is a common treatment for Eaton-Lambert Syndrome?
3, 4-diaminopyridine (DAP) increases Ach release from the presynaptic terminal.
109
What is the pathophysiology of Guillain-Barre Syndrome?
Immunologic assault on myelin in the peripheral nerves.
110
What typically precedes paralysis in Guillain-Barre Syndrome?
A flu-like illness usually precedes paralysis by 1-3 weeks.
111
What is the most common etiology for Guillain-Barre Syndrome?
Campylobacter jejuni bacteria.
112
What type of paralysis is characteristic of Guillain-Barre Syndrome?
Flaccid paralysis that begins in the distal extremities and ascends bilaterally.
113
What treatments are effective for Guillain-Barre Syndrome?
Plasmapheresis or IV IgG.
114
What is Familial Periodic Paralysis characterized by?
Acute episodes of skeletal muscle weakness accompanied by changes in serum potassium concentration.
115
What distinguishes hypokalemic periodic paralysis from hyperkalemic periodic paralysis in diagnosis?
* Hypokalemic: Weakness after glucose-insulin infusion.
* Hyperkalemic: Weakness after oral potassium administration.
116
What is the treatment for both forms of Familial Periodic Paralysis?
Acetazolamide.
117
What is Malignant Hyperthermia triggered by?
Halogenated anesthetics and depolarizing neuromuscular blockers.
118
What is the pathophysiology of Malignant Hyperthermia?
Defective ryanodine receptor releases too much calcium into the muscle cell, leading to rigidity and metabolic changes.
119
What are the consequences of increased intracellular calcium in myocytes during Malignant Hyperthermia?
* Rigidity from sustained contraction
* Accelerated metabolic rate and rapid depletion of ATP
* Increased oxygen consumption/CO2 and heat production
* Mixed respiratory and lactic acidosis
120
What is the most sensitive indicator of Malignant Hyperthermia?
EtCO2 that rises out of proportion to minute ventilation.
121
What is the gold standard for diagnosing Malignant Hyperthermia?
Caffeine-Halothane Contracture Test.
122
What is the treatment for Malignant Hyperthermia?
* Discontinue the triggering agent
* Administer Dantrolene
* Hyperventilate with 100% O2
* Cool the patient
* Correct lactic acidosis
* Treat hyperkalemia
123
What is the most common form of muscular dystrophy?
Duchenne Muscular Dystrophy (DMD).
124
What is the pathophysiology of Duchenne Muscular Dystrophy?
Absence of dystrophin protein, leading to destabilization of the sarcolemma during muscle contraction.
125
What are the cardiac implications of Duchenne Muscular Dystrophy?
* Degeneration of cardiac muscle
* Reduced contractility
* Mitral regurgitation
* Cardiomyopathy
126
What is scoliosis?
Lateral and rotational curvature of the spine and ribcage.
127
What does the Cobb Angle measure?
The magnitude of the spinal curvature.
128
What are some complications of the prone position in surgery?
* Upper airway edema
* Cerebral hypoperfusion
* Ischemic optic neuropathy
* Brachial plexus injury
* Pressure on iliac crest
129
What anesthetic considerations should be taken for scoliosis patients?
* Assess respiratory reserve
* Prepare for significant blood loss
* Monitor end-organ perfusion
130
What is the target mean arterial pressure (MAP) during deliberate hypotension?
60 mmHg
## Footnote
Risk of cerebral hypoperfusion and ischemic optic neuropathy
131
What should be monitored to assess end-organ perfusion?
Serial ABG and urine output
132
What is a risk associated with venous air embolism?
Increases dead space and is observed as a reduction in EtCO2
133
What does the Wake-Up Test entail?
Turning off anesthetic agents to assess patient responsiveness
134
What indicates a need to reduce distraction on spinal rods during the Wake-Up Test?
If the patient can move his hands but not his feet
135
List some risks associated with the Wake-Up Test.
* Pain
* Awareness
* Tracheal extubation
* Removal of lines
* Air embolism
* Surgical instrument damage
136
What do SSEPs monitor?
Sensory function
137
What do MEPs monitor, and what should not be used during this monitoring?
Motor function; DO NOT use neuromuscular blockers
138
Which joints are impacted in patients with rheumatoid arthritis concerning airway management?
* Temporomandibular Joint
* Cricoarytenoid Joints
* Cervical Spine
139
What is a common complication of rheumatoid arthritis?
Atlantoaxial subluxation
140
What indicates atlanto-occipital subluxation on a lateral X-ray of the C-spine?
Distance greater than 3mm between anterior arch of the atlas and odontoid process
141
What is the hallmark symptom of rheumatoid arthritis?
Morning stiffness that generally improves with activity
142
What laboratory tests are increased in rheumatoid arthritis?
* C-reactive protein
* Sedimentation rate
143
What is the goal of medical management for rheumatoid arthritis?
Reducing inflammation
144
Name some antirheumatic drugs used in the treatment of rheumatoid arthritis.
* Methotrexate
* Cyclosporine
* Etanercept
145
What is the primary characteristic of systemic lupus erythematosus (SLE)?
Proliferation of antinuclear antibodies
146
What are the common problems associated with SLE?
* Polyarthritis
* Dermatitis
147
What mnemonic helps remember exacerbation triggers for SLE?
PISSED CHIMP
148
List the triggers represented in the mnemonic PISSED CHIMP.
* Pregnancy
* Infection
* Surgery
* Stress
* Enalapril
* D-penicillamine
* Captopril
* Hydralazine
* Isoniazid
* Methyldopa
* Procainamide
149
What are some medical treatments for SLE?
* Corticosteroids
* NSAIDs
* Immunosuppressants
* Antimalarials
150
What is the primary complication of cricoarytenoid arthritis in SLE?
Hoarseness, stridor, and airway obstruction
151
What is the risk associated with antiphospholipid antibodies in SLE patients?
Hypercoagulability and thrombosis
152
What is the classic problem associated with Marfan Syndrome?
Dilated aortic root
153
What are the classic findings in patients with Marfan Syndrome?
* Tall stature
* Pectus excavatum
* Kyphoscoliosis
* Hyperflexible joints
154
What is a notable complication of Ehlers-Danlos Syndrome?
Spontaneous bleeding into joints and abdominal aortic aneurysm
155
What is the unique finding in Osteogenesis Imperfecta?
Blue sclera
156
What condition is characterized by prolonged contracture after a voluntary contraction?
Myotonic Dystrophy
157
What are some anesthetic considerations for Scleroderma?
* Limited mouth opening
* Pulmonary fibrosis
* Renal failure
158
What is CREST syndrome associated with?
Calcinosis, Raynaud’s, Esophageal hypomotility, Sclerodactyly, Telangiectasia
159
What causes Paget’s Disease?
Excess osteoblastic and osteoclastic activity
160
What are the most common problems associated with Paget’s Disease?
* Pain
* Fractures
