Board Review 8 Page-2

Front 1

S/S of tension pneumothorax:

Back 1

Hypotension
Hypoxemia
Tachycardia
↑ CVP
↑ PIP
Absence of unilateral breath sounds
Tracheal shift
Asymmetric chest wall movement

Front 2

Differences in Neonatal Respiratory System:

Back 2

↓ Lung compliance
↑ Chest wall compliance
↓ FRC ≈ 30 ml/kg

Front 3

Complications of Transtracheal Jet Ventilation:

Back 3

1. Barotrauma & pneumothorax

2. Sub Q emphysema

3. Mediastinal air (emphysema)

4. Exhalation difficulty

5. Arterial perforation

6. Esophageal puncture

7. Damage to tracheal mucosa

Front 4

Cranial nerves

Back 4

oh oh oh, to touch and feel vaginas gives Vic a hard-on

oh: Olfactory
oh: Optic
oh: oculomotor
to: trochlear
touch: trigminal
and: abducens
vaginas: vestibulocochlear
gives: glossopharyngeal
Vic: vagus
A: (Accessory)
Hard-on: Hypoglossal

Front 5

I Olfactory

Back 5

Smell

Front 6

II Optic

Back 6

Vision

Front 7

III Occulomotor

Back 7

Adduction of eye (medial re), pupil size

Front 8

IV Trochlear

Back 8

Eye movements

Front 9

V Trigeminal

Back 9

Chewing, mastication, Facial sensory

Front 10

VI Abducens

Back 10

Abduction of eye (lateral rectus)

Front 11

VII Facial

Back 11

Facial muscles, taste (anterior 1/3 tongu

Front 12

VIII Acoustic

Back 12

Balance (vestibular), hearing (cochlear)

Front 13

IX Glossopharyngeal

Back 13

Taste (posterior 1/3), carotid & sinus af

Front 14

X Vagus

Back 14

Parasympathetic efferents, ↓ HR

Front 15

XI Spinal Accessory

Back 15

Motor control of larynx & pharynx

Front 16

XII Hypoglossal

Back 16

Tongue muscles

Front 17

Intracranial Transmural Pressure =

Back 17

MAP-ICP

Front 18

ICP:
Normal =

Back 18

5-15 mm Hg

Front 19

IC Volume:

-Brain matter & intracellular
-H2O
-Blood
-CSF

Back 19

Brain matter & Intracellular H2O = 80%

Blood 12%

CSF = 8%

Front 20

Cranial Fossae:

Anterior =
Middle =
Posterior =

Back 20

Anterior = Frontal lobe
Middle = Temporal lobe
Posterior = Brainstem & cerebellum

Front 21

Twelve S/S of ↑ ICP:

Back 21

1. Headache
2. N & V
3. Blurred vision
4. Unilateral pupil dilation
5. Papilledema
6. Cranial nerve III (oculomotor) paralysis, ∅ adduct
7. Cranial nerve VI (abducens) paralysis, ∅ abduct
8. HTN
9. Bradycardia
10. Irregular respirations
11. Altered LOC
12. Seizures

Front 22

Cushing's Triad

Back 22

HTN, Bradycardia, Irregular respirations

Front 23

Treatment of ↑ ICP:

Back 23

1. Dehydrate the brain with Mannitol or Lasix
2. Give steroids
3. Hyperventilate to PaCO2 25-30 mm Hg (1/2 life 6 hours)
4. Restrict fluids
5. Elevate HOB to 300
6. Administer cerebral vasoconstrictor (pentathol, etomidate)
7. Control BP
8. Cool pt to 340 C for cerebral protection

Front 24

Specific gravity of CSF =

Back 24

1.003-1.009

Front 25

CSF forms @ __ ml/hr or _____ml/day in the choroid plexus of brain

Back 25

21 ml/hr

500 ml/day

Front 26

Where is the Choroid plexus located?

Back 26

Choroid plexus is located specifically in temporal horn of each lateral ventricle, the posterior portion of the third ventricle, and the roof of the fourth ventricle.

Front 27

CSF is reabsorbed mostly in the

Back 27

CSF is reabsorbed mostly in the arachnoid villi (4/5), but also in spinal villi & lymphatics.

Front 28

Total volume of CSF

Back 28

Total volume of CSF = 150 ml

Front 29

the most common site of CSF obstruction

Back 29

Aqueduct of Sylvius

Front 30

Four factors governing passage across BBB:

Back 30

Size
Charge
Lipid solubility
Degree of protein binding
The Chemoreceptor trigger zone (CRTZ) and the area surrounding the posterior pituitary have no BBB.

Front 31

Four electrolyte disorders that ↓ Seizure threshold:

Back 31

1. Hypocalcemia
2. Hypomagnesemia
3. Hyponatremia
4. Hypernatremia
Demerol is the opiod most likely to cause seizures

Front 32

Acute Spinal Shock:

Hypotension occurs due to?

bradycardia due to?

Back 32

Hypotension occurs due to sympathetic blockade

bradycardia due to blockade of cardiac accelerators.

Front 33

Triple H Therapy:

For treatment of

Back 33

For treatment of cerebral vasospasm
-Hypervolemia = CVP > 10 mm Hg, PCWP = 12-20
-Hypertension = SBP 160-200 mm Hg
-Hemodilution = Hct 33%

Front 34

Occulocardiac Reflex:


Afferent pathway =

Efferent pathway =

Back 34

Afferent pathway = Trigeminal nerve

Efferent pathway = Vagus nerve

Front 35

Wake-up test monitors the?

Back 35

monitors the anterior (ventral) spinal cord, which is supplied by the anterior spinal arteries. These are motor tracts.

Front 36

Complications of wake-up test:

Back 36

1. Recall
2. Extubation
3. Dislodgement of spinal instrumentation
4. VAE from spontaneous ventilation

Front 37

Estimated Blood Volume:

Premie =

Infant =

Toddler =

Child =

Men =

Women=

Back 37

Premie = 90 ml/kg
Infant = 80
Toddler = 75
Child = 72
Men = 70
Women = 65

Front 38

Total Body Water (TBW)

Adult =

Neonate =

Premie =

Back 38

Adult = 60%

Neonate = 80%

Premie = 90%

Front 39

CPP =

Back 39

MAP-ICP or MAP-RAP

Front 40

In Parkinson’s avoid:

Back 40

Reglan

Compazine

Droperidol

Front 41

Hyperventilation

Back 41

↓ K+
↓ Ca++

Front 42

Describe the flow of CSF:

Back 42

Choroid Plexus - Lateral Ventricle - Foramen Monroe - 3rd Ventricle - Aqueduct of Sylvius - 4th Ventricle - Foramen luschka and Foramen Magendie - subarachnoid space - Brain - Arachnoid Villi

Front 43

What blood vessels make up the Circle of Willis?

Back 43

R/L Internal Carotid

Basilar & Vertebral Arteries

Front 44

Spinal Cord:

Sensory =

Motor =

Preganglionic SNS

Back 44

Sensory – Afferent – Dorsal Horn ‘sad’

Motor – Efferent – Ventral Horn ‘motor VehiclE’

Preganglionic SNS – Intermediolateral Horn

Front 45

Dorsal-Lemniscal (Sensory):

SSEP Monitoring?

Back 45

(posterior spinal arteries)•

Touch, pressure, vibration= propioception

•Dorsal (posterior) cord – Cuneatus & Gracilis tracts

•Ascend ipsilateral side

•Decussate @ brainstem to contralateral thalamus & sensory cortex/ direct route

•Also goes to RAS where it percolates to sensory cortex
Reticular activating system/ indirect route

Front 46

Ascending Pain (Anterolateral):

Back 46

Lateral Spinothalamic Tract

Front 47

Ascending Pain (Anterolateral):

A-δ Fibers –

Back 47

Myelinated, Fast “first” Pain & temp

Rexed’s lamina I & V, dorsal horn

Neurotransmitter - glutamate

Front 48

Ascending Pain (Anterolateral):

C Fibers –

Back 48

Unmyelinated, Slow “dull” Pain & temp

Rexed’s lamina II (substantia gelatinosa) & III, dors

Neurotransmitter – substance P

Interneurons go from II & III to V

Front 49

Ascending Pain (Anterolateral):


Both fibers ascend or descend in the tract of Lissauer 1-3 segmnt

Both fibers decussate and ascend on the contralateral side.

Back 49

..

Front 50

Descending Pain (Dorsolateral):

Dorsolateral Funiculus –

Back 50

modulates pain

(spinal analgesia)

Originate in the periventricular and periaqueductal gray areas and terminate on enkephalin-releasing interneurons in Rexed’s lamina II (substantia gelatinosa). This inhibits the release of substance P. (Presynaptic inhibition)

Front 51

Pain categories:

Nociceptive:

Neuropathic:

Back 51

Nociceptive: (physiologic, carried by A-delta & C fibers)

Somatic-sharp & well localized
Visceral-diffuse, dull & vague

Neuropathic:
Caused by abnormal processing of painful stimuli. Neuropathic pain may occur after injury to neural tissue secondary to systemic disease, infection, trauma, ischemia, deficiencies in metabolism or nutrition, or exposure to environmental toxins or neurotoxin medications.

Front 52

Five factors that alter the latency and/or amplitude of SSEP:

Back 52

1. ↓ Cerebral perfusion 20 hypotension, ↓ PaCO2, ↑ ICP
2. Cerebral hypoxia
3. Hypothermia
4. Hyperthermia
5. Hemodilution; Hct < 15%

Front 53

Preganglionic Parasympathetic Nerves originate:

Back 53

Cranial nerves III, VII, IX, & X
Sacral segments S2-S4

Myocyte = muscle cell

Front 54

Weak Acids:

Back 54

Weak Acids: (Thiopental, other barbit, [+ Charge/ Na+, Mg++],

Proton Donor

Acid + Acid = unionized

Front 55

Weak Base:

Back 55

Weak Base: (LA, ketamine, opiods, benzos) [- Charge/ Cl-, SO4-]

Proton Acceptor

Base + Base = unionized

Front 56

Local Anesthesia:

Potency =

Duration =

Speed of Onset=

Back 56

Potency = lipid solubility

Duration = protein binding
& solubility

Speed of Onset = pKa

Front 57

What is the "Order" in which local anesthetics block the different nerves

"Tammy is carrying pickled eggs, beer, summer sausage"

Back 57

Tammy = Tracheal
Is = Intercostal
Carrying = Caudal
Pickled = Paracervical
Eggs= Epidural
Beer = Brachial Plexus
Summer = Spinal
Sausage = Subcutaneous