Neuro Exam 1 Intracranial Masses

Front 1

periodic increases in arterial blood pressure with reflex slowing of the heart rate, Bodies last ditch effort to perfuse the brain

Back 1

cushing response

Front 2

what are the three parts to cushinngs triad

Back 2

HTN, Bradycardia (due to vegas nerve), and irregular respiration (due to pressure on brainstem)

Front 3

This is an extension of the dura mater and separates the cerebellum from the cerebrum to support the occipital lobe

Back 3

tentorium cerebelli

Front 4

which is more common infratenntorial lesions or supratentorial lesions?

Back 4

supratentorial

Front 5

Decorticate rigidity, syncope, seizures, hemiplegia, aphasia, and ataxia are symptoms related to what type of lesions

Back 5

supratentorial

Front 6

schwannomas arise at what cranial nerve?

Back 6

8 also affects 5,7,8,9,10,11
(away reflexes)

Front 7

what is the most common mass-40% of all brain tumors

Back 7

glioblastoma

Front 8

What is the most common lesions in children?

Back 8

infratentorial lesions

Front 9

cerebellar dysfunction and brainstem compression leading to dysarthria, ataxia, altered LOC, cranial nerve palsies and decerebrate rigidity are symptoms of what type of lesion

Back 9

infratentorial lesions

Front 10

A patient with extended elbows and teethed clenched, arms and head back, knocked knees is showing what type of posturing

Back 10

decerebrate

Front 11

if your patient has elbows wrist and fingers flexed with knocked knees what type of posturing are they showing

Back 11

decorticate

Front 12

decorticate posturing shows dysfunction where and interruption of what tracts?

Back 12

supratentorial dysfunction with interruption of the corticospinal tracts

Front 13

disease caused by too much Growth Hormone

Back 13

acromegaly

Front 14

Caused by tumor in posterior pituitary

Back 14

DI, or SIADH

Front 15

neurohypophysis is also known as.....

Back 15

posterior pituitary

Front 16

rhythmic waxing and waning of both rate and depth of respirations followed by brief periods of apnea

Back 16

cheyne stokes

Front 17

if a patients breathing pattern is cheyne stokes in nature where is the lesion?

Back 17

infratentorial brainstem, pons

Front 18

anytime there are respiratory symptoms think...

Back 18

pons and medulla

Front 19

intracranial hypertension is defined as ICP>

Back 19

20

Front 20

you want to keep the PaCO2 in what range during neuro cases?

Back 20

25-35 after induction

Front 21

what drug increases ICP, CBF 50-60%, increases CVR, CSF volume, and seizure activity.

Back 21

ketamine

Front 22

what is the gold standard for neuro induction agents?

Back 22

thiopental

now propofol b/c no more thiopental

Front 23

what is a metabolite of meperidine that causes shivering

Back 23

normeperidine

Front 24

what is the best inhalation agent to use in neuro cases?

Back 24

iso

Front 25

would you give neuro patient NS or LR? IS albumin ok?

Back 25

NS. No albumin

avoid glucose containing solutions

Front 26

LR is ________

Back 26

hypoosmolar which will cause brain swelling...DO NOT USE IN NEURO

Front 27

________pressure rather an oncotic pressure of fluids is the determining factor in producing cerebral edema

Back 27

osmotic pressure

Front 28

if your patient has a meningioma it is important to monitor what?

Back 28

H&H because the tumors are highly vascular so lots of bleeding may occur

Front 29

in the sitting postion there is improved surgical exposure and access to face and airway, also allows for visibility of stimulation to what cranial nerve

Back 29

VII

Front 30

what is a major disadvantage of the sitting position?

Back 30

venous air embolism

Front 31

if your patient is lateral supine with extreme head turn what are you at risk for?

Back 31

clamping internal jugular

Front 32

where do you zero the aline if you are monitoring CPP

Back 32

base of skull at level of external auditory meatus

Front 33

this is caused by subatmospheric pressure in an opened vein that leads to air entrained into venous circulation

Back 33

venous air embolism

Front 34

VAE is most common in what position?

Back 34

sitting

Front 35

there is a ______% incidence of VAE when the head is higher than the heart

Back 35

20-60

Front 36

BP differences in different positions will be equal to ________________-between the organ in question and brain

Back 36

hydrostatic pressure difference

Front 37

when monitoring for a VAE what is the earliest detector and most noninvasive monitor?

Back 37

precordial doppler

Front 38

what are 5 ways to monitor for VAE

Back 38

precordial doppler, pa catheter capnography end tidal nitrogen and TEE

Front 39

what is the gold standard for monitoring for VAE

Back 39

TEE

Front 40

if a patient has a probe patent foramen ovale what can happen to the air that is entrained with a VAE

Back 40

it can easily pass into the arterial circulation

Front 41

what will you see on your ETCO2 monitor if there is a venous air embolism?

Back 41

sudden decrease in end tidal co2

Front 42

should you see nitrogen on your end tidal monitor?

Back 42

no, may be seen with venous air embolism

Front 43

what type of murmur will you hear in late manifestations of venous air embolism

Back 43

mill wheel murmur

Front 44

air entrainment of large amounts produce sudden circulatory arrest by obstruction what?

Back 44

right ventricular outflow

Front 45

what is the first thing you should do when you suspect a VAE

Back 45

notify the surgeon so he can flood the field with saline of pack the bone with bone wax

Front 46

Should you continue N2O use if VAE is suspected?

Back 46

no

Front 47

what change of position should be used in the case of suspected VAE>

Back 47

trendelenberg on L side

Front 48

passage of air into the arterial circulation

Back 48

paradoxical air embolism

Front 49

what is the lethal volume of air in an adult?

Back 49

200-300ml

Front 50

what changes may be seen on EKG with VAE

Back 50

large T wave

Front 51

linear skull fractures are commonly associated with what type of hematomas

Back 51

subdural or epidural hematomas

Front 52

what is associated with CSF rhinorrhea pneumocephalus craninal nerve palsies and even a cavernous sinus carotid artery fistula

Back 52

basilar skull fractures

Front 53

these types of skull fractures often present with an underlying brain contusion

Back 53

depressed skull fracture

Front 54

raccoon eyes or battles sign are signs of what type of skull fracture

Back 54

basilar skull fracture

Front 55

when a blow to the head is extremely severe it may not damage the brain on the side of the head where the blow is struck but on the opposite side. This phenomenon is known as

Back 55

couteroup

Front 56

what are examples of injuries that show coup and coutercoup effect

Back 56

shaken baby and vehicular accidents

Front 57

if you have a fixed and dilated pupil on the same side what CN has been effected?

Back 57

CNIII

Front 58

A patient who "talks and drops" probably is experiencing what kind of head bleed?

Back 58

epidural bleed very fast bleed peaks in 6-8 hours

Front 59

a barbituate coma is only useful in cases of what type of intracranial hypertension

Back 59

refractory

Front 60

what are the indications for an intracranial pressure monitor

Back 60

GCS 3-8 after resuscitation and an abnormal CT scan, or >40 motor posturing SBP<90

Front 61

you should avoid giving patients with suspected head trauma any premedication that will later their mental status or there ________

Back 61

neuro exam (i.e anticholinergic induced pupillary dilation)