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200 Cards in this Set
- Front
- Back
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Awake Craniotomy is done when (choose any that apply)
a) resection close to eloquent tissue b) brain tumor resection c) ictal foci resection (for epiliepsy) d) transphenoidal hypophysectomy |
resection close to eloquent tissue
brain tumor resection ictal foci resection (for epiliepsy) |
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Which of the following patients would you not want to do an awake crani on (choose all that apply)
a) very young b) ETOH abuse c) anxious d) difficult airway |
very young
ETOH abuse anxious difficult airway |
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Why would you not want to give versed to an awake crani? __________________________
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B/C don't want retrograde amnesia, you need them to remember all the instructions given to them so they can follow directions during sugery
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Cortical Stimulation is done to identify
a) sensory & motor areas b) foci responsible for seizures c) functional areas |
functional areas
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Cortical evoked potentials are done to identify
a) sensory & motor areas b) foci responsible for seizures c) functional areas |
sensory & motor areas
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EEG is done to identify
a) sensory & motor areas b) foci responsible for seizures c) functional areas |
foci responsible for seizures
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During Brain mapping your pt has a seizure what do you do?
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Treat with Barbs or Propofol 1mg/kg (of either)
secure airway if happens @ end of case you can use Versed or Dilantin |
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T/F Spontaneous breathing keeps the brain "slack"
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True
this is great for brain swelling |
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Partial seizures
a) focal onset in brain b) no focal onset c) simple /complex d) inhibitory/excitatory |
focal onset in brain
simple /complex simple → no spread/symptoms complex → spread / loss of consciousness |
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Generalized Seizures
a) focal onset in brain b) no focal onset c) simple /complex d) inhibitory/excitatory |
no focal onset
inhibitory/excitatory Inhibitory → petit mal (atonic) Excitatory → grand mal (tonic, clonic, myotonic) |
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Which type of seizure has motor activity but no EEG changes
a) partial b) generalized c) pseudoseizure |
pseudoseizure
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Which sedative hypnotics activate EEG seizures & myoclonic activity
a) Methohexital b) Etomidate c) Ketamine d) Propofol |
Methohexital
Etomidate Ketamine → doses > 4mg/kg |
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Which sedative hypnotics activates myoclonic activity only
a) Methohexital b) Etomidate c) Ketamine d) Propofol |
Propofol
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Which volatile anesthetics are seizure producers
a) Enflurane b) Sevoflurane c) Isoflurane d) Desflurane e) Halothane f) N2O alone g) N2O + Isoflurane |
Enflurane
Sevoflurane N2O + Isoflurane |
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BOARD ?
What volatile anesthetic is the #1 offender for causing seizures? |
Enflurane
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T/F Synthetic analgesics such as Alfentanil, Fentanyl, Sunfentanyl, & Remifentanil are all PRO-Eleptic
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True!
Alfentanil has the most pro-eleptic effect They are good for finding ictal cortex |
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What does long term anticonvulsant therapy with Phenytoin or Carbamazepine have on NDMRs?
TEST ? |
you will need to increase the dose of NDMR b/c of down regulation of receptors
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What drugs effect the metabolism of Carbamazepine?
a) E-mycin b) Cimetidine c) propofol d) versed |
E-mycin
Cimetidine |
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Phenytoin & Carbamazepine cause
a) ↑ liver enzymes b) ↓ liver enzymes c) have no effect on liver enzymes TEST ? |
↑ liver enzymes
(may also have resistance to Opioids) |
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Lamotrigine & Oxcarbazepine (antileptics)
a) depress hemopoietic system & cardiac toxicity b) cause thrombocytopenia c) cause platelet dysfunction d) potentiate CNS depressants e) cause non-ion gap Acidosis |
potentiate CNS depressants
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Carbamazepine
a) depress hemopoietic system & cardiac toxicity b) cause thrombocytopenia c) cause platelet dysfunction d) potentiate CNS depressants e) cause non-ion gap Acidosis |
depress hemopoietic system & cardiac toxicity
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Topriamate
a) depress hemopoietic system & cardiac toxicity b) cause thrombocytopenia c) cause platelet dysfunction d) potentiate CNS depressants e) cause non-ion gap Acidosis |
cause non-ion gap Acidosis
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Valproic Acid
a) depress hemopoietic system & cardiac toxicity b) cause thrombocytopenia c) cause platelet dysfunction d) potentiate CNS depressants e) cause non-ion gap Acidosis |
cause thrombocytopenia
cause platelet dysfunction Check plt & bleeding times |
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T/F Antihistamines activate seizure foci
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True
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Your pt has Von Recklinghausen's disease & is coming in for excision of an intracranial tumor, why would you be more concerned about airway issues in this patient?
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Because these patients also have respiratory tract tumors which can compromise airway
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Why would you not want to use Barbs or Benzos on a pt scheduled for resection of epileptogenic region?
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Because they interfere with EEG
they ↑ seizure threshold which means they won't have seizures & docs need to see foci |
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Which Volatile agent would you want to use in a patient who is having resection of epileptogenic region?
a) desflurane b) isoflurane c) sevoflurane d) N2O |
Sevoflurane
because it CAUSES seizures |
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T/F Resection of the hippocampus (amygdalahippocampectomy) may cause severe bradycardia
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True
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Cerebral Hemispherectomy
a) seizure foci are very diffuse b) usually kids c) ↑ Morbidity/Mortality |
seizure foci are very diffuse
usually kids (FLKs) ↑ Morbidity/Mortality ( ↑ blood loss, lyte/metab disturbances, coagulopathies, seizures, VAE, ↓ temp) |
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Vagal Nerve Stimulator placement is done for seizures refractory to medications which Volatile would you want to use?
a) sevoflurane b) isoflurane c) desflurane d) isoflurane + N2O |
isoflurane
desflurane b/c you DONT want seizures during the case!! |
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What side is the Vagal Nerve Stimulator placed on?
a) left b) right TEST ? |
LEFT mid-cervical neck
this ↓'s risk of Bradycardia |
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The left vagal nerve innervates
a) AV node b) SA node TEST ? |
AV node
"AVril Lavigne has LEFT the building" |
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The right vagal nerve innervates
a) AV node b) SA node TEST ? |
SA node
"Sarah is Always RIGHT" |
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Complications related to Vagal Nerve Stimulator placement
a) bradycardia b) N/V c) "constricted throat" sensation d) hoarseness |
bradycardia
N/V (30 - 50%) "constricted throat" sensation (r/t superior laryngeal irritation hoarseness d/t recurrent laryngeal irritation |
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Your pt is having a Transphenoidal Hypophysectomy which of the following co-morbs are commonly found in this type of patient
a) acromegaly b) cushing disease c) panhypopituitarism d) hypo / hyper thyroid |
acromegaly (AIRWAY lg tongue, epiglottis, turbinates)
cushing disease (↑ ACTH, muscle weakness, ↓ K = ↓ muscle relaxant dose) panhypopituitarism (thyroid/steroid replacement) hypo / hyper thyroid (CV effects, MAC & NDMR considerations) |
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T/F Sevoflurane & Desflurane desensitize heart to the effects of exogenous epinephrine
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True, good to remember during Transphenoidal Hypophysectomy b/c surgeon injects epinephrine to ↓ bleeding
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What is the glascow coma scale for the following assessment
pt opens eyes to pain, mumbles words, reaches for the area that you are causing pain in |
eyes: 2
verbal: 2 motor: 5 = 9 |
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Severe head injury is classified as a glascow coma scale of _____________________
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< or equal to 8
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Mild head injury is classified as a glascow coma scale of ___________________
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13 - 15
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T/F Traumatic Brain Injury is the #1 cause of disability / death in kids & adults
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True
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Traumatic Brain Injury most often happens in which population (choose all that apply)
a) adolescents b) young adults c) elderly d) males e) females f) toddlers |
adolescents
young adults elderly males |
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Leading causes of Traumatic Brain Injury
a) falls b) MVAs c) assaults d) blasts among military personel |
falls
MVAs assaults blasts among military personel |
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Your TBI pts ICP is normal, are the following medications /treatments appropriate for him?
a) Steroids b) hyperventilation c) prophylactic anti-convulsants |
NO!
keep PaCO2 > 25 mmHg prophylactic anti-convulsants do NOT prevent seizures |
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T/F ICP monitoring should be done on anyone with a GCS of 3 - 8 & has an abnormal CT
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True
also would monitor if any two or more of the following exist > 40 years posturing SBP < 90 mmHg |
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T/F Hyperventilation should be avoided in TBI patients for the first 24 hours
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True
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Your TBI patient has a BP of 210/110 what are your thoughts on treating it?
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NOT until Dura is open, the ↑ BP is most likely the way brain is getting blood @ this time
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Where would you like to keep your CPP in a pt with TBI?
________________ |
50 - 70 mmHg
if keep less than 70 can help avoid ARDS |
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Which of the following would be considered Secondary Injuries (choose any that apply)
a) contusion b) hematoma c) ischemia d) herniation e) hemorrhage |
ischemia
herniation hemorrhage as well as intracranial HTN |
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Which cranial hematoma is the most dangerous
a) epidural b) subdural c) intracerebral |
epidural
tearing of meningeal vessels unconsciousness spasm / clot formation RE-BLEED is EMERGENCY |
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Examples of Primary Injury in a TBI pt include ( choose any that apply)
a) concussion b) contusion c) laceration d) hematoma |
concussion
contusion laceration hematoma |
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How are Primary Injuries in TBI pts treated
a) surgical b) hyperventilate c) diuresis d) barbs w/ ICP monitoring |
hyperventilate
diuresis (mannitol &/or lasix) barbs w/ ICP monitoring Primary injuries are NON OPERATIVE |
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Extra-cellular cerebral edema develops in white matter how long after initial injury in a TBI pt
a) immediately b) within 2 hours c) 24 hours post injury |
24 hours post injury
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Dilated pupils, hemiparesis, unilateral decerebration are s/s of which type of hematoma
a) epidural b) subdural c) intracranial |
subdural
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Acute Subdural hematoma will have symptoms
a) within 72 hours b) within 3 - 15 days c) after 2 weeks |
within 72 hours
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SubAcute Subdural hematoma will have symptoms
a) within 72 hours b) within 3 - 15 days c) after 2 weeks |
within 3 - 15 days
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Chronic Subdural hematoma will have symptoms
a) within 72 hours b) within 3 - 15 days c) after 2 weeks |
after 2 weeks
usually in people older than 50 years |
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T/F Acute Subdural Hematomas are commonly caused by trauma but may occur spontaneously
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True
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T/F Acute Subdural Hematomas are associated with coagulopathies, aneurysms, & neoplasms
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True
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Coup & Cotrecoup Injury
a) shaken baby syndrome b) coup is initial injury c) coup is secondary injury d) cotrecoup is initial injury e) cotrecoup is secondary injury |
shaken baby syndrome
coup is initial injury cotrecoup is secondary injury |
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The golden hours for TBI are
a) 1-2 hours b) 2 - 4 hours c) 4-6 hours |
2 - 4 hours
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Your pt has a basilar skull fracture what is your plan for intubation? _________________
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RSI w/ cricoid, NO Nasal ETT, always asume cervical instability and use in line stabilization
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Glascow Scores of ______ must go to trauma 1 centers
a) < 5 b) < 6 c) < 9 d) < 11 |
< 9
Trauma 1 centers must have 24 hour scanning ability, ICP monitoring, OR with neuro team |
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Evacuation of a hematoma in a GCS < 9 must be carried out in what time frame
a) 1 - 2 hours b) 2 - 4 hours c) 4 - 6 hours |
2 - 4 hours
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Lateral C-Spine views can miss _____% of spinal fractures
a) 10% b) 20% c) 30% d) 35% |
20%
it is recommended that A-P & odontoid views also be done with 7% of those missing the fracture as well |
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Signs & symptoms of a Basal Skull fracture include
a) tympanic cavity hemorrhage b) otorrhea c) petechia on mastoid process d) petechia around the eyes |
tympanic cavity hemorrhage
otorrhea petechia on mastoid process petechia around the eyes |
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Battle's sign
a) petechia around the eyes b) otorrhea c) petechia on mastoid process |
petechia on mastoid process
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Racoon eyes (panda's sign)
a) petechia around the eyes b) otorrhea c) petechia on mastoid process |
petechia around the eyes
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What are your best option(s) for intubation in a pt with soft tissue edema & facial fractures (choose any that apply)
a) fiberoptic b) illuminated stylet c) fast track LMA d) cricothyroidotomy |
fiberoptic
illuminated stylet fast track LMA |
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What are your best option(s) for intubation in a pt with severe facial and laryngeal injuries (choose any that apply)
a) fiberoptic b) illuminated stylet c) fast track LMA d) cricothyroidotomy |
cricothyroidotomy
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In the TBI patient is it appropriate to use Sux for RSI or do you always need to use Roc b/c of the ↑ ICP associated with Sux
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Sux is fine to use in a TBI pt (of course K needs to be low enough) the ↑ ICP can be counteracted with hyperventilation so the benefit far out weighs the risk
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While there is no "ideal crystalloid" for pt with TBI what would be your best choice? ____________________
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NS the goal is to avoid cerebral edema
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Your TBI pt is hypertensive, tachycardic and has an ↑ CO prior to dura opening should you treat it?
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Probably not as it will usually go away once the dura is open
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T/F EKG changes / fatal arrhythmias in TBI pts are r/t surges of epinephrine
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True
treat these with labatelol or esmolol once the dura is open |
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An IV solution containing less Na concentration than serum is hypo / hyper osmotic?
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HYPO osmotic
1/2 NS & LR |
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What do Hypo-osmotic solutions do to the brain?
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CAUSE CEREBRAL EDEMA
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The ideal colloid for TBI pts is
a) Albumin 5% b) Hespan c) Whole Blood d) PRBCs |
Whole Blood
typically whole blood is not an option |
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What effect does 3% NS have on a TBI pt
a) ↓ ICP b) ↑ systemic BP c) improve regional blood flow to brain |
↓ ICP
↑ systemic BP improve regional blood flow to brain |
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Your pt has severe intracranial HTN, and causes a reflex arterial HTN and bradycardia and irregular resps what is this phenomenon known as? _____________
TEST ? |
Cushings Triad
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Where do you want to keep the CPP if your pt has intracranial HTN? ________________
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CPP = 50 - 70 mmHg
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Treatment of intracranial HTN with a GCS < 8 has 2 Tiers of treatment, Tier 1 involves
a) ventricular drainage b) mannitol 0.25 - 1 g/kg c) hyperventilation to 30 - 35 d) hyperventilation to < 30 |
ventricular drainage
mannitol 0.25 - 1 g/kg hyperventilation to 30 - 35 (hyperventilation to < 30 is done in Tier 2 when HTN is refractory to Tier 1 tx) |
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Tier 2 treatments for intracranial HTN involves
a) hyperventilation to < 35 b) high dose barbs c) decompressive craniotomy d) should only be done when HTN is refractory to Tier 1 treatments |
hyperventilation to < 35
high dose barbs decompressive craniotomy should only be done when HTN is refractory to Tier 1 treatments |
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Surgery for an increasing intracranial mass should be done within ____ of injury
a) 2 hours b) 4 hours c) 6 hours |
4 hours
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The best anesthesia technique for a pt with severe intracranial HTN would be
a) TIVA b) Volatile |
TIVA
Narcs STP infusion 2 -3 mg/kg/hr NDMR O2 + air |
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A pt with less severe TBI (minimal intracranial HTN)
would benefit from which anesthesia technique a) TIVA b) Volatile |
Volatile
Narcs BZDs Sub-minimum MAC Scopolamine |
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Which of the following could be a cause of increased Peak Airway pressures
a) hemopneumothorax b) ↑ intra-abdominal pressures c) kinked ETT d) expiratory valve stuck |
hemopneumothorax
↑ intra-abdominal pressures kinked ETT expiratory valve stuck you don't want ↑ peak airway pressures in a TBI pt! |
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Mannitol loses it's affect in how long? _______________
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1 - 3 hours you may need to redose it during your crani
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If your pt with TBI has cerebral edema that just keeps getting worse & you have him on volatiles what should you do?
a) switch to Opioids b) switch to STP gtt c) ask the surgeon to hurry up |
switch to Opioids
switch to STP gtt STP 5 - 25mg/kg bolus over 5 - 10 min then gtt 4 - 10 mg/kg/hr caution may need to add Neosynephrine & Dopamine to ↑ preload & BP |
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Malignant Brain Swelling maxes, when?
a) 4 - 6 hours post injury b) 6 - 12 hours post injury c) 12 - 72 hours post injury |
12 - 72 hours post injury
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T/F Propfol ↓'s CBF more than CMRO2 which can lead to ischemia
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True
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Which of the following may be the cause of brain swelling or herniation (choose any that apply)
a) improper positioning b) contralateral intracerebral hematoma c) venous drainage obstruction d) acute hydrocephalus from intraventricular bleed |
improper positioning
contralateral intracerebral hematoma venous drainage obstruction acute hydrocephalus from intraventricular bleed |
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List the four herniation pathways
1.__________________ 2.__________________ 3.__________________ 4.__________________ |
Subfalcine
Uncal (transtentorial) Cerebellar Transcalvarium |
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An Uncal herniation
a) supratentorial b) Infratentorial c) down through tentorium d) pushes brain into other hemisphere |
supratentorial
down through tentorium "my UNCAL has a SUPRA in his TENT" found in lower portion of brain as it pushes thru the tentorium |
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Central herniation
a) supratentorial b) Infratentorial c) conical pressing down d) pushes brain into other hemisphere |
supratentorial
conical pressing down found mid brain where it narrows thus making the "cone" shape |
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Subflacine herniation
a) supratentorial b) Infratentorial c) conical pressing down d) pushes brain into other hemisphere |
supratentorial
pushes brain into other hemisphere |
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Transcalvarial herniation
a) supratentorial b) Infratentorial c) conical pressing down d) brain is pushed thru opening in skull |
supratentorial
brain is pushed thru opening in skull |
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Tonsillar herniation
a) supratentorial b) Infratentorial c) displacement of cerebral tonsils thru foramen magnum into spinal column d) brain is pushed thru opening in skull |
Infratentorial
displacement of cerebral tonsils thru foramen magnum into spinal column |
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Decompressive Craniectomy
a) used for ICP control b) for diffuse swelling resistant to medical mgt c) ↓'s ICP by ↓ volume constraints on brain d) may or may not improve outcome |
used for ICP control
for diffuse swelling resistant to medical mgt ↓'s ICP by ↓ volume constraints on brain may or may not improve outcome |
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Neurogenic Pulmonary Edema is r/t _____________________
How do you treat it? __________ |
SNS surge d/t intracranial HTN
α blockers & CNS depressants NPE characteristically presents within minutes to hours of a severe central nervous system insult Dyspnea is the most common symptom |
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Why would DIC occur in a TBI patient? ____________________
How would you treat that? _____ |
Brain tissue releases THROMBOPLASTIN which activates the intrinsic clotting cascade
Tx with PRBCs, FFP, Plt, Cryo |
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Which of the following are a part of the systemic sequelae caused by TBI (choose all that apply)
a) ulcers, hemorrhage (GI) b) EKG changes c) DIC d) Diabetes Insipidus, SIADH |
ulcers, hemorrhage (GI)
EKG changes DIC Diabetes Insipidus, SIADH |
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T/F Diabetes Insipidus is common with facial trauma or basilar skull fractures
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True
s/s polyuria "dilute" urine polydipsia (excessive thirst) ↑ Na r/t lg urine output ↑ serum osmolality Tx: vasopressin |
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T/F SIADH aka "H2O intoxication" happens 3 -15 days post brain injury
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True
↓ Na r/t renal excretion urine osmo > serum osmo H2O toxicity = anorexia, vomiting personality changes |
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T/F Non-Ketotic Hyperosmolar Hyperglycemic Coma can be caused by things such as ______ that are used to treat TBI
a) Steroids b) mannitol c) Dilantin |
Steroids(increases glucose levels)
mannitol Dilantin (increases glucose levels) |
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S/S of non-ketotic hyperosmolar hyperglycemic coma are
a) ↓ Na b) hyperglycemia c) hypertonicity d) hypokalemia |
↓ Na
hyperglycemia hypertonicity hypokalemia |
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T/F Treatment of SIADH involves H2O restriction & 3% NS
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True
Note: if Na is low /low normal do NOT treat with 3% NS risk central pontine myelination |
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Cervical segment C1 is known as
a) atlas b) axis Test? |
atlas
"he's got the whole world in his hands" |
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Cervical segment C2 is known as
a) atlas b) axis Test? |
axis
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The total number of vertebrae is
a) 33 b) 30 c) 29 d) 28 |
33
but as Adults it is functionally reduced to 24 with fusion of presacral, sacral and coccyx bones |
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Match the number of vertebrae in each region
Cervical.............................7 Thoracic.............................5 Lumbar..............................12 |
Cervical = 7
Thoracic = 12 Lumbar = 5 (fused 5 sacral & 4 coccyx) |
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When referring to the spinal column dorsal is the front or back
TEST? |
Back
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When referring to the spinal column ventral is the front or back
TEST? |
Front
(that's where you would find a ventral hernia) |
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The Anterior Spinal column is made up of (choose 3)
a) anterior longitudinal ligament b) anterior 1/2 of vert. body c) interconnecting ligaments d) disc and annulus TEST? |
ANTERIOR longitudinal ligament
ANTERIOR 1/2 vert. body disc & annulus |
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The middle Spinal column is made up of (choose 3)
a) Posterior longitudinal ligament b) posterior 1/2 of vert. body c) interconnecting ligaments d) disc and annulus e) facet joints Test? |
MIDDLE segment is made up of
POSTERIOR longitudinal ligament POSTERIOR 1/2 of vert. body disc & annulus |
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The Posterior Spinal column is made up of (choose 4)
a) Posterior longitudinal ligament b) facet joints c) ligamentum flavum d) interconnecting ligaments e) posterior elements TEST? |
POSTERIOR COLUMN is made up of
"FLIP" F acet joints L igamentum I nterconnecting ligaments P osterior elements |
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What elements make up the vertebral canal
a) 2 pedicles b) 2 lamina c) 2 facet joints d) body e) spinous process |
2 pedicles
2 lamina body |
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Blood supply above the cervical cord is supplied by
a) 1 anterior spinal artery b) 2 anterior spinal arteries c) 1 posterior spinal artery d) 2 posterior spinal arteries e) artery of Adamkiewicz |
1 anterior artery
2 posterior blood supplied through Aorta via the vertebral and segmental arteries |
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Blood supply below the cervical cord is supplied by
a) 1 anterior spinal artery b) 2 anterior spinal arteries c) 1 posterior spinal artery d) 2 posterior spinal arteries e) Artery of Adamkiewicz TEST? |
Artery of Adamkiewicz
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Where does the Artery of Adamkiewicz arise from?
TEST? |
Left side of aorta between T9 - T11
damage to this = parapalegia in thoracic region |
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Where does the spinal cord Venous drainage begin and end?
____________________ TEST? |
Begins: RADIAL veins
Ends: Caval veins |
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Do spinal & epidural veins have valves?
___________________ TEST? |
NO!!!!
this makes them susceptible to engorgement...pregnancy, obestity) |
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Blood Flow to the spinal cord
a) 30ml/100g/min b) 40 ml/100g/min c) 60 ml/100g/min d) 70 ml/100g/min |
60 ml/100g/min
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AutoRegulation in the spinal cord
a) 30 - 130 mmHg b) 50 - 150 mmHg c) 60 - 120 mmHg d) 70 - 170 mmHg |
60 - 120 mmHg
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Spondylosis
a) degeneration of vertebrae b) displacement of vertebrae c) related to degeneration of vertebrae |
degeneration of vertebrae
cervical or lumbar |
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Spondylolisthesis
a) degeneration of vertebrae b) displacement of vertebrae c) related to degeneration of vertebrae |
displacement of vertebrae
cervical or lumbar |
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Spondylotic
a) degeneration of vertebrae b) displacement of vertebrae c) related to degeneration of vertebrae |
related to degeneration of vertebrae
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Cervical Spondylosis
a) degenerative spinal stenosis b) 90% are > 65 years c) medical tx for 4 - 6 weeks |
degenerative spinal stenosis
90% are > 65 years medical tx for 4 - 6 weeks |
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Cervical Spondylotic Myelopathy
a) #1 dysfunction > 55 years b) degenerative or congenital c) motor weakness d) Lhermitte's sign |
Basically motor weakness is caused by the degeneration of the bone
#1 dysfunction > 55 years degenerative or congenital motor weakness Lhermitte's sign (electric shock when neck is flexed goes down back/legs) |
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Cervical Disk Herniation
a) #1 dysfunction > 40 years b) usually C5 - C6 or C6-C7 c) medical treatment d) ACDF surgical treatment |
#1 dysfunction > 40 years
usually C5 - C6 or C6-C7 medical treatment ACDF surgical treatment |
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Chiari malformation
a) a communicating form of syringomyelia b) a non-communicating syringomyelia c) tonsillar herniation d) caused by trauma to spinal cord |
a communicating form of syringomyelia
tonsillar herniation |
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Non-Communicating syringomyelia
a) caused by chiari malformation b) caused by trauma, cancer, arachanoiditis c) a cyst in the spinal cord |
caused by trauma, cancer, arachanoiditis
a cyst in the spinal cord |
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"Cape" like loss of pain & temperature sensation is associated with
a) thoracic herniation b) cervical spondylosis c) Syringomyelia d) Alkylosing Spondylitis |
Syringomyelia
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Scoliosis
a) curve > 10 b) ↓ pulmonary function c) ideopathic d) de novo |
curve > 10
↓ pulmonary function ideopathic de novo Curves > 60 degrees = SOB, Dyspnea |
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"de novo" scoliosis
a) occurs in adolescence b) occurs after maturation |
"de novo" means start of new condition
occurs after maturation this is d/t degenerative spine disease |
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ideopathic scoliosis
a) occurs in adolescence b) occurs after maturation |
occurs in adolescence
and is treated in adulthood |
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Concerns in pts with Rheumatoid Arthritis
a) possible fiberoptic intubation b) ↑ risk atlanto axial subluxation c) vertebral artery compromise d) neuro deficits |
possible fiberoptic intubation
↑ risk atlanto axial subluxation vertebral artery compromise neuro deficits |
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Alkylosing Spondylitis
a) long term disease b) inflammation of sacroiliac & axial skeletal joints c) men > women d) radicular pain |
(think about the guy that comes into MILFs) long term disease
inflammation of sacroiliac & axial skeletal joints men > women radicular pain |
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Osteoporosis causes include (choose all that apply)
a) hyperthyroidism b) Calcium disorders c) GI disorders d) chronic steroid use |
hyperthyroidism
Calcium disorders GI disorders chronic steroid use |
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Axial Forces
a) vertical force on spine b) horizontal force on spine c) tolerated more than shearing forces d) not tolerated as well as shearing forces |
vertical force on spine "↓" force
tolerated more than shearing forces |
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Shearing Forces
a) vertical force on spine b) horizontal force on spine c) tolerated more than axial forces d) not tolerated as well as axial forces |
horizontal force on spine
"→ ← " not tolerated as well as axial forces |
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Shear injuries
a) "rear end collisions" b) involves all 3 columns of spine c) ↑ risk of facet locking d) horizontal |
"rear end collisions"
involves all 3 columns of spine ↑ risk of facet locking horizontal |
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Flexion Compression
a) hyperflexion b) hyperextension c) loss of ant. vertebral height d) subluxation or dislocation |
hyperflexion
loss of ant. vertebral height |
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Flexion Distraction
a) hyperflexion b) hyperextension c) loss of ant. vertebral height d) subluxation or dislocation |
hyperflexion
subluxation or dislocation |
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Hyperextension
a) ↓ AP diameter of spinal canal b) compresses spinal cord c) r/t facial or frontal trauma d) usually cervical |
↓ AP diameter of spinal canal
compresses spinal cord r/t facial or frontal trauma usually cervical Think about the guy getting sucker punched & his head flies back |
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T/F Rotation fractures can cause subluxation, dislocation, vertebral body injury, locked facet joints
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True
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The odontoid process is found
a) on C1 b) on C2 |
C2
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An avulsion fracture
a) typically stable b) involves the odontoid process c) typically unstable d) involves facets |
typically stable
involves the odontoid process |
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What is the most common cause of cervical injury? ___________
TEST? |
MVAs
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Leading causes of death in pt with Spinal Cord Injury (SCI)
a) respiratory b) cardiac c) pulmonary embolism d) septicemia |
respiratory
cardiac pulmonary embolism septicemia |
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Pentaplegia
a) C1 b) C3 - C5 c) paralysis of ↓ cranial nerves & diaphragm, arms & legs d) + diaphragm & some upper extremity motor |
C1
paralysis of ↓ cranial nerves & diaphragm, arms & legs |
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Tetraplegia
a) C1 b) C3 - C5 c) paralysis diaphragm, arms & legs d) T1 and below |
C3 - C5
paralysis diaphragm, arms & legs AKA quadraplegia |
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T/F If SCI is just below C5-C6 it is possible to have a functional diaphragm and some upper extremity movement
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True
can be called "tetraplegia" |
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Paraplegia
a) T1 & below b) C5 - C6 c) paralysis of legs only d) paralysis of diaphragm & legs |
T1 & below
paralysis of legs only |
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T/F The term perineal paraplegia refers to SCI @ S2 - S5
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True
pt will have bladder, bowel, sexual disfunctions |
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Corticospinal Tract
a) carries motor impulses b) carries sensory impulses c) found in anterior spinal column d) found in posterior spinal column TEST? |
carries motor impulses
found in anterior spinal column |
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Spinalthalamic Tract
a) carries motor impulses b) carries sensory impulses c) found in anterior spinal column d) found in posterior spinal column TEST ? |
carries sensory impulses
found in posterior spinal column |
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Cervicomedullary syndrome
a) damage to cervical cord b) damage to brainstem c) r/t excessive traction/compression |
damage to cervical cord
damage to brainstem r/t excessive traction/compression |
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A cervicomedullary syndrome pt with loss of facial sensory to forehead, ear & chin has suffered an injury where?
a) medulla b) C3 - C4 |
C3 - C4
"3" areas of loss forehead, ear, chin |
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A cervicomedullary syndrome pt with peripheral sensory loss has suffered an injury where?
a) medulla b) C3 - C4 |
medulla
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Brown Sequard Syndrome
a) 1/2 cord effected b) ipsilateral paralysis c) contralateral pain & temp loss d) ipsilateral pain & temp loss e) contralateral paralysis |
1/2 cord effected
ipsilateral paralysis contralateral pain & temp loss damage side = paralysis opp. side = loss pain/temp |
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Conus Medullaris Syndrome
a) T12-L1 b) Sacral & Lumbar cord effected c) neurogenic bowel/bladder |
T12-L1
Sacral & Lumbar cord effected neurogenic bowel/bladder "conus" narrowing just above cauda equina |
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Cauda Equina Syndrome
a) L1 - L2 & below b) lumbar & sacral roots c) neurogenic bowel/bladder |
L1 - L2 & below
lumbar & sacral roots neurogenic bowel/bladder "C ord E nd" (C auda E quina) cord ends @ L1 - L2 |
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After SCI you would expect to see
a) impaired autoregulation b) ↑ catecholamines c) ↓ blood flow to spinal cord d) loss of CO2 responsiveness |
impaired autoregulation
↑ catecholamines (→ vasogenic edema) ↓ blood flow to spinal cord (as early as 30 minutes) loss of CO2 responsiveness |
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T/F there are many theories as to why secondary injury happens after spinal cord injury, regardless of what they are they all end up with CELL DEATH & NEUROLOGIC DYSFUNCTION
TEST? |
True
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SCI above T5
a) HOTN b) Sympathectomy c) HTN |
HTN
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SCI below T5
a) HOTN b) Sympathectomy c) HTN |
HOTN
Sympathectomy |
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SCI & temperature
a) pt is poikiothermic b) unable to sweat in hot conditions c) prone to hypothermia |
pt is poikiothermic (takes on temperature of environment)
unable to sweat in hot conditions prone to hypothermia (if ambient temperature is less than body temp) |
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T/F The risk of DVT in SCI is 40 - 100%
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True
PE is the 3rd leading cause of death in SCI DVT occurs more often when it is complete SCI |
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Hyperreflexic Syndrome is found in 85% of SCI injuries above
a) T12 b) T8 c) T7 d) T5 |
T5
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In Autonomic Hyperreflexic Syndrome
a) constriction of blood vessels is above injury b) constriction of blood vessels is below injury c) dilation of vessels is above injury d) dilation of vessels is below injury |
constriction of blood vessels is below injury
dilation of vessels is above injury (pt will be flushed have a pounding headache) (this is because of carotid/aortic baroreceptors in response to signal from below) |
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Which of the following could cause Autonomic Hyperreflexic Syndrome
a) distended bladder b) pain below SCI injury c) constipation |
distended bladder
pain below SCI injury constipation |
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HTN with Autonomic Hyperreflexia can be extremely dangerous what ganglionic blocker is used to treat it?
BOARD ? |
Trimethophan
nicotinic antagonist prevents stimulation of postsynaptic receptors by competing with acetylcholine for these receptor sites it reduces sympathetic tone & causes vasodilation |
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You need to do a RSI on your SCI Trauma patient who is coming back to the OR 36 hours after his injury what do you use for muscle relaxation on induction?
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NOT SUX, THAT'S FOR DANG SURE! (risk ↑K)
Rocuronium would be OK |
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Why would you need to be cautious when using Phenylephrine in an SCI pt?
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b/c vessels are already maximally constricted. The SVR will ↑ but so will afterload (pt can't handle this) and CO ↓'s
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Acute Normovolemic Hemodilution
a) goal Hct is 30% b) blood volume replaced with crystalloids c) requires preop Hgb >12 d) pt can't have ♥, lung, renal issues e) pt can't have HTN TEST ? |
goal Hct is 30%
blood volume replaced with crystalloids requires preop Hgb >12 pt can't have ♥, lung, renal issues pt can't have HTN |
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Intraoperative Cell Salvage
a) no plts found in this salvaged blood b) final Hct of 60% c) final Hct of 30% d) pt may have oozing after infusion of salvaged blood |
no plts found in this salvaged blood
final Hct of 60% pt may have oozing after infusion of salvaged blood (d/t no plts & citrate) |
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Huntingtons Disease
a) jerky movements → rigid dystonia b) aspiration risk c) prolonged Sux d) ↓ versed doses |
jerky movements → rigid dystonia
aspiration risk prolonged Sux d/t abnormal plasma cholinesterase ↓ versed doses |
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In ALS (Amyotrophic Lateral Sclerosis)
a) loss of motor neurons upper/lower b) upper will be spastic c) lower will be flaccid d) NO SUX e) aspiration risk |
loss of motor neurons upper/lower
upper will be spastic (cause people who are "up" are spastic) lower will be flaccid NO SUX aspiration risk |
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What cranial nerves are affected in ALS
a) V, VII b) VI, VIII c) IX, X d) XII |
V, VII (5 + 7 = 12)
XII IX, X (9, 10 a big fat hen) also the Anterior Horn |
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ALS is degeneration of
a) corticospinal tract b) spinothalmic tract |
corticospinal tract
these guys are "jerks" MOTOR!!!! anterior column |
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Which neurologic disorder is the most common?
a) Parkinson's b) Alzheimer's c) ALS d) Multiple Sclerosis |
Alzheimer's
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Which neurologic disorder is the 2nd most common?
a) Parkinson's b) Alzheimer's c) ALS d) Multiple Sclerosis |
Parkinson's
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Which neurologic disease would you want to avoid giving dopamine antagonists to
a) Parkinson's b) Alzheimer's c) ALS d) Multiple Sclerosis |
Parkinson's
Drugs such as reglan, droperidol, phenothiazines |
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Which neurologic disease would you want to avoid giving demerol to
a) Parkinson's b) Alzheimer's c) ALS d) Multiple Sclerosis |
Parkinson's
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Which of the following neurologic disorders are at a high risk for aspiration
a) Huntingtons b) ALS c) Parkinson's d) Guillain Barre e) Alzheimers |
Huntingtons
ALS Parkinson's Guillain Barre "H"e "ALwayS" "P"ukes "G"astric juices |
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Which neurologic disorders would you not want to give Sux to?
a) ALS b) Parkinsons c) Guillain Barre d) Mulitple Sclerosis e) Huntingtons |
ALS
Guillain Barre Mulitple Sclerosis "A"nn "G"us and "M"ary hate SUX |
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Which neurologic disorder has a resistance to NDMRs in early stages but is sensitive to them later (upto 4 years)
a) Huntingtons b) ALS c) Guillain Barre d) Multiple Sclerosis |
Guillain Barre
Guillain is a resistive guy Barre is a sensitive guy THIS IS THE ONLY DISEASE THAT GOES AWAY! |
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Which neurologic disease process is hyperthermia really bad in?
a) Huntingtons b) ALS c) Guillain Barre d) Multiple Sclerosis |
Multiple Sclerosis
hyperthermia will exacerbate the disease |
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Which neurologic disease processes have abnormal plasma cholinesterase associated with them?
a) Huntingtons b) ALS c) Parkinsons d) Alzheimers |
Huntingtons
Alzheimers (this is b/c these pts take anticholinesterase drugs like tacrin & donzepril) |
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Which of the following is the most common Demyelinating disease process
a) Guillain Barre b) Multiple Sclerosis c) ALS |
Guillain Barre
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Which of the following demyelinating diseases has progressive ascending symmetrical paralysis?
a) Guillain Barre b) Multiple Sclerosis c) ALS TEST? |
Guillain Barre
moves from LOWER → UPPER |
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What surgical position has the highest risk of VAE?
TEST? |
Sitting
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Proper placement of the precordial doppler for detection of VAE is?
TEST? |
RIGHT of the sternum between 3 & 6 intercostal space
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Volatile Anesthetics that increase ICP include
TEST? |
SEVO, DES, N2O
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You have a 75 yo pt w/signs of leaking aneurysm. you see inverted t waves, prolonged QT & U waves do you think it's cardiac related?
TEST? |
It's an expected result with this type of injury, but check the Ca & K levels just to be sure
DO NOT GIVE Esmolol b/c you don't want to change the transmural pressure & cause more bleeding |
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Does Ketamine increase CBV?
TEST? |
Yes, but it doesn't decrease CMRO2
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Which of the following is false regarding vasospasm?
oxyhgb may be implicated best Hct for oxygenation is 33% Triple H therapy involves: Hyperventilation, Hypervolemia, Hypertension TEST? |
Triple H Therapy
Does NOT include Hypertension! But it does include Hemodilution |
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Successful factors for awake crani: cooperative pt, good rapport, good airway
TEST? |
that's the answer
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Which surgery is used for epilepsy refractory to medical treatment?
TEST? |
Vagal Nerve Stimulator
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The most effective drug for identification of ictal cortex is?
TEST? |
Alfentanil
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Complications of vagal nerve stimulator include
TEST? |
bradycardia, hoarseness, unilateral vocal cord paralysis
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