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200 Cards in this Set

  • Front
  • Back
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)
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
Why would you not want to give versed to an awake crani? __________________________
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
Cortical Stimulation is done to identify
a) sensory & motor areas
b) foci responsible for seizures
c) functional areas
functional areas
Cortical evoked potentials are done to identify
a) sensory & motor areas
b) foci responsible for seizures
c) functional areas
sensory & motor areas
EEG is done to identify
a) sensory & motor areas
b) foci responsible for seizures
c) functional areas
foci responsible for seizures
During Brain mapping your pt has a seizure what do you do?
Treat with Barbs or Propofol 1mg/kg (of either)
secure airway

if happens @ end of case you can use Versed or Dilantin
T/F Spontaneous breathing keeps the brain "slack"
True
this is great for brain swelling
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
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)
Which type of seizure has motor activity but no EEG changes
a) partial
b) generalized
c) pseudoseizure
pseudoseizure
Which sedative hypnotics activate EEG seizures & myoclonic activity
a) Methohexital
b) Etomidate
c) Ketamine
d) Propofol
Methohexital
Etomidate
Ketamine → doses > 4mg/kg
Which sedative hypnotics activates myoclonic activity only
a) Methohexital
b) Etomidate
c) Ketamine
d) Propofol
Propofol
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
BOARD ?

What volatile anesthetic is the #1 offender for causing seizures?
Enflurane
T/F Synthetic analgesics such as Alfentanil, Fentanyl, Sunfentanyl, & Remifentanil are all PRO-Eleptic
True!
Alfentanil has the most pro-eleptic effect

They are good for finding ictal cortex
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
What drugs effect the metabolism of Carbamazepine?
a) E-mycin
b) Cimetidine
c) propofol
d) versed
E-mycin
Cimetidine
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)
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
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
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
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
T/F Antihistamines activate seizure foci
True
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?
Because these patients also have respiratory tract tumors which can compromise airway
Why would you not want to use Barbs or Benzos on a pt scheduled for resection of epileptogenic region?
Because they interfere with EEG

they ↑ seizure threshold which means they won't have seizures & docs need to see foci
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
T/F Resection of the hippocampus (amygdalahippocampectomy) may cause severe bradycardia
True
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)
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!!
What side is the Vagal Nerve Stimulator placed on?
a) left
b) right

TEST ?
LEFT mid-cervical neck
this ↓'s risk of Bradycardia
The left vagal nerve innervates
a) AV node
b) SA node

TEST ?
AV node

"AVril Lavigne has LEFT the building"
The right vagal nerve innervates
a) AV node
b) SA node

TEST ?
SA node

"Sarah is Always RIGHT"
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
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)
T/F Sevoflurane & Desflurane desensitize heart to the effects of exogenous epinephrine
True, good to remember during Transphenoidal Hypophysectomy b/c surgeon injects epinephrine to ↓ bleeding
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
Severe head injury is classified as a glascow coma scale of _____________________
< or equal to 8
Mild head injury is classified as a glascow coma scale of ___________________
13 - 15
T/F Traumatic Brain Injury is the #1 cause of disability / death in kids & adults
True
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
Leading causes of Traumatic Brain Injury
a) falls
b) MVAs
c) assaults
d) blasts among military personel
falls
MVAs
assaults
blasts among military personel
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
T/F ICP monitoring should be done on anyone with a GCS of 3 - 8 & has an abnormal CT
True
also would monitor if any two or more of the following exist
> 40 years
posturing
SBP < 90 mmHg
T/F Hyperventilation should be avoided in TBI patients for the first 24 hours
True
Your TBI patient has a BP of 210/110 what are your thoughts on treating it?
NOT until Dura is open, the ↑ BP is most likely the way brain is getting blood @ this time
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
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
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
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
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
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
Dilated pupils, hemiparesis, unilateral decerebration are s/s of which type of hematoma
a) epidural
b) subdural
c) intracranial
subdural
Acute Subdural hematoma will have symptoms
a) within 72 hours
b) within 3 - 15 days
c) after 2 weeks
within 72 hours
SubAcute Subdural hematoma will have symptoms
a) within 72 hours
b) within 3 - 15 days
c) after 2 weeks
within 3 - 15 days
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
T/F Acute Subdural Hematomas are commonly caused by trauma but may occur spontaneously
True
T/F Acute Subdural Hematomas are associated with coagulopathies, aneurysms, & neoplasms
True
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
The golden hours for TBI are
a) 1-2 hours
b) 2 - 4 hours
c) 4-6 hours
2 - 4 hours
Your pt has a basilar skull fracture what is your plan for intubation? _________________
RSI w/ cricoid, NO Nasal ETT, always asume cervical instability and use in line stabilization
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
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
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
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
Battle's sign
a) petechia around the eyes
b) otorrhea
c) petechia on mastoid process
petechia on mastoid process
Racoon eyes (panda's sign)
a) petechia around the eyes
b) otorrhea
c) petechia on mastoid process
petechia around the eyes
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
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
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
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
While there is no "ideal crystalloid" for pt with TBI what would be your best choice? ____________________
NS the goal is to avoid cerebral edema
Your TBI pt is hypertensive, tachycardic and has an ↑ CO prior to dura opening should you treat it?
Probably not as it will usually go away once the dura is open
T/F EKG changes / fatal arrhythmias in TBI pts are r/t surges of epinephrine
True
treat these with labatelol or esmolol once the dura is open
An IV solution containing less Na concentration than serum is hypo / hyper osmotic?
HYPO osmotic
1/2 NS & LR
What do Hypo-osmotic solutions do to the brain?
CAUSE CEREBRAL EDEMA
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
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
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
Where do you want to keep the CPP if your pt has intracranial HTN? ________________
CPP = 50 - 70 mmHg
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)
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
Surgery for an increasing intracranial mass should be done within ____ of injury
a) 2 hours
b) 4 hours
c) 6 hours
4 hours
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
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
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!
Mannitol loses it's affect in how long? _______________
1 - 3 hours you may need to redose it during your crani
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
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
T/F Propfol ↓'s CBF more than CMRO2 which can lead to ischemia
True
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
List the four herniation pathways
1.__________________
2.__________________
3.__________________
4.__________________
Subfalcine
Uncal (transtentorial)
Cerebellar
Transcalvarium
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
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
Subflacine herniation
a) supratentorial
b) Infratentorial
c) conical pressing down
d) pushes brain into other hemisphere
supratentorial
pushes brain into other hemisphere
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
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
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
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
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
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
T/F Diabetes Insipidus is common with facial trauma or basilar skull fractures
True
s/s polyuria "dilute" urine
polydipsia (excessive thirst)
↑ Na r/t lg urine output
↑ serum osmolality
Tx: vasopressin
T/F SIADH aka "H2O intoxication" happens 3 -15 days post brain injury
True
↓ Na r/t renal excretion
urine osmo > serum osmo
H2O toxicity = anorexia, vomiting personality changes
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)
S/S of non-ketotic hyperosmolar hyperglycemic coma are
a) ↓ Na
b) hyperglycemia
c) hypertonicity
d) hypokalemia
↓ Na
hyperglycemia
hypertonicity
hypokalemia
T/F Treatment of SIADH involves H2O restriction & 3% NS
True

Note: if Na is low /low normal do NOT treat with 3% NS risk central pontine myelination
Cervical segment C1 is known as
a) atlas
b) axis

Test?
atlas

"he's got the whole world in his hands"
Cervical segment C2 is known as
a) atlas
b) axis

Test?
axis
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
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)
When referring to the spinal column dorsal is the front or back

TEST?
Back
When referring to the spinal column ventral is the front or back

TEST?
Front
(that's where you would find a ventral hernia)
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
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
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
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
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
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
Where does the Artery of Adamkiewicz arise from?

TEST?
Left side of aorta between T9 - T11
damage to this = parapalegia in thoracic region
Where does the spinal cord Venous drainage begin and end?
____________________
TEST?
Begins: RADIAL veins

Ends: Caval veins
Do spinal & epidural veins have valves?
___________________
TEST?
NO!!!!
this makes them susceptible to engorgement...pregnancy, obestity)
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
AutoRegulation in the spinal cord
a) 30 - 130 mmHg
b) 50 - 150 mmHg
c) 60 - 120 mmHg
d) 70 - 170 mmHg
60 - 120 mmHg
Spondylosis
a) degeneration of vertebrae
b) displacement of vertebrae
c) related to degeneration of vertebrae
degeneration of vertebrae

cervical or lumbar
Spondylolisthesis
a) degeneration of vertebrae
b) displacement of vertebrae
c) related to degeneration of vertebrae
displacement of vertebrae
cervical or lumbar
Spondylotic
a) degeneration of vertebrae
b) displacement of vertebrae
c) related to degeneration of vertebrae
related to degeneration of vertebrae
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
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)
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
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
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
"Cape" like loss of pain & temperature sensation is associated with
a) thoracic herniation
b) cervical spondylosis
c) Syringomyelia
d) Alkylosing Spondylitis
Syringomyelia
Scoliosis
a) curve > 10
b) ↓ pulmonary function
c) ideopathic
d) de novo
curve > 10
↓ pulmonary function
ideopathic
de novo

Curves > 60 degrees = SOB, Dyspnea
"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
ideopathic scoliosis
a) occurs in adolescence
b) occurs after maturation
occurs in adolescence
and is treated in adulthood
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
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
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
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
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
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
Flexion Compression
a) hyperflexion
b) hyperextension
c) loss of ant. vertebral height
d) subluxation or dislocation
hyperflexion
loss of ant. vertebral height
Flexion Distraction
a) hyperflexion
b) hyperextension
c) loss of ant. vertebral height
d) subluxation or dislocation
hyperflexion

subluxation or dislocation
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
T/F Rotation fractures can cause subluxation, dislocation, vertebral body injury, locked facet joints
True
The odontoid process is found
a) on C1
b) on C2
C2
An avulsion fracture
a) typically stable
b) involves the odontoid process
c) typically unstable
d) involves facets
typically stable
involves the odontoid process
What is the most common cause of cervical injury? ___________

TEST?
MVAs
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
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
Tetraplegia
a) C1
b) C3 - C5
c) paralysis diaphragm, arms & legs
d) T1 and below
C3 - C5
paralysis diaphragm, arms & legs

AKA quadraplegia
T/F If SCI is just below C5-C6 it is possible to have a functional diaphragm and some upper extremity movement
True

can be called "tetraplegia"
Paraplegia
a) T1 & below
b) C5 - C6
c) paralysis of legs only
d) paralysis of diaphragm & legs
T1 & below

paralysis of legs only
T/F The term perineal paraplegia refers to SCI @ S2 - S5
True
pt will have bladder, bowel, sexual disfunctions
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
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
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
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
A cervicomedullary syndrome pt with peripheral sensory loss has suffered an injury where?
a) medulla
b) C3 - C4
medulla
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
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
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
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
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
SCI above T5
a) HOTN
b) Sympathectomy
c) HTN
HTN
SCI below T5
a) HOTN
b) Sympathectomy
c) HTN
HOTN
Sympathectomy
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)
T/F The risk of DVT in SCI is 40 - 100%
True
PE is the 3rd leading cause of death in SCI
DVT occurs more often when it is complete SCI
Hyperreflexic Syndrome is found in 85% of SCI injuries above
a) T12
b) T8
c) T7
d) T5
T5
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)
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
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
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?
NOT SUX, THAT'S FOR DANG SURE! (risk ↑K)
Rocuronium would be OK
Why would you need to be cautious when using Phenylephrine in an SCI pt?
b/c vessels are already maximally constricted. The SVR will ↑ but so will afterload (pt can't handle this) and CO ↓'s
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
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)
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
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
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
ALS is degeneration of
a) corticospinal tract
b) spinothalmic tract
corticospinal tract
these guys are "jerks"
MOTOR!!!! anterior column
Which neurologic disorder is the most common?
a) Parkinson's
b) Alzheimer's
c) ALS
d) Multiple Sclerosis
Alzheimer's
Which neurologic disorder is the 2nd most common?
a) Parkinson's
b) Alzheimer's
c) ALS
d) Multiple Sclerosis
Parkinson's
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
Which neurologic disease would you want to avoid giving demerol to
a) Parkinson's
b) Alzheimer's
c) ALS
d) Multiple Sclerosis
Parkinson's
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
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
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!
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
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)
Which of the following is the most common Demyelinating disease process
a) Guillain Barre
b) Multiple Sclerosis
c) ALS
Guillain Barre
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
What surgical position has the highest risk of VAE?

TEST?
Sitting
Proper placement of the precordial doppler for detection of VAE is?

TEST?
RIGHT of the sternum between 3 & 6 intercostal space
Volatile Anesthetics that increase ICP include

TEST?
SEVO, DES, N2O
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
Does Ketamine increase CBV?

TEST?
Yes, but it doesn't decrease CMRO2
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
Successful factors for awake crani: cooperative pt, good rapport, good airway

TEST?
that's the answer
Which surgery is used for epilepsy refractory to medical treatment?

TEST?
Vagal Nerve Stimulator
The most effective drug for identification of ictal cortex is?

TEST?
Alfentanil
Complications of vagal nerve stimulator include

TEST?
bradycardia, hoarseness, unilateral vocal cord paralysis