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54 Cards in this Set
- Front
- Back
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Which of the following drugs may be used FIRST to reduce ICP?
a) loop diuretics b) neuromuscular blocking agents c) barbituates d) analgesics |
d) analgesics
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Current guidelines recommend hyperventilation may be used to reduce ICP. What is the optimal range of PaCO2?
a) less than 25 mm Hg b) less than 35 mm Hg c) 35 to 45 mm Hg d) 45 to 55 mm Hg |
c) 35 to 45 mm Hg
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A patient with a GCS less than ________ must have the airway secured.
a) 9 b) 10 c) 13 d) 15 |
a) 9
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MAP should be maintained at more than ______ mm Hg to keep the cerebral perfusion pressure greater than ____ mm Hg.
a) 90; 70 b) 100; 80 c) 50; 40 d) 40; 80 |
a) 90; 70
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The Glascow Coma Scale assesses
a) cognition b) speech patterns c) arousal d) problem-solving abilities |
c) arousal
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A unilaterally dilated pupil is indicative of
a) atropine or atropine-like drugs b) a brainstem lesion c) opiod overdose d) cranial nerve lesion |
d) cranial nerve lesion
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The most important component of the neurologic assessment is
a) vital signs b) level of consciousness c) pupillary reactions d) protective reflexes |
b) level of consciousness
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Your patient responds to stimuli & the GCS is 15. What would be your initial assessment and your next action?
a) level of responsiveness is intac; vital signs would be the next logical step b) level of responsiveness most probably not intact; an in-depth neuro assessment is required c)you are unable to completely evaluate the level of responsiveness and need more clinical data d) the patient demonstrates no cognitive deficits; pupillary assessment would be the next logical step |
c)you are unable to completely evaluate the level of responsiveness and need more clinical data
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An increase in brain volume can result in
a) herniation b) cerebral vasodilation c) autoregulation d) hydrocephelus |
a) herniation
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Cerebral edema is caused by
a) an increase in cerebral blood flow b) an increase in brain volume c) an increase in CSF d) an increase in ICP |
b) an increase in brain volume
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Cerebral perfusion decreases when
a) ICP is high b) MAP is low c) ICP is the same as MAP d) all of the above |
d) all of the above
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Normal cerebral perfusion pressure is
a) highly individualized b) 50 to 80 mm Hg c) 80 to 100 mm Hg d) 100 to 120 mm Hg |
c) 80 to 100 mm Hg
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What is the cerebral perfusion pressure if the MAP is 95 mm Hg and ICP is 15 mm Hg?
a) 65 mm Hg b) 80 mm Hg c) 110 mm Hg d) 125 mm Hg |
b) 80 mm Hg
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Flexion of the neck may cause elevations in intracranial volume by
a) causing a decrease in venous outflow b) causing increase in venous return c) causing cerebral vasodilation d) increasing venous outflow |
a) causing a decrease in venous outflow
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Which of the following components of intracranial volume is displaced most easily and rapidly?
a) brain volume b) cerebral blood volume c) CSF d) cranium |
c) CSF
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The Monro-Kellie hypothesis states that volume increases in the adult intracranial vault
a) are initially well tolerated through compensatory mechanisms b) are tolerated well because of the flexibility of the cranial vault c) can be compensated for only by cerebrospinal fluid buffering techniques d) usually result in death because the vault is unable to accomodate increases in volume |
a) are initially well tolerated through compensatory mechanisms
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Cerebral blood flow decreases with
a) cerebral edema b) low cardiac output c) cerebral vasoconstriction d) all of the above |
d) all of the above
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Pressure regulation is an autoregulatory mechanism whereby cerebral blood vessels constrict in response to
a) systemic hypertension b) hypercarbia c) systemic hypotension d) hypoxia |
a) systemic hypertension
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Cerebral blood vessels dilate in response to
a) increased serum oxygen b) increased serum carbon dioxide c) decreased serum oxygen d) decreased serum carbon dioxide |
b) increased serum carbon dioxide
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Define arousal (not sexually; Steve).
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The component of consciousness concerned with the ability of an individual simply to respond to environmental stimuli; such as opening eyes to speech or turning the head towards a noise.
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Define autoregulation.
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The localized matching of cerebral blood flow with cerebral metabolism.
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What is the blood-brain barrier?
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A network of cells and membranes that control brain volume and contents by controlling permeability.
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What is cerebral blood flow?
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Blood flow to the brain is maintained at a constant rate by vasodilation of the vessels to increase the flow or vasoconstriction to decrease the flow.
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What is cerebral blood volume?
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The amount of blood in the cranial vault at any given point in time; occupies about 10% of the total intracranial volume.
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What is cerebral perfusion pressure?
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An estimate of the adequacy of cerebral circulation. Perfusion pressure to the brain that is the difference between the MAP and the mean ICP. It is calculated as follows: CCP = MAP - ICP
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What is the circle of Willis?
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An area in the brain where carotid arteries and vertebral arteries unite to provide collateral blood flow to either side of the brain.
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Define consciousness.
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A state of general awareness of oneself and environment; made up of the components of arousal and content.
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What is content in terms of consciousness?
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The component of consciousness concerned with interpreting environmental stimuli; includes thinking, memory, problem solving, orientation, and speech.
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Describe Cushing's triad.
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Vital sign changes that occur when ICP equals MAP and includes: 1) increased systolic blood pressure 2) decreased diastolic blood pressure and 3) bradycardia
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Define decerebrate positioning.
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Abnormal extension. Neck is extended with jaw clenched; arms pronate and extend straight out; feet are plantar flexed.
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Define decorticate positioning.
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Abnormal flexion. Upper arms move upward to the chest; elbows, wrists, and fingers flex; legs extend with internal rotation; flex feet
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Describe doll's eye movements.
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Oculocephalic reflex. Reflexive movements of the eyes in the opposite direction of head rotation.
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Describe expressive aphasia.
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The inability to write or use language appropriately.
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Describe global aphasia.
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The inability to use or understand language.
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What is herniation of the brain?
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A shifting or displacement of brain tissue, which causes pressure and traction on cerebral structures and produces clinical symptoms.
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What is hydrocephalus?
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A clinical syndrome caused by an increased production of cerbrospinal fluid that exceeds the absorbtion rate.
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Describe hyperemia.
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A state in which cerebral blood flow is higher than cerbral metabolic needs; also known as "luxury perfusion."
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What is Intracranial Hypertension?
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Increased intracranial pressure.
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Describe the Monro-Kellie hypothesis.
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A principle that states that the skull is a rigid vault filled with noncompressible contents: brain, blood, and cerebrospinal fluid; if any one component increases in volume, one or both remaining components must decrease in volume.
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What is Nystagmus?
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Lateral tonic deviation of the eyes towards a stimulus.
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What is Otorrhea?
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Drainage of fluid from the ear. (usually blood or CSF)
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Define receptive aphasia.
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The inability to understand written or spoken words.
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Describe responsiveness.
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A term synonymous with consciousness which is a general state of awarenss of oneself and environment.
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What is the reticular activating system (RAS)?
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A pathway of neurons and neuronal connections for transmission of sensory stimuli from the lower brainstem to the cerebral cortex; the anatomic basis of the arousal component of consciousness.
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Which of the following is protective because it is the primary collateral pathway when major cerebral vessels are occluded?
a) circle of Willis b) left internal carotid artery c) right internal carotid artery d) middle cerebral artery |
a) circle of Willis
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Cerebral arteries are more prone to rupture during hypertension because
a) there are so many of them b) they have autoregulation c) they are thin and delicate d) they are not protected by skeletal muscles |
c) they are thin and delicate
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Which of the following are TRUE statements about the venous circulation of th brain?
a) craniospinal veins are valveless b) craniospinal veins drain by gravity c) the venous circulation is a low-pressure system d) all of the above |
d) all of the above
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The localized matching of CBF with cerebral metabolism occurs through
a) autoregulation b) anaerobic metabolism c) luxury perfusion d) CSF |
a) autoregulation
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ICP remains relatively stable, and under normal conditions, it is usually less than
a) 5 mm Hg b) 15 mm Hg c) 30 mm Hg d) 50 mm Hg |
b) 15 mm Hg
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Which mechanism controls brain volume?
a) cerebral blood flow b) displacement of CSF c) blood-brain barrier d) vasoconstriction |
c) blood-brain barrier
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Normal adult CSF pressure in the supine position is
a) 1 to 5 mm Hg b) 5 to 13 mm Hg c) 13 to 20 mm Hg d) 50 to 200 mm Hg |
b) 5 to 13 mm Hg
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CPP depends on all of the following EXCEPT
a) cerebral blood volume b) brain volume c) CSF volume d) cerebral medullary regulation |
d) cerebral medullary regulation
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CPP must be greater than ______ mm Hg to ensure adequate cerebral oxygenation.
a) 70 b) 60 c) 50 d) 40 |
a) 70
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Your patient's MAP is 80 mm Hg and the ICP is 15 mm Hg. What is the cerebral perfusion pressure?
a) 50 mm Hg b) 65 mm Hg c) 95 mm Hg d) 110 mm Hg |
b) 65 mm Hg
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