Neuro Anesthesia Half-Day End-of-Block Test
Acute arterial hypertension in a patient with an intra-cranial mass may:
A) Directly increase ICP
B) Increase vasogenic edema
C) Increase brain shift
D) All of the above
Autonomic hyperreflexia:
A) Is associated with tachycardia
B) Is often associated with headache and hypotension
C) Is rare in cervical spinal cord injury
D) Presents with hypertension, bradycardia, and facial flushing
E) Is associated with flushing below the level of injury
Patients with spinal cord trauma:
A) May have return of deep tendon reflexes after initial flaccid paralysis
B) Rarely have hypotension during the acute period
C) Must always be given vigorous fluid infusion for hypotension
D) Often manifest hypocalcemia
E) Develop autonomic hyperreflexia during the period of spinal shock
Surgical injection of the carotid sinus with a local anesthetic can be expected to:
A) Produce bradycardia
B) Produce hypotension
C) Produce hypertension
D) Prevent reflex bradycardia and hypotension
E) Produce tachycardia
If barbiturate therapy is used 'to attempt brain 'protection, the end point should be:
A) A blood pressure greater than 100 mmHg
B) An isoelectric EEG
C) A PaCOZ of less than 40 mmHg
D) A normal cerebral blood flow
E) Burst-suppression on the EEG
The most common type of brain tumor associated with vasogenic edema is:
A) Meningioma
B) Astrocytoma
C) Medulloblastoma
D) Metastatic
E) Choroid plexus papilloma
The "Cushing triad" includes:
A) Bradycardia
B) Hypotension
C) Tachycardia
D) Decerebrate posturing
E) Dilated pupils
CT scan evidence of reduced intracranial compliance includes:
A) Brain shift
B) Edema
C) Slit-like ventricles
D) Obliteration of basal CSF cisterns
E) All of the above
The main goal in the anesthetic induction of the patient for intracranial aneurysm clipping is:
A) Avoidance of mean arterial pressure below 50 mmHg
B) Maintenance of a stable transmural pressure
C) Avoidance of decrease in intracranial pressure
D) Stabilization of the heart rate with Propranolol
E) Establishment of hypothermic conditions to allow brain protection
A common complication of ruptured aneurysm is:
A) Hydrocephalus
B) Hypernatremia
C) Disseminated intravascular coagulopathy
D) Quadriplegia
E) Blindness
EKG changes most often associated with ruptured aneurysms are:
A) Shortened PT intervals and peaked T-waves
B) Prolonged QT interval, T-wave inversion, and prominent U waves.
C) Atrial fibrillation
D) Bradycardia
E) Sinus arrest
During pregnancy, aneurysm rupture:
A) Occurs in about one in 100,000 patients
B) Is responsible for about 20% of maternal deaths
C) Is most likely in the second trimester
D) Always requires immediate surgery
E) Rarely causes hypertension
The risk of perioperative stroke (i.e., permanent neurologic deficit) following carotid endarterectomy
A) Less than 1%
B) 2 to 5%
C) 6 to 10%
D) 11 to 15%
E) Greater than 15%
The ability of the brain to autoregulate cerebral blood flow (CBF) refers to:
A) Maintenance of constant CBF despite changes in PaC02
B) Maintenance of constant CBF despite changes in temperature
C) Maintenance of constant CBF, despite changes in cerebral metabolic rate for oxygen
D) Maintenance of constant CBF changes in blood pressure
E) The relationship between CBF and cerebral metabolic rate for glucose
What percentage of patients with severe head injury also have fractured cervical vertebra?
A) 5%
B) 10%
C) 15%
D) 20%
E) 25%
Glucose should be avoided in intravenous solutions because:
A) It increases perioperative sepsis
B) High glucose levels are associated with cardiac dysrhythmias
C) High glucose levels cause cerebrovascular dilatation
D) Glucose has antidiuretic action
E) High glucose levels are associated with increased CNS damage following ischemia
The brain compensates for a rising ICP by:
A) Decreasing electrophysiologic activity
B) Redistributing CSF and intracranial blood
C) Decreasing mean blood pressure
D) Increasing heart rate
E) Decreasing CSF drainage
Cerebral perfusion pressure is equal to:
A) Systolic blood pressure minus central venous pressure
B) Mean arterial pressure minus jugular venous pressure
C) Diastolic blood pressure minus pulmonary capillary wedge pressure
D) Systolic blood pressure minus one-third diastolic blood pressure
E) Diastolic blood pressure minus jugular venous pressure
The usual incidence of venous air embolism in sitting posterior fossa craniectomy is:
A) 10%
B) 20%
C) 40%
D) 60%
E) 80%
The usual incidence of venous air embolism in supine posterior fossa craniectomy is:
A) 10%
B) 20%
C) 40%
D) 60%
E) 80%
The most clinically useful early monitor for air embolism is:
A) Expired PCO2
B) Doppler
C) Pulmonary capillary wedge pressure
D) Atrial pressure
E) Esophageal stethoscope
Facial nerve function can be evaluated during a posterior fossa craniotomy by:
A) EMG
B) SSEP
C) EEG
D) BAER
E) Peripheral nerve blockade monitor
The blood supply to the motor tracts of the spinal cord is primarily from the:
A) Posterior spinal artery
B) Anterior spinal artery
C) Penetrating branches of the radicular arteries
D) Artery of Adamkiewicz
E) Basilar artery
The electroencephalographic (EEG) waveform with a frequency range of 8 to 13 Hz is associated with:
A) Alpha activity
B) Beta activity
C) Theta activity
D) Delta activity
E) Gamma activity
The compressed spectra array (CSA) recording of the electroencephalogram (EEG):
A) Is more accurate than a standard tracing
B) Presents data in a format of amplitude, time and frequency
C) Is more accurate for determination of sudden events
D) Requires no training for interpretation
E) Should be in use for all neurosurgical procedures
Hormonal products of the anterior pituitary include all of the following EXCEPT:
A) Growth hormone
B) Leutenizing hormone
C) Antidiuretic hormone
D) Follicle-stimulating hormone
E) Thyrotropin
Which is the most profound chemical stimulus for regulation of cerebral blood flow?
A) Metabolic alkalosis
B) Hypothermia
C) Hyperthermia
D) Carbon dioxide
E) Hypercalcemia
When ventilating the patient with a head injury, all of the following statements are true EXCEPT:
A) The patient should be kept supine
B) Prolonged hyperventilation has diminished efficacy in reducing ICP
C) PEEP may be appropriate
D) Hypoxia and hypercarbia should be avoided
E) The patient should be prevented from coughing
Mannitol may lead to subdural hematoma by:
A) Causing cerebral edema
B) Affecting clotting mechanisms
C) Reducing ICP
D) Causing hypertension
E) Leakage through the vein wall
Treatment of the neurosurgical patient with mannitol may be followed by all of the following EXCEPT:
A) Initial hypervolemia
B) Decreased urine volume
C) Hypovolemia
D) Decreased venous pressure
E) A fall in arterial pressure
Signs of air embolism include all of the following EXCEPT:
A) Arrhythmia
B) Hypertension
C) Heart murmur
D) Bubbles at the operative site
E) Decreased end-expired carbon dioxide
As the neurosurgeon manipulates tissue in the posterior fossa, there is sudden arrhythmia. The anesthetists should:
A) Lower the head
B) Administer lidocaine
C) Inform the neurosurgeon
D) Turn off all anesthesia
To obtain maximum benefit from hyperventilation during a neurosurgical procedure, the PaC02 should be maintained at:
A) 25 to 30 mmHg
B) 20 to 25 mmHg
C) 15 to 20 mmHg
D) 35 to 40 mmHg
E) 40 to 45 mmHg
Following closed head injury, systemic sequelae may include all of the following EXCEPT:
A) Disseminated intravascular coagulation
B) Diabetes insipidus
C) Syndrome of inappropriate secretion of antidiuretic hormone
D) Hypoglycemia
E) Hypocarbia
An intraoperative "wake up" test performed during surgery on the spine:
A) Determines if distraction of the vertebral column compromised neurological function.
B) Is not necessary if somatosensory evoked potentials are monitored
C) Is a test of sensory function
D) Determines adequacy of fluid replacement
E) Assesses motor function in the upper extremities
When the transducer system, the stopcock immediately above the transducer diaphragm is opened to air and:
A) The transducer should be positioned at the point where pressure is measured
B) The position relative to the patient is irrelevant
C) The transducer should be positioned at the level the catheter enters the radial artery
D) The arm must be positioned at the level of the right atrium
E) The transducer should be re-zeroed whenever the position is changed
Neurotransmitters in the central nervous system which exert an inhibitory action of postsynaptic neurons include all except:
A) Dopamine
B) Glycine
C) Serotonin
D) Gamma-aminobutyric acid (GABA)
E) Glutamate
All are true about dexamethasone except:
A) Will reduce the edema due to brain tumor
B) Has an effect because of its osmolar property
C) Is less effective in control of edema secondary to injury
D) Is effective in preventing Addison's disease
E) May cause an increase in serum glucose
In the patient with an acute injury at the C4/5 level an unlikely finding would be:
A) A major loss of diaphragmatic power
B) No breathing
C) Grossly impaired alveolar ventilation
D) Disturbance of heart rate
E) Flaccid quadriplegia
With regards to autonomic hyperreflexia, all are true except:
A) Occurs with a lesion above T5
B) May be initiated by bladder distention
C) Is accompanied by severe hypertension
D) Is accompanied by tachycardia
E) May be prevented by the use of epidural anesthesia
Considerations in the care of a patient with arteriovenous malformation; All are true except:
A) Critical control of blood pressure during induction
B) Barbiturate-induced coma for control of cerebral blood flow during resection may be necessary.
C) Controlled hypotension may be necessary
D) Malignant brain swelling may occur
E) Once the AVM is resected the risk of cerebral oedema is reduced
Complications associated with the sitting position include all of the following except:
A) Sciatic and cranial nerve trauma
B) Pneumocephalus.
C) Quadriplegia.
D) Airway edema.
E) Subarachnoid hemorrhage
The risk of significant hemodynamic consequences during air embolus may depend on all except:
A) Rate of entry
B) Site of air entrainment
C) Volume of air entrained
D) The age of the patient
E) Whether the patient has a patent foramen ovale
Treatment of cerebral edema includes all of the following except:
A) Osmotic diuretics
B) Loop diuretics
C) Steroids
D) Surgical decompression
E) “Triple H” therapy
During hypothermia all are true except:
A) Cerebral metabolism is decreased
B) Cerebral vascular resistance increases
C) Cerebral vasculature remains responsive to carbon dioxide
D) More glucose is required by the brain for metabolism
E) Dysrhythmias are more common
The use of induced hypotension in neurosurgery: All are true except:
A) Usually is needed for short intervals
B) Can be useful in AVM surgery
C) Causes increased physiologic dead space
D) May be relatively contraindicated
E) Is best achieved using nimodopine
With regards to air embolism; all are true except:
A) Is most common in the sitting position
B) Occurs most often with occipital craniectomy
C) Occurs through the diploic veins and venous sinuses
D) Requires a relatively negative venous pressure at the wound
E) Is a rare occurrence
Causes of arrhythmia associated with neurosurgical procedures include all of the following except:
A) Orbital decompression
B) Tentorial manipulation
C) Tonsillar herniations
D) Carotid artery ligation
E) Bipolar electrocautery
During a cerebral aneurysm procedure, sodium nitroprusside is infused. All of the following may be seen except:
A) Short duration of action
B) Bradycardia
C) Acidemia
D) Increasing dose requirement over time
E) Cyanide toxicity
When a precordial Doppler ultrasonic transducer is used to detect air embolus all are true except:
A) Can detect 0.5. Ml of air
B) Functions at 15 Hz
C) Should be placed over the right side of the heart
D) Is more sensitive than capnography
E) Should be positioned between the 2nd and 5th intercostal space
Which of the following anesthetic agents increase cerebral blook flow?
A) Thiopental
B) Etomidate
C) Propofol
D) Halothane
All of the following is/are associated with an increased risk of neurologic deficit subsequent to operations for spinal deformity? Except:
A) Neuromuscular scoliosis
B) Increase in amplitude of somatosensory evoked potentials (SEP)
C) Use of sublaminar wires
D) Increase in latency of SEP
Which of the following is/are characteristic of neurogenic pulmonary edema? Except:
A) Symptoms within 12 hours after central nervous system injury
B) Resolution within hours to days with supportive therapy.
C) Increased ventilation/perfusion mismatching
D) Consolidated infiltrates seen on chest radiograph
Appropriate airway management in a patient with potential cervical spine injury could include all of the following except:
A) Oral intubation with stabilization of the cervical spine
B) Light-wand-guided oral intubation
C) Fiberoptic nasal intubation
D) Blind nasotracheal intubation
E) Direct laryngoscopy conventional
Following craniotomy to remove a right frontal meningioma, a 44-year-old white male is noted to have urinary output of 250 mL/hour. Which of the following serum urinary electrolyte laboratory values are compatible with the diagnosis insipidus?
A) Serum Na 128 mEq/L; urine Na 75 mEq/L; urine osmolality 80 mOsm/L
B) Serum Na 128 mEq/L; urine Na 100 mEq/L; urine osmolality 475 mOsm/L
C) Serum Na 146 mEq/L; urine Na 10 mEq/L; urine osmolality 80 mOsm/L
D) Serum Na 138 mEq/L; urine Na mEq/L; urine osmolality 290 mOsm/L
The MOST Common etiology of hyponatremia in head-injured patients is?
A) Fluid Restriction
B) High calorie tube feeding
C) Inappropriate secretion of antidiuretic hormone
D) Mannitol administration
Following carotid endarterectomy, a patient develops new hemiplegia while in the postanesthesia care unit. The least likely cause of this finding would be:
A) Cerebral embolism
B) Reperfusion injury
C) Arterial thrombosis
D) Intracerebral hemorrhage
What is the most likely mechanism for subdural hematoma after administration of mannitol in elderly patients?
A) Cortical vein disruption
B) Systemic hypertension
C) Coagulopathy
D) Altered blood brain barrier
Useful monitors for Post fossa craniotomy include all except:
A) BAEP
B) Facial nerve monitor
C) CVP
D) TEE
The major anesthetic concern for a patient with a C6-7 spine injury 72 hours ago:
A) hypersensitivity to succinylcholine
B) spinal shock
C) apnea
D) hypertension
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