STUDENT PRESENTATION EXAM #3

neuro and renal

Neuro APP

Which cells form the myelin sheath in the brain and spinal cord?

A. Astrocytes

B. Oligodendrocytes

C. Microglialcells

D. Transitional epithelial cells

B.

Which brain center secretes melatonin?

A. Thalamus

B. Hypothalamus

C. Medullaoblongata

D. Pineal gland

D. Pineal gland

What is the major inhibitory neurotransmitter found in the CNS?

A. Glutamate

B. GABA

C. Glycine

D. Opioid

B. GABA

The cervical spinal cord blood supply is via which two arteries? (Select 2).

A. Vertebral artery

B. Artery of Adamkiewicz

C. Radicular arteries

D. Carotid arteries

A., C.

Which rexed laminae are located in the dorsal horn and receive sensory information from the periphery?

A. Laminae VII, VIII, IX

B. LaminaeI-VI

C. Laminae V, VI, X

D. Laminae I, II, III

B.

Which type of glial cells form the myelin sheaths in the brain and spinal cords?

A. Astrocytes

B. Oligodendrocytes

C. Microglialcells

D. Ependymal cells

B.

Muscarinic cholinergic receptors are found on (Select 3):

A. Smooth muscle

B. Cardiac muscle

C. Adrenal medulla

D. Sweat glands

A., B., D.

Which of the following does NOT disrupt the BBB?

A. Trauma

B. Tumors

C. Ischemia

D. Sepsis

D.

Sympathetic preganglionic neurons secrete _____, sympathetic postganglionic neurons secrete _____, parasympathetic preganglionic neurons secrete ______, and parasympathetic postganglionic neurons secrete ______.

A. NE, ACh, ACh, NE

B. ACh, ACh, ACh, NE

C. NE, NE, ACh, ACh

D. ACh, NE, ACh, ACh

D.

Blood is supplied to the brain from two arterial circulations. Which two arteries are responsible?

A. Vertebral and femoral

B. Femoral and mesenteric

C. Vertebral and carotid

D. Carotid and femoral

C.

What is the primary function of the ependymal cells?

A. Forms the choroid plexus which secretes CSF

B. Facilitate phagocytosis

C. Form myelin sheath in the brain and spinal cord

D. Modulate impulses from the limbic system to the cerebral cortex

A.

What are known as the special sense neurons?

A. Bipolar

B. Unipolar

C. Multipolar

D. Pseudo unipolar

A.

Normal hydrostatic pressure of CSF is

A. 0-5 mmHg

B. 5-15 mmHg

C. 15-25 mmHg

D. 25-35 mmHg

B.

Which of the following fiber types control muscle tone?

A. A-gamma fibers

B. A-deltafibers

C. C fibers

D. B fibers

A.

The largest portion of the spinal canal is at

A. L4

B. L5

C. L3

D. None of the above

B.

What amino acid is used in TURP procedures but can cause the unfortunate side effect of

post-operative visual impairment?

A. NE

B. GABA

C. SubstanceP

D. Glycine

D.

Which meningeal layer adheres to the brain and spinal cord?

A. Epidural space

B. Arachnoid mater

C. Pia mater

D. Dura mater

C.

Neuro Anesthesia Management

At what range is CPP autoregulated?

A. 10-50 mmHg

B. 24-72 mmHg

C. 50-150 mmHg

D. 250-1,000 mmHg

C. 50-150 mmHg

Which of the following is not part of Cushing's Triad?

A. Hypertension

B. Bradycardia

C. Irregular breathing

D. Intense hunger

D. Intense hunger

What is the gold standard IV fluid to initiate in craniotomy fluid management?

A. D 1⁄2 NS w/ 40 mEq K+

B. LR

C. 3% NS

D. 0.9% NS

D.

Using dextrose containing fluids for craniotomy fluid management does what?

A. Provides consistent glucose to the patient's brain intraoperatively

B. Reduces post-op adverse events

C. Exacerbates ischemia and should be avoided

D. Reduces intra-operative ICP

C.

What are some LATE symptoms of VAE? (Select 2).

A. Increased PAP

B. Hypotension

C. Sudden drop in ETCO2

D. "Mill Wheel" murmur

B. Hypotension

D. "Mill Wheel" murmur

What is the most sensitive detector of venous air embolism?

A. Using a stethoscope at the apex of the heart

B. Precordialdoppler

C. TEE

D. Capnography

C.

All of the following are early signs of a venous air embolism EXCEPT:

A. Sudden drop in ETCO2

B. Air seen on TEE

C. Hypotension

D. Increased PAP

C.

Which of the following is not a symptom of increased ICP?

A. N/V

B. Dry mouth

C. Mydriasis

D. Coma

B.

Anesthesia considerations for a patient undergoing a craniotomy includes all of the

following EXCEPT: (Select 3).

A. Careful blood pressure control to maintain within 10% of preoperative levels

B. Administration of dextrose-containing IVF to maintain hypervolemia

C. Mild hyperventilation to target PaCO2 of 30-35 mmHg

D. Induction with IV propofol is preferred compared to ketamine

E. Rapid, sudden emergence from anesthesia

F. Complete avoidance of opioids in the postoperative period to control pain.

B, E, F

Which method is not used to monitor or detect a venous air embolism during surgery?

A. TEE

B. Foley catheter

C. P A catheter

D. Precordial doppler

E. Capnography

B.

Which induction agent will elevate CMRO2?

A. Thiopental

B. Propofol

C. Lorazepam

D. Ketamine

D. Ketamine

When monitoring SSEPs during a long spinal case, what should your anesthetic plan include?

A. Sevoflurane at a MAC of 1.5

B. Keep MAC less than 0.5 or TIVA

C. MAC does not affect SSEPs

D. Propofol at high doses

B.

All of the following can be used to decrease cerebral blood volume except

A. Hyperventilation

B. Reduce intrathoracic pressure

C. Hyperthermia

D. Head of be > 30 degrees

C.

All of the following are early signs and symptoms of VAE EXCEPT:

A. Sudden drop in ETCO2

B. Increased PAP

C. Hypotension

D. Air seen on TEE

C. Hypotension

During induction for a craniotomy, the goal is to avoid

A. Increases in ICP

B. Decreases in ICP

C. Decreasing CBF

D. Both A & C

D.

Which of the following is a late symptom of a VAE?

A. Sudden drop in ETCO2

B. Increased PAP

C. Air seen on TEE

D. Hypoxemia

D. Hypoxemia

What is the gold standard for craniotomy fluid management?

A. LR

B. D5W

C. D5 1⁄2 NS

D. 0.9% NaCl

D.

Endocrine APP

1. Glucose is the most abundant fuel for the body. Which organ is a glucose obligate organ?

A. Liver

B. Heart

C. Brain

D. Pancreas

C.

Anesthetic management of a patient with diabetes mellitus includes which of the following?

A. Avoid LMA

B. Assess electrolytes and hydration

C. May be sensitive to respiratory depressant drugs

D. May have impaired thermoregulation

E. All of the above

E.

The main variable in influencing ADH secretion is:

A. Low blood glucose

B. Vasodilation

C. Elevated atrial pressure

D. Elevated plasma osmolarity

D.

Which endocrine gland produces ADH?

A. Anterior pituitary

B. Posterior pituitary

C. Hypothalamus

D. Pineal gland

C. Hypothalamus

What effect does acidosis have on serum ionized calcium?

A. Increased

B. Decreased

C. No effect

D. All of the above

A.

What is correct regarding steroid hormones?

A. They are unbound and have a long half-life

B. They are bound and have a short half-life

C. They are bound and have a longer half-life

D. They are unbound and have a short half-life

C. They are bound and have a longer half-life

Anesthetic considerations for acromegaly includes all of the following EXCEPT?

A. May require smaller than typical ETT

B. Nasal intubation

C. Difficult mask ventilation

D. Difficult intubation

B. Nasal intubation

Which metabolic process refers to the creation of free fatty acids and glycerol from triglyceride stores?

A. Lipolysis

B. Glycolysis

C. Oxidative phosphorylation

D. Gluconeogenesis

A. Lipolysis

Which of the following hormones are NOT released from the anterior pituitary? (Select 3).

A. Growth hormone

B. Prolactin

C. Vasopressin

D. Somatostatin

E. Follicle-stimulating hormone

F. Calcitonin

C, D, F

Which of the following is NOT a hormone molecule type?

A. Peptide

B. Tyrosine AA derivative

C. Adipose

D. Steroid

C.

What does FSH do?

A. Ovarian follicle development in women B. Hunger inhibition

C. Spermatogenesis in males

D. A & B only

E. A & C only

F. All of the above

E.

Which of the following hormones is NOT secreted by the anterior pituitary hormone?

A. LH

B. FSH

C. ADH

D. ACTH

C.

Which of the following is NOT a clinical manifestation of diabetes insipidus?

A. Dehydration

B. Low urine osmolarity

C. High urine osmolarity

D. High serum osmolarity

C. High urine osmolarity

Choose the common finding of Dwarfism that is NOT correct.

A. Hypoglycemia

B. Mild obesity

C. Hyperglycemia

D. Delayed puberty

C.

What vasopressin receptor stimulates vasoconstriction?

A. V1

B. V2

C. V3

D. V4

A. V1

Which hormones are most common for benign hyper-secreting pituitary adenomas? (Select 3).

A. Prolactin

B. GH

C. ACTH

D. LH

A, B, C

Which of the following anesthesia considerations regarding SIADH is the MOST important?

A. Assessing patients volume status

B. Fluid management

C. Hourly assessments of UOP, serum Na+, plasma osmolarity, and urine osmolarity

D. Prevent nausea and vomiting

D.

Endocrine Diseases

Which symptom is not part of the pheochromocytoma triad?

A. Headache

B. Diaphoresis

C. Tachycardia

D. Flatulence

D.

All are signs and symptoms of hypothyroidism EXCEPT?

A. Weight gain

B. Lethargy

C. Delayed GI emptying

D. Exophthalmos

D.

HHS is associated with fluid loss up to how much?

A. 500 ml

B. 1 L

C. 9 L

D. 15 L

C.

Select the 2 enzymes that breakdown catecholamines.

A. Metanephrine

B. MAO

C. COMT

D. VMA

B, C

What medication should be avoided in a patient undergoing anesthesia and has Addison's disease?

A. Dexmedetomidine

B. Propofol

C. Lactated Ringers

D. Etomidate

D. Etomidate

Do most pheochromocytomas secrete epinephrine or norepinephrine and which blood pressure medication should be first line?

A. Norepinephrine; Phenoxybenzamine

B. Epinephrine; Labetolol

C. Norepinephrine; CCB

D. Epinephrine; Clonidine

A. Norepinephrine; Phenoxybenzamine

Treatment of a patient experiencing a thyroid storm includes all of the following EXCEPT:

A. Antithyroid mediations (PTU)

B. IV fluids

C. Glucocorticoids

D. Deepen the sedation/paralytic

D.

According to the American Diabetes Association, the threshold for hypoglycemia is a serum blood glucose below or equal to ____.

A. 50 mg/dL

B. 120 mg/dL

C. 40 mg/dL

D. 70 mg/dL

D.

The CRNA is caring for a patient undergoing surgery to remove a pheochromocytoma. Which of the following anesthesia considerations would in inappropriate?

A. Preoperative use of metoprolol, followed by phenoxybenzamine as needed to manage catecholamine excess-related hypertension and dysrhythmias.

B. Treatment of hypotension with IVF and phenylephrine in the intra-operative period

C. Preoperative anxiolysis with administration of midazolam

D. Maintenance with volatile agents (sevoflurane, isoflurane) or TIVA (propofol)

for rapid titration of anesthetic depth

A.

What is the biggest difference between DKA and HHS?

A. Only one has increased glucose

B. Only one has ketoacidosis

C. Only one has increased osmolarity

D. Only one requires volume replacement

B.

Which of the following is a role of cortisol?

A. Protein breakdown

B. Adiposebreakdown

C. Inflammation suppression

D. Increases the number of -receptors in the myocardium

E. A & B only

F. All of the above

G. None of the above

F.

Which of the following is NOT a sign/symptom of Cushing Syndrome?

A. Moon face

B. Gynecomastia

C. Dry tongue

D. Na+ and fluid retention

C.

Which region of the adrenal gland is incorrectly paired?

A. Zona glomerulosa - mineralocorticoids

B. Zona fasciculata-androgens

C. Zona fasciculata-glucocorticoids

D. Medulla - catecholamines

B.

Choose the correct statement about primary insufficiency for Addison's disease.

A. Decreased release of steroids from adrenals

B. Occurs due to HPA axis suppression from glucocorticoid therapy

C. Adrenal glands do not secrete enough steroids

D. Life threatening medical emergency

C. Adrenal glands do not secrete enough steroids

In hypothyroidism, what happens to the TSH level?

A. Increases

B. Decreases

C. No change

A.

Which medication should you avoid in patients with adrenal insufficiency?

A. Etomidate

B. Propofol

C. Versed

D. Rocuronium

A. Etomidate

Insulin deficiency in DKA leads to a triad of severe conditions including all of the following effects EXCEPT:

A. Ketonemia

B. Hyperglycemia

C. Hyperkalemia

D. Acidemia

C.

Max dilation of cerebal vascular if PaCO2 is

80-100

Anesthetic agent that decreases CBF

Propofol

barbss, etomidate super decrease

prop, benzos, dexmedetomidine decrease

What fiber for pain, temp touch

A delta & dC technically

sensory/ afferent