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Quizzes > Quizzes for Business > Healthcare

Take the Neuro Anesthesia Knowledge Test

Sharpen Your Neuro Anesthesia Clinical Skills

Difficulty: Moderate
Questions: 20
Learning OutcomesStudy Material
Colorful paper art promoting a Neuro Anesthesia Knowledge Test quiz.

This free Neuro Anesthesia Knowledge Test challenges anesthesiology trainees and practitioners to deepen their understanding of cerebral hemodynamics, neurophysiologic monitoring, and patient safety. Perfect for medical students prepping for board exams or clinicians seeking a quick knowledge test, this practice quiz offers 15 thought-provoking multiple-choice questions. Each question can be tailored to your needs in the editor, making it ideal for personalized study. Explore related Neuro System Knowledge Test or the Anesthesia Coding Skills Assessment to broaden your expertise. Visit our quizzes library for more.

What is the normal range of intracranial pressure (ICP) in a healthy adult?
7-15 mmHg
20-25 mmHg
30-40 mmHg
0-5 mmHg
Normal ICP in adults ranges from 7 to 15 mmHg under resting conditions. Values above 20 mmHg are considered elevated and may require medical intervention.
Which physiologic factor is the primary determinant of cerebral blood flow (CBF) under normal conditions?
Mean arterial pressure (MAP)
Arterial oxygen tension (PaO2)
Arterial carbon dioxide tension (PaCO2)
Blood glucose level
PaCO2 is a potent regulator of cerebral vessel diameter, with hypercapnia causing vasodilation and hypocapnia causing vasoconstriction. Changes in PaCO2 thus directly alter CBF.
Which intravenous anesthetic agent is preferred for rapid emergence and early neurologic assessment after neurosurgery?
Ketamine
Propofol
Thiopental
Midazolam
Propofol has rapid redistribution and metabolism leading to fast recovery of consciousness. This allows for an early postoperative neurologic examination.
Which ventilation strategy is commonly used intraoperatively to reduce intracranial pressure?
Hypoventilation to PaCO2 of 50 - 55 mmHg
Maintain PaCO2 at 45 - 50 mmHg
Mild hyperventilation to PaCO2 of 30 - 35 mmHg
Hyperventilate to PaCO2 of 20 - 25 mmHg
Mild hyperventilation lowers PaCO2 to 30 - 35 mmHg, causing cerebral vasoconstriction and decreased cerebral blood flow and ICP. Excessive hyperventilation can risk cerebral ischemia.
Which surgical position is associated with the highest risk of venous air embolism in neurosurgery?
Lithotomy
Lateral
Sitting
Supine
In the sitting position, the surgical site is above the level of the heart, creating negative venous pressure and increasing the risk of air entrainment. Vigilant monitoring is required.
According to the Monro-Kellie doctrine, why must an increase in one intracranial component be offset by a decrease in another?
The skull can expand to accommodate increased volume
Intracranial contents volume is constant within a rigid skull
Brain tissue can redistribute to compensate
CSF is actively produced to match blood volume changes
The Monro-Kellie doctrine states that brain tissue, CSF, and blood occupy a fixed volume in the skull. An increase in one component must be balanced by a decrease in another to maintain pressure.
Somatosensory evoked potentials (SSEPs) primarily monitor which neural pathway?
Vestibulospinal tract
Corticospinal tract
Dorsal column - medial lemniscal pathway
Spinothalamic tract
SSEPs evaluate the integrity of the dorsal column - medial lemniscal pathway, which transmits light touch and proprioceptive information from peripheral nerves to the cortex.
Which intraoperative anesthetic strategy best preserves motor evoked potential (MEP) signals?
Sevoflurane at 2 MAC
Total intravenous anesthesia with minimal or no muscle relaxant
High-dose rocuronium infusion
Nitrous oxide 70% in oxygen
MEPs require intact neuromuscular transmission and minimal volatile anesthetic effect. TIVA with propofol and avoiding muscle relaxants preserves MEP amplitude.
What is the preferred airway management technique for a neurosurgical patient with an unstable cervical spine?
Awake fiberoptic intubation with inline stabilization
Blind nasal intubation
Standard direct laryngoscopy after rapid-sequence induction
Supraglottic airway device placement
Awake fiberoptic intubation allows controlled, minimal movement of the cervical spine while securing the airway. Inline stabilization prevents further spinal injury.
Which anesthetic agent is known to increase the amplitude of somatosensory evoked potentials (SSEPs)?
Propofol
Ketamine
Sevoflurane
Desflurane
Ketamine often increases SSEP amplitude by its dissociative properties and relative sparing of synaptic transmission in the dorsal columns. Volatile agents tend to depress evoked potentials.
Which monitoring modality is most sensitive for the early detection of venous air embolism during neurosurgery?
End-tidal CO2 monitoring
Precordial Doppler ultrasound
Central venous pressure waveform
Pulse oximetry
Precordial Doppler ultrasound is highly sensitive and noninvasive, detecting small volumes of air entering the circulation long before changes in end-tidal CO2 or blood pressure occur.
What is the recommended initial reversal strategy for warfarin in a patient with an intracranial hemorrhage?
Vitamin K orally over 24 hours
Cryoprecipitate infusion
Prothrombin complex concentrate (PCC)
Fresh frozen plasma infusion
PCC rapidly replenishes vitamin K-dependent clotting factors with less volume and more rapid effect than plasma. Immediate correction is critical in intracranial bleeding.
At 1 MAC of isoflurane, what is the approximate change in cerebral metabolic rate for oxygen (CMRO2)?
Increases CMRO2 by 20%
Decreases CMRO2 by about 20%
Decreases CMRO2 by about 80%
No significant change
At 1 MAC, isoflurane decreases CMRO2 by roughly 20% - 40%. This reduction in metabolic demand contributes to its neuroprotective profile.
How should the head and face be positioned in the prone position to minimize ocular pressure and prevent ischemic optic neuropathy?
Trendelenburg with head flexed
Neutral head alignment on a foam headrest with eyes free
Slight neck extension on a standard pillow
Head turned laterally on cotton pads
Neutral alignment in a specialized foam headrest prevents direct pressure on the eyes and ensures venous drainage, reducing the risk of increased intraocular pressure and optic neuropathy.
Below what arterial oxygen tension (PaO2) threshold does cerebral vasodilation begin to increase cerebral blood flow?
PaO2 < 60 mmHg
PaO2 < 40 mmHg
PaO2 < 80 mmHg
PaO2 < 50 mmHg
Cerebral vessels begin to dilate significantly when PaO2 drops below 50 mmHg, increasing cerebral blood flow to maintain oxygen delivery to the brain.
In a patient with chronic hypertension, how is the cerebral autoregulation curve altered?
Steepened curve without shifting
Shifted to the left (lower MAP thresholds)
Flattened curve without changing thresholds
Shifted to the right (higher MAP thresholds)
Chronic hypertension causes adaptive vessel remodeling, shifting the autoregulation curve to the right. Higher MAPs are then required to maintain constant CBF.
What is the primary mechanism by which mannitol reduces intracranial pressure?
Direct vasoconstriction of cerebral arteries
Increased CSF production
Crossing the blood - brain barrier to act as a diuretic
Creation of an osmotic gradient drawing water from brain tissue
Mannitol remains in the intravascular compartment and increases plasma osmolarity, drawing water out of the brain parenchyma into the bloodstream to lower ICP.
Which component of the intracranial pressure waveform indicates severely decreased intracranial compliance?
P3 (dicrotic) wave
A (plateau) waves
P2 (tidal) wave
P1 (percussion) wave
Plateau or A waves are abrupt elevations of ICP lasting 5 - 20 minutes and signify a loss of intracranial compliance and severely impaired autoregulation.
What is the initial positional management for a suspected intraoperative venous air embolism?
Left lateral decubitus with Trendelenburg tilt
Right lateral decubitus with reverse Trendelenburg
Prone with neutral alignment
Supine with head elevated
The left lateral decubitus (Durant position) with Trendelenburg tilt traps air in the right atrium and reduces the risk of air entering pulmonary circulation, facilitating aspiration.
How do high levels of positive end-expiratory pressure (PEEP) typically affect intracranial pressure (ICP)?
Decrease ICP by reducing cardiac output
Increase ICP by raising intrathoracic pressure and reducing venous return
Decrease ICP by improving cerebral venous drainage
No significant effect on ICP
High PEEP elevates intrathoracic pressure, impeding cerebral venous outflow and raising ICP. Careful titration is needed in neurosurgical patients.
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Learning Outcomes

  1. Analyze cerebral hemodynamics and intracranial pressure management
  2. Evaluate anesthetic effects on neurophysiologic monitoring data
  3. Identify optimal airway and ventilation strategies in neurosurgical cases
  4. Apply pharmacologic principles of neuro specific anesthetic agents
  5. Demonstrate patient positioning and safety protocols for neurosurgery
  6. Master perioperative risk assessment for neurologic complications

Cheat Sheet

  1. Optimize cerebral perfusion pressure - Think of your brain like a delicate garden: elevating the head of the bed to about 30° encourages proper blood flow and keeps intracranial pressure from flooding the scene. This simple adjustment can make a world of difference when you're balancing oxygen delivery and pressure inside the skull. Cerebral Edema on Wikipedia
  2. Prevent hypoxia and hypercapnia - Low oxygen and high carbon dioxide levels are like opening floodgates for brain swelling, since they cause powerful cerebral vasodilation. Keeping oxygenation and ventilation in check helps you avoid those dangerous pressure spikes. Cerebral Edema on Wikipedia
  3. Pretreat before rapid sequence intubation - Using sedatives and nondepolarizing muscle relaxants before intubation is like giving your patient a calming blanket: it reduces acute ICP surges. Although IV lidocaine sounds promising, the evidence just isn't there - stick with proven sedative agents. Cerebral Edema on Wikipedia
  4. Use PEEP with caution - Positive end-expiratory pressure can trickle oxygen back into your lungs but, at the same time, might hamper brain venous drainage and nudge ICP upward. Apply PEEP thoughtfully and monitor intracranial dynamics closely. Cerebral Edema on Wikipedia
  5. Maintain CPP above 60 mm Hg - Cerebral perfusion pressure is your brain's lifeline, so keeping it above 60 mm Hg ensures cells get the nutrients they crave. Avoid hypotonic fluids and consider hypertonic saline to pull extra fluid out of swollen brain tissues. Cerebral Edema on Wikipedia
  6. Leverage propofol for sedation - Propofol is a multitasker: it calms the patient, drops metabolic demand, and even fights seizures, all while giving you tight control over drug levels thanks to its quick on/off action. Just watch out for potential blood pressure dips. Cerebral Edema on Wikipedia
  7. Choose nondepolarizing neuromuscular blockers - Agents like doxacurium and atracurium help with ventilation in brain-injured patients without the ICP spikes that succinylcholine can cause. Although data are limited, these safer options are wise picks in critical scenarios. Cerebral Edema on Wikipedia
  8. Prefer enteral nutrition wisely - Feeding through the gut is ideal for acute brain injury, but make sure formulas limit free water so you don't inadvertently worsen edema. Think of it as hydrating strategically rather than flooding the system. Cerebral Edema on Wikipedia
  9. Control hyperglycemia - High blood sugar behaves like a magnet for swelling and raises the risk of hemorrhagic transformation in stroke patients. Target a blood glucose below 180 mg/dL to keep your brain's environment as stable as possible. Cerebral Edema on Wikipedia
  10. Use hypertonic saline over mannitol when needed - Hypertonic saline not only pulls fluid out of the brain to lower ICP but also helps maintain blood volume, making it a hero in cases of hypovolemia or low sodium. It's often the preferred osmotic agent in tricky scenarios. Cerebral Edema on Wikipedia
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