Directions For Items 1-14: if only 1,2, and 3 are correct if only 1 and 3 are correct if only 2 and 4 are correct if only 4 is correct if all are correct

1. Which of the following may provide protection of the central nervous system during ischemia?

1. Barbiturates
2. Nimodipine
3. Hypothermia
4. Hyperglycemia

2. Which of the following statements concerning traumatic spinal cord injury in a 6-year-old child is/are true?

1. In automobile-related accidents, the child is more likely to sustain such injury as a pedestrian than as a passenger.
2. Findings on x-ray study of the spine are more likely to be normal than in older children.
3. Injuries to the occiput and proximal cervical spine are more likely in this child than in a 16-year-old person.
4. Incomplete myelopathy indicates a poor prognosis.

3. Which of the following is/are more common during craniotomy in the lateral or prone than in the sitting position?

1. Myocardial infarction
2. Cranial nerve damage
3. Hypotension
4. Intraoperative transfusion

4. Prevention of and treatment for neurologic injury due to cerebral ischemia include

1. Hypothermia prior to complete ischemia
2. Production of an isoelectric electroencephalogram by administration of thiopental prior to open valvular repair
3. Administration of calcium-entry blocking drugs following focal ischemia with acute cerebral infarction
4. Administration of thiopental following complete ischemia

5. A 17-year-old-boy sustains severe injury of the spinal cord at C7-C8. Potential perioperative complications during immediate surgical stabilization of the cervical spine include

1. Impaired oxygenation
2. Hypovolemia
3. Pulmonary edema
4. Autonomic hyperreflexia

6. In normal patients cerebral blood flow is increased by

1. Increasing PaCO2, from 40 to 50 mm Hg
2. Decreasing PaO2, from 100 to 70 mm Hg
3. Doubling cerebral metabolic rate
4. Increasing mean arterial blood pressure from 80 to 100 mm Hg

7. Which of the following anesthetic agents increase cerebral blood flow?

1. Thiopental
2. Etomidate
3. Propofol
4. Halothane

8. Which of the following statements is/are true regarding the use of isoflurane for treatment of refractory status epilepticus?

1. Isoflurane should be used only after intravenous anticonvulsant drugs have failed to control the seizures.
2. Isoflurane is an effective titratable anticonvulsant.
3. Suppression of seizure activity with isoflurane usually requires simultaneous hemodynamic support.
4. Seizures return upon discontinuation of isoflurane.

9. Which of the following can be used to prevent head movement during endotracheal intubation in a patient with a spinal cord injury?

1. Soft collar
2. Tongs and traction
3. Hard collar
4. Manual axial traction

10. Which of the following is/are associated with an increased risk of neurologic deficit subsequent to operations for spinal deformity?

1. Neuromuscular scoliosis
2. Decrease in amplitude of somatosensory evoked potentials (SEP)
3. Use of sublaminar wires
4. Increase in latency of SEP

11. Expected results of nitrous oxide administration include

1. Increased intracranial pressure
2. Cerebral vasodilation
3. Decreased amplitude of somatosensory evoked potentials
4. Depression of the electroencephalogram

12. Which of the following is/are characteristic of neurogenic pulmonary edema?

1. Symptoms within 12 hours after central nervous system injury
2. Resolution within hours to days with supportive therapy
3. Increased ventilation/perfusion mismatching
4. Consolidated infiltrates seen on chest radiographs

13. Appropriate airway management in a patient with potential cervical spine injury could include

1. Oral intubation with stabilization of the cervical spine
2. Light-wand-guided oral intubation
3. Fiberoptic nasal intubation
4. Blind nasotracheal intubation

14. Which of the following statements about intracranial pressure (ICP) plateau waves (Lundberg A waves) is/are true?

1. Increases in ICP are as high as 50 mm Hg above baseline.
2. Duration of these waves is fixed.
3. They result from poor intracranial compliance.
4. They precipitate cerebral vasoconstriction.

Directions For Items 15-21:

Select the one that is BEST in each case. Please note the use of EXCEPT or LEAST in some terms.

15. Following craniotomy to remove a right frontal meningioma, a 44-year-old white male is noted to have a urinary output of 250 mL/hour. Which of the following serum urinary electrolyte laboratory values are compatible with the diagnosis of postoperative diabetes insipidus?

1. Serum Na 128 mEq/L; urine Na 75 mEq/L; urine osmolality 80 mOsm/L
2. Serum Na 128 mEq/L; urine Na 100 mEq/L; urine osmolality 475 mOsm/L
3. Serum Na 146 mEq/L; urine Na 10 mEq/L; urine osmolality 80 mOsm/L
4. Serum Na 138 mEq/L; urine Na mEq/L; urine osmolality 290 mOsm/L

16. Which of the following statements about stroke and carotid artery surgery is LEAST likely true?

1. The most common cause of perioperative strokes is thromboembolic.
2. Postoperative hyperperfusion in patients with tight stenosis causes stroke.
3. Stroke risk is 25%-40% within five years of the onset of transient ischemic attacks.
4. The use of single bolus thiopental prior to carotid clamping should be routine when using general anesthesia.

17. Which of the following statements about severe Guillain-Barre syndrome is MOST likely true?

1. Plasmapheresis therapy significantly shortens the time of dependence on mechanical ventilation.
2. Corticosteroid therapy lowers mortality.
3. Autonomic dysfunction is rare.
4. Hyperreflexia is common.

18. When given general anesthesia for cesarean delivery after thiopental induction with succinylcholine 1.5 mg/kg and maintenance with 50% N20, 50% 02, and 0.5% halothane, patients MOST commonly exhibit

1. No evidence of intraoperative awareness one minute after incision.
2. Inadequate anesthesia at the time of incision.
3. Recall of intraoperative events.
4. An abrupt increase in electroencephalographic frequency with intubation.

19. Which of the following statements about the use of hyperventilation to treat intracranial hypertension is MOST likely true?

1. Hyperventilation lowers intracranial pressure (ICP) by reducing cerebral blood volume.
2. Electroencephalographic findings indicative of cerebral ischemia in normal brain tissue are likely at a PaCO2 of 30 mm Hg.
3. Beneficial reductions in ICP due to hyperventilation are usually delayed for approximately six hours.
4. The cerebral vasculature both in traumatized brain and in normal brain tissue responds equally well to hyperventilation

20. The MOST common etiology of hyponatremia in head-injured patients is?

1. Fluid restricition
2. High calorie tube feeding
3. Inappropriate secretion of antidiuretic hormone
4. Mannitol administration

21. Following carotid endarterectomy, a patient develops new hemiplegia while in the postanesthesia care unit. The least likely cause of this finding would be

1. Cerebral embolism
2. Reperfusion injury
3. Arterial thrombosis
4. Intracerebral hemorrhage

Questions obtained with permission from the ASA and ABA