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Single best answer.

  1. Each of the following parameters of cerebral perfusion and metabolism is approximately equal to 50 EXCEPT

a)     Cerebral oxygen consumption in mL O²/min for a normal adult

b)     Lower limit of mean arterial pressure for cerebral autoregulation in mmHg

c)     Normal cerebral blood flow in mL/100g tissue/min

d)     PaO² at which cerebral blood flow increases

e)     PaCO² at which cerebral blood flow doubles

  1. An 8-kg, 5-month-old infant undergoes craniotomy for an arteriovenous malformation. During the procedure, severe hemorrhaging occurs and packed red blood cells 3 units are transfused rapidly. During infusion of the third unit, hypotension, nodal bigeminy, and prolongation of the QT interval are noted. The most appropriate management includes administration of

a)     bicarbonate

b)     calcium

c)     ephedrine

d)     lidocaine

e)     potassium 

  1. Which of the following statements concerning autonomic hyperflexia after spinal cord transection is true?

a)     It occurs within 24 hours after the injury

b)     It occurs with lesions below T10

c)     It is caused by a reflex increase in parasympathetic outflow

d)     It is characterized by paroxysmal hypotension and tachycardia

e)     It is prevented by blocking afferent visceral pathways

  1. A 70-kg, 46-year-old man is undergoing clipping of a cerebral aneurysm with nitrous oxide, opioid, relaxant anesthesia. He is otherwise healthy. As the surgeons are about to enter the dura, the brain is noted to be tense and bulging. Heart rate is 100 bpm and mean arterial pressure is 90 mmHg, Pa0² 120 mmHg, PaCO² is 23 mmHg, and pH is 7.50.

Which of the following should be done immediately?

a)     Hyperventiliation to a PaCO² of 15 to 20 mmHg

b)     Administration of furosemide 20 mg intravenously

c)     Administration of mannitol 0.5 g/kg

d)     Administration of thiopental 250 mg in increments

e)     Addition of halothane 1% to deepen anesthesia

  1. Which of the following is most reliable for treatment of cerebral artery vasospasm associated with subarachnoid hemorrhage?

a)     Antifibrinolytic therapy

b)     Hyperventilation

c)     Mannitol infusion

d)     Nitroprusside infusion

e)     Volume expansion

  1. One hour after induction of anesthesia for a posterior fossa craniotomy using opioid, relaxant, and nitrous oxide, the brain begins to protrude through the dura. The most effective measure to decreases intracranial pressure is to

a)     administer additional opioid

b)     decrease PaCO² from 25 to 15 mm Hg

c)     drain cerebrospinal fluid

d)     discontinue nitrous oxide

e)     induce hypotension

  1. Which of the following statements concerning air embolism during intracranial operations is true?

a)     It does not occur in supine patients

b)     It is prevented by positive end-expiratory pressure

c)     It is confined to the right side of the heart and the pulmonary vasculature

d)     It is detectable by measurement of end-tidal nitrogen

e)     It is most efficiently treated by aspiration from a pulmonary artery catheter

  1. The EEG of a patient undergoing anesthesia with high-dose fentanyl would most likely show

a)     the same pattern seen with enflurane 0.5 MAC

b)     cessation of low-frequency activity

c)     accentuation of high-frequency activity

d)     uniform depression of all frequencies

e)     low-frequency, high-amplitude activity

  1. Which of the following statements concerning cerebral vasospasm following intracranial hemorrhage is true?

a)     It is accompanied by paradoxical intracranial hypotension

b)     It responds to nitroprusside therapy

c)     It persists more than 48 hours after hemorrhage

d)     It is exacerbated by intravascular volume expansion

e)     It is confirmed by ST-T wave changes in the absence of myocardardial ischemia


DIRECTIONS For each of the questions or incomplete statements below, ONE or MORE of the answers or completions given is correct. On the answer sheet fill in the circle containing

A if only 1, 2, and 3 are correct,

B if only 1 and 3 are correct,

C if only 2 and 4 are correct,

D if only 4 is correct,

E if all are correct.





   A                  B                     C                     D                     E

1, 2, 3              1, 3                  2, 4                  4                  All are

ONLY                ONLY               ONLY             ONLY                correct       








10.) Four weeks after spinal cord transection at T5, a 24-year-old man is undergoing cystoscopy with nitrous oxide, oxygen, and isoflurane delivered by mask with assisted ventilation. At the start of the procedure, he appears stable; temperature is 36°C, heart rate is 84 bpm, respirations are 24/min, and blood pressure is 110/70 mmHg. As the procedure continues, his face and neck become red, heart rate decreases to 42 bpm, and blood pressure increases to 220/110 mmHg.

Management should include:


1.     discontinuation of all anesthetics

2.     emptying the patient’s bladder

3.     administration of succinylcholine and tracheal intubation

4.     administration of a ganglionic blocker


11.) Brain stem auditory evoked potentials (BAEPs) are superior to somatosensory evoked potentials (SSEPs) for intraoperative monitoring because BAEPs are

1.     affected less by hypothermia

2.     affected less by patient cooperation

3.     more likely to detect spinal cord ischemia

4.     more resistant to the effects of anesthesia


12.) A 32-year-old woman is unresponsive and has bilateral pupillary dilation in the PACU 30 minutes after clipping of a large intracranial aneurysm. Intraoperatively, hypotension was induced with isoflurane and trimethaphan. Edrophonium was used to antagonize vecuronium-induced neuromuscular block. Possible causes of the papillary dilation include

1.) residual trimethaphan

2.) residual isoflurane

3.) cerebral hypoperfusion

4.) residual edropphonium


13.) An 18-year-old patient undergoes surgical ablation of a seizure focus under fentanyl, droperidol, nitrous oxide, and a relaxant. Postoperatively, grimacing and torticollis develop after administration of prochlorperazine for nausea and vomiting. Appropriate management includes administration of

1.) benztropine

2.) phenytoin

3.) diphenhydramine

4.) physostigmine


14.) During insertion of a Harrington rod, somatosensory evoked responses show increased latency and decreased amplitude. These findings are consistent with

1.) deeping isoflurane anesthesia

2.) hypothermia

3.) spinal cord ischemia

4.) administration of etomidate


15.) Motor tract dysfunction during spinal instrumentation will be defected by

1.) electromyography

2.) somatosensory evoked potentials

3.) electroencephalography

4.) wake-up testing


16.) Perioperative events associated with surgical excision of a mass at the pontomedullary junction include

a)     bradycardia

b)     obtunded gag reflex

c)     prolonged apnea

d)     meiosis


17.) A patient is undergoing clipping of a giant aneurysm requiring deliberate hypotension. Adding isoflurane will

            1.) increase cerebral blood flow

            2.) eliminate responsiveness of the cerebral vasculature to carbon dioxide

            3.) decrease cerebral metabolic rate

            4.) increase intracranial pressure


Answers:           1-         E

                        2-         B

                        3-         E

                        4-         C

                        5-         E

                        6-         C

                        7-         D

                        8-         E

                        9-         C

10-       C

11-       D

12        B

13-       B

14-       A

15-       D

16-       A

17-       B



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