Parkinson's Disease Treatment Quiz

A patient with a Glasgow Coma Scale (GCS) score of 9 is considered to have a moderate brain injury. This score indicates that the patient is opening their eyes to pain, verbalizing incomprehensible sounds, and moving in response to localized pain. However, they are not fully alert and their responses are not appropriate or purposeful. Therefore, the number 9 on the GCS scale is not considered "comatose."

An occlusive dressing is the immediate treatment for a pneumothorax that communicates with the atmospheric air. This is because an occlusive dressing creates an airtight seal over the wound, preventing further air from entering the pleural space. By sealing the wound, the occlusive dressing helps to restore normal lung function and prevent the collapse of the lung. Needle decompression and chest tube insertion may be necessary in more severe cases, but the immediate treatment is to apply an occlusive dressing. Suture is not appropriate for treating a pneumothorax.

When a patient is in the sitting position, the distance between the level of the heart and the level of the tragus of the ear is approximately 20cm. As per the question, we need to estimate the difference in Mean Arterial Pressure (MAP) at these two levels. MAP is a measure of the average blood pressure in the arteries during a cardiac cycle. In the sitting position, due to the effect of gravity, blood pressure is higher at the level of the heart compared to the tragus of the ear. Therefore, we can estimate that the MAP at the level of the heart is 15mmHg higher than the MAP at the level of the tragus of the ear.

GA usually prevents autonomic dysreflexia and spinal also works well. EPIDURAL NOT EFFECTIVE.

Side note: After aneurysm repair.... Vaospasm most likely to occur >3 days postop (0-3 days post op at greater risk for rebleed rather than vasospasm).

Transesophageal echocardiography (TEE) is the most sensitive method of monitoring for venous air embolism (VAE). TEE involves inserting a probe into the esophagus to obtain detailed images of the heart and blood vessels. This technique allows for real-time visualization of the heart and can detect even small amounts of air in the circulation. It is considered the gold standard for diagnosing VAE and is particularly useful during surgical procedures where air embolism is a potential risk, such as cardiac surgeries. TEE provides immediate feedback, allowing prompt intervention to prevent further complications.

Patients with elevated intracranial pressure (ICP) should avoid coughing, straining, and vasodilators. Coughing and straining can increase ICP by causing increased intrathoracic and intraabdominal pressure, which can lead to increased cerebral blood volume and subsequently increased ICP. Vasodilators can also worsen elevated ICP by causing cerebral vasodilation, leading to increased cerebral blood flow and increased pressure within the skull. Therefore, it is important to avoid all of these factors in patients with elevated ICP to prevent further complications.

The correct symptoms of increased ICP, known as Cushing's triad, include increased SBP (systolic blood pressure), decreased HR (heart rate), and abnormal breathing. This is a classic presentation of increased intracranial pressure, where the body compensates by increasing blood pressure while decreasing heart rate. Abnormal breathing patterns, such as Cheyne-Stokes respiration or irregular respirations, may also be observed.

Hyperthermia is not a common post-operative complication of thoracic surgery. Hyperthermia refers to an elevated body temperature above the normal range, which is typically caused by external factors such as heat exposure or certain medical conditions. In the context of thoracic surgery, common post-operative complications include phrenic nerve injury, thoracic duct injury, bronchopleural fistula, and acute lung injury. These complications are more directly related to the surgical procedure and can occur due to various factors such as surgical trauma, infection, or inflammation.

CSF (Cerebrospinal fluid) should be drained in increments of 5-10ml with ongoing assessment. This is because draining too much CSF at once can lead to complications such as low pressure headaches or spinal cord injury. By draining smaller amounts and continuously assessing the patient's condition, any adverse effects can be detected and managed promptly. This approach ensures a safer and more effective CSF drainage procedure.

Droperidol, Phenergan, and Reglan should be avoided in Parkinson's patients because they can worsen the symptoms of Parkinson's disease. Droperidol is an antipsychotic medication that can cause movement disorders, including tardive dyskinesia, which can be particularly problematic for individuals with Parkinson's. Phenergan is an antihistamine that can cause sedation and worsen motor symptoms. Reglan is a medication used to treat gastrointestinal issues but can also cause movement disorders and exacerbate Parkinson's symptoms. Therefore, these three drugs should be avoided in Parkinson's patients to prevent worsening of their condition.

SSEP is only sensory. Ok to block motor. MEP is for motor. CAN'T block.

Cor Pulmonale is a condition characterized by right-sided heart failure due to lung disease. The most common cause of Cor Pulmonale is chronic obstructive pulmonary disease (COPD). COPD is a progressive lung disease that obstructs airflow and causes difficulty in breathing. The long-term exposure to irritants, such as cigarette smoke, is the primary cause of COPD. The damage to the lungs in COPD leads to increased pulmonary artery pressure, which can eventually result in right-sided heart failure and Cor Pulmonale. Therefore, COPD is the most likely cause of Cor Pulmonale among the given options.

The statement is true because the Tensilon test is indeed used to differentiate between a myasthenic crisis and a cholinergic crisis. In a myasthenic crisis, the patient's muscle weakness improves after administration of edrophonium, whereas in a cholinergic crisis, the muscle weakness worsens. Atropine is given in a cholinergic crisis to counteract the excessive cholinergic stimulation. Therefore, the correct answer is true.

Indirect lung injury refers to damage to the lungs that is not caused directly by trauma or a physical injury. Sepsis, cardiopulmonary bypass, and drug overdose can all lead to indirect lung injury. Sepsis is a severe infection that can cause inflammation and damage to the lungs. Cardiopulmonary bypass is a procedure used during heart surgery that can cause lung inflammation and injury. Drug overdose, especially with certain substances like opioids, can lead to respiratory depression and lung damage. Therefore, sepsis, cardiopulmonary bypass, and drug overdose can all result in indirect lung injury.

Mannitol cannot be given if the BBB is disrupted because of increased brain swelling.

Virchow's triad refers to the three main risk factors for developing PE (pulmonary embolism). These risk factors include venous stasis, which refers to the slowing or stagnation of blood flow in the veins; venous injury, which can occur due to trauma or surgery; and hypercoagulation, which is an abnormal increase in blood clotting. Diabetes is not considered one of the main risk factors for PE. Therefore, the correct answer is venous stasis, venous injury, and hypercoagulation.

Airway hyperreactivity refers to an exaggerated response of the airways to various stimuli, such as allergens or irritants. During the perioperative period, patients with upper respiratory tract infections (URIs) may experience airway hyperreactivity. The correct answer of 6 weeks suggests that it may take up to six weeks or more for the airway hyperreactivity to subside after a URI. This is important for the anesthesia provider to consider when planning and managing the airway of a patient undergoing surgery, as the hyperreactivity may increase the risk of complications during anesthesia.

During mediastinoscopy, it is important to place either an arterial line or a pulse ox probe on the right side. This is done in order to identify any compression of the innominate artery. The innominate artery is a major blood vessel located in the mediastinum, and compression of this artery can lead to serious complications. By monitoring the arterial line or pulse ox probe on the right side, any changes or abnormalities in blood flow or oxygenation can be detected promptly, allowing for timely intervention if necessary.

Normal= >80%
Mild= 65-80
Moderate= 50-64
Marked= 35-49
Severe= FEV1 less than 35!

CPP is more important. Side note, HALO is the most effective form of stabilization when preventing cervical movement.

ICP stands for intracranial pressure, which is the pressure inside the skull. Normal ICP ranges from 5 to 10 mmHg. CPP stands for cerebral perfusion pressure, which is the pressure needed to ensure adequate blood flow to the brain. Normal CPP ranges from 65 to 80 mmHg. Therefore, the correct answer indicates that normal ICP is 5-10 and normal CPP is 65-80.

For every 1mmHg change in PaCO2, there is a 2ml/100g/min increase in CBF. This means that as the partial pressure of carbon dioxide in arterial blood increases or decreases by 1mmHg, the cerebral blood flow (CBF) increases or decreases by 2ml/100g/min. This relationship highlights the importance of PaCO2 in regulating CBF, as changes in PaCO2 can directly impact cerebral perfusion.

The correct answer is "All of the above". This means that all the listed options - pH, volume >25ml, and presence of particulate matter - are considered critical values for aspiration. In other words, if any of these criteria are met, it indicates a potential issue with aspiration.

Ketamine is the correct answer because it is the drug of choice for emergency induction of an asthmatic patient due to its bronchodilation effects. It can help alleviate the symptoms of asthma by relaxing the airway muscles and improving airflow. However, one side effect of ketamine is increased secretions, which can be counteracted by giving Robinul, a medication that reduces secretions.

The minimum amount of air that can be detected on precordial doppler is 0.25ml.

The correct answer is 3. For a double lumen ETT, it is important to never put more than 3ml into the blue (bronchial) balloon. This is because overinflating the balloon can cause trauma to the bronchial mucosa and lead to complications such as bronchial rupture or mucosal ischemia. It is crucial to ensure that the balloon is properly inflated to maintain appropriate lung isolation during surgery, but exceeding the recommended volume can be harmful to the patient.

The correct order of the fastest to slowest method of reducing ICP is mannitol > lasix > hyperventilation > steroids. Mannitol is a potent osmotic diuretic that rapidly reduces intracranial pressure by drawing water out of the brain tissue. Lasix is a loop diuretic that also helps to decrease fluid volume in the brain. Hyperventilation lowers ICP by causing vasoconstriction and reducing cerebral blood flow. Steroids, such as dexamethasone, are typically used to treat brain swelling but have a slower onset of action compared to the other methods mentioned.

Anesthesia providers inhibit hypoxic pulmonary vasoconstriction by performing two common actions: providing too much tidal volume and applying too much positive end-expiratory pressure (PEEP). Too much tidal volume refers to delivering excessive amounts of air during each breath, which can lead to overdistension of the lungs and hinder hypoxic pulmonary vasoconstriction. Similarly, excessive PEEP, which is the pressure maintained in the airways at the end of expiration, can also interfere with this physiological response by increasing lung volume and impairing the redirection of blood flow to well-ventilated areas.

65-8=57
CPP= MAP-ICP or CPP=MAP-CVP

This is due to hypoxic pulmonary vasoconstriction. ITS YOUR FRIENNNNNNNNND.

In Parkinson's, there is an imbalance of dopamine to acetylcholine. Therefore, there is a DECREASED inhibition of extrapyramidal symptoms resulting in akinesia, akathesia, and tardive dyskinesia.

Non-selective beta blockers cause bronchoconstriction. H2 blockers and morphine cause histamine release. Des and iso are airway irritants.

Depolarizing neuromuscular blocking agents (NMBA) should be avoided in patients with Duchenne's muscular dystrophy due to exaggerated potassium (K+) release. Depolarizing NMBA, such as succinylcholine, cause a prolonged depolarization of the muscle membrane, leading to an excessive release of K+ from the muscle cells. In patients with Duchenne's muscular dystrophy, who already have a defect in the dystrophin protein that helps maintain the integrity of muscle cells, this exaggerated K+ release can lead to life-threatening hyperkalemia and cardiac arrhythmias. Therefore, it is important to avoid depolarizing NMBA in these patients to prevent this complication.

This patient's hypertrophic muscles and walking on his tip toes are indicative of Muscular Dystrophy. Muscular Dystrophy is a group of genetic disorders characterized by progressive muscle weakness and wasting. The hypertrophic muscles seen in this patient may be a compensatory response to the muscle weakness. Walking on the tip toes can be a result of calf muscle tightness or weakness, which is commonly seen in Muscular Dystrophy. Huntington's, Parkinson's, and Myasthenia Gravis do not typically present with hypertrophic muscles and walking on tip toes.

Due to upregulation.

Tracheal stenosis is a condition where the tracheal opening becomes narrow, limiting the airflow. This commonly occurs due to prolonged intubation or tracheostomy, which can cause scarring and inflammation in the trachea. In this case, the correct answer is 5mm, indicating that tracheal stenosis is indicated when the patient's tracheal opening is less than 5mm.

Cystic Fibrosis causes dehydrated, viscous secretions, which can lead to airway obstruction and difficulty in clearing mucus. Anticholinergic drugs can help in reducing the viscosity of secretions and promoting airway clearance by blocking the action of acetylcholine, which is responsible for increasing mucus production. On the other hand, non-depolarizing, GABA agonist, and beta-blocking drugs do not directly address the issue of dehydrated secretions and may not be as effective in improving airway clearance. Therefore, anticholinergic drugs are preferred in the management of Cystic Fibrosis.

Fibrosis is more pronounced but non-cardiogenic pulmonary edema is the hallmark finding.

Tension pneumothorax is a life-threatening condition where air accumulates in the pleural space, causing the lung to collapse and putting pressure on the heart and other structures in the chest. In tension pneumothorax, the trachea is shifted away from the affected lung and towards the normal lung. This is because the increased pressure in the affected side pushes the trachea away. Additionally, breath sounds are absent on the affected side due to the collapsed lung. Needle decompression is the immediate treatment for tension pneumothorax and is performed between the 2nd and 3rd intercostal space anteriorly to release the trapped air.

The correct dosing for mannitol is 0.25-1 g/kg. This means that the recommended dosage of mannitol is between 0.25 grams to 1 gram per kilogram of body weight. This dosing range ensures that the appropriate amount of mannitol is administered based on the individual's weight, allowing for optimal therapeutic effects while minimizing the risk of side effects or overdosing.

Mannitol is a diuretic medication commonly used to decrease intracranial pressure and reduce intraocular pressure. However, it should be avoided in patients with congestive heart failure (CHF) and renal failure because it can exacerbate fluid overload and worsen their condition. CHF patients already have impaired cardiac function and may not tolerate the additional fluid volume, while renal failure patients have compromised kidney function and may not be able to adequately excrete the excess fluid. Therefore, administration of mannitol in these patients can lead to fluid retention and potentially worsen their cardiac and renal function.

Lidocaine reduces CMRO2 and CBF up to 30%. Isoflurane reduces CMR up to 50 %. Halothane reduces CMR up to 25%. Hypothermia decreases CMR 5-7% per 1 degree celcius change. Hyperventilation causes a decrease in paCO2 which causes cerebral vasoconstriction.

Ketamine and N20 are the two anesthetic agents that increase CMRO2. Ketamine is a dissociative anesthetic that increases cerebral metabolic rate of oxygen consumption (CMRO2) by stimulating the release of catecholamines. N20, also known as nitrous oxide, increases CMRO2 by increasing cerebral blood flow. Both of these agents have the ability to enhance brain activity and metabolism, leading to increased CMRO2.

Burst suppression "is an electroencephalography (EEG) pattern that is characterized by periods of high-voltage electrical activity alternating with periods of no activity in the brain. The pattern is found in patients with inactivated brain states, such as from general anesthesia, coma, or hypothermia."