1
ADV PRINCIPLES NEURO EXAM LATEST VERSION -2025/2026-
100+ QUESTIONS AND VERIFIED ANSWERS ALL THE BEST
2 ways Phenytoin might alter Muscle Relaxants (Roc/Vec) due to CYP540 enzyme
induction?
Increased dose
Decreased DoA
0.5-1 mg/kg of _____ given 1-2 minutes before DL and intubation blocks the
predictable increase in HR and BP
Esmolol
(quick on/off)
T/F Sux's increase on ICP may be inhibited by pretreatment of NDMR
True
Roc 5-10 mg
Contraindication for Succinylcholine? Why?
Neurological or denervated muscle - potential for life-threatening hyperkalemia
Can you use Nitrous Oxide in neurosurgical cases?
Yes, but sometimes the risks outweigh the benefits
Effects of Anesthetics on Cerebral Dynamics chart
Only inhalation agent that increases CMRO2?
Nitrous Oxide
T/F All inhalation agents increase CBF / ICP and decrease CPP
True
Major advantage of Etomidate?
, 2
Cerebral vasoconstriction > reduced ICP without reducing CPP (not much change
in MAP)
4 disadvantages of Etomidate?
Adrenocortical suppression
Myoclonus
N/V
Thrombophlebitis
An advantage of this type of sedation is that procedures requiring "wake-up" tests
can be more readily accomplished compared with usual anesthetic regimens (esp
during awake craniotomies)
Dexmedetomidine
What drug should be avoided in the neurosurgical patient because its metabolite,
normeperidine, is known for causing seizures?
Meperidine (Demerol)
Known to produce negative changes in cerebral physiology, increasing CBF by
60%-80% and potentially elevating ICP
Ketamine
Monroe-Kellie Doctrine states:
An increase in one of the compartments (brain (80-90%), blood, intracranial water,
CSF) must be accompanied by a decrease in the others for ICP to remain
unchanged.
ICP pressures exceeding _____ mmHg are indicative of intracranial HTN and
require monitoring and trx
20 mmHg
What is the gold standard for ICP monitoring?
Intraventricular catheter (because of its precision)
, 3
CBF is autoregulated between a MAP of
50-150 mmHg
What is the most important determinant of CBF? Why?
PaCO2
Bc CBF is proportional to PaCO2 when PaCO2 is 25-85 mmHg (ETCO2 20-80
mmHg)
Most potent vasodilator in the cerebral vascular system?
CO2
Changes in PaCO2, PaO2 and Temperature that alter cerebral vascular resistance
(CVR)?
Hypercarbia (hypoventilation) dilates vasculature, increases CBF.
Hypocarbia (hyperventilation) constricts vasculature, decreases CBF.
CMRO2 = ___mL O2 / ___g brain tissue/min (or ~50mL/min)
3.5 mL
100 g
CPP formula
CPP = MAP - ICP (or CVP whatever is higher)
Calculate CPP. MAP of 65, ICP of 10, CVP of 6
65 - 10 = 55 mmHg CPP
T/F there is a linear relationship between PaCO2 and CBF
True
CSF pH around the ____ controls CVR
ADV PRINCIPLES NEURO EXAM LATEST VERSION -2025/2026-
100+ QUESTIONS AND VERIFIED ANSWERS ALL THE BEST
2 ways Phenytoin might alter Muscle Relaxants (Roc/Vec) due to CYP540 enzyme
induction?
Increased dose
Decreased DoA
0.5-1 mg/kg of _____ given 1-2 minutes before DL and intubation blocks the
predictable increase in HR and BP
Esmolol
(quick on/off)
T/F Sux's increase on ICP may be inhibited by pretreatment of NDMR
True
Roc 5-10 mg
Contraindication for Succinylcholine? Why?
Neurological or denervated muscle - potential for life-threatening hyperkalemia
Can you use Nitrous Oxide in neurosurgical cases?
Yes, but sometimes the risks outweigh the benefits
Effects of Anesthetics on Cerebral Dynamics chart
Only inhalation agent that increases CMRO2?
Nitrous Oxide
T/F All inhalation agents increase CBF / ICP and decrease CPP
True
Major advantage of Etomidate?
, 2
Cerebral vasoconstriction > reduced ICP without reducing CPP (not much change
in MAP)
4 disadvantages of Etomidate?
Adrenocortical suppression
Myoclonus
N/V
Thrombophlebitis
An advantage of this type of sedation is that procedures requiring "wake-up" tests
can be more readily accomplished compared with usual anesthetic regimens (esp
during awake craniotomies)
Dexmedetomidine
What drug should be avoided in the neurosurgical patient because its metabolite,
normeperidine, is known for causing seizures?
Meperidine (Demerol)
Known to produce negative changes in cerebral physiology, increasing CBF by
60%-80% and potentially elevating ICP
Ketamine
Monroe-Kellie Doctrine states:
An increase in one of the compartments (brain (80-90%), blood, intracranial water,
CSF) must be accompanied by a decrease in the others for ICP to remain
unchanged.
ICP pressures exceeding _____ mmHg are indicative of intracranial HTN and
require monitoring and trx
20 mmHg
What is the gold standard for ICP monitoring?
Intraventricular catheter (because of its precision)
, 3
CBF is autoregulated between a MAP of
50-150 mmHg
What is the most important determinant of CBF? Why?
PaCO2
Bc CBF is proportional to PaCO2 when PaCO2 is 25-85 mmHg (ETCO2 20-80
mmHg)
Most potent vasodilator in the cerebral vascular system?
CO2
Changes in PaCO2, PaO2 and Temperature that alter cerebral vascular resistance
(CVR)?
Hypercarbia (hypoventilation) dilates vasculature, increases CBF.
Hypocarbia (hyperventilation) constricts vasculature, decreases CBF.
CMRO2 = ___mL O2 / ___g brain tissue/min (or ~50mL/min)
3.5 mL
100 g
CPP formula
CPP = MAP - ICP (or CVP whatever is higher)
Calculate CPP. MAP of 65, ICP of 10, CVP of 6
65 - 10 = 55 mmHg CPP
T/F there is a linear relationship between PaCO2 and CBF
True
CSF pH around the ____ controls CVR
