DNB Theory Examination Neuroanaesthesia

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A. Answer the following with diagram where appropriate

1. Briefly discuss the factors influencing cerebral autoregulation in health and disease ?

2. Draw a neat labeled diagram of cerebral blood flow. How does the blood flow to the hypothalamus differ from the rest of the brain?

3. What are the potential hazards faced by a patient placed in sitting position for posterior fossa surgery?

4. A patient is admitted to the ICU with a severe closed head injury which does not require neurosurgical intervention. How will you manage this patient during the 1st week?

5. A 25 year old man is admitted with a fracture of the cervical spain at C5/6 with spinal cord trauma. Describe the management of this patient in the first 48 hours after injury?

B. Choose the single CORRECT response

A 40 year old patient is anaesthetized and positioned in L lateral decubitus position for a R temporal craniotomy. Which of the following statement is FALSE?

The L lung is better perfused
The R lung is better ventilated
An axillary rollis usedto push the humeral head away from the brachial plexus
An arterial pressure monitor on the dependent limb can detect vascular compromise

In a patient posted for excision of a posterior fossa tumour in sitting position, which of the following statements is False?

TEEis the most sensitive monitor to detect VAE
The neck should be flexed to reduce chance change of cerebral ischemia
The arterial pressure transducer is levelled to the tragus to monitor cerebral perfusion
The lower extremities should be flexed so that the knees are at the level of the heart

All of the following are appropriate ways to reduce blood accumulation in oropharynx and stomach during trans sphenoidal pituitary surgery EXCEPT

Infiltration of nasal mucosa with epinephrine + local anaesthetic solution
Using a pharyngeal pack before skin incision
Suctioning the oropharynx before emergence
Placing a nasogastric tube to decompress the stomach before emergence

The distal castheter of CSF shunts maybe placed in all of the following places EXCEPT

Pleural cavity
Peritoneal cavity
R atrium
Lateral ventricle

Which of the following statements about airway management of a trauma patient with suspected cervical spine injury is TRUE?

A cord injury is suspected only if there is cervial spine fracture or displacement on radiological examination
If cord injury is suspected, intubation should only be done using a flexible bronchoscope with the patient awake
Mask ventilation causes more cervical spine movement than direct laryngoscope
The cervial collar should not be removed while intubating using a direct laryngoscope

C. Choose the ALL the CORRECT responses

A 30 year old male victim of an RTA presents to ER with HR 32/min and BP 210/110mmHg. Which of the following statements are TRUE about the ongoing event?

Subfalcine is the most common type of brain herniation
Brain herniation is also referred to as 'Code Brain'
Subfalcine hernia and cingulate hernia refer to the same entity resulting in midline shift
The tentorial incisura in the falx cerebri is a potential site for herniation

The following statements are true about intracranial hemorrhage and outcome

The measured volume of intraparenchymal hematoma is the best predictor of mortality
Vasospasm occurs after traumatic SAH and aneurysmal SAH
Chronic SDH evacuation done under LA has a better outcome in terms of mortality as compared to GA
Intraventricular hemorrhage is apredictor of poor outcome independent of hydrocephalus

Which of the following statements regarding monitoring the brain metabolism using cerebral Micro-dialysis are FALSE?

The brain tissue fluid is directly aspirated and the concentration of the metabolites measured
It is used as a test to confirm secondary brain injury after after it is evident on other monitor
A high Lactate-Pyruvate ratio indicates cerebral ischemia
A rise in glucose in the micro-dialysate 2-3 days after a brain injury indicates cell death

B peripheral nerve fibres