EDAIC Neuroanesthesia and Neuromonitoring 5

Question 1

A patient undergoes carotid endarterectomy under regional cervical plexus block. During carotid clamping they become confused and agitated. The BEST immediate management is:

Accepted Answer

Request the surgeon to place a carotid shunt

Answer

New neurological symptoms during carotid clamping in an awake patient indicate inadequate cerebral perfusion; immediate shunt placement restores blood flow.

Question 2

Which drug reduces the incidence of cerebral vasospasm after subarachnoid hemorrhage and is given for 21 days?

Accepted Answer

Nimodipine

Answer

Oral nimodipine (60 mg every 4 hours for 21 days) is the only proven pharmacological intervention to reduce neurological deficits from vasospasm after SAH.

Question 3

When performing lumbar puncture, which position optimizes CSF flow and is preferred in obese patients?

Accepted Answer

Sitting upright leaning forward

Answer

The sitting upright position widens interlaminar spaces and is preferred in obese patients where the lateral position makes midline identification unreliable.

Question 4

Which ICP waveform component, when dominant (P2 > P1), indicates reduced intracranial compliance?

Accepted Answer

P2 (tidal wave)

Answer

Normally P1>P2>P3; when P2 exceeds P1, intracranial compliance is reduced and the brain cannot buffer volume changes, indicating impending decompensation.

Question 5

In a patient with a Glasgow Coma Scale (GCS) of 7 following head trauma, which airway management decision is most appropriate?

Accepted Answer

Rapid sequence intubation with cricoid pressure

Answer

GCS ≤8 indicates inability to protect the airway; RSI with cricoid pressure (modified if basal skull fracture suspected) provides definitive airway control.

EDAIC - European Diploma in Anesthesiology and Intensive Care Practice Test

EDAIC - European Diploma in Anesthesiology and Intensive Care Practice Test

EDAIC Neuroanesthesia and Neuromonitoring 5