chapter 11. quiz 2. Regulation of Cerebral Blood Flow
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Questions and Answers

What is the lower limit of autoregulation (LLA) for cerebral blood flow in normal humans?

  • 90 mm Hg
  • 70 mm Hg (correct)
  • 60-65 mm Hg
  • 80-85 mm Hg

What is the upper limit of autoregulation (ULA) for cerebral blood flow in normal humans?

  • 190-195 mm Hg
  • 170 mm Hg
  • 180 mm Hg
  • 150 mm Hg (correct)

What is cerebral perfusion pressure (CPP) defined as?

  • Difference between LLA and ULA
  • Autoregulation limits
  • Cerebral blood flow resistance
  • MAP minus intracranial pressure (ICP) (correct)

How is autoregulation affected by rapid changes in arterial pressure?

<p>It causes a transient alteration in CBF (C)</p> Signup and view all the answers

How does the autoregulatory mechanism respond to an increase in mean arterial pressure (MAP) concerning cerebral blood flow (CBF)?

<p>It counteracts by narrowing vessel radius and increasing resistance. (C)</p> Signup and view all the answers

Which proposed mechanism of autoregulation involves a myogenic response of vascular smooth muscle to pressure changes?

<p>Myogenic mechanism (A)</p> Signup and view all the answers

Why is autoregulation of cerebral blood flow considered significant clinically?

<p>It prevents excessive perfusion and hypoperfusion injuries. (B)</p> Signup and view all the answers

What is the primary function of autoregulation of cerebral blood flow?

<p>To maintain a constant level of perfusion pressure (D)</p> Signup and view all the answers

when the CBF become pressure-dependent (pressure-passive) and linearly varies with CPP.

<p>Above and below the autoregulatory plateau (A)</p> Signup and view all the answers

According to the myogenic hypothesis, changes in CPP lead to direct changes in

<p>tone of vascular smooth muscle (A)</p> Signup and view all the answers

What is the relationship between increased neuronal activity and local brain metabolism in terms of cerebral blood flow (CBF)?

<p>Increased neuronal activity results in increased local brain metabolism, leading to an increase in CBF. (A)</p> Signup and view all the answers

Which factors are involved in the regulation of cerebral metabolic rate (CMR)?

<p>A combination of metabolic, glial, neural, and vascular factors (A)</p> Signup and view all the answers

What is the traditional view of neurovascular coupling?

<p>It is based on a feed-forward mechanism where neuronal activity directly increases CBF. (C)</p> Signup and view all the answers

Which by-products of metabolism are implicated in mediating neurovascular coupling?

<p>K+, H+, lactate, adenosine, and ATP (D)</p> Signup and view all the answers

What is the role of glutamate release due to increased synaptic activity in relation to cerebral blood flow?

<p>Glutamate release enhances CBF by affecting vascular tone. (D)</p> Signup and view all the answers

How are regional cerebral blood flow and metabolism typically coupled?

<p>They are tightly coupled and involve a combination of various factors. (B)</p> Signup and view all the answers

What is the role of Glutamate in neurovascular coupling?

<p>Results in the synthesis and release of NO (D)</p> Signup and view all the answers

How does glutamate activation of metabotropic glutamate receptors (mGluR) in astrocytes affect cerebral blood flow?

<p>Promotes prostaglandin and epoxyeicosatrienoic acids generation (D)</p> Signup and view all the answers

What contributes to vascular dilation in the setting of reduced oxygen tension at the tissue level?

<p>Release of adenosine (C)</p> Signup and view all the answers

Which neurotransmitter released by nerves innervating cerebral vessels is NOT mentioned as potentially involved in neurovascular coupling?

<p>Dopamine (A)</p> Signup and view all the answers

How is the net result on vascular tone determined in neurovascular coupling?

<p>By the relative contribution of multiple signaling pathways (A)</p> Signup and view all the answers

What can influence CMR according to the text?

<p>Functional state of the nervous system (A)</p> Signup and view all the answers

How do anesthetic drugs generally affect cerebral metabolic rate (CMR)?

<p>Suppress CMR (C)</p> Signup and view all the answers

What happens to the CMR when plasma concentrations of certain anesthetics like propofol increase?

<p>CMR decreases proportionally (A)</p> Signup and view all the answers

Which component of cerebral metabolic rate (CMR) remains unaffected by anesthetic drugs?

<p>Housekeeping component for cellular integrity (A)</p> Signup and view all the answers

What is the effect of increasing general anesthetics on CMRO2 when EEG suppression is completely achieved using any anesthetic agent?

<p>CMRO2 remains similar (A)</p> Signup and view all the answers

In what scenario does the CMR increase extremely ?

<p>epileptic activity (C)</p> Signup and view all the answers

What sets ketamine and nitrous oxide apart from other anesthetic drugs regarding their impact on CMR?

<p>They do not affect CMR (D)</p> Signup and view all the answers

What is a distinguishing feature of the effects of barbiturates compared to isoflurane and sevoflurane on cerebral blood flow (CBF) and cerebral metabolic rate (CMR)?

<p>with barbiturates, Uniform reduction in CBF and CMR throughout the brain (A)</p> Signup and view all the answers

At what approximate concentration of isoflurane associated with a burst-suppression pattern are cortical somatosensory evoked responses to median nerve stimulation difficult to elicit?

<p>~1.5 MAC (A)</p> Signup and view all the answers

Why does a further decrease in cerebral metabolic rate (CMR) occur with temperature reduction beyond that at which EEG suppression first occurs?

<p>Due to decreased energy utilization associated with both electrophysiological function and cellular integrity maintenance (B)</p> Signup and view all the answers

What happens to cerebral blood flow (CBF) between 37°C and 42°C?

<p>Increases (C)</p> Signup and view all the answers

What effect does hyperthermia above 42°C have on cerebral oxygen consumption?

<p>Dramatic reduction (C)</p> Signup and view all the answers

What is the primary difference between the effects of anesthetic drugs and hypothermia on cerebral metabolic rate (CMR)?

<p>Hypothermia decrease both electrophysiological function and energy utilization associated with cellular integrity maintenance (B)</p> Signup and view all the answers

How do the EEG characteristics of burst-suppression states differ among anesthetic drugs?

<p>They differ among anesthetic drugs (C)</p> Signup and view all the answers

What is the relevance of the EEG characteristics of burst-suppression states among anesthetic drugs?

<p>They may provide insights into differences in the neuroprotective potential of the drugs (D)</p> Signup and view all the answers

What is the approximate decrease in cerebral metabolic rate (CMR) per degree Celsius of temperature reduction?

<p>6% to 7% (B)</p> Signup and view all the answers

At what temperature range can hypothermia lead to complete suppression of the EEG?

<p>18°C-20°C (D)</p> Signup and view all the answers

What effect can hypothermia have on EEG when the temperature drops below 20-18°C?

<p>Complete suppression (B)</p> Signup and view all the answers

How does a decrease in temperature impact cerebral metabolic rate (CMR)?

<p>Decreased CMR (B)</p> Signup and view all the answers

How does mild hypothermia affect the cerebral metabolic rate of oxygen (CMRO2) at 18°C compared to normothermic control values?

<p>It decreases to less than 10% (A)</p> Signup and view all the answers

What explains the brain's tolerance for moderate periods of circulatory arrest at temperatures around 18°C and colder?

<p>Decrease in CMRO2 below 10% of normothermic control values (D)</p> Signup and view all the answers

What is the primary effect of hypothermia on the basal component of the cerebral metabolic rate?

<p>Suppresses it (A)</p> Signup and view all the answers

How does the cerebral metabolic rate respond as the temperature drops below the point where EEG suppression first occurs?

<p>It decreases further (A)</p> Signup and view all the answers

What is the relationship between cerebral metabolic rate and tolerance to circulatory arrest at colder temperatures?

<p>Lower metabolic rate leads to better tolerance (D)</p> Signup and view all the answers

How does cerebral blood flow (CBF) respond to hypocapnia when resting CBF is increased?

<p>The reduction in CBF is more intense (C)</p> Signup and view all the answers

What happens to the cerebrovascular response to changes in Paco2 during severe hypotension?

<p>No response is observed (C)</p> Signup and view all the answers

How does moderate hypotension affect the response of cerebral blood flow (CBF) to hypercarbia?

<p>The increase in CBF is reduced (C)</p> Signup and view all the answers

What is the effect of modest hypotension on hypocapnia-induced vasoconstriction?

<p>Slightly affects vasoconstriction (A)</p> Signup and view all the answers

How do anesthetic drugs that increase resting CBF impact the response of the cerebral circulation to CO2?

<p>They enhance the response to CO2 (A)</p> Signup and view all the answers

What happens to the cerebrovascular response to changes in Paco2 under normal circumstances?

<p>It increases with increasing Paco2 values (A)</p> Signup and view all the answers

What happens to cerebral blood flow (CBF) when there is hypercarbia?

<p>CBF increases significantly. (D)</p> Signup and view all the answers

Which factor mediates the vasodilatory response to hypercapnia?

<p>Nitric oxide (NO) (B)</p> Signup and view all the answers

What effect does acute systemic metabolic acidosis have on cerebral blood flow (CBF)?

<p>It has little immediate effect on CBF. (A)</p> Signup and view all the answers

What happens to cerebrospinal fluid (CSF) pH and CBF levels after a sustained period of hyperventilation and Acute restoration of a normal Paco2 value ?

<p>CBF increases while CSF pH decreases. (B)</p> Signup and view all the answers

How does acute restoration of a normal Paco2 value affect cerebrospinal fluid (CSF) pH after a sustained period of hypoventilation ?

<p>It leads to CSF alkalosis. (A)</p> Signup and view all the answers

What is the theoretical risk associated with an acute restoration of a normal Paco2 value after hypercapnia?

<p>Risk of cerebral ischemia. (C)</p> Signup and view all the answers

What is the theoretical risk associated with an acute restoration of a normal Paco2 value after hypocapnia?

<p>increased CBF with a concomitant increase in ICP (D)</p> Signup and view all the answers

With hypercarbia, cerebral autoregulatory response is?

<p>response to hypertension is attenuated (A)</p> Signup and view all the answers

how much CBF changes for each 1 mm Hg change in Paco2 around normal Paco2 values?

<p>1 to 2 mL/100 g/min (C)</p> Signup and view all the answers

when the CBF response to Paco2 is attenuated

<p>Paco2 of 75 to 80 mm Hg (B)</p> Signup and view all the answers

How does the rostral ventrolateral medulla (RVLM) respond to hypoxia?

<p>By increasing cerebral blood flow (CBF) (A)</p> Signup and view all the answers

What is the effect of high Pao2 values on cerebral blood flow (CBF)?

<p>CBF decreases modestly (B)</p> Signup and view all the answers

What is the theoretical risk associated with hypercapnia followed by an acute restoration of a normal Paco2 value?

<p>Risk of ischemia (A)</p> Signup and view all the answers

What effect does a reduction in Pao2 below 60 mm Hg have on cerebral blood flow (CBF)?

<p>Rapidly increases CBF (C)</p> Signup and view all the answers

Which of the following variables leads to a more significant increase in cerebral blood flow (CBF) according to the text?

<p>Hypoxemic hypoxia (B)</p> Signup and view all the answers

What mediates cerebral vasodilation during hypoxia, as mentioned in the text?

<p>Both neurogenic effects and local humoral influences (B)</p> Signup and view all the answers

What role does deoxyhemoglobin play in hypoxia-induced increases in cerebral blood flow (CBF)?

<p>Releasing NO and ATP (A)</p> Signup and view all the answers

What happens to cerebral oxygen delivery during hypoxia when arterial content is equivalently reduced by hypoxia or hemodilution?

<p>Cerebral oxygen delivery better maintained during hypoxemic hypoxia (A)</p> Signup and view all the answers

How does opening of ATP-dependent K+ channels in vascular smooth muscle impact cerebral blood flow?

<p>Increases CBF (A)</p> Signup and view all the answers

what is The relationship between oxyhemoglobin saturation, as evaluated by pulse oximetry, and CBF?

<p>is inversely linear (C)</p> Signup and view all the answers

the greatest neurogenic influence appears to be exerted on ?

<p>larger cerebral arteries (A)</p> Signup and view all the answers

Which nuclei are likely to give rise to intraaxial pathways influencing cerebral blood flow?

<p>Fastigial nucleus (C)</p> Signup and view all the answers

What effect does hemorrhagic shock, characterized by high sympathetic tone, have on autoregulation of cerebral blood flow?

<p>Shifts the lower end of the autoregulatory curve to the right (A)</p> Signup and view all the answers

How does sympathetic denervation impact cerebral blood flow during hemorrhagic shock?

<p>Increases cerebral blood flow (A)</p> Signup and view all the answers

Activation of cerebral sympathetic innervation result in ?

<p>shifts the ULA to the right (C)</p> Signup and view all the answers

What effect does anemia have on cerebral vascular resistance and cerebral blood flow (CBF)?

<p>Reduces resistance and increases CBF as a compensatory response to reduced oxygen delivery (C)</p> Signup and view all the answers

What is the impact of hypoxia compared to hemodilution on cerebral blood flow?

<p>Hypoxia significantly increases CBF compared to hemodilution (D)</p> Signup and view all the answers

In patients with acute ischemic stroke, why is viscosity manipulation not beneficial in reducing cerebral injury?

<p>Reducing viscosity does not affect CBF in ischemic areas (C)</p> Signup and view all the answers

How does a hematocrit of 30% to 34% impact oxygen delivery in patients with focal cerebral ischemia?

<p>It results in maximal oxygen delivery (C)</p> Signup and view all the answers

Why is viscosity not a target for manipulation in patients at risk due to cerebral ischemia?

<p>Viscosity reduction does not enhance oxygen delivery (B)</p> Signup and view all the answers

In focal cerebral ischemia, why is reducing viscosity through hemodilution significant for increasing CBF?

<p>It further dilutes the blood, improving CBF in ischemic territories (B)</p> Signup and view all the answers

What effect does the administration of epinephrine have on cerebral blood flow (CBF) under hypotensive epidural anesthesia?

<p>Maintains CBF (A)</p> Signup and view all the answers

reduction in cardiac output (CO) by approximately 30% results in a decrease in CBF by about:

<p>10% (C)</p> Signup and view all the answers

What is the primary factor that influences cerebral blood flow (CBF) according to the provided text?

<p>perfusion pressure (C)</p> Signup and view all the answers

In which disease states does augmentation of cardiac output NOT increase cerebral blood flow (CBF) according to the text?

<p>Traumatic head injury (C)</p> Signup and view all the answers

What is suggested by the relationship between cardiac output (CO) and cerebral blood flow (CBF) based on the available data?

<p>The influence of CO on CBF varies depending on the clinical scenario (A)</p> Signup and view all the answers

Which factor is increasingly being recognized as an important determinant of cerebral blood flow (CBF)?

<p>Cardiac output (D)</p> Signup and view all the answers

How do medications like β-antagonists and α2-agonists impact autoregulation according to the text?

<p>By modulation of sympathetic nervous system activity (C)</p> Signup and view all the answers

How does congestive heart failure affect the capacity of autoregulatory mechanisms to maintain CBF in response to hypotension?

<p>limit the capacity of autoregulatory mechanisms to maintain CBF in response to hypotension (C)</p> Signup and view all the answers

What role does the sympathetic nervous system play in the cerebrovascular response to hypotension?

<p>Decreases vasodilatory capacity of cerebral vessels (C)</p> Signup and view all the answers

How do hypercarbia and hypoxia affect autoregulation according to the text?

<p>Attenuate autoregulation (D)</p> Signup and view all the answers

What is a major determinant of cerebral blood flow (CBF) according to the text?

<p>MAP (perfusion pressure) (D)</p> Signup and view all the answers

What is the primary focus of anesthetics in modulating autoregulation according to the text?

<p>Suppression of autonomic neural activity (D)</p> Signup and view all the answers

What factor is deemed to render the static representation of cerebral autoregulation invalid?

<p>Multitude of factors affecting perfusion pressure (D)</p> Signup and view all the answers

In the context of autoregulatory curves, what is suggested to be more accurate than a single static curve?

<p>A family of autoregulatory curves (B)</p> Signup and view all the answers

What is recommended as a key part of anesthetic management concerning cerebral perfusion in individual patients?

<p><strong>Maintenance of circulatory volume</strong> and cardiac output consideration (A)</p> Signup and view all the answers

How do medications like CCB, nitrates, ARB, ACEI impact autoregulation according to the text?

<p>direct reduction of vasomotor tone (B)</p> Signup and view all the answers

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