Week One — Circulation, Pressure, and the Slack Brain
Ten questions on the first four days. Most of them will not sit inside a single day, because the mistakes this week is guarding against happen where two days meet — a pressure target chosen from one day and a transducer zeroed by another.
01
What this is
no new material
**No new material. Harder questions.**
This week gave you four things: how a deficit's *shape* narrows its mechanism, how loosely flow actually tracks metabolism, why the mean ICP is the least informative number the monitor holds, and why a slack brain is decided before the dura is opened.
Most of what follows asks you to use two of those at once. That is deliberate. Each day was safe on its own; the errors that reach a patient live in the joins — a MAP floor taken from the autoregulation curve and applied to a patient whose collateral supply you never checked, or a head-up position that helps venous drainage and quietly corrupts the perfusion pressure you are reading.
Answer first, then read. Checking the day before answering turns retrieval
practice into rereading, and the two feel identical while you are doing them.
03
The questions
9 of 10 application or analysis
Item 1Analysis Neuro 1 · Week 1
A 74-year-old with treated hypertension and an 80% left internal carotid stenosis has a six-hour prone spine fusion during which MAP was held at 65 mm Hg. She wakes with proximal arm and leg weakness on the right and preserved face and language. Which reading of that pattern is best supported by this week?
Item 2Analysis Neuro 1 · Week 1
A patient with a supratentorial mass is positioned head-up 30 degrees for venous drainage. The arterial line is zeroed at the phlebostatic axis. The monitor shows MAP 80, ICP 20, and the chart records CPP 60. The head is roughly 20 cm above the heart. What is actually true?
Item 3Analysis Neuro 1 · Week 1
A patient with a supratentorial mass has been ventilated to a PaCO₂ of about 25 mm Hg for eight hours in the intensive care unit and comes for craniotomy. Which statement best describes the position you inherit?
Item 4Application Neuro 1 · Week 1
You are about to blunt the sympathetic response to skull pin placement in a 70 kg patient. Which is correct?
Item 5Analysis Neuro 1 · Week 1
Two patients each have a mean intracranial pressure of 18 mm Hg. In the first, P1 is taller than P2. In the second, P2 has risen above P1 and the waveform is rounded. What is the defensible position?
Item 6Application Neuro 1 · Week 1
Forty minutes into an elective craniotomy the dura is opened and the surgeon reports a tight brain. Which response best reflects this week?
Item 7Analysis Neuro 1 · Week 1
You are asked to accept a period of deliberate hypotension in a patient with unilateral carotid disease, on the grounds that the circle of Willis will maintain cross-flow. What is the best objection?
Item 8Application Neuro 1 · Week 1
During sensory stimulation, cerebral blood flow and oxygen utilisation are measured independently. Which pattern is expected, and what does it explain?
Item 9Application Neuro 1 · Week 1
A chronically hypertensive patient with a usual MAP near 110 presents for elective craniotomy. Which approach to the intraoperative pressure floor best reflects this week?
Item 10Recall Neuro 1 · Week 1
Which sequence names the most stimulating steps of a craniotomy, and what follows from knowing them?