Anatomy

Question 1

What is the correct position of a CVL placed in the right IJ on a CXR?

Answer 1

tip at the cavoatrial junction, at the first anterior intercostal space ABOVE the level of the carina

Question 2

What are the anatomic predictors of difficult mask ventilation?

Answer 2

thyromental distance < 6 cm

limited mandibular protrusion

BMI > 30

beard

Question 3

What is the relative position of the popliteal artery to the tibial nerve in the popliteal fossa?

Answer 3

popliteal artery lies medial to the tibial nerve at the level of its split from the sciatic nerve

Question 4

What is the sensitivity of the Mallampati score in predicting difficult laryngoscopy?

Answer 4

poor: in a meta-analysis only 35% of difficult intubations were Mallampati III or IV

Question 5

In which patients is atlanto-axial instability of concern?

Answer 5

Down syndrome

achondroplasia

osteogenesis imperfecta

RA

ankylosing spondylitis

Question 6

What nerve provides sensation to the airway below the level of the vocal cords? Where can it be anesthetized?

Answer 6

recurrent laryngeal nerve

through the cricothyroid membrane, transtracheal injection

[RL-CT TT]

Question 7

What nerve provides sensation to the airway from the vocal cords to the inferior aspect of the epiglottis? Where can it be anesthetized?

Answer 7

superior laryngeal nerve, internal branch

through the thyrohyoid membrane, at the greater cornu of the hyoid bone

Question 8

What nerve provides sensation to the airway from the superior aspect of the epiglottis to the base of the tongue? Where can it be anesthetized?

Answer 8

glossopharyngeal nerve

at the base of the posterior tonsillar pillars

Question 9

What can complicate a block of the glossopharyngeal nerve? Why?

Answer 9

sinus bradycardia -> asystole

the glossopharyngeal nerve provides afferent signals from the carotid baroreceptors

Question 10

What forms the stellate ganglion?

Answer 10

Fusion of the lowest cervical and first thoracic ganglia

Question 11

How do you distinguish the paralyzed vocal cord from the normal cord in a unilateral recurrent laryngeal nerve injury?

Answer 11

injured cord is fixed in the paramedian position

normal cord will cross the midline to meet the injured cord during phonation

Question 12

Which nerve mediate the gag reflex? Cough reflex?

Answer 12

Gag reflex: glossopharyngeal afferent, vagus efferent

Cough reflex: superior laryngeal nerve and recurrent laryngeal nerve

Question 13

Which nerves are at risk for damage during CVL placement in the IJ?

Answer 13

Vagus nerve: within the carotid sheath, between the IJ and carotid

Sympathetic chain: posterior to the carotid sheath

Phrenic nerve: lateral to the carotid sheath

Question 14

What complications are more common with CVL placement in the LEFT IJ vs. the right IJ?

Answer 14

Pneumothorax

Thoracic duct injury

Question 15

Where do the spinal cord and dura terminate in neonates and adults?

Answer 15

spinal cord: L1 in adults, L3 in neonates

dura: S2 in adults (PSIS), S3 in neonates

Question 16

What nerve roots give rise to the ileoinguinal and ileohypogastric nerves?

Answer 16

T12-L1

Question 17

What is contained in the femoral triangle?

Answer 17

Question 18

Which nerve roots give rise to the obturator nerve?

Answer 18

ANTERIOR divisino of L2-L4

Question 19

What nerve is injured when legs are crossed?

Answer 19

sural nerve

Question 20

What is the most common peripheral nerve injury under anesthesia?

Answer 20

ulnar nerve

Question 21

What is the most common nerve injury in the lateral decubitus position?

Answer 21

brachial plexus