Anatomy

Question 1

What 5 nerves comprise the superficial cervical plexus?

Answer 1

Lesser occipital Greater occipital Greater auricular Transverse cervical Supraclavicular

Question 2

Where can the superficial cervical plexus be blocked?

Answer 2

The midpoint of the posterior border of the SCM

Question 3

What nerve is often blocked along with the superficial cervical plexus? How would you know?

Answer 3

Accessory nerve Paralysis of the ipsilateral trapezius

Question 4

What spinal levels give rise to the cervical plexus?

Answer 4

C1-C4

Question 5

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

Answer 5

recurrent laryngeal nerve

through the cricothyroid membrane

Question 6

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

Answer 6

superior laryngeal nerve, internal branch

through the thyrohyoid membrane

Question 7

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 7

glossopharyngeal nerve

at the base of the posterior tonsillar pillars

Question 8

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

Answer 8

sinus bradycardia -> asystole

the glossopharyngeal nerve provides afferent signals from the carotid baroreceptors

Question 9

What innervates all but one of the airway muscles?

Answer 9

Recurrent laryngeal nerve

Question 10

What is the only airway muscle not innervated by the recurrent laryngeal nerve? What is it innervated by? What does it do?

Answer 10

• cricothyroid muscle
• external branch of the superior laryngeal nerve
• tenses vocal cords

Question 11

What forms the stellate ganglion?

Answer 11

Fusion of the lowest cervical and first thoracic ganglia

Question 12

What anatomic landmark helps to identify C6?

Answer 12

Cricoid cartilage

Question 13

Where is a stellate ganglion block performed? Why?

Answer 13

Medial to the carotid pulse at C6 Avoid intravascular injection into the vertebral artery which is protected by the transverse process at C6

Question 14

What indicates a successful stellate ganglion block?

Answer 14

Horner’s syndrome (ptosis, miosis, anhidrosis) Increase in arm temperature (increased blood flow)

Question 15

What is Chassaignac’s tubercle?

Answer 15

Anterior tubercle of the C6 vertebra, separating the carotid and vertebral arteries

Question 16

What anatomic landmark is associated with C7?

Answer 16

Vertebra prominens

Question 17

What are the borders of the epidural space?

Answer 17

anterior: posterior longitudinal ligament lateral: pedicles and intervertebral foraminae posterior: ligamentum flavum rostral: foramen magnum caudal: sacral hiatus

Question 18

What anatomic landmark helps to identify T3?

Answer 18

Scapular spines

Question 19

What anatomic landmark helps to identify T12?

Answer 19

The lowest rib

Question 20

What anatomic landmark helps to identify S2?

Answer 20

Posterior superior iliac spine

Question 21

What nerve is most commonly missed by an axillary nerve block? How would you test for it?

Answer 21

Musculocutaneous Test sensation along the lateral aspect of the forearm

Question 22

What nerve is most commonly missed by an interscalene block?

Answer 22

Ulnar nerve and 2nd intercostal brachial

Question 23

Where are the branching nerves of the brachial plexus located relative to the axillary artery?

Answer 23

Median nerve: superior Ulnar nerve: inferior Radial nerve: posterior and somewhat lateral

Question 24

What nerve may be compromised during brachial arterial line placement at the elbow?

Answer 24

Median nerve lying medial to the artery

Question 25

What nerve is comprised of anterior divisions of the lumbar plexus?

Answer 25

Obturator nerve

Question 26

What nerves are comprised of posterior divisions of the lumbar plexus?

Answer 26

Femoral nerve and lateral femoral cutaneous nerve

Question 27

What two nerves are given off by the sacral plexus?

Answer 27

Sciatic nerve and posterior cutaneous nerve of the thigh

Question 28

What are the borders of the popliteal fossa?

Answer 28

Upper border: semitendinosis and semimembranosis (medial), biceps femoris (lateral) Lower border: gastrocnemius

Question 29

Which vessel can cause trigeminal neuralgia by compressing the trigeminal nerve?

Answer 29

Superior cerebellar artery

Question 30

Which nerve causes laryngospasm by involuntary adduction of the vocal cords?

Answer 30

Superior laryngeal nerve

Question 31

Between which spinal levels does the artery of Adamkiewicz (great radicular artery) arise in 75% of people?

Answer 31

T9-T12

Question 32

Which maneuver is most important for overcoming airway obstruction?

Answer 32

Head extension