Anatomy/Position Exam Flashcards
1
Q
In the adult patient , the superior border of the thyroid cartilage overlies:
A
at the C4 level
2
Q
In the adult, the larynx extends from the superior border of the thyroid cartilage to the______
A
inferior border of the cricoid ring at the C6 level.
3
Q
What bone Provide the chief support for the larynx?
A
The hyoid bone,
4
Q
Where does the hyoid bone lies?
A
C3
5
Q
RCA Branches
A
SA node branch AV node branch Right Marginal Branch PDA Conus Branch Right posterolateral branches
6
Q
RCA Branches (RASPCR)
A
SA node branch AV node branch Right Marginal Branch PDA Conus Branch Right posterolateral branches
7
Q
LCA Branches
LaCiDi LPI
A
LAD Circumflex Diagonal Left Marginal Posterolateral banches Intraventricular septal branches
8
Q
The celiac plexus block is utilized for various types of _________Most frequently for relief of pain associated with
A
abdominal VISCERAL pain syndromes,
Intra-abdominal cancer
9
Q
Potential complications of celiac plexus block include
A
inadvertent aortic puncture or spinal or epidural anesthesia.
10
Q
Positioning for Celiac plexus block? why?
A
It is generally performed with the patient in the prone position with a pillow placed under the abdomen to decrease lumbar lordosis.
11
Q
Where is the level of Celiac plexus?
A
T12-L1
12
Q
What are the Branches of the Facial Nerve (CN VII)
A
CeMaBuTemZy Cervical nerves Mandibular Buccal Temporal Zygomatic
13
Q
After completion of the stellate ganglion block, sympathetic blockade of the right upper extremity can be best assessed by
A
observing: a temperature change in the right arm
14
Q
Stellate ganglion block is most commonly performed for patients with
A
Upper extremity pain (CRPS I or II).
15
Q
Side effect of Stellate Ganglion Block
A
Horner’s syndrome
16
Q
What causes HORNER”S SYNDROME symptoms ?
A
SNS denervation
17
Q
Signs of Horner’s Syndrome
MEP
A
Miosis
Ptosis
Enophtalmos of the globe on the IPSILATERAL side of the block
18
Q
Although practitioners look for the development of Horner’s syndrome as a metric for efficacy of the block, its presence
A
does not necessarily equate to sympathetic denervation of the upper extremity.
19
Q
Fibers found in the spinothalamic tract of the spinal cord are involved in the transmission of: (Select 3)
A
Simple touch
Pain
Temperature
20
Q
Endogenous glucocorticoids are secreted by the and the.
A
zona fasciculata of the adrenal gland.
21
Q
The zona glomerulosa secretes
A
mineralocorticoids (aldosterone)
22
Q
Zona reticularis secretes
A
androgens
23
Q
The adrenal medulla secretes 2 hormones and %
A
epinephrine (80%) and norepinephrine (20%).
24
Q
What is the only cartilage of the larynx that forms a complete ring?
A
The Cricoid Cartilage
25
The larynx consists of 9 cartilages: TECACoCu
(singular)
Thyroid
Epiglottis
Cricoid cartilages
(paired).
Arytenoids
Cuneiforms
Corniculates
26
Abduct Cords Vocal Cords (think abduct a kid in the back)
Posterior Cricoarytenoids
27
Adduct Cords Vocal Cords (opposite word)
Lateral Cricoarytenoids
28
Tense the vocal Cords
CricoThyroid (Cord Tense ) CT
29
Shortens and Relaxes cords
Thyroarytenoids
30
Cranial nerves possessing only motor function include:
(HAT)
Hypoglossal
Abducens
Trochlear
31
The primary complication associated with the sitting position is
venous air embolization
32
Hypoperfusion of the Cerebral vasculature with this position
Sitting
33
Position associated with Pooling of blood in the LE
Sitting
34
Position associated with decrease FRC
Sitting
35
Explain VAE
Air entrained into the vasculature as a result of NEGATIVE PRESSURE GRADIENT CREATED when the operative site is ABOVE THE LEVELS of the HEART
36
Incidence of VAE in the sitting position is
1-76%
37
after an extended surgery in the supine position, it is noted that the patient's legs are crossed. After awakening, the patient complains of numbness on the lateral and posterior portion of the sole of his foot The nerve most likely injured is the______
SURAL NERVE
38
Why do Conscious patient cross their legs?
Conscious patients cross their legs to alleviate lumbosacral strain in the supine position.
39
Crossing legs result in injury of the
Superficial Peroneal nerve in the dependent leg
| AND sural nerve in the superior leg
40
Damage to the sural nerve result in
Numbness of the posterior portion of the sole of the foot and heel of the lateral foot AND the Achilles just above the ankle.
41
The protective mechanism which prevents over distention of the alveoli at high lung volumes is known as the:
Hering-Breuer reflex
42
What elicit the Hering-Breuer Inflation Reflex?
Stimulation of stretch receptors in the lungs can elicit the Hering-Breuer inflation reflex.
43
What does the Hering-Breuer reflex do?
may decrease the frequency of the inspiratory efforts by causing a transient apnea.
44
The component of the nephron that is involved in the concentration of urine via the countercurrent mechanism is the:
Loop of Henle
45
The primary function of the Loop of Henle is the a
establishment of a hyperosmotic state within the medullary area of the kidney
46
Mechanism that is vital to the conservation of salt and water.
Countercurrent mechanism (hyperosmotic state within the medullary)
47
Water conservation and the production of a concentrated urine involve a countercurrent exchange system or "multiplier" in which a
concentration gradient causes fluid to be exchanged across parallel sides of the hairpin-shaped loop. The gradient increases as the loop moves from the renal cortex into the medulla.
48
Countercurrent exchange system or "multiplier" is for
Water conservation and the production of a concentrated urine
49
In the counter current mechanism, the gradient increases...
The gradient increases as the loop moves from the renal cortex into the medulla.
50
The brachial plexus arises from spinal nerve roots C8-T1.
C8-T1.
51
The Brachial plexus roots divide into the ______,___trunks
superior, middle and inferior trunks.
52
In Brachial Plexus , Divisions then give rise to the
lateral, posterior and medial cords.
53
In Brachial Plexus, The posterior cord gives rise to the
| and the
the axillary and radial nerves
54
In Brachial Plexus, lateral cord gives rise to the
musculocutaneous and median nerves
55
In Brachial Plexus, medial cord gives rise to the
median and ulnar nerves.
56
The two cerebral hemispheres of the brain are connected by the:
corpus callosum
57
The majority of blood supply to the lower and anterior two thirds of the spinal cord arises from the:
great ventral radicular artery
58
What arises from the GREAT VENTRAL RADICULAR ARTERY?
lower and anterior two thirds of the spinal cord blood supply
59
The great ventricular radicular artery (A.K.A. the
artery of Adamkiewicz or arteria radicularis magna)
60
Where does the ARTERY OF ADAMKIEWICZZ enters the cord at and
approximately T7
61
Supplies the lumbosacral segment (Artery)
ARTERY OF ADAMKIEWICZ (a.k.a Great ventricular radicular artery)
62
It is the largest and most important radicular artery.
ARTERY OF ADAMKIEWICZ (a.k.a Great ventricular radicular artery)
63
Spinal cord segments that receive blood from one source are prone to ?
particularly prone to ischemic injury if flow is interrupted.
64
Interruption of flow from this artery results in paraplegia.
ARTERY OF ADAMKIEWICZ (a.k.a Great ventricular radicular artery)
65
Interruption of flow in Artery of Adamkiewitcz causes
Paraplegia
66
A potential problem associated with cannulation of the dorsalis pedis artery for monitoring of blood pressure is:
the waveform may be distorted and result in overestimation of the pressure
67
Reflects the highest systolic blood pressure in the body.
The dorsalis pedis pulse .
As the arterial pulse leaves the heart, pulse pressure increases due to decreasing arterial lumen size and the reflection of the BP wave as it moves towards the periphery. This reflection causes an additive effect for systolic BP.
68
Attributes associated with the development of post-operative ulnar neuropathy include:
```
Male Sex(70-90%)
Extreme obesity (BMI>38)
Prolonged bedrest,
Preexisting contralateral ulnar neuropathy
```
69
Anesthesia-related ulnar nerve injury is thought to be secondary to
External nerve compression or stretch caused by intraoperative malpositioning.
70
Cerebrospinal fluid: occupies a volume of
approximately 150 mL in the subarachnoid space
71
Role of CSF for brain and SC
Cerebrospinal fluid supports and cushions the spinal cord and brain.
72
CSF is produced by at a rate of approximately
choroid plexuses in the brain's ventricles
73
How much CSF produced per day?
500 mL/day.
74
How is CSF reabsorbed?
It is largely reabsorbed by arachnoid granulations and by small CNS capillaries.
75
The cricopharyngeus muscle receives sensory innervation primarily from the:
glossopharyngeal nerve
76
What is the cricopharyngeus muscle an integral part of?
the upper esophageal sphincter
77
The cricopharyngeus receives SENSORY INNERVATION from
Primarily from the glossopharyngeal Nerve (CN IX)
78
The cricopharyngeus receives MOTOR INNERVATION from
Vagus Nerve (CN X)
79
It acts as a barrier to regurgitation in the conscious patient.
Cricopharyngeus Muscle
80
Arterial blood supply to the larynx arises from the:
superior and inferior thyroid arteries
81
Gives rise to the superior laryngeal artery.
The superior thyroid artery
82
The superior thyroid artery is a branch of the
external carotid
83
This artery supplies the supraglottic region of the larynx.
Superior LARYNGEAL ARTERY
84
Is a branch of the inferior thyroid artery, (artery)
The inferior laryngeal artery
85
Supplies the infraglottic region of the larynx.
Inferior Laryngeal artery
86
The lower border of the scapula corresponds to spinal level
T7
87
Vertebrae PROMINENS level
C7
88
Inferior Edge of the SCAPULA
T10
89
T10 level Landmark
Umbilicus
90
L4 level landmark
Highest points of illiac crests
91
S2 level landmark
Level of posterior iliac spines
92
Anatomic dead-space ends at the:
terminal bronchiole
93
What is the last airway component incapable of gas exchange?
The terminal bronchiole is the
94
Part of the airway devoid of cartilaginous support
Terminal bronchiole
95
Terminal bronchiole the highest proportion of
smooth muscle in its walls relative to the other airway components
96
What is the first site in the tracheobronchial tree where gas exchange occurs?
The respiratory bronchiole, which follows the terminal bronchiole
97
The most serious complication of a supraclavicular block is:
Pneumothorax
98
What is the principal cause of Pneumothorax during a supraclavicular block?
Needle angle that "aims" toward the apex of the lung.
99
What is the incidence of Pneumothorax with supraclavicular block?
0.5-5%
100
What is the incidence of phrenic nerve blockade and why?
Although the incidence of phrenic nerve blockade is 30 - 50%, its effects are usually well-tolerated by the patient with normal pulmonary function.
101
Potential complications associated with an interscalene block include: (Select 4)
PITT
Phrenic nerve block
Pneumothorax
Injection of local anesthetic into the vertebral artery,
Total spinal (SAB Injection)
102
The ansa cervicalis innervates the:
sternohyoid muscle
103
The ansa cervicalis is a component of the______ plexus,
cervical
104
What does the ANSA Cervicalis provides?
provides motor innervation to the sternohyoid and the inferior belly of the omohyoid muscles.
105
What is Chassaignac's tubercle as far as landmark?
anatomic landmark for the placement of interscalene and cervical plexus blocks.
106
It is the transverse process of the verterbal body at C6
Chassaignac's tubercle
107
Where can the Chassaignac's tubercle be palpated?
lateral to the cricoid cartilage.
108
Cerebrospinal fluid flows from the third to the fourth ventricle via the:
cerebral aqueduct of Sylvius (A.K.A. cerebral aqueduct)
109
CSF is secreted by the ______ ________ in _______ and ______flows
Choroid plexus
| lateral ventricles 1 and 2
110
CSF flow through the________ to the 3rd ventricle,
foramen of Monro
111
CSF flow through the foramen of Monro to the
3rd ventricle
112
AFter 3rd ventricle through the foramina of Magendie and Luschka (A.K.A. _______ and _______to the________
lateral and medial apertures of 4th ventricle)
| subarachnoid space.
113
The preportal organs are the
| 3S PC
stomach, spleen, pancreas, small intestine, and colon.
114
Accessory muscles of respiration involved in forceful exhalation include:
rectus abdominis
115
During forceful exhalation (e.g. with coughing and the clearing of secretions), muscles active are
the rectus abdominis
| the transversus abdominis and the external and internal oblique muscles of the abdomen are active
116
During forceful inspiration,
The sternocleidomastoid and scalene muscles contract in conjunction with the diaphragm and the intercostals
117
In the adult, during placement of a pulmonary artery catheter through the right internal jugular vein, the right ventricle should be entered at approximately:
25 - 35 cm
118
Cardiac structure Distance in cm : RA
15-25 cm
119
Cardiac structure Distance in cm: RV
25-25 cm
120
Cardiac structure Distance in cm: PA
35-45 cm
121
Cardiac structure Distance in cm: PA wedge position
45-50cm
122
The dominant motor nerve innervating the biceps brachii is the:
musculocutaneous
123
The musculocutaneous provides the majority of
motor function to the biceps which resides in the anterior compartment of the arm
124
When performing a brachial plexus block, the "four P's" mnemonic? why?
"push, pull, pinch, pinch" is utilized to ascertain block effectiveness.
125
During the four Ps test of brachial plexus block, f the patient is unable to pull the forearm towards the upper arm, this would indicate a
weakening of the biceps due to local anesthetic effect on the musculocutaneous.
126
Ductus venosus turns into
Ligamentum Venosum
127
Ductus Arteriosus turns into
Ligamentum Arteriosum
128
Foramen Ovale turns into
Fossa Ovalis
129
Umbilical Vein turns into
Ligamentum Teres
130
Umbilical Artery turns into the
Medial Umbilical Ligament
131
Motor innervation of the superior oblique muscle of the eye is supplied by the:
trochlear nerve
132
The majority of extraocular muscles receive motor innervation from the ______nerve (CN # ___)
From the oculomotor nerve (CN III)
133
Provides motor innervation to the lateral rectus muscle of the eye.
The abducens (CN VI)
134
provides motor innervation to the superior oblique muscle of the eye.
the trochlear nerve (CN IV)
135
Lateral inferior plantar aspect of foot innervated by
Sural nerve
136
Heels main nerve
Tibial (calcaneal branch)
137
Mid Medial aspect of foot innervated by
Saphenous nerve
138
Most medial to half of plantar foot
Medial Plantar nerve
139
Of the following, the therapeutic intervention that causes the least ventilatory compromise in the prone patient is the:
use of a Jackson table
140
The degree to which pulmonary mechanics are altered are suggested to be
frame-dependent and not dependent on body habitus.
141
Use of the Jackson table compared to wilson and chest rolls
smallest change in pulmonary compliance and peak airway pressures when compared with use of the Wilson frame and chest rolls.
142
Ideal BMI
18.5-24.9
143
Overweight BMI
25-29.9
144
Obese BMI
30-39.9
145
Morbid BMI
>40
146
The sural nerve: where it provides sensory innervation to the posterior portion of the sole of the foot, as well as to the posterior portion of the heel and the portion of the Achilles tendon immediately above the ankle.
travels superficially with the saphenous nerve behind the lateral malleolus into the ankle
147
The sural nerve: where it
travels superficially with the saphenous nerve behind the lateral malleolus into the ankle
148
It travels superficially with the short saphenous nerve behind the lateral malleolus into the ankle,
Sural Nerve
149
Sural Nerve sensory innervations
provides sensory innervation to the posterior portion of the sole of the foot, as well as to the posterior portion of the heel and the portion of the Achilles tendon immediately above the ankle.
150
Sural Nerve sensory innervations
provides sensory innervation to the posterior portion of the sole of the foot, as well as to the posterior portion of the heel and the portion of the Achilles tendon immediately above the ankle.
151
The three major proteins that compose the thin filament of the sarcomere are (TAT)
actin, troponin, and tropomyosin.
152
According to the Cooley classification of aortic aneurysms, Type B refers to a:
fusiform ascending aorta and proximal arch
153
According to the Cooley classification of aortic aneurysms, Type A refers to a:
Saccular transverse arch
154
According to the Cooley classification of aortic aneurysms, Type C refers to a:
Fusiform aneurysm extending into the proximal aorta
155
According to the Cooley classification of aortic aneurysms, Type D refers to a:
Fusiform aneurysm involving the entire aorta
156
The pudendal block:
blocks the distribution of sacral nerves 2,3, and 4
157
Provides analgesia for the second stage of labor
The pudendal block
158
Which innervate the lower vagina and perineum.
Pudental blocking distribution of sacral nerves 2, 3 and 4,
159
It is useful for forceps or vacuum deliveries or episiotomy.
Pudental block
160
Place the blocks in descending order of peak-plasma concentration following block placement.
IvTIcPaLBBESS
TransTracheal
Intercostal
Caudal
Epidural
161
The innermost layer of the wall of a blood vessel is known as the:
tunica intima
162
The tunica _____serves mainly for the regulation of exchange of material and a thin membrane of vascular tissue
Intima
163
The sinus which is in close proximity to the optic chiasma and the hypophysis is the:
k.
sphenoid sinus
164
Pituitary tumor surgery may be achieved via a
trans-nasal approach through the sphenoid sinus.
165
Overall, the__________ sinuses play an important role as the site of infectious processes.
paranasal
166
sinuses are paired and may extend into the basal part of the occipital bone.
The sphenoid
167
The roof of the Sphenoid sinus has close connections with the
optic canal and the chiasmatic groove (upward) as well as to the hypophysis toward the back
168
Venous drainage from the orbit of the eye is achieved primarily through the:
superior ophthalmic vein
169
What is the venous drainage system for the orbit
superior and inferior ophthalmic veins.
170
For the venous drainage system for the orbit, where do These veins drain into?
The cavernous sinus.
171
The venous system of the orbit is valveless and blood flow in this area is determined by
pressure gradients and external forces on the globe.
172
The primary vein of the orbit is the
superior ophthalmic vein
173
The ophtalmic vein is entered by the
ciliary veins, lacrimal veins and the superior vortex veins which drain the choroid of the globe.
174
Complications resulting from the Trendelenburg position include: (Select 3)
Edema of the upper airway
Inadvertent right mainstem intubation
Increased myocardial oxygen consumption
175
The Trendelenburg position is used to
improve exposure of the pelvic organs.
176
How does the trendelenburg position help during hypotension?
it is assumed to increase venous return and mean arterial pressure.
177
Trendelenburg and patient with CAD
overall myocardial work is increased, an effect which may be detrimental to patients with CAD.
178
Ocular, facial and pharyngeal edema are associated with as well as a result of the
the Trendelenburg position
179
Inadvertent right mainstem intubation associated with what position
The Trendelenburg position
180
Cephalad movement of the mediastinum and the carina.
Trendelenburg position
181
The fissure forming the boundary between the frontal and temporal lobes of the brain is known as the:
lateral sulcus
182
is the deepest lateral furrow which forms the boundary between the frontal and temporal lobes of the brain.
The lateral sulcus (A.K.A. the Sylvian fissure),
183
The central sulcus is the border between the
frontal and parietal lobes.
184
The parieto-occipital sulcus forms the boundary between the
parietal and occipital lobes.
185
The parietal cells of the stomach are responsible for the secretion of:
hydrochloric acid
186
Cells secrete HCL acid
Parietal
187
Parietal cells in the stomach secrete hydrochloric acid in response to the
sight and smell of food; pepsinogen is also secreted by the chief cells at this time.
188
Gastrin is secreted by the
G cells
189
Gastrin is secreted by G cells in response to
gastric distention.
190
Other gastric secretions include
serotonin, histamine and mucus.
191
are released in response to duodenal acidity.
Secretin and pancreatic bicarbonate
192
A 76-year-old male is scheduled for fulguration of bladder tumors. In order to achieve complete anesthesia of the bladder dome, it is necessary attain a level of spinal anesthesia of at least:
T10
193
When awake and anesthetized to the level of the dome of the bladder (T10), the patient may respond to
bladder distention, thereby helping the urologist minimize the potential for bladder rupture.
194
The width of the synaptic gap at the motor axon terminal is approximately:
20 - 50 nm
195
The motor axon terminal is separated from the muscle cell it innervates by a synaptic gap or cleft of only
20 - 50 nm.
196
holds the nerve ending and its associated muscle cell in close alignment.
A carbohydrate-rich, filamentous material in the synapse
197
The neurotransmitter secreted by the motor axon is
acetylcholine.
198
The secretion of anti-diuretic hormone (ADH) causes the
reabsorption of free water in the nephron.
199
What are the sites of action of ADH include the: (Select 2)
Distal tubule
| Collecting duct
200
The late distal tubule reabsorbs what percentage of water?
10% of filtered water.
201
This area is permeable to water only in the presence of ADH.
Distal tubule
202
also permeable to water in the presence of ADH and causes the reabsorption of water into the medullary interstitium, thereby reducing the volume of and concentrating the urine.
The collecting duct is
203
Part of kidney reducing the volume of and concentrating the urine.
Collecting duct
204
Functions of the spleen include:
Reservoir for platelets
Removal of foreign antigens
Removal of aged and damaged erythrocytes
205
Functions of the spleen include:
Hematopoiesis in the fetus
Blood filtering by splenic sinusoids
Removal of foreign antigens by macrophages
IgM production, and removal of aged RBCs and abnormal blood cells.
206
The spleen has a minor role as a reservoir of ______but has no specific reservoir function for _____
platelets ; RBCs.
207
The portal triad consists of the: (Select 3)
hepatic artery, portal vein, bile duct
208
Portal triads, found throughout the liver, are found at each of the
corners of the six-sided liver lobule.
209
The vessels of the portal triads send distributing branches along the sides of the lobules; these branches open up into the
liver sinusoids.
210
In the cardiac myocyte, the area which delineates the border between two separate sarcomeres is known as the:
"Z" band
211
represents the region of the sarcomere which contains thin filaments only
The "I" band
212
is characterized by an area of overlap of thick and thin fibers.
the "A" band
213
The "M" band is present centrally within the "A" band and is composed of
thick filaments which form a hexagonal matrix of myosin binding with protein C.
214
Perioperative vision loss occurs most frequently in anesthetized patients undergoing what kind of procedure?
cardiac surgical procedures
215
Patients undergoing extensive spine procedures while in the prone position may develop
vision loss, primarily from posterior ischemic optic neuropathy.
216
Effects of aging on the cardiovascular system include:
decreased response to β-receptor stimulation
stiffening of the myocardium, arteries and veins
cardiac conduction system changes
defective ischemic preconditioning by volatile anesthetics.
changes in the ANS with increased sympathetic and decreased parasympathetic activity,
217
Nerve fibers involved in the mediation of sharp pain include the:
A-delta fibers
218
Larger myelinated A delta fibers are believed to mediate the transmission of
sharp pain.
219
mediate the transmission of dull pain.
Small, unmyelinated C fibers
220
Primary venous drainage of the lower two-thirds of the esophagus occurs via the:
azygous vein
221
Azygous vein is the primary venous drainaige of the
lower 2/3 of the esophagus
222
the azygous vein which enters the _______At approximately the __________space on the (R/L)
superior vena cava at approximately the 5th intercostal space on the right.
223
Aside from the Azygous vein, Additional esophageal drainage is achieved via
submucosal venous plexuses, the hemiazygous and accessory hemiazygous veins.
224
The upper third of the esophagus drains into the
inferior thyroid vein.
225
Direct anastomosis with the internal carotid artery at the circle of Willis occurs with the:
middle cerebral artery
226
The pneumotaxic center 3 functions:
limits the depth of inspiration; is located in the rostral pons; when maximally activated, increases ventilatory frequency
227
The pneumotaxic respiratory center is in the Its primary
rostral pons.
228
function is to limit the depth of inspiration
Pneumotaxic
229
When maximally activated, the pneumotaxic center
increases ventilatory frequency; however, it performs no pacemaking function and has no intrinsic rhythmicity.
230
performs no pacemaking function and has no intrinsic rhythmicity.
Pneumotaxic
231
The neurotransmitter secreted by the motor end-plate which results in the stimulation of nicotinic (N2) receptors is:
acetylcholine
232
a specialized portion of the membrane of the muscle fiber where nicotinic acetylcholine receptors are concentrated.
The motor end plate
233
When an action potential stimulates the nerve fiber,
acetylcholine is released and stimulates nicotinic subtype 2 (N2) receptors, which are ion channels.
234
Upon stimulation, these N2 receptors open, resulting in an
increase in membrane potential to threshold potential and ultimately excitation-contraction-coupling of the muscle fiber.
235
When performing a glossopharyngeal nerve block, the branches of the nerve are most easily accessed via:
the palatoglossal folds bilaterally
236
The glossopharyngeal nerve provides sensory innervation to the following areas:
posterior third of the tongue
the vallecula,
the anterior surface of the epiglottis
the walls of the pharynx, and the tonsils.
237
When performing a glossopharyngeal nerve block, the nerves are most easily accessed as they traverse the
palatoglossal folds, the soft ridges that extend from the posterior aspect of the soft palate to the base of the tongue bilaterally.
238
Primary branches of the trigeminal nerve (CN V) include the: (Select 3)
ophthalmic nerve, maxillary nerve, mandibular nerve
239
The trigeminal nerve, CN V, divides into three primary branches:
the uppermost ophthalmic branch (sensory only), the maxillary nerve (sensory only) and the mandibular nerve (mixed motor and sensory), the largest branch of the three.
240
Sensory only nerves of trigeminal
Ophthalmic
| Maxillary
241
Mixed motor and sensory of the trigeminal
Mandibular
242
Mixed motor and sensory nerve branch of the trigeminal
Mandibular
243
During the division of the tracheobroncheal tree, loss of cartilage occurs at approximately the:
16th generation
244
Subdivisions, A.K.A. airway generations, are utilized to classify
branching of the tracheobronchial tree.
245
The trachea comprises 0 generation and the airways further divide until
the alveolar sacs and alveoli are reached terminally at the 23rd generation.
246
The airways begin to lose cartilage just distal to the small
intrasegmental bronchi. This occurs at approximately the 16th airway generation.
247
Structures contained within the carotid sheath include the:
common carotid artery, internal jugular vein, vagus nerve
248
Structures located within the carotid sheath are the
common carotid artery, the vagus nerve and the internal jugular vein.
249
When utilizing the axillary approach to block the brachial plexus, the nerve which most frequently requires supplemental blockade is the:
. Supplemental infiltration of local anesthetic is typically required particularly if surgery is to be performed on the lateral cutaneous region of the forearm.
musculocutaneous nerve
250
Because the musculocutaneous nerve branches from the brachial plexus relatively early, blockade of this nerve is difficult to achieve via the
axillary approach to brachial plexus blockade
251
When utilizing the axillary approach to block the brachial plexus, the nerve which most frequently requires supplemental blockade is the musculocutaneous nerve. Supplemental infiltration of ________is typically required particularly if surgery is to be performed on the lateral
local anesthetic
| cutaneous region of the forearm
252
Nerves arising from the sacral plexus include the:
The three major components of the sciatic nerve are the tibial and the common peroneal nerves, and the posterior femoral cutaneous nerve to the thigh.
sciatic nerve
253
The sciatic nerve arises from the sacral plexus and is derived from the ventral rami of the
4th lumbar to 3rd sacral nerve roots.
| L4 to S3
254
The three major components of the sciatic nerve are the
tibial and the common peroneal nerves, and the posterior femoral cutaneous nerve to the thigh.
255
A 39-week gestation primipara is brought into the OR for cesarean section. Upon laying flat, she becomes diaphoretic and nauseated. The most effective maneuver to rectify these symptoms is:
Place the patient in a slight left lateral tilt with a wedge under her right hip
256
With a pregnant patient in the supine position, a mobile abdominal mass such as a tumor or a gravid uterus may
compress the great vessels of the abdomen and compromise circulation.
257
This is known as the aortocaval or supine hypotensive syndrome.
With a pregant patient in the supine position, a mobile abdominal mass such as a tumor or a gravid uterus maycompress the great vessels of the abdomen and compromise circulation.
258
Treating Aortocaval compression
leftward tilt of the tabletop or by a wedge under the right hip.
259
Nerves originating from the Edinger-Westphal nucleus include the:
accessory oculomotor nerve
260
Cranial and certain accessory nerves originate from various
nucleii found in the pons and medulla.
261
originates from the Edinger-Westphal nucleus is the _______which is located adjacent to the_________
The accesory oculomotor nerve; oculomotor nucleus.
262
Sensory innervation of the larynx below the level of the vocal cords is provided by the:
recurrent laryngeal nerve. The recurrent laryngeal nerve provides sensory innervation to the larynx below the vocal cords and motor innervation to all of the muscles of the larynx with the exception of the cricothyroid muscle.
263
The larynx receives innervation from two major nerves.
Superior laryngeal Nerve
| Recurrent laryngeal nerve
264
The superior laryngeal nerve branches into two nerves:
The internal branch which provides sensory innervation to the larynx above the vocal cords and the external branch which provides motor innervation to the cricothyroid muscle.
265
Provides motor innervation to the cricothyroid muscle.
External branch of Superior Laryngeal nerve
266
Which branch of the superior laryngeal nerve provide Sensory innervation to the larynx ABOVE the vocal cords
Internal branch of the superior laryngeal nerve
267
The recurrent laryngeal nerve provides
sensory innervation to the larynx BELOW the vocal cords and motor innervation to all of the muscles of the larynx with the exception of the cricothyroid muscle.
268
Sensory innervation to the larynx below the vocal cords provided by what nerve?
Recurrent laryngeal nerve
269
Recurrent laryngeal nerve provide motor innervation to all of the muscles of the larynx with the exception of the
cricothyroid muscle.
270
Compartment syndrome has been associated with:
elevation of the extremities
271
Compartment syndrome is a potentially life-threatening complication that causes damage to
neural and vascular structures from swelling of tissues within the muscular compartment.
272
Reported to contribute to the development of compartment syndrome in surgical patients.
```
Prolonged surgical procedures
Operative positions
Elevation of the extremities
Intraoperative hypotension
Increasing age
Extremes of body habitus
```
273
The recurrent laryngeal nerve provides the motor supply to all intrinsic laryngeal muscles except the
cricothyroid muscle
274
provides the motor supply to all intrinsic laryngeal muscles except the cricothyroid muscle
Recurrent laryngeal nerve
275
Injury may occur during thyroid and parathyroid surgery.
Recurrent laryngeal nerve
276
The vagus nerve (cranial nerve X), via the ____and _______ is responsible for the _____and ________
superior and recurrent laryngeal nerves, is responsible for the sensory and motor innervation of the larynx.
277
Bone marrow depression and peripheral neuropathy have been associated with prolonged exposure to anesthetic concentrations of:
nitrous oxide
278
How does nitrous inhibit Vitamin B12
By irreversibly oxidizing the cobalt atom in vitamin B12, nitrous oxide inhibits vitamin B12 dependent enzymes.
279
As a result of these enzyme inhibitions, methionine synthetase and thymidylate synthetase, prolonged exposure to nitrous oxide has been associated with
bone marrow depression megaloblastic anemia, peripheral neuropathy and teratogenicity.
280
What is dynamic compliance?
Is the Presence gas flow
281
Dynamic compliance is based on
PEAK PRESSURE
282
Static complicance is the
Absence of gas flow
283
Static compliance is based on
Plateau pressure.
284
Static compliance Cstat =
Tidal volume / (Pplat - PEEP)
285
Dynamic compliance Cdyn =
Tidal volume / (Ppeak - PEEP)
286
PE on compliance and resistance
PE do not change compliance and resistance
287
Plugging or bronchospasm increases what pressures?
Increase Airway resistance and peak pressure
288
Plugging or bronchospasm increases what pressures?
| What happens to the curve , plateau and static pressure?
Increase Airway resistance and peak pressure so dynamic compliance CURVE shifts to the RIGHT and flattens, PLATEAU AND STATIC remains unchanged
289
Tension pneumothorax, atelectasis, and pulmonary edema, BRONCHIAL intubation cause what to lung compliance? what happens to peak pressure and plateau pressure
Causes reduced lung compliance
| Increases both peak pressure and plateau pressure, so both static and dynamic compliance fall.
290
Opioids with slowest peak onset
morphine
291
Over inflation of tracheal cuff complications
vocal cord paralysis from pressure on RLN
292
What does ED95 means really?
The dose that will REDUCE TWITCH HEIGHT by 95%.
293
Potency of benzodiazepines
Lorazepam > Midazolam > Diazepam
294
Most likely to rupture of the papillary muscle
Posteromedial papillary muscle
295
What are the 2 Enzymes inhibited by nitrous oxide that can lead to peripheral neurophathy, megaloblastic anemia?
methionine synthetase and thymidylate synthetase,
