Anatomy/Position Exam Flashcards
In the adult patient, the superior border of the thyroid cartilage overlies at what spine level?
at the C4 level
In the adult, the larynx extends from the superior border of the thyroid cartilage to the______ at what level (spine)
inferior border of the cricoid ring at the C6 level.
What bone Provide the chief support for the larynx?
The hyoid bone
Where does the hyoid bone lies?
C3
Name the RCA Branches(6)
SA node branch
AV node branch
Right Marginal Branch
PDA
Conus Branch
Right posterolateral branches
Name the LCA Branches (6)
LaCiDi LPI
LAD
Circumflex
Diagonal
Left Marginal
Posterolateral banches
Intraventricular septal branches
The celiac plexus block is utilized for relief of pain associated with
abdominal VISCERAL pain syndromes
Intra-abdominal cancer
What are the 2 most important potential complications of celiac plexus block include:
inadvertent aortic puncture or spinal or epidural anesthesia.
What is the positioning to perform a Celiac plexus block? Why?
It is generally performed with the patient in the prone position with a pillow placed under the abdomen to decrease lumbar lordosis.
Where is the level of Celiac plexus?
T12-L1
What are the Branches of the Facial Nerve (CN VII)
CeMaBuTemZy
Cervical nerves
Mandibular
Buccal
Temporal
Zygomatic
After completion of the stellate ganglion block, the sympathetic blockade of the right upper extremity can be best assessed by
observing a temperature change in the right arm
A Stellate ganglion block is most commonly performed for patients with what kind of pain?
Upper extremity pain (CRPS I or II).
What is the most common side effect of a Stellate Ganglion Block?
Horner’s syndrome
What causes “HORNER’S SYNDROME” symptoms ?
SNS denervation
List the signs of Horner’s Syndrome
MEP
Miosis
Ptosis
Enophtalmos of the globe on the IPSILATERAL side of the block
Although practitioners look for the development of Horner’s syndrome as a metric for the efficacy of the block, its presence
does not necessarily equate to sympathetic denervation of the upper extremity.
Fibers found in the spinothalamic tract of the spinal cord are involved in the transmission of: (3)
Simple touch
Pain
Temperature
Endogenous glucocorticoids are secreted by what “zona” of the adrenal gland?
zona fasciculata of the adrenal gland.
What does the zona glomerulosa secretes
mineralocorticoids (aldosterone)
Zona reticularis of the adrenal gland secretes what kind of hormones?
androgens
The adrenal medulla secretes what two hormones and in what percentage?
epinephrine (80%) and norepinephrine (20%).
What is the only cartilage of the larynx that forms a complete ring?
The Cricoid Cartilage
The larynx consists of 9 cartilages: TECACoCu
(singular) Tec-ACuCo
Thyroid
Epiglottis
Cricoid cartilages
(paired).
Arytenoids
Cuneiforms
Corniculates
What cartilages ABduct the Vocal Cords (think abduct a kid in the back)
Posterior Cricoarytenoids
What cartilages ADduct Cords Vocal Cords (opposite word)?
Lateral Cricoarytenoids
What cartilage tenses the vocal Cords?
CricoThyroid (Cord Tense ) CT
What cartilage shortens and relaxes the vocal cords
Thyroarytenoids
The cranial nerves possessing only motor function include:
(HAT)
Hypoglossal
Abducens
Trochlear
The primary complication associated with the sitting position is:
venous air embolization
Hypoperfusion of the Cerebral vasculature with surgery done in which position?
Sitting
This position is associated with pooling of blood in the LE
Sitting
What position is associated with a decrease in FRC?
Sitting
Explain how Venous Air Embolism (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
Incidence of VAE in the sitting position is
1-76%
A patient complains of numbness on the lateral and posterior portion of the sole of his foot after surgery. The nerve most likely injured is the______
SURAL NERVE
Why do conscious patient cross their legs?
Conscious patients cross their legs to alleviate lumbo-sacral strain in the supine position.
Crossing legs result in injury of the
Superficial Peroneal nerve in the dependent leg
AND sural nerve in the superior leg
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.
The protective mechanism which prevents over distention of the alveoli at high lung volumes is known as the:
Hering-Breuer reflex
What elicit the Hering-Breuer Inflation Reflex?
Stimulation of stretch receptors in the lungs can elicit the Hering-Breuer inflation reflex.
What does the Hering-Breuer reflex do?
may decrease the frequency of the inspiratory efforts by causing a transient apnea.
The component of the nephron that is involved in the concentration of urine via the countercurrent mechanism is the:
Loop of Henle
The primary function of the Loop of Henle is the a
establishment of a hyperosmotic state within the medullary area of the kidney
Mechanism that is vital to the conservation of salt and water.
Countercurrent mechanism (hyperosmotic state within the medullary)
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.
Countercurrent exchange system or “multiplier” is for
Water conservation and the production of a concentrated urine
In the counter current mechanism, the gradient increases…
The gradient increases as the loop moves from the renal cortex into the medulla.
The brachial plexus arises from spinal nerve roots C8-T1.
C8-T1.
The Brachial plexus roots divide into the ______,___trunks
superior, middle and inferior trunks.
In Brachial Plexus , Divisions then give rise to the
lateral, posterior and medial cords.
In Brachial Plexus, The posterior cord gives rise to the
and the
the axillary and radial nerves
In Brachial Plexus, lateral cord gives rise to the
musculocutaneous and median nerves
In Brachial Plexus, medial cord gives rise to the
median and ulnar nerves.
The two cerebral hemispheres of the brain are connected by the:
corpus callosum
The majority of blood supply to the lower and anterior two thirds of the spinal cord arises from the:
great ventral radicular artery
What arises from the GREAT VENTRAL RADICULAR ARTERY?
lower and anterior two thirds of the spinal cord blood supply
The great ventricular radicular artery (A.K.A. the
artery of Adamkiewicz or arteria radicularis magna)
Where does the ARTERY OF ADAMKIEWICZZ enters the cord at and
approximately T7
Supplies the lumbosacral segment (Artery)
ARTERY OF ADAMKIEWICZ (a.k.a Great ventricular radicular artery)
It is the largest and most important radicular artery.
ARTERY OF ADAMKIEWICZ (a.k.a Great ventricular radicular artery)
Spinal cord segments that receive blood from one source are prone to ?
particularly prone to ischemic injury if flow is interrupted.
Interruption of flow from this artery results in paraplegia.
ARTERY OF ADAMKIEWICZ (a.k.a Great ventricular radicular artery)
Interruption of flow in Artery of Adamkiewitcz causes
Paraplegia
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
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.
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
Anesthesia-related ulnar nerve injury is thought to be secondary to
External nerve compression or stretch caused by intraoperative malpositioning.
Cerebrospinal fluid: occupies a volume of
approximately 150 mL in the subarachnoid space
Role of CSF for brain and SC
Cerebrospinal fluid supports and cushions the spinal cord and brain.
CSF is produced by at a rate of approximately
choroid plexuses in the brain’s ventricles
How much CSF produced per day?
500 mL/day.
How is CSF reabsorbed?
It is largely reabsorbed by arachnoid granulations and by small CNS capillaries.
The cricopharyngeus muscle receives sensory innervation primarily from the:
glossopharyngeal nerve
What is the cricopharyngeus muscle an integral part of?
the upper esophageal sphincter
The cricopharyngeus receives SENSORY INNERVATION from
Primarily from the glossopharyngeal Nerve (CN IX)
The cricopharyngeus receives MOTOR INNERVATION from
Vagus Nerve (CN X)
It acts as a barrier to regurgitation in the conscious patient.
Cricopharyngeus Muscle
Arterial blood supply to the larynx arises from the:
superior and inferior thyroid arteries
Gives rise to the superior laryngeal artery.
The superior thyroid artery
The superior thyroid artery is a branch of the
external carotid
This artery supplies the supraglottic region of the larynx.
Superior LARYNGEAL ARTERY
Is a branch of the inferior thyroid artery, (artery)
The inferior laryngeal artery
Supplies the infraglottic region of the larynx.
Inferior Laryngeal artery
The lower border of the scapula corresponds to spinal level
T7
Vertebrae PROMINENS level
C7
Inferior Edge of the SCAPULA
T10
T10 level Landmark
Umbilicus
L4 level landmark
Highest points of illiac crests
S2 level landmark
Level of posterior iliac spines
Anatomic dead-space ends at the:
terminal bronchiole
What is the last airway component incapable of gas exchange?
The terminal bronchiole is the
Part of the airway devoid of cartilaginous support
Terminal bronchiole
Terminal bronchiole the highest proportion of
smooth muscle in its walls relative to the other airway components
What is the first site in the tracheobronchial tree where gas exchange occurs?
The respiratory bronchiole, which follows the terminal bronchiole
The most serious complication of a supraclavicular block is:
Pneumothorax
What is the principal cause of Pneumothorax during a supraclavicular block?
Needle angle that “aims” toward the apex of the lung.
What is the incidence of Pneumothorax with supraclavicular block?
0.5-5%
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.
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)
The ansa cervicalis innervates the:
sternohyoid muscle
The ansa cervicalis is a component of the______ plexus,
cervical
What does the ANSA Cervicalis provides?
provides motor innervation to the sternohyoid and the inferior belly of the omohyoid muscles.
What is Chassaignac’s tubercle as far as landmark?
anatomic landmark for the placement of interscalene and cervical plexus blocks.
It is the transverse process of the verterbal body at C6
Chassaignac’s tubercle
Where can the Chassaignac’s tubercle be palpated?
lateral to the cricoid cartilage.
Cerebrospinal fluid flows from the third to the fourth ventricle via the:
cerebral aqueduct of Sylvius (A.K.A. cerebral aqueduct)
CSF is secreted by the ______ ________ in _______ and ______flows
Choroid plexus
lateral ventricles 1 and 2
CSF flow through the________ to the 3rd ventricle,
foramen of Monro
CSF flow through the foramen of Monro to the
3rd ventricle
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.
The preportal organs are the
3S PC
stomach, spleen, pancreas, small intestine, and colon.
Accessory muscles of respiration involved in forceful exhalation include:
rectus abdominis
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
During forceful inspiration,
The sternocleidomastoid and scalene muscles contract in conjunction with the diaphragm and the intercostals
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
Cardiac structure Distance in cm : RA
15-25 cm
Cardiac structure Distance in cm: RV
25-25 cm
Cardiac structure Distance in cm: PA
35-45 cm
Cardiac structure Distance in cm: PA wedge position
45-50cm
The dominant motor nerve innervating the biceps brachii is the:
musculocutaneous
The musculocutaneous provides the majority of
motor function to the biceps which resides in the anterior compartment of the arm
When performing a brachial plexus block, the “four P’s” mnemonic? why?
“push, pull, pinch, pinch” is utilized to ascertain block effectiveness.
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.
Ductus venosus turns into
Ligamentum Venosum
Ductus Arteriosus turns into
Ligamentum Arteriosum
Foramen Ovale turns into
Fossa Ovalis
Umbilical Vein turns into
Ligamentum Teres
Umbilical Artery turns into the
Medial Umbilical Ligament
Motor innervation of the superior oblique muscle of the eye is supplied by the:
trochlear nerve
The majority of extraocular muscles receive motor innervation from the ______nerve (CN # ___)
From the oculomotor nerve (CN III)
Provides motor innervation to the lateral rectus muscle of the eye.
The abducens (CN VI)
provides motor innervation to the superior oblique muscle of the eye.
the trochlear nerve (CN IV)
Lateral inferior plantar aspect of foot innervated by
Sural nerve
Heels main nerve
Tibial (calcaneal branch)
Mid Medial aspect of foot innervated by
Saphenous nerve
Most medial to half of plantar foot
Medial Plantar nerve
Of the following, the therapeutic intervention that causes the least ventilatory compromise in the prone patient is the:
use of a Jackson table
The degree to which pulmonary mechanics are altered are suggested to be
frame-dependent and not dependent on body habitus.
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.
Ideal BMI
18.5-24.9
Overweight BMI
25-29.9
Obese BMI
30-39.9
Morbid BMI
> 40
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
The sural nerve: where it
travels superficially with the saphenous nerve behind the lateral malleolus into the ankle
It travels superficially with the short saphenous nerve behind the lateral malleolus into the ankle,
Sural Nerve
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.
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.
The three major proteins that compose the thin filament of the sarcomere are (TAT)
actin, troponin, and tropomyosin.
According to the Cooley classification of aortic aneurysms, Type B refers to a:
fusiform ascending aorta and proximal arch
According to the Cooley classification of aortic aneurysms, Type A refers to a:
Saccular transverse arch
According to the Cooley classification of aortic aneurysms, Type C refers to a:
Fusiform aneurysm extending into the proximal aorta
According to the Cooley classification of aortic aneurysms, Type D refers to a:
Fusiform aneurysm involving the entire aorta
The pudendal block:
blocks the distribution of sacral nerves 2,3, and 4
Provides analgesia for the second stage of labor
The pudendal block
Which innervate the lower vagina and perineum.
Pudental blocking distribution of sacral nerves 2, 3 and 4,
It is useful for forceps or vacuum deliveries or episiotomy.
Pudental block
Place the blocks in descending order of peak-plasma concentration following block placement.
IvTIcPaLBBESS
TransTracheal
Intercostal
Caudal
Epidural
The innermost layer of the wall of a blood vessel is known as the:
tunica intima
The tunica _____serves mainly for the regulation of exchange of material and a thin membrane of vascular tissue
Intima
The sinus which is in close proximity to the optic chiasma and the hypophysis is the:
k.
sphenoid sinus
Pituitary tumor surgery may be achieved via a
trans-nasal approach through the sphenoid sinus.
Overall, the__________ sinuses play an important role as the site of infectious processes.
paranasal
sinuses are paired and may extend into the basal part of the occipital bone.
The sphenoid
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
Venous drainage from the orbit of the eye is achieved primarily through the:
superior ophthalmic vein
What is the venous drainage system for the orbit
superior and inferior ophthalmic veins.
For the venous drainage system for the orbit, where do These veins drain into?
The cavernous sinus.
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.
The primary vein of the orbit is the
superior ophthalmic vein
The ophtalmic vein is entered by the
ciliary veins, lacrimal veins and the superior vortex veins which drain the choroid of the globe.
Complications resulting from the Trendelenburg position include: (Select 3)
Edema of the upper airway
Inadvertent right mainstem intubation
Increased myocardial oxygen consumption
The Trendelenburg position is used to
improve exposure of the pelvic organs.
How does the trendelenburg position help during hypotension?
it is assumed to increase venous return and mean arterial pressure.
Trendelenburg and patient with CAD
overall myocardial work is increased, an effect which may be detrimental to patients with CAD.
Ocular, facial and pharyngeal edema are associated with as well as a result of the
the Trendelenburg position
Inadvertent right mainstem intubation associated with what position
The Trendelenburg position
Cephalad movement of the mediastinum and the carina.
Trendelenburg position
The fissure forming the boundary between the frontal and temporal lobes of the brain is known as the:
lateral sulcus
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),
The central sulcus is the border between the
frontal and parietal lobes.
The parieto-occipital sulcus forms the boundary between the
parietal and occipital lobes.
The parietal cells of the stomach are responsible for the secretion of:
hydrochloric acid
Cells secrete HCL acid
Parietal
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.
Gastrin is secreted by the
G cells
Gastrin is secreted by G cells in response to
gastric distention.
Other gastric secretions include
serotonin, histamine and mucus.
are released in response to duodenal acidity.
Secretin and pancreatic bicarbonate
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
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.
The width of the synaptic gap at the motor axon terminal is approximately:
20 - 50 nm
The motor axon terminal is separated from the muscle cell it innervates by a synaptic gap or cleft of only
20 - 50 nm.
holds the nerve ending and its associated muscle cell in close alignment.
A carbohydrate-rich, filamentous material in the synapse
The neurotransmitter secreted by the motor axon is
acetylcholine.
The secretion of anti-diuretic hormone (ADH) causes the
reabsorption of free water in the nephron.
What are the sites of action of ADH include the: (Select 2)
Distal tubule
Collecting duct
The late distal tubule reabsorbs what percentage of water?
10% of filtered water.
What area This area is permeable to water only in the presence of ADH.
Distal tubule
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
Which part of the nephron reduces the volume of and concentrates the urine?
Collecting duct
List 3 functions of the spleen:
Reservoir for platelets
Removal of foreign antigens
Removal of aged and damaged erythrocytes
Explain some other 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.
The spleen has a minor role as a reservoir of ______but has no specific reservoir function for _____
platelets ; RBCs.
The portal triad (vessels) consists of the: (Select 3)
hepatic artery, portal vein, bile duct
Portal triads, found throughout the liver, are found at each of the corners of the :;
Six-sided liver lobule.
The vessels of the portal triads send distributing branches along the sides of the lobules; these branches open up into the
liver sinusoids.
In the cardiac myocyte, the area which delineates the border between two separate sarcomeres is known as the:
“Z” band
What band represents the region of the sarcomere which contains thin filaments only?
The “I” band
is characterized by an area of overlap of thick and thin fibers.
the “A” band
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.
Perioperative vision loss occurs most frequently in anesthetized patients undergoing what kind of procedure?
cardiac surgical procedures
Patients undergoing extensive spine procedures while in the prone position may develop
vision loss, primarily from posterior ischemic optic neuropathy.
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,
Nerve fibers involved in the mediation of sharp pain include the:
A-delta fibers
Larger myelinated A delta fibers are believed to mediate the transmission of
sharp pain.
mediate the transmission of dull pain.
Small, unmyelinated C fibers
Primary venous drainage of the lower two-thirds of the esophagus occurs via the:
azygous vein
Azygous vein is the primary venous drainaige of the
lower 2/3 of the esophagus
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.
Aside from the Azygous vein, Additional esophageal drainage is achieved via
submucosal venous plexuses, the hemiazygous and accessory hemiazygous veins.
The upper third of the esophagus drains into the
inferior thyroid vein.
Direct anastomosis with the internal carotid artery at the circle of Willis occurs with the:
middle cerebral artery
The pneumotaxic center 3 functions:
limits the depth of inspiration; is located in the rostral pons; when maximally activated, increases ventilatory frequency
The pneumotaxic respiratory center is in the Its primary
rostral pons.
function is to limit the depth of inspiration
Pneumotaxic
When maximally activated, the pneumotaxic center
increases ventilatory frequency; however, it performs no pacemaking function and has no intrinsic rhythmicity.
performs no pacemaking function and has no intrinsic rhythmicity.
Pneumotaxic
The neurotransmitter secreted by the motor end-plate which results in the stimulation of nicotinic (N2) receptors is:
acetylcholine
a specialized portion of the membrane of the muscle fiber where nicotinic acetylcholine receptors are concentrated.
The motor end plate
When an action potential stimulates the nerve fiber,
acetylcholine is released and stimulates nicotinic subtype 2 (N2) receptors, which are ion channels.
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.
When performing a glossopharyngeal nerve block, the branches of the nerve are most easily accessed via:
the palatoglossal folds bilaterally
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.
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.
Primary branches of the trigeminal nerve (CN V) include the: (Select 3)
ophthalmic nerve, maxillary nerve, mandibular nerve
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.
Sensory only nerves of trigeminal
Ophthalmic
Maxillary
Mixed motor and sensory of the trigeminal
Mandibular
Mixed motor and sensory nerve branch of the trigeminal
Mandibular
During the division of the tracheobroncheal tree, loss of cartilage occurs at approximately the:
16th generation
Subdivisions, A.K.A. airway generations, are utilized to classify
branching of the tracheobronchial tree.
The trachea comprises 0 generation and the airways further divide until
the alveolar sacs and alveoli are reached terminally at the 23rd generation.
The airways begin to lose cartilage just distal to the small
intrasegmental bronchi. This occurs at approximately the 16th airway generation.
Structures contained within the carotid sheath include the:
common carotid artery, internal jugular vein, vagus nerve
Structures located within the carotid sheath are the
common carotid artery, the vagus nerve and the internal jugular vein.
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
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
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
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
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
The three major components of the sciatic nerve are the
- Tibial
- Common peroneal nerves
- Posterior femoral cutaneous nerve to the thigh.
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
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.
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.
How to treat Aortocaval compression?
leftward tilt of the tabletop or by a wedge under the right hip.
Which nerve originates from the Edinger-Westphal?
accessory oculomotor nerve
Cranial and certain accessory nerves originate from various nuclei found the _____and ______(brain)
nucleii found in the pons and medulla.
originates from the Edinger-Westphal nucleus is the _______which is located adjacent to the_________
The accesory oculomotor nerve; oculomotor nucleus.
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.
The larynx receives innervation from two major nerves.
Superior laryngeal Nerve
Recurrent laryngeal nerve
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.
Provides motor innervation to the cricothyroid muscle.
External branch of Superior Laryngeal nerve
Which branch of the superior laryngeal nerve provide Sensory innervation to the larynx ABOVE the vocal cords
Internal branch of the superior 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.
Sensory innervation to the larynx below the vocal cords provided by what nerve?
Recurrent laryngeal nerve
Recurrent laryngeal nerve provide motor innervation to all of the muscles of the larynx with the exception of the
cricothyroid muscle.
Compartment syndrome has been associated with:
elevation of the extremities
Compartment syndrome is a potentially life-threatening complication that causes damage to
neural and vascular structures from swelling of tissues within the muscular compartment.
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
The recurrent laryngeal nerve provides the motor supply to all intrinsic laryngeal muscles except the
cricothyroid muscle
provides the motor supply to all intrinsic laryngeal muscles except the cricothyroid muscle
Recurrent laryngeal nerve
Injury may occur during thyroid and parathyroid surgery.
Recurrent laryngeal nerve
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.
Bone marrow depression and peripheral neuropathy have been associated with prolonged exposure to anesthetic concentrations of:
nitrous oxide
How does nitrous inhibit Vitamin B12
By irreversibly oxidizing the cobalt atom in vitamin B12, nitrous oxide inhibits vitamin B12 dependent enzymes.
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.
What is dynamic compliance?
Is the Presence gas flow
Dynamic compliance is based on
PEAK PRESSURE
Static complicance is the
Absence of gas flow
Static compliance is based on
Plateau pressure.
Static compliance Cstat =
Tidal volume / (Pplat - PEEP)
Dynamic compliance Cdyn =
Tidal volume / (Ppeak - PEEP)
PE on compliance and resistance
PE do not change compliance and resistance
Plugging or bronchospasm increases what pressures?
Increase Airway resistance and peak pressure
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
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.
Opioids with slowest peak onset
morphine
What and how does overinflation of the tracheal cuff lead to complications?
vocal cord paralysis from pressure on RLN
What does ED95 mean?
The dose that will REDUCE TWITCH HEIGHT by 95%.
Potency of benzodiazepines
Lorazepam > Midazolam > Diazepam
Most likely to rupture of the papillary muscle
Posteromedial papillary muscle
What are the 2 Enzymes inhibited by nitrous oxide that can lead to peripheral neuropathy, and megaloblastic anemia?
methionine synthetase
thymidylate synthetase
