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SEE/NCE Boards CoreConcepts > Anatomy/Position Exam > Flashcards

Anatomy/Position Exam Flashcards

1
Q

In the adult patient, the superior border of the thyroid cartilage overlies at what spine level?

A

at the C4 level

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2
Q

In the adult, the larynx extends from the superior border of the thyroid cartilage to the______ at what level (spine)

A

inferior border of the cricoid ring at the C6 level.

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3
Q

What bone Provide the chief support for the larynx?

A

The hyoid bone

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4
Q

Where does the hyoid bone lies?

A

C3

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5
Q

Name the RCA Branches(6)

A

SA node branch
AV node branch
Right Marginal Branch
PDA
Conus Branch
Right posterolateral branches

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6
Q

Name the LCA Branches (6)

LaCiDi LPI

A

LAD
Circumflex
Diagonal
Left Marginal
Posterolateral banches
Intraventricular septal branches

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7
Q

The celiac plexus block is utilized for relief of pain associated with

A

abdominal VISCERAL pain syndromes

Intra-abdominal cancer

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8
Q

What are the 2 most important potential complications of celiac plexus block include:

A

inadvertent aortic puncture or spinal or epidural anesthesia.

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9
Q

What is the positioning to perform a 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.

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10
Q

Where is the level of Celiac plexus?

A

T12-L1

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11
Q

What are the Branches of the Facial Nerve (CN VII)

A

CeMaBuTemZy

Cervical nerves
Mandibular
Buccal
Temporal
Zygomatic

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12
Q

After completion of the stellate ganglion block, the sympathetic blockade of the right upper extremity can be best assessed by

A

observing a temperature change in the right arm

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13
Q

A Stellate ganglion block is most commonly performed for patients with what kind of pain?

A

Upper extremity pain (CRPS I or II).

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14
Q

What is the most common side effect of a Stellate Ganglion Block?

A

Horner’s syndrome

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15
Q

What causes “HORNER’S SYNDROME” symptoms ?

A

SNS denervation

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16
Q

List the signs of Horner’s Syndrome

MEP

A

Miosis
Ptosis
Enophtalmos of the globe on the IPSILATERAL side of the block

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17
Q

Although practitioners look for the development of Horner’s syndrome as a metric for the efficacy of the block, its presence

A

does not necessarily equate to sympathetic denervation of the upper extremity.

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18
Q

Fibers found in the spinothalamic tract of the spinal cord are involved in the transmission of: (3)

A

Simple touch
Pain
Temperature

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19
Q

Endogenous glucocorticoids are secreted by what “zona” of the adrenal gland?

A

zona fasciculata of the adrenal gland.

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20
Q

What does the zona glomerulosa secretes

A

mineralocorticoids (aldosterone)

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21
Q

Zona reticularis of the adrenal gland secretes what kind of hormones?

A

androgens

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22
Q

The adrenal medulla secretes what two hormones and in what percentage?

A

epinephrine (80%) and norepinephrine (20%).

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23
Q

What is the only cartilage of the larynx that forms a complete ring?

A

The Cricoid Cartilage

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24
Q

The larynx consists of 9 cartilages: TECACoCu

A

(singular) Tec-ACuCo
Thyroid
Epiglottis
Cricoid cartilages

(paired).
Arytenoids
Cuneiforms
Corniculates

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25
Q

What cartilages ABduct the Vocal Cords (think abduct a kid in the back)

A

Posterior Cricoarytenoids

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26
Q

What cartilages ADduct Cords Vocal Cords (opposite word)?

A

Lateral Cricoarytenoids

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27
Q

What cartilage tenses the vocal Cords?

A

CricoThyroid (Cord Tense ) CT

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28
Q

What cartilage shortens and relaxes the vocal cords

A

Thyroarytenoids

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29
Q

The cranial nerves possessing only motor function include:

A

(HAT)
Hypoglossal
Abducens
Trochlear

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30
Q

The primary complication associated with the sitting position is:

A

venous air embolization

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31
Q

Hypoperfusion of the Cerebral vasculature with surgery done in which position?

A

Sitting

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32
Q

This position is associated with pooling of blood in the LE

A

Sitting

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33
Q

What position is associated with a decrease in FRC?

A

Sitting

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34
Q

Explain how Venous Air Embolism (VAE)

A

Air entrained into the vasculature as a result of NEGATIVE PRESSURE GRADIENT CREATED when the operative site is ABOVE THE LEVELS of the HEART

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35
Q

Incidence of VAE in the sitting position is

A

1-76%

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36
Q

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______

A

SURAL NERVE

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37
Q

Why do conscious patient cross their legs?

A

Conscious patients cross their legs to alleviate lumbo-sacral strain in the supine position.

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38
Q

Crossing legs result in injury of the

A

Superficial Peroneal nerve in the dependent leg

AND sural nerve in the superior leg

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39
Q

Damage to the sural nerve result in

A

Numbness of the posterior portion of the sole of the foot and heel of the lateral foot AND the Achilles just above the ankle.

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40
Q

The protective mechanism which prevents over distention of the alveoli at high lung volumes is known as the:

A

Hering-Breuer reflex

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41
Q

What elicit the Hering-Breuer Inflation Reflex?

A

Stimulation of stretch receptors in the lungs can elicit the Hering-Breuer inflation reflex.

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42
Q

What does the Hering-Breuer reflex do?

A

may decrease the frequency of the inspiratory efforts by causing a transient apnea.

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43
Q

The component of the nephron that is involved in the concentration of urine via the countercurrent mechanism is the:

A

Loop of Henle

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44
Q

The primary function of the Loop of Henle is the a

A

establishment of a hyperosmotic state within the medullary area of the kidney

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45
Q

Mechanism that is vital to the conservation of salt and water.

A

Countercurrent mechanism (hyperosmotic state within the medullary)

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46
Q

Water conservation and the production of a concentrated urine involve a countercurrent exchange system or “multiplier” in which a

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.

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47
Q

Countercurrent exchange system or “multiplier” is for

A

Water conservation and the production of a concentrated urine

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48
Q

In the counter current mechanism, the gradient increases…

A

The gradient increases as the loop moves from the renal cortex into the medulla.

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49
Q

The brachial plexus arises from spinal nerve roots C8-T1.

A

C8-T1.

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50
Q

The Brachial plexus roots divide into the ______,___trunks

A

superior, middle and inferior trunks.

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51
Q

In Brachial Plexus , Divisions then give rise to the

A

lateral, posterior and medial cords.

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52
Q

In Brachial Plexus, The posterior cord gives rise to the

and the

A

the axillary and radial nerves

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53
Q

In Brachial Plexus, lateral cord gives rise to the

A

musculocutaneous and median nerves

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54
Q

In Brachial Plexus, medial cord gives rise to the

A

median and ulnar nerves.

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55
Q

The two cerebral hemispheres of the brain are connected by the:

A

corpus callosum

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56
Q

The majority of blood supply to the lower and anterior two thirds of the spinal cord arises from the:

A

great ventral radicular artery

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57
Q

What arises from the GREAT VENTRAL RADICULAR ARTERY?

A

lower and anterior two thirds of the spinal cord blood supply

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58
Q

The great ventricular radicular artery (A.K.A. the

A

artery of Adamkiewicz or arteria radicularis magna)

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59
Q

Where does the ARTERY OF ADAMKIEWICZZ enters the cord at and

A

approximately T7

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60
Q

Supplies the lumbosacral segment (Artery)

A

ARTERY OF ADAMKIEWICZ (a.k.a Great ventricular radicular artery)

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61
Q

It is the largest and most important radicular artery.

A

ARTERY OF ADAMKIEWICZ (a.k.a Great ventricular radicular artery)

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62
Q

Spinal cord segments that receive blood from one source are prone to ?

A

particularly prone to ischemic injury if flow is interrupted.

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63
Q

Interruption of flow from this artery results in paraplegia.

A

ARTERY OF ADAMKIEWICZ (a.k.a Great ventricular radicular artery)

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64
Q

Interruption of flow in Artery of Adamkiewitcz causes

A

Paraplegia

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65
Q

A potential problem associated with cannulation of the dorsalis pedis artery for monitoring of blood pressure is:

A

the waveform may be distorted and result in overestimation of the pressure

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66
Q

Reflects the highest systolic blood pressure in the body.

A

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.

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67
Q

Attributes associated with the development of post-operative ulnar neuropathy include:

A 
Male Sex(70-90%)
Extreme obesity (BMI>38)
Prolonged bedrest, 
Preexisting contralateral ulnar neuropathy
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68
Q

Anesthesia-related ulnar nerve injury is thought to be secondary to

A

External nerve compression or stretch caused by intraoperative malpositioning.

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69
Q

Cerebrospinal fluid: occupies a volume of

A

approximately 150 mL in the subarachnoid space

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70
Q

Role of CSF for brain and SC

A

Cerebrospinal fluid supports and cushions the spinal cord and brain.

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71
Q

CSF is produced by at a rate of approximately

A

choroid plexuses in the brain’s ventricles

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72
Q

How much CSF produced per day?

A

500 mL/day.

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73
Q

How is CSF reabsorbed?

A

It is largely reabsorbed by arachnoid granulations and by small CNS capillaries.

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74
Q

The cricopharyngeus muscle receives sensory innervation primarily from the:

A

glossopharyngeal nerve

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75
Q

What is the cricopharyngeus muscle an integral part of?

A

the upper esophageal sphincter

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76
Q

The cricopharyngeus receives SENSORY INNERVATION from

A

Primarily from the glossopharyngeal Nerve (CN IX)

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77
Q

The cricopharyngeus receives MOTOR INNERVATION from

A

Vagus Nerve (CN X)

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78
Q

It acts as a barrier to regurgitation in the conscious patient.

A

Cricopharyngeus Muscle

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79
Q

Arterial blood supply to the larynx arises from the:

A

superior and inferior thyroid arteries

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80
Q

Gives rise to the superior laryngeal artery.

A

The superior thyroid artery

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81
Q

The superior thyroid artery is a branch of the

A

external carotid

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82
Q

This artery supplies the supraglottic region of the larynx.

A

Superior LARYNGEAL ARTERY

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83
Q

Is a branch of the inferior thyroid artery, (artery)

A

The inferior laryngeal artery

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84
Q

Supplies the infraglottic region of the larynx.

A

Inferior Laryngeal artery

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85
Q

The lower border of the scapula corresponds to spinal level

A

T7

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86
Q

Vertebrae PROMINENS level

A

C7

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87
Q

Inferior Edge of the SCAPULA

A

T10

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88
Q

T10 level Landmark

A

Umbilicus

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89
Q

L4 level landmark

A

Highest points of illiac crests

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90
Q

S2 level landmark

A

Level of posterior iliac spines

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91
Q

Anatomic dead-space ends at the:

A

terminal bronchiole

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92
Q

What is the last airway component incapable of gas exchange?

A

The terminal bronchiole is the

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93
Q

Part of the airway devoid of cartilaginous support

A

Terminal bronchiole

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94
Q

Terminal bronchiole the highest proportion of

A

smooth muscle in its walls relative to the other airway components

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95
Q

What is the first site in the tracheobronchial tree where gas exchange occurs?

A

The respiratory bronchiole, which follows the terminal bronchiole

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96
Q

The most serious complication of a supraclavicular block is:

A

Pneumothorax

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97
Q

What is the principal cause of Pneumothorax during a supraclavicular block?

A

Needle angle that “aims” toward the apex of the lung.

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98
Q

What is the incidence of Pneumothorax with supraclavicular block?

A

0.5-5%

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99
Q

What is the incidence of phrenic nerve blockade and why?

A

Although the incidence of phrenic nerve blockade is 30 - 50%, its effects are usually well-tolerated by the patient with normal pulmonary function.

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100
Q

Potential complications associated with an interscalene block include: (Select 4)
PITT

A

Phrenic nerve block
Pneumothorax
Injection of local anesthetic into the vertebral artery,
Total spinal (SAB Injection)

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101
Q

The ansa cervicalis innervates the:

A

sternohyoid muscle

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102
Q

The ansa cervicalis is a component of the______ plexus,

A

cervical

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103
Q

What does the ANSA Cervicalis provides?

A

provides motor innervation to the sternohyoid and the inferior belly of the omohyoid muscles.

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104
Q

What is Chassaignac’s tubercle as far as landmark?

A

anatomic landmark for the placement of interscalene and cervical plexus blocks.

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105
Q

It is the transverse process of the verterbal body at C6

A

Chassaignac’s tubercle

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106
Q

Where can the Chassaignac’s tubercle be palpated?

A

lateral to the cricoid cartilage.

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107
Q

Cerebrospinal fluid flows from the third to the fourth ventricle via the:

A

cerebral aqueduct of Sylvius (A.K.A. cerebral aqueduct)

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108
Q

CSF is secreted by the ______ ________ in _______ and ______flows

A

Choroid plexus

lateral ventricles 1 and 2

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109
Q

CSF flow through the________ to the 3rd ventricle,

A

foramen of Monro

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110
Q

CSF flow through the foramen of Monro to the

A

3rd ventricle

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111
Q

AFter 3rd ventricle through the foramina of Magendie and Luschka (A.K.A. _______ and _______to the________

A

lateral and medial apertures of 4th ventricle)

subarachnoid space.

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112
Q

The preportal organs are the

3S PC

A

stomach, spleen, pancreas, small intestine, and colon.

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113
Q

Accessory muscles of respiration involved in forceful exhalation include:

A

rectus abdominis

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114
Q

During forceful exhalation (e.g. with coughing and the clearing of secretions), muscles active are

A

the rectus abdominis

the transversus abdominis and the external and internal oblique muscles of the abdomen are active

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115
Q

During forceful inspiration,

A

The sternocleidomastoid and scalene muscles contract in conjunction with the diaphragm and the intercostals

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116
Q

In the adult, during placement of a pulmonary artery catheter through the right internal jugular vein, the right ventricle should be entered at approximately:

A

25 - 35 cm

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117
Q

Cardiac structure Distance in cm : RA

A

15-25 cm

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118
Q

Cardiac structure Distance in cm: RV

A

25-25 cm

119
Q

Cardiac structure Distance in cm: PA

A

35-45 cm

120
Q

Cardiac structure Distance in cm: PA wedge position

A

45-50cm

121
Q

The dominant motor nerve innervating the biceps brachii is the:

A

musculocutaneous

122
Q

The musculocutaneous provides the majority of

A

motor function to the biceps which resides in the anterior compartment of the arm

123
Q

When performing a brachial plexus block, the “four P’s” mnemonic? why?

A

“push, pull, pinch, pinch” is utilized to ascertain block effectiveness.

124
Q

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

A

weakening of the biceps due to local anesthetic effect on the musculocutaneous.

125
Q

Ductus venosus turns into

A

Ligamentum Venosum

126
Q

Ductus Arteriosus turns into

A

Ligamentum Arteriosum

127
Q

Foramen Ovale turns into

A

Fossa Ovalis

128
Q

Umbilical Vein turns into

A

Ligamentum Teres

129
Q

Umbilical Artery turns into the

A

Medial Umbilical Ligament

130
Q

Motor innervation of the superior oblique muscle of the eye is supplied by the:

A

trochlear nerve

131
Q

The majority of extraocular muscles receive motor innervation from the ______nerve (CN # ___)

A

From the oculomotor nerve (CN III)

132
Q

Provides motor innervation to the lateral rectus muscle of the eye.

A

The abducens (CN VI)

133
Q

provides motor innervation to the superior oblique muscle of the eye.

A

the trochlear nerve (CN IV)

134
Q

Lateral inferior plantar aspect of foot innervated by

A

Sural nerve

135
Q

Heels main nerve

A

Tibial (calcaneal branch)

136
Q

Mid Medial aspect of foot innervated by

A

Saphenous nerve

137
Q

Most medial to half of plantar foot

A

Medial Plantar nerve

138
Q

Of the following, the therapeutic intervention that causes the least ventilatory compromise in the prone patient is the:

A

use of a Jackson table

139
Q

The degree to which pulmonary mechanics are altered are suggested to be

A

frame-dependent and not dependent on body habitus.

140
Q

Use of the Jackson table compared to wilson and chest rolls

A

smallest change in pulmonary compliance and peak airway pressures when compared with use of the Wilson frame and chest rolls.

141
Q

Ideal BMI

A

18.5-24.9

142
Q

Overweight BMI

A

25-29.9

143
Q

Obese BMI

A

30-39.9

144
Q

Morbid BMI

A

> 40

145
Q

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.

A

travels superficially with the saphenous nerve behind the lateral malleolus into the ankle

146
Q

The sural nerve: where it

A

travels superficially with the saphenous nerve behind the lateral malleolus into the ankle

147
Q

It travels superficially with the short saphenous nerve behind the lateral malleolus into the ankle,

A

Sural Nerve

148
Q

Sural Nerve sensory innervations

A

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.

149
Q

Sural Nerve sensory innervations

A

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
Q

The three major proteins that compose the thin filament of the sarcomere are (TAT)

A

actin, troponin, and tropomyosin.

151
Q

According to the Cooley classification of aortic aneurysms, Type B refers to a:

A

fusiform ascending aorta and proximal arch

152
Q

According to the Cooley classification of aortic aneurysms, Type A refers to a:

A

Saccular transverse arch

153
Q

According to the Cooley classification of aortic aneurysms, Type C refers to a:

A

Fusiform aneurysm extending into the proximal aorta

154
Q

According to the Cooley classification of aortic aneurysms, Type D refers to a:

A

Fusiform aneurysm involving the entire aorta

155
Q

The pudendal block:

A

blocks the distribution of sacral nerves 2,3, and 4

156
Q

Provides analgesia for the second stage of labor

A

The pudendal block

157
Q

Which innervate the lower vagina and perineum.

A

Pudental blocking distribution of sacral nerves 2, 3 and 4,

158
Q

It is useful for forceps or vacuum deliveries or episiotomy.

A

Pudental block

159
Q

Place the blocks in descending order of peak-plasma concentration following block placement.
IvTIcPaLBBESS

A

TransTracheal
Intercostal
Caudal
Epidural

160
Q

The innermost layer of the wall of a blood vessel is known as the:

A

tunica intima

161
Q

The tunica _____serves mainly for the regulation of exchange of material and a thin membrane of vascular tissue

A

Intima

162
Q

The sinus which is in close proximity to the optic chiasma and the hypophysis is the:
k.

A

sphenoid sinus

163
Q

Pituitary tumor surgery may be achieved via a

A

trans-nasal approach through the sphenoid sinus.

164
Q

Overall, the__________ sinuses play an important role as the site of infectious processes.

A

paranasal

165
Q

sinuses are paired and may extend into the basal part of the occipital bone.

A

The sphenoid

166
Q

The roof of the Sphenoid sinus has close connections with the

A

optic canal and the chiasmatic groove (upward) as well as to the hypophysis toward the back

167
Q

Venous drainage from the orbit of the eye is achieved primarily through the:

A

superior ophthalmic vein

168
Q

What is the venous drainage system for the orbit

A

superior and inferior ophthalmic veins.

169
Q

For the venous drainage system for the orbit, where do These veins drain into?

A

The cavernous sinus.

170
Q

The venous system of the orbit is valveless and blood flow in this area is determined by

A

pressure gradients and external forces on the globe.

171
Q

The primary vein of the orbit is the

A

superior ophthalmic vein

172
Q

The ophtalmic vein is entered by the

A

ciliary veins, lacrimal veins and the superior vortex veins which drain the choroid of the globe.

173
Q

Complications resulting from the Trendelenburg position include: (Select 3)

A

Edema of the upper airway
Inadvertent right mainstem intubation
Increased myocardial oxygen consumption

174
Q

The Trendelenburg position is used to

A

improve exposure of the pelvic organs.

175
Q

How does the trendelenburg position help during hypotension?

A

it is assumed to increase venous return and mean arterial pressure.

176
Q

Trendelenburg and patient with CAD

A

overall myocardial work is increased, an effect which may be detrimental to patients with CAD.

177
Q

Ocular, facial and pharyngeal edema are associated with as well as a result of the

A

the Trendelenburg position

178
Q

Inadvertent right mainstem intubation associated with what position

A

The Trendelenburg position

179
Q

Cephalad movement of the mediastinum and the carina.

A

Trendelenburg position

180
Q

The fissure forming the boundary between the frontal and temporal lobes of the brain is known as the:

A

lateral sulcus

181
Q

is the deepest lateral furrow which forms the boundary between the frontal and temporal lobes of the brain.

A

The lateral sulcus (A.K.A. the Sylvian fissure),

182
Q

The central sulcus is the border between the

A

frontal and parietal lobes.

183
Q

The parieto-occipital sulcus forms the boundary between the

A

parietal and occipital lobes.

184
Q

The parietal cells of the stomach are responsible for the secretion of:

A

hydrochloric acid

185
Q

Cells secrete HCL acid

A

Parietal

186
Q

Parietal cells in the stomach secrete hydrochloric acid in response to the

A

sight and smell of food; pepsinogen is also secreted by the chief cells at this time.

187
Q

Gastrin is secreted by the

A

G cells

188
Q

Gastrin is secreted by G cells in response to

A

gastric distention.

189
Q

Other gastric secretions include

A

serotonin, histamine and mucus.

190
Q

are released in response to duodenal acidity.

A

Secretin and pancreatic bicarbonate

191
Q

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:

A

T10

192
Q

When awake and anesthetized to the level of the dome of the bladder (T10), the patient may respond to

A

bladder distention, thereby helping the urologist minimize the potential for bladder rupture.

193
Q

The width of the synaptic gap at the motor axon terminal is approximately:

A

20 - 50 nm

194
Q

The motor axon terminal is separated from the muscle cell it innervates by a synaptic gap or cleft of only

A

20 - 50 nm.

195
Q

holds the nerve ending and its associated muscle cell in close alignment.

A

A carbohydrate-rich, filamentous material in the synapse

196
Q

The neurotransmitter secreted by the motor axon is

A

acetylcholine.

197
Q

The secretion of anti-diuretic hormone (ADH) causes the

A

reabsorption of free water in the nephron.

198
Q

What are the sites of action of ADH include the: (Select 2)

A

Distal tubule

Collecting duct

199
Q

The late distal tubule reabsorbs what percentage of water?

A

10% of filtered water.

200
Q

What area This area is permeable to water only in the presence of ADH.

A

Distal tubule

201
Q

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.

A

The collecting duct is

202
Q

Which part of the nephron reduces the volume of and concentrates the urine?

A

Collecting duct

203
Q

List 3 functions of the spleen:

A

Reservoir for platelets
Removal of foreign antigens
Removal of aged and damaged erythrocytes

204
Q

Explain some other functions of the spleen include:

A

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.

205
Q

The spleen has a minor role as a reservoir of ______but has no specific reservoir function for _____

A

platelets ; RBCs.

206
Q

The portal triad (vessels) consists of the: (Select 3)

A

hepatic artery, portal vein, bile duct

207
Q

Portal triads, found throughout the liver, are found at each of the corners of the :;

A

Six-sided liver lobule.

208
Q

The vessels of the portal triads send distributing branches along the sides of the lobules; these branches open up into the

A

liver sinusoids.

209
Q

In the cardiac myocyte, the area which delineates the border between two separate sarcomeres is known as the:

A

“Z” band

210
Q

What band represents the region of the sarcomere which contains thin filaments only?

A

The “I” band

211
Q

is characterized by an area of overlap of thick and thin fibers.

A

the “A” band

212
Q

The “M” band is present centrally within the “A” band and is composed of

A

thick filaments which form a hexagonal matrix of myosin binding with protein C.

213
Q

Perioperative vision loss occurs most frequently in anesthetized patients undergoing what kind of procedure?

A

cardiac surgical procedures

214
Q

Patients undergoing extensive spine procedures while in the prone position may develop

A

vision loss, primarily from posterior ischemic optic neuropathy.

215
Q

Effects of aging on the cardiovascular system include:

A

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,

216
Q

Nerve fibers involved in the mediation of sharp pain include the:

A

A-delta fibers

217
Q

Larger myelinated A delta fibers are believed to mediate the transmission of

A

sharp pain.

218
Q

mediate the transmission of dull pain.

A

Small, unmyelinated C fibers

219
Q

Primary venous drainage of the lower two-thirds of the esophagus occurs via the:

A

azygous vein

220
Q

Azygous vein is the primary venous drainaige of the

A

lower 2/3 of the esophagus

221
Q

the azygous vein which enters the _______At approximately the __________space on the (R/L)

A

superior vena cava at approximately the 5th intercostal space on the right.

222
Q

Aside from the Azygous vein, Additional esophageal drainage is achieved via

A

submucosal venous plexuses, the hemiazygous and accessory hemiazygous veins.

223
Q

The upper third of the esophagus drains into the

A

inferior thyroid vein.

224
Q

Direct anastomosis with the internal carotid artery at the circle of Willis occurs with the:

A

middle cerebral artery

225
Q

The pneumotaxic center 3 functions:

A

limits the depth of inspiration; is located in the rostral pons; when maximally activated, increases ventilatory frequency

226
Q

The pneumotaxic respiratory center is in the Its primary

A

rostral pons.

227
Q

function is to limit the depth of inspiration

A

Pneumotaxic

228
Q

When maximally activated, the pneumotaxic center

A

increases ventilatory frequency; however, it performs no pacemaking function and has no intrinsic rhythmicity.

229
Q

performs no pacemaking function and has no intrinsic rhythmicity.

A

Pneumotaxic

230
Q

The neurotransmitter secreted by the motor end-plate which results in the stimulation of nicotinic (N2) receptors is:

A

acetylcholine

231
Q

a specialized portion of the membrane of the muscle fiber where nicotinic acetylcholine receptors are concentrated.

A

The motor end plate

232
Q

When an action potential stimulates the nerve fiber,

A

acetylcholine is released and stimulates nicotinic subtype 2 (N2) receptors, which are ion channels.

233
Q

Upon stimulation, these N2 receptors open, resulting in an

A

increase in membrane potential to threshold potential and ultimately excitation-contraction-coupling of the muscle fiber.

234
Q

When performing a glossopharyngeal nerve block, the branches of the nerve are most easily accessed via:

A

the palatoglossal folds bilaterally

235
Q

The glossopharyngeal nerve provides sensory innervation to the following areas:

A

posterior third of the tongue
the vallecula,
the anterior surface of the epiglottis
the walls of the pharynx, and the tonsils.

236
Q

When performing a glossopharyngeal nerve block, the nerves are most easily accessed as they traverse the

A

palatoglossal folds, the soft ridges that extend from the posterior aspect of the soft palate to the base of the tongue bilaterally.

237
Q

Primary branches of the trigeminal nerve (CN V) include the: (Select 3)

A

ophthalmic nerve, maxillary nerve, mandibular nerve

238
Q

The trigeminal nerve, CN V, divides into three primary branches:

A

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.

239
Q

Sensory only nerves of trigeminal

A

Ophthalmic

Maxillary

240
Q

Mixed motor and sensory of the trigeminal

A

Mandibular

241
Q

Mixed motor and sensory nerve branch of the trigeminal

A

Mandibular

242
Q

During the division of the tracheobroncheal tree, loss of cartilage occurs at approximately the:

A

16th generation

243
Q

Subdivisions, A.K.A. airway generations, are utilized to classify

A

branching of the tracheobronchial tree.

244
Q

The trachea comprises 0 generation and the airways further divide until

A

the alveolar sacs and alveoli are reached terminally at the 23rd generation.

245
Q

The airways begin to lose cartilage just distal to the small

A

intrasegmental bronchi. This occurs at approximately the 16th airway generation.

246
Q

Structures contained within the carotid sheath include the:

A

common carotid artery, internal jugular vein, vagus nerve

247
Q

Structures located within the carotid sheath are the

A

common carotid artery, the vagus nerve and the internal jugular vein.

248
Q

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.

A

musculocutaneous nerve

249
Q

Because the musculocutaneous nerve branches from the brachial plexus relatively early, blockade of this nerve is difficult to achieve via the

A

axillary approach to brachial plexus blockade

250
Q

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

A

local anesthetic

cutaneous region of the forearm

251
Q

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.

A

sciatic nerve

252
Q

The sciatic nerve arises from the sacral plexus and is derived from the ventral rami of the

A

4th lumbar to 3rd sacral nerve roots.

L4 to S3

253
Q

The three major components of the sciatic nerve are the

A
  • Tibial
  • Common peroneal nerves
  • Posterior femoral cutaneous nerve to the thigh.
254
Q

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:

A

Place the patient in a slight left lateral tilt with a wedge under her right hip

255
Q

With a pregnant patient in the supine position, a mobile abdominal mass such as a tumor or a gravid uterus may

A

compress the great vessels of the abdomen and compromise circulation.

256
Q

This is known as the aortocaval or supine hypotensive syndrome.

A

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.

257
Q

How to treat Aortocaval compression?

A

leftward tilt of the tabletop or by a wedge under the right hip.

258
Q

Which nerve originates from the Edinger-Westphal?

A

accessory oculomotor nerve

259
Q

Cranial and certain accessory nerves originate from various nuclei found the _____and ______(brain)

A

nucleii found in the pons and medulla.

260
Q

originates from the Edinger-Westphal nucleus is the _______which is located adjacent to the_________

A

The accesory oculomotor nerve; oculomotor nucleus.

261
Q

Sensory innervation of the larynx below the level of the vocal cords is provided by the:

A

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.

262
Q

The larynx receives innervation from two major nerves.

A

Superior laryngeal Nerve

Recurrent laryngeal nerve

263
Q

The superior laryngeal nerve branches into two nerves:

A

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.

264
Q

Provides motor innervation to the cricothyroid muscle.

A

External branch of Superior Laryngeal nerve

265
Q

Which branch of the superior laryngeal nerve provide Sensory innervation to the larynx ABOVE the vocal cords

A

Internal branch of the superior laryngeal nerve

266
Q

The recurrent laryngeal nerve provides

A

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.

267
Q

Sensory innervation to the larynx below the vocal cords provided by what nerve?

A

Recurrent laryngeal nerve

268
Q

Recurrent laryngeal nerve provide motor innervation to all of the muscles of the larynx with the exception of the

A

cricothyroid muscle.

269
Q

Compartment syndrome has been associated with:

A

elevation of the extremities

270
Q

Compartment syndrome is a potentially life-threatening complication that causes damage to

A

neural and vascular structures from swelling of tissues within the muscular compartment.

271
Q

Reported to contribute to the development of compartment syndrome in surgical patients.

A 
Prolonged surgical procedures
Operative positions
Elevation of the extremities
Intraoperative hypotension
Increasing age
Extremes of body habitus
272
Q

The recurrent laryngeal nerve provides the motor supply to all intrinsic laryngeal muscles except the

A

cricothyroid muscle

273
Q

provides the motor supply to all intrinsic laryngeal muscles except the cricothyroid muscle

A

Recurrent laryngeal nerve

274
Q

Injury may occur during thyroid and parathyroid surgery.

A

Recurrent laryngeal nerve

275
Q

The vagus nerve (cranial nerve X), via the ____and _______ is responsible for the _____and ________

A

superior and recurrent laryngeal nerves, is responsible for the sensory and motor innervation of the larynx.

276
Q

Bone marrow depression and peripheral neuropathy have been associated with prolonged exposure to anesthetic concentrations of:

A

nitrous oxide

277
Q

How does nitrous inhibit Vitamin B12

A

By irreversibly oxidizing the cobalt atom in vitamin B12, nitrous oxide inhibits vitamin B12 dependent enzymes.

278
Q

As a result of these enzyme inhibitions, methionine synthetase and thymidylate synthetase, prolonged exposure to nitrous oxide has been associated with

A

bone marrow depression megaloblastic anemia, peripheral neuropathy and teratogenicity.

279
Q

What is dynamic compliance?

A

Is the Presence gas flow

280
Q

Dynamic compliance is based on

A

PEAK PRESSURE

281
Q

Static complicance is the

A

Absence of gas flow

282
Q

Static compliance is based on

A

Plateau pressure.

283
Q

Static compliance Cstat =

A

Tidal volume / (Pplat - PEEP)

284
Q

Dynamic compliance Cdyn =

A

Tidal volume / (Ppeak - PEEP)

285
Q

PE on compliance and resistance

A

PE do not change compliance and resistance

286
Q

Plugging or bronchospasm increases what pressures?

A

Increase Airway resistance and peak pressure

287
Q

Plugging or bronchospasm increases what pressures?

What happens to the curve , plateau and static pressure?

A

Increase Airway resistance and peak pressure so dynamic compliance CURVE shifts to the RIGHT and flattens, PLATEAU AND STATIC remains unchanged

288
Q

Tension pneumothorax, atelectasis, and pulmonary edema, BRONCHIAL intubation cause what to lung compliance? what happens to peak pressure and plateau pressure

A

Causes reduced lung compliance

Increases both peak pressure and plateau pressure, so both static and dynamic compliance fall.

289
Q

Opioids with slowest peak onset

A

morphine

290
Q

What and how does overinflation of the tracheal cuff lead to complications?

A

vocal cord paralysis from pressure on RLN

291
Q

What does ED95 mean?

A

The dose that will REDUCE TWITCH HEIGHT by 95%.

292
Q

Potency of benzodiazepines

A

Lorazepam > Midazolam > Diazepam

293
Q

Most likely to rupture of the papillary muscle

A

Posteromedial papillary muscle

294
Q

What are the 2 Enzymes inhibited by nitrous oxide that can lead to peripheral neuropathy, and megaloblastic anemia?

A

methionine synthetase
thymidylate synthetase

SEE/NCE Boards CoreConcepts (49 decks)

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