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DSouza 2015 > Anatomy & Regional > Flashcards

Anatomy & Regional Flashcards

1
Q

Vasopressin and ACTH, TrH secreted from … nucleus

A

Paraventricular

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2
Q

Thermoregulation, Thirst, GnRH, and non REM regulated/secreted through … nucleus

A

Preoptic area

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3
Q

SA node and bronchial tree have predominantly PSNS or SNS tone?

A

PSNS

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4
Q

Innervation of sweat gland (short preganglionic neuron releases … and postganglionic sympathetic neuron release … and act on … receptors

A

Both ACh and act on muscurinic

All other postganglionic sympathetic releases NE with exception of adrenal medulla releases Epi and NE

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5
Q

Autonomic neurotransmitters

ACh

A

all preganglionic PSNS and SNS

all postganglionic PSNS

Postganglionic SYMPATHETIC sweat glands

Postganglionic sympathetic on skeletal blood vessels

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6
Q

Autonomic neurotransmitters

NE and Epi

Only Epi

A

NE and Epi -> Postganglionic adrenal medulla

All other POSTganglionic not to adrenal and not PSNS pulse the 2 postganglionic SNS to sweat glands and skeletal blood vessels (which both stimulated by ACh)

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7
Q

SNS nerve supply to the UE originated from … and synapses into … ganglion. Postganglionic fibers supply …. and their function …

A

T1 to T4/5 (sympathetic in general originates T1 - L2/3)

Synapses into sup, middle, and inf cervical ganglion

Postganglionic supply H&N, UE, heart and lung

Function; vasmotor, pilmotor, secretory, and pupillary dilatation.

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8
Q

PSNS originated from

A

Craniosacral

Cranial 3,7,9,10
S2-4

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9
Q

Causes of Atlanta-axial instability

A

RA
Achondroplasia
Down syndrome

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10
Q

Anesthetic consideration in ankylosing spondylitis

A

Airway( cervical immobility and instability, TMJ stiffness)

Systemic; restrictive lung, aortic insufficiency, uveitis, vasculitis

Neuroaxial; osseous ligments, reduces intervertebral space

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11
Q

Nerve supply to tongue

A

Ant 2/3 Trigeminal (sensory) Facial (Taste)

Post 1/3 sensory and taste by IX

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12
Q

Nerve supply to epiglottis

A

IX -> sup surface

Sup laryngeal N -> inf surface

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13
Q

Sensory innervation of larynx

A

Above vocal -> sup laryngeal N

Below vocals -> recurrent laryngeal

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14
Q

Motor innervation of larynx

A

Recurrent laryngeal supplies all except cricothyroid which supplied by sup laryngeal N (function is tensor of vocal cord)

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15
Q

To block sup laryngeal N, inject into

A

Post Cornu of hyoid bone

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16
Q

To block Recurrent laryngeal N, inject into

A

Transtracheal

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17
Q

To block IX N, inject into

A

Tonillar fossa

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18
Q

Recurrent laryngeal N injury causes

A

Hoarseness if unilateral

Airway obstruction if b/l

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19
Q

Sup laryngeal N injury causes

A

Change in voice (cricothyroid which is a tensor of vocal cord loses its function)

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20
Q

To prevent gag reflex, block … N and for cough, block …. N

A

IX for gag

Sup and recurrent laryngeal N for cough

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21
Q

Location of recurrent laryngeal N in neck

A

Btw trachea and esophagus, medial to carotid sheath

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22
Q

Location of vagus nerve in neck

A

Within crayons sheath, btw internal jugular and carotid A

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23
Q

Relation of sympathetic chain to carotid sheath

A

Posterior to the sheath

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24
Q

Relation of phrenic to carotid sheath

A

Lateral to the sheath

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25
Q

PXT higher risk with left or right internal jugular venous cannulation ?

A

Left

Because the diaphragm higher on left side and also the thoracic duct more likely to be injured with the left

26
Q

The most complication with interscalene block …

A

Ipsilateral diaphragmatic paralysis

27
Q

When trapezius twitch elicited during interscalene block, direct the needle to

A

Anteriorly

28
Q

With axillary block, least likely brachial nerve to be blocked ?

A

C5 Musculocutaneous (which supplies lateral forearm) to supplement with this Nerve block, inject within the body of coracobrachialis

It will block for sure the C8-T1 (ulnar and medial)

29
Q

With interscalene block, least likely to block nerve?

A

C8-T1

It will for sure block C5-C6 (all radial, medial, axillary and musculocutaneous except Ulnar)

30
Q

During brachial blockade is it motor or sensory that is blocked first?

A

Motor

31
Q

Interscalene block will be more successful when … twitch is elicited

A

Biceps (musocutaneous N)

32
Q

Intercostobrachial N supplies the … and it is or not part of brachial pluxes

A

Medial aspect of the arm

It is not (it is form from T2 which is not in brachial pluxes)

33
Q

The onset of brachial plexus block is fastest with … approach

A

Supraclavicular

34
Q

Axillary block will miss … nerve, which supplies the …

A

Musculocutaneous

sensory of Lateral forearm

35
Q

To supplement axillary block with Musculocutaneous nerve block, inject the local at …

A

The body of coracobrachialis muscle

36
Q

The base of middle finger supplied by …

A

Median N

37
Q

Sciatic nerve block landmark

A

Greater trochanter and posterior superior iliac spine

38
Q

Landmark for meralgia parasthetica …

A

Anterior superior iliac spine

39
Q

Landmark of stellate ganglion block

A

Tubercle of chassaiganc (tubercle of transverse process of C6)

40
Q

Landmark of superficial cervical plexus block

A

Posterior border of SCM

41
Q

Landmark of Deep cervical plexus block

A

Mastoid process and tubercle of chassaiganc

42
Q

Landmark of deep cervical plexus block

A

At the transverse process of C2-C4

43
Q

The correct position for CVP tip catheter

A

At 2nd costochondral junction on right side

At level of 4th vertebra

RA/SVC junction

44
Q

Celiac plexus is formed by … and …

A

Greater splanchnic nerve and lesser splanchnic nerve (T5-L1)

45
Q

Where is the celiac pluxes located in relation to spine

A

L1

46
Q

Celiac plexus has preganglionic… and celiac ganglion is a …. the postganglionic provides …

A

Preganglionic has sympathetic and parasympathetic

The ganglion is symptomatic and postganglionic provides sympathetic and sensory

47
Q

Distribution of celiac plexus

A

Mid stomach to mid transverse colon (visceral pain only)

48
Q

The 2 most common SE of celiac plexus block

A

Orthostatic hypotension due to splanchnic vasodilation

And diarrhea

The 3rd MCC is paraplegic due to injury to the artery of adamkewicz

49
Q

Neuroaxial blockade time interval and anticoagulant

Tidopidine
Therapeutic LMWH
Ppx LMWH

A

14 days
24 hours
12 hours

50
Q

Potential Advers effect of spinal microcatheters ?

A

Increases incidence of transient neurological sx and cauda equina syndrome (LBP, sensory abnormality in saddle area, bowel and bladder dysfunction and weakness of LL)

51
Q

Midline spinal needle passes through…

Paramedian approach passes 2 ligaments …. and encounter …. muscle instated.

A

Skin -> SC tissue -> supraspinous ligament -> interspinous -> ligmantum flavum -> dura -> arachnoid

(Dose not encounter anterior spinous ligament).

Paramedian approach passes supraspinous and interspinous; instead encounters paraspinous muscle).

52
Q

The bony landmark of the end of dura sac is ….

A

Posterior superior iliac spine

53
Q

Level where spinal cord ends in adults … and neonates ….

A

L1

L3

54
Q

The level where dura ends in adults at … and neonates …

A

S2

S3

55
Q

Factors affecting the spread after subarachnoid blockade are

A

Total dose
Baricity
Position during and immediately following injection of hyperbaric solution

(Height has minimal effect).

56
Q

Subdural block can be differentiated from subarachnoid blockade by …

A

Slower onset
Extensive sensory block with minimal motor block
Hypotension less than spinal, but more than epidural

57
Q

What’s the indicator of complete resolution of spinal blockade

A

Ability to urinate

58
Q

Ilioinginal vs iliohypogastric

Origin

Supplies

Site of block

A

Both originates from L1

Peins, sctoutm/labia, upper medial thigh (where iliohypogastric just inguinal region)

Both at 2 cm above medial to the anterior superior iliac spine

59
Q

What’s the sole block option for femoral muscle biopsy?

A

Femoral block

60
Q

Femoral triangle bouderies, content and floor?

A

Sup: inguinal ligament
Medial: adductor longus
Lateral: sartorius

Contain LN -> V -> A -> N (medial to lateral) vein closer to peins

The floor made of adductor longus, pectinius -> iliospoas (medial to lateral)

DSouza 2015 (21 decks)

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