Anatomy & Special Flashcards
Doubling the distance from a radiation source, decreases exposure by a factor of _____?
4
LES tone with cricoid pressure
decreased
Sensory innervation to medial leg and ankle?
saphenous nerve
sensory and motor to plantar foot?
posterior tibial nerve
location of deep peroneal nerve on foot?
lateral to dorsalis pedis pulse
sensory to anterior leg, ankle, dorsal foot, and toes (excluding web between 1st and 2nd toe)?
superficial peroneal nerve
Innervates all muscles of the larynx except the cricothyroid muscle?
RLN
Unilateral RLN injury results in…?
hoarseness
Partial BILATERAL RLN injury results in…?
Complete obstruction, stridor, and respiratory distress because adductors unopposed (most dangerous injury)
Complete BILATERAL RLN injury results in…?
aphonia or aspiration risk
Hypotension after spinal anesthesia due to 3 main mechanisms:
(1) arterial dilation (decreased after load)
(2) venodilation (decreased preload) - this is most dramatic!
(3) bradycardia 2/2 PANS dominance (bc cardioaccelerator fibers T1-T4 are blocked) -AND- Bezold Jarisch reflex.
**Use epinephrine early to prevent poor cerebral perfusion
mid esophageal aortic valve short axis view identifies which structures?
The RV and right coronary cusp which are always ANTERIOR
The non-coronary cusp which is always located next to the interatrial septum
Operator 1 vs Operator 2 responsibilities during manual in-line stabilization
operator 1 maintains head/neck neutrality
operator 2 stabilizes shoulders against OR table
Cause of back pain after large volume injection of 2-choroprocaine?
muscle spasms due to EDTA - a preservative that chelates Ca2+ of nearby muscles. These spasms are self-limited.
TAP block landmarks?
bottom of rib cage superiorly
top of pelvis inferiorly
latissimus dorsi lateral side
external oblique other lateral side
anesthetic concerns with ankylosing spondylitis?
difficult airway 2/2 fused cervical spine
epidural hematoma 2/2 multiple attempts in setting of platelet dysfunction from NSAID use
nerves and arteries in the antecubital fossa
Notice median nerve, ulnar nerve, and radial nerve locations with respect to vessels
Bier block time limit?
90 minutes, ideally less than 1 hour
Bier block mechanism?
(1) diffusion of local anesthetic from veins into capillaries and then into vasa nervosa –> nerve conduction block
(2) local anesthetic diffuses into small nerves that supply overlying skin
(3) tourniquet causes distal ischemia which also impairs nerve conduction leading to anesthesia
which nerve provides sensation to anterior tongue?
V3 - mandibular branch of trigeminal nerve
nerve that supplies posterior tongue?
glossopharyngeal (CN IX)
Nerve that supplies soft palate?
glossopharyngeal nerve (CN IX)
Nerve that supplies oropharynx?
glossopharyngeal nerve (CN IX)
Nerve that supplies hypopharynx (below the epiglottis all the way to the vocal cords)?
SLN internal branch (CN X)
*mnemonic SIME
sensory innervation of larynx and trachea (all below the vocal cords)?
RLN (CN X)
Narrowest part of airway in adults versus neonates?
adults: glottic opening, i.e. vocal cords
neonates: cricoid cartilage
MOTOR innervation of vocal cords?
RLN = both ABduction and ADDuction
All the muscles of the larynx are innervated by RLN except?
cricothyroid muscle - innervated by external branch of SLN
Which type of pneumocytes participate in gas exchange?
Type I
Which type of pneumocytes produce surfactant?
type II
Coronary supply to anterior distribution?
LAD
Coronary supply to anterolateral distribution?
LCX
Coronary supply to anteroseptal distribution?
LAD
Coronary supply to inferior distribution?
RCA
Coronary supply to inferolateral distribution?
RCA & LCX
Coronary supply to inferoseptal distribution?
RCA & LAD
1st line treatment for aortic dissection?
beta blockers to decrease HR and contractility (shear force on dissection)
additional anti-hypertensives after beta-blockade
treatment of chylothorax?
chest tube
low carb & high fat/protein diet
PEEP
anterior spinal cord blood supply?
via 1 spinal artery:
superior - vertebral arteries and posterior intercostal arteries
inferior - Artery of Adamkiewics which arises from a single posterior intercostal artery between T8-L1
blood supply to posterior spinal cord?
via 2 (paired) posterior spinal arteries from the vertebral artery
anterior spinal artery infarction affects?
lateral corticospinal (motor) tract
spinothalamic (pain & temp) tract
spinal cord termination in adults vs neonates?
adults = L1
neonates = L3
innervation of facet joint?
medial branch of the POSTERIOR division of spinal nerves
aka dorsal rami
Stellate ganglion block at which level?
C6-C7
SANS blockade via stellate ganglion results in?
ipsilateral Horner’s syndrome: ptosis, miosis, anhidrosis, psuedoenophthalmos, and hyperemia;
nasal congestion
temperature increase in ipsilateral arm
-AND- unopposed PANS
Also possible: globus sensation, RLN block
intercostobrachial block is a field block of which 2 nerves?
median brachial cutaneous nerve (C8-T1)
intercostobrachial nerve (T2)
landmarks of classic sciatic nerve block
PSIS
greater trochanter
sacral hiatus
cauda equina syndrome associated with?
pooling & maldistribution of hyperbaric local anesthetic via pencil point needles or spinal micro catheters
muscle that ABducts vocal cords?
POSTERIOR cricoarytenoid (innervated by RLN)
muscle that ADDucts vocal cords?
LATERAL cricoarytenoid innervated by RLN
Carotid sinus stimulation results in…?
hypotension and bradycardia
“think sinus pressure”
name of calcium channel receptor on sarcoplasmic reticulum that leads to muscle contraction?
Ryanodine recepter 1 (these receptors open only briefly in normal muscle but have prolonged opening in malignant hyperthermia)
pathogenesis for malignant hyperthermia?
sustained muscle contraction –> general hypermetabolic state –> incr CO2, lactate, and heat production –> muscle breakdown –> rhabdo, hyperkalemia, and myoglobinuria–> cardiac arrhythmias and renal dysfunction
treatment for malignant hyperthermia related cardiac arrhythmias?
Avoid calcium channel blockers because treatment with dantrolene already reduces Ca2+ from sarcoplasmic reticulum
standard antiarrhythmics safe: procainamide, amiodarone, lidocaine
Preferred type of anesthesia in multiple sclerosis?
general anesthesia with a careful eye on body temperature because even a 1 degree increase can cause an MS exacerbation
Avoid spinal anesthesia; epidurals and PNBs have been used safely in the past
**these patients often have autonomic instability that can lead to marked hypotension
Avoid nitrous for how long after air injection during eye surgery?
5 days
Avoid nitrous for how long after sulfur hexafluoride (eye surgery)?
10 days
Avoid nitrous for how long after perfluorocarbons (eye surgery)?
90 days
Is pheochromocytoma an absolute or relative contraindication to ECT?
Absolute
Is a recent MI (<4-6 weeks) an absolute or relative contraindication to ECT?
absolute
Is a recent CVA ( <3 months) an absolute or relative contraindication to ECT?
absolute
Is recent intracranial surgery an absolute or relative contraindication to ECT?
absolute
Is an unstable cervical spine an absolute or relative contraindication to ECT?
absolute
Is angina an absolute or relative contraindication to ECT?
relative
Is congestive heart failure an absolute or relative contraindication to ECT?
relative
Is a cardiac rhythm device an absolute or relative contraindication to ECT?
relative
Is severe pulmonary disease an absolute or relative contraindication to ECT?
relative
Is major bone fracture an absolute or relative contraindication to ECT?
relative
Is glaucoma an absolute or relative contraindication to ECT?
relative
Is retinal detachment an absolute or relative contraindication to ECT?
relative
Is thrombophlebitis an absolute or relative contraindication to ECT?
relative
Is pregnancy an absolute or relative contraindication to ECT?
relative
What is significant about the FIRST phase (out of 2) of ECT? (5-10 second tonic phase of seizure)
PANS surge –> bradycardia and hypotension
What is most significant about the second phase (out of 2) of ECT? (up to 10 minutes max of clonic seizure activity)
SANS activity –> hypertension and tachycardia
Types of infections that benefit from hyperbaric oxygen?
soft-tissue necrotizing infections, refractory chronic osteomyelitis, intracranial abscess, mucormucosis
Types of gas-bubble diseases that benefit from hyperbaric oxygen?
air embolism, decompression sickness
Types of poisonings/envenomations that benefit from hyperbaric oxygen?
carbon monoxide, cyanide, carbon tetrachloride, hydrogen sulfide, brown recluse spider bites
Types of acute ischemia that benefit from hyperbaric oxygen?
crush injuries, compromised skin flaps, central retinal after/vein occlusions
Types chronic ischemia that benefit from hyperbaric oxygen?
ischemic ulcers, radiation necrosis
Types of acute hypoxia that benefit from hyperbaric oxygen?
oxygen support during therapeutic lung lavage, significant blood loss anemia if transfusion delayed or unavailable
Types of thermal injuries that benefit from hyperbaric oxygen?
burns