APPLIED ANATOMY | Part I Flashcards
Which is the nerve supply to the all the intrinsic muscles of the larynx?
A. Inferior laryngeal n.
B. Glossopharyngeal n.
C. Superior laryngeal n.
D. recurrent laryngeal n.
D. Recurrent laryngeal n.
The recurrent laryngeal nerves supply all the intrinsic muscles of the larynx (with the exception of the cricothyroid muscle).
Which of the following is NOT innervated by the recurrent laryngeal nerve?
A. Thyrohyoid m.
B. Cricothyroid m.
C. Posterior cricoarytenoid m.
B. Cricothyroid m.
This muscle is the tensor of the vocal cord:
A. Thyrohyoid m.
B. Cricothyroid m.
C. Aryepiglotticus m.
D. Thyroepiglotticus m.
B. Cricothyroid m.
Coughing that occurs during awake intubation can be prevented by local anesthetic blockade at which nerve:
A. Glossopharyngeal n.
B. Hypoglossal n.
C. Recurrent Laryngeal n. & superior laryngeal n.
D. Vagus n.
C. Recurrent Laryngeal n. & superior laryngeal n.
Suppression of the ‘gag’ reflex during awake intubation can be done with blockade of which nerve?
A. Glossopharyngeal n.
B. Hypoglossal n.
C. Recurrent Laryngeal n.
D. superior laryngeal n.
E. Vagus n.
A. Glossopharyngeal n.
All of the following are intrinsic muscles of the larynx EXCEPT:
A. Thyrohyoid m.
B. Cricothyroid m.
C. Posterior cricoarytenoid m.
D. Mylohyoid m.
D. Mylohyoid m.
INTRINSIC MUSCLES OF THE LARYNX
Hoarseness after laryngoscopy is indicative of an injury to which nerve?
A. Unilateral recurrent laryngeal n.
B. Bilateral superior laryngeal n.
C. Unilateral superior laryngeal n.
D. Vagus n.
A. Unilateral recurrent laryngeal n.
Unopposed vocal cord ADDUCTION means an injury to which nerve?
A. Bilateral recurrent laryngeal n.
B. Bilateral superior laryngeal n.
C. Inferior laryngeal n.
A. Bilateral recurrent laryngeal n.
The adult larynx is vertically situated in:
A. C4 - C6
B. C5 - C7
C. C3 - C5
A. C4 - C6
In adult, the 1st tracheal ring is anterior to what cervical vertebrae?
A. C4
B. C5
C. C6
D. C2
C. C6
TRUE or FALSE
The upper epiglottis is innervated by CN 9 (Glossopharyngeal n.)
TRUE
Upper epiglottis - CN 9
Lower epiglottis - CN 10
Gag reflex - CN 9
Carina is opposite to which level of vertebrae?
A. T7
B. T5
C. T4
B. T5
Larynx in ADDUCTION corresponds to a:
A. closed larynx
B. open larynx
A. closed larynx
ADDUCTION = larynx is closed
ABDUCTION = larynx is open
The muscle responsible for the adduction of larynx:
A. lateral cricoarytenoid
B. posterior cricoarytenoid
C. superior cricoarytenoid
B. posterior cricoarytenoid
ADDUCTION = Closed larynx = Posterior cricoarytenoid m.
ABDUCTION = Open larynx = Lateral cricoarytenoid m.
The most common location where nasogastric tube is misplaced:
A. pyriform fossa
B. arytenoid
C. false cord
A. pyriform fossa
What nerve innervates the cricothyroid muscle?
A. External branch of SLN
B. Internal branch of RLN
C. Internal branch of SLN
A. External branch of SLN
Mouth opening is measured from which of the following among edentulous patient?
A. Interalveolar distance
B. Interincisor distance
C. Perialveolar distance
A. Interalveolar distance
Normal set of teeth = measure from Interincisor distance
Which of the following is the LEAST sensitive indicator of a DIFFICULT LARYNGOSCOPY?
A. Mouth opening
B. Mallampati
C. TM distance
D. Upper lip bite
A. Mouth opening
Mouth opening - 20%
Upper lip bite - 67% (most sensitive indicator)
Which of the following is the LEAST specific indicator of a DIFFICULT LARYNGOSCOPY?
A. TM distance
B. Sternomental distance
C. Mouth opening
D. Mallampati
D. Mallampati
Mallampati - 80%
Mouth opening - 97% (most specific)
Transtracheal block during awake intubation targets which nerve?
A. Recurrent laryngeal n.
B. Superior laryngeal n.
C. Hypoglossal n.
A. Recurrent laryngeal n.
Tactile sensation from the anterior third of the tongue is carried by fibers of the:
A. Trigeminal nerve
B. Facial nerve
C. Glossopharyngeal nerve
D. Hypoglossal nerve
A. Trigeminal nerve
The tongue has innervation for both gustatory (aka “taste”) and tactile (general sensory) input. Gustatory (taste) sensation for the anterior two-thirds of the tongue is provided by the facial nerve (CN VII), and for the posterior third of the tongue by the glossopharyngeal nerve (CN IX).
Tactile sensation for the anterior two-thirds of the
tongue is provided by the trigeminal nerve (CN V), and for the posterior one-third of the tongue by the glossopharyngeal nerve (CN IX).
Which among the following is the MOST SPECIFIC method of airway evaluation?
A. Mallampati classification
B. Thyromental distance
C. Sternomental distance
D. Mouth opening
B. Thyromental distance
Which among the following is the most
SENSITIVE method of airway evaluation?
A. Mallampati classification
B. Thyromental distance
C. Sternomental distance
D. Mouth opening
C. Sternomental distance
Any incisions or needle punctures to the
cricothyroid membrane must be made in its
______ to avoid vessel puncture.
A. Superior third
B. Middle third
C. Inferior third
C. Inferior third
The following are independent risk factors for difficult mask ventilation EXCEPT:
A. Presence of teeth
B. Presence of a beard
C. Body mass index >26 ng/m2
D. Age >55 yrs
A. Presence of teeth
Which is NOT among the criteria for difficult mask ventilation?
A. Inability for one anesthesiologist to maintain oxygen saturation >92%
B. Use of fresh gas flow button more than twice
C. Change of operator required
D. Minimal gas leak around face mask
D. Minimal gas leak around face mask
Expiratory chin drop facilitates _______
A. Positive pressure inspiration
B. Gas egress
C. Endotracheal intubation
D. LMA placement
B. Gas egress
Which of the following nerve blocks carries the HIGHEST risk of pneumothorax when it is performed with the anatomic
landmarks technique?
A) Infraclavicular block
B) Interscalene block
C) Supraclavicular block
C) Supraclavicular block
A supraclavicular block (SCB) classically has been considered to carry a 1% to 6% risk of pneumothorax (PTX), but this rate
likely decreases with provider experience and with ultrasound.
The SCB is known as the do-it-all block or the spinal of the arm block because the nerves are closely packed and
readily blocked. It can be used for shoulder, elbow, and wrist surgery, but most practitioners use it for surgery below the mid humerus level.
The SCB may be performed by placing the ultrasound transducer firmly over the supraclavicular fossa. The subclavian artery (ScA) is visualized in the short axis (SAX) and will serve as the reference point.
Which of the following is LEAST common complication of interscalene brachial plexus block?
A. Ipsilateral phrenic nerve
B. ulnar nerve (C8-T1) sparing
C. vertebral artery puncture
D. Horner syndrome
E. Pneumothorax
E. Pneumothorax
Interscalene brachial plexus block is associated with ipsilateral phrenic nerve and recurrent laryngeal nerve blockade, ulnar nerve (C8-T1) sparing, vertebral artery puncture, and Horner syndrome (ptosis, miosis, anhidrosis, hyperemia of the ipsilateral conjunctiva, and nasal congestion).
at the level where the nerves course under the ____ muscle, the divisions converge to form three cords.
A. pectoralis minor muscle
B. pectoralis major muscle
C. middle scalene muscle
D. anterior scalene muscle
A. pectoralis minor muscle
From highest to lowest levels of local anesthetic systemic absorption, which is ACCURATELY described according to propensity to systemic absorption?
A. intercostal blocks > caudal > epidural > brachial plexus > intravenous regional > lower extremity blocks
B. intercostal blocks > intravenous regional> caudal > epidural > brachial plexus > lower extremity blocks
C. intercostal blocks > intravenous regional> brachial plexus > caudal > epidural > lower extremity blocks
A. intercostal blocks > caudal > epidural > brachial plexus > intravenous regional > lower extremity blocks
- ICE BivLE
True of the boundaries of Paravertebral space in the THORACIC region EXCEPT:
A. Medially: The vertebral body, intervertebral disc and foramen, and spinous processes
B. Anterolaterally: Parietal pleura
C. Posteriorly: spinous process
C. Posteriorly: spinous process - FALSE
Medially: The vertebral body, intervertebral disc and foramen, and spinous processes (angulation decreases from T1 to L4/L5).
Anterolaterally: The parietal pleura.
Posteriorly: The costotransverse process
Which of the following emerges from the lateral trunk of the sciatic nerve?
A. tibial nerve
B. common peroneal nerve
B. common peroneal nerve
The sciatic nerve—the largest nerve of the body—is usually the conjunction of two trunks initially enveloped in a common sheath: a lateral trunk (L4– S2), which eventually emerges as the common peroneal nerve, and a medial trunk (L4–S3), which later becomes the tibial nerve.
Which of the following emerges from the MEDIAL trunk of the sciatic nerve?
A. tibial nerve
B. common peroneal nerve
A. tibial nerve
Deep cervical plexus block is indicated for parathyroid surgery as well as carotid
endarterectomy. Which of the following is INCORRECTLY paired regarding the complications and the nerve affected:
A. Phrenic nerve: hemidiaphragmatic paresis
B. Horner Syndrome : cervicothoracic ganglion(sympathetic)
C. Hoarseness: superior laryngeal nerve
Phrenic nerve palsy leading to hemidiaphragmatic paresis is common with
deep cervical plexus block.
This block is not indicated in any patient
who depends on the diaphragm for tidal ventilation and bilateral blocks are never recommended.
Other well-described side effects include Horner syndrome (if the superior cervical or cervicothoracic ganglion is blocked), stellate ganglion block, and hoarseness due to recurrent laryngeal nerve block.
- HOARSENESS = Recurrent laryngeal nerve
Which of the following is NOT a target nerve for scalp block?
A. greater occipital nerve
B. lesser occipital nerve
C. zygomatico-temporal nerve
D. anterior branch of great auricular nerve
E. posterior branch of great auricular nerve
D. anterior branch of great auricular nerve
ASRA |
READ
For optimal scanning of the lateral femoral cutaneous block, what type of ultrasound approach can minimize the error in scanning?
A. short-axis view, in-plane view
B. short-axis view, out of plane
C. long-axis view, out of plane
B. short-axis view, out of plane
Which of the following nerves should be blocked for an operation at the medial aspectof the lower leg?
A.Femoral
B.Sciatic
C.Common peroneal
D.Tibial
A. Femoral
The QL block is an abdominal wall interfascial plane block in which the
local anesthetic is injected around the thoracolumbar fascia (TLF). QL 1 is relative to which border of QL muscle?
A. anterior
B. lateral
C. posterior
The QL block is an abdominal wall interfascial plane block in which the
local anesthetic is injected around the thoracolumbar fascia (TLF) on the:
Lateral = QL1
Posterior = QL2
Anterior = QL3 or transmuscular
The lateral QL (QL1) block targets the QL and transversus abdominis muscles.
- The posterior QL (QL2) block targets the middle thoracolumbar fascial plane
between the QL and erector spinae muscles. - The anterior QL (QL3 or transmuscular) block targets the QL and psoas muscles.
TRUE or FALSE
Among the new fascial plane blocks, QL cannot be performed using Nerve Stimulator.
Why?
TRUE!
QL cannot be performed using NS because there are NO major nerves to activate or stimulate.
Quadriceps weakness is evident after an anterior QL block because local anesthetic can spread to the _____
A. fascia iliaca
B. psoas muscle
C. transversus abdominis muscle
D. iliacus muscle
A. fascia iliaca
Clinical pearls | BARASH 9th edit
This is the safest site for the needle alignment relative to ‘in plane’ approach during a lumbar plexus block:
A. L3 - L5
B. L2 - L4
C. L1 - L3
A. L3 - L5
Puncture of the kidney can be a potential complication of lumbar plexus block; if attempting real-time needle insertion, the safest needle alignment will be IP to a longitudinally placed probe over the
L3–L5 transverse processes since the kidney may come to view at a more cephalad position.
Adductor spasm seen in patient with Multiple sclerosis can be relieved by blocking this nerve:
A. Obturator n.
B. Femoral n.
C. Lateral femoral cutaneous n.
D. Saphenous n.
Four terminal nerves of the lumbar plexus can be anesthetized in the lower extremity: the lateral femoral cutaneous, femoral, obturator, and saphenous.
Obturator nerve block can effectively prevent obturator reflex during transurethral bladder tumor resections, treat pain in the hip area, relieve adductor spasm (as seen in multiple sclerosis patients), or serve as a diagnostic tool when studying hip mobility.
This nerve block often complements sciatic nerve block when anesthesia of the medial aspect of the ankle and foot is required.
A. Saphenous nerve block
B. Deep peroneal nerve block
C. Ankle block
D. Sural nerve block
A. Saphenous nerve block
Saphenous nerve block
often complements sciatic nerve block when anesthesia of the medial aspect
of the ankle and foot is required.
After performing an interscalene block, your patient complains of pain in his
fourth and fifth digits. Which dermatomes are not adequately covered with an
interscalene block?
A. C5-C6
B. C6-C7
C. C7-C8
D. C8-T1
D. C8-T1
A successful ankle block for transmetatarsal amputation of the first and second toes should include each of the following nerves EXCEPT:
(A) saphenous
(B) deep peroneal
(C) superficial peroneal
(D) sural
(E) tibial
(D) sural
To eliminate involuntary expulsive effort with contraction in the second stage of labor, a nerve block must include at least:
(A) T6-T12
(B) T4-S5
(C) T8-L2
(D) L1-S2
(E) S2-S4
(E) S2-S4
An 18-year-old woman has knee pain during arthroscopy performed with femoral and sciatic nerve blocks for repair of a torn medial meniscus. The most appropriate management is addition of which of the following nerve blocks?
(A) Deep peroneal
(B) Obturator
(C) Popliteal
(D) Saphenous
(E) Superficial peroneal
(B) Obturator
Five minutes after a stellate ganglion block is performed, a patient becomes restless, then apneic. The most likely cause is
(A) paratracheal hematoma
(B) phrenic nerve block
(C) recurrent laryngeal nerve block
(D) subarachnoid injection
(E) vertebral artery injection
(B) phrenic nerve block
