CC Regional/ Anatomy Flashcards
In the adult patient, the superior border of the thyroid cartilage is:
A. C2
B. C4
C. C6
D. C8
Answer: B (C4)
The patient presents for a stellate ganglion block for the treatment of CRPS Type I of the RUE. After completion of the block, sympathetic blockade of the RUE can be assessed by observing:
A. Ptosis of the Right eye
B. Miosis of the Right Pupil
C. Enopthalamus of the Right globe
D. Temperature change of the right arm
Answer D
Temp change in right arm
Stellate ganglion block is
most commonly performed
for patients with upper
extremity pain (CRPS I or II).
Horner’s syndrome, a side
effect of stellate ganglion
block, is heralded by
symptoms of SNS
denervation such as miosis,
ptosis, and enophthalmos of
the globe on the ipsilateral
side of the block. Although
practitioners look for the
development of Horner’s
syndrome as a metric for
efficacy of the block, its
presence does not necessarily
equate to sympathetic
denervation of the upper
extremity.
A superior laryngeal nerve block:
A. provides sensory block to the epiglottis and airway mucosa to the level of the VC
B. Is achieved via an injection through the cricothyroid membrane while the patient is instructed to cough
C. Provides blockade of the external branch of the SLN
D. Requires that air be aspirated initially to ensure proper placement of needle
Answer: A
The cricoid cartilage:
A. is the most narrow portion of the adult airway
B. Brodens into a flat plate anteriorly
C. Is the first cartilaginous structure encountered during laryngoscopy
D. Is the only cartilage of the larynx that forms a complete ring
D
In the adrenal gland, glucocorticoids are only secreted in the:
A. Zone Fasciculata
B. Zona Reticularis
C. Zona Glomerulus
D. Medulla
Answer: A
Fibers found in the spinothalamic tract of the SC are involved in transmission of:
A. Proprioception
B. Simple TOuch
C. Pain
D. Fine Motor control
E. Temp
F. Coordinated motor control
G. SNS functions
Answer: B, C, E
Match the term with the associated muscle:
- Thyroarytenoid
- Lateral Cricoarytenoid
- Post. Cricoarytenoid
- Cricothyroid
A. Opens (Abducts) VC
B. Closes (Adducts) VC
C. Tenses and elongates the VC
D. Shortens and relaxes VC
Thyroarytenoid – shortens and relaxes VC
Lat Cricoarytenoid - Closes (adducts) VC
Post Cricoarytenoid - Opens (abducts) VC
Cricothyroid - Tenses and elongates VC
Cranial nerves processing only motor function include:
A. Hypoglossal
B. Optic
C. Trigeminal
D. Facial
E. Trochlear
F. Abducens
Answer : E, F, A
Primary complication associated with the sitting position:
A. Venous air embolism
B. Cerebral hypoperfusion
C. Venous pooling in LE
D. A significant decrease in FRC
Answer: A
Although hypoperfusion of
the cerebral vasculature,
pooling of blood in the lower
extremities and a decrease in
FRC may all occur in the
sitting position, VAE is the
principal hazard. Air may be
entrained into the vasculature
as a result of a negative
pressure gradient created
when the operative site is
above the level of the heart.
The incidence of venous air
embolism in the sitting
position ranges from 1-76%.
The component of the nephron that is involved in the concentration of urine via the countercurrent mechanism is the:
A. Distal tubule
B. Loop of Henle
C. PCT
D. JGA
Answer: B
The loop of henle is the establishment of a hyperosmotic state within the
medullary area of the kidney,
a mechanism that is vital to
the conservation of salt and
water. 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.
The protective mechanism which prevents the over dissension of the alveoli at high lung volumes is known as:
A. Driving reflex
B. Pharyngeal dilator reflex
C. Paradoxic reflex of head
D. Herring-Breuer Reflex
Answer: D
Stimulation of stretch
receptors in the lungs can
elicit the Hering-Breuer
inflation reflex. This reflex
may help prevent over
distention of the alveoli at
high lung volumes by
inhibiting large tidal volumes
and may decrease the
frequency of the inspiratory
efforts by causing a transient apnea
Upon removal of the drapes after an extended surgery in the supine position, it is noted that the patient’s legs are crosse.d After awakening, the patient complains of numbness on the lateral and posterior portion of the of the sole of his foot. The nerve root most likely injured is the:
A. Obturator nerve
B. Saphenous Nerve
C. Sural Nerve
D. Deep peroneal nerve
Answer: C
The posterior cord of the tracheal plexus gives rise to the: (choose 2)
A. Median N
B. Ulnar N.
C. Axillary N
D. Musculocutaneous N
E. Radial N
F. Intercosto-brachial N
Answer C, E
A potential problem associated with cannulation of the dorsals pedis artery for monitoring BP:
A. th vessel is deep and torturous, resulting in difficult cannulation
B. The waveform may be distordted resulting in overestimation of BP
C. Risk of Sural Nerve damage
D. Risk of saphenous Nerve damage
B
Attributes associated with the development of post-op ulnar neuropathy include: (choose 4)
A. Male Sex
B. Extreme obesity
C. Female Sex
D. Prolonged bedrest
E. Preexisting contralateral ulnar neuropathy
F. The use of DMR
G. use of regional anesthetic techniques
Answer: A, B, E, D
Cerebrospinal fluid:
A. is produced at a rate of 200 mL/day in the adult
B. Is reabsorbed by the choroid plexus
C. Is produced by the arachnoid granulations
D. Occupies a volume of approximately 150 mL in the SA space
Answer: D
Cerebrospinal fluid supports
and cushions the spinal cord
and brain. It occupies a
volume of approximately 150
mL in the subarachnoid space.
It is produced by choroid
plexuses in the brain’s
ventricles at a rate of
approximately 500 mL/day. It
is largely reabsorbed by
arachnoid granulations and by
small CNS capillaries.
A view of the larynx is shown. Label each with the corresponding structure.
Arytenoid Muscles
Thyroid Cartilage
Cricoid cartilage
Arytenoid catilage
A. Thyroid Cartilage
B. Cricoid Cartilage
C. Arytenoid Cartilage
D. Arytenoid Muscles
Arterial blood supply to the larynx arises form the:
A. Right and left Pulmonary arteries
B. Superior and inferior thyroid arteries
C. Superior and inferior bronchial arteries
D. Right and left common carotid arteries
Answer: B
The cricoparyngeous muscle receives sensory innervation primarily from the:
A. Glossopharyngeal Nerve
B. Vagus Nerve
C. Hypoglossal Nerve
D. Spinal accessory Nerve
Answer: A
The lower border of the scapula corresponds to the spinal level:
A. T5
B. T7
C. T9
D. T11
Answer: T7
Anatomic dead space ends at the:
A. Terminal Bronchiole
B. Respiratory bronchiole
C. Alveolar Duct
D. Respiratory Lobule
Answer: A Terminal Bronchiole
The most serious complication of a supraclavicular block is:
A. Phrenic Nerve Block
B. Subclavian artery puncture
C. Pneumothorax
D. Paresthesias
Answer: C Pneumothorax
Chassaignac’s Tubercle may be palpated at:
A. The level of the hyoid bone at C3
B. The superior level of the thyroid cartilage at C4
C. The cricoid cartilage at C6
D. The suprasternal notch at C7
Answer: C
Chassaignac’s tubercle is an
anatomic landmark for the
placement of interscalene and
cervical plexus blocks. It is
the transverse process of the
verterbal body at C6 and may
be palpated lateral to the
cricoid cartilage.
The Ansa Cervicalis innervates the:
A. Glossogenious muscle
B. Thyrohyoid muscle
C. Geniohyoid muscle.
D. Sternohyoid muscle
Answer: Sternohyoid muscle
Potential complications associated with an inter scale block include: (choose 4)
A. Phrenic nerve block
B. Injection of LA into vertebral artery
C.Total spinal
D. Enopthalamus
E. Ptosis of the contralateral eye
F. Pneumothorax
G. Perforation of the Posterior communicating artery
Answer A, B, C, F
CSF flows form the third to fourth ventricle through the:
A. Foramen of Monroe
B. Cerebral Aqueduct of Sylvius
C. Foramen of Luschka
D. Foramen of Magendie
Answer B
Cerebral aqueduct of Sylvius
CSF is secreted by the
choroid plexus in lateral
ventricles 1 and 2, flows
through the foramen of
Munro to the 3rd ventricle,
through aqueduct of Sylvius
(A.K.A. cerebral aqueduct) to
4th ventricle and through the
foramina of Magendie and
Luschka (A.K.A. lateral and
medial apertures of 4th
ventricle) to the subarachnoid
space.
Organ designed as preportal organs include: (select 4)
A. Stomach
B. Adrenals
C. Pancreas
D. Small intestines
E. Kidneys
F. Spleen
G. Lungs
Answer: A, C, D, F
Accessory muscles involved in forceful expiration include:
A. SCM
B. Intercostals
C. Scalenes
D. Rectus Abdominis
Answer D
Drag and drop to the corresponding Structures
- Ductus Venosus
- Ductus Arteriosus
- Foramen Ovale
- Umbilical Vein
Fossa Ovalis
Lig Arteriosum
Lig Teres Hepatis
Ligament Venoisum
- Ductus Venosus – Ligament Venosium
- Ductus Arteriosis - Ligament Arterosum
- Foramen Ovale - Fossa Ovale
- Umbilical Vein - Ligament Teres Hepatis
The dominant motor nerve innervating the bicep brachii is the:
A. Radial
B. Ulnar
C. Median
D. Musculocutaneous
Answer: D - musculocutaneous
In the adult during placement of the PAC through the Right IJ, the RV should be entered at approximately
____ cm
Answer: 25 - 35 cm
Motor innervation to the Superior oblique muscle of the eye is supplied by:
A. Abducens
B. Occulomotor
C. Trochlear
D. Ophthalmic
Answer: A
Although the majority of
extraocular muscles receive
motor innervation from the
oculomotor nerve (CN III),
the trochlear nerve (CN IV)
provides motor innervation to
the superior oblique muscle of
the eye. The abducens (CN
VI) provides motor
innervation to the lateral
rectus muscle of the eye.
A plantar view of the foot is shown Match the locations with the name.
A
B
C
D
A. Saphenous
B. Medial Plantar
C. Tibial Nerve
D. Sural
Of the following, the therapeutic intervention that causes the least ventilatory compromise in the prone patient is the:
A. Use of Wilson Frame
B. Use of a Jackson Table
C. Proper placement of the chest rolls
D. Use of an abdominal binder
Answer; Use of a Jackson Table
The body mass index classification for adults with obesity is:
A. 20
B. 25
C. 30
D. 40
Answer: C
The Sural Nerve:
A. travels superficially with the saphenous nerve behind the lateral malleolus into the ankle
B. Provides sensory information to the anterior portion of the sole of the foot
C. May be injured form sustained pressure on the lateral tibial epicondyle
D. Arise form the roots of the fourth and fifth lumbar nerve
Answer: A
The Sural nerve is formed from the union of a branch of
the tibial and the common
peroneal nerves. It travels
superficially with the short
saphenous nerve behind the
lateral malleolus into the
ankle, 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.
Components that complete the thin filament of the contractile apparatus include:
A. Myosin, Troponin and Tropomycin
B. Tropnin, myosin and Actin
C. Actin, Troponin and Tropmyosin
D. Myosin, Actin and Tropomyosin
Answer: C
Actin, Troponin and Tropomyosin
Place the blocks in descending order of peak plasma concentrations following block placement:
Intercostal
Epidural
Trans-tracheal
Caudal
- Tracheal (Highest)
- Intercostal (second)
- Caudal (Third)
- Epidural (Fourth)
The pudendal block:
A. Blocks visceral efferent as they join the lumbar sympathetic chain
B. Blocks the distribution of sacral nerves 2, 3, 4
C. Blocks Frankenhauser plexus
D. Is useful for visceral pain associated with the first stage of labor
Answer: B
The pudendal block provides
analgesia for the second stage
of labor by blocking
distribution of sacral nerves 2,
3 and 4, which innervate the
lower vagina and perineum. It
is useful for forceps or
vacuum deliveries or
episiotomy.
The sins which is in close proximity to the optic chasm and the hypophysis is the:
A. Frontal
B. Ethmoid
C. Sphenoid
D. Maxillary
Answer: C
The innermost layer of the wall of a blood vessel is known as:
A. Tunica Intima
B. Tunica Media
C. Tunica Muscularis
D. Tunica Vascular
Answer: Tunica Intima
Which of the following nerves is located in the groove between the tendons of the anterior tibial and extensor hallicus longs muscle.
A. Posterior Tibial
B. Deep peroneal N
C. Sural Nerve
D. Saphenous Nerve
Answer: B Deep Peroneal
The deep peroneal nerve is
located behind the anterior
tibial artery, between the
tendons of the anterior tibial
and extensor hallucis longus
muscles.
Venous drainage from the orbit of the eye is achieved primarily through
A. Ciliary veins
B. Lacrimal Veins
C. Superior Vortex Veins
D. Superior ophthalmic vein
Answer: D - SUperior Opthalamic Vein
Complications resulting rom trendelenburg position include (select 3):
A. Decreased pulmonary capillary wedge pressure
B. Edema of the Upper Airway
C. Inadvertent right maintem intubation
D. Decreased CVP
E. Decreased MAP
F. Increased myocardial oxygen consumption
B, C, F
The fissure forming the boundary between the frontal and temporal lobes of the brain is called the:
A. Central sulcus
B. Lateral Sulcus
C. Corpus Callosum
D. Inula
B
The secretion of ADH causes the reabsorption of free water. The sites of action include (choose 2):
A. PCT
B. Depending loop
C. Ascending loop
D. DCT
E. Collecting Ducts
F. Renal Caleculi
Answer: D, E
The late distal tubule
reabsorbs 10% of filtered
water. This area is permeable
to water only in the presence
of ADH. The collecting duct
is 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 78M is scheduled for fulguration of bladder tumors. In order to achieve complete anesthesia of the bladder dome, it is necessary to obtain a level of spinal anesthesia at least:
A. T8
B. T10
C. L2
D. L4
Answer: B T10
The width of the synaptic gap at the motor terminal is approximately: ______ nm
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.
Functions of the spleen include (Choose 3):
A. Reservoir for platelets
B. Reservoir for RBCs
C. Removal of foreign antigens
D. Erythropoiesis in fetus and adults
E. Production of IgG
F. Removal of aged and damaged erythrocytes
A, C, F
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
platelets but has no specific
reservoir function for RBCs.
The portal triad includes (choose 3)
A. Hepatic Artery
B. Portal Vein
C. Hepatic Vein
D. Bile Duct
E. Cystic Duct
F. Vagus Nerve
A, B, D
Hepatic Artery, Portal Vein, Bile Duct
In the cardiac myocyte, the area that delineates the border between two separate sarcomeres is known as the:
A. “A” Band
B. “I” Band
C. “M” Band
D. “Z” Band
Answer: Z
The Z band bisects each “I” band of sarcomere
Nerve fibers inolved in the mediation of sharp pain include:
A. A-Beta fibers
B .A-gamma fibers
C. A - delta fibers
D. C fibers
Answer; C
Larger myelinated A delta
fibers are believed to mediate
the transmission of sharp
pain. Small, unmyelinated C
fibers mediate the
transmission of dull pain.
Effects of aging on the CV system include (select 3)
A. increased PNS activity
B. decreased response to beta receptor stimulation
C. Enhanced ischemic conditioning by VA
D. Stiffening of the myocardium
E. Decreased sympathetic activity
F. Cardiac conduction system changes
Answer: B, D, F
Effects of aging on the
cardiovascular system
include:
1) decreased
response to β-receptor
stimulation,
2) stiffening of
the myocardium, arteries and
veins,
3) changes in the ANS
with increased sympathetic
and decreased
parasympathetic activity,
4) conduction system changes,
and
5) defective ischemic
preconditioning by volatile
anesthetics.
Periop vision loss occurs most frequently in anesthetized patients:
A. undergoing cardiac surgical procedures
B. In the prone position
C. In the steep trendelenburg position
D. Receiving glycine bladder irritant
Answer: A
Perioperative vision loss
occurs most frequently in
patients undergoing cardiac
surgical procedures.
Primary venous drainage of the lower 2/3 of the esophagus occurs via the:
A. Inferior thyroid vein
B. Accessory hemizygous vein
C. Azygous vein
D. Hemizygous vein
Answer: C
The primary venous drainage
of the lower two-thirds of the
esophagus occurs via the
azygous vein which enters the
superior vena cava at
approximately the 5th
intercostal space on the right.
Direct anastomosis with the ICA at the circle of willis occurs with the:
A. PCA
B. ACA
C. MCA
D. Basilar Artery
Answer: C
The pneumotaxic center (select 3):
A. Limits the depth of inspiration
B. is located in the rostral pons
C. Sends impulses to the inspiratory DRG neurons
D. When maximally activated, increases ventilatory frequency
E. Has intrinsic rhythmaticity
F. is the major pacemaker for RR
Answer: A, B, D
Primary branches of the trigeminal nerve include: (select 3):
A. Mandibular N
B. Zygomatic N.
C. Ophthalmic N.
D. Buccal N.
E. Maxillary N.
F. Lingual N
Answer: A, C, E
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.
The NT secreted by the motor end-plate which results in stimulation of nicotinic receptors is:
A. GABA
B. ACh
C. NE
D. Dopamine
Answer: B - ACH
During the division of the tracheobronchial tree, the loss of cartilage occurs at approximately the:
A. 5th generation
B. 11th generation
C. 16th generation
D. 22nd generation
Answer: C - 16th generation
Structures contained within the carotid sheath include (Choose 3) :
A. Common carotid artery
B. Internal carotid Artery
C. Internal jugular vein
D. External Jugular Vein
E. Vagus Nerve
F. Phrenic Nerve
A, C, E
When utilizing the axillary approach to block the brachial plexus, the Neve that frequently needs supplemental blockade is the:
A. Musculocutaneous nerve
B. Ulnar Nerve
C. Median Nerve
D. Radial Nerve
A: Musculocutaneous nerve
Nerves originating from the Edinger-Westphall nucleus include the:
A. Trochlear
B. Abducens
C. Ophthalmic
D. Accessory Oculomotor Nerve
Answer: D
accessory oculomotor nerve
The accesory oculomotor
nerve originates from the
Edinger-Westphal nucleus
which is located adjacent to
the oculomotor nucleus.
Nerves arising from the sacral plexus include:
A. Femoral
B. Ileoinguinal Nerve
C. Sciatic
D. Obturator
Answer C
A 39 week gestation primipara is brought to the OR for C/S. Upon laying flat, she becomes diaphoretic and nauseated. The most effective maneuver to rectify these symptoms is:
A. Volume load the patient with 1L 0.9% NS
B. Place the patient in light left lateral tilt with wedge under R hip
C. Place the patient in trendelenburg position
D. Place the patient in a slight R tilt with wedge under left hip
Answer: B
Compartment syndrome has been associated with:
A. Intraop HTN
B. Elevation of extremities
C. Use of patient warming devices
D. Use of regional techniques
Answer: B
Sensory innervation of the larynx below the level of VC is provided by the:
A. SLN, external branch
B. SLN, internal branch
C. Glossopharyngeal
D. RLN
Answer: D
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.
