Chapter 1: Topographical Anatomy as Landmarks

Question 1

What vetebra level corresponds with the Axilla?

Answer 1

T3

Question 2

What vetebra level corresponds with the Cardioaccelatory Fibers?

Answer 2

T1 - T4

Question 3

What vetebra level corresponds with the Chassaignac Tubercle?

Answer 3

C6

Question 4

What vetebra level corresponds with the Xiphoid Process?

Answer 4

T7

Question 5

What vetebra level corresponds with the Inferior Border of the Scapula?

Answer 5

T8

Question 6

What vetebra level corresponds with the Level of the Celiac Plexus?

Answer 6

L1

Question 7

What vetebra level corresponds with the Lumbar Plexus?

Answer 7

T12 - L4

Question 8

What vetebra level corresponds with the Origin of artery of Adamkiewicz in 85% of patients?

Answer 8

T9 - L2

Question 9

What vetebra level corresponds with the Posterior superior iliac spine (PSIS), termination of subarachnoid space (adults)?

Answer 9

S2

Question 10

What vetebra level corresponds with the Sacral Plexus?

Answer 10

L4 - S3

Question 11

What vetebra level corresponds with the Termination of Spinal Cord in Adults?

In Peds?

Answer 11

Adults = L2

Pediatrics = L3

Question 12

What vertebrae level corresponds with the Termination of subarachnoid space (pediatrics)?

Answer 12

S3

Question 13

What are the 4 landmarks you should identify in an interscalene block?

Where should you needle insertion point be?

Answer 13

Mark the:

1. Sternal head of SCM

2. Clavicular heads of the sternocleidomastoid (SCM) muscle

3. The cricoid cartilage

4. Clavicle.

The needle insertion should be in the interscalene groove at C6 that is posterior to the clavicular head of the SCM and between the anterior and middle scalene muscles.

Question 14

What are the landmarks for an infraclavicular block?

Where should the needle insertion site be?

Answer 14

Mark the coracoid process

The needle insertion is 2 cm inferior and 2 cm medial to the coracoid process.

Question 15

For an Axillary Nerve Block:

What is your landmark?

Answer 15

Palpate or visualize the pulse of the axillary artery and guide the needle through the artery until arterial blood is aspirated. Penetrate further until blood return stops (you have now passed through the axillary artery) then inject anesthetic.

• This will cover the radial nerve as it is directly posterior to the axillary artery.
• Withdraw needle and again pass through the axillary artery. Once you exit the artery and are anterior to it, inject again to cover the median and ulnar nerves.

Question 16

If you want to anesthetize the musculocutaneous nerve, where would you inject local anesthetic?

Answer 16

Musculocutaneous—Typically combined with the axillary approach to ensure lateral forearm anesthesia. Local anesthetic can be injected into the belly of the coracobrachialis muscle, which sits just posterior to the biceps.

Question 17

Where is your landmark for an ulnar nerve block?

Answer 17

Isolated block can be done at the elbow between the medial epicondyle and olecranon process, medial to the ulnar artery.

Question 18

Where are the two locations you can do a selective (isolated) radial nerve block?

Answer 18

Isolated block can be done:

1. At elbow between the brachioradialis and biceps tendons.
2. At the wrist in the anatomic snuff box between brachioradialis and biceps tendons.

Question 19

Where can a selective median nerve block be performed? (2 locations)

Answer 19

Isolated block can be done:

1. At elbow medial to the brachial artery at the pronator teres muscle.

2. At the wrist between the palmaris longus and flexor carpi radialis tendons.

Question 20

What are the cardiac landmarks of auscultation relating to to the 4 cardiac valves?

Answer 20

Aortic valve—Second intercostal space to the right of sternum

Pulmonic valve—Second intercostal space to the left of sternum

Tricuspid valve—Fifth intercostal space to the left of sternum

Mitral valve—Fifth intercostal space at the left midclavicular line