Exam 1- Neuraxial Principles Pre-Test Flashcards

1
Q

What is the outermost layer surrounding the spinal cord?

A
  • Dura mater

Surrounding the spinal cord in the bony vertebral column are three membranes (from innermost to outermost): the pia mater, the arachnoid mater, and the dura mater.

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2
Q

The dural sac terminates at what level?

A
  • S2
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3
Q

What are the cardio-accelerator nerve fibers?

A
  • T1, T2, T3, T4

The effects of neuraxial blocks on blood pressure are similar in some ways to the combined use of intravenous α1- and β-adrenergic blockers on cardiac output: decreased stroke volume and heart rate caused by blockade of the peripheral (T1-L2) and cardiac (T1-T4) sympathetic fibers as well as adrenal medullary secretion.

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4
Q

What is the absolute contraindication of spinal anesthesia?

A
  • Patient refusal
  • Localized sepsis
  • Allergy to any of the drugs planned for administration.
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5
Q

Sensory blockade of which dermatome level is necessary for upper abdominal surgery?

A

T4

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6
Q

For isobaric solution, what is the most important factor in determining the spread of the local anesthetic in a subarachnoid block?

A
  • Dose

The dose, volume, and concentration are inextricably linked (Volume × Concentration = Dose), but dose is the most reliable determinant of local anesthetic spread (and thus block height) when compared with either volume or concentration for isobaric and hypobaric local anesthetic solutions. Hyperbaric local anesthetic injections are primarily influenced by baricity.

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7
Q

_______ is an ultra–short-acting ester local anesthetic and that was metablozied by pseudocholinesterase.

A
  • Chlorprocaine
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8
Q

The blood that resides in the venous system is approximately ____% of the total blood volume

A
  • 75%
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9
Q

The effects of Bezold-Jarisch reflex are manifested as ________, ________, and __________.

A
  • Bradycardia
  • Hypotension
  • Coronary Dilation

The Bezold-Jarisch reflex responds to noxious ventricular stimuli sensed by chemoreceptors and mechanoreceptors within the LV wall by inducing the triad of hypotension, bradycardia, and coronary artery dilatation

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10
Q

The diaphragm is innervated by ______, _________, ________.

A
  • C3
  • C4
  • C5
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11
Q

The incidence of cauda equina syndrome is linked to high dose of which local anesthetic?

A
  • Lidocaine

The rate of cauda equina syndrome is approximately 0.1 per 10,000 and invariably results in permanent neurologic deficit. The lumbosacral roots of the spinal cord may be particularly vulnerable to direct exposure of large doses of local anesthetic, whether it is administered as a single injection of relatively highly concentrated local anesthetic (e.g., 5% lidocaine)

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12
Q

______ is the metabolite of ester local anesthetics.

A
  • Para-aminobenzoic acid (PABA)
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13
Q

Which local anesthetic has high affinity to cardiac toxicity?

A
  • Bupivacaine
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14
Q

Two mL of hyperbaric bupivacaine 0.75% concentration is equivalent to how many mg?

A
  • 15 mg
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15
Q

Functional residual capacity is a combination of which lung volumes?

A
  • ERV
  • RV
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16
Q

Patients with emphysema will present with which pulmonary pressure-volume loop?

A
  • Loop A
17
Q

Parturients will present with which pulmonary pressure-volume loop?

A
  • Loop D

Pregnancy causes restrictive patterns because of the effect of the growing fetus on pulmonary pressures.

18
Q

What is the dermatome level for the umbilical area?

A
  • T10
19
Q

Label the conditions involved with Loops A, B, C, and D

A
20
Q

Continuous monitoring is required for which parameter as per the AANA standards?
A. Pupillary response
B. Neuromuscular response
C. Central Venous Pressure
D. Blood Pressure

A

D. Blood Pressure is part of cardiovascular status that requires continuous monitoring.

21
Q

In a healthy adult, what is the approximate O2 saturation for PaO2 of 40mmHg?
A. 50%
B. 75%
C. 65%
D. 90%

A

B. 75%

In a healthy adult the approximate O2 saturation for a PaO2 of 40 mmHg is 75%.

22
Q

During an Allen’s test, what is the purpose of having the patient make a tight fist?
A. Test for adequate grip strength
B. Assess metacarpal range of motion.
C. To place pressure on the radial nerve
D. To exsanguinate the palm.

A

D. Exsanguinate the palm.

23
Q

The total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each gas is whose law?
A. Dalton
B. Boyle
C. Charles
D. Ficks

A

A. Dalton

24
Q

Which type of SSEP is most commonly monitored during surgical procedures?
A. Beta Wave
B. Short-latency
C. Long-latency
D. Alpha Wave

A

B. Short-latency

25
Q

Which of the 4 types of adult hemoglobin would NOT be measured at 940nm wavelength?

A

Carboxyhemoglobin

26
Q

Physiologic effects of hypocarbia are:
A. Blunting of the respiratory drive and respiratory acidosis
B. Respiratory alkalosis and potassium shifts to intravascular space.
C. Respiratory alkalosis and increased ICP.
D. Blunting of respiratory drive and decreased cerebral blood flow.

A

D. Blunting of respiratory drive and decreased cerebral blood flow.

27
Q

End-tidal CO2 is typically measured at the end-point of which phase?

A

Phase III.

28
Q

The capnogram has a prolonged upstroke with an alpha angle >110 degrees, what is the problem causing the change?
A. The heart is beating in close proximity to the heart
B. The ETT is partially obstructed
C. The waveform is normal
D. Spontaneous ventilation is occurring.

A

B. The ETT is partially obstructed.

29
Q

What are the causes of decreased ETCO2? (Select 2).
A. Hypothermia
B. Poor gas sampling.
C. Seizures
D. Hypoventilation

A

A & B

Hypothermia and poor gas sampling.

30
Q

The cause of this End-tidal capnogram is due to:

A. Hyperventilation
B. Circuit leak
C. Obstructed ETT.
D. Exhausted Absorbent.

A

D. Exhausted absorbent.

If the inspiratory baseline is elevated and carbon dioxide is greater than zero, CO2 is being rebreathed.

Differential diagnosis includes an incompetent expiratory valve, exhausted CO2 absorbent, gas channeling through the absorbent, or an imperfectly calibrated capnometer.

31
Q

The fast-flush test of an arterial line is a method that determines:
A. Assessment of vascular tree.
B. Transducer leveling
C. Changes in the conduction system
D. System dynamic response.

A

D. System dynamic response.

The fast-flush test provides a convenient bedside method for determining system dynamic response and assessing signal distortion.

32
Q

Which method of heat transfer results in a loss of heat to air immediately surrounding the body?

A

Convection is the loss of heat to air immediately surrounding the body.