Exam 1 - Neuraxial Principles Pre-Test

Question 1

What is the outermost layer surrounding the spinal cord?

Answer 1

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.

Question 2

The dural sac terminates at what level?

Answer 2

S2

so anything past s2 is no longer considered spinal procedure!

Question 3

What are the cardio-accelerator nerve fibers?

Answer 3

T1-T4!

Question 4

What is an absolute contraindication of spinal anesthesia? select 3.
A. pt refusal
B. multiple sclerosis
C. chronic headache/backache
D. dermal site infection
E. deformities of spinal column
F. BT: 15 mins

Answer 4

A. Patient refusal
D. evidence of dermal site infection
F. coagulopathy (INR >1.5, plts <100k, PT >28 secs, aPTT >64 secs, BT >14 mins)
Also:
- severe or critical valve heart dz
- HSS
- operation > duration
- increased ICP
- severe CHF (EF <40%)

Question 5

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

Answer 5

T4

Question 6

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

Answer 6

• 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.

Question 7

_______ is an ultra–short-acting ester local anesthetic and is metabolized by pseudocholinesterase.

Answer 7

• Chloroprocaine

Question 8

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

Answer 8

• 75%

Question 9

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

Answer 9

• 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

Question 10

The diaphragm is innervated by ______, _________, ________.

Answer 10

• C3
• C4
• C5

Question 11

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

Answer 11

• 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)

Question 12

______ is the resulting metabolite of ester local anesthetics.

Answer 12

• Para-aminobenzoic acid (PABA)

Question 13

Which local anesthetic has high affinity to cardiac toxicity?

Answer 13

• Bupivacaine

Question 14

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

Answer 14

• 15 mg

Question 15

Functional residual capacity is a combination of which lung volumes?

Answer 15

• ERV
• RV

Question 16

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

Answer 16

• Loop A

Question 17

Parturients will present with which pulmonary pressure-volume loop?

Answer 17

• Loop D

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

Question 18

What is the dermatome level for the umbilical area?

Answer 18

• T10

Question 19

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

Answer 19