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SRNA3Regional > EXAM 2 REVIEW > Flashcards

EXAM 2 REVIEW Flashcards

1
Q

Landmarks for the interscalene brachial plexus block included 3 of the following:
select on or more:

A

The posterior border of the sternoclidomastoid muscle
the clavicle
the external jugular vein

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2
Q

Ultrasound scanning generates heat in the tissues. Higher frequencies are absorbed a > rate than lower frequencies. Choose 2 additional true statements from those below regarding ultrasound frequencies. Select one or more:

A

If the penetration is not sufficient to visualize the structures of interest (Target), a lower frequency is selected to increase penetration.
c. Higher scanning frequencies provide better axial resolution

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3
Q

. This image is an axial section Ultrasound, the probe is in the patient’s axilla, AA = axillary Artery , CB= Coracobrachialis muscle, Match the lower case letter with the nerve over which they lie.
MUSTMEAN URINATE REALLY (ABCD)

A

Musculocutaneous nerve a
Median nerve b
Ulnar nerve c
Radial nerve d

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4
Q

Match the following complications and side effects for cervical plexus blocks. If you inadvertently penetrate and inject the following anatomical sites, what would you expect to see if local is injected?
Vertebral artery

A

– seizures

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5
Q

Dural puncture

A

total spinal

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6
Q

Jugular vein

A

systemic toxicity (cardiovascular and CNS)

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7
Q

Recurrent laryngeal nerve –

A

ipsilateral vocal cord paralysis

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8
Q

Phrenic nerve

A

– ipsilateral hemi diaphragmatic paralysis

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9
Q

Which three of the following are true in regards to an interscalene brachial plexus block. Select one or more:

A

b. T1 is often missed
c. Levels C4 through C8 are reliably blocked
d. It is indicated for analgesia for shoulder and arm surgery

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10
Q

Which root is likely to be spared causing inadequate analgesia to the medial arm and forearm when performing an interscalene block? Select one:

A

C1

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11
Q

Once you have effectively positioned your patient for a spinal anesthetics, using your fingers, you palpate the top of the bilateral iliac crests . This is known as “Tuffer’s line”. This line should represent which level of the vertebrae?

A

L3/L4

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12
Q

The axillary block is an excellent choice of anesthesia technique for surgeries on 3 of the following areas.
Select one or more:

A

A. Forearm
B. Hand
C. Elbow

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13
Q

While performing an interscalene brachial plexus block, a triceps twitch is obtained at 0.4 mA. What is the most appropriate next action

A

b. aspirate then inject

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14
Q

Which of the following is not typical of Horner’s Syndrome

Select one:

A

b. Dilated pupil

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15
Q

Match the block to the brachial plexus level at which it is performed
branches –

A

axillary ( not a true block )

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16
Q

Match the block to the brachial plexus level at which it is performed
branches –cords –

A

infraclavicular

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17
Q

Match the block to the brachial plexus level at which it is performed
branches –divisions –

A

supraclavicular

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18
Q

Match the block to the brachial plexus level at which it is performed
branches – roots/ trunks –

A

interscalene

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19
Q

Match the following Structures associated with a Midline Spinal approach
( 1 = first to be punctured, 7 = last)

A 
Ligamentum Flavum  5
Interspinous ligament  4
Subcutaneous 2
Supraspinous ligament  3
Arachnoid  7
Dura  6
Skin  1
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20
Q

Which of the following nerves is least likely to be adequately anesthesized by an interscalene block? Select one

A

Supraclavicular nerve

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21
Q

Hyperbaric LAs have a specific gravity ______than that of the CSF

A

b. >

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22
Q

Identify layers

A
  1. Supraspinous ligament
  2. Infraspinous ligament
  3. Ligamentum Flavum
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23
Q

Ispilateral ptosis, miosis, and anhydrosis, and hoarseness AKA Horner’s syndrome can result from performing that block

A

Interscalene

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24
Q

A patient has suffered a fracture of the humerus near mid shaft. He is unable to extend his wrist and lacks sensation over the dorsal surface of the first 3 ½ digits. What nerve has been injured?

A

The radial nerve

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25
Q

Diaphragmatic stimulation is seen while performing an interscalene block.What is the most appropriate action

A

Redirect the stimulating needle more posteriorly

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26
Q

Match the signal to the tissue

Hypoechoic

A

FAT

27
Q

Match the signal to the tissue

Anechoic (pulsatile)

A

ARTERIES

28
Q

Match the signal to the tissue

Hyperechoic

A

BONE

29
Q

Match the signal to the tissue Anechoic (compressible)

A

VEINS

30
Q

As a clear, accurate image of the target is acquired via US, a stimulating needle is placed, and viewed approaching the target. It is at this point we begin to see the benefit of the ______ _______.
Select one

A

Dual Technique

31
Q

Match the following: (RTDCB)

3 anterior and 3 posterior -

A

DIVISIONS

32
Q

Match the following: (RTDCB)

Terminal nerves –

A

BRANCHES

33
Q

Match the following: (RTDCB) C5 -T1 —

A

ROOTS

34
Q

Match the following: (RTDCB) lateral, Medial, Posterior →

A

CORDS

35
Q

Superior (C5, C6), Middle (C7), Inferior (C8, T1) –

A

TRUNKS

36
Q

Match the type of block with the level of the brachial plexus?Interscalene block

A
  • Level of the roots/trunks
37
Q

Match the type of block with the level of the brachial plexus? block

A

Level of the branches

38
Q

Match the type of block with the level of the brachial plexus?Infraclavicular block

A
  • Level of the cords
39
Q

Match the type of block with the level of the brachial plexus?Supraclavicular block

A
  • Level of the divisions
40
Q

Match the following tissues with the appropriate Ultrasound image
Veins

A

HYPO/ANECHOIC, COMPRESSIBLE

41
Q

Match the following tissues with the appropriate Ultrasound image Nerves

A

(Above clavical) HYPOECHOIC

42
Q

Match the following tissues with the appropriate Ultrasound image Arteries

A

HYPO/ANECHOIC, pulsatile, maintain a round shape

43
Q

Match the following tissues with the appropriate Ultrasound image Bone

A

EXTREMELY HYPERECHOIC, LINES WITH A HYPOECHOIC SHADOW

44
Q

Match the following tissues with the appropriate Ultrasound image Tendons

A

PREDOMINANTLY HYPERECHOIC

45
Q

Match the following tissues with the appropriate Ultrasound image Muscle

A

HETEROGENOUS, MIXTURE OF BOTH HYPERECHOIC LINES WITHIN a HYPOECHOIC TISSUE BACKGROUND

46
Q

Once the SAB is performed, strict attention to the patient’s hemodynamic status is crucial. Three parameters which must be monitored include:

A

A. Block height is critical
B. Heart rate is critical
D. Blood pressure taken at short intervals

47
Q

By the time the brachial plexus passes behind the lower border of the pectoralis minor muscle in the axilla, the cords quickly begin to form the principle terminal nerves of the brachial plexus, namely these 4 nerves.
Select one or more:A. Femoral

A

B. Radial
C. Ulnar
D. Median
E. Musculocutaneous

48
Q

With reference to the performance of an interscalene blocks, what are the consequences of injecting our “skin local” too deep? Select one

A

Deposition of LA into the plexus resulting in nerve injury, and/or making your attempts at motor response via nerve stimulator more difficult to impossible

49
Q
  1. Match the tissue type with its echodensity ( Either hypoechoic/anechoic, or hyperechoic)
    Arteries—-
A

Anechoic (pulsatile)

50
Q

Mixture of hyperechoic lines within a hypoechoic tissue background

A

Muscles—-

51
Q

Hypoechoic/anechoic (compressible)

A

Veins —-

52
Q

Hyperechoic lines with a hypoechoic shadow

A

Bone—–

53
Q

Hypoechoic with irregular hyperechoic lines

A

Fat——

54
Q

Mostly Hypoechoic

A

Nerves —

55
Q

hyperechoic technical artifct (hypoechoic)

A

Tendons—

56
Q 
Roots (5) A-E
MARMU F-J
LPM (Cords)
SMI (Trunk)
RTDCB

RMLSR

A 
A.	C5
B.	C6
C.	C7
D.	C8
E.	T1
F.	Musculocutaneous nerve
G.	Axillary nerve
H.	Radial nerve
I.	Median nerve
J.	Ulnar nerve
K.	Lateral cord
L.	Posterior cord
M.	Medial cord
N.	Superior trunk
O.	Middle trunk
P.	Inferior trunk
Q.	Brachial Plexus roots
R.	Brachial Plexus trunks
S.	Brachial Plexus divisions
T.	Brachial Plexus Cords
U.	Brachial Plexus Branches and terminal nerves
57
Q

Spinal anesthesia can be administered using

A

either a cutting or non-cutting needle.

58
Q

Examples of a cutting needle include the

A

Quincke-Greene or Pitkin Babcock,

59
Q

Example of noncutting-tip pencil point needles include the

A

Sprotte, Whitacre, and Pencan needles which have a pencil point tip and rounded edges.

60
Q

Spinal needles gauge and length from

A

22- to 29-gauge and in lengths of approximately 3.5 inches (88 mm) and 5inches (120 mm).

61
Q

To prevent PDPH use

A

Use small cutting needles are used, the incidence of PDPH is clearly reduced with the use of NONCUTTING needles
Pencil-point needles are associated with a less than 1% risk of PDPH.

62
Q

Most blocks are performed using

A

25- to 27-gauge, 3.5-inch (88-mm) needles

63
Q

Horner’s syndrome 5 Symptoms (RAMPP)

-

A
  • PTOSIS (Drooping of the eyelid, may be mistaken for stroke)
  • MYOSIS (Unilateral pupil constriction, stroke like)
  • PHRENIC NERVE PALSY (problematic with preexisting respiratory compromise
  • RECURRENT LARYNGEAL NERVE PALSY (Hoarseness)
  • ANHIDROSIS (Unilateral inability to produce facial sweating)
64
Q

Dual technique

A

use of US and PNS

SRNA3Regional (17 decks)

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