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SRNA3Regional > Exam #3 Review > Flashcards

Exam #3 Review Flashcards

1
Q

Of the following, which three are relative/absolute contraindications for epidural blockade?
Select one or more:
c. Tattoo at insertion site
d. Previous epidural with subsequent post – dural puncture headache

A

a. Increased ICP
b. Marked Hypovolemia
e. infection at the site

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2
Q

Identify layers

IP SADEL SIST

A 
A. Intervertebral disc
B. Pia mater
C. Spinal Nerve
D. Arachnoid Mater
E. Dura Mater
F. Epidural Fat
G. Ligamentum Flavum
H. Spinous Process
I. Interspinous Ligament
J. Supraspinous Ligament
K. Transverse Process
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3
Q

The anatomy of the femoral nerve is described in 4 of the following statements:
Select one or more:
a. Passes over the inguinal ligament just medial to femoral artery

A

b. From L2-L4
c. Passes under inguinal ligament just lateral to femoral artery
d. branches just after inguinal ligament
e. Largest branch of the lumbar plexus

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4
Q

The ____ nerve, a branch of the femoral nerve, runs superficially along the medial
aspect of the knee and leg, just posterior to the saphenous vein, within the canal.
Select one:
a. Obturator
b. Femoral
d. Sciatic

A

c. Saphenous

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5
Q
  1. The saphenous nerve supplies motor function to which structures?
    Select one:
    a. Extensor halicis longus
    b. Soleus
A

c. Nothing, it is purely sensory

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6
Q

The saphenous nerve supplies motor function to which structures?
Select one:
a. Extensor halicis longus
b. Soleus

A

c. Nothing, it is purely sensory

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7
Q

Advantages for the patient, of a short bevel (blunt) needle, over a conventional
hypodermic “cutting” needle for nerve block includes:
Select one:
a. Reusable
c. Less painful
d. Ease of advancement
e. Stiffer

A

b. Lower risk of nerve damage

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8
Q 
Indications for the adductor canal block include procures of the following:
Select one:
b. Foot/ankle
c. Hip/thigh
d. Posterior thigh
A

a. Knee

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9
Q 
All of the following are contents found in the epidural space except?
Select one:
a. Fat
b. Spinal nerves
c. Epidural nerves
A

d. CSF

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10
Q

Indications for the TAP block include 4 of the following surgical procedures?
Select one or more:
a. Mastectomy

A

b. Hernia repair
c. Appendectomy
d. Caesarean section
e. Abdominal Hysterectomy

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11
Q

Neuraxial techniques refer to which of the following? (select all that apply)

a. Plexus blockade
d. Therapeutic sympathetic blockde
e. Local lidocaine injection

A

b. Epidurals

c. Spinals

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12
Q

The aim of the TAP block is to deposit local anesthetic in the plane between the ____
___ and ____ ____ muscles targeting the spinal nerves in this plane. The innervation to
abdominal skin, muscles and parietal peritoneum will be interrupted.
Select one:
b. External oblique /Rectus Abdominus
c. Costal Margin/ Iliac Crest

A

Internal oblique/ Transverse Abdominus

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13
Q

When placing an epidural above L1-L2 we increase the risk of?
Select one:
a. Puncturing the pleural cavity
b. Post-dural puncture headache
c. This placement is no riskier than any other
d. Cardiovascular toxicity

A

Trauma to the spinal cord

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14
Q 
Muscles of the anterior thigh are innervated by:
Select one:
b. Sciatic nerve
c. Tibial nerve
d. Lateral femoral cutaneous nerve
e. Obturator nerve
A

Femoral nerve

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15
Q

Which of the following surgical procedures would not be an indication for a femoral
nerve block?
Select one:
b. Surgery of the extensor mechanism of the knee
c. Surgery on or around the knee
d. Knee arthroplasty
e. Below the knee amputation

A

a. Hip replacement

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16
Q

The Adductor Canal is made up of the ___ muscle superficially, and the ____ muscle as
the deep component. The side wall completing a triangle is the ___ ____. Within these
three structure, a tunnel or canal is formed allowing for passage of the saphenous
nerve, and the distal femoral artery and vein (Choose 3 answers)
Select one or more:
a. Vastus laterallis

A

b. Vastus medialis
c. Sartorius
d. Adductor Longus

17
Q

Advantages of epidural anesthesia/analgesia include 3 of the following:
Select one or more:
b. Labor epidurals can be very difficult to convert to a surgical anesthetic

A

a. Labor Epidural analgesia is the moly method currently recognized which can relive
pain while minimizing maternal/fetal physiology
c. Epidural anesthesia is well suited for long procedure, offering extended refli from pain
for the post-op period as well
d. Labor epidurals permit immediate bonding between mother and baby

18
Q

You are peforming a poilteal block in the prone position. You have placed your
stimulating needle via ultrasound proximal to the popliteal fossa, in the vicinity of the
sciatic nerve. TWicthes are obtained in the toes and maintained down to 0.3 mA on the
stimulator. The next move would be to:
Select one:
b. Withdraw the needle and abandon the procedure
c. Withdraw the needle slightly to obtain twitches in the muscles of the calf
d. Advance the needle slowly until you feel the pop of the epineurium and high
pressures are needed to inject

A

a. Aspirate and inject 30-40ml of LA

19
Q

When stimulating during a femoral nerve block, a twitch is obtained in the anterior thigh
but the knee cap is not moving, what is the most approiate action to take next?
Select one:
a. Aspirate and inject the local anesthetic
b. Remove stimulator needle and re-direct
c. Pull out and reassess landmarks
d. Pull needle back, too far in the muscle

A

Advance slightly to obtain the “patellar snap”

20
Q

Common indications
For the Popliteal (Sciatic) Block include 3 of the following:
Select one or more:
b. Procedures on the medial aspect of the lower legs

A

a. Achilles Tendon Repair
c. Debridement of foot wounds
d. Corrective Foot Surgeries

21
Q

Innervation of the anterolateral abdominal wall arises from the anterior rami of spinal
nerves ____. The anterior from the intercostal space to enter the abdominal wall
between the internal oblique and transverus absdominus muscles, which they perforate
and supply, ending as anterior cutanoues branches supplying the skin of the fron of the
…. ( need to review question)
Select one:
a. L4 to L5
c. T1 to T6

A

b. T7 to L1

22
Q 
22. The normal depth of insertion for the epidural cathert is \_\_\_\_ cm at the skin.
Select one:
a. 6
c. 15
d. 8
A

b. 12

23
Q
  1. Proper drug slection and dosing are essential to providing adequate analgesia
    /anesthesia. Some questions the provider might ask themselves dosing an epidural
    catheter include 4 of the following:
    select one or more:
    d. If I get a bloody aspirate in the epidural catheter, it should be ok to go ahead and inject
    local right?
A

a. what is the procedure being performed?
b. What do is the epidural meant to do?
c. What position will the patient be in for this procedure?
e. What is the duration of the procedure?

24
Q

ADD Epidural-know dosing of epidural

A

Proper drug selection and dosing
LA= 20ML
HIGH CONCENTRATION, LOW DOSE
LOW CONCENTRATION, HIGH DOSE

25
Q

ADD Each 5 cm on the

A

epidural catheter is marked with black
lines. 10cm = 2lines, 15cm = 3, 20cm = 4 lines
there is a long black line between the 11-12 cm insertion marks

26
Q

ADD Epidural test dose (epi)

A

5 ML OF 1.5 LIDO/EPI 200,000 WITH 2ML FENTANYL 100MCG; 1ML

IN THE SYRINGE FILTER “DEADVSPACE, GIVE 3ml TEST DOSE, 3 ML LOADING DOSE

27
Q

ADD Femoral Nerve block anatomy

Landmarks:

A

femoral (inguinal) crease, femoral artery pulse

28
Q

ADD Innervation (Muscles of the anterior thigh)

A

Femoral nerve innervates: Front and medial sides of the thigh (Ant. Thigh), medial leg and foot
(saphenous nerve),
articular branches of the hip and knee joints

29
Q

ADD Saphenous nerve functions

A

Sensory no motor

30
Q

ADD- Tap block anatomy and indications
Complications: intraperitoneal injection, bowel hematoma,
transient femoral nerve palsy, Local anesthetic toxicity
peritonitis or ischemia of the bowel.

A

The innervation to …abdominal skin and muscles,
parietal peritoneum
20-30 ml of 0.25% ropivacaine per side.

31
Q

ADD-Tap block Indications=

A 
Postoperative analgesia
appendectomy,
laparotomy,  
laparoscopic surgery, 
abdominoplasty, 
cesarean delivery, and
operations on the abdominal wall.
32
Q

ADD- Where do I inject LA for TAP block?

A

Injected in the fascia between the internal oblique and transverse abdominis muscles

33
Q

ADD- Adductor Canal musculature (SVA)

A

Sartorius muscle - superficial
Vastus Intermedius/medialis- deep
Adductor Longus - side wall

34
Q

ADD Indications for adductor canal block

A

Procedure of the knee

SRNA3Regional (17 decks)

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