Exam 4 Prodigy Only Flashcards
1
Q
What psychological effect of a caudal anesthetic should you consider prior to performing the procedure on a toddler?
A
Inability to walk following the procedure.
2
Q
Select two populations with a higher incidence of postdural puncture headache.
A
Female, Pregnant, (in their 30s)
3
Q
When preparing to perform a popliteal block using the posterior approach, you locate the nerve in the popliteal fossa. The popliteal fossa is bounded by What structures:
A
semitendinosus tendon
semimembranosus tendon
biceps femoris tendon
4
Q
The popliteal fossa is bounded laterally by the and medially by the semimembranosus and semitendinosis tendons. The popliteal artery is found lateral to the semitendinosus tendon.
A
biceps femoris tendon
5
Q
The popliteal fossa is NOT bounded by the
A
Popliteal artery
6
Q
The choroid plexus produces CSF in the ventricles at
A
approximately 30 mL/hour.
7
Q
What produce CSF in the ventricles ?
A
Choroid plexus
8
Q
Following an axillary brachial plexus block with 40 mL of local anesthetic, a patient states she still has intact sensation to the lateral aspect of the forearm. To remedy this, you should
A
Inject a 3-5 mL field block into the belly of the coracobrachialis muscle
9
Q
Because the_____________ nerve branches off of the brachial plexus very early, it is typically not blocked with an axillary approach leaving its distribution to the__________ -_____ intact. For procedures that may involve that distribution, a (n)_______ block should be augmented with a 3-5 mL local anesthetic injection into the________ muscle where the musculocutaneous nerve emerges. .
A
musculocutaneous ; lateral forearm; axillary ;coracobrachialis
10
Q
Injecting 2-3 mL at the level of the ulnar styloid across the volar aspect of the forearm would block the radial nerve which would provide anesthesia to the
A
lateral 3 1/2 fingers
11
Q
Injecting 3-5 mL of local anesthetic at the posterior surface of the elbow just proximal to the arcuate ligament would block the
A
ulnar nerve.
12
Q
When planning to perform a popliteal block, you recognize that
A
the normal volume of local anesthetic for a popliteal block is 35-40 mL
13
Q
The sciatic nerve does divide into the
A
tibial and common peroneal nerve, but does so at the upper boundary of the popliteal fossa
14
Q
The popliteal artery may be found immediately.
A
lateral to the semitendinosus tendon
15
Q
The saphenous nerve is a branch of the
A
femoral nerve (think FemSa)
16
Q
The cervical enlargement occurs at and the
A
C4-T1
17
Q
Lumbar enlargement which occurs from.
A
L2-S3
18
Q
The cervical enlargement is due to the nerve roots that produce the
A
brachial plexus
19
Q
The lumbar enlargement is due to nerve roots that produces the
A
lumbar plexus.
20
Q
The main advantage of a two-level combined spinal/epidural anesthetic is that it
A
allows the anesthesia provider the ability to test the function of the epidural catheter prior to placing the spinal anesthetic.
21
Q
Disadvantages of the two-level method include:
A
difficulty distinguishing between the epidural test dose and CSF when performing the spinal anesthetic, CSF flow may be hindered by the compression of the dural sac by the epidural test dose, the epidural catheter can be cut by the spinal needle, and there is a risk of dural puncture with the epidural catheter.
22
Q
Neuraxial anesthesia can block sympathetic nerve transmission and result in hypotension. If the block is high enough to block the_________ bradycardia may also occur.
A
cardioacceleratory fibers in the T1 to T4 range, bradycardia may also occur.
23
Q
3 of the most appropriate treatments for sympathectomy with neuraxia
A
the continued administration of IV fluids
Ephedrine
Alpha agonist such as phenylephrine
24
Q
Which regional anesthetic technique is frequently used for abdominal surgery in neonates?
A
Caudal epidural block
25
Which nerve roots are associated with the obturator nerve?
L2 - L4
26
Approximately how much cerebrospinal fluid is normally contained in the subarachnoid space of the spinal canal?
30-80
27
Which would be considered the definitive treatment for postdural puncture headache?
Epidural blood patch 90% cure
28
Which of the following actions would be appropriate choices for prolonging the duration of a spinal anesthetic? (select two)
Increasing the dose of the local anesthetic injected
| Adding 5 mcg of sufentanil to the local anesthetic
29
Highly protein-bound anesthetics such as (3) have longer durations than less protein-bound agents such as (2)
tetracaine, bupivacaine, and ropivacaine ; mepivacaine and lidocaine.
30
Which meningeal layer is thin and is in direct contact with the outer surface of the spinal cord?
Pia mater
31
Abdominal muscles that are located between the subcostal margin and iliac crest with their position from most superficial to most deep.
From superficial to deep, the order is: external oblique, internal oblique, transversus abdominis.
32
What intravenous agent has been shown to be advantageous in the prevention of spinal-induced hypotension (SIH) if administered prophylactically?
Ondansetron 4-8 mg It is thought to prevent the reflex bradycardia due to sympathectomy that contributes to SIH.
33
Which complication occurs more frequently with an epidural than with a spinal anesthetic?
Backache (specially in OB patients)
34
What nerve roots contribute fibers to the ulnar nerve?
C8 , T1
35
Which drug class would be least likely to increase the risk for postoperative urinary retention?
Opioids, sympatholytics
36
Where in the popliteal fossa can the popliteal artery be found?
immediately lateral to the semitendinosus tendon
37
The intercristal line (also called Tuffner's line) spans between what structures?
The tops of both iliac crests
38
A line that spans between the tops of the iliac crest (called the intercristal line or Tuffner's line) typically crosses the ______ or _____interspace.
L3-L4 or L5-S1
39
The normal specific gravity of CSF is between
1.004 to 1.009.
40
In a supine patient, the apex of the lumbar curve is usually at
L3-L4
41
During an axillary brachial plexus block, you can choose to begin the injection high in the axilla, in the middle, or near the inferior border of the axilla. What is the primary benefit of choosing a higher approach?
greater chance of blocking the musculocutaneous nerve
42
Which ligament of the back is referred to as the yellow ligament?
Ligamentum flavum
43
How is a two-level combined spinal-epidural performed?
The epidural catheter is inserted, then the spinal is performed two interspaces below the epidural
44
Following a successful axillary approach to a brachial plexus block, you perform a separate block to anesthetize the intercostobrachial nerve because
. it doesn't travel in the brachial plexus sheath at all
45
When performing a brachial plexus block using the axillary approach, it is often necessary to perform separate blocks of the
medial brachial cutaneous and intercostobrachial nerves because the former exits the sheath just below the clavicle and the latter doesn't travel in the sheath at all.
46
These two nerves provide sensation to the skin of the medial and posterior proximal arm.
Medial brachia cutaneous and intercostobrachial nerves
47
Depo-Dur is a long-acting form of_______ used for
Morphine
48
Depo-Dur should be administered as a ________and never mixed with_______
Sole agent; LA
49
Which of the following spinal needles would be the best choice to decrease the risk of postdural puncture headache when performing a combined spinal/epidural?
The use of 25 gauge blunt-tip needles (such as a Whitacre needle) helps reduce the incidence of postdural puncture headache.
50
Following administration of a spinal anesthetic, your patient exhibits somnolence despite the fact that he has not received sedation medication. You know this can be due to the effect of neuraxial anesthesia on the
reticular activating system
51
Spinal anesthesia greatly reduces the amount of sensory input that is relayed to the_____resulting in
reticular activating system. The result is that a normal, healthy patient can experience somnolence.
52
The cauda equina is the bundle of nerve fibers that arise off the and distribute to the legs.
terminal portion of the spinal cord
53
Where is Cauda Equina visible?
space between L5 and S1.
54
In what region of the spinal column is the epidural space the largest?
Lumbar (5-6mm wide)
55
Which of the following events would be attributed to the effects of using methylmethacrylate to cement artificial components during a total hip arthroplasty?
Pulmonary hypertension
Systemic hypotension
Cardiovascular collapse
56
The injection of a 5-8 mL of local anesthetic subcutaneously near the inferior border of the medial malleolus would anesthetize which nerve?
Saphenous
57
The paramedian approach to an epidural avoids what structure?
Interspinous ligament
58
The paramedian approach avoids the interspinous ligament. If the needle hits bones during the procedure, it is likely that it struck the
vertebral lamina of the superior vertebra.
59
Which of the following is a contraindication to performing a peripheral nerve block on a patient?
. Bleeding diathesis
60
The contraindications to peripheral nerve blocks are generally the same as for neuraxial anesthesia except that
peripheral nerve blocks do not produce the high-degree sympathectomy associated with neuraxial blocks and therefore would not be contraindicated in stenotic cardiac valve lesions or increased intracranial pressure.
61
Age < 6 months is not a contraindication to
peripheral or neuraxial blockade.
62
Which of the following statements are true regarding cardiac arrest during a spinal anesthetic?
It is usually preceded by bradycardia
| It is associated with a drop in preload
63
Which of the following statements about ultrasound-guided nerve blocks are true?
A medical ultrasound machine functions between the frequencies of 2-13 MHz
64
Tissue that reflects ultrasound waves poorly appears
gray to black on the monitor.
65
A high-frequency ultrasound is best for viewing
superficial structures.
66
In what positions is a patient most commonly placed for a caudal anesthetic
Prone
| Lateral
67
What is the only additive to the local anesthetic for a Bier block that has been proven effective?
Ketorolac 15-30 mg added to the local anesthetic has been shown to provide additional postoperative analgesia without increasing postoperative bleeding.
68
Which of the following conditions can cause a decrease in the specific gravity of the cerebrospinal fluid?
liver disease.
69
The specific gravity of the CSF can increase with
hyperglycemia, uremia, and increased age
70
In the supine position, the most dependent area of the spinal column occurs at about the level of
T4
71
Compared to general anesthesia, a spinal block is associated with a(n)
Decreased blood loss
72
Neuraxial anesthesia is associated with less opioid administration and, as a result, less urinary retention, nausea, and vomiting. It is also associated with a decreased incidence of
thromboembolic phenomenon, better respiratory function, decreased blood loss, and better outcomes in high-risk patients.
73
What nerve roots contribute to the radial nerve?
C5- T1
74
In performing an intercostal nerve block, it is important to remember that
The nerve travels just below the artery on the inferior surface of the rib
75
The intercostal neurovascular bundle travels on the __________ of the rib. From superior to inferior in the bundle are the
inferior surface of the rib .vein, artery, and nerve (VAN)
76
The musculocutaneous nerve is situated between the
pectoralis major and coracobrachialis muscles.
77
A caudal anesthetic is used predominantly in pediatric anesthesia because in patients under the age of 12 (select two)
- The spread of local anesthetic in the caudal epidural space is more reliable
- The sacral hiatus is larger
78
If a hyperbaric spinal anesthetic is injected at the L3 interspace and then the patient is positioned supine, how will the drug spread through the subarachnoid space and why?
The drug will spread in both a caudal and cephalad direction
79
When preparing to perform a popliteal block using the posterior approach, you locate the nerve in the popliteal fossa. The popliteal fossa is bounded by all of the following structures except the
popliteal artery
80
What nerves are blocked as part of an ankle block?
Saphenous
Deep peroneal
Superficial peroneal
Posterior tibial
81
The deep peroneal, saphenous, posterior tibial, sural, and superficial peroneal are anesthetized during an _____block.
ankle
82
The standard test dose for epidural anesthesia contains What amount of lidocaine?
15 mg/mL of lidocaine
83
The standard test dose for epidural anesthesia contains
3 mL of 1.5% lidocaine and 1:200,000 epinephrine or 15 mg/mL of lidocaine and 5 mcg/mL of epinephrine.
84
A test dose contains a total of ____mg lidocaine and ____ mcg epinephrine.
45; 15
85
Which nerve roots are associated with the musculocutaneous nerve?
C5-C7
86
Which condition would you most expect to see in a patient with a midthoracic neuraxial anesthetic?
Normal PaO2
Midthoracic levels of neuraxial anesthesia typically leave the tidal volume, respiratory rate, minute ventilation, PaO2, and PaCO2 levels largely unaffected.
87
The level of activity in the reticular activating system is primarily determined by the
amount of sensory information from the body
88
During a brachial plexus block, the nerve stimulator used in regional anesthesia is adjusted to _______milliamps after the needle has been introduced into the subcutaneous tissues.
2 mA
89
The specific gravity for four different local anesthetic preparations are shown below. Which would would tend to move cephalad the most in a patient in the sitting position?
SG 1.000
90
Which position is associated with the highest rate for success when performing a combined spinal/epidural anesthetic? and why?
Sitting. This is probably due to the higher hydrostatic pressure in the subarachnoid space in the sitting position, which makes the detection of CSF more likely.
91
Which of the following represents the normal cerebrospinal fluid pressure?
10-20 cm H2O
92
What two muscles form the crease in the axilla in which the ultrasound probe is placed during an ultrasound-guided axillary block?
The biceps and pectoralis major form the crease in the axilla in which the ultrasound probe is placed during an ultrasound-guided axillary block.
93
What is the appropriate volume of 1:1000 epinephrine to add to a spinal anesthetic to prolong the duration of the block?
0.1 to 0.2 mL of 1:1000 (1 mg/mL) epinephrine is the dose typically added to the local anesthetic to prolong the duration of the spinal.
94
Garlic on platelet aggregation
Garlic can disrupt platelet aggregation for up to 7 days after discontinuation.
95
Ginkgo and ginseng and coagulation
Ginkgo and ginseng both impair coagulation for about 36 hours after discontinuation.
96
All of the following nerves can be blocked at the level of the wrist except the
Medial cutaneous nerve
97
What is the most proximal technique and the only approach that will provide sufficient analgesia for surgery on the shoulder and upper extremity?
The interscalene technique
98
The coccyx is made up of four small bone segments that become fused into two bones by the age of:
25-30 years of age
99
You are about to perform a sciatic block. You know that the sciatic nerve provides motor innervation to all of the following muscles except the
Quadriceps
100
Which syndrome causes persistent paralysis of the nerves, resulting in lower extremity weakness and bladder and bowel dysfunction?
Cauda equina syndrome
101
The use of hyperbaric local anesthetics such as lidocaine 5% in spinal anesthesia is associated with
Cauda equina syndrome
102
What volume of local anesthetic would you expect to use in an ultrasound-guided popliteal sciatic block?
20 ml
103
Which nerve travels subcutaneously from the lateral side of the knee joint and is the terminal branch of the femoral nerve?
Saphenous
104
All of the nerves of the foot and ankle are branches of the sciatic nerve except for the
Saphenous
105
Which of the following is accurate concerning an epidural blood patch for postdural puncture headache?
The procedure can be repeated in 24 hours if the blood patch fails
106
The umbilical area is directly anterior to which vertebra?
The umbilical area is directly anterior to L3 vertebrae. This is not to be confused, however, with dermatone level (cutaneous sensation), which for the umbilical area is T7-T11.
107
The sympathetic block associated with a spinal anesthetic produces
increased GI blood flow
108
You are performing an intercostal nerve block and suspect that you penetrated the pleural cavity with a 22 gauge needle. You order a chest x-ray, but no air leak is noted on the film. What is the next most prudent step?
Monitor the patient for the development of any symptoms (rationale -->
109
Dissolving the drug in sterile water will result in a solution that is
hypobaric in relationship to the CSF. You are performing a spinal on a patient in the sitting position and wish for the local anesthetic to move in a cephalad direction after injection. To accomplish this, you should dissolve the local anesthetic in
110
What nerve roots contribute to the median nerve?
C6-T1
111
Which of the following is true regarding the saphenous nerve?
It can be blocked by injecting local anesthetic anterior to the medial malleolus
112
The cricoid cartilage is an anatomic landmark that corresponds to the vertebral body of
C6.
113
What two anatomical landmarks need to be identified first in order to perform an ultrasound-guided axillary nerve block?
Terminal branches of the brachial plexus
| Axillary artery
114
Most clinicians limit the use of a Bier block to procedures lasting less than one hour. Why is this?
The pain from the tourniquet becomes too intense
115
An axillary brachial plexus block is best suited for procedures at or below the elbow.
Surgery on the forearm
116
The injection of 3-5 mL of local anesthetic into the coracobrachialis muscle will anesthetize the
musculocutaneous nerve
117
The classic 3 mL test dose for epidural anesthesia contains_____lidocaine and ____epi
45 mg , 15 mcg
118
Long thoracic nerve is seen as the descending branch that takes contributions from
C5, C6 and C7.
119
What is the primary advantage of using an Andrews frame for lumbar spine surgery?
The Andrews frame secures the patient in knee-chest position with the abdomen hanging freely which reduces intra-abdominal pressure and contributes to decreased blood loss. Because the legs are below the level of the heart, venous return is decreased and severe hypotension can result.
120
he most common complication associated with the use of the Andrews frame for performing surgery on the lumbar spine is:
Hypotension from decreased venous return
121
Compared to general anesthesia, a spinal block is associated with
decreased opioid requirements
122
In patients who can tolerate it, what is the recommended volume of crystalloid that should be administered prophylactically as a preventative strategy against spinal-induced hypotension?
15 ml/kg
123
The sympathetic innervation to the gastrointestinal tract arises from the
T5 to L2 spinal segments.
124
What is traditionally added to the local anesthetic to make the solution hyperbaric? (select two)
Dissolving the drug in 5% or 8% dextrose will make the solution hyperbaric. Dissolving the solution in cerebrospinal fluid will result in an isobaric solution. Dissolving the drug in sterile water will result in a solution that is hypobaric in relationship to the CSF.
125
Which of the following represents an appropriate volume of local anesthetic to administer in a caudal anesthetic to achieve an umbilical level of anesthesia in a 30 kilogram 8 year-old patient?
0.5 to 1 mL of solution per kg of bodyweight should be injected in a caudal anesthetic to achieve an umbilical level of anesthesia.
126
When performing a wrist block, you inject 3 mL of local anesthetic at the level of the
styloid process on the volar aspect of the arm between the palmaris longus and flexor carpi radialis tendons.
127
When performing a wrist block, you inject 3 mL of local anesthetic at the level of the styloid process on the volar aspect of the arm between the palmaris longus and flexor carpi radialis tendons. What nerve are you anesthetizing when you do this?
Median
128
What volume of local anesthetic would be appropriate for a caudal anesthetic for an adult undergoing a sacral procedure? abdominal procedure?
A 3 mL test dose is administered first. For sacral procedures, 12-15 mL is sufficient. 20-30 mL is usually required for anesthesia up to a T10 dermatome.
129
How will the femoral nerve appear on the ultrasound monitor?
Lateral to the femoral artery
| Hyperechoic
130
Sympathetic innervation to the gastrointestinal tract arises from the ______ to ______ spinal cord segments.
T5 to L2
131
In most adults (99%), the spinal cord extends from the medulla oblongata to the level of the
L2 vertebra.
132
Tetracaine and bupivacaine are both highly protein-bound local anesthetics. When compared to less protein-bound drugs such as______ and _____highly protein-bound drugs have a longer duration of action
mepivacaine and lidocaine,
133
___and ____are both highly protein-bound local anesthetics
Tetracaine and bupivacaine
134
What psychological effect of a caudal anesthetic should you consider prior to performing the procedure on a toddler?
Inability to walk after the procedure
135
The risk for dural puncture, vascular injury, and neural damage is greatest when performing
Cervical epidural blocks
136
ou are performing a combined spinal/epidural anesthetic. You have already administered the spinal anesthetic and are preparing to inject local anesthetic through the epidural catheter. How will this affect the spinal block?
It will increase the height of the spinal block
137
Which of the following statements regarding combined spinal and epidural analgesia is true?
The epidural space should be identified with the use of air to prevent confusion of saline with CSF
138
You inject local anesthetic subcutaneously at the inferior border of the medial malleolus. Which nerve are you anesthetizing?
Saphenous
139
The average distance from the skin to the lumbar epidural space using a midline approach is:
5cm
140
Which of the following should be avoided in patients undergoing total hip arthroplasty?
Nitrous oxide should be avoided because of the high risk for venous air entrainment during this procedure.
141
A properly performed popliteal block will anesthetize which of the following nerves? (select four)
Common peroneal nerve
Tibial nerve
Deep peroneal nerve
Sural nerve
142
PoP you feel when you're doing a caudal block is the
Sacrococcygeal ligament
