Module 1

Question 1

Where are stimulator electrodes placed?

Answer 1

directly over ulnar groove, proximal to wrist crease

Question 2

Electrode 1 placement

Answer 2

Adductor Polices, distal to the thenar eminence

Question 3

Electrode 2 placement

Answer 3

On first dorsal interosseous muscle on back of hand

Question 4

Ground (G) placement

Answer 4

Index Finger

Question 5

Neuromuscular Blockade means…(simplified)

Answer 5

airway muscles are not ready

Question 6

Potential Adverse Effects of Residual Neuromuscular Blockade in Postoperative Period

Answer 6

• Need tracheal reintubation
• Impaired oxygenation and ventilation
• Impaired pulmonary function
• Increased risk of aspiration and pneumonia
• Pharyngeal Dysfunction
• Delayed discharge from PACU

Question 7

Intubation

Answer 7

Endotracheal tube placed down patients throat to assist with breathing. Once intubated, tube is connected to ventilator

Question 8

Triad of Anesthesia

Answer 8

• Hypnosis
• Analgesia
• Muscle Relaxation

Question 9

Hypnosis

Answer 9

Put the brain to sleep

Question 10

Analgesia

Answer 10

Control pain

Question 11

Muscle Relaxation

Answer 11

Paralytics

Question 12

NMBA

Answer 12

Neuromuscular Blocking Agents

Question 13

Neuromuscular Blocking Agents

Answer 13

Administered adjectively to anesthesia to produce paralysis

Question 14

NMBAs 2-steps

Answer 14

Step 1: Paralyze vocal cords to allow intubation of the trachea
Step 2: Optimize surgical field by inhibiting spontaneous breathing and causing relaxation of the skeletal muscles

Question 15

2 Types of NMBAs

Answer 15

Depolarizing and Non-Depolarizing Agents

Question 16

Depolarizing NMBAs

Answer 16

cause rapid depolarization which makes muscle fibers resistant to stimulation by Acetylcholine (Ach)

Question 17

Duration of Depolarizing agents

Answer 17

rapid (seconds), 7-12min durations

Question 18

Non-Depolarizing NMBAs

Answer 18

cause total paralysis by blocking the binding of acetylcholine and the inotropic activity of Ach receptors

Question 19

Duration of Non-Depolarizing NMBAs

Answer 19

takes effect in minutes, lasts 30min-2hr

Question 20

Depolarizing NMBA examples

Answer 20

Succinylcholine (Anectine)

Question 21

Non-Depolarizing NMBA examples

Answer 21

Cisatracurium
Pencuronium
Rapacuronium
Miuccuronium
Attracurium
Vecuronium

Question 22

What reverses non-depolarizing agents

Answer 22

anticholinestease inhibitors

Question 23

Most popular depolarizing agent

Answer 23

Succinylcholine (anectine)
- does NOT exhibit TOF fade

Question 24

Which agents will cause TOF fade

Answer 24

Non-depolarizing agents ending in ‘-ium’

Question 25

Reversal Agents def and examples

Answer 25

any drug used to reverse anesthetics, narcotics, potentially toxic agents
- Suggamedex
- Neostigmine

Question 26

What is given in combo with Neostigmine

Answer 26

Glycopyrollate

Question 27

Glycopyrrolate

Answer 27

given to counteract Neostigmine potential cardiac, pulmonary, or gastrointestinal side effects
- an anticholinergic drug

Question 28

NMJ

Answer 28

Neuromuscular Junction

Question 29

Neuromuscular Junction

Answer 29

• The synaptic connection between the terminal end of the motor nerve and a muscle
• The site for transmitting action potential from nerve to muscle
• It is the site for many diseases and site of action for many pharmacological drugs

Question 30

3 main parts NMJ

Answer 30

• Nerve Terminal – presynaptic part
• Motor End Plate – Post synaptic part
• Synaptic Cleft – area between nerve terminal and motor end plate

Question 31

3 Sites of Stimulation

Answer 31

• Orbicularis Oculi
• Flexor Hallucis Brevis
• Posterior Tibial Nerve

Question 32

Orbicularis Oculi

Answer 32

Facial muscles surrounding each orbit, primary function to close the eylid

Question 33

Flexor Hallucis Brevis

Answer 33

Small intrinsic muscle in foot, primary function is to flex big toe and innervated by posterior tibial nerve

Question 34

Posterior Tibial Nerve

Answer 34

Medial aspect of the ankle between medial malleolus and achilles tendon

Question 35

AchE

Answer 35

Acetylcholinesterase (aka acetylhydrolase)

Question 36

Acetylcholinesterase

Answer 36

Is the primary cholinesterase in the body. It is an enzyme that catalyzes the breakdown of acetylcholine into acetate and choline

Question 37

Ach

Answer 37

Acetylcholine

Question 38

Acetylcholine

Answer 38

The neurotransmitter used at the NMJ . It is the chemical that motor neurons of the nervous system release to activate muscles

Question 39

Cholinergic

Answer 39

Inhibit, enhance, or mimic the action of the neurotransmitter Ach, the primary transmitter of nerve impulses within the parasympathetic nervous system. (ie, that part of the autonomic nervous system that contracts smooth muscles and dilates blood vessels, etc.)

Question 40

nchR

Answer 40

Nicotinic Receptor

Question 41

Nicotinic Receptor

Answer 41

A type of Ach receptor that responds to nicotine and Ach
- receives Ach and NMBAs

Question 42

Neuromuscular Activation

Answer 42

• An influx of Ca++ in nerve terminals leads to the release of ACh
• Ach binds nicotinic receptors at the motor end plane and causes depolarization / NA+ entry
• Action potential caused by Na+ depolarizes muscle fibers

Question 43

Action Potential

Answer 43

The change in electrical potential is associated with the passage of an impulse along the membrane of a muscle cell or nerve cell

Question 44

TOF

Answer 44

Train of Four

Question 45

TOFR

Answer 45

Train of Four Ratio

Question 46

TOFC

Answer 46

Train of Four Count

Question 47

PTC

Answer 47

Post Tetanic Count

Question 48

MMG

Answer 48

Mechanomyography

Question 49

AMG

Answer 49

Acceleromyography

Question 50

EMG

Answer 50

Electromyography

Question 51

KMG

Answer 51

Kinemyography