Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pain Exam 2 > Module 4: Part 1 > Flashcards

Module 4: Part 1 Flashcards

1
Q

____________ vertebrae total

A

33

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how many cervical vertebrae

A

7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how many thoracic vertebrae

A

12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how many lumbar vertebrae

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how many fused sacral vertebrae

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how many fused coccygeal vertebrae

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

function of the spine

A

Protect the spinal cord and support body weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Filum terminale

A

penetrates dura & attaches conus medullaris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

where does the spinal cord run in adults

A

foramen magnum to L1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

cauda equina is below

A

L1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

afferent/dorsal nerves are

A

somatosensory

“SAD”
sensory afferent dorsal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

efferent/ventral nerves are

A

motor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what happens to epidural veins in pregnancy

A

they are engorged, caution in epidurals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

dural sheath after exiting the spinal cord

A

present for a small distance after exiting the spinal cord, part of the reason for SLOWER onset of the block with epidural –

diffusion across dura sheath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

layer that adheres to spinal cord

A

pia mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

layer that adheres to dura mater

A

arachnoid mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

tough, fibrous outer layer of the spinal cord

A

dura mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

where is CSF contained

A

between pia & arachnoid maters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

subdural space is between

A

arachnoid and dura maters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

which artery lies in the pia matter in front of the spinal cord

A

*** come back to this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

which artery is derived from the vertebral arteries

A

single anterior artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

⭐️
____________ is the sole source of blood supply to the anterior cord

A

single anterior artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

where do the 2 posterior spinal arteries originate from

A

from the cerebellar arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

vessels located on each side of the spinal cord

A

2 Posterior spinal arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

radicular blood supply comes from (2)

A

Intercostal arteries
Lumbar arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

artery of adamkiewicz

A

(large) from aorta
usually from the left side
anterior, lower 2/3rd spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

injury to artery of adamkiewicz

A

anterior cord syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Anterior spinal artery syndrome

A

neurologic condition resulting from the occlusion of the anterior spinal artery

characterized by:
* motor paralysis
* loss of pain & temp sensation
* occasional autonomic dysfunction

occlusion → decreased blood flow → infarction of the anterior 2/3 of the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

C8 dermatome

A

little finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

T4 dermatome

A

nipple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

T6 dermatome

A

Xiphoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

T10 dermatome

A

umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

S2-4 dermatomes

A

sacral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Each spinal nerve carries

A

somatic (sensory) information from a specific area of skin (dermatome) on the surface of the body.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Α- alpha fibers

A

motor & proprioception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Α- β fibers

A

touch, pressure, small motor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

A-gamma fibers

A

Touch & pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Α- delta fibers

A

Sharp pain, heat, & cold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

B fibers

A

myelinated autonomic fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

B fibers are (pre/post) ganglionic

A

Preganglionic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Small fibers, and easiest to block with LA

A

β- fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Unmyelinated fibers

A

C fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Postganglionic sympathetic fibers

A

C- fibers

44
Q

Small, slow conduction

A

C fibers

45
Q

Dull pain, temperature, and touch

A

C fibers

46
Q

site of action for neuraxial blockade

A

Nerve root

47
Q

The effect of LA on nerve fibers varies according to (3)

A

the size of the nerve fibers, myelinated, and concentration of LA

48
Q

____________ fibers are more easily blocked than larger & myelinated fibers

A

Smaller & moderately myelinated

49
Q

blocking order of fibers

A
50
Q

sympathetic nervous system (SNS) function

A

fight or flight

51
Q

which nervous system controls vascular tone

A

SNS

52
Q

(SNS)
Small Preganglionic B fibers that exit spinal cord from…

A

T1-L2

SNS = thoracolumbar (T1-L2)
PNS = craniosacral

53
Q

What level are the cardiac accelerator fibers

A

T1-T4

54
Q

Blockade of the cardiac accelerator fibers causes

A

a vagal response

55
Q

Level of sympathetic block is ____________ above the sensory level

A

2 - 3 dermatomes

56
Q

Preganglionic neurons exit cranium with

A

cranial and sacral nerves

57
Q

Postganglionic PNS fibers found in

A

their target organs

58
Q

PNS nerve fibers are located ____________ and are ____________

A

outside of the subarachnoid space

rarely affected by a spinal or epidural blockade

59
Q

Physiological responses to Neuraxial Blockade result from (2)

A

decreased sympathetic tone
unopposed parasympathetic tone

60
Q

differential blockade results in

A

sympathetic blockade that may be 2 segments higher ➔ than the sensory block which in turn is ➔ 2 segments higher than the motor blockade

61
Q

autonomic blockade decreases

A

sympathetic tone

62
Q

Neuroaxial blocks typically produces

A

variable decreases in BP, HR and cardiac contractility

63
Q

site of local action is proportional to the degree of

A

sympathectomy

64
Q

vasomotor tone is determined by

A

sympathetic fibers arising from T5-L1, innervating the arterial and venous smooth muscle

65
Q

A high sympathetic blocks the cardiac accelerator fibers that arise at

A

T1-T4

66
Q

SNS blockade affects vasomotor tone at

A

T5-L1

67
Q

what happens to vasomotor tone with SNS blockade

A

Venous dilation/pooling below block level

Decrease circulating volume

68
Q

cardiac accelerator fiber blockade effects (2)

A

bradycardia (treatment- atropine)

unopposed vagal tone (sudden cardiac arrest)

69
Q

profound hypotension is worse in what position

A

worse with a head-up position

70
Q

lack of left uterine displacement can cause

A

profound hypotension

71
Q

what position can help with profound hyptension

A

trendelenburg (autotransfusion)

72
Q

treatment of profound hypotension

A

vasopressors

73
Q

bezold-jarisch reflex

A

blunt the serotonin release re: decreased venous return ➔ causes HYPOTENSION

Bezold-Jarisch reflex (BJR): activated by serotonin; when 5-HT3 receptors on the endings of vagal afferent nerves in the heart are stimulated.
Zofran (5-HT antagonist) can mitigate the hypoTN

74
Q

direct alpha-adrenergic effects

A

prompt Vasconstriction with severe bradycardia, especially is patient is dehydrated / low volume status — for OB, ACOG recommends PHENYLEPHRINE

75
Q

pulmonary responses to neuraxial blockade

A

usually minimal

76
Q

diaphragm is innervated by

A

phrenic nerve (C3-C5)

77
Q

a high level block impairs which accessory muscles

A

intercostal & abdominal

78
Q

neuraxial block is not appropriate for patients with (2)

A

severe lung disease & surgery above the umbilicus

79
Q

GI sympathectomy allows (2)

A

Vagal dominance

Small contracted gut & active peristalsis

80
Q

renal blood flow with normal blood pressure

A

renal blood flow is autoregulared

81
Q

lumbar/sacral neuraxial blockade causes what urinary effects

A

SNS bladder control blocked

82
Q

metabolic & endocrine neuraxial blockade effects

A
83
Q

Neuraxial blockade benefits (2)

A

partially suppress response major abd/thoracic surgery

fully suppress response in lower extremity surgery

84
Q

neuraxial blockade can be the primary anesthetic for

A

Lower Abdominal
Inguinal
Rectal
Urogenital (OB cerclage)
Lower Extremity

85
Q

absolute contraindications to neuraxial anesthesia (reference Table 45-1)

A
86
Q

relative contraindications to neuraxial anesthesia

A
87
Q

controversial contraindications to neuraxial anesthesia

A
88
Q

informed consents of (4)

A

Make sure you document that you have discussed the advantages & disadvantages of the anesthetic

Discuss risk

Give pt time to ask questions & to provide answers

GETA is always be “plan B”
(pt must understand that spinal/epidurals don’t always work)

89
Q

what to document with informed consent

A

Document the informed consent, including that all questions were fully answered, and the patient verbalized they understand the procedure fully and agree with a treatment plan.

90
Q

pre-procedure for neuraxial anesthesia

A
91
Q

benzodiazepine pre-procedure

A

Midazolam

Protect the brain against the excitatory effects of LA

Increases seizure threshold

OB typically none

92
Q

opioids pre-procedure

A

Used to lessen discomfort (Hip or femur fracture)

Will provide analgesia to the patient lying in an uncomfortable position for a long period of time

This will allow the patient in pain to be positioned appropriately for the spinal

93
Q

anticoagulants & antiplatelet drug guidelines

A
94
Q

anticoagulant guidelines before and after neuraxial blockades

A
95
Q

lovenox causes many cases of ____________ with neuraxial blockade

A

epidural hematoma from EARLY or INTRAoperative use

***no neuraxial 12 hrs

96
Q

fibrinolytic treatment and neuraxial blockade

A

no neuraxial should be done per ASRA. — some sources say 48 hrs ???

97
Q

oral anticoagulant drugs guidelines

A
98
Q

Warfarin reduces the production of factors

A

VII, IX, X, and prothrombin

99
Q

heparin and LMWH inhibit

A

factor Xa and thrombin

100
Q

Fondaparinux, rivaroxaban, and apixaban are

A

direct factor Xa inhibitors.

all have “xa” in the name

101
Q

Dabigatran is a

A

direct thrombin inhibitor

102
Q

coagulation cascade

A
103
Q

spinal anesthesia definition

A

It is the reversible chemical blockade of neuronal transmission produced by the injection of a LA into the CSF contained in the subarachnoid space

104
Q

spinal anesthesia goal

A

Render patient insensitive to surgical stimuli while producing minimal physiologic alteration

105
Q

advantages and disadvantages of spinal anesthesia

A
106
Q

⭐️
Autonomic nerve blocks will block sympathetic outflow in which region of the spine?

A

T1-L2

SNS = thoracolumbar outflow

Pain Exam 2 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions