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Ane Class Practice > Pain Exam 2-S4 > Flashcards

Pain Exam 2-S4 Flashcards

1
Q

How many vertebrae in the human spine?

A

33

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2
Q

How many Cervical vertebrae?

A

7 cervical

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3
Q

How many Thoracic vertebrae?

A

12 thoracic

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4
Q

How many Lumbar vertebrae?

A

5 lumbar

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5
Q

How many Sacral vertebrae?

A

5 fused sacral

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6
Q

How many coccygeal vertebrae?

A

4 fused coccygeal

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7
Q

Which vertebrae are fused?

A

Sacral and Coccygeal

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8
Q

Where is the end of the spinal cord?
What is it called?

A

L1- end of spinal cord
Conus medullaris

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9
Q

Afferent nerves are located _____ and function as what?

A

Dorsal
Somatosensory

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10
Q

Efferent nerves are located ____ and function as what?

A

Ventral
Motor

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11
Q

What are the layers of the spinal cord for an epidural?

A

Skin
Subcutaneous
Supraspinous
Interspinous
Ligamentum Flavum
Epidural space

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12
Q

Meningeal layer order?
1
2
3

A

Outer- Dura mater
Middle- Arachnoid mater
Inner- Pia mater

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13
Q

CSF is contained between what 2?

A

Arachnoid and Pia mater

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14
Q

Subdural space is between what 2?

A

Dura and Arachnoid mater

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15
Q

The single Anterior Artery, which is the sole source of blood supply to the anterior cord lies where?

A

Pia mater

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16
Q

The 2 posterior spinal arteries originate from what?

A

Cerebellar arteries
Located at Sides of spinal cord

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17
Q

The Artery of Adamkiewicz which supplies the lower 2/3rd of the spinal cord originates from ____ and is usually on ____ side?

A

Aorta
Left side

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18
Q

C8 dermatome?

A

Little finger

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19
Q

T4 dermatome?

A

Nipple

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20
Q

T6 dermatome?

A

Xiphoid process

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21
Q

T10 dermatome?

A

Umbilicus

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22
Q

S2-S4 dermatome?

A

Sacral

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23
Q

L2-L3 dermatome?

A

Knee

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24
Q

A-alpha fibers are for what?

A

Motor and Proprioception

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25
Q

A-beta fibers are for what?

A

Touch, pressure, small motor

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26
Q

A-gamma fibers are for what?

A

Touch and pressure

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27
Q

A-delta fibers are for what?

A

Sharp pain, heat and cold

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28
Q

These fibers are myelinated
- autonomic fibers
- Preganglionic SNS
- Small
- Easiest to block with locals

A

B-fibers

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29
Q

These fibers are unmyelinated
- Postganglionic sympathetic fibers
- small, slow
- Dull pain, temperature, touch

A

C-fibers

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30
Q

What is the site of action for neuraxial blockade?

A

Bathing the nerve root

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31
Q

What is the order of nerve fiber blockade?

A

B-fiber (autonomic)- 1st
C-fiber (slow pain)
A-delta (pin prick/cold sensation)
A-beta (touch)
A-alpha (motor)- Most resistant

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32
Q

Which nerve fibers are blocked first?

A

B-fibers
autonomic

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33
Q

Which nerve fibers are blocked last?

A

A-alpha
large myelinated, motor

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34
Q

This system
- Thoracolumbar
- Controls vascular tone
- Exits spinal cord T1-L2
- Blockade of cardiac accelerator fibers cause vagal response
- level of block is 2-3 dermatomes above sensory level?

A

Sympathetic nervous system
(SNS)

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35
Q

This system
- Craniosacral
- Exits cranium
- Postganglionic fibers found in target organs
- Nerve fibers located outside of the subarachnoid space.
- Rarely affected by spinal or epidural block

A

Parasympathetic nervous system
(PNS)

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36
Q

The physiologic response to neuraxial blockade result from what 2 things?

A

Decreased sympathetic tone
Unopposed parasympathetic tone

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37
Q

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

A

Differential blockade

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38
Q

This blockade involves thoracolumbar outflow at T1-L2, blockade decreases sympathetic tone and involves small, myelinated B fibers?

A

Autonomic blockade

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39
Q

Vasomotor tone is determined by sympathetic fibers arising from___ which innervate what?

A

T5-L1
Arterial and venous smooth muscle

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40
Q

A high sympathetic blocks the ______ that arise at T1-T4?

A

Cardiac accelerator fibers

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41
Q

Cardiac accelerator fibers arise from where?

A

T1-T4

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42
Q

SNS blockade at T5-L1 affects what?

A

Vasomotor tone

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43
Q

SNS blockade at T1-T4 affects what?

A

Cardiac accelerator fibers

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44
Q

The diaphragm is innervated by ___ nerve and located at ___?

A

Phrenic nerve
C3-C5

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45
Q

What are the 2 absolute contraindications to neuraxial anesthesia?

A

Patient refusal
Lack of consent

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46
Q

How long to wait for neuraxial block with prophylatic dose of low molecular weight heparin?

47
Q

How long to wait for neuraxial block with treatment/therapeutic dose of low molecular weight heparin?

48
Q

How long to wait for neuraxial block with low dose prophylaxis of heparin?

49
Q

How long to wait for neuraxial block if patient is on oral anticoagulant drugs?
ex: Apixaban, Rivaroxaban

A

72hrs or
3 days

50
Q

How long to wait for neuraxial block if patient is taking warfarin?

51
Q

Spinal/epidural major back landmark?

A

Superior aspect of the iliac crest (Tuffier’s line)
Spinous process

52
Q

Tuffier’s line is usually at what location?

A

L4-L5
Superior aspect iliac crest

53
Q

Which patient movement helps with rounding out back with neuraxial anesthesia?

54
Q

Normal CSF specific gravity?

A

1.003-1.008

55
Q

Hyperbaric locals have what specific gravity?

56
Q

Hypobaric locals have what specific gravity?

57
Q

What is added to local anesthetics to constrict blood vessels at the site and slow absorption of the local?

A

Epinephrine

58
Q

Intrathecal Opioid dose?
Fentanyl

A

15-25mcg
Respiratory depression at high doses, itching
2-4hrs

59
Q

Intrathecal Opioid dose?
Meperidine

60
Q

Intrathecal Opioid dose?
Morphine

A

0.1-0.5mg
delayed respiratory depression
Longest lasting 24hrs

61
Q

Hyperbaric solution allow the local to move which direction?

A

Moves downwards

62
Q

Hypobaric solution allow the local to move which direction?

A

Moves upwards

63
Q

The block level is assessed using what?

A

Alcohol sponge first then tongue blade

64
Q

Which fibers are blocked first due to their small size?

A

Autonomic
B fibers

65
Q

What is the earliest sign that the spinal is working?

A

Decrease in Blood pressure

66
Q

Unmyelinated C and myelinated A-delta fibers are associated with what blockade?

A

Autonomic blockade
Temperature and light touch

67
Q

Myelinated A-beta and A-gamma fibers are associated with what blockade?

A

Differential block
Loss of motor and touch

68
Q

Motor block is ___ dermatomes below sensory block?

69
Q

A profound motor block is associated with which nerve fibers?

70
Q

When assessing motor block,
S1-S2 level is associated with?

A

Dorsiflex of feet

71
Q

When assessing motor block,
L4-L5 level is associated with?

A

Flexion of toes

72
Q

When assessing motor block,
L2-L3 level is associated with?

A

Raise of knees

73
Q

When assessing motor block,
T6-T12 level is associated with?

A

Lifting shoulders

74
Q

Symptoms occur within 1-3 days, severe back pain, fever, paralysis.
- elevated WBC
- Urgent surgical evacuation
- Antibiotics needed

A

Epidural Abscess

75
Q

This is caused by a compromise in blood supply by aorta clamping or artery of Adamkiewicz.
- Flaccid paralysis

A

Anterior spinal artery syndrome

76
Q

Numbess, tingling and motor weakness of the lower extremities.
Caused by hyperbaric concentration of LA confined to small area?

A

Cauda Equina Syndrome

77
Q

Autonomic blockade of bladder muscles
- Blocked S2-S4 fibers?

A

Urinary Retention

78
Q

Cephalgia that is occipital and radiates to frontal or orbital regions with associated cervical muscle spasms.
Hallmark- postural headache

A

PDPH
spinal headache

79
Q

Treatment of PDPH includes?

A

Resolve in 5-7 days, bed rest, hydration, analgesics, IV caffeine
If not better may need blood patch 20mL

80
Q

What level must platelets be in order for epidural/spinal?

81
Q

The ligamentum flavum is normally how far from the skin?

82
Q

What layers will you penetrate when inserting an epidural?

A

Skin
Subq
Supraspinous
Interspinous
Ligamentum flavum
Epidural space

83
Q

Touhy needle is used with which neuraxial procedure?

84
Q

How far is the tip of the needle to the proximal edge of the hub?

85
Q

How much catheter is left in the epidural space?

86
Q

Epidural catheter markings/how far?
1st marking?
2nd double marking?
Thick marking?
3rd triple mark?
4th quad mark?

A

1st- 5cm
2nd- 10cm
Thick- 12cm tip of the needle in epidural space
3rd- 15cm
4th- 20cm

87
Q

What is the normal test dose for epidural?

A

3ml of 2% Lidocaine with epi

88
Q

Epidural Test dose positive symptoms
- Increase in HR of 15-20 bpm
- numb tongue, dizziness, ringing in ears would indicate what?

A

Intravascular injection

89
Q

Epidural Test dose positive symptoms
- immediate onset of sensory and motor block in the buttocks and lower extremities (T10 block)?

A

Subarachnoid injection

90
Q

The distribution of the LA in the epidural space is dependent on the ____?

A

Volume injected

91
Q

The primary objective of the epidural is to block the ____ fibers located in the dorsal roots?

A

Afferent
(Sensory)

92
Q

If the block does not reach the desired level, you can give a top off dose which is how much?

A

One half of the initial volume

93
Q

What is the most important factor in adjusting epidural dosage?

A

If patient has been pregnant before.
They need 1/3rd the dose

94
Q

High spinal symptoms/treatment?

A

Sudden and extensive motor block, inability to talk, apnea.

Treatment is controlled ventilation, ETT, cardiovascular support

95
Q

Is a test dose given for a combined spinal/epidural?

96
Q

T/F
0.5 mA is nearly 100% successful when using a stimuplex needle?

97
Q

T/F the sound waves through the ultrasound travel at 3.7-7mega hertz frequency?

98
Q

Which frequency (high or low) is good for higher resolution and superficial structures such as interscalene and supraclavicular blocks?

A

High frequency

99
Q

Which frequency (high or low) is good for increased depth of sound penetration and used for deeper structures such as transgluteal sciatic?

A

Low frequency

100
Q

Which transducer is better for increased depth and increased field of view?
Linear or curved?

101
Q

Tissue echogenicity
Veins?

A

Anechoic (compressible)

102
Q

Tissue echogenicity
Arteries?

A

Anechoic (pulsatile)

103
Q

Tissue echogenicity
Fat?

A

Hypoechoic

104
Q

Tissue echogenicity
Bones?

A

Hyperechoic

105
Q

Tissue echogenicity
Nerves?

A

Hyperechoic

106
Q

With color doppler,
If the source is moving towards the receiver the frequency is higher and will display?

107
Q

With color doppler, if the source is moving away from the receive the frequency is lower and will display?

108
Q

Symptoms of a high spinal include?

A

Difficulty breathing, SOB, requiring endotracheal intubation

109
Q

Symptoms of a total spinal include?

A

Loss of consciousness

110
Q

What is the typical test dose of local anesthetic?

A

3mL of 1.5% Lidocaine with epi 1:200,000
45mg lidocaine
15mcg epi

111
Q

LAST Lipid dose for >70kg?

A

Bolus 100mL over 2 mins then
200mL over 20 mins

112
Q

LAST Lipid dose for <70kg?

A

Bolus 1.5mL/Kg over 2 mins then
0.25mL/kg/min

113
Q

Max LAST lipid dose ?

114
Q

The Epidural space is between what two things?

A

Dura mater and Ligamentum Flavum

Ane Class Practice (27 decks)

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