Principles- Spinal/Epidural Flashcards
Which type of surgery commonly involves the use of epidural anesthesia as an adjunct to general anesthesia (GETA)?
A) Ophthalmic surgery
B) Thoracic surgery
C) Cosmetic surgery
D) Dental surgery
Correct Answer: B) Thoracic surgery
Rationale: Epidural anesthesia is often used as an adjunct to general anesthesia in thoracic surgery to help manage pain post-operatively.
For which of the following procedures is neuraxial anesthesia indicated?
A) Cardiac surgery
B) Vascular surgery on the legs
C) Cranial surgery
D) ENT surgery
Correct Answer: B) Vascular surgery on the legs
Rationale: The slide indicates that vascular surgery on the legs is one of the clinical indications for the use of neuraxial anesthesia.
Which surgery listed as an indication for neuraxial anesthesia involves the lower extremities?
A) Orthopaedic surgery
B) Thoracic surgery
C) Ophthalmic surgery
D) Plastic surgery
Correct Answer: A) Orthopaedic surgery
Rationale: Orthopaedic surgery, which often involves the lower extremities, is listed as an indication for the use of neuraxial anesthesia.
Spinal anesthesia is used in surgical procedures involving which areas of the body?
A) Upper abdomen
B) Lower abdomen and perineum
C) Skull and brain
D) Chest and arms
Correct Answer: B) Lower abdomen and perineum
Rationale: The slide specifies that neuraxial anesthesia is indicated for surgical procedures involving the lower abdomen, perineum, and lower extremities.
Which of the following is NOT an indication for the use of neuraxial anesthesia according to the slide?
A) Surgical procedures involving the lower abdomen
B) Vascular surgery on the legs
C) Orthopaedic surgery
D) Cardiac surgery
Correct Answer: D) Cardiac surgery
Rationale: Cardiac surgery is not mentioned as an indication for the use of neuraxial anesthesia on the slide.
Which of the following is a benefit of neuraxial anesthesia in reducing postoperative complications?
A) Increased narcotic usage
B) Reduced postoperative ileus
C) Increased bleeding
D) Increased respiratory complications
Correct Answer: B) Reduced postoperative ileus
Rationale: Neuraxial anesthesia helps in reducing postoperative ileus, which is a common complication after surgery.
Neuraxial anesthesia is beneficial in reducing the need for which type of medication postoperatively?
A) Antibiotics
B) Antihistamines
C) Narcotics
D) Antipyretics
Correct Answer: C) Narcotics
Rationale: One of the significant benefits of neuraxial anesthesia is the reduction in the need for narcotics, which are often used for pain management after surgery.
Which type of postoperative complication related to blood clots is reduced by the use of neuraxial anesthesia?
A) Deep vein thrombosis (DVT)
B) Embolic stroke
C) Thromboembolic events
D) Myocardial infarction
Correct Answer: C) Thromboembolic events
Rationale: Neuraxial anesthesia helps in reducing thromboembolic events, which are complications related to blood clots.
What is the term for nausea and vomiting that occurs after surgery, and what are some risk factors for it?
A) Postoperative nephrotic vomiting; obesity, diabetes, and hypertension
B) Postoperative nausea and vomiting (PONV); smoking, age above 40, and being female
C) Postoperative necrotic vomiting; high BMI, sedentary lifestyle, and male gender
D) Postoperative neuralgia and vomiting; genetic predisposition, youth, and male gender
Correct Answer: B) Postoperative nausea and vomiting (PONV); smoking, age above 40, and being female
Rationale: PONV stands for postoperative nausea and vomiting, with risk factors including smoking, being over 40 years old, and being female.
Which benefit of neuraxial anesthesia relates to the reduction of respiratory issues after surgery?
A) Reduced pneumonia incidence
B) Reduced respiratory complications
C) Improved asthma control
D) Decreased COPD exacerbations
Correct Answer: B) Reduced respiratory complications
Rationale: Neuraxial anesthesia is beneficial in reducing respiratory complications that can occur postoperatively.
What is one of the benefits of neuraxial anesthesia related to mental state post-surgery?
A) Sedation
B) Great mental alertness
C) Confusion
D) Hallucinations
Correct Answer: B) Great mental alertness
Rationale: Neuraxial anesthesia helps in maintaining great mental alertness post-surgery, unlike general anesthesia which can cause grogginess and confusion.
How does neuraxial anesthesia affect urinary retention post-surgery?
A) It increases urinary retention
B) It decreases urinary retention
C) It has no effect on urinary retention
D) It causes urinary incontinence
Correct Answer: B) It decreases urinary retention
Rationale: (Note that with opioid adjuncts, you will have increased retention). One of the benefits of neuraxial anesthesia is less urinary retention, which helps patients recover more quickly.
Which benefit of neuraxial anesthesia contributes to quicker postoperative recovery activities?
A) Increased need for sedation
B) Quicker to eat, void, and ambulate
C) Delayed discharge times
D) Increased postoperative pain
Correct Answer: B) Quicker to eat, void, and ambulate
Rationale: Neuraxial anesthesia allows for quicker postoperative recovery activities, enabling patients to eat, void, and ambulate sooner.
What is one way neuraxial anesthesia can reduce the length of hospital stay after surgery?
A) Increased risk of complications
B) Avoid unexpected overnight admission from complications of general anesthesia
C) Requirement for extended monitoring
D) Increased incidence of postoperative infections
Correct Answer: B) Avoid unexpected overnight admission from complications of general anesthesia
Rationale: By reducing complications associated with general anesthesia, neuraxial anesthesia can help avoid unexpected overnight admissions, thus shortening hospital stay.
How does neuraxial anesthesia affect discharge times from the Post-Anesthesia Care Unit (PACU)?
A) It delays discharge times
B) It has no effect on discharge times
C) It results in quicker PACU discharge times
D) It increases the need for PACU monitoring
Correct Answer: C) It results in quicker PACU discharge times
Rationale: Neuraxial anesthesia leads to quicker PACU discharge times, allowing patients to be moved out of the recovery unit sooner.
What type of pain management does neuraxial anesthesia provide before surgical incision?
A) Postoperative analgesia
B) Reactive analgesia
C) Preemptive analgesia
D) Delayed analgesia
Correct Answer: C) Preemptive analgesia
Rationale: Neuraxial anesthesia offers preemptive analgesia, which helps manage pain before the surgical incision is made.
How does neuraxial anesthesia affect the body’s stress response to surgery?
A) It exacerbates the stress response
B) It has no effect on the stress response
C) It blunts the stress response
D) It eliminates the stress response
Correct Answer: C) It blunts the stress response
Rationale: One of the benefits of neuraxial anesthesia is that it blunts the body’s stress response to surgery, aiding in a smoother recovery process.
Which of the following spinal deformities is a relative contraindication for neuraxial anesthesia due to potential technical difficulties and complications?
A) Spinal stenosis
B) Scoliosis
C) Kyphoscoliosis
D) All of the above
Correct Answer: D) All of the above
Rationale: Spinal stenosis, scoliosis, and kyphoscoliosis are all deformities of the spinal column that can complicate the administration of neuraxial anesthesia, making them relative contraindications.
Why is a preexisting disease of the spinal cord, such as Multiple Sclerosis or post-polio syndrome, considered a relative contraindication for neuraxial anesthesia?
A) It has no impact on anesthesia administration
B) It can exacerbate the underlying progressive, degenerative disease
C) It always leads to complete anesthesia failure
D) It poses no risk but is avoided for convenience
Correct Answer: B) It can exacerbate the underlying progressive, degenerative disease
Rationale: Neuraxial anesthesia can potentially exacerbate preexisting progressive, degenerative diseases of the spinal cord, such as Multiple Sclerosis or post-polio syndrome, hence it is considered a relative contraindication.
Which condition listed is a common chronic issue that can complicate the administration of neuraxial anesthesia?
A) Chronic hypertension
B) Chronic headache/backache
C) Chronic renal failure
D) Chronic obstructive pulmonary disease (COPD)
Correct Answer: B) Chronic headache/backache
Rationale: Chronic headache and backache can complicate the administration of neuraxial anesthesia, as they may indicate an increased risk of puncture headache or exacerbate existing pain
What is a recommended course of action if neuraxial anesthesia cannot be successfully administered after multiple attempts?
A) Continue attempting until successful
B) Switch to general anesthesia after three unsuccessful attempts
C) Consult another anesthesiologist for more attempts
D) Use only local anesthesia
Correct Answer: B) Switch to general anesthesia after three unsuccessful attempts
Rationale: If neuraxial anesthesia cannot be performed successfully after three attempts, it is recommended to switch to general anesthesia to avoid complications and patient discomfort.
How should a clinician approach neuraxial anesthesia in patients with spinal deformities to improve the chances of success?
A) Use a standard approach without modifications
B) Employ different positioning and approach techniques
C) Avoid neuraxial anesthesia altogether
D) Increase the dosage of anesthetic
Correct Answer: B) Employ different positioning and approach techniques
Rationale: In patients with spinal deformities, using different positioning and approach techniques can improve the chances of successfully administering neuraxial anesthesia.
What is a primary absolute contraindication for neuraxial anesthesia due to the risk of epidural hematoma?
A) Prothrombin time (PT) of 13 seconds
B) Platelet count of 120,000
C) International normalized ratio (INR) > 1.5
D) Activated Partial Thromboplastin Time (aPTT) of 30 seconds
Correct Answer: C) International normalized ratio (INR) > 1.5
Rationale: An INR greater than 1.5 indicates a higher risk of bleeding, which is a contraindication for neuraxial anesthesia due to the risk of epidural hematoma.
What type of headache is a potential complication of neuraxial anesthesia, and how should a patient’s history be considered to mitigate this risk?
A) Tension headache; check for history of migraines
B) Puncture headache; check for previous headaches or back pain
C) Cluster headache; check for family history of headaches
D) Sinus headache; check for sinus infections
Correct Answer: B) Puncture headache; check for previous headaches or back pain
Rationale: Puncture headache is a potential complication of neuraxial anesthesia. It is important to check for a history of previous headaches or back pain to assess the risk and manage accordingly.
Which laboratory value, would be an absolute contraindication for performing neuraxial anesthesia?
A) Prothrombin time (PT) of 14 seconds
B) Platelet count of 150,000
C) Bleeding time of 5 minutes
D) Activated Partial Thromboplastin Time (aPTT) of 66 seconds
Correct Answer: D) Activated Partial Thromboplastin Time (aPTT) of 66 seconds
Rationale: An elevated aPTT indicates a coagulation disorder, making neuraxial anesthesia risky due to potential bleeding complications.
greater than 2X normal which is
aPTT: 25-32 seconds
Bleeding time = 3-7 minutes
Prothrombin time (PT) = 12 to 14 seconds
Why is patient refusal considered an absolute contraindication for neuraxial anesthesia?
A) It can lead to legal complications and lack of patient cooperation
B) It has no impact on the procedure
C) It is only a relative contraindication
D) It increases the efficacy of the procedure
Correct Answer: A) It can lead to legal complications and lack of patient cooperation
Rationale: Performing neuraxial anesthesia against a patient’s wishes can lead to legal issues and reduce patient cooperation during and after the procedure.
What is the significance of platelet count below 100,000 in the context of neuraxial anesthesia?
A) It indicates a strong immunity
B) It suggests a higher risk of bleeding complications
C) It is within normal range and not concerning
D) It signifies no issues related to anesthesia
Correct Answer: B) It suggests a higher risk of bleeding complications
Rationale: A platelet count below 100,000 increases the risk of bleeding, which is a significant concern when performing neuraxial anesthesia. Consider trends
How does evidence of a dermal site infection impact the decision to proceed with neuraxial anesthesia?
A) It has no impact on the procedure
B) It requires additional antibiotics before proceeding
C) It is an absolute contraindication due to the risk of spreading the infection to the spinal area
D) It indicates the need for a higher dose of anesthetic
Correct Answer: C) It is an absolute contraindication due to the risk of spreading the infection to the spinal area
Rationale: Dermal site infection poses a risk of spreading infection to the spinal area, making it an absolute contraindication for neuraxial anesthesia.
What is the role of platelet activation in the hemostatic process, and how does it relate to bleeding time?
A) Platelet activation is irrelevant to hemostasis
B) Longer bleeding time indicates a problem with platelet activation and adhesion
C) Shorter bleeding time signifies issues with platelet activation
D) Platelet activation decreases bleeding time without affecting hemostasis
Correct Answer: B) Longer bleeding time indicates a problem with platelet activation and adhesion
Rationale: Platelet activation is crucial for hemostasis. Longer bleeding time suggests problems with platelet adhesion and activation, which are essential for forming a stable clot.
vWB: call platelets to join together.. sticky
Which valvular condition is considered an absolute contraindication for neuraxial anesthesia when the valve area is ≤ 1.0 cm²?
A) Mild mitral stenosis
B) Moderate aortic stenosis
C) Severe aortic stenosis
D) Mild tricuspid regurgitation
Correct Answer: C) Severe aortic stenosis
Rationale: Severe aortic stenosis with a valve area of 0.7 - 1.0 cm², (below 0.7 is critical).. is an absolute contraindication for neuraxial anesthesia due to the risk of hemodynamic instability and myocardial ischemia.
Idiopathic hypertrophic subaortic stenosis (HSS) poses a particular risk during neuraxial anesthesia. What is the primary concern with this condition?
A) Increased risk of bleeding
B) Decreased systemic vascular resistance (SVR) leading to hypotension and worsening ischemia
C) Increased intracranial pressure
D) Enhanced coagulation leading to thrombosis
Correct Answer: B) Decreased systemic vascular resistance (SVR) leading to hypotension and worsening ischemia
Rationale: In patients with HSS, a decrease in SVR can lead to hypotension and worsen ischemia, creating a dangerous cycle of decreased cardiac output and increased myocardial ischemia.
What does an increased intracranial pressure (ICP) imply for the administration of neuraxial anesthesia?
A) It is safe to proceed with neuraxial anesthesia
B) It requires only careful monitoring during the procedure
C) It is an absolute contraindication due to the risk of brain herniation
D) It necessitates the use of higher doses of anesthetics
Correct Answer: C) It is an absolute contraindication due to the risk of brain herniation
Rationale: Increased ICP is an absolute contraindication for neuraxial anesthesia because the procedure can exacerbate the pressure, leading to brain herniation and severe neurological damage.
Which clinical signs are used to determine the severity of aortic stenosis (AS) in the absence of an echocardiogram?
A) Hypertension, tachycardia, and edema
B) Angina, syncope, and heart failure
C) Bradycardia, hypotension, and dyspnea
D) Palpitations, dizziness, and cyanosis
Correct Answer: B) Angina, syncope, and heart failure
Rationale: Angina, syncope, and heart failure are key clinical signs indicating severe aortic stenosis. These symptoms suggest significant obstruction and poor prognosis, warranting caution with neuraxial anesthesia.
Failure is the most significant
Why is an operation duration exceeding the duration of local anesthetic considered a contraindication for neuraxial anesthesia?
A) It results in prolonged sedation
B) It may require conversion to general anesthesia mid-operation, risking complications
C) It ensures complete anesthetic coverage
D) It has no clinical significance
Correct Answer: B) It may require conversion to general anesthesia mid-operation, risking complications
Rationale: If the operation is expected to last longer than the duration of the local anesthetic, there is a risk of needing to convert to general anesthesia during the procedure, which can introduce additional risks and complications.
What is the primary difference in the onset time between spinal and epidural anesthesia?
A) Spinal has a slower onset than epidural
B) Epidural has a rapid onset
C) Spinal has a rapid onset while epidural is slower
D) Both have the same onset time
Correct Answer: C) Spinal has a rapid onset while epidural is slower
Rationale: Spinal anesthesia typically works within 5 minutes, whereas epidural anesthesia takes about 10-15 minutes to take effect.
Which characteristic of spinal anesthesia makes it likely to cause hypotension compared to epidural anesthesia?
A) Rapid onset of action
B) Minimal motor block
C) Controlled spread of local anesthetic
D) Segmental nature of the block
Correct Answer: A) Rapid onset of action
Rationale: The rapid onset of spinal anesthesia can cause a sudden drop in blood pressure, making hypotension more likely compared to the slower onset and gradual effect of epidural anesthesia.
In what way is the spread of anesthesia different between spinal and epidural techniques?
A) Spinal anesthesia spread can be controlled with the volume of local anesthetic
B) Epidural anesthesia often extends higher than expected
C) Spinal anesthesia may extend extracranially, whereas epidural spread is controlled
D) Both have an unpredictable spread
Correct Answer: C) Spinal anesthesia may extend extracranially, whereas epidural spread is controlled
Rationale: The spread of spinal anesthesia can be higher than expected and may extend extracranially, while epidural anesthesia spread can be controlled with the volume of local anesthetic.
What is a notable difference in the nature of the block between spinal and epidural anesthesia?
A) Spinal anesthesia provides a segmental block
B) Epidural anesthesia provides a dense block
C) Spinal anesthesia provides a dense block, whereas epidural provides a segmental block
D) Both provide a dense block
Correct Answer: C) Spinal anesthesia provides a dense block, whereas epidural provides a segmental block
Rationale: Spinal anesthesia typically results in a dense block affecting a larger area, while epidural anesthesia provides a segmental block, allowing for more localized control.
How does the motor block differ between spinal and epidural anesthesia?
A) Spinal anesthesia results in minimal motor block
B) Epidural anesthesia results in a dense motor block
C) Spinal anesthesia results in a dense motor block, while epidural has minimal motor block
D) Both result in dense motor blocks
Correct Answer: C) Spinal anesthesia results in a dense motor block, while epidural has minimal motor block
Rationale: Spinal anesthesia results in a dense motor block due to the higher concentration of local anesthetic, whereas epidural anesthesia results in minimal motor block, allowing for better motor function preservation.
Which statement best describes the relationship between maternal and fetal blood pressure during spinal anesthesia?
A) Fetal blood pressure is independent of maternal blood pressure
B) Fetal blood pressure directly mirrors maternal blood pressure
C) Fetal blood pressure is higher than maternal blood pressure
D) Fetal blood pressure is lower than maternal blood pressure
Correct Answer: B) Fetal blood pressure directly mirrors maternal blood pressure
Rationale: During spinal anesthesia, the fetal blood pressure can be influenced by maternal blood pressure changes, making it crucial to manage maternal hypotension effectively to avoid fetal distress.
What is a key difference in the onset of anesthesia between spinal and epidural techniques?
A) Spinal anesthesia has a slower onset than epidural
B) Epidural anesthesia takes effect in 5 minutes
C) Spinal anesthesia has a rapid onset of 5 minutes, while epidural is slower at 10-15 minutes
D) Both spinal and epidural have the same onset time
Correct Answer: C) Spinal anesthesia has a rapid onset of 5 minutes, while epidural is slower at 10-15 minutes
Rationale: Spinal anesthesia typically has a rapid onset within 5 minutes, whereas epidural anesthesia takes 10-15 minutes to take effect.
Why does epidural anesthesia require more skill for placement compared to spinal anesthesia?
A) Epidural anesthesia uses a smaller needle
B) Epidural anesthesia is placed at a fixed level
C) Epidural anesthesia involves threading a catheter and avoiding the spinal cord
D) Epidural anesthesia has no influence from gravity
Correct Answer: C) Epidural anesthesia involves threading a catheter and avoiding the spinal cord
Rationale: The placement of an epidural involves threading a catheter and requires precision to avoid the spinal cord, necessitating greater skill compared to the simpler spinal injection.
Which characteristic of spinal anesthesia allows for manipulation of dermatome spread after dosing?
A) Segmental block nature
B) Incremental dosing
C) Influence of baricity and patient positioning within the first 5 minutes
D) Volume-based control
Correct Answer: C) Influence of baricity and patient positioning within the first 5 minutes
Rationale: Spinal anesthesia allows for manipulation of the spread of anesthesia by adjusting the patient’s position and utilizing the baricity of the anesthetic solution within the first 5 minutes after administration.
How does the concentration and dosing of local anesthetic differ between spinal and epidural anesthesia?
A) Spinal uses volume-based dosing, epidural uses dose-based
B) Spinal anesthesia involves a concentrated and fixed dose, while epidural dosing varies with volume
C) Epidural uses a fixed dose, spinal uses volume-based dosing
D) Both use the same concentration and dosing method
Correct Answer: B) Spinal anesthesia involves a concentrated and fixed dose, while epidural dosing varies with volume
Rationale: Spinal anesthesia typically uses a concentrated and fixed dose, whereas epidural anesthesia dosing varies with the volume administered.
What factor primarily influences the spread of local anesthetic in spinal anesthesia?
A) Position of the patient alone
B) Volume of anesthetic
C) Baricity of the anesthetic and initial patient positioning
D) Skill of the practitioner
Correct Answer: C) Baricity of the anesthetic and initial patient positioning
Rationale: The spread of local anesthetic in spinal anesthesia is primarily influenced by the baricity of the anesthetic solution and the initial positioning of the patient.
Why is local anesthetic toxicity more likely with epidural anesthesia compared to spinal anesthesia?
A) Higher concentration of local anesthetic used in spinal anesthesia
B) Greater volume of local anesthetic used in epidural anesthesia
C) Rapid onset of spinal anesthesia increases toxicity risk
D) Epidural anesthesia uses less anesthetic overall
Correct Answer: B) Greater volume of local anesthetic used in epidural anesthesia
Rationale: The larger volume of local anesthetic used in epidural anesthesia increases the risk of systemic toxicity compared to the smaller, more concentrated doses used in spinal anesthesia.
How many vertebrae comprise the human vertebral column, and what are the sections they are divided into?
A) 30 vertebrae; Cervical, Thoracic, Lumbar, Sacral
B) 33 vertebrae; Cervical, Thoracic, Lumbar, Sacral, Coccygeal
C) 31 vertebrae; Cervical, Thoracic, Lumbar, Sacral, Coccygeal
D) 34 vertebrae; Cervical, Thoracic, Lumbar, Sacral, Coccygeal
Correct Answer: B) 33 vertebrae; Cervical, Thoracic, Lumbar, Sacral, Coccygeal
Rationale: The human vertebral column consists of 33 vertebrae divided into five sections: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused), and 4 coccygeal (fused).
What characteristic is unique to the cervical vertebrae among the other vertebrae in the spinal column?
A) Presence of large vertebral bodies
B) Presence of intervertebral foramina
C) Presence of transverse foramina
D) Fusion of vertebrae
Correct Answer: C) Presence of transverse foramina
Rationale: Cervical vertebrae are distinguished by the presence of transverse foramina, which allow for the passage of the vertebral arteries.
Which type of spinal curvature is associated with an exaggerated inward curve of the lumbar spine?
A) Scoliosis
B) Kyphosis
C) Lordosis
D) Normal curvature
Correct Answer: C) Lordosis
Rationale: Lordosis is characterized by an exaggerated inward curve of the lumbar spine, often referred to as swayback.
Which spinal levels are typically targeted for spinal anesthesia placement?
A) C1-C2
B) T1-T2
C) L3-L4, L4-L5, L5-S1
D) S1-S2
Correct Answer: C) L3-L4, L4-L5, L5-S1
Rationale: Spinal anesthesia is typically administered at the lumbar levels L3-L4, L4-L5, and L5-S1 to avoid damage to the spinal cord, which ends at approximately the L1-L2 level in adults.
In terms of spinal anatomy, what does the term “baricity” refer to, and how does it affect the administration of spinal anesthesia?
A) Baricity refers to the size of the vertebrae; it affects the amount of anesthetic needed
B) Baricity refers to the density of the anesthetic solution relative to cerebrospinal fluid; it affects the spread of the anesthetic
C) Baricity refers to the concentration of the anesthetic solution; it affects the duration of anesthesia
D) Baricity refers to the position of the patient; it has no effect on the spread of the anesthetic
Correct Answer: B) Baricity refers to the density of the anesthetic solution relative to cerebrospinal fluid; it affects the spread of the anesthetic
Rationale: Baricity describes the density of the anesthetic solution compared to cerebrospinal fluid (CSF). Hyperbaric solutions are denser and tend to sink, whereas hypobaric solutions are lighter and rise. Isobaric solutions have the same density as CSF and tend to remain at the level of injection.
Which part of the vertebral column is fused and provides a stable base for the spinal column, as well as attachment points for the pelvis?
A) Cervical vertebrae
B) Thoracic vertebrae
C) Lumbar vertebrae
D) Sacral vertebrae
Correct Answer: D) Sacral vertebrae
Rationale: The sacral vertebrae are fused to form the sacrum, which provides a stable base for the spinal column and attachment points for the pelvis.
What are the two main parts of each vertebra, excluding C1?
A) Vertebral body and spinous process
B) Anterior segment (body) and posterior segment (vertebral arch)
C) Transverse process and vertebral foramen
D) Superior articular process and inferior articular process
Correct Answer: B) Anterior segment (body) and posterior segment (vertebral arch)
Rationale: Each vertebra, except for C1, is divided into an anterior segment known as the body and a posterior segment called the vertebral arch.
Which structures link the anterior and posterior segments of a vertebra?
A) Transverse process and spinous process
B) Pedicle and lamina
C) Superior and inferior articular processes
D) Vertebral body and vertebral foramen
Correct Answer: B) Pedicle and lamina
Rationale: The pedicle and lamina link the anterior and posterior segments of a vertebra, forming the vertebral arch.
What is the function of the vertebral foramen?
A) It serves as an attachment point for muscles
B) It houses the spinal cord, nerve roots, and the epidural space
C) It connects the ribs to the vertebrae
D) It provides structural support to the vertebral column
Correct Answer: B) It houses the spinal cord, nerve roots, and the epidural space
Rationale: The vertebral foramen is a crucial space within the vertebra that houses the spinal cord, nerve roots, and the epidural space, providing a protective cushioning area around the spinal cord.
Which vertebra is unique and does not have the typical two-part structure of the anterior and posterior segments?
A) C2
B) L1
C) S1
D) C1
Correct Answer: D) C1
Rationale: The C1 vertebra, also known as the atlas, is unique because it does not have a typical vertebral body or spinous process, differentiating it from other vertebrae.
What is the primary purpose of the epidural space within the vertebral column?
A) It facilitates the movement of intervertebral discs
B) It provides a pathway for the spinal nerves
C) It serves as a cushioning area for the spinal cord and houses the administration of epidural anesthesia
D) It connects the anterior and posterior segments of the vertebrae
Correct Answer: C) It serves as a cushioning area for the spinal cord and houses the administration of epidural anesthesia
Rationale: The epidural space is a protective cushioning area around the spinal cord and is the site for administering epidural anesthesia.
How do the structures of the vertebra, such as the lamina and pedicle, contribute to the stability and function of the spinal column?
A) They allow for flexibility and movement of the vertebral column
B) They connect the ribs to the vertebrae
C) They form the vertebral foramen, which provides stability and protects the spinal cord
D) They are sites for muscle attachment
Correct Answer: C) They form the vertebral foramen, which provides stability and protects the spinal cord
Rationale: The lamina and pedicle form the vertebral foramen, which is crucial for providing stability to the spinal column and protecting the spinal cord and nerve roots.
Epidural space is also inside the foramen
What is the primary anatomical function of the transverse processes of the vertebrae?
A) They protect the spinal cord
B) They serve as attachment points for muscles and ligaments
C) They provide cushioning between vertebrae
D) They connect the vertebrae to the ribs
Correct Answer: B) They serve as attachment points for muscles and ligaments
Rationale: The transverse processes stick out laterally from the vertebrae and provide attachment points for muscles and ligaments, aiding in the stability and movement of the spine.
Which vertebral structure serves as a crucial landmark for locating the midline of the back during procedures such as epidural or spinal anesthesia?
A) Transverse process
B) Vertebral foramen
C) Spinous process
D) Pedicle
Correct Answer: C) Spinous process
Rationale: The spinous process sticks out posteriorly and serves as an important landmark for finding the midline of the back, which is crucial for procedures like epidural or spinal anesthesia.
How does the location and function of the spinous process differ from that of the transverse process in a vertebra?
A) The spinous process extends laterally while the transverse process extends posteriorly
B) The spinous process extends posteriorly and serves as a midline landmark, while the transverse process extends laterally and provides muscle attachment
C) Both processes extend laterally and serve the same function
D) The spinous process is involved in cushioning, while the transverse process protects the spinal cord
Correct Answer: B) The spinous process extends posteriorly and serves as a midline landmark, while the transverse process extends laterally and provides muscle attachment
Rationale: The spinous process extends posteriorly and serves as a landmark for midline, while the transverse process extends laterally and provides attachment points for muscles and ligaments.
Why is it important to use the midline approach when administering epidural or spinal anesthesia?
A) It reduces the risk of damaging the spinal cord
B) It ensures the anesthetic spreads evenly
C) It prevents infection at the injection site
D) It facilitates easier access to the intervertebral discs
Correct Answer: A) It reduces the risk of damaging the spinal cord
Rationale: Using the midline approach helps in accurately placing the needle between the spinous processes, reducing the risk of damaging the spinal cord and other critical structures.
Which vertebral structure connects the vertebral body to the posterior elements, including the lamina and spinous process?
A) Transverse process
B) Pedicle
C) Vertebral foramen
D) Superior articular proces
Correct Answer: B) Pedicle
Rationale: The pedicle is the structure that connects the vertebral body to the posterior elements such as the lamina and spinous process, forming the sides of the vertebral arch.
What is a key anatomical difference between the spinous processes of the lumbar vertebrae compared to the thoracic and cervical vertebrae?
A) Lumbar spinous processes tilt downward
B) Thoracic and cervical spinous processes extend directly backwards
C) Lumbar spinous processes extend directly backwards
D) Lumbar spinous processes are shorter and thinner
Correct Answer: C) Lumbar spinous processes extend directly backwards
Rationale: Unlike the cervical and thoracic vertebrae, whose spinous processes tilt downward (caudal direction), the lumbar spinous processes extend directly backwards (posteriorly), facilitating easier access to the epidural and intrathecal spaces.
Why does the approach to needle insertion differ between the lumbar and thoracic regions during spinal or epidural anesthesia?
A) The thoracic region has more space between vertebrae
B) The lumbar spinous processes are angled downward
C) The thoracic spinous processes tilt downward, requiring a cephalad needle approach
D) The lumbar region requires a caudal needle approach
Correct Answer: C) The thoracic spinous processes tilt downward, requiring a cephalad needle approach
Rationale: In the thoracic region, the spinous processes tilt downward (caudally), necessitating a cephalad (upward) approach for needle insertion, whereas the lumbar region’s spinous processes extend directly backwards, allowing for a more straightforward approach.
Which region of the vertebral column requires a 40-degree needle angulation for proper epidural or spinal anesthesia placement?
A) Cervical region
B) Thoracic region
C) Lumbar region
D) Sacral region
Correct Answer: B) Thoracic region
Rationale: In the thoracic region, the spinous processes tilt downward at approximately a 40-degree angle, necessitating the same angulation for proper needle placement during epidural or spinal anesthesia.
How does the orientation of the lumbar spinous processes facilitate spinal anesthesia?
A) By providing a wider surface area for needle insertion
B) By requiring a cephalad approach
C) By sticking out directly backwards, simplifying the approach
D) By tilting downward, making access easier
Correct Answer: C) By sticking out directly backwards, simplifying the approach
Rationale: The lumbar spinous processes extend directly backwards (posteriorly), making it easier to reach the spaces around the spinal cord, such as the epidural and intrathecal spaces, simplifying the approach for spinal anesthesia.
What is the clinical significance of the spinous process orientation when performing a midline approach for neuraxial blocks?
A) It determines the type of anesthetic used
B) It affects the duration of anesthesia
C) It guides the angle and direction of needle insertion
D) It has no clinical significance
Correct Answer: C) It guides the angle and direction of needle insertion
Rationale: The orientation of the spinous processes is critical for guiding the angle and direction of needle insertion during a midline approach for neuraxial blocks, ensuring proper placement and effectiveness of the anesthesia.
What is the primary function of the intervertebral discs located between each vertebra?
A) Provide structural support to the spinal cord
B) Act as shock absorbers
C) Facilitate the passage of spinal nerves
D) Connect the vertebrae to the ribs
Correct Answer: B) Act as shock absorbers
Rationale: Intervertebral discs are soft pads located between each vertebra that act as shock absorbers, helping to cushion and protect the spinal column during movement.
Which structures form the anterior and posterior sides of the intervertebral foramina?
A) Anterior: vertebral body and pedicle; Posterior: spinous process and lamina
B) Anterior: intervertebral disc and vertebral body; Posterior: facet joints
C) Anterior: transverse process and intervertebral disc; Posterior: vertebral foramen
D) Anterior: nucleus pulposus and annulus fibrosus; Posterior: pedicle and lamina
Correct Answer: B) Anterior: intervertebral disc and vertebral body; Posterior: facet joints
Rationale: The anterior side of the intervertebral foramen is formed by the vertebral body and the intervertebral disc, while the posterior side is formed by the facet joints.
What is the potential impact of intervertebral disc degeneration on the foramina?
A) It has no impact on the foramina
B) It makes the foramina larger
C) It causes the foramina to become smaller, potentially compressing spinal nerves
D) It strengthens the foramina, preventing nerve compression
Correct Answer: C) It causes the foramina to become smaller, potentially compressing spinal nerves
Rationale: As intervertebral discs degenerate, the foramina can become smaller, which may lead to compression of the spinal nerves, causing pain, numbness, or weakness.
Which posterior vertebral structure primarily contributes to the formation of the intervertebral foramen through which spinal nerves exit?
A) Spinous process
B) Vertebral body
C) Pedicle
D) Facet joint
Correct Answer: D) Facet joint
Rationale: The facet joints form the posterior side of the intervertebral foramen, which is the opening through which spinal nerves exit the vertebral column.
How can the anatomical orientation of the intervertebral discs affect patients with disc problems during spinal anesthesia?
A) It makes it easier for them to bend forward
B) It causes them to experience no pain while bending
C) It can make bending forward difficult and painful, requiring alternative positioning for the procedure
D) It has no effect on their ability to bend forward
Correct Answer: C) It can make bending forward difficult and painful, requiring alternative positioning for the procedure
Rationale: Patients with disc problems often find it difficult and painful to bend forward, so alternative positioning, such as lying on their side, may be required for spinal anesthesia.
What technique can be employed to administer spinal anesthesia in patients with severe back issues who cannot bend forward easily?
A) Standing approach
B) Lateral approach with the patient lying on their side
C) Prone approach
D) Supine approach with the patient flat on their back
Correct Answer: B) Lateral approach with the patient lying on their side
Rationale: For patients with severe back issues, a lateral approach with the patient lying on their side can be an effective alternative to the traditional sitting position for spinal anesthesia.
Which two parts form each facet joint in the vertebral column?
A) Vertebral body and transverse process
B) Inferior articular process of one vertebra and superior articular process of the vertebra below
C) Spinous process and pedicle
D) Lamina and transverse process
Correct Answer: B) Inferior articular process of one vertebra and superior articular process of the vertebra below
Rationale: Each facet joint is formed by the inferior articular process of one vertebra connecting with the superior articular process of the vertebra directly below it.
What is the primary function of the facet joints in the vertebral column?
A) To absorb shock between vertebrae
B) To provide a passage for spinal nerves
C) To guide and limit the spine’s movement, keeping motions controlled
D) To connect the vertebrae to the ribs
Correct Answer: C) To guide and limit the spine’s movement, keeping motions controlled
Rationale: Facet joints help guide and limit the spine’s movement, ensuring that the motions of the back are controlled and stable.
How can an injury to a facet joint impact the spinal nerves?
A) It has no effect on the spinal nerves
B) It can press on nearby spinal nerves, causing pain and muscle spasms
C) It strengthens the spinal nerves
D) It only affects the muscles, not the nerves
Correct Answer: B) It can press on nearby spinal nerves, causing pain and muscle spasms
Rationale: If a facet joint gets injured, it can press on nearby spinal nerves, leading to pain, muscle spasms, and potentially affecting the area of skin (dermatome) served by that nerve.
Which movement is facilitated by the function of the facet joints?
A) Rotation of the vertebrae
B) Flexion (bending forward) and extension (bending backward)
C) Lateral bending
D) None of the above
Correct Answer: B) Flexion (bending forward) and extension (bending backward)
Rationale: Facet joints facilitate and control flexion (bending forward) and extension (bending backward) movements of the vertebral column.
What symptoms might indicate an issue with the facet joints that could affect spinal anesthesia procedures?
A) Increased flexibility
B) Muscle weakness without pain
C) Pain and muscle spasms in the area of the skin served by the affected nerve (dermatome)
D) Enhanced movement and stability of the spine
Correct Answer: C) Pain and muscle spasms in the area of the skin served by the affected nerve (dermatome)
Rationale: Symptoms such as pain and muscle spasms in the area of the skin served by the affected nerve (dermatome) may indicate an issue with the facet joints, which could affect the procedure.
What anatomical landmark corresponds with the level of the L4 vertebra and is commonly used for locating the site for spinal anesthesia?
A) Vertebra prominens (C7)
B) Root of the spine of the scapula (T3)
C) Superior aspect of the iliac crest
D) Posterior superior iliac spine
Correct Answer: C) Superior aspect of the iliac crest
Rationale: The superior aspect of the iliac crest aligns with the level of the L4 vertebra and is used as a key landmark for locating the site for spinal anesthesia.
What is the clinical significance of the intercristal line (Tuffier’s Line) in spinal anesthesia?
A) It aligns with the C7 vertebra
B) It helps identify the L4-L5 intervertebral space for safe needle insertion
C) It corresponds to the T3 vertebra in infants
D) It is used to measure spinal cord length
Correct Answer: B) It helps identify the L4-L5 intervertebral space for safe needle insertion
Rationale: The intercristal line (Tuffier’s Line) runs across the top edges of the iliac crests and matches the L4 vertebra, helping to identify the L4-L5 intervertebral space for safe needle insertion.
Why is it important to locate the posterior superior iliac spine when performing midline procedures such as epidural or spinal anesthesia?
A) It helps identify the T7 vertebra
B) It aligns with the L1-L2 intervertebral space
C) It serves as a landmark to maintain midline alignment during needle insertion
D) It indicates the end of the spinal cord
Correct Answer: C) It serves as a landmark to maintain midline alignment during needle insertion
Rationale: Locating the posterior superior iliac spine helps practitioners maintain midline alignment during needle insertion for procedures like epidural or spinal anesthesia. S2
In infants up to one year of age, the intercristal line corresponds with which intervertebral space?
A) L3-L4
B) L4-L5
C) L5-S1
D) S1-S2
Correct Answer: C) L5-S1
Rationale: In infants up to one year of age, the intercristal line corresponds with the L5-S1 intervertebral space, which is important for accurately locating the site for spinal procedures in this age group.
Which spinal level is considered safe for administering spinal anesthesia in adults to avoid the spinal cord and is above Tuffier’s line?
A) L5-S1
B) L4-L5
C) L3-L4
D) S1-S2
Correct Answer: C) L3-L4
Rationale: The spinal cord typically ends around the L1 level in adults, so administering spinal anesthesia at the L3-L4 intervertebral space is considered safe to avoid the spinal cord.
Which vertebral level is typically targeted for spinal anesthesia in pediatric patients to avoid the spinal cord?
A) L1-L2
B) L2-L3
C) L3-L4
D) L4-L5
Correct Answer: D) L4-L5
Rationale: In pediatric patients, the spinal cord extends to approximately the L3 vertebral level. To avoid the spinal cord and reduce the risk of injury, spinal anesthesia is typically administered at the L4-L5 intervertebral space - or hiatus (NYSORA) (OpenAnesthesia).
What is the sacral hiatus, and where is it located?
A) A fused bone at the top of the sacrum
B) An opening at the base of the sacrum, aligning with the S5 vertebra
C) A ligament connecting the sacrum to the coccyx
D) A bony projection on the lateral aspect of the sacrum
Correct Answer: B) An opening at the base of the sacrum, aligning with the S5 vertebra
Rationale: The sacral hiatus is an opening located at the base of the sacrum, aligning with the S5 vertebra. It is covered by the sacrococcygeal ligament and acts as an access point for caudal anesthesia.
Which ligament covers the sacral hiatus and is crucial for performing caudal anesthesia?
A) Anterior longitudinal ligament
B) Posterior longitudinal ligament
C) Sacrococcygeal ligament
D) Ligamentum flavum
Correct Answer: C) Sacrococcygeal ligament
Rationale: The sacrococcygeal ligament covers the sacral hiatus and is crucial for the administration of caudal anesthesia, providing access to the epidural space.
What anatomical structures serve as landmarks for locating the sacral hiatus when performing caudal anesthesia, especially in pediatric patients?
A) Iliac crests
B) Sacral cornua
C) Ischial tuberosities
D) Pubic symphysis
Correct Answer: B) Sacral cornua
Rationale: The sacral cornua are bony projections on either side of the sacral hiatus and serve as important landmarks for locating the hiatus when performing caudal anesthesia, particularly in pediatric patients.
Why is the sacral hiatus considered a safe access point for caudal anesthesia in pediatric patients?
A) It is located far from the spinal cord
B) It provides direct access to the spinal cord
C) It is located at the level of the lumbar vertebrae
D) It is covered by a thick layer of muscle
Correct Answer: A) It is located far from the spinal cord
Rationale: The sacral hiatus is considered a safe access point for caudal anesthesia in pediatric patients because it is located at the base of the sacrum, far from the spinal cord, reducing the risk of injury.
What is the clinical significance of the incomplete lamina of the S5 vertebra in relation to caudal anesthesia?
A) It increases the risk of nerve damage
B) It creates the sacral hiatus, allowing for caudal anesthesia access
C) It prevents the use of the sacral hiatus for anesthesia
D) It causes the sacrum to fuse with the coccyx
Correct Answer: B) It creates the sacral hiatus, allowing for caudal anesthesia access
Rationale: The incomplete lamina of the S5 vertebra results in the formation of the sacral hiatus, which serves as an access point for caudal anesthesia.
Where does the spinal cord originate and terminate in adults and infants?
A) Originates at the foramen magnum, terminates at L4 in adults and L2 in infants
B) Originates at the medulla oblongata, terminates at L1-L2 in adults and L3 in infants
C) Originates at the cerebellum, terminates at L2-L3 in adults and L4 in infants
D) Originates at the brainstem, terminates at L3 in adults and L1-L2 in infants
Correct Answer: B) Originates at the medulla oblongata, terminates at L1-L2 in adults and L3 in infants
Rationale: The spinal cord originates at the medulla oblongata and terminates at the L1-L2 vertebrae in adults and at the L3 vertebra in infants. This is critical to know for safely performing spinal anesthesia and avoiding the spinal cord.
What is the conus medullaris and where is it located?
A) The beginning of the spinal cord at the brainstem
B) The tapered end of the spinal cord, located at L1-L2 in adults and L3 in infants
C) The bundle of spinal nerves extending from L2 to S5
D) The space between the dura mater and the vertebrae
Correct Answer: B) The tapered end of the spinal cord, located at L1-L2 in adults and L3 in infants
Rationale: The conus medullaris is the tapered end of the spinal cord. In adults, it is located at the L1-L2 vertebrae, and in infants, it is at the L3 vertebra.
What is the function of the cauda equina, and where is it located?
A) It provides support to the vertebral column, located between L1 and L3
B) It is a bundle of spinal nerves extending from the conus medullaris to the dural sac, located from L2 to S5
C) It is the origin of the spinal cord, located at the medulla oblongata
D) It encloses the cerebrospinal fluid, located from T12 to L1
Correct Answer: B) It is a bundle of spinal nerves extending from the conus medullaris to the dural sac, located from L2 to S5
Rationale: The cauda equina is a bundle of spinal nerves that extend from the conus medullaris to the dural sac, consisting of nerve roots from L2 to S5 and the coccygeal nerve.
Why is it important to consider the termination level of the dural sac in spinal anesthesia?
A) To ensure the needle does not penetrate the vertebral body
B) To avoid damage to the spinal cord, especially in infants where the dural sac ends lower
C) To correctly identify a viable spot for spinal anesthetics.
D) To determine the dosage of local anesthetic
C) To correctly identify a viable spot for spinal anesthetics.
Rationale: if you are below the dural sac you will not be in the CSF, therefore no spinal anesthetic.
The dural sac contains the cerebrospinal fluid and extends to S2 in adults and S3 in infants
Which nerve roots are involved in the cauda equina, and what potential symptoms might arise from their compression?
A) C1 to C7; motor weakness in the arms
B) T1 to T12; thoracic pain and weakness
C) L2 to S5; lower back pain, numbness, and muscle weakness in the lower limbs
D) S1 to S5; bladder and bowel dysfunction
Correct Answer: C) L2 to S5; lower back pain, numbness, and muscle weakness in the lower limbs
Rationale: The cauda equina consists of nerve roots from L2 (conus medullaris @ L1) to S5. (and coccygeal nerve). Compression of these nerves can result in lower back pain, numbness, and muscle weakness in the lower limbs, as well as potential bowel and bladder dysfunction.
Where does the dural sac end in adults and infants, and why is this significant for spinal anesthesia?
A) S1 in adults, S2 in infants; significant for identifying lumbar puncture sites
B) S2 in adults, S3 in infants; significant for avoiding cerebrospinal fluid leakage
C) S2 in adults, S3 in infants; significant because areas below this do not contain cerebrospinal fluid
D) S1 in adults, S2 in infants; significant for epidural anesthesia placement
Correct Answer: C) S2 in adults, S3 in infants; significant because areas below this do not contain cerebrospinal fluid
Rationale: The dural sac ends at S2 in adults and at S3 in infants. This is significant for spinal anesthesia because areas below these levels do not contain cerebrospinal fluid (CSF), meaning they are not suitable for spinal anesthesia.
What is the primary function of the filum terminale, and what are its parts?
A) Conducts nerve impulses; internal filum and external filum
B) Anchors the spinal cord to the coccyx; internal filum and external filum
C) Protects the spinal cord from injuries; internal filum and external filum
D) Connects the spinal cord to the brain; internal filum and external filum
Correct Answer: B) Anchors the spinal cord to the coccyx; internal filum and external filum
Rationale: The filum terminale’s primary function is to anchor the spinal cord to the coccyx. It consists of two parts: the internal filum terminale (from the conus medullaris to the dural sac) and the external filum terminale (from the dural sac to the coccyx).
Which structure continues from the end of the spinal cord and extends down to the coccyx, and what is it a continuation of?
A) Cauda equina; continuation of the dura mater
B) Filum terminale; continuation of the pia mater
C) Conus medullaris; continuation of the arachnoid mater
D) Dural sac; continuation of the spinal cord
Correct Answer: B) Filum terminale; continuation of the pia mater
Rationale: The filum terminale continues from the end of the spinal cord (conus medullaris) and extends to the coccyx. It is a continuation of the pia mater and serves to anchor the spinal cord in place.
Why is it important to avoid performing spinal anesthesia below the S2 level in adults?
A) To prevent damage to the cauda equina
B) Because the filum terminale ends at S2
C) Because there is no cerebrospinal fluid below S2
D) To avoid puncturing the sacrococcygeal ligament
Correct Answer: C) Because there is no cerebrospinal fluid below S2
Rationale: Below the S2 level in adults, there is no cerebrospinal fluid (CSF), which is essential for the proper administration and effect of spinal anesthesia.
What does the cauda equina consist of, and why is it clinically significant?
A) A bundle of spinal nerves from L2 to S5; it is significant for lower limb and pelvic organ function
B) The terminal end of the spinal cord; it is significant for spinal cord termination
C) Nerve roots from the coccyx to the sacrum; it is significant for sacral nerve function
D) A structure continuing from the pia mater; it anchors the spinal cord
Correct Answer: A) A bundle of spinal nerves from L2 to S5; it is significant for lower limb and pelvic organ function
Rationale: The cauda equina consists of a bundle of spinal nerves extending from the L2 to S5 vertebrae. It is clinically significant as it affects the function of the lower limbs and pelvic organs, and its compression can lead to cauda equina syndrome, a serious condition requiring immediate medical attention.
What is the origin of the anterior and posterior spinal arteries?
A) Subclavian artery
B) Carotid artery
C) Vertebral artery
D) Cranial Vault
Correct Answer: C) Vertebral artery
Rationale: Both the anterior and posterior spinal arteries originate from the vertebral artery. This is important for understanding the blood supply to the spinal cord.
Which part of the spinal cord does the anterior spinal artery primarily supply, and what is its function?
A) Posterior 1/3, sensory function
B) Anterior 2/3, motor function
C) Anterior 2/3, both motor and sensory functions
D) Lateral 1/3, autonomic functions
Correct Answer: B) Anterior 2/3, motor function
Rationale: The anterior spinal artery supplies the anterior two-thirds of the spinal cord, which is predominantly involved in motor functions (efferent pathways).
How does the collateral circulation of the posterior spinal arteries protect the spinal cord from ischemia?
A) By providing multiple pathways for blood to reach the sensory parts of the spinal cord
B) By increasing the flow of cerebrospinal fluid
C) By decreasing the blood pressure in the spinal arteries
D) By directly supplying the motor neurons
Correct Answer: A) By providing multiple pathways for blood to reach the sensory parts of the spinal cord
Rationale: The posterior spinal arteries have many connections (collateral anastomotic links) with the subclavian and intercostal arteries, which help protect the sensory part of the spinal cord from ischemia by providing alternative pathways for blood flow.
Why is the anterior spinal artery more vulnerable to ischemia compared to the posterior spinal arteries?
A) It has fewer protective anastomotic links
B) It supplies a smaller area of the spinal cord
C) It is located closer to the vertebral body
D) It is paired, unlike the posterior spinal arteries
Correct Answer: A) It has fewer protective anastomotic links
Rationale: The anterior spinal artery is a single artery and does not have as many protective anastomotic links as the paired posterior spinal arteries, making the motor part of the spinal cord it supplies more vulnerable to ischemia.
What is the clinical significance of the anterior spinal artery syndrome?
A) It primarily affects the sensory pathways of the spinal cord
B) It results in motor deficits due to ischemia of the anterior two-thirds of the spinal cord
C) It causes increased cerebrospinal fluid production
D) It exclusively affects the upper cervical spinal cord
Correct Answer: B) It results in motor deficits due to ischemia of the anterior two-thirds of the spinal cord
Rationale: Anterior spinal artery syndrome occurs due to ischemia of the anterior two-thirds of the spinal cord, leading to motor deficits and affecting the motor pathways.
What are the primary consequences of anterior spinal artery syndrome?
A) Loss of proprioception and vibration sensation
B) Motor paralysis and loss of pain and temperature sensation below the affected area
C) Complete sensory and motor paralysis
D) Loss of fine touch and pressure sensation
Correct Answer: B) Motor paralysis and loss of pain and temperature sensation below the affected area
Rationale: Anterior spinal artery syndrome primarily results in motor paralysis and the loss of pain and temperature sensation below the affected area, as it affects the anterior two-thirds of the spinal cord which is responsible for motor functions and some sensory functions.
Which artery provides crucial blood supply to the lower two-thirds of the spinal cord, and where does it typically arise?
A) Iliac artery; between the T4 and T6 regions
B) Artery of Adamkiewicz; between the T9 and L2 regions
C) Posterior spinal artery; between the T1 and T3 regions
D) Radicular artery; between the L2 and S1 regions
Correct Answer: B) Artery of Adamkiewicz; between the T9 and L2 regions
Rationale: The artery of Adamkiewicz is a crucial artery that supplies blood to the lower two-thirds of the spinal cord. It typically arises from the aorta between the T9 and L2 regions.
Which factors can lead to ischemia of the anterior spinal artery?
A) Hypertension, vasculopathy, hyperlipidemia
B) Low blood pressure, mechanical blockage, vasculopathy, bleeding
C) Diabetes, hyperthyroidism, smoking
D) High cholesterol, obesity, sedentary lifestyle
Correct Answer: B) Low blood pressure, mechanical blockage, vasculopathy, bleeding
Rationale: Ischemia of the anterior spinal artery can be caused by low blood pressure (profound hypotension), mechanical blockage, blood vessel disease (vasculopathy), and bleeding (hemorrhage).
Which ligament is particularly thick in the lower back and forms the sidewalls of the epidural space, indicating entry into the epidural space when pierced?
A) Anterior longitudinal ligament
B) Posterior longitudinal ligament
C) Ligamentum flavum
D) Supraspinous ligament
Correct Answer: C) Ligamentum flavum
Rationale: The ligamentum flavum is particularly thick in the lower back and forms the sidewalls of the epidural space. Piercing this ligament indicates entry into the epidural space during procedures.
What is the function of the interspinous ligament?
A) Connecting the tips of the spinous processes
B) Providing stability by joining adjacent vertebrae
C) Running along the front of the vertebral bodies
D) Indicating entry into the epidural space
Correct Answer: B) Providing stability by joining adjacent vertebrae
Rationale: The interspinous ligament is located between the spinous processes of the vertebrae and provides stability by joining adjacent vertebrae.
Which ligament runs along the back of the vertebral bodies inside the spinal column and is important to avoid during spinal procedures?
A) Anterior longitudinal ligament
B) Posterior longitudinal ligament
C) Ligamentum flavum
D) Supraspinous ligament
Correct Answer: B) Posterior longitudinal ligament
Rationale: The posterior longitudinal ligament runs along the back of the vertebral bodies inside the spinal column and should be avoided during spinal procedures to prevent damage to the spinal cord.
What is the main function of the supraspinous ligament?
A) Connecting the anterior aspects of the vertebrae
B) Running along the length of the vertebral bodies
C) Connecting the tips of the spinous processes from the upper back to the lower back
D) Providing sensory innervation to the spinal cord
Correct Answer: C) Connecting the tips of the spinous processes from the upper back to the lower back
Rationale: The supraspinous ligament runs along the back, connecting the tips of the spinous processes from the upper back down to the lower back, providing stability.
Why is it important to avoid going past the Dura Mater during epidural procedures?
A) It can cause damage to the vertebral bodies
B) It can result in hitting the spinal cord if above L1
C) It can lead to a punctured dura mater
D) It can cause a drop in cerebrospinal fluid pressure
Correct Answer: B) It can result in hitting the spinal cord if above L1
Rationale: Avoiding going past the Dura Mater during epidural procedures is crucial because, if above L1, it can result in hitting the spinal cord, leading to serious complications.
What are the layers traversed during a midline spinal approach?
A) Skin, subcutaneous fat, ligamentum flavum, dura mater, subdural space, arachnoid mater, subarachnoid space
B) Skin, subcutaneous fat, supraspinous ligament, interspinous ligament, ligamentum flavum, dura mater, subdural space, arachnoid mater, subarachnoid space
C) Skin, subcutaneous fat, anterior longitudinal ligament, dura mater, subdural space, arachnoid mater, subarachnoid space
D) Skin, subcutaneous fat, supraspinous ligament, ligamentum flavum, dura mater, subdural space, arachnoid mater, subarachnoid space
Correct Answer: B) Skin, subcutaneous fat, supraspinous ligament, interspinous ligament, ligamentum flavum, dura mater, subdural space, arachnoid mater, subarachnoid space
Rationale: In a midline approach, the needle passes through the skin, subcutaneous fat, supraspinous ligament, interspinous ligament, ligamentum flavum, dura mater, subdural space, arachnoid mater, and finally into the subarachnoid space where cerebrospinal fluid (CSF) is obtained.
In which situations is the paramedian approach preferred over the midline approach for spinal anesthesia?
A) When the patient has lower back pain
B) When the interspinous ligament is calcified or the patient cannot flex their spine
C) For faster onset of anesthesia
D) When the patient is allergic to local anesthetics
Correct Answer: B) When the interspinous ligament is calcified or the patient cannot flex their spine
Rationale: The paramedian approach is preferred when the interspinous ligament is calcified or when the patient cannot flex their spine. This approach bypasses the interspinous ligament and allows for easier needle placement.
What angle and positioning are used for the paramedian approach in spinal anesthesia?
A) 10 degrees off the midline, 2 cm lateral and 2 cm inferior
B) 15 degrees off the midline, 1 cm lateral and 1 cm inferior
C) 20 degrees off the midline, 1 cm lateral and 1 cm superior
D) 5 degrees off the midline, 2 cm lateral and 1 cm inferior
Correct Answer: B) 15 degrees off the midline, 1 cm lateral and 1 cm inferior
Rationale: In the paramedian approach, the needle is inserted 15 degrees off the midline, positioned 1 cm lateral and 1 cm inferior to the interspace between the vertebrae.
Why is it critical to know the different layers traversed during a spinal anesthesia procedure?
A) To ensure the patient remains comfortable
B) To minimize the dose of anesthetic used
C) To avoid puncturing the spinal cord and ensure correct placement of the needle
D) To determine the duration of the anesthesia
Correct Answer: C) To avoid puncturing the spinal cord and ensure correct placement of the needle
Rationale: Knowing the different layers traversed during a spinal anesthesia procedure is critical to avoid puncturing the spinal cord and to ensure the needle is correctly placed in the subarachnoid space.
Which ligament must be pierced to enter the epidural space during a epidural procedure?
A) Anterior longitudinal ligament
B) Posterior longitudinal ligament
C) Ligamentum flavum
D) Supraspinous ligament
Correct Answer: C) Ligamentum flavum
Rationale: Piercing the ligamentum flavum indicates entry into the epidural space during a spinal procedure.
What are the layers of the meninges, from outermost to innermost?
A) Arachnoid mater, dura mater, pia mater
B) Dura mater, pia mater, arachnoid mater
C) Dura mater, arachnoid mater, pia mater
D) Pia mater, dura mater, arachnoid mater
Correct Answer: C) Dura mater, arachnoid mater, pia mater
Rationale: The meninges consist of three layers that cover the brain and spinal cord. From outermost to innermost, they are: dura mater, arachnoid mater, and pia mater.
Which space is found between the dura mater and the ligamentum flavum?
A) Subarachnoid space
B) Epidural space
C) Subdural space
D) Intraspinal space
Correct Answer: B) Epidural space
Rationale: The epidural space is located between the dura mater and the ligamentum flavum. It is the space where epidural anesthesia is administered.
What is the significance of the subarachnoid space in spinal anesthesia?
A) It contains the cerebrospinal fluid (CSF) necessary for intrathecal anesthesia
B) It provides a cushion for the spinal cord against mechanical injury
C) It houses the blood vessels that supply the spinal cord
D) It is the potential space for epidural injections
Correct Answer: A) It contains the cerebrospinal fluid (CSF) necessary for intrathecal anesthesia
Rationale: The subarachnoid space contains cerebrospinal fluid (CSF), which is essential for intrathecal (spinal) anesthesia. This space is accessed to deliver the anesthetic directly into the CSF.
During a spinal anesthesia procedure using the midline approach, which structure is pierced immediately before entering the subarachnoid space?
A) Arachnoid mater
B) Ligamentum flavum
C) Dura mater
D) Pia mater
Correct Answer: C) Dura mater
Rationale: (POP) In a spinal anesthesia procedure, the needle passes through the dura mater immediately before entering the subarachnoid space, where cerebrospinal fluid (CSF) is present.
Which of the following is a potential space and is not typically present under normal physiological conditions?
A) Epidural space
B) Subarachnoid space
C) Subdural space
D) Intrathecal space
Correct Answer: C) Subdural space
Rationale: The subdural space is a potential space that is not typically present under normal physiological conditions. It can become apparent when there is bleeding or other pathology that separates the dura mater from the arachnoid mater.
Which space contains cerebrospinal fluid (CSF) and is crucial for spinal anesthesia?
A) Epidural space
B) Subdural space
C) Subarachnoid space
D) Intraspinal space
Correct Answer: C) Subarachnoid space
Rationale: The subarachnoid space, located between the arachnoid mater and the pia mater, contains cerebrospinal fluid (CSF). This space is critical for spinal anesthesia as it allows the anesthetic to mix directly with the CSF.
What is the significance of the epidural space in regional anesthesia?
A) It is the space where cerebrospinal fluid is collected
B) It contains fat and small blood vessels and is the site for epidural anesthesia
C) It is a potential space between the dura mater and the arachnoid mater
D) It is located within the pia mater
Correct Answer: B) It contains fat and small blood vessels and is the site for epidural anesthesia
Rationale: The epidural space, located outside the dura mater, contains fat and small blood vessels (epidural veins). It is the site where epidural anesthesia is administered.
What happens if an epidural needle inadvertently enters the subdural space?
A) The block will have no effect
B) The block can spread caudally, potentially causing unexpected results
C) The patient will feel immediate pain
D) The needle will encounter cerebrospinal fluid
Correct Answer: B) The block can spread caudally, potentially causing unexpected results
Rationale: If an epidural needle inadvertently enters the subdural space, the block can spread caudally, potentially causing unexpected and unintended effects.
What is the cranial boundary of the epidural space?
A) Foramen magnum
B) Sacrococcygeal ligament
C) Posterior longitudinal ligament
D) Ligamentum flavum
Correct Answer: A) Foramen magnum
Rationale: The cranial boundary of the epidural space is at the foramen magnum, located at the base of the skull.
Which ligament forms the anterior border of the epidural space?
A) Ligamentum flavum
B) Posterior longitudinal ligament
C) Anterior longitudinal ligament
D) Sacrococcygeal ligament
Correct Answer: B) Posterior longitudinal ligament
Rationale: The anterior border of the epidural space is lined by the posterior longitudinal ligament along the vertebrae.
Which of the following is NOT a boundary of the epidural space?
A) Foramen magnum
B) Sacrococcygeal ligament
C) Pia mater
D) Vertebral pedicles
Correct Answer: C) Pia mater
Rationale: The boundaries of the epidural space include the foramen magnum (cranial), sacrococcygeal ligament (caudal), posterior longitudinal ligament (anterior), and vertebral pedicles (lateral). The pia mater is not a boundary of the epidural space; it is the innermost layer of the meninges covering the spinal cord.
What marks the posterior border of the epidural space?
A) Posterior longitudinal ligament
B) Ligamentum flavum and vertebral lamina
C) Sacrococcygeal ligament
D) Vertebral bodies
Correct Answer: B) Ligamentum flavum and vertebral lamina
Rationale: The posterior border of the epidural space is framed by the ligamentum flavum and the bony plates of the vertebrae (vertebral lamina).
Which statement is true regarding the epidural space?
A) It is located inside the dura mater and contains cerebrospinal fluid (CSF)
B) It is located outside the dura mater and contains fat and small blood vessels
C) It extends only from the cervical to the lumbar regions
D) It is formed by the pia mater and the arachnoid mater
Correct Answer: B) It is located outside the dura mater and contains fat and small blood vessels
Rationale: The epidural space is located outside the dura mater and contains fat and small blood vessels (epidural veins). It extends from the foramen magnum to the sacrococcygeal ligament at the bottom.
What is the primary function of the fatty tissue in the epidural space?
A) Provide structural support
B) Absorb and decrease the availability of certain drugs
C) Cushion the spinal cord
D) Facilitate the passage of blood vessels
Correct Answer: B) Absorb and decrease the availability of certain drugs
Rationale: Fatty tissue in the epidural space can absorb and decrease the availability of drugs like bupivacaine more than lidocaine or fentanyl.
Which statement about the epidural veins (Batson’s Plexus) is accurate?
A) They have valves that prevent backflow of blood.
B) Their density decreases laterally.
C) They are valveless and can become engorged under certain conditions.
D) They do not drain blood from the spinal cord linings.
Correct Answer: C) They are valveless and can become engorged under certain conditions.
Rationale: The epidural veins are valveless and form a plexus that drains blood from the spinal cord and its linings. They can become engorged under conditions like obesity or pregnancy, increasing the risk during needle procedures.
Why is it crucial to avoid injecting into the epidural veins during an epidural procedure?
A) It can cause immediate systemic toxicity.
B) It leads to rapid absorption of the local anesthetic.
C) It may cause thrombosis.
D) All of the above.
Correct Answer: D) All of the above.
Rationale: Injecting into the epidural veins can cause immediate systemic toxicity, lead to rapid absorption of the local anesthetic, and may cause thrombosis.
What anatomical feature increases the risk of hitting an epidural vein during needle procedures?
A) The presence of numerous valves
B) Increased density of veins laterally
C) Thickening of the ligamentum flavum
D) Narrowing of the epidural space cranially
Correct Answer: B) Increased density of veins laterally
Rationale: The density of epidural veins increases laterally, making it more likely to hit a vein if the needle is inserted too far to the side.
In which condition is the epidural space particularly engorged, increasing the risk during needle procedures?
A) Hypotension
B) Dehydration
C) Pregnancy
D) Hypercalcemia
Correct Answer: C) Pregnancy
Rationale: The epidural space, particularly the epidural veins, can become engorged under conditions like pregnancy, increasing the risk during needle procedures.
The presence of the plica mediana dorsalis is controversial and not definitively confirmed. If it does exist, where is it thought to be located, and what potential impact might it have on epidural anesthesia?
A. Between the supraspinous ligament and the interspinous ligament; it might act as a barrier to medication spread within the epidural space.
B. Between the ligamentum flavum and the dura mater; it might act as a barrier to medication spread within the epidural space.
C. Between the interspinous ligament and the ligamentum flavum; it might facilitate the spread of medications within the epidural space.
D. Between the dura mater and the arachnoid mater; it might act as a barrier to CSF flow.
Answer: B. Between the ligamentum flavum and the dura mater; it might act as a barrier to medication spread within the epidural space.
Which of the following clinical scenarios is most likely attributed to the presence of the plica mediana dorsalis during an epidural procedure?
A. The patient experiences bilateral sensory and motor block despite accurate catheter placement.
B. The patient has an effective motor block but incomplete sensory block.
C. The patient exhibits a unilateral block where only one side of the body is affected.
D. The patient reports severe headache and back pain immediately after the procedure.
Answer: C. The patient exhibits a unilateral block where only one side of the body is affected.
What steps might a clinician take if they suspect the presence of the plica mediana dorsalis is causing a unilateral block during an epidural anesthesia procedure?
A. Increase the dosage of local anesthetic injected through the catheter.
B. Reposition the patient and pull the catheter back by approximately 1 cm.
C. Push the catheter further into the epidural space.
D. Switch to a different type of anesthetic agent.
Answer: B. Reposition the patient and pull the catheter back by approximately 1 cm.
Which structure in the epidural space is considered a potential barrier to medication spread and is sometimes linked to complications in catheter placement?
A. Ligamentum flavum
B. Dura mater
C. Plica mediana dorsalis
D. Epidural veins (Batson’s plexus)
Answer: C. Plica mediana dorsalis
In the context of epidural anesthesia, which of the following is the most appropriate description of the plica mediana dorsalis?
A. A structure that enhances the uniform spread of anesthetic agents within the epidural space.
B. A connective tissue band that may exist between the ligamentum flavum and the dura mater, potentially causing unilateral blocks.
C. A ligament that runs along the anterior border of the epidural space, preventing anterior spread of medications.
D. A vascular plexus that drains blood from the spinal cord and is located laterally in the epidural space.
Answer: B. A connective tissue band that may exist between the ligamentum flavum and the dura mater, potentially causing unilateral blocks.
What is the primary target space when performing a spinal anesthetic procedure?
A) Epidural space
B) Subarachnoid space
C) Subdural space
D) Interspinous ligament
Answer: B - Subarachnoid space
Rationale: The subarachnoid space, also known as the intrathecal space, is the primary target for spinal anesthesia as it contains cerebrospinal fluid (CSF), nerve roots, and the spinal cord itself.
What sensation is typically felt during spinal anesthesia when the needle passes through the dura mater?
A) Sharp pain
B) No sensation
C) A characteristic “pop”
D) Tingling in the legs
Answer: C - A characteristic “pop”
Rationale: The “pop” sensation is commonly felt when the needle pierces the dura mater, indicating entry into the subarachnoid space.
What are the key contents of the subarachnoid space?
A) Fat and small blood vessels
B) Cerebrospinal fluid (CSF), nerve roots, and the spinal cord
C) Lymphatic vessels and adipose tissue
D) Only cerebrospinal fluid (CSF)
Answer: B - Cerebrospinal fluid (CSF), nerve roots, and the spinal cord
Rationale: The subarachnoid space contains cerebrospinal fluid (CSF), nerve roots, and the spinal cord, which are crucial for the proper functioning of the central nervous system.
What could potentially happen if the needle is advanced too far anteriorly during a spinal anesthetic procedure?
A) It could cause an epidural hematoma
B) It could pass through several layers including the pia mater, spinal cord, and posterior longitudinal ligament before reaching bone
C) It could result in a unilateral block
D) It could get lodged in the interspinous ligament
Answer: B - It could pass through several layers including the pia mater, spinal cord, and posterior longitudinal ligament before reaching bone
Rationale: Advancing the needle too far anteriorly can cause it to pass through multiple layers, potentially leading to serious complications by damaging the spinal cord and associated structures.
What can happen if local anesthetic is inadvertently injected into the subdural space during an epidural procedure?
a) Failed spinal block
b) High spinal effect
c) Increased blood pressure
d) No effect
Answer: b) High spinal effect
Rationale: If local anesthetic is inadvertently injected into the subdural space during an epidural, it can cause a “high spinal” effect, meaning the medication affects a larger area than intended.
What is the result of an accidental injection into the subdural space during spinal anesthesia?
a) Enhanced anesthesia
b) Failed spinal block
c) Prolonged anesthesia
d) No effect
Answer: b) Failed spinal block
Rationale: An accidental injection into the subdural space during spinal anesthesia can result in a failed spinal block due to improper delivery of the anesthetic.
What is the primary role of the dura mater?
A) It directly covers the spinal cord.
B) It acts as a middle protective layer between other meningeal layers.
C) It is a tough fibrous shield that protects the spinal cord.
D) It contains cerebrospinal fluid (CSF) and nerve roots.
Answer:
C) It is a tough fibrous shield that protects the spinal cord.
Rationale:
The dura mater is the outermost layer of the meninges and serves as a tough fibrous shield that protects the spinal cord. It starts at the foramen magnum and extends down to the dural sac.
Which meningeal layer lies directly beneath the dura mater?
A) Pia mater
B) Arachnoid mater
C) Subarachnoid space
D) Epidural space
Answer:
B) Arachnoid mater
Rationale:
The arachnoid mater is the second meningeal layer, situated directly beneath the dura mater. It acts as a protective middle layer between the dura mater and the pia mater.
What is the significance of the pia mater in spinal anesthesia procedures?
A) It should be punctured during the procedure.
B) It is a potential space.
C) It directly covers the spinal cord and should never be punctured.
D) It acts as the primary target for spinal anesthesia.
Answer:
C) It directly covers the spinal cord and should never be punctured.
Rationale:
The pia mater is the innermost meningeal layer that is highly vascular and directly attached to the surface of the spinal cord. It should never be punctured during spinal anesthesia procedures to avoid damaging the spinal cord.
How many pairs of spinal nerves are there in the human body?
a) 32
b) 29
c) 31
d) 33
Correct Answer: c) 31
Rationale: The human body has 31 pairs of spinal nerves.
Which of the following is true about the C8 nerve?
a) It exits above the C8 vertebra
b) It exits below the C7 vertebra
c) It exits above the C7 vertebra
d) It exits below the C8 vertebra
Correct Answer: b) It exits below the C7 vertebra
Rationale: The C8 nerve is unique because it exits below the C7 vertebra. The rest exit below from that point.
What type of information does the anterior (ventral) nerve root carry?
a) Sensory information from the body to the spinal cord
b) Motor and autonomic information from the spinal cord to the body
c) Sensory and motor information to the body
d) Autonomic and sensory information from the body to the spinal cord
Correct Answer: b) Motor and autonomic information from the spinal cord to the body
Rationale: The anterior (ventral) nerve root is responsible for carrying motor and autonomic information from the spinal cord to the body.
Which of the following nerves is not correctly paired with its corresponding vertebrae?
a) C1 nerve exits above the C1 vertebra
b) C2 nerve exits above the C2 vertebra
c) C7 nerve exits below the C7 vertebra
d) C8 nerve exits below the C7 vertebra
Correct Answer: c) C7 nerve exits below the C7 vertebra
Rationale: The C1 to C7 nerves exit above their corresponding vertebrae, with the C8 nerve exiting below the C7 vertebra.
12 thoracic nerves
5 lumbar
5 sacral
1 coccygeal
What is a dermatome?
a) A nerve that controls muscle movement
b) An area of skin that receives sensory nerves from a single spinal nerve root
c) A bone in the spinal column
d) A blood vessel in the spinal cord
Correct Answer: b) An area of skin that receives sensory nerves from a single spinal nerve root
Rationale: A dermatome is defined as an area of skin that receives sensory nerves from a single spinal nerve root.
Which spinal nerve serves the umbilicus (belly button) area?
a) L3
b) T10
c) S1
d) C5
Correct Answer: b) T10
Rationale: The umbilicus (belly button) area is actually served by the T10 nerve.
Which of the following statements about dermatomes and spinal nerves is correct?
a) Dermatomes are aligned with the vertebrae of the spine
b) Each dermatome is served by multiple spinal nerve roots
c) A dermatome may appear to align with one part of the spine but is connected to a different spinal nerve root
d) The spinal nerves serving dermatomes are responsible for motor control only
Correct Answer: c) A dermatome may appear to align with one part of the spine but is connected to a different spinal nerve root
Rationale: Although a dermatome may physically appear to align with a certain part of the spine, it is actually connected to a different spinal nerve root.
For a surgical procedure planned around the level of the nipples, which spinal nerve should the block target?
a) T4
b) T10
c) L1
d) S1
Correct Answer: a) T4
Rationale: The area at the level of the nipples is served by the T4 nerve, so the block should target the T4 spinal nerve.
Which cranial nerve is responsible for the sensory innervation of the face?
a) Cranial Nerve II
b) Cranial Nerve V
c) Cranial Nerve VII
d) Cranial Nerve IX
Correct Answer: b) Cranial Nerve V
Rationale: The sensory information from the face is transmitted through the trigeminal nerve, which is Cranial Nerve V.
What is the primary function of the V1 branch of the trigeminal nerve?
a) Sensory input from the lower jaw and teeth
b) Sensory input from the forehead, scalp, and upper eyelids
c) Sensory input from the cheeks and upper lip
d) Motor function for facial expressions
Correct Answer: b) Sensory input from the forehead, scalp, and upper eyelids
Rationale: The V1 branch, also known as the ophthalmic nerve, handles sensation from the forehead, scalp, and upper eyelids.
The V2 branch of the trigeminal nerve is responsible for sensory input from which areas?
a) Forehead, scalp, and upper eyelids
b) Lower jaw, lower teeth, and part of the tongue
c) Lower eyelids, cheeks, nostrils, upper lip, and upper teeth
d) Paranasal sinuses and upper face
Correct Answer: c) Lower eyelids, cheeks, nostrils, upper lip, and upper teeth
Rationale: The V2 branch, also known as the maxillary nerve, is responsible for sensory input from the lower eyelids, cheeks, nostrils, upper lip, and upper teeth.
Which of the following branches of the trigeminal nerve also has a motor function?
a) V1 - Ophthalmic Nerve
b) V2 - Maxillary Nerve
c) V3 - Mandibular Nerve
d) None of the above
Correct Answer: c) V3 - Mandibular Nerve
R
ationale: The V3 branch, also known as the mandibular nerve, conveys sensations from the lower jaw, lower teeth, lower lip, and part of the tongue, and it also has a motor function for the muscles of mastication. mylohyoid m.
Which dermatome level is targeted for peri-anal or anal surgery, commonly referred to as a “saddle block”?
a) S2-S5
b) T10
c) L2
d) T8
Correct Answer: a) S2-S5
Rationale: The dermatome level S2-S5 is targeted for peri-anal or anal surgery, known as a “saddle block.”
For a foot or ankle surgery, which dermatome level should be blocked?
a) S2
b) L1
c) T6
d) L2
Correct Answer: d) L2
Rationale: The dermatome level L2 is appropriate for blocking during foot or ankle surgery.
A patient undergoing a cesarean section should have which dermatome level blocked?
a) T10
b) L1
c) T4
d) T8
Correct Answer: c) T4
Rationale: The dermatome level T4 is targeted for a cesarean section or upper abdominal procedures.
Which dermatome level corresponds to a vaginal delivery or uterine procedure?
a) L2
b) S3
c) T10
d) T6
Correct Answer: c) T10
Rationale: The dermatome level T10 is used for vaginal delivery, uterine procedures, hip procedures, tourniquet, and TURP (transurethral resection of the prostate).
Testicular Procedure dermatome?
T8
What is the primary target of the local anesthetic (LA) in spinal anesthesia?
a) Postganglionic fibers
b) Myelinated preganglionic fibers of the spinal nerve roots
c) Sympathetic ganglia
d) Dorsal root ganglion (DRG)
Correct Answer: b) Myelinated preganglionic fibers of the spinal nerve roots
Rationale: In spinal anesthesia, the local anesthetic acts on the myelinated preganglionic fibers of the spinal nerve roots and inhibits neural transmission in the superficial layers of the spinal cord.
In the context of epidural anesthesia, what is the process by which the local anesthetic (LA) reaches the nerve roots?
a) Direct injection into the nerve roots
b) Diffusion through the dural cuff
c) Infiltration of the spinal cord directly
d) Absorption through the bloodstream
Correct Answer: b) Diffusion through the dural cuff
Rationale: In epidural anesthesia, the local anesthetic diffuses through the dural cuff to reach the nerve roots.
What is a potential complication related to the leakage of the local anesthetic (LA) in epidural anesthesia?
a) Infiltration of the cerebrospinal fluid
b) Blockade of postganglionic fibers
c) Leakage into the paravertebral area through the intervertebral foramen
d) Absorption by the paraspinal muscles
Correct Answer: c) Leakage into the paravertebral area through the intervertebral foramen
Rationale: The local anesthetic can leak through the intervertebral foramen into the paravertebral area, potentially affecting surrounding structures.
Which of the following factors does NOT affect the spread of local anesthetic in the spinal or epidural space?
a) Patient position
b) Dose
c) Barbotage
d) Site of injection
Correct Answer: c) Barbotage
Rationale: Barbotage (repeated aspiration and reinjection of CSF) does not affect the spread of local anesthetic, although it may influence the procedure duration.
Why is dose considered crucial when using a hypo- or isobaric solution for local anesthesia?
a) It determines the patient’s position during the procedure
b) It affects how far and wide the anesthetic spreads
c) It correlates with the patient’s age
d) It is related to the volume of CSF
Correct Answer: b) It affects how far and wide the anesthetic spreads
Rationale: Dose is the most reliable factor affecting the spread of anesthetic when using hypo- or isobaric solutions.
Which of the following is a non-controllable factor that affects the spread of local anesthetic in the spinal space?
a) Patient position
b) Baricity
c) Increased intra-abdominal pressure
d) Site of injection
Correct Answer: c) Increased intra-abdominal pressure
Rationale: Increased intra-abdominal pressure due to conditions like obesity, pregnancy, or ascites is a non-controllable factor that affects the spread of local anesthetic.
In patients with decreased cerebrospinal fluid (CSF) volume, what adjustment should be made to the dose of local anesthetic?
a) Increase the dose
b) Decrease the dose
c) Maintain the same dose
d) Switch to a different anesthetic
Correct Answer: b) Decrease the dose
Rationale: In patients with decreased CSF volume, such as those who are elderly, pregnant, or have obesity or ascites, the dose of local anesthetic should be lowered to prevent excessive spread of the block.
What is the most important procedure-related factor affecting the spread of local anesthetic in epidural anesthesia?
a) Speed of injection
b) Patient height
c) Level of injection
d) Addition of vasoconstrictors
Correct Answer: c) Level of injection
Rationale: The level of injection is the most important procedure-related factor for determining the spread of the anesthetic.
Which factor does NOT significantly affect the spread of local anesthetic in epidural anesthesia?
a) Additives in the anesthetic
b) Local anesthetic volume
c) Local anesthetic dose
d) Pregnancy
Correct Answer: a) Additives in the anesthetic
Rationale: Additives in the anesthetic may change the onset time or duration but do not significantly affect the spread.
For pain medication administered through the epidural, what is the typical drip rate in cc per hour?
a) 2-4 cc
b) 5-7 cc
c) 8-12 cc
d) 15-20 cc
Correct Answer: c) 8-12 cc
Rationale: The typical drip rate for pain medication through an epidural is 8-12 cc per hour.
In the lumbar region, how does the local anesthetic spread in epidural anesthesia?
a) Mostly spreads caudad
b) Mostly spreads cephalad
c) Spreads equally caudad and cephalad
d) Does not spread significantly
Correct Answer: b) Mostly spreads cephalad
Rationale: In the lumbar region, the local anesthetic mostly spreads cephalad.
When administering an epidural block for a procedure, what is the recommended dose per segment?
a) 0.5-1 mL
b) 1-2 mL
c) 2-4 mL
d) 4-6 mL
Correct Answer: b) 1-2 mL
Rationale: The recommended dose per segment for an epidural block is 1-2 mL.
Which nerve fiber type is characterized by heavy myelination and is responsible for motor function and proprioception?
a) Aα (alpha)
b) Aβ (beta)
c) Aγ (gamma)
d) C
Correct Answer: a) Aα (alpha)
Rationale: Aα (alpha) fibers are heavily myelinated and are responsible for skeletal muscle motor function and proprioception.
Which nerve fiber subtype has the fastest conduction velocity and is blocked fourth in sequence during anesthesia?
a) Aδ (delta)
b) B
c) Aα (alpha)
d) C
Correct Answer: c) Aα (alpha)
Rationale: Aα (alpha) fibers have the fastest conduction velocity (++++) and are blocked fourth in sequence.
What is the primary function of Aγ (gamma) nerve fibers?
a) Fast pain and temperature sensation
b) Skeletal muscle tone
c) Touch and pressure sensation
d) Preganglionic ANS fibers
Correct Answer: b) Skeletal muscle tone
Rationale: Aγ (gamma) fibers are medium myelinated and are responsible for skeletal muscle tone.
Which nerve fibers are typically blocked first during the onset of anesthesia?
a) Aα (alpha)
b) Aδ (delta)
c) B
d) C
Correct Answer: c) B
Rationale: B fibers, which are lightly myelinated and serve preganglionic autonomic functions, are typically blocked first.
Which type of nerve fibers are associated with postganglionic autonomic nervous system (ANS) functions and have the second onset of block during anesthesia?
a) Aα (alpha)
b) Aβ (beta)
c) B
d) C
Correct Answer: d) C
Rationale: C fibers, which are unmyelinated and associated with postganglionic ANS functions, have the second onset of block during anesthesia.
At lower concentrations of local anesthetic (LA) than needed for motor blockage, which type of blockade occurs?
a) Motor blockade
b) Sensory blockade
c) Complete neural blockade
d) Autonomic blockade
e) both b & d
e) both b & d
rationale: sensory blockade occurs at a lower concentration than that of a motor blockade and autonomic at even lower concentrations.
Which of the following is a sign that the local anesthetic has affected the autonomic function during a spinal anesthesia procedure?
a) Muscle spasm
b) Hypotension and bradycardia
c) Increased heart rate
d) Sensory loss in the lower extremities
Correct Answer: b) Hypotension and bradycardia
Rationale: The first indication that local anesthetic has affected autonomic function is hypotension and bradycardia, which means the autonomic preganglionic fibers are blocked.
Which fibers are responsible for fast pain and temperature sensation and are typically affected third during a block?
a) Aα (alpha) fibers
b) Aβ (beta) fibers
c) Aγ (gamma) fibers
d) Aδ (delta) fibers
Correct Answer: d) Aδ (delta) fibers
Rationale: Aδ (delta) fibers are responsible for fast pain and temperature sensation and are typically affected third during a block.
Which type of nerve fibers require the highest concentration of local anesthetic to achieve a block?
a) B fibers
b) C fibers
c) Aα (alpha) fibers
d) Aδ (delta) fibers
Correct Answer: c) Aα (alpha) fibers
Rationale: Aα (alpha) fibers, which are responsible for motor function and proprioception, require the highest concentration of local anesthetic to achieve a block.
In the context of differential blockade, how much higher is the sensory block level compared to the motor block level?
a) 1 level
b) 2 levels
c) 4 levels
d) 6 levels
Correct Answer: b) 2 levels
Rationale: The sensory block level is 2 levels higher than the motor block level.
What is the difference in levels between the sympathetic block and the sensory block in a differential blockade?
a) 1-2 levels
b) 2-4 levels
c) 2-6 levels
d) 4-6 levels
Correct Answer: c) 2-6 levels
Rationale: The sympathetic block level is 2-6 levels higher than the sensory block level.
Which type of blockade occurs at the lowest concentrations of local anesthetic, affecting neither sensory nor motor neurons?
a) Motor blockade
b) Sensory blockade
c) Autonomic blockade
d) Complete neural blockade
Correct Answer: c) Autonomic blockade
Rationale: Autonomic blockade occurs at the lowest concentrations of local anesthetic, affecting neither sensory nor motor neurons. (highest blockade)
If a patient has a sensory block at T10, at which level would you expect the motor block to occur?
a) T8
b) T10
c) T12
d) L1
Correct Answer: c) T12
Rationale: If the sensory block is at T10, the motor block would occur 2 levels lower, at T12.
Why is it important to anticipate treatment for symptoms when the sensory block is at T10?
a) T10 affects respiratory function
b) Possible affects on cardiac accelerators
c) The motor block is too high
d) It does not have any significant impact
Correct Answer: b) Possible affects on cardiac accelerators
Rationale: The T1-T4 levels include the cardiac accelerators, and blocking these levels can decrease heart rate and blood pressure. If the sensory block is at T10, it’s important to anticipate and treat symptoms related to this bc autonomic functions can be impacted as high as 6 levels from sensory; thus reaching T4.
During the nerve block onset, which fibers are responsible for the loss of pain and temperature sensation?
a) Aα (alpha) and Aβ (beta)
b) Aγ (gamma) and Aβ (beta)
c) C and Aδ (delta)
d) B and Aγ (gamma)
Correct Answer: c) C and Aδ (delta)
Rationale: C and Aδ (delta) fibers are responsible for the loss of pain and temperature sensation during the onset of a nerve block.
In what order does nerve block recovery occur for the following fibers: B, Aα (alpha), C?
a) C → Aα (alpha) → B
b) Aα (alpha) → C → B
c) B → Aα (alpha) → C
d) B → C → Aα (alpha)
Correct Answer: b) Aα (alpha) → C → B
Rationale: During recovery from a nerve block, motor function (Aα fibers) comes back first, followed by sensory (C fibers), and B fibers are blocked the longest and recover last.
Which nerve fibers are associated with the loss of touch and pressure during a nerve block?
a) Aα (alpha)
b) Aβ (beta)
c) Aγ (gamma)
d) C fibers
Correct Answer: b) Aβ (beta)
Rationale: Aβ (beta) fibers are associated with the loss of touch and pressure during a nerve block.
What is the last fiber type to recover after a nerve block?
a) Aα (alpha)
b) Aβ (beta)
c) C fibers
d) B fibers
Correct Answer: d) B fibers
Rationale: B fibers are blocked the longest and are the last to recover after a nerve block.
Which sense is the first to be blocked when monitoring a sensory block?
a) Pain
b) Touch
c) Temperature
d) Pressure
Correct Answer: c) Temperature
Rationale: Temperature is the first sense to be blocked; for example, the patient may not feel cold from an alcohol pad.
What is the second sense to be blocked during sensory block monitoring?
a) Pressure
b) Temperature
c) Pain
d) Touch
Correct Answer: c) Pain
Rationale: Pain is the second sense to be blocked, which can be assessed using stimuli like a pinprick.
What is the last sense to be blocked during sensory block monitoring?
a) Temperature
b) Pain
c) Touch
d) Proprioception
Correct Answer: c) Touch
Rationale: Touch or pressure is the last sense to be blocked, involving light touch or pressure sensation.
According to the Modified Bromage Scale, what does a score of 2 indicate?
a) No motor block
b) Slight motor block
c) Moderate motor block
d) Complete motor block
Correct Answer: c) Moderate motor block
Rationale: A score of 2 on the Modified Bromage Scale indicates a moderate motor block where the patient cannot raise an extended leg or move the knee but can move the feet.
0: No motor block.
1: Slight motor block. The patient cannot raise an extended leg but can still move the knees and feet.
2: Moderate motor block. The patient cannot raise an extended leg or move the knee but can move the feet.
3: Complete motor block. The patient cannot move the legs, knees, or feet
What is the primary concern for transferring a patient from the Post Anesthesia Care Unit (PACU) regarding motor function?
a) Ensuring complete motor block
b) Ensuring the patient is awake
c) Ensuring motor function return
d) Ensuring the patient has no pain
Correct Answer: c) Ensuring motor function return
Rationale: The primary concern for transferring a patient from the PACU is ensuring the return of motor function.
Which level of motor block is typically desired for surgical procedures according to the Modified Bromage Scale?
a) 0-1
b) 1-2
c) 2-3
d) 0-3
Correct Answer: c) 2-3
Rationale: For surgical procedures, a level 3 (complete motor block) or possibly level 2 (moderate motor block) is typically desired to ensure adequate anesthesia.
What is the primary cause of decreased preload in patients under neuraxial anesthesia?
a) Increased heart rate
b) Vasoconstriction
c) Sympathectomy causing venous dilation and blood pooling
d) Increased cardiac output
Correct Answer: c) Sympathectomy causing venous dilation and blood pooling
Rationale: Sympathectomy causes veins to dilate, leading to blood pooling in the periphery and reducing the blood returning to the heart, thereby decreasing preload.
In elderly or cardiac patients, how much can systemic vascular resistance (SVR) decrease due to neuraxial anesthesia?
a) 5%
b) 10%
c) 15%
d) 25%
Correct Answer: d) 25%
Rationale: In elderly or cardiac patients, SVR can decrease by up to 25%.
What is the initial response of cardiac output (CO) to neuraxial anesthesia, and how does it change over time?
a) Initially increases, then decreases
b) Initially decreases, then increases
c) Remains constant
d) Decreases gradually
Correct Answer: a) Initially increases, then decreases
Rationale: Cardiac output may initially increase due to changes in blood vessel dilation speeds, but it eventually decreases over time. Due to reduced SNS tone.
Why is ondansetron given to manage the Bezold-Jarisch reflex?
a) It increases heart rate
b) It decreases stroke volume
c) It blocks 5-HT3 receptors involved in the reflex
d) It enhances sympathetic tone
Correct Answer: c) It blocks 5-HT3 receptors involved in the reflex
Rationale: Ondansetron is given because the Bezold-Jarisch reflex is mediated by 5-HT3 receptors in the vagus nerve and ventricular myocardium, and blocking these receptors helps manage the reflexive bradycardia and prevent potential asystole.
What cardiovascular effect is associated with the activation of the Bezold-Jarisch reflex during neuraxial anesthesia?
a) Hypertension
b) Tachycardia
c) Bradycardia and potential asystole
d) Increased cardiac output
Correct Answer: c) Bradycardia and potential asystole
Rationale: The Bezold-Jarisch reflex can cause significant bradycardia and potentially lead to asystole due to ventricular underfilling.
What is the effect of the reverse Bainbridge reflex?
a) Increases heart rate by 15-20 beats per minute
b) Decreases heart rate by 15- 20 beats per minute
c) Increases systemic vascular resistance
d) Decreases cardiac output
Correct Answer: b) Decreases heart rate by 15-20 beats per minute
Rationale: The reverse Bainbridge reflex triggers a decrease in heart rate by approximately 20 beats per minute due to reduced stretching of the heart’s right atrium. (theory)
What can result from unopposed parasympathetic tone to the cardioaccelerator fibers during neuraxial anesthesia?
a) Hypertension and tachycardia
b) Bradycardia, hypotension, and sudden cardiac arrest
c) Increased cardiac output
d) Increased systemic vascular resistance
Correct Answer: b) Bradycardia, hypotension, and sudden cardiac arrest
Rationale: Unopposed parasympathetic tone to the cardioaccelerator fibers can result in profound bradycardia, hypotension, and sudden cardiac arrest.
In which demographic is sudden cardiac arrest more commonly seen due to high parasympathetic tone?
a) Elderly patients
b) Children
c) Young adults
d) Middle-aged adults
Correct Answer: c) Young adults
Rationale: Sudden cardiac arrest can be seen in young adults with high parasympathetic tone.
What is the incidence rate of sudden cardiac arrest during spinal anesthesia?
a) 1:1,000
b) 1:10,000
c) 7:10,000
d) 7:1,000
Correct Answer: c) 7:10,000
Rationale: The incidence rate of sudden cardiac arrest during spinal anesthesia is 7:10,000.
How long after the onset of spinal anesthesia can sudden cardiac arrest typically occur?
a) 10-20 minutes
b) 20-60 minutes
c) 1-2 hours
d) 2-4 hours
Correct Answer: b) 20-60 minutes
Rationale: Sudden cardiac arrest can typically occur 20-60 minutes after the onset of spinal anesthesia.
What treatment is recommended for hypotension with high heart rate during neuraxial anesthesia?
a) Ephedrine
b) Ondansetron
c) Phenylephrine
d) Atropine
Correct Answer: c) Phenylephrine (1mL)..
Rationale: For hypotension with a high heart rate, phenylephrine is recommended to decrease the heart rate and increase blood pressure .. Wait until HR goes down to take BP.. opposite with ephedrine.
What systolic blood pressure threshold indicates the need to treat hypotension during neuraxial anesthesia?
a) 120 mmHg
b) 100 mmHg
c) 90 mmHg
d) 80 mmHg
Correct Answer: d) 80 mmHg
Rationale: Treatment for hypotension is generally considered necessary when the systolic blood pressure drops to around 80 mmHg. Monitoring trends and being proactive in managing hypotension is crucial.
What role do vasopressors like phenylephrine play in preventing spinal-anesthesia induced hypotension?
a) They decrease heart rate
b) They constrict blood vessels to maintain blood pressure
c) They increase blood volume
d) They block pain receptors
Correct Answer: b) They constrict blood vessels to maintain blood pressure
Rationale: Vasopressors like phenylephrine help maintain blood pressure by constricting blood vessels.
How do 5-HT3 antagonists like ondansetron help in managing hypotension related to spinal anesthesia?
a) They increase heart rate
b) They mitigate reflexes that cause hypotension, such as the Bezold-Jarisch reflex
c) They constrict blood vessels
d) They increase stroke volume
Correct Answer: b) They mitigate reflexes that cause hypotension, such as the Bezold-Jarisch reflex
Rationale: Drugs like ondansetron can mitigate reflexes that cause hypotension, such as the Bezold-Jarisch reflex mediated by the vagus nerve.
What is the recommended approach to fluid management during spinal anesthesia to prevent hypotension?
a) Pre-block hydration with 1-2 liters of fluids
b) Co-loading with intravenous fluids right after the spinal block
c) Avoiding all intravenous fluids
d) Administering fluids only if hypotension occurs
Correct Answer: b) Co-loading with intravenous fluids right after the spinal block
Rationale: Co-loading with intravenous fluids (around 15 mL/kg) right after the spinal block is effective in preventing drops in blood pressure.
Why should excessive fluids be avoided in patients with heart problems during spinal anesthesia?
a) They can increase heart rate excessively
b) They can overload the circulatory system
c) They can cause vasoconstriction
d) They can lead to dehydration
Correct Answer: b) They can overload the circulatory system
Rationale: Excessive fluid can overload the circulatory system, especially in patients with heart problems.
What is a key preventive method for optimizing blood flow and reducing risks during spinal anesthesia?
a) Administering vasoconstrictors
b) Adjusting the patient’s position
c) Pre-block hydration
d) Increasing fluid intake
Correct Answer: b) Adjusting the patient’s position
Rationale: Adjusting the patient’s position, such as slight pelvic tilting, can optimize blood flow and reduce risks
Why is Trendelenburg positioning not recommended with hyperbaric spinal anesthesia?
a) It can increase the risk of aspiration
b) It can cause excessive sedation
c) It affects the cardiac accelerators negatively
d) It leads to vasodilation
Correct Answer: c) It affects the cardiac accelerators negatively
Rationale: Trendelenburg positioning is not recommended with hyperbaric spinal anesthesia because it can negatively affect the cardiac accelerators.
What is the role of atropine in the treatment of spinal-anesthesia induced hypotension?
a) Vasoconstriction
b) Fluid management
c) Treatment of bradycardia
d) Increasing stroke volume
Correct Answer: c) Treatment of bradycardia
Rationale: Atropine may be used if the patient is experiencing bradycardia.
Which type of fluids should be administered first to maintain adequate blood volume during spinal anesthesia?
a) Crystalloids
b) Colloids
c) Blood products
d) Hypertonic solutions
Correct Answer: a) Crystalloids
Rationale: Crystalloids should be administered first to maintain adequate blood volume.
Why should colloids be used cautiously in fluid management during spinal anesthesia?
a) They are less effective than crystalloids
b) They can cause renal issues
c) They increase the risk of hypertension
d) They do not increase blood volume
Correct Answer: b) They can cause renal issues
Rationale: Colloids can cause renal issues and should be used cautiously.
What is a potential risk of using a >20-degree tilt in the Trendelenburg position?
a) Increased cardiac output
b) Reduced cerebral perfusion
c) Increased heart rate
d) Enhanced block effectiveness
Correct Answer: b) Reduced cerebral perfusion
Rationale: Using a >20-degree tilt can reduce cerebral perfusion because the tilt can reduce venous brain drainage.
Why should position adjustments be made cautiously before the block is set during spinal anesthesia?
a) To avoid increasing block height due to gravity
b) To enhance fluid absorption
c) To prevent nausea and vomiting
d) To improve patient comfort
Correct Answer: a) To avoid increasing block height due to gravity
Rationale: If the block is not set yet, position adjustments can influence the block height due to gravity, potentially increasing it.
What impact does a high thoracic level (T4) dermatome spread of local anesthetic have on tidal volume and arterial blood gases (ABG)?
a) Tidal volume increases, ABG decreases
b) Tidal volume decreases, ABG remains unchanged
c) Tidal volume and ABG remain unchanged
d) Tidal volume remains unchanged, ABG decreases
Correct Answer: c) Tidal volume and ABG remain unchanged
Rationale: Even with high thoracic level (T4) spread of local anesthetic, tidal volume and ABG remain unchanged.
Which pulmonary function is decreased due to the loss of abdominal muscle contribution in forced expiration?
a) Tidal volume
b) Inspiratory reserve volume
c) Expiratory reserve volume (ERV)
d) Total lung capacity
Correct Answer: c) Expiratory reserve volume (ERV)
Rationale: The loss of abdominal muscle contribution in forced expiration results in a decrease in ERV.
Why should caution be used in patients with COPD or Pickwickian syndrome during neuraxial anesthesia?
a) They are at risk of hypertension
b) They may experience increased tidal volume
c) They are at higher risk of dyspnea and panic
d) They have a higher risk of renal issues
Correct Answer: c) They are at higher risk of dyspnea and panic
Rationale: Patients with COPD or Pickwickian syndrome may experience feelings of dyspnea and panic due to loss of sensory feedback from the chest area.
What is a common cause of apnea during neuraxial anesthesia?
a) High concentrations of local anesthetics
b) Reduced blood flow to the brainstem
c) Increased tidal volume
d) Increased blood pressure
Correct Answer: b) Reduced blood flow to the brainstem
Rationale: Apnea is typically due to reduced blood flow to the brainstem, affecting the brain’s breathing centers.
What advice should be given to patients experiencing dyspnea due to a high thoracic blockade during neuraxial anesthesia?
a) They should be given sedatives
b) They will be fine and can raise the head of the bed a bit
c) They should hold their breath
d) They should lie completely flat
Correct Answer: b) They will be fine and can raise the head of the bed a bit
Rationale: Reassuring patients that they will be fine and raising the head of the bed a bit can help alleviate dyspnea caused by a high thoracic blockade. (maybe a little nasal cannula)
Under what conditions could high concentrations of local anesthetics in the spinal fluid rarely cause nerve paralysis that stops breathing?
a) If the patient is hypertensive
b) If the block spreads very high and affects the phrenic nerve
c) If the patient is dehydrated
d) If the patient is sedated
Correct Answer: b) If the block spreads very high and affects the phrenic nerve
Rationale: High concentrations of local anesthetics in the spinal fluid can rarely cause nerve paralysis that stops breathing if the block spreads very high and affects the phrenic nerve.
What nerve primarily mediates parasympathetic innervation to the GI tract?
a) Phrenic nerve
b) Vagus nerve
c) Sciatic nerve
d) Splanchnic nerve
Correct Answer: b) Vagus nerve
Rationale: Parasympathetic innervation to the GI tract is primarily mediated via the vagus nerve, which originates in the medulla.
Which sensations are transmitted by parasympathetic afferent fibers to the GI tract?
a) Pain and temperature
b) Satiety, distension, and nausea
c) Touch and pressure
d) Motor control and proprioception
Correct Answer: b) Satiety, distension, and nausea
Rationale: Parasympathetic afferent fibers transmit sensations of satiety, distension, and nausea.
What effect do parasympathetic efferent fibers have on the GI tract?
a) Inhibit peristalsis and gastric secretion
b) Transmit visceral pain
c) Promote tonic contractions, sphincter relaxation, peristalsis, and secretion
d) Cause sphincter contraction and vasoconstriction
Correct Answer: c) Promote tonic contractions, sphincter relaxation, peristalsis, and secretion
Rationale: Parasympathetic efferent fibers promote tonic contractions, sphincter relaxation, peristalsis, and secretion.
From which spinal levels does the sympathetic innervation of the GI tract originate?
a) T1-T4
b) T2-T6
c) T5-L2
d) L1-L4
Correct Answer: c) T5-L2
Rationale: Sympathetic innervation of the GI tract stems from T5-L2.
What is the primary role of sympathetic afferent fibers in the GI tract?
a) Transmit visceral pain
b) Promote peristalsis and secretion
c) Inhibit sphincter contraction
d) Enhance vasodilation
Correct Answer: a) Transmit visceral pain
Rationale: Sympathetic afferent fibers in the GI tract transmit visceral pain.
From which spinal levels does the sympathetic innervation of the stomach originate?
a) T4 and T5
b) T8
c) T10
d) T11-L1
Correct Answer: b) T8
Rationale: The sympathetic innervation of the stomach originates from the T8 spinal level.
Which organs are innervated by sympathetic fibers originating from the T10-L1 spinal levels?
a) Heart and liver
b) Kidney and testes
c) Small intestine and colon
d) Diaphragm and esophagus
Correct Answer: b) Kidney and testes
Rationale: The kidney and testes are innervated by sympathetic fibers originating from the T10-L1 spinal levels.
What is the effect of neuraxial anesthesia on sympathetic tone in GI?
a) Increases sympathetic tone
b) Reduces sympathetic tone
c) No effect on sympathetic tone
d) Alters sympathetic tone unpredictably
Correct Answer: b) Reduces sympathetic tone
Rationale: Local anesthetics used in neuraxial blocks decrease the activity of sympathetic nerves, thereby reducing sympathetic tone.
