Regional

Question 1

What nerves need to be blocked for an awake intubation?

Answer 1

Glossopharyngeal (IX) and vagus (X)

Question 1

What branch of the glossopharyngeal nerve can be blocked (invasive) for awake intubation and how?

Answer 1

Lingual branch; using needle to inject local at the junction of the base of the tongue and the glossopalatine arch (near tonsillar pillars)

Question 1

What does the glossopharyngeal nerve innervate?

Answer 1

Posterior 1/3 of tongue, the vallecula, and the ant surface of the epiglottis (lingual); walls of the pharynx (pharyngeal); tonsils (tonsillar)

Question 2

What structures does the internal SLN innervate?

Answer 2

Base of tongue, posterior epiglottis, aryepiglottic fold, arytenoids (internal); cricothyroid muscle (external)

Question 3

Where is the SLN block performed?

Answer 3

2-4 mm inferior and lateral to the greater cornu of the hyoid bone where it pierces the thyrohyoid membrane

Question 4

Describe non-invasive SLN block approach

Answer 4

Local-soaked pledgets placed into piriform fossae

Question 5

What does the RLN innervate? How is it blocked?

Answer 5

Vocal cords, trachea and all muscles of larynx except for cricothyroid; locate cricothyroid membrane and place needle perpendicular to axis of trachea

Question 6

What do the greater and lesser palatine nerves innervate?

Answer 6

Nasal turbinates and posterior 2/3 of nasal septum

Question 7

How can the palatine nerves be blocked (non-invasive)?

Answer 7

Local-soaked pledgets passed along upper border of middle turbinate to posterior wall o nasopharynx (origin of both nerves at pterygopalatine ganglion

Question 8

How can the palatine nerves be blocked (invasive)?

Answer 8

Inject local 1 cm medial to junction of 2nd and 3rd molar (greater palatine foramen into pterygopalatine ganglion fossa)

Question 9

What does the cricothyroid muscle do?

Answer 9

Tenses the vocal cords (adduct)

Question 10

Most common symptom of RLN injury?

Answer 10

Hoarseness

Question 11

Which nerve must be blocked for awake tracheostomy?

Answer 11

RLN

Question 12

Where does RLN run? Inadvertently blocked?

Answer 12

Between trachea and esophagus; can inadvertently be blocked with stellate ganglion block

Question 13

What happens with bilateral RLN injury?

Answer 13

Rapid, severe respiratory obstruction

Question 14

How is brachial plexus divided?

Answer 14

Roots, trunks, divisions, cords, branches

Question 15

What roots are in brachial plexus?

Answer 15

Anterior primary divisions of C5-C8, T1; fuse above first rib

Question 16

How many trunks are a part of the brachial plexus? Where do they form?

Answer 16

3 trunks at level of first rib

Question 17

What are divisions?

Answer 17

Each trunk divides into anterior and posterior divisions

Question 18

What happens at the cord level?

Answer 18

Plexus recombined to for 3 cords - medial, lateral, posterior in relation to ____ artery

Question 19

Which cord(s) give rise to flexor nerves?

Answer 19

Medial and lateral

Question 20

Which cord(s) give rise to extensor nerves?

Answer 20

Posterior

Question 21

What gives rise to the median nerve?

Answer 21

Lateral and medial cord

Question 22

What gives rise to the ulnar nerve?

Answer 22

Medial cord

Question 23

What gives rise to the musculocutaneous nerve?

Answer 23

Lateral cord

Question 24

What gives rise to the axillary nerve?

Answer 24

Posterior cord

Question 25

What gives rise to the radial nerve?

Answer 25

Posterior cord -> axillary nerve -> radial nerve

Question 26

Where is median nerve? (axillary)

Answer 26

Above axillary artery

Question 27

Where is ulnar nerve? (axillary)

Answer 27

Below axillary artery

Question 28

Where is axillary vein? (axillary)

Answer 28

Anterior to axillary artery

Question 29

Where is radial nerve? (axillary)

Answer 29

Posterior and inferior to axillary artery

Question 30

Where is interscalene block performed?

Answer 30

At C6, level of the cricoid cartilage between anterior and middle scalenes