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Final Written > Regional and anatomy > Flashcards

Regional and anatomy Flashcards

1
Q

Interscalene block blocks where

A

Shoulder and upper arm

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2
Q

Supraclavicular block blocks what

A

Upper limb distal to shoulder

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3
Q

Functions of larynx

A 
Protects tracheobronchial tree 
Sound production 
Coughing 
Straining 
Modification of respiration
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4
Q

Location of larynx in adults

A

Anterior neck base of tongue to cricoid
C4 to C6

C3 and more anterior in neonates

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5
Q

Larynx cartilages

A

3 unpaired cricoid thyroid epiglottic
3 paired cuneiform, arytenoids, corniculate

Hyoid bone technically not part of larynx

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6
Q

Ligaments of larynx

A

Cricothroid ligament attaches cricoid to thyroid and ends superiority as free margin which thickens and becomes val ligament within true cords

Upper border of quadrangular membrane joins the lateral epiglottis with the arytenoid and corniculate cartilage to form aryepiglottic fold. Free lower margin thick’s and becomes vestibular ligament in false cords

Extrinsic ligaments Ie cricothracheal

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7
Q

Muscles of larynx

A

2 tensor muscles are cricothyroid and vocalist
Cricothyroid causes increased pitch phonation and vocalis anataginises that

Posterior cricoarytenoid is THE vocal cord adductor (closes)

Lateral cricoarytenoid, thryoarytenoid and interarytenoid are vocal cord abductors (open)

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8
Q

Laryngeal Inervation

A

Motor and sensory via branches of vagus nerve

Superior laryngeal nerve two branches external supplies cricothyroid muscle
Internal supplies sensation above cords

Recurrent laryngeal nerve motor to all other intrinsic muscles of larynx and sensation below cords

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9
Q

Injury to laryngeal nerves

A

Injury to superior laryngeal nerve
Hoarseness due to paralysis of cricothyroid (cricothyroid normally increases pitch) is unilateral the other one will compensate over time and voice will return but if bilateral hoarseness permenant

Injury to recurrent laryngeal nerve
Paralysis of abductors (opening) is more than adductors (closing via posterior arytenoids) so will be drawn inwards

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10
Q

Where does recurrent laryngeal loop

A

Right loops under SCA

Left loops under aorta

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11
Q

Blood supply of larynx

A

Superior thyroid artery (branch external carotid artery)

Inferior thyroid artery (branch of right subclavian)

Thyroid IMA artery in 3-10% (branch right common carotid)

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12
Q

Describe nasal cavity

A

Pyramidal structure
Cells squamous anterior ans become columnar with glands posterior
Superior middle and inferior turbinate

Boundaries 
Roof sphenoid and ethmoid 
Lateral medial orbit and maxillary sinus 
Medial septum 
Floor hard palate (maxilla and palatine)
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13
Q

Blood supply to nasal cavity

A

Maxillary artery (external carotid branches)

Sphenopalatine main branch
Facial artery

Veins follow artery and drain into cavernous sinus

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14
Q

Nerve supply of airways

A

V1 branches anterior ethmoidal nerve supplies anterior nasal passage and septum
V2 branches nasal lesser palatine and sphenopalatine gums hard palate and posterior nasal cavity
V3 branches lingual nerve supplies tongue

IX glossopharyngeal is posterior third tongue upper pharynx

X superior laryngeal nerve sensation above cords and cricothyroid

X recurrent laryngeal nerve sensation below cords and intrinsic muscles

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15
Q

Anterior abdominal wall superior inferior lateral

A

Superior is costal ligament and costal margin of 12th rib and xiohisternum

Lateral is lat Dorsi

Inferior is Inguinal ligament

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16
Q

Fasciae layers

A

External oblique
Internal oblique
Transverse abdominus

17
Q

Inner action of anterior abdominal wall

A

T7-t9 above umbilicus
T10 is umbilicus
T11-12 below umbilucus plus minus l1 iliohypogastric and ikioinguinal

18
Q

Indications TAP block

A 
C section 
Open appendix 
Cholecystectomy 
Open inguinal hernia 
Prostate Tommy 
Abdominal hysterectomy
19
Q

Triangle of petit landmarks

A

Inferior iliac crest posterior lat Dorsi anterior external oblique

20
Q

Complications of TAP block

A 
Intrahepatic injections 
Intraperitoneal injection 
Bowel damage 
Transient femoral nerve palsy 
LAST
21
Q

Draw table of bupivaine and lidocaine for

Pka 
Unionised at physiological ph 7.4 
Plasma protein binding 
Elimination half life 
Relative lipid solubility 
Potency
A

Pka bupivicaine 8.1 lidocaine 7.9
Unionised at physiological ph 7.4 bup15% lidocaine 25%
Plasma protein binding bupivaine 95% lidocaine 70%
Elimination half life bupivicaine 160mins lidocaine 100mins
Relative lipid solubility bupivaine 1000 lidocaine 150
Potency bupivaine 8 lidocaine 2

22
Q

LAST effects

A 
Cardiovascular 
Arrhytmias
Hypotension 
Chest pain
Cardiac arrest

Neuro
Agitation
Seizures
Coma

23
Q

Treatment LAST

A

Secure airways
Stop infusions
Intralipid 20% 1.5ml kg (3 boluses 5 mins apart)
Intralipid infusion 15ml kg hr increased to 30

Max dose 12 ml kg

24
Q

Max dose intralipid

A

12 ml kg

25
Q

Side effects of too much intralipid

A

Pancreatitis

Lipidaemia effects in biochemistry

26
Q

Interscalene block for shoulder surgery - how to do

A

Trained assistance IV access and monitoring stop before you block

Position supine head turned to contra lateral side

Interscalene groove (cal rifle, posterior border scm, anterior scalene)

Needle 50mm stimuplex

10-20ml 0.5% Levo

27
Q

Complications of interscalene block

A 
Phrenic nerve 
Recurrent laryngeal nerve injury 
Stella the ganglion and Horner’s 
Rural spread 
Spinal cord damage 
LAST 
Pneumothorax
28
Q

Complications of deck chair position

A

Venous air embolism
Stroke
Brachial plexus injury
Bezold Jarish refresh

29
Q

Benefits of regional techniques on fistula formation

A 
Vasodilation increases fistula flow 
Better surgical outcomes 
Faster maturation time 
Motor block 
Analgesia 
Avoids risks GA
30
Q

Causes of upper limb ischaemia

A 
Venous thromboembolism
AF and arterial embolism 
Dissection 
Trauma 
Iatrogenic 
Vasculitis 
Atherosclerosis
31
Q

Thoracic outlet syndrome

A

Venous arterial nerve symptoms cause by compression or damage of brachial plexus and subclavian vessels as they pass under first rib

32
Q

Treatment thoracic outlet syndrome

A

Physio
Analgesia
Surgery

33
Q

Implications of wrong side block

A 
Wrong side surgery 
Loss trust 
Anxiety 
Pain 
LAST
34
Q

Stop before you block

A

Who check inn
Stop before needle check mark, confirm with patient and consent form
Can be instigated any menber of team

35
Q

Factors leading to wrong sided block

A 
Distraction
Social activity 
List changes 
Mark covered 
Long time between who and block 
Moving patient 
Junior anaesthetist

Final Written (12 decks)

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