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Quarter 5 > Regional Final > Flashcards

Regional Final Flashcards

1
Q

Indications for Intercostal Block

A
  • thoracic or upper abdominal surgery
  • rib fractures
  • breast surgery
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2
Q

Overview of Intercostal nerve blocks

A
  • need to perform blockade of two dermatomes above incision and two levels below
  • does not block visceral pain
  • does not provide adequate coverage for intraoperative anesthesia
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3
Q

Landmarks for Intercostal block

A

angle of rib

(6-8 cm lateral to the spinous process)

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4
Q

Risks of Intercostal block

A
  • Pneumothorax
  • local anesthetic toxicity
  • hematoma
  • nerve damage
  • epidural anesthesia
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5
Q

Technique for Paravertebral

A

2.5 cm lateral to midline

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6
Q

longest lumbar transverse process

A

L3

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7
Q

Trigeminal Nerve

[overview]

A

5th CN providing sensory innervation to face

  • preganglionic fibers exit brainstem and synapse with trigemincal (gasserian) ganglion
  • post-ganglionic fibers exit to form:
    • V1 - opthalmic
    • V2 - maxillary
    • V3 - Mandibular
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8
Q

most common trigeminal nerves to have pain

A

V2 (maxillary) and V3 (mandibular)

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9
Q

–carbamezapine

A

treats seizures and nerve pain

(especially trigeminal neuralgia)

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10
Q

Complications of Trigeminal Nerve Block

A
  • intravascular injection (carotid)
  • persistent paresthesias
  • total spinal
  • profound facial numbness
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11
Q

indications for Supraorbital block

A

lower forehead or upper eyelid

(blepheroplasty)

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12
Q

amount of local anesthetic in Supraorbital block

A

2 - 3 mL

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13
Q

injection of LA inside the cone of the eye provides anesthesia and akinesia of ___ and ____

A

globe and extraocular muscles

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14
Q

Oculocardiac Reflex

[afferent]

A

trigeminal

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15
Q

oculocardiac reflex

[efferent]

A

vagus nerve

increase in parasympathetic tone

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16
Q

steps in oculocardiac reflex

A

pressure on eyeball

ciliary nerves and ciliary ganglion

gasserian ganglion

trigeminal sensory nucleus in 4th ventricle

vagus nerve

increase parasympathetic tone and bradycardia

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17
Q

highest incidence of oculocardiac reflex

A

children

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18
Q

Treatment of oculocardiac reflex

A

removal of stimulus

anti-cholinergics

check depth of anesthesia

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19
Q

sensory anterior 2/3 of tongue

A

trigeminal

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20
Q

sensory above vocal cords

A

internal branch of superior laryngeal nerve

(vagus)

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21
Q

sensory posterior 1/3 of tongue

A

glossopharyngeal

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22
Q

sensory below vocal cords

A

recurrent laryngeal nerve

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23
Q

The recurrent laryngeal nerve innervates all muscles of the pharynx except _____

A

cricothyroid muscle

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24
Q

innervation of cricothyroid muscle

A

external branch of the superior laryngeal nerve

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25
Q

Transtracheal block indication

A

blunts gag reflex

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26
Q

nerves involved in gag reflex

A

afferent (CN IX) and efferent (CN X)

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27
Q

nerves in lumbar plexus

A

T-12 to L-4

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28
Q

nerves in femoral branch

A

L2 - L4

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29
Q
A

1= Femoral Artery

2= Femoral Nerve

3= Femoral Vein

4= Anterior Superior Iliac Spine

5= Inguinal Ligament

6=Sartorius

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30
Q
A
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31
Q

}In the PACU your patient complains of knee pain after a Total Knee Arthroplasty. A continuous femoral nerve block has already been placed. What do you do?

A

adductor canal block

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32
Q

Boundaries of Adductor canal block

A

sartorius

vastus medialis

adductur longus and magnus

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33
Q

Advantage of adductor canal block over femoral

A

sensory block only

no motor fibers involved; good for athletes that need to recover quickly

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34
Q
A

Adductor canal block

35
Q

Indications for Saphenous nerve block

A

saphenous vein harvesting

or

supplementation for medial foot/ankle surgery in combination with sciatic nerve block

36
Q
A

saphenous nerve block

37
Q

nerves in sciatic branch

38
Q

largest nerve in the body

39
Q

landmarks for sciatic nerve block

A

ischial tuberosity and greater trochanter

40
Q

sciatic nerve block needle insertion

A

4cm distal to midpoint between ischial tuberosity and greater trochanter

41
Q

branches of sciatic nerve

A

tibial and common peroneal

42
Q

which nerve causes dorsiflexion?

A

common peroneal

43
Q

which nerve causes plantarflexion?

A

tibial nerve

44
Q

boundaries of popiiteal fossa

A

bicep femoris

semi-tendenosis and semi-membranosus

45
Q
A

Popliteal block

if two nerves are seen (common peroneal and tibial) move caudally

46
Q

Which is most appropriate combination of nerve blocks for knee arthroscopy with a tourniquet:

A

transgluteal sciatic nerve block

and

lumbar plexus block

47
Q

(5) nerves in ankle block

A
  • deep peroneal
  • posterior tibial
  • saphenous
  • superficial peroneal
  • sural
48
Q
A
  1. Saphenous
  2. Deep Peroneal
  3. Superficial Peroneal
  4. Medial plantar Branch of Tibial
  5. Lateral Plantar branch of tibial
  6. Tibial
  7. Sural
49
Q

TAP

A

transversus abdominis plane

50
Q

“triangle” in TAP block

A

latissimus dorsi

external oblique

iliac crest

51
Q

indications for T.A.P.

A

large bowel resection

appendectomy or cholecystectomy

C-section

renal transplant

52
Q

TAP ultrasound

53
Q

indications for fascia iliaca block

A

anterior thigh and knee surgery

55
Q

TEG

A

Thromboelastogram

56
Q

R parameter on TEG

A

clotting time

(reaction time)

57
Q

reasons for elongated R parameter

A

slow enzymatic reaction

factor deficiency or dysfunction

residual heparin

58
Q

The R value represents which of the following

phases of hemostasis?

A

Activation of coagulation pathways and initial fibrin formation

59
Q

alpha parameter

A

kinetics of clot formation

60
Q

Which TEG parameters will best

demonstrate the need for coagulation factors?

61
Q

Maximum amplitude in TEG

A

represents clot strength

62
Q

what do you give for a low MA?

63
Q

pain assessment in children

64
Q

dose of oral acetaminophen

A

10 - 15 mg/kg

65
Q

dose of oral ibuprofen

A

5 - 10 mg/kg

66
Q

dose of naproxen

67
Q

IV dose of fentanyl

A

0.5 - 1 mg/kg

68
Q

IV dose of morphine

69
Q

EMLA

A

lidocaine and prilocaine cream

  • may cause methemoglobinemia in children < 3 months of age
70
Q

most commonly used anesthetic

especially in children

A

bupivacaine

71
Q

cardiotoxicity is ____ common than neurotoxicity in children

72
Q

signs of cardiotoxicity

A

increased HR and NP

increased amplitude of T-waves on EKG

73
Q

infants spinal cords end at ____

74
Q

neuropraxia

A

blunt injury to nerve

  • myelin damage
  • conduction slowing
75
Q

axonotmesis

A

loss of axonal continuity

  • endoneuriu intact
  • no conduction
76
Q

neurotmesis

A

complete interruption of the entire nerve

  • loss of axonal and endoneurial continuity
77
Q

delay between neuraxial block and heparin

A

1 hour

remove epidural 2 hours after last heparin dose

78
Q

Lovenox

A

low-molecular weight heparin

  • activates anti-thrombin accelerating interaction with factor Xa and thrombin
79
Q

difference between Type I and II CRPS

A

type II has a defined nerve injury

80
Q

TENS

A

transcutaneous electrical nerve stimulation

81
Q

which nerve is spared in a 3-1 block?

82
Q

nerves in obturator block

83
Q

Myasthenia Gravis

{overview}

A

resistant to Sux

  • may be on pyridostigmine therapy
  • destroy ACh receptors at neuromuscular junctions
84
Q

Multiple Sclerosis

[overview]

A

demyelinating disease of the CNS

  • do NOT perform spinal/epidural

Quarter 5 (8 decks)

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