spinal and epidural part 2

Question 1

order of meningeal layers posterior to anterior

Answer 1

dura mater
arachnoid mater
pia mater

Question 2

epidural space is located_________ and contains

Answer 2

located outside the dura mater
contains fat ,lymphatics and small blood vessels

Question 3

subdural space is a ________ space between the

Answer 3

potential space between the dural and arachnoid mater

Question 4

subarachnoid space is between _______ and is filled with ____________

Answer 4

between arachnoid and pia
filled with CSF which cushions and protects the spinal cord

Question 5

the epidural space starts at the ___________ and goes to _______

Answer 5

foramen magnum and goes to S5

Question 6

what are the borders of the epidural space

Answer 6

cranial border
caudal border
anterior border- lined by posterior longitudinal ligament
lateral borders-marked by bony projections of the vertebrae
posterior borders- framed by ligaments flavum and the bony plates or the vertebrae

Question 7

what is the batson’s plexus

Answer 7

valveless and from a plexus draining blood from the cord and its linings

Question 8

density of epidural veins increases _______

Answer 8

laterally

Question 9

epidural veins are engorged under conditions like

Answer 9

obesity or pregnancy

Question 10

what is the significance of engorged epidural veins

Answer 10

increased risk of bleeding

Question 11

What is the plica mediana dorsalis

Answer 11

thought to be a band of connective tissue located between the ligamentum flavum and the dura mater

Question 12

what is the potential impact of the plica

Answer 12

barrier formation: might act as a barrier within the epidural space
medication spread: this barrier could affect how medications spread when injected into the epidural space

Question 13

what is the clinical relevance of plica

Answer 13

catheter insertion
unilateral blocks

Question 14

what does the subarachnoid space contain

Answer 14

CSF, nerve roots, spinal cord

Question 15

what is the characteristic felt when passing through the dura mater during a spinal

Answer 15

pop

Question 16

what happens is an epidural dose is injected into subdural space

Answer 16

high spinal meaning the medication affects a larger area than intended

Question 17

spinal dosing into the subdural space can result in

Answer 17

failed spinal

Question 18

which meningeal layer should never be punctured

Answer 18

pia mater
directly attached to spinal cord

Question 19

how many pairs of spinal nerves do we have

Answer 19

31

Question 20

which nerve root brings sensory information from the body back to spinal cord

Answer 20

posterior (dorsal)

Question 21

what does the anterior (ventral) nerve root carry

Answer 21

motor and autonomic body processes

Question 22

anterior and inner surface of lower limb dermatomes

Answer 22

L1-4

Question 23

foot dermatomes

Answer 23

L4,5 S1

Question 24

medial side of great toes dermatome

Answer 24

L4

Question 25

posterior and outer surface of lower limbs dermatomes

Answer 25

S1,2 L5

Question 26

lateral margin of foot and little toe dermatome

Answer 26

S1

Question 27

Perineum dermatomes

Answer 27

S2-4

Question 28

level of umbilicus dermatome

Answer 28

T10

Question 29

inguinal or groin regions dermatome

Answer 29

T12

Question 30

clavicles dermatome

Answer 30

C5

Question 31

lateral parts of upper limbs dermatome

Answer 31

C5-7

Question 32

medial sides of the upper limbs dermatomes

Answer 32

C8 T1

Question 33

thumb dermatome

Answer 33

C6

Question 34

hand dermatome

Answer 34

C6-8

Question 35

ring and little fingers dermatome

Answer 35

C8

Question 36

level of nipples dermatome

Answer 36

T4

Question 37

what surgery relates to dermatomes S2-S5

Answer 37

peri-anal/ anal surgery

Question 38

what surgery relates to dermatome L2

Answer 38

foot/ ankle surgery

Question 39

what surgery related to dermatome L1

Answer 39

thigh/ lower leg/ knee

Question 40

what surgery relates to dermatome T10

Answer 40

vaginal delivery/ uterine/ hip procedure/ tourniquet/TURP

Question 41

what surgery relates to dermatome S3

Answer 41

scrotum

Question 42

what surgery relates to dermatome S2

Answer 42

penis

Question 43

what surgery relates to dermatome T8

Answer 43

testicular procedure

Question 44

what surgery relates to dermatome T6

Answer 44

urologic/gynecologic. lower abdominal

Question 45

what surgery relates to dermatome T4

Answer 45

C section/ upper abdominal

Question 46

what are controllable factors that affect spread of LA in spinal

Answer 46

Baricity patient position dose site of injection

Question 47

what are non controllable factors that affect spread of LA in spinal

Answer 47

volume of CSF increased intra-abdominal pressure age

Question 48

what does not affect the spread of LA in spinal

Answer 48

barbotage speed of injection orientation of bevel addition of vasoconstrictor gender

Question 49

what are controllable factors in an epidural that significantly affect spread

Answer 49

LA volume level on injection dose

Question 50

what are non controllable factors that significantly affect the spread of LA in epidural

Answer 50

pregnancy old age

Question 51

what are controllable factors in an epidural that have a small effect of spread

Answer 51

LA concentration patient position

Question 52

what are non controllable factors in an epidural that have a small effect on spread

Answer 52

height of patient

Question 53

what are controllable factors of an epidural that does not affect spread

Answer 53

additives in the anesthetic (might change onset time or duration but not spread) direction of the bevel speed of injection

Question 54

list the nerve fiber blocked in order

Answer 54

B C A-delta A-gamma A-beta A-alpha

Question 55

what do B fibers do

Answer 55

autonomic preganglionic fibers

Question 56

what do C fibers do

Answer 56

pain and temperature

Question 57

what to A delta fibers do

Answer 57

pain and temperature

Question 58

what do A gamma fibers do

Answer 58

motor tone

Question 59

what do A beta fibers do

Answer 59

tough and pressure

Question 60

what do A alpha do

Answer 60

motor and proprioception

Question 61

what fibers are sensation

Answer 61

A beta A delta c

Question 62

what fibers are motor

Answer 62

A alpha A gamma

Question 63

order of nerve block recovery

Answer 63

reverse of onset a alpha a beta a gamma C and A delta B fibers

Question 64

what fiber is blocked the longest

Answer 64

B fibers

Question 65

what does the modified bromage scale evaluate

Answer 65

function of lumbosacral nerves, which are the lower spine and sacral nerve area and does not assess movement above these regions scale 0-3 (3 complete block)

Question 66

neuraxial CV effects in healthy vs diseased patients

Answer 66

healthy decrease in SVR by 15% elderly or cardiac patients SVR can decrease up to 25%

Question 67

what is the bezold jarisch reflex

Answer 67

response to ventricular underfilling potentially leading to a significant bradycardia and systole mediated by 5-HT3 receptors in the vagus nerve and ventricular myocardium

Question 68

what is the reverse bainbridge reflex

Answer 68

triggered by reduced stretching of hearts right atrium

Question 69

what are the 4 preventative measures for hypotension related to spinal anesthesia discussed in class

Answer 69

vasopressors 5-HT3 antagonists (ondansetron) fluid management (co-loading) positioning (slight pelvic tilt)

Question 70

failure to treat or delay treatment will increase

Answer 70

mortality

Question 71

what is the phrenic nerve supplied by

Answer 71

C3,4,5