Spinal & Epidural Part 2 ( Tubog) Exam 1 Flashcards
Which meningeal layer is the outermost?
A. Arachnoid mater
B. Dura mater
C. Pia mater
D. Subdural space
B. Dura mater
Slide 29
What mengieal layer is considered the middle layer surrounding the spinal cord?
A. Epidural mater
B. Subarachnoid space
C. Subdural space
D. Arachnoid mater
D. Arachnoid mater
Slide 29
What structure directly covers the spinal cord?
A. Dura mater
B. Arachnoid mater
C. Pia mater
D. Epidural veins
C. Pia mater
Innermost layer
Slide 29
Which statements are true about the epidural space? Select 3
A. It is located outside the dura mater
B. It contains fat
C. It contains large blood vessels
D. It is filled with cerebrospinal fluid (CSF)
E. It contains small blood vessels
F. It is between the arachnoid mater and pia mater
A. It is located outside the dura mater
B. It contains fat
E. It contains small blood vessels
Slide 30
Features of the subdural space include:
Select 2
A. Located between the dura mater and arachnoid mater
B. A potential space
C. Filled with cerebrospinal fluid (CSF)
D. Contains fat and small blood vessels
E. Located between the dura mater and epidural space
A. Located between the dura mater and arachnoid mater
B. A potential space
Slide 30
The subarachnoid space:
A. Is located between the arachnoid mater and pia mater
B. Is located between the dura mater and the arachnoid mater
C. Contains epidural veins
D. Is filled with cerebrospinal fluid (CSF)
E. Is a potential space
A. Is located between the arachnoid mater and pia mater
C. Is filled with cerebrospinal fluid (CSF) -CSF cushions and protects the spinal cord
Slide 30
Where is the cranial border of the epidural space located?
A. Near the ligament connected to the coccyx
B. At the foramen magnum
C. Along the vertebrae
D. Framed by the bony plates of the vertebrae
B. At the foramen magnum At the top, (base of the skull)
slide31
What forms the caudal border of the epidural space?
A. The posterior longitudinal ligament
B. Ligamentum flavum
C. The sacrococcygeal ligament
D. The vertebral pedicles
C. The sacrococcygeal ligament - it’s at the bottom where the ligament is connected to the coccyx
Slide 31
What marks the anterior border of the epidural space?
A. Ligamentum flavum
B. The anterior longitudinal ligament
C. The bony projections of the vertebrae (vertebral pedicles)
D. The bony plates of the vertebrae (vertebral lamina)
E. The posterior longitudinal ligament
E. In the front, lined by the posterior longitudinal ligament along the vertebrae
Slide 31
What forms the lateral borders of the epidural space?
A. The posterior longitudinal ligament
B. The bony projections of the vertebrae
C. The sacrococcygeal ligament
D. Ligamentum flavum
B. The bony projections of the vertebrae on the sides (verterbral pedicles)
Slide 31
The posterior borders of the epidural space are at the back, framed by __________ and the bony plates of the vertebrae __________.
A. ligamentum flavum, vertebral lamina
B. posterior longitudinal ligament, vertebral pedicles
C. sacrococcygeal ligament, vertebral lamina
D. arachnoid mater, intervertebral discs
A. ligamentum flavum, vertebral lamina
The epidural space contains nerves, __________, lymphatics, and blood vessels.
A. epithelial tissue
B. interstitial fluid
C. fatty tissue
D. connective tissue
C. fatty tissue
Slide 32
How does the fatty tissue in the epidural space affect drug absorption?
A. It has no effect on drug absorption
B. It absorbs and increases the availability of drugs
C. It absorbs and decreases the availability of certain drugs
D. It only affects the absorption of morphine
C. It absorbs and decreases the availability of certain drugs
(e.g., bupivacaine is absorbed more than lidocaine or fentanyl or morphine).
slide 32
What is a characteristic of epidural veins (Batson’s Plexus)?
A. They have valves
B. They form a plexus
C. Their density decreases laterally
D. They are unaffected by obesity or pregnancy
B. They form a plexus -draining blood from the cord and its linings
Slide 32
Functions and features of epidural veins (Batson’s Plexus) include: Select 3
A. Valveless structure
B. A plexus returning blood to the cord
C. Density increases laterally
D. Engorge during pregnancy
E. Decrease the risk of puncture
A. Valveless structure
C. Density increases laterally
D. Engorge during pregnancy
increasing the risk during needle procedures in this area.
Slide 32
True or False
The presence of this Plica Mediana Dorsalis is controversial but has been definitively confirmed.
FALSE
The presence of this structure is controversial and not definitively confirmed.
Slide 33
Where is the plica mediana dorsalis thought to be located?
A. Between the spinal cord and the pia mater
B. Between the ligamentum flavum and the dura mater
C. Between the arachnoid mater and pia mater
D. Between the spinal cord and the epidural space
B. Between the ligamentum flavum and the dura mater
Slide 33
The plica mediana dorsalis might have clinical relevance by: Select 3
A. Facilitating catheter insertion
B. Acting as a barrier within epidural space
C. Increasing the spread of medications
D. Playing a role in complications
E. Possibly causing unilateral blocks
B. Acting as a barrier within epidural space
D. Playing a role in complications during epidural catheter placement
E. Possibly causing unilateral blocks
Medication spread - This barrier could affect how medications spread when injected into the epidural space
Slide 33
Where is the subarachnoid space located?
A. Superficial to the arachnoid mater
B. Deep to the arachnoid mater
C. Superficial to the dura mater
D. Deep to the pia mater
B. Deep to the arachnoid mater
Slide 34
The subarachnoid space:
A. Is located superficial to the arachnoid mater
B. Contains cerebrospinal fluid (CSF)
C. Contains nerve roots
D. Contains fat and small blood vessels
B. Contains cerebrospinal fluid (CSF)
C. Contains nerve roots
Contains the spinal cord itself**
Slide 34
What is the primary target when performing a spinal anesthetic procedure?
A. Epidural space
B. Subdural space
C. Subarachnoid space
D. Ligamentum flavum
C. Subarachnoid space
Slide 34
If the needle is advanced too far anteriorly during a spinal anesthetic procedure, it could pass through several layers before reaching bone, EXCEPT this one:
A. Pia mater
B. Spinal cord
C. Posterior longitudinal ligament
D. Anterior longitudinal ligament
D. Anterior longitudinal ligament
Slide 34
During spinal anesthesia, a characteristic “pop” is often felt when the needle passes through this outer membrane:
A. pia mater
B. arachnoid mater
C. dura mater
D. ligamentum flavum
C. dura mater
Slide 34
Where is the subdural space located?
A. Between the pia mater and arachnoid mater
B. Between the dura mater and arachnoid mater
C. Between the dura mater and ligamentum flavum
D. Between the pia mater and spinal cord
B. Between the dura mater and arachnoid mater
Slide 35
What can happen if local anesthetic is inadvertently injected into the subdural space during an epidural?
A. It can have no effect
B. It can only affect the area of injection
C. It can cause a “low spinal” effect
D. It can cause a “high spinal” effect
D. It can cause a “high spinal” effect
meaning the medication affects a larger area than intended.
Slide 35
What can result from an accidental injection in the subdural space during spinal anesthesia?
A. Increased effectiveness of the spinal block
B. A failed spinal block
C. A “high” spinal block
D. Enhanced spread of medication
B. A failed spinal block
Slide 35
Which meningeal layer is a tough fibrous shield that protects the spinal cord?
A. Arachnoid mater
B. Pia mater
C. Dura mater
D. Epidural space
C. Dura mater
The first meningeal layer encountered after advancing through epidural space
Slide 36
Where does the dura mater start and extend to?
A. From the foramen magnum to the dural sac
B. From the spinal cord to the pia mater
C. From the arachnoid mater to the pia mater
D. From the epidural space to the dural sac
A. From the foramen magnum to the dural sac
Slide 36
Which meningeal layer is directly beneath the dura mater and acts as a protective middle layer?
A. Pia mater
B. Epidural space
C. Subdural space
D. Arachnoid mater
D. Arachnoid mater
*A thin layer of connective tissue *
Slide 36
What is the innermost meningeal layer that directly covers the spinal cord?
A. Dura mater
B. Arachnoid mater
C. Pia mater
D. Subdural space
C. Pia mater
Slide 36
The pia mater:
A. Is a highly vascular structure
B. Is the delicate outermost layer that directly covers the spinal cord
C. Is the delicate innermost layer that directly covers the spinal cord
D. Should never be punctured during a spinal
E. Is punctured during a spinal
F. Lies directly beneath the dura mater
A. Is a highly vascular structure
C. Is the delicate innermost layer that directly covers the spinal cord
D. Should never be punctured during spinal
Slide 36
Slide 37
How many pairs of spinal nerves does the spinal cord have?
A. 21 pairs
B. 25 pairs
C. 31 pairs
D. 35 pairs
C. 31 pairs
Slide 37
Which nerve is an exception by exiting below its corresponding vertebra?
A. C1 nerve
B. C5 nerve
C. C7 nerve
D. C8 nerve
D. C8 nerve
C8 Nerve: This nerve is an exception as it exits below the C7 vertebra.
Slide 37
How many pairs of cervical nerves are there?
A. 5 pairs
B. 8 pairs
C. 12 pairs
D. 31 pairs
B. 8 pairs
Slide 37
Matching
A. Cervical - 8
B. Thoracic - 12
C. Lumbar - 5
D. Sacral - 5
E. Coccyx - 1
Slide 37
Each nerve is formed by the joining of two different nerve roots: the anterior (ventral) nerve root and the __________ (dorsal) nerve root.
A. lateral
B. medial
C. superior
D. posterior
E. central
D. posterior
Slide 37
What type of information does the anterior (ventral) nerve root carry?
A. Sensory information
B. Motor and autonomic information
C. Both sensory and motor information
D. Only autonomic information
B. Motor and autonomic information
information from the spinal cord to the body.
Slide 37
he posterior (dorsal) nerve root brings __________ information from the body back to the spinal cord.
A. sensory
B. autonomic
C. motor
D. mixed
A. sensory
information from the body back to the spinal cord.
Slide 37
A dermatome is an area of skin that receives sensory nerves from a __________ spinal nerve root.
A. single
B. double
C. multiple
D. complex
A. single
Slide 37
True or False
Even though a dermatome may physically appear to align with a certain part of the spine, it is actually connected to a different spinal nerve root.
True
The umbilicus (belly button) looks like it should be served by the L3 nerve, but it’s actually served by the T10 nerve.
Slide 37
Dermatome time…
Matching
Slide 39
more..matching
Matching
Slide 39
another one..
Matching
you did it!
Slide 39