Spinal & Epidural Part 4 ( Tubog) Exam 1 Flashcards
The failure of a dura puncture site to properly “seal over” once breached by a needle can lead to a continuous leak of ______.
A) blood
B) cerebrospinal fluid
C) synovial fluid
D) interstitial fluid
B) cerebrospinal fluid (CSF), CSF
The CSF leak d/t dura puncture lowers the pressure in the brain area, causing the brain to ______ slightly and stretch the surrounding membranes, leading to a ______.
A) expand, migraine
B) contract, seizure
C) sag, headache
D) swell, stroke
C) sag, headache
Slide 91
The headache associated with Post Dural Puncture Headache (PDPH) is usually felt from the ______ to the back of the head and may be accompanied by other symptoms such as ______, sensitivity to light, double vision, and ringing in the ears.
A) temples, vertigo
B) crown, dizziness
C) forehead, nausea
D) neck, fever
C) forehead, nausea
Fronto-Occipital
Slide 91 Postdural Puncture Headache
Which of the following symptoms is commonly associated with postdural puncture headache (PDPH)?
A) Headache that feels worse when lying down
B) Headache that occurs immediately after puncture
C) Headache that feels worse when sitting or standing
D) Headache that is localized to one side of the head
C) Headache that feels worse when sitting or standing
Slide 91
The headache from PDPH usually occurs ______ days post puncture.
A) 1-2
B) 2-3
C) 3-4
D) 4-5
B) 2-3
Slide 91
Factors affecting the risk of PDPH include patient factors such as being younger, being female, and being ______.
A) elderly
B) male
C) pregnant
D) overweight
C) pregnant
Slide 91
Practitioner factors affecting the risk of PDPH include using a needle with a cutting tip such as ______ and using a large ______ needle.
A) Quincke, diameter
B) Whitacre, gauge
C) Tuohy, diameter
D) Sprotte, flexible
A) Quincke, diameter
Pencil point and smaller diameter helps prevent PDPH
Slide 91
One of the key preventative measures to reduce the risk of PDPH is to position the needle ______ to the spine’s long axis.
A) parallel
B) perpendicular
C) paramedian
D) oblique
B) perpendicular
Slide 91
True or False
Using air for Loss of Resistance with epidural placement is a practitioner factor for increased risk of Postdural Puncture Headache
True
Slide 91
Which of the following needle designs has the highest incidence of PDPH?
A) Quincke 22 gauge
B) Whitacre 27 gauge
C) Sprotte 24 gauge
D) Tuohy 16 gauge
A) Quincke 22 gauge
cutting needle
Slide 91
The main treatment for severe headaches after dural puncture is the ______, which involves injecting the patient’s own blood into the ______ space.
A) intrathecal blood patch, intrathecal
B) epidural blood patch, epidural
C) epidural blood patch, subarachnoid
D) subarachnoid blood patch, subdural
B) epidural blood patch, epidural
Slide 92
Select all the conservative treatments for postdural puncture headache (PDPH).
Select 3
A) Bed rest
B) NSAIDs
C) Physical Theraphy
D) Caffeine
E) Intravenous fluids
A) Bed rest
B) NSAIDs
D) Caffeine
Slide 92
Select all the interventional treatments for postdural puncture headache (PDPH). Select 2
A) External Ventricular Device (EVD)
B) Sphenopalatine ganglion block
C) Spinal fusion
D) Nerve ablation
E) Epidural blood patch
B) Sphenopalatine ganglion block - It is a simpler, low-risk treatment alternative for PDPH.
E) Epidural blood patch
Slide 92
The epidural blood patch is not routinely recommended within 24 hours of a dural puncture; ______ has shown to be the standard for better outcomes.
A) 32 hours
B) 36 hours
C) 48 hours
D) 72 hours
C) 48 hours has shown to be the standard for better outcomes.
Slide 92
How much of the patient’s own blood is typically injected into the epidural space during an epidural blood patch to treat postdural puncture headache (PDPH)?
A) 5-10 mL
B) 10-20 mL
C) 20-30 mL
D) 30-40 mL
B) 10-20 mL
What is the success rate of the epidural blood patch in treating postdural puncture headache (PDPH)?
A) About 70%
B) About 80%
C) About 90%
D) About 95%
C) About 90%
Slide 92
If two epidural blood patches do not work, what should be considered next?
A) Increasing the dose of caffeine
B) Switching to oral analgesics
C) Other causes of headache
D) Repeating the epidural blood patch
C) Other causes of headache
Cardiothoracic consult
Slide 92
The sphenopalatine ganglion block procedure involves soaking a cotton swab with which of the following solutions?
Select 2
A) 1-2% Lidocaine
B) 0.9% Saline solution
C) 0.5% bupivacaine
D) 3% Chloroprocaine
A) 1-2% Lidocaine
C) 0.5% bupivacaine
Slide 92
How long should the cotton swab be left in place during the sphenopalatine ganglion block procedure to reduce headache symptoms?
A) 1-2 minutes
B) 3-4 minutes
C) 5-10 minutes
D) 15-20 minutes
C) 5-10 minutes
This can quickely reduce headache symptoms
Slide 92
The higher incidence of paresthesia during needle placement is typically associated with ______ techniques, and the deficit usually follows the area where the paresthesia occurred.
A) lumbar puncture
B) combined spinal-epidural
C) intramuscular injection
D) peripheral nerve block
B) combined spinal-epidural (CSE)
Slide 93
When paresthesia is elicited during needle placement, ______ of the needle is indicated to prevent further injury.
A) advancement
B) retraction
C) redirection
D) withrawal
C) redirection
Slide 93
If a spinal block has not set up after 15-20 minutes and no anesthesia effect is observed, it may be necessary to ______ the block.
A) adjust
B) delay
C) discontinue
D) repeat
D) repeat
Slide 93
In the case of a patchy block, repeating the block should be avoided due to the risk of ______, and alternative strategies such as ______ or general anesthesia should be considered.
A) infection, antibiotics
B) neurotoxicity, IV sedation
C) bleeding, anticoagulants
D) inflammation, corticosteroids
B) neurotoxicity, IV sedation
Slide 93
Select all the correct statements about the risk factors and management of paresthesia during needle and catheter placement.
Select 3
A) Higher incidence if paresthesia was encountered after placement.
C) Epidural catheter placement has a much lower risk.
D) Noncooperative or moving patients can increase risks.
E) Placement was not aligned with the midline
C) Epidural catheter placement has a much lower risk.
D) Noncooperative or moving patients can increase risks.
E) Placement was not aligned with the midline
Higher incidence if paresthesia was encountered during placement.
Slide 93