Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

apa 1 /sim S. Horvath > spinals & epidurals > Flashcards

spinals & epidurals Flashcards

1
Q

from superficial to deep, what are the ligaments

A

interspinous ligament, ligamentum flavus, posterior longitudinal ligament, anterior longitudinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

piercing the ___ contributes to the loss of resistance when the needle enters the epidural space

A

ligamentum flavum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

midline approach passes thru which 3 ligaments

A

surpaspinous, interspinous, ligamentum flavum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

paramedian approach passes thru

A

ligamentum flavum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

an epidural hematoma accumulates between the ___ and the ___

A

dura bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

epidural space is located between?

A

ligamentum flavum and dura mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

subdural space is located between?

A

dura mater and arachnoid mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

subarachnoid space is located between?

A

arachnoid mater and pia mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how many cervical vertebra

A

7 (c1-c7)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how many thoracic vertebra?

A

12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how many lumbar vertebra

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how many sacral vertebra

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how many coccygeal vertebra

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

LA’s are bases or acids?

A

weak bases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

esters have __ structure

A

c-o-c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

amides have __ structure

A

N-h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

agents with a ___ pka value will have a ___ onset

A

lower , faster. because a greater fraction of molecules will exist in the uncharged form, this will more easily diffuse across nerve membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

the ___ form of an LA is most lipid soluble and is able to gain access to the axon

A

uncharged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

mechanism of LA’s

A

block nerve conduction by impairing propagation of the action potential in axons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

LA’s ___ the rate of rise of the action potential such that threshold potential is not reached

A

decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

does the unionized form of the drug work while inside the cell?

A

no! it becomes ionized once inside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

LA’s work ___cellularly

A

intra.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

agents with a high degree of protein binding will have a ___duration

A

prolonged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

pka determines __ of onset of neural blockade

A

speed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

which fibers are more easily blocked, thin or thick??

A

thin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

which fibers are more readily blocked, myelinated or unmyelinated?

A

myelinated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what plays the greatest role in conduction speed of a nerve fiber

A

diameter / myelinaton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

which fibers are the biggest

A

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

which fibers are the smallest

A

C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

A alpha

A

skeletal muscle - motor. and proprioception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

A beta

A

touch pressure proprioception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

a gamma

A

skeletal muscle tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

a delta

A

fast pain, temp and touch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

B fibers act where? myelinated?

A

pre-ganglionic ANS fibers. light myelination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

C fibers are myelinated?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

C fiber sympathetic function

A

postganglionic ANS fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

C fiber dorsal root function

A

slow pain, temp, touch.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

which fibers are blocked first

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

which fibers are blocked second

A

c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

which fibers are blocked last

A

A - gamma/delta, then alpha/beta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

sequence of block

A

ATP-TP-MVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

ATP-TP-MVP

A

autonomic, temp, pain, touch, pressure, motor, vibration, proprioception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

b fibers are __ sized and ___ myelinated

A

small , lightly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

how are esters metabolized

A

plasma cholinesterase break them down in the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

how are amides metabolized

A

in the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what is basicity

A

density relative to the desntiy/ specific gravity of CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

hypobaric will ___ while hyperbaric will

A

float, sink

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

addition of water makes a solution ___

A

hypobaric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

addition of dextrose makes a solution

A

hyperbaric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

addition of epi to an LA will ___ the risk of systemic toxicity

A

decrease. it decreases the rate of absorption, thus minimizing peak blood levels of LA’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

epi ___ the intensity of a block

A

increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

how does epi effect the duration of anesthesia

A

prolongs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

when would you not add epi?

A

areas with poor circulation (fingers toes penis), beir block, htn, CAD, arrhythmia, hyperthyroid, utero-placental insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

how does sodium bicarb affect spinal

A

raises the ph and increases the conc of non-ionized base, which increases the rate of diffusion across the nerve membrane and speeds the onset of blockade.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

addition of fentanyl to LA ___ onset, ___ level , and ___ duration

A

shortens, increases, prolongs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

action of opioids is ___ with LA’s

A

synergistic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

amide allergic reaction is caused by

A

methyl paraben preservative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

ester allergic reaction is caused by

A

PABA (metabolite )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

number one contraindicatio to a spinal is

A

patient refusal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

if you threaten someone into something it is ___, if you actually do it, its ____

A

assault, battery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what is the most anterior ligament

A

ligamentum flavum

62
Q

what is the most posterior ligament

A

supraspinous ligament

63
Q

where does the spinal cord end at birth

A

L3

64
Q

where does the spinal cord end in an adult

A

L1

65
Q

what are the 3 meninges of the spinal cord

A

pia mater, dura mater, arachnoid mater

66
Q

csf specific gravity

A

1.004-1.009

67
Q

volume of csf in spinal canal

A

30-80

68
Q

total volume of CSF

A

140

69
Q

the level of anesthetic varies ___ with the dose of LA used

A

directly

70
Q

the greater the volume of injected drug, the ___ the spread

A

farther

71
Q

turbulence ___ the spread of the drug and the level of blockade obtained

A

increases

72
Q

if you increase ABD pressure, you will get ___ of a spread

A

more

73
Q

most commonly used LA’s are ____baric

A

hyper

74
Q

hyperbaric solutions flow to the most ____ part of the CSF column

A

dependent

75
Q

fibers conveying sensation are ___ easily blocked than larger motor fibers

A

more

76
Q

in the lumbar region the epidural space is ___ wide at midline

A

5-6mmm

77
Q

in the mid-thoracic region the epidural space is __ wide

A

3-5mm

78
Q

the thoracic epidural requires ___ dose of LA

A

smaller

79
Q

the thoracic epidural requires ___ dose of LA

A

smaller

80
Q

CNS toxicity presents as

A

lightheadedness, tinnitus, metallic taste, visual disturbance, numbness of tongue and lip

81
Q

which LA is the most CV toxic

A

bupivocaine

82
Q

if you suspect toxicity, ___ ventilate

A

hyper (to blow off CO2)

83
Q

absolute contraindicatoins

A

significant coagulopathy, increased ICP, lack of pt cooperation, infection at site

84
Q

relative contraindications

A

hypovolemia, spinal cord disease, surgical time, musculoskeletal deformity, patients with a fixed volume cardiac state such as idiopathic hypertrophic aortic stenosis , difficult airway

85
Q

new onset lower limb weakness, new onset back pain , new onset bowel or bladder dysfunction would make you concerned about

A

spinal or epidural hematoma

86
Q

segmental level for lower extremities

A

T12

87
Q

segmental level for hip, vag/utuerus, bladder, prostate

A

T10

88
Q

lower extrem

A

T8

89
Q

testes/ovaries

A

T8

90
Q

lower intraabdominal

A

T6

91
Q

which ligament is the closest point to the epidural space

A

ligamentum flavum

92
Q

which ligament connects the spinous processes

A

interspinous ligament

93
Q

which ligament connects the apices of spinous processes

A

supraspinous ligament

94
Q

which ligament is most anterior and most dense

A

ligamentum flavum

95
Q

what is the end of the spinal cord

A

conus medularis

96
Q

what forms the cauda equina

A

conus medlars, lumbar, sacral, and coccygeal nerve roots

97
Q

what forms the cauda equina

A

conus medlars, lumbar, sacral, and coccygeal nerve roots

98
Q

what 3 meninges cover the spinal cord

A

pia mater, dura mater, arachnoid

99
Q

what is the tough fibrous sheath running through the length of the cord

A

dura mater

100
Q

how does increased pressure effect level of spinal blockade

A

pressure against the inferior vc causes epidural venous engorgement, and reduces the volume of csf. LA spreads farther.

101
Q

increasing the dose of an isobaric anesthetic will affect ___ more than ___

A

duration, spread.

102
Q

for lateral - affected side ___ if using hyperbaric technique

A

up

103
Q

for lateral - affected side ___ if hyperbaric technique

A

down

104
Q

sitting position, use ___baric anesthetics

A

hyper

105
Q

prone technique is good for which procedures

A

rectum, perineum, anus

106
Q

prone Is used with ___baric anesthesia

A

hypo

107
Q

midline approach- needle is angled ___

A

cephalad

108
Q

paramedian approach - needle is angled

A

medially and slightly cephalad and passed lateral to the supraspinous ligament

109
Q

how to reduce the incidence of post-dural puncture HA with needle insertion

A

insert so the bevel is parallel to the fibers that run longitudinal

110
Q

how is correct placement of a spinal confirmed

A

free flow of CSF into the hub of the needle

111
Q

fixation of LA takes approx

A

20 min

112
Q

neural block&raquo_space;>

A

autonomic > sensory > motor

113
Q

from skin to epidural space ranges

A

3-9mm

114
Q

epidural blockade develops in a ___ type manner

A

segmental

115
Q

___ block has greater control of sensory and motor blockade

A

epidural

116
Q

epidural medication spreads in a ___ direction

A

cephalad

117
Q

epidural meds get to the subarachnoid space by the process of

A

diffusion

118
Q

why should the epidural needle always enter the epidural space in the midline

A

widest and risk of puncturing epidural veins, spinal arteries , or spinal nerve roots is decreased

119
Q

technique for lumbar epidural - which two techniques to locate the epidural space

A

loss of resistance or hanging drop

120
Q

thoracic epidural - needle

A

insert in cephalad direction due to sharp downward angulation of the thoracic vertebral spinous processes

121
Q

what does the epidural test dose consist of

A

3ml local with 1:200,000 epi

122
Q

onset of sympathetic block is ___ with epidural

A

slower

123
Q

onset of sympathetic block is ___ with epidural

A

slower

124
Q

list everything from skin to spinal cord

A

skin, subcutaneous tissue, muscle, supraspinous ligament, interspinous ligament, ligamentum flavor, epidural space, dura mater, subdural space, arachnoid mater, subarachnoid space, pia mater , spinal cord

125
Q

what happens when you accidentally inject LA into the subdural space during an epidural

A

either high spinal with delayed onset (epidural dose) or failed spinal (spinal dose)

126
Q

what spinal nerve root for thumb

A

c6

127
Q

what spinal nerve root for 2nd and third digits

A

c7

128
Q

what spinal nerve root for 4th and 5th digits

A

c8

129
Q

site of action for spinals

A

myelinated preganglionic fibers of the spinal nerve roots

130
Q

site of action for epidural

A

must diffuse thru the dural cuff before they can block the nerve roots

131
Q

what factors influence spread of SAB the most

A

basicity, pt position, site, volume of csf, density of csf

132
Q

what is the primary determinant of spread for epidural anesthesia

A

volume

133
Q

how is differential blockade different with epidural anesthesia?

A

there is no autonomic differential blockade with epidural anesthesia. sensory block is 2-4 dermatomes higher than motor block.

134
Q

dont do a spinal/epidural if platelets are

A

<100,000

135
Q

dont do a spinal/epidural if PT, aPTT and or bleeding is

A

twice the normal value

136
Q

2 classifications of spinal needles

A

cutting tip and non cutting tip

137
Q

which tip has the higher risk of PDPH

A

cutting

138
Q

which tip needle is more easily deflected

A

cutting

139
Q

cutting tip names

A

quincke, pitkin

140
Q

which needle requires less force

A

cutting

141
Q

which needle is less likely to injure the caudal equina?

A

non-cutting

142
Q

what are the 3 epidural needles

A

crawford, hosted, tuohy

143
Q

what epidural needle has the most pronounced curvature

A

tuohy - 30degrees - helps prevent dural puncture

144
Q

which epidural needle has no curve

A

crawford

145
Q

hustead needle curve

A

15

146
Q

neuraxial opioids do not cause

A

sympathectomy, skeletal muscle weakness, changes in proprioception

147
Q

where does the subarachnoid space terminate in an adult

A

S2 dural sac

148
Q

subarachnoid space ending in infant

A

S3

149
Q

where is the conus medularris in adult

A

L1-L2

150
Q

where and what is Tuffier’s line

A

line formed between the tops of the iliac crests at l3-l4 or l5-s1

apa 1 /sim S. Horvath (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions