Unit 1 Module 3 (Exam 1) Flashcards
Which patient group is most likely to undergo spinal decompression due to degenerative spine disease?
A. Patients over 60 years old
B. Patients under 60 years old
C. Patients with sedentary life styles
D. Patients with no history of back pain
B. Patients under 60 years old
Slide 3
What is the most common spinal condition in patients over 60 years old?
A. Herniated disc
B. Degenerative disc disease
C. Spinal stenosis
D. Spondylolisthesis
C. Spinal stenosis
Slide 3
What type of anesthesia is typically required for most spine surgeries?
A. Regional anesthesia
B. Conscious sedation
C. Local anesthesia
D. General endotracheal anesthesia
D. General endotracheal anesthesia
slide 5
Airway management during spine surgery can be challenging due to surgical __________ and patient __________.
A. equipment; medications
B. monitoring; blood pressure
C. positioning; anatomy
D. sedation; anesthesia type
C. positioning; anatomy
Slide 5
Motor and sensory monitoring in spine surgery is critical to avoid __________ of nerve conduction.
A. enhancement
B. severance
C. paralysis
D. relaxation
B. severance
MEPs and SSEPs must be monitored
Slide 5
Why are paralytic agents often avoided during spine surgeries?
A. Paralytics cause excessive sedation.
B. Paralytics can impair nerve monitoring
C. Paralytics increase the risk of airway complications.
D. Paralytics are unnecessary for general anesthesia cases.
B. Paralytics can impair nerve monitoring
Slide 5
Patients undergoing spine surgery may experience large __________ due to the complexity of the procedure.
A. blood loss
B. electrolyte shifts
C. fluid intake
D. clot formation
A. blood loss
Slide 5
Which is NOT a condition that may require reconstructive spine surgery?
A. Scoliosis
B. Kyphosis
C. Kyphoscoliosis
D. Olecranonaplasty
D. Olecranonaplasty
Reconstructive surgery
* Scoliosis
* Kyphosis
* Kyphoscoliosis
* Revision of previous thoracolumbar fusions
Slide 6
A __________ is often performed to remove part of a herniated disc that is pressing on a nerve.
A. microdiscectomy
B. spinal fusion
C. kyphoplasty
D. thoracotomy
A. microdiscectomy
Slide 6
True or False
Spinal fusion can be performed through either an anterior or posterior approach.
True
Slide 6
Which of the following characteristics define scoliosis?
Select 2
A. Lateral rotation of the spine greater than 10°
B. Posterior curvature of the spine
C. Vertebral rotation
D. Degeneration of intervertebral discs
A. Lateral rotation of the spine greater than 10°
C. Vertebral rotation
Slide 7
Types of scoliosis include congenital, idiopathic, and __________.
A. degenerative
B. traumatic
C. infectious
D. neuromuscular
D. neuromuscular
Slide 7
Back pain in adult scoliosis is often caused by arthritis and __________.
A. spinal cord swelling
B. disc degeneration
C. muscle spasms
D. nerve regeneration
B. disc degeneration
back pain because of the misalignment of the vertebrae causing compression of the nerves
slide 8
Spinal stenosis can cause pain that worsens when a patient is __________.
A. lying down
B. eating
C. swimming
D. standing
D. standing or walking
Slide 8
Radiculopathy is caused by the compression or __________ of a nerve at the spinal column.
A. stretching
B. pinching
C. relaxing
D. dissolving
B. pinching
Slide 8
What is a common respiratory complication in thoracic scoliosis?
A. Restrictive lung disease
B. Obstructive lung disease
C. Pulmonary embolism
D. Chronic bronchitis
A. Restrictive lung disease
Decreased chest wall compliance
Slide 10
What preoperative assessment is crucial for patients with thoracic scoliosis?
A. Neurological testing
B. Exercise tolerance
C. Bone density testing
D. Thyroid function tests
B. Exercise tolerance
Slide 10
True or False
Pulmonary function tests (PFTs) are irrelevant in the preoperative assessment of scoliosis patients.
False
Pulmonary function tests (PFTs) are relevant in the preoperative assessment of scoliosis patients.
Review: normal values for tidal volume, minute ventilation, functional residual capacity, forced vital capacity are FEV1 and then expiratory flow rates and peak
Slide 10
What is a primary cause of chronic hypoxemia in patients with thoracic scoliosis?
A. V/Q mismatch
B. Obstructive airway disease
C. Coronary artery disease
D. Chronic kidney disease
A. V/Q mismatch
Causing chronic hypoxemia
Slide 11
What condition is associated with increased pulmonary vascular resistance in scoliosis patients?
A. Myocardial infarction
B. Cor pulmonale
C. Aortic stenosis
D. Hypotension
B. Cor pulmonale
Slide 11
Which cardiac changes may be seen on an EKG in patients with cor pulmonale?
Select 2
A. Left ventricular hypertrophy
B. Right ventricular hypertrophy
C. Right atrial enlargement
D. Left atrial enlargement
E. Atrial fibrillation
B. Right ventricular hypertrophy (RVH)
C. Right atrial enlargement (RAE)
Slide 11
Which preoperative test helps assess pulmonary hypertension in scoliosis patients?
A. Electroencephalogram
B. Echocardiogram
C. Pulmonary function test
D. Chest X-ray
B. Echocardiogram (echo)
..with a pre-op echo or a Doppler ultrasound result that measures the pulmonary artery systolic pressure…
Slide 11
In surgeries with significant blood loss, platelet abnormalities and __________ coagulopathy may occur.
A. respiratory
B. peripheral
C. chronic
D. dilutional
D. dilutional
Slide 12
The breakdown of primary clots, known as __________, can increase the risk of bleeding during surgery.
A. hypercoagulation
B. fibrinolysis
C. thrombocytosis
D. hemostasis
B. fibrinolysis
Slide 12
True or False
The number of vertebral levels fused can impact the amount of blood loss during surgery.
True
Slide 12
Which factors are associated with anticipated large blood loss during corrective spine surgery?
Select 3
A. Surgical Technique
B. Mean arterial pressure
C. Type of anesthesia
D. Operative time
E. Length of hospital stay
A. Surgical Technique
B. Mean arterial pressure
D. Operative time
Slide 12
Which spinal cord level is responsible for partial diaphragm innervation?
A. C5
B. C6
C. C7
D. T1
A. C5
Slide 13
What mnemonic helps remember the spinal levels responsible for diaphragm function?
A. C5 through C8 keeps the body straight
B. T1 to T3 stabilizes the spine
C. C3, C4, and C5 keep the diaphragm alive
D. L1 to L3 controls lower limb movement
C. C3, C4, and C5 keep the diaphragm alive
Slide 13
Flaccid paralysis due to a C5 spinal cord injury may affect which muscles?
Select 3
A. Deltoid
B. Trapezius
C. Brachialis
D. Brachioradialis
E. Pectoralis major
A. Deltoid
C. Brachialis
D. Brachioradialis
Flaccid muscles innervated by C5
* Deltoid
* Biceps
* Brachialis
* Brachio-radialis
Slide 13
What is a common effect of spinal cord injuries at T5 or higher?
A. Physiologic sympathectomy
B. Increased cardiac output
C. Peripheral neuropathy
D. Chronic hypertension
A. Physiologic sympathectomy
Slide 14
Hypotension caused by a spinal injury at T5 or higher may be treated with __________.
A. glycopyrrolate
B. nalozone
C. atropine
D. midodrine
D. midodrine
Slide 14
What condition may develop in spinal injuries higher than T1 to T4?
A. Hyperthermia
B. Bradycardia
C. Tachypnea
D. Cyanosis
B. Bradycardia
Slide 14
In cases of spinal injury-induced bradycardia, direct-acting beta agonists like __________ are recommended.
A. epinephrine
B. atropine
C. lidocaine
D. glycopyrrolate
A. epinephrine
Slide 14
What condition can develop with a complete spinal cord transection above T5 or T6?
A. Pulmonary embolism
B. Hypoglycemia
C. Autonomic hyperreflexia
D. Septic shock
C. Autonomic hyperreflexia
Slide 15
True or false
Severe transient hypertension occurs below the level of injury in autonomic hyperreflexia.
True
Slide 15
Which symptoms occur above the level of injury in autonomic hyperreflexia?
Select 2
A. Bradycardia
B. Tachycardia
C. Vasodilation
D. Dysrhythmias
A. Bradycardia
D. Dysrhythmias
Slide 15
What compensatory responses occur above the level of injury in autonomic hyperreflexia?
A. Cutaneous vasodilation
B. Hypotension
C. Blanching of the skin
D. Hypertension
A. Cutaneous vasodilation
Slide 15
A common trigger for autonomic hyperreflexia is a full __________ or bowel.
A. stomach
B. bladder
C. lung
D. artery
B. bladder
Slide 16
Hypertension in autonomic hyperreflexia is caused by widespread __________ below the level of injury.
A. vasodilation
B. vasoconstriction
C. bleeding
D. ischemia
B. vasoconstriction
Massive sympathetic response
Slide 16
Baroreceptors detect increased blood pressure and signal the brain to __________ the heart rate.
A. increase
B. stabilize
C. slow
D. eliminate
C. slow
Slide 16
Descending inhibitory signals fail to reach the sympathetic activation site because of the __________.
A. severe hypotension
B. reduced heart rate
C. decreased blood volume
D. blockage at the spinal cord
D. blockage at the spinal cord
Slide 16
Noxious stimulation, such as __________, can cause autonomic hyperreflexia.
A. deep sleep
B. low oxygen saturation
C. surgery
D. physical inactivity
C. surgery
Slide 17
What are key treatment strategies for autonomic hyperreflexia?
Select 3
A. Perform intubation
B. Remove stimulus
C. Deepen the anesthetic
D. Decrease fluid intake
E. Direct-acting vasodilators
B. Remove stimulus
C. Deepen the anesthetic
E. Administer direct-acting vasodilators
Slide 17
Injury to which spinal cord levels is most likely to result in respiratory failure?
A. C3-C5
B. T1-T4
C. C6-C7
D. C5-T7
A. C3-C5
Slide 18
Injury to the C5-T7 region may impair abdominal and __________ support of respiration.
A. spinal
B. intercostal
C. sternal
D. scapular
B. intercostal
Slide 18
Which interventions may be necessary for spinal cord injury patients with respiratory complications?
Select 3
A. Physical therapy for lower limbs
B. Monitoring for atelectasis
C. Continuous sedation
D. Increased caloric intake
E. Secretion clearance
F. Airway management
B. Monitoring for atelectasis - increased risk of infection
E. Secretion clearance - cough assistance
F. Airway management
Slide 18
What term describes the inability to maintain a constant core temperature due to spinal cord injury?
A. Poikilothermia
B. Hypothermia
C. Hyperthermia
D. Thermoregulation
A. Poikilothermia
The word “poikilothermic” comes from the Greek words poikilos which means “varied” and thermos which means “heat”.
Slide 19
Which mechanism is disrupted below the level of a spinal cord injury, contributing to poikilothermia?
A. Vasodilation
B. Vasoconstriction
C. Parasympathetic inhibition
D. Renal function
B. Vasoconstriction
Sympathetic disruption of pathways and temperature sensation
Slide 19
Which interventions help manage poikilothermia in spinal cord injury patients?
Select 3
A. Warm air circulation
B. Increase operating room temperature
C. Use of cold compresses
D. Warm IV fluids
E. Lava rocks
A. Warm air circulation
B. Increase operating room temperature
D. Warm IV fluidsC
Slide 19
Airway management issues are more common in which types of spine surgeries?
A. Lumbar and thoracic spine surgeries
B. Cervical and lumbar spine surgeries
C. Abdominal and pelvic surgeries
D. Pelvic and cervical spine surgeries
E. Cervical and thoracic spine surgeries
E. Cervical and thoracic spine surgeries
Slide 22
Preoperative tests for patients with spinal deformities may include pulmonary function tests (PFTs) and __________ especially if restrictive respiratory patterns are present.
A. arterial blood gases
B. hemoglobin A1c
C. liver enzyme levels
D. urine analysis
A. arterial blood gases (ABG)
Slide 22
Severe kyphoscoliosis can lead to __________ compromise, which may require careful preoperative evaluation.
A. gastrointestinal
B. neurological
C. cardiovascular
D. renal
C. cardiovascular
…issues such as reduced cardiac output, pulmonary hypertension, and right heart failure, due to the distortion of the thoracic cavity and the impact on heart and lung function…
Slide 22
Preoperative evaluation of _________ involves assessing range of motion and surgical positioning.
A) Neuro
B) Musculoskeletal
C) Cardiac
D) Respiratory
B) Musculoskeletal
Slide 23
In the neuro assessment during preop evaluation, you should…(select 2)
A) Assess reflexes
B) Document pre-existing motor deficits
C) Check surgical equipment
D) Document pre-existing sensory deficits
B) Document pre-existing motor deficits
D) Document pre-existing sensory deficits
Flaccid deltoid and biceps –> cervical spine fracture
Slide 23
The preoperative evaluation includes labs based on comorbidities and the __________.
A) Patient’s diet
B) Patient’s dance skills
C) Patient’s occupation
D) Type of procedure
D) Type of procedure
Slide 23
Finish this sentence
The 6 P’s
Proper planning preventing p______ p______ performance
Proper planning preventing piss poor performance 🤨
Slide 23
Which of the following are components of preoperative cervical spine evaluation?
Select 2
A) C-collar clearance
B) Atlas-axial stability
C) Documentation of TOF
D) Halo device check
A) C-collar clearance - Preop c-spine clearance
D) Halo device check 😇
Slide 24
Factors affecting preoperative cervical spine stability include:
Select 2
A) Atlanto-axial instability
B) Range of motion in legs only
C) Horn device check
D) Presence of traction devices
A) Atlanto-axial instability
D) Presence of traction devices
😈
Slide 24
Which drug can cause muscle fasciculations during intubation, especially in patients with cervical instability?
A) Succinylcholine
B) Propofol
C) Fentanyl
D) Rocuronium
A) Succinylcholine
Rocuronium (NDMB) may be preferable if you need to paralyze
Slide 26
Compared to volatile anesthetics, TIVA typically offers:
A) Increased suppression of MEP and SSEP signals
B) Better neurophysiologic monitoring
C) More rapid recovery
D) Greater risk of airway irritation
B) Better neurophysiologic monitoring
Plan must consider need for neurophysiologic monitoring
SSEP / MEP / EMG
slide 26
Which of the following anesthetics is most likely to affect SSEP and MEP monitoring?
A) Desflurane
B) Propofol
C) Ketamine
D) Etomidate
A) Desflurane
Slide 26
Which of the following airway management techniques provides the most visualization and is commonly used in difficult airway cases?
A) Direct laryngoscopy
B) Oral mask ventilation
C) Nasal cannula oxygenation
D) Video laryngoscopy
D) Video laryngoscopy
..as soon as we have a cervical collar, it is going to be deemed as a difficult intubation and we go straight to video laryngoscopy
Slide 27
In patients with cervical instability, airway management often involves __________ intubation to minimize movement.
Select 2
A) Rapid sequence
B) Sedated
C) Nasotracheal
D) Awake
B) Sedated
D) Awake
Slide 27
Which airway devices are used for lung isolation?
Select 2
A) Double-lumen tube (DLT)
B) Bronchial blocker
C) Single-lumen ETT
D) Nasopharyngeal airway
A) Double-lumen tube (DLT)
B) Bronchial blocker
Slide 28
Which of the following procedures may be performed under neuraxial/regional anesthesia?
Select 2
A) Lumbar laminectomy (2-3 levels)
B) Craniotomy
C) Intervertebral disc surgery
D) Thoracic spine fusion
E) Lumbar laminectomy (1-2 levels)
C) Intervertebral disc surgery
E) Lumbar laminectomy (1-2 levels)
Slide 29
True or False
The surgeon can provide additional nerve block during spinal surgery under direct visualization of the spinal cord.
True
Slide 29
The primary goals during a surgical procedure, focus on:
A) Speed and efficiency of the procedure.
B) Preventing injury and maintaining low venous pressure to surgical site
C) Minimizing the use of resources and equipment.
D) Ensuring patient comfort post-operatively.
B) Preventing injury and low venous pressure to surgical site
slide 31
According to the lecture, which of the following is a critical anatomical structure to avoid injury to during a procedure?
A) Muscles
B) Peripheral nerves
C) Skin
D) Blood vessels
B) Peripheral nerves
eyes and bony prominences
slide 31
the specific goals of a surgical procedure:
A) Are universal regardless of the surgical site.
B) Vary depending on the site of the procedure and surgical approach.
C) Primarily depend on the patient’s medical history.
D) Are solely determined by the surgeon’s preference.
B) Vary depending on the site of the procedure and surgical approach.
slide 31
Which of the following is NOT explicitly mentioned as a goal related to avoiding injury during positioning
A) Protecting the eyes.
B) Minimizing scarring.
C) Avoiding injury to peripheral nerves.
D) Protecting bony prominences.
B) Minimizing scarring.
slide 31
Which position includes arms tucked neutral and head on a padded head rest according to lecture
A.anterior supine
B. beach chair
C. posterior prone
D.lateral
A. anterior supine
slide 32
Which positioning includes arms tucked neutral and head in mayfield device
A.anterior supine
B. lithotomy
C.posterior cervical prone
D. lateral
C. posterior cervical prone
mayfield device very stimulating
slide 32
Why is cervical sitting uncommon position?
A. PE risk
B. uncomfortable
C. DVT risk
D. VAE risk
D. VAE risk
slide 35
Thoracic spine positioning anterior approach requires: select 3
A.lateral position with bean bag
B.Double lumen tube
C.bronchial blocker
D.supine position with arms tucked in neutral
A.lateral position with bean bag
B.Double lumen tube (or)
C.bronchial blocker
slide 36
Thoracic spine positioning posterior approach can be with (select 3)
A. double lumen ETT
B. gel headrest (prone view)
C. arms tucked or at 90 degrees abduction
D.single lumen ETT
E. arms abducted >90 degrees
B. gel headrest (prone view)
C. arms tucked or at 90 degrees abduction
D.single lumen ETT
slide 36
For an anterior approach of the lumbar spine which positioning will you use?
A. beach chair
B. lithotomy
C. supine laparotomy
D. lateral
c. supine laparotomy
slide 37
Posterior approach lumbar spine positioining consits of
A. lithotmy
B. supine
C.beach chair
D. prone
d. prone
slide 37
What medication should be considered in preop for a patient going prone?
A. neostigmine
B. atropine
C. Atenelol
D. glycopyrolate
D. glycopyrolate
anti-sialogogue
slide 38
Airway consideration during the prone positioning include all the following except
A. add corrugated adapter
B.assess for +BBS after turning
C. unintentional extubation
D.risk of ETT kinking
E. decreased VT
F. airway edema
E. decrease in VT
slide 38
Positioning for prone should include considerations for
A. buttox padding
B. posterior head protection
C. posterior calf protection
D. eye protection
D. eye protection
slide 39
Postoperative visual loss incidence is
A.>/=0.1%
B. </= 1%
C. </= 0.01%
D. </= 0.1%
D. </= 0.1%
slide 40
Causes of postoperative visual loss includes all the following EXCEPT
A. cortical brain ischemia
B. retinal artery vein occlusion
C. medulla ischemia
D. ischemic optic neuropathy
C. medulla ischemia
slide 40
true or false
Ischemic optic neuropathy occus with pressure to the eyes
FALSE
without pressure to the eyes
does occur due to decreased blod flow or O2 delivery
slide 41
Risk factors for ischemic optic neuropathy include all the following except
A. Wilson frame use
B. Decreased colloid use
C. Obesity
D. Duration of surgery >6 hours
E. Increased crystalloid use
F. Male
G. blood loss >100ml
E. increased crystalloid use
slide 42
Which of the following is NOT a listed treatment for Ischemic Optic Neuropathy (ION)?
A) Acetazolamide
B) Diuretics
C) Beta-blockers
D) Corticosteroids
C. beta blockers
slide 44
According to the information provided, what are potential treatment strategies for ION? (Select 4)
A) Acetazolamide
B) Increasing Blood Pressure (BP) or Hemoglobin (Hgb)
C) Hypobaric Oxygen
D) Diuretics
E) Corticosteroids
A) Acetazolamide
B) Increasing Blood Pressure (BP) or Hemoglobin (Hgb)
D) Diuretics
E) Corticosteroids
slide 44
The listed treatments for ION aim to address what primary issue?
A) Reduce intraocular pressure
B) Improve blood flow and oxygenation to the optic nerve
C) Decrease inflammation in the brain
D) Prevent further vision loss
B) Improve blood flow and oxygenation to the optic nerve
slide 44 also gemini– i thought it was a good question :)
Which of the following treatments for ION focuses on increasing oxygen delivery to the affected area?
A) Acetazolamide
B) Diuretics
C) Hyperbaric Oxygen (O2)
D) Corticosteroids
C) Hyperbaric Oxygen (O2)
slide 44
Which of the following is NOT explicitly mentioned as a preventative measure for ION in the lecture?
A) Maintaining the head in a neutral/midline position.
B) Administering corticosteroids.
C) Considering blood transfusion or colloids.
D) Minimizing surgical hypotension or using hypotensive techniques cautiously.
B) Administering corticosteroids.
slide 45
Central retinal artery occlusion is due to
A.decreased blood supply to entire retina
B. decreased blood supply to part of retina
C. increase pressure to retina
D. decreased O2 to retina
A. decreased blood supply to entire retina
slide 46
Retinal arterial branch occlusion is due to
A.decreased blood supply to entire retina
B. decreased blood supply to part of retina
C. increase pressure to retina
D. decreased O2 to retina
B. decreased blood supply to part of retina
What positioning table is this called
A. Jackson Spine table
B.C table
C. straight table
D. Wilson frame
D. Wilson frame
slide 47
What positioning table is this
A. Jackson Spine table
B.C table
C. straight table
D. Wilson frame
A. Jackson Spine table
Why do we use prone pillow (select 2)
A. increase pressure to occular nerve
B. prevent pressure on nose and mouth
C. no pressure to ears or breasts
D. limit pressure to forehead
B. prevent pressure on nose and mouth
C. no pressure to ears or breasts
slide 50
When positioning a patient prone, which of the following is crucial regarding the head and neck?
A) Maintaining alignment of the axis.
B) Encouraging full range of motion.
C) Allowing for extreme flexion and extension.
D) Positioning in lateral rotation.
A) Maintaining alignment of the axis.
slide 52
Which arm position is generally preferred when a patient is in the prone position?
A) Abduction greater than 90 degrees.
B) Full external rotation.
C) “Superman” or “surrender” position.
D) Allowing arms to hang freely.
C) “Superman” or “surrender” position.
slide 52
When positioning the arms in the “superman” or “surrender” position, what is a key consideration?
A) Abducting the arms to at least 180 degrees.
B) Considering tension on shoulder musculature.
C) Ensuring the elbows are fully extended.
D) Maintaining the arms in a pronated position.
B) Considering tension on shoulder musculature.
slide 52
When positioning a patient prone, what is a primary concern regarding the iliac crests and genitalia?
A) Ensuring proper alignment with the spine.
B) Avoiding compression.
C) Maintaining skin integrity.
D) Preventing pressure on bony prominences.
B) Avoiding compression.
slide 53
According to the lecture, what specific instruction is given regarding the checking of the iliac crests and genitalia?
A) Check before and after the procedure.
B) Someone must check.
C) Check every 15 minutes.
D) No specific instruction is given.
B) Someone must check.
slide 53
What position should the hips and knees be in when a patient is prone?
A) Fully extended.
B) Slightly flexed.
C) Hyper-extended.
D) In a position of comfort.
B) Slightly flexed.
slide 53
When using pillows or pads during prone positioning, what specific area should be protected from pressure?
A) Iliac crests.
B) Knees.
C) Fibular heads.
D) Genitalia.
C) Fibular heads.
slide 53
In the prone positioning what will be increased (select 3)
A. intraabdominal pressure
B. bleeding from epidural veins
C. venous return
D. intrathoracic pressure
E. pulmonary compliance
A. intraabdominal pressure
B. bleeding from epidural veins
D. intrathoracic pressure
slide 54
In the prone positioning what will be decreased (select 3)
A. intraabdominal pressure
B. FRC
C. venous return
D. intrathoracic presure
E. pulmonary compliance
B. FRC
C. venous return
E. pulmonary compliance
slide 54
Matching
Prone Positioning Device:
Siemens Positioning System
Andrews Frame
Wilson Frame
Jackson Spine Table
Longitudinal Bolster
Characteristics:
a. Chest supported, abdomen hangs free, partial pelvic support, legs below heart level.
b. Chest supported, partial abdominal compression, pelvis supported, legs at heart level.
c. Chest supported, partial abdominal compression, partial pelvic support, legs slightly below heart.
d. Chest supported, abdomen hangs free, pelvis supported, legs supported at thigh, at heart level.
e. Partial chest support, partial abdominal compression, partial pelvic support, legs at heart level.
b (Siemens Positioning System - Chest supported, partial abdominal compression, pelvis supported, legs at heart level)
a (Andrews Frame - Chest support, abdomen hangs free, partial pelvic support, legs below heart level)
c (Wilson Frame - Chest supported, partial abdominal compression, partial pelvic support, legs slightly below heart)
d (Jackson Spine Table - Chest supported, abdomen hangs free, pelvis supported, legs supported at thigh, at heart level)
e (Longitudinal Bolster - Partial chest support, partial abdominal compression, partial pelvic support, legs at heart level)
slide 55
Prone
Which of the following positioning devices is considered the most stable for head and neck positioning?
A) Prone positioner
B) C-shaped face piece
C) Horseshoe headrest
D) Mayfield tongs
D) Mayfield tongs
Slide 56
Prone
Select 3 potential cardiac effects of the prone position:
A) Pooling of blood in extremities
B) Increased preload
C) Decreased cardiac output
D) Compression of abdominal muscles
A) Pooling of blood in extremities
C) Decreased cardiac output
D) Compression of abdominal muscles
Slide 57
Prone
Which of the following are 2 respiratory complications related to the prone position?
A) Decreased lung compliance
B) Increased airway resistance
C) Improved work of breathing
D) Compression of abdomen and thorax
A) Decreased lung compliance,
D) Compression of abdomen and thorax
Slide 57
Prone
Select 2 possible neurovascular concerns when the head is positioned incorrectly in the prone position:
A) Increased intracranial pressure
B) Decreased cerebral venous drainage
C) Decreased cerebral blood flow (CBF)
D) Increased venous return from the brain
B) Decreased cerebral venous drainage
C) Decreased cerebral blood flow (CBF)
Slide 57
Spine Sx
Which 3 surgical procedures or conditions are associated with greater blood loss during spine surgery?
A) Transpedicular osteotomy
B) Minor skin incisions
C) Number of levels included in surgery
D) Surgery for tumors
A) Transpedicular osteotomy
C) Number of levels included in surgery
D) Surgery for tumors
Slide 59
Spine Sx
Select 3 factors that can elevate intraoperative blood loss during spine surgery:
A) Increased intraabdominal pressure
B) Short surgery duration
C) Age > 50 years
D) Obesity
A) Increased intraabdominal pressure
C) Age > 50 years
D) Obesity
Slide 59
Spine Sx
Which 3 factors should be considered when deciding on a transfusion during spine surgery?
A) Patient comorbidities
B) Hemodynamic profile
C) Patient height
D) Higher allowable blood loss
A) Patient comorbidities
B) Hemodynamic profile
D) Higher allowable blood loss
Slide 60
Spine Sx
What is the recommended hemoglobin (Hgb) threshold to consider a transfusion during spine surgery?
A) 5-6 g/dL
B) 7-8 g/dL
C) 9-10 g/dL
D) Above 11 g/dL
B) 7-8 g/dL
Slide 60
Spine Sx
Cost-effectiveness is a benefit of which surgical strategy for managing blood loss?
A) Use of a cell saver
B) Increased fluid administration
C) Continuous arterial pressure monitoring
D) Application of a tourniquet
A) Use of a cell saver
Slide 60
Spine Sx
When is preoperative autologous blood donation typically recommended for spine surgery?
A) When the estimated blood loss (EBL) is less than 200 mL
B) When the EBL is anticipated to be 500-1000 mL
C) When no significant blood loss is expected
D) Only in cases of emergency surgery
B) When the EBL is anticipated to be 500-1000 mL
Slide 61
Spine Sx
Which of the following conditions is a contraindication for preoperative autologous blood donation?
A) Diabetes
B) Obesity
C) Significant cardiac disease
D) Mild anemia
C) Significant cardiac disease
Slide 61
Spine Sx
Which 2 antifibrinolytic drugs used to reduce blood loss in spine surgery?
A) Tranexamic acid (TXA)
B) Aminocaproic acid (Amicar)
C) Furosemide
D) Albumin
A) Tranexamic acid (TXA)
B) Aminocaproic acid (Amicar)
Slide 62
Spine Sx
Which of the following are correct regarding the administration of tranexamic acid (TXA) during spine surgery? (Select 3)
A) Initial IV dose is 10 mg/kg
B) Infusion rate is 10-15 mg/kg/hr
C) Infusion rate is 2 mg/kg/hr
D) Infusion is discontinued at the end of the procedure
E) Initial IV dose is 100 mg/kg
A) Initial IV dose is 10 mg/kg
C) Infusion rate is 2 mg/kg/hr
D) Infusion is discontinued at the end of the procedure
Slide 62
Spine Sx
Which of the following are correct regarding the administration of aminocaproic acid (Amicar) during spine surgery? select 3
A) Initial IV dose is 10 mg/kg
B) Infusion rate is 10-15 mg/kg/hr
C) Infusion rate is 2 mg/kg/hr
D) Initial IV dose is 100 mg/kg
E) Infusion is discontinued at the end of the procedure
B) Infusion rate is 10-15 mg/kg/hr
D) Initial IV dose is 100 mg/kg
E) Infusion is discontinued at the end of the procedure
Slide 62
Spine Sx
Which of the following statements are correct regarding intraoperative hemodilution in spine surgery? (Select 2)
A) Involves removal of 450-500 mL of blood after anesthesia induction
B) Blood volume is replaced with crystalloid or colloid to maintain normovolemia
C) Blood is removed prior to anesthesia induction
D) It reduces intraoperative bleeding risks
E) No fluid replacement is required after blood removal
A) Involves removal of 450-500 mL of blood after anesthesia induction
B) Blood volume is replaced with crystalloid or colloid to maintain normovolemia
S;ide 63
Spine Sx
Which of the following are correct regarding intentional (deliberate) hypotension in spine surgery? (Select 2)
A) It is recommended for routine spine surgeries
B) It can increase the risk of end-organ ischemia
C) It is not recommended in spine surgery
D) It helps maintain normovolemia
E) It may cause an increase in blood flow to critical organs
B) It can increase the risk of end-organ ischemia,
C) It is not recommended in spine surgery,
Slide 63
Neurophysiologic Monitoring
Which of the following statements are correct regarding the intraoperative wake-up test during corrective surgery? (Select 2)
A) It is performed following the completion of instrumentation.
B) It evaluates gross motor movements of the upper and lower extremities.
C) It reduces blood pressure.
D) It is conducted before anesthesia induction.
E) It helps assess the stability of surgical instrumentation.
A) It is performed following the completion of instrumentation
B) It evaluates gross motor movements of the upper and lower extremities
Slide 65
Neurophysiologic Monitoring
Which of the following are potential complications of the intraoperative wake-up test? (Select 3)
A) Inadvertent extubation
B) Cardiac arrest
C) Air embolism
D) Violent movements causing displacement of instrumentation
A) Inadvertent extubation
C) Air embolism
D) Violent movements causing displacement of instrumentation
Slide 65
Neurophysiologic Monitoring
Which pathway is monitored using somatosensory evoked potentials (SSEP)?
A) Anterior spinal cord motor pathways
B) Dorsal column pathways of proprioception and vibration
C) Nerve root pathways of pain and temperature
D) Cerebral cortex sensory pathways
B) Dorsal column pathways of proprioception and vibration
Slide 66
Neurophysiologic Monitoring
Motor evoked potential (MEP) is used to evaluate which part of the spinal cord?
A) Dorsal sensory pathways
B) Posterior nerve roots
C) Anterior motor portion
D) Pain and temperature pathways
C) Anterior motor portion
Slide 66
Neurophysiologic Monitoring
What is the primary purpose of monitoring electromyograms (EMG) during spine surgery?
A) Evaluate proprioception and vibration pathways
B) Monitor nerve root injury during pedicle screw placement and nerve decompression
C) Detect changes in cerebral oxygen levels
D) Measure cardiac output during surgery
B) Monitor nerve root injury during pedicle screw placement and nerve decompression
Slide 66
Neurophysiologic Monitoring
What does somatosensory evoked potential (SSEP) monitoring measure?
A) Electrical activity from peripheral nerves measured centrally
B) Pain responses in the spinal cord
C) Blood flow in the spinal cord
D) Nerve root activity during pedicle screw placement
A) Electrical activity from peripheral nerves measured centrally
Slide 67
Neurophysiologic Monitoring
What is the purpose of motor evoked potential (MEP) monitoring during surgery?
A) To measure peripheral nerve impulses
B) To detect impulses triggered in the brain and monitor specific muscle groups
C) To measure respiratory muscle function
D) To evaluate oxygen levels in the spinal cord
B) To detect impulses triggered in the brain and monitor specific muscle groups
Slide 68
Neurophysiologic Monitoring
Which of the following are potential adverse effects of motor evoked potential (MEP) monitoring? select 5
A) Cognitive defects
B) Seizures
C) Intraoperative awareness
D) Scalp burns
E) Cardiac arrhythmias
F) Increased oxygen saturation
G) Reduced muscle reflexes
H) Enhanced recovery time
A) Cognitive defects
B) Seizures
C) Intraoperative awareness
D) Scalp burns
E) Cardiac arrhythmias
Slide 68
Neurophysiologic Monitoring - Bite injuries
Which of the following can prevent tongue and dental injuries during motor evoked potential (MEP) monitoring?
A) Placement of a bite block between the molars
B) Use of muscle relaxants
C) Increased anesthesia depth
D) Cooling the patient’s mouth
A) Placement of a bite block between the molars
Slide 69
Neurophysiologic Monitoring
MEP monitoring should be avoided in patients with which of the following conditions? (Select 3)
A) Cochlear implants
B) Active seizures
C) Diabetes
D) Vascular clips in the brain
A) Cochlear implants
B) Active seizures
D) Vascular clips in the brain
Slide 69
Neurophysiologic Monitoring
What does amplitude represent in neurophysiologic monitoring?
A) Time for a signal to travel through the spinal cord
B) Signal strength
C) Body temperature regulation
D) Electrical resistance
B) Signal strength
Slide 70
Neurophysiologic Monitoring
What is latency in neurophysiologic monitoring?
A) Signal frequency variation
B) Strength of electrical impulses
C) Time it takes for a signal to travel through the spinal cord
D) Heart rate variability
C) Time it takes for a signal to travel through the spinal cord
Slide 70
Neurophysiologic Monitoring
Which of the following are confounding factors that can affect neurophysiologic monitoring results? (Select 6)
A) Hypotension
B) Hypothermia
C) Hypocarbia
D) Hypoxia
E) Anemia
F) Hyperglycemia
G) Volatile agents
H) Elevated potassium levels
A) Hypotension
B) Hypothermia
C) Hypocarbia
D) Hypoxia
E) Anemia
G) Volatile agents
Slide 70
Neurophysiologic Monitoring
Volatile anesthetic agents can decrease ____ and increase ____ during neurophysiologic monitoring.
A) blood pressure; heart rate
B) amplitude; latency
C) oxygen saturation; signal transmission speed
D) sensitivity; specificity
B) decrease amplitude;
increase latency
Slide 71
Neurophysiologic Monitoring
At what level should volatile anesthetic agents be stabilized for neurophysiologic monitoring?
A) 1.0 MAC
B) 0.5 MAC
C) 1.5 MAC
D) 0.25 MAC
B) 0.5 MAC
Slide 72
Neurophysiologic Monitoring
Why should nitrous oxide (N₂O) be eliminated during MEP monitoring?
A) It increases oxygen delivery
B) It enhances the motor response
C) It reduces signal strength by decreasing amplitude
D) It accelerates signal transmission
C) It reduces signal strength by decreasing amplitude
Slide 72
Neurophysiologic Monitoring
Which of the following anesthetic agents have the least effect on motor evoked potentials (MEPs) during total intravenous anesthesia (TIVA)? select 3
A) Opioids
B) Ketamine
C) Propofol
D) Midazolam
A) Opioids
B) Ketamine
D) Midazolam
Slide 73
Neurophysiologic Monitoring
Which anesthetic agent can depress motor evoked potentials (MEPs) during TIVA?
A) Opioids
B) Propofol
C) Ketamine
D) Midazolam
B) Propofol
Slide 73
Neurophysiologic Monitoring
What is a key anesthetic consideration for motor evoked potentials (MEPs)?
A) Use muscle relaxants throughout the procedure
B) Avoid muscle relaxants after intubation
C) Increase volatile agent concentration
D) Use high-dose nitrous oxide
B) Avoid muscle relaxants after intubation
Castillo: Muscle relaxation or muscle relaxance would affect me MEPS because they relax the muscle
Slide 74
Neurophysiologic Monitoring
What should be done if there are acute changes in amplitude or latency during neurophysiologic monitoring?
A) Continue surgery without changes
B) Discontinue the surgery
C) Increase volatile anesthetic agents
D) Reduce blood pressure to below baseline
B) Discontinue the surgery
Slide 74
Neurophysiologic Monitoring
Which of the following actions can help address acute neurophysiologic changes during surgery? (Select 2)
A) Maintain blood pressure within normal limits to 20% above baseline
B) Reduce blood pressure to below baseline
C) Discontinue volatile agents
D) Increase volatile anesthetic concentration
A) Maintain blood pressure within normal limits to 20% above baseline
C) Discontinue volatile agents
Castillo: We need to make sure that our baseline and 20% of our blood pressure is still being met.Or we need to discontinue our voltal agents in order to assess this properly
Slide 74
PostOp Care
Which factor may indicate the need for postoperative ventilation?
select 3
A) Procedure duration of over 4 hours
B) Minimal blood loss
C) Thoracic cavity invasion
D) Presence of facial or laryngeal edema
A) Procedure duration of over 4 hours
C) Thoracic cavity invasion
D) Presence of facial or laryngeal edema
Slide 76
PostOp Care
What is a recommended practice when extubation is considered after a prolonged procedure?
A) Immediate extubation without assessment
B) Extubate over a tube exchanger
C) Delayed extubation for 24 hours
D) Use a high-dose sedative before extubation
B) Extubate over a tube exchanger
Slide 76
PostOp Care
Which condition should be assessed when procedures last more than 4 hours?
A) Hyperthermia
B) Edema formation
C) Dehydration
D) Hypotension
B) Edema formation
Slide 76
PostOp Care
Excessive blood loss greater than ________ may require postoperative ventilation.
A) 200 mL or 5 mL/kg
B) 1000 mL or 15 mL/kg
C) 2000 mL or 30 mL/kg
D) 500 mL or 10 mL/kg
C) 2000 mL or 30 mL/kg
Slide 76
PostOp Care
What is a key consideration when using NSAIDs for postoperative pain management for multimodal analgesia?
A) Avoid NSAIDs altogether
B) Use NSAIDs in high doses
C) Use NSAIDs cautiously
D) NSAIDs are the primary analgesic
C) Use NSAIDs cautiously
Slide 77
PostOp Care
Which of the following are methods of postoperative analgesia management? (Select 4)
A) Multimodal analgesia
B) Extreme use of NSAIDs
C) Patient-controlled analgesia (PCA)
D) Wound local anesthetic infiltration
E) Intrathecal morphine
F) Nitrous oxide administration
A) Multimodal analgesia
C) Patient-controlled analgesia (PCA)
D) Wound local anesthetic infiltration
E) Intrathecal morphine
Slide 77
PostOp Care
What is a common approach for providing postoperative epidural analgesia?
A) Continuous epidural infusion
B) Intermittent epidural bolus every 6 hours
C) Single-dose injection only
D) Oral opioid administration
A) Continuous epidural infusion
Slide 78
PostOp Care
Which of the following techniques is recommended for managing pain at multiple levels during epidural analgesia?
A) Use of a single epidural catheter
B) Double epidural techniques
C) Peripheral nerve block
D) Subcutaneous opioid injections
B) Double epidural techniques
Slide 78
PostOp Care
What is the recommended initial dose approach for epidural pain control?
A) Initial dose of local anesthetic only
B) Initial dose of opioids rather than local anesthetic
C) Combination of muscle relaxants and NSAIDs
D) Nitrous oxide administration
B) Initial dose of opioids rather than local anesthetic
Slide 78
PostOp Care
Which of the following is an appropriate epidural opioid dose for postoperative pain management?
A) Hydromorphone PF 0.1 – 0.3 mg
B) Hydromorphone PF 0.5 – 1 mg
C) Morphine 20 mg
D) Fentanyl 200 mcg
B) Hydromorphone PF 0.5 – 1 mg
Slide 78
PostOp Care
Which of the following is a type of postoperative peripheral nerve block for Spinal surgeries?
A) Epidural block
B) Sciatic nerve block
C) Erector spinae block
D) Intrathecal block
C) Erector spinae block
Slide78
Complications
In which surgical procedure is the risk of venous air embolism (VAE) highest?
A) Craniotomy
B) Laminectomy
C) Appendectomy
D) Thyroidectomy
B) Laminectomy
Slide 80
Complications
Which of the following 2 factors increase the risk of venous air embolism during a laminetomy?
A) Large amount of exposed bone
B) Surgical site above the heart
C) Use of general anesthesia
D) Patient in a supine position
A) Large amount of exposed bone
B) Surgical site above the heart
Slide 80
Complications
Which of the following are 3 clinical signs and diagnostic indicators of venous air embolism (VAE)?
A) Unexplained hypotension
B) Increase in ETCO₂
C) Decrease in ETCO₂
D) Increased end-tidal nitrogen levels
E) Elevated body temperature
A) Unexplained hypotension
C) Decrease in ETCO₂
D) Increased end-tidal nitrogen levels
Prevention & Treatment
Slide 80
