Unit 1 Module 3 (Exam 1) Flashcards by Kimberly Diane Hill

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

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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

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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

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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

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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

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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

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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

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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

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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

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True or False

Spinal fusion can be performed through either an anterior or posterior approach.

True

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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

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Types of scoliosis include congenital, idiopathic, and __________.

A. degenerative
B. traumatic
C. infectious
D. neuromuscular

D. neuromuscular

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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

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Spinal stenosis can cause pain that worsens when a patient is __________.

A. lying down
B. eating
C. swimming
D. standing

D. standing or walking

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Radiculopathy is caused by the compression or __________ of a nerve at the spinal column.

A. stretching
B. pinching
C. relaxing
D. dissolving

B. pinching

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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

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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

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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

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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

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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

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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. Atrial fibrillation

B. Right ventricular hypertrophy (RVH)
C. Right atrial enlargement (RAE)

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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…

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In surgeries with significant blood loss, platelet abnormalities and __________ coagulopathy may occur.

A. respiratory
B. peripheral
C. chronic
D. dilutional

D. dilutional

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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

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# True or False The number of vertebral levels fused can impact the amount of blood loss during surgery.

True ## Footnote 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 ## Footnote Slide 12

Which spinal cord level is responsible for partial diaphragm innervation? A. C5 B. C6 C. C7 D. T1

A. C5 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote Slide 14

What condition may develop in spinal injuries higher than T1 to T4? A. Hyperthermia B. Bradycardia C. Tachypnea D. Cyanosis

B. Bradycardia ## Footnote 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 ## Footnote 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 ## Footnote Slide 15

# True or false Severe transient hypertension occurs below the level of injury in autonomic hyperreflexia.

True ## Footnote 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 ## Footnote 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 ## Footnote Slide 15

A common trigger for autonomic hyperreflexia is a full __________ or bowel. A. stomach B. bladder C. lung D. artery

B. bladder ## Footnote 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* ## Footnote 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 ## Footnote 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 ## Footnote Slide 16

Noxious stimulation, such as __________, can cause autonomic hyperreflexia. A. deep sleep B. low oxygen saturation C. surgery D. physical inactivity

C. surgery ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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". ## Footnote 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* ## Footnote 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. Warm intravenous fluids (IVF) ## Footnote Slide 19

Airway management issues are more common in which types of spine surgeries? Select 2 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 ## Footnote 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) ## Footnote 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...* ## Footnote Slide 22

Preoperative evaluation of _________ involves assessing range of motion and surgical positioning. A) Neuro B) Musculoskeletal C) Cardiac D) Respiratory

B) Musculoskeletal ## Footnote Slide 23

In the neuro assessment during preop evaluation, you should: 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* ## Footnote 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 ## Footnote Slide 23

# Finish this sentence The 6 P's Proper planning preventing p______ p______ performance

Proper planning preventing **piss poor** performance 🤨 ## Footnote 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 😇 ## Footnote 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 😈 ## Footnote 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* ## Footnote 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* ## Footnote slide 26

Which of the following volatile anesthetics is most likely to affect SSEP and MEP monitoring? A) Desflurane B) Propofol C) Ketamine D) Etomidate

A) Desflurane ## Footnote 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* ## Footnote 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 ## Footnote 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 ## Footnote 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) ## Footnote Slide 29

# True or False The surgeon can provide additional nerve block during spinal surgery under direct visualization of the spinal cord.

True ## Footnote Slide 29

The primary goals during a surgical procedure, as indicated in the image, 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 ## Footnote slide 31

# Krista 56-80 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 ## Footnote 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. ## Footnote 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. ## Footnote 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 ## Footnote 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 ## Footnote slide 32

Why is cervical sitting uncommon position? A. PE risk B. uncomfortable C. DVT risk D. VAE risk

D. VAE risk ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote slide 37

Posterior approach lumbar spine positioining consits of A. lithotmy B. supine C.beach chair D. prone

d. prone ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote slide 39

Postoperative visual loss incidence is A.>/=0.1% B.

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 ## Footnote 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 ## Footnote slide 41

Risk factors for ischemic optic neuropathy include all the following except A. Wilson frame use B.decerased colloid use C.obesity D.duration of surgery >6 hours E. increased crystalloid use F.Male G. blood loss >100ml

E. increased crystalloid use ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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) ## Footnote slide 44

Which of the following is NOT explicitly mentioned as a **preventative** measure or treatment strategy for ION in the provided information? 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. ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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. ## Footnote 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. ## Footnote 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. ## Footnote 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. ## Footnote 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. ## Footnote 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. ## Footnote 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. ## Footnote 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 ## Footnote 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 ## Footnote slide 54

Column A: Prone Positioning Device Siemens Positioning System Andrews Frame Wilson Frame Jackson Spine Table Longitudinal Bolster Column B: 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) ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote Slide 57

# Prone Select all 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) ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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) ## Footnote 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 ## Footnote Slide 62

# Spine Sx Which of the following are correct regarding the administration of aminocaproic acid (Amicar) during spine surgery? 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 ## Footnote 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 ## Footnote 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, ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote Slide 68

# Neurophysiologic Monitoring Which of the following are potential adverse effects of motor evoked potential (MEP) monitoring? 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote Slide 72

# Neurophysiologic Monitoring Which of the following anesthetic agents have the least effect on motor evoked potentials (MEPs) during total intravenous anesthesia (TIVA)? A) Opioids B) Ketamine C) Propofol D) Midazolam

A) Opioids B) Ketamine D) Midazolam ## Footnote 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 ## Footnote 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* ## Footnote 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 ## Footnote 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* ## Footnote Slide 74

# PostOp Care Which factor may indicate the need for postoperative ventilation? 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote Slide 80

# Complications Which of the following 2 factors increase the risk of venous air embolism during a laminetom7? 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 ## Footnote 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* ## Footnote Slide 80