Upper Extremities

Question 1

what mA is used for nerve stimulation technique

Answer 1

0-5 mA

Question 2

what frequency is used for nerve stimulation technique

Answer 2

1 or 2 Hz

Question 3

most practitioners inject local anesthetic when current between ____________ mA results in a motor response

Answer 3

0.2 and 0.5

Question 4

ultrasound technique frequency

Answer 4

1-20 MHz

Question 5

how are nerves best imaged

Answer 5

cross-section where they have a characteristic honeycomb appearance

Question 6

technique most frequently utilized for nerve blocks

Answer 6

in-plane, as the entire shaft of the needle can be visualized as it approaches the target nerve and navigates surrounding structures.

Question 7

Answer 7

in plane

Question 8

Answer 8

out of plane

Question 9

what determines block effects

Answer 9

total drug mass (DOSE) not the concentration

Question 10

what forms the brachial plexus

Answer 10

brachial plexus is formed by the union of the anterior primary divisions (ventral rami) of the fifth through the eighth cervical spinal nerves (C5–C8) and the first thoracic spinal nerve (T1).

Question 11

the lateral cord gives off the lateral branch of the median nerve and terminates as

Answer 11

the musculocutaneous nerve

Question 12

the medial cord gives off the medial branch of the median nerve and terminates as

Answer 12

the ulnar nerve

Question 13

the posterior cord gives off the axillary nerve and terminates as

Answer 13

the radial nerve

Question 14

what block are used for shoulder and proximal humerus procedures

Answer 14

interscalene

Question 15

surgeries distal to the mid humerus can be anesthetized via which 3 blocks

Answer 15

supraclavicular, infraclavicular, axillary

Question 16

An interscalene brachial plexus block is indicated for procedures involving

Answer 16

the shoulder and upper arm

Question 17

roots most densely blocked with interscalene

Answer 17

C5 to C7

Question 18

cutaneous branch of C3 and C4

Answer 18

supraclavicular

Question 19

what bilateral block is ABSOLUTELY contraindicated and why

Answer 19

Bilateral interscalene blocks are absolutely contraindicated. Hemidiaphragmatic paresis may result in dyspnea, hypercapnia, and hypoxemia

Question 20

horner syndrome 3 symptoms

Answer 20

myosis, ptosis, anhidrosis

Question 21

if the recurrent laryngeal nerve is blocked patients may experience

Answer 21

hoarseness

Question 22

As little as ____________ mL of local anesthetic delivered into the vertebral artery may induce a seizure.

Answer 22

1

Question 23

The brachial plexus passes between the anterior and middle scalene muscles at the level of

Answer 23

the cricoid cartilage, or C6

Question 24

The external jugular vein often crosses the interscalene groove at the level of

Answer 24

the cricoid cartilage.

Question 25

If surgical anesthesia is desired for the entire shoulder, the ____________ must usually be anesthetized separately (2)

Answer 25

intercostobrachial (T2) and supraclavicular (C3 and C4)

Question 26

The brachial plexus at C6 appears most commonly as

Answer 26

three hypoechoic circles with hyperechoic borders.

Question 27

The primary target for local anesthetic admin in an interscalene block should be

Answer 27

between the two most superficial nerves (most commonly C5 and C6)

Question 28

a supraclavicular block offers dense anesthesia of the brachial plexus for surgical procedures

Answer 28

at or distal to the elbow

Question 29

the supraclavicular block is not ideal for shoulder surgery unless combined with

Answer 29

a suprascapular nerve block.

Question 30

the supraclavicular block commonly spares the ____________ nerve

Answer 30

ulnar

Question 31

Nearly half of patients undergoing supraclavicular block will experience

Answer 31

ipsilateral phrenic nerve palsy,

Question 32

The brachial plexus appears as

Answer 32

multiple hypoechoic disks (sometimes referred to as a cluster of grapes)

Question 33

most important injection location for supraclavicular block

Answer 33

the most important injection location is the “corner pocket” between the artery, plexus, and first rib.

Question 34

Brachial plexus block at the level of the cords provides excellent anesthesia for procedures ...

Answer 34

at, or distal to, the elbow

Question 35

optimal needle positioning for infraclavicular block

Answer 35

optimal needle positioning is between the axillary artery and the posterior cord

Question 36

At the lateral border of the pectoralis minor muscle, the cords of the brachial plexus form large terminal branches oriented around

Answer 36

the axillary artery

Question 37

what nerves are usually spared with an axillary approach

Answer 37

The axillary, musculocutaneous, and medial brachial cutaneous nerves

Question 38

A ____________ technique is more effective for the axillary nerve block because of ____________

Answer 38

multiple injection; fascial separation between nerves.

Question 39

The median nerve is derived from

Answer 39

the lateral and medial cords of the brachial plexus

Question 40

The median nerve provides the primary motor innervation to

Answer 40

the muscles in the anterior forearm responsible for flexing the fingers and wrist (with some contribution from the ulnar nerve) as well as to the thenar muscles

Question 41

the median nerve provides sensory innervation to

Answer 41

the hand

Question 42

The ulnar nerve is the continuation of

Answer 42

the medial cord of the brachial plexus

Question 43

compression of which nerve results in cubital tunnel syndrome

Answer 43

ulnar nerve

Question 44

the terminal branch of the posterior cord of the brachial plexus

Answer 44

radial nerve

Question 45

terminal sensory branches of the radial nerve

Answer 45

lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the forearm

Question 46

The radial nerve is most easily visualized on ultrasound as

Answer 46

a structure consisting of two hypoechoic circles with hyperechoic borders immediately deep to the brachioradialis muscle in the forearm 2 to 3 cm distal to the lateral epicondyle

Question 47

Blocking the ____________ nerve is essential to complete the anesthesia for the forearm and wrist when performing an axillary brachial plexus block.

Answer 47

musculocutaneous

Question 48

the most proximal of the major nerves to emerge from the plexus

Answer 48

musculocutaneous

Question 49

the musculocutaneous nerve innervates which 2 muscles

Answer 49

coracobrachialis and biceps

Question 50

where does the intercostobrachial nerve originate

Answer 50

in the upper thorax (T2) and becomes superficial on the medial upper arm

Question 51

what is the intercostobrachial block frequently used for

Answer 51

during upper extremity surgeries, the intercostobrachial nerve block is frequently performed as a supplement to brachial plexus blockade for awake upper extremity surgery under regional anesthesia

Question 52

used as the anesthetic for intravenous regional anesthesia

Answer 52

lidocaine

Question 53

Blocking the stellate ganglion (cervicothoracic sympathetic block) causes

Answer 53

sympathetic blockade of the ipsilateral face and arm, which presents as Horner’s syndrome

Question 54

what nerve is supplied by ALL branches of the brachial plexus

Answer 54

median nerve

Question 55

what structure is between the anterior and middle scalene muscles

Answer 55

interscalene

Question 56

supraclavicular block has highest complication of ____________

Answer 56

pneumothorax

Question 57

median nerve block landmark

Answer 57

flexor carpi radialis tendon

Question 58

ulnar nerve block landmark

Answer 58

flexor carpi ulnaris tendon

Question 59

infraclavicular blocks at the level of

Answer 59

the cords

Question 60

axillary nerve motor and sensory function

Answer 60

o Motor: deltoid and teres minor muscles; externally rotate shoulder; abduct arm o Sensory: lateral side of arm below shoulder

Question 61

radial nerve motor and sensory function

Answer 61

o Motor: extension of elbow, wrist, fingers o Sensory: dorsal radial side of hand; posterior lateral side of arm

Question 62

musculocutaneous nerve motor and sensory function

Answer 62

o Motor: flexion at elbow o Sensory: lateral forearm

Question 63

push

Answer 63

radial

Question 64

pull

Answer 64

musculocutaneous

Question 65

pinching thumb and pinky

Answer 65

ulnar

Question 66

pinching thumb and index

Answer 66

median

Question 67

deep cervical plexus block can cause

Answer 67

hemidiaphragmatic paralysis

Question 68

ulnar nerve motor and sensory

Answer 68

o Motor: wrist flexion; all finger adduction; flexion/opposition of pinky/ring finger towards thumb o Sensory: pinky and ½ of ring finger

Question 69

median nerve motor and sensory

Answer 69

o Motor: forearm flexors and thumb abduction; forearm pronation; wrist flexion; opposition of middle finger, ring finger, and thumb o Sensory: thumb, pointer finger, middle finger