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Flashcards in Anatomy Deck (75):
1

In the adult patient, the superior border of the thyroid cartilage overlies:

C4 In the adult, the larynx extends from the superior border of the thyroid cartilage at the C4 level to the inferior border of the cricoid ring at the C6 level. The hyoid bone, which provides the chief support for the larynx, overlies C3.

2

Branches of the left coronary artery include: (Select 3)

cicumflex, diagonal, left anterior descending

3

Regarding a block of the celiac plexus:

it is frequently utilized to mitigate visceral pain The celiac plexus block is utilized for various types of intra-abdominal visceral pain syndromes, most frequently for relief of pain associated with intra-abdominal cancer. It is generally performed with the patient in the prone position with a pillow placed under the abdomen to decrease lumbar lordosis. It is performed at the level of T12-L1. Potential complications of celiac plexus block include inadvertent aortic puncture or spinal or epidural anesthesia.

4

Branches of the facial nerve (CN VII) include the:

zygomatic nerve, buccal nerve, mandibular nerve Branches of the facial nerve (CN VII) include the temporal, zygomatic, buccal, mandibular, and cervical nerves.

5

A patient presents for a stellate ganglion block for the treatment of CRPS Type I of the right upper extremity. After completion of the block, sympathetic blockade of the right upper extremity can be best assessed by observing:

a temperature change in the right arm

Stellate ganglion block is most commonly performed for patients with upper extremity pain (CRPS I or II). Horner's syndrome, a side effect of stellate ganglion block, is heralded by symptoms of SNS denervation such as miosis, ptosis, and enophthalmos of the globe on the ipsilateral side of the block. Although practitioners look for the development of Horner's syndrome as a metric for efficacy of the block, its presence does not necessarily equate to sympathetic denervation of the upper extremity.

pg. 1233
Cousins, MJ, Carr DB, Horlocker, TT et al. Neural Blockade in Clinical Anesthesia and Pain Medicine. Philadelphia: Lippincott Williams & Wilkins, 2009.

6

A superior laryngeal nerve block: provides block to where?

provides a sensory block to the epiglottis and the airway mucosa to the level of the vocal cords

The superior laryngeal nerve is comprised of two branches: the external branch which provides motor innervation to the cricothyroid muscle, and the internal branch which provides sensory innervation to the laryngeal mucosa above the level of the vocal cords. SLN block is performed between the lateral aspect of the hyoid bone and the thyroid cartilage at the thyrohyoid membrane.

pg. 1318
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

7

Fibers found in the spinothalamic tract of the spinal cord are involved in the transmission of: (Select 3)

simple touch, pain, temperature

"U.S. National Library of Medicine.."
URL: http://www.ncbi.nlm.nih.gov/books/NBK10967/

8

In the adrenal gland, glucocorticoids are chiefly secreted in the:

zona fasciculata

Endogenous glucocorticoids are secreted by the zona fasciculata of the adrenal gland. The zona glomerulosa secretes mineralocorticoids (aldosterone) and the zona reticularis secretes androgens. The adrenal medulla secretes epinephrine (80%) and norepinephrine (20%).

pg. 823
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

9

What is the only cartilage of the larynx that forms a complete ring?

The cricoid cartilage: is the only cartilage of the larynx that forms a complete ring

The larynx consists of 9 cartilages: the thyroid, epiglottis and cricoid cartilages (singular) and the arytenoids, corniculates, and cuneiforms (paired). Of the laryngeal cartilages, the cricoid is the only one to form a complete ring.

pp. 423, 452
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

10

A list of laryngeal muscle functions is shown (Click here to display definitions). By dragging & reordering the selections in yellow, match the term with the associated muscle.


1) Opens (abducts) vocal cords

2) Closes (adducts) vocal cords, closes glottis

3) Tenses and elongates vocal cords

4) Shortens and relaxes vocal cords

1) Opens (abducts) vocal cords

2) Closes (adducts) vocal cords, closes glottis

3) Tenses and elongates vocal cords

4) Shortens and relaxes vocal cords

1. post cryicoarytenoid
2. lat cyricoarytenoid
3. cricothyroid
4. thyroarytenoid

11

Cranial nerves possessing only motor function include:

Cranial Nerve Innervation Cranial Nerve Innervation
I Sensory VII Both
II Sensory VIII Sensory
III Motor IX Both
IV Motor X Both
V Both XI Motor
VI Motor XII Motor

12

The primary complication associated with the sitting position is:

venous air embolization

Although hypoperfusion of the cerebral vasculature, pooling of blood in the lower extremities and a decrease in FRC may all occur in the sitting position, VAE is the principal hazard. Air may be entrained into the vasculature as a result of a negative pressure gradient created when the operative site is above the level of the heart. The incidence of venous air embolism in the sitting position ranges from 1-76%.

pp. 428-429
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

13

Upon removal of the drapes after an extended surgery in the supine position, it is noted that the patient's legs are crossed. After awakening, the patient complains of numbness on the lateral and posterior portion of the sole of his foot. The nerve most likely injured is the:

sural nerve

Conscious patients cross their legs to alleviate lumbosacral strain in the supine position. This may result in injury of the superficial peroneal nerve in the dependent leg and the sural nerve in the superior leg. Damage of the sural nerve may result in numbness of the posterior portion of the sole of the foot and heel the lateral foot, and the Achilles just above the ankle.

pp. 429-430, 1099
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

14

The protective mechanism which prevents over distention of the alveoli at high lung volumes is known as the:

Hering-Breuer reflex

Stimulation of stretch receptors in the lungs can elicit the Hering-Breuer inflation reflex. This reflex may help prevent over distention of the alveoli at high lung volumes by inhibiting large tidal volumes and may decrease the frequency of the inspiratory efforts by causing a transient apnea.

pg. 579
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

15

The component of the nephron that is involved in the concentration of urine via the countercurrent mechanism is the:

loop of Henle

The primary function of the Loop of Henle is the establishment of a hyperosmotic state within the medullary area of the kidney, a mechanism that is vital to the conservation of salt and water. Water conservation and the production of a concentrated urine involve a countercurrent exchange system or "multiplier" in which a concentration gradient causes fluid to be exchanged across parallel sides of the hairpin-shaped loop. The gradient increases as the loop moves from the renal cortex into the medulla.

pp. 699-700
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

16

The posterior cord of the brachial plexus gives rise to the: (Select 2)

axillary nerve, radial nerve

The brachial plexus arises from spinal nerve roots C8-T1. These roots divide into the superior, middle and inferior trunks. Trunks further subdivide into 3 anterior and 3 posterior divisions. Divisions then give rise to the lateral, posterior and medial cords. The posterior cord gives rise to the axillary and radial nerves, the lateral cord gives rise to the musculocutaneous and median nerves, and the medial cord gives rise to the median and ulnar nerves.

Plate 418
Netter, FH. Atlas of Human Anatomy, 5th Edition. Philadelphia: Saunders Elsevier, 2011.

17

The two cerebral hemispheres of the brain are connected by the:

corpus callosum

Plate 111
Netter, FH. Atlas of Human Anatomy, 5th Edition. Philadelphia: Saunders Elsevier, 2011.

18

The majority of blood supply to the lower and anterior two thirds of the spinal cord arises from the:

great ventral radicular artery

The great ventricular radicular artery (A.K.A. the artery of Adamkiewicz or arteria radicularis magna) enters the cord at approximately T7 and supplies the lumbosacral segment. It is the largest and most important radicular artery. Spinal cord segments that receive blood from one source are particularly prone to ischemic injury if flow is interrupted. Interruption of flow from this artery results in paraplegia.

pg. 659
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

19

A potential problem associated with cannulation of the dorsalis pedis artery for monitoring of blood pressure is:

the waveform may be distorted and result in overestimation of the pressure

The dorsalis pedis pulse reflects the highest systolic blood pressure in the body. As the arterial pulse leaves the heart, pulse pressure increases due to decreasing arterial lumen size and the reflection of the BP wave as it moves towards the periphery. This reflection causes an additive effect for systolic BP.

pg. 56
Karlet, M. Nurse Anesthesia Secrets. St. Louis: Mosby, 2005.

20

Attributes associated with the development of post-operative ulnar neuropathy include: (Select 4)

male sex, extreme obesity, prolonged bedrest, preexisting contralateral ulnar neuropathy

Anesthesia-related ulnar nerve injury is thought to be secondary to external nerve compression or stretch caused by intraoperative malpositioning. Occurrence is associated with the following factors: male sex (70-90% of cases), contralateral ulnar nerve dysfunction, high BMI (> 38) and prolonged postoperative bedrest.

pg. 800
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

21

How much volume of CSF is in the subarachnoid space?

Cerebrospinal fluid: occupies a volume of approximately 150 mL in the subarachnoid space

Cerebrospinal fluid supports and cushions the spinal cord and brain. It occupies a volume of approximately 150 mL in the subarachnoid space. It is produced by choroid plexuses in the brain's ventricles at a rate of approximately 500 mL/day. It is largely reabsorbed by arachnoid granulations and by small CNS capillaries.

pg. 564
Hansen, JT and Lambert, DR. Netter's Clinical Anatomy. Philadelphia: Elsevier, 2005.

22

The cricopharyngeus muscle receives sensory innervation primarily from the:

glossopharyngeal nerve

The cricopharyngeus muscle, an integral part of the upper esophageal sphincter, receives sensory innervation primarily from the glossopharyngeal nerve (CN IX). It receives motor innervation primarily from the vagus (CN X) and to a lesser extent from CN IX. It acts as a barrier to regurgitation in the conscious patient.

pg. 442
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

Aviv, J. "Voice and Swallowing Center." 2011
URL: http://www.entandallergy.com/vas/services/swallowing_normal.php

23

Arterial blood supply to the larynx arises from the:

superior and inferior thyroid arteries

The superior thyroid artery, a branch of the external carotid, gives rise to the superior laryngeal artery. This artery supplies the supraglottic region of the larynx. The inferior laryngeal artery, a branch of the inferior thyroid artery, supplies the infraglottic region of the larynx.

pg. 563
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

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24

A view of the larynx is shown (Click here to display graphic). By dragging & reordering the selections in yellow, match the name with the corresponding structure.

A view of the larynx is shown (Click here to display graphic). By dragging & reordering the selections in yellow, match the name with the corresponding structure.

25

The lower border of the scapula corresponds to spinal level:

T7

Important landmarks associated with dermatome levels include: C7 - vertebra promenens, T7 - inferior edge of scapula, T10 - umbilicus, L4 - highest points of iliac crests and S2 - level of posterior iliac spines.

pg. 1048
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

26

Anatomic dead-space ends at the:

terminal bronchiole

The terminal bronchiole is the last airway component incapable of gas exchange. It has a diameter of < 1 mm, it is devoid of cartilaginous support, and it has the highest proportion of smooth muscle in its walls relative to the other airway components. The respiratory bronchiole, which follows the terminal bronchiole, is the first site in the tracheobronchial tree where gas exchange occurs.

pg. 235
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

27

The most serious complication of a supraclavicular block is:

pneumothorax

The most feared complication of supraclavicular block is pneumothorax. Its principal cause is a needle angle that "aims" toward the apex of the lung. Its incidence ranges from 0.5 - 5%. Although the incidence of phrenic nerve blockade is 30 - 50%, its effects are usually well-tolerated by the patient with normal pulmonary function.

pp. 51-52
Brown, DL. Atlas of Regional Anesthesia. Philadelphia: Elsevier, 2006.

28

Potential complications associated with an interscalene block include: (Select 4)

phrenic nerve block, injection of local anesthetic into the vertebral artery, total spinal & pneumothorax

Potential complications associated with the use of interscalene blocks include: subarachnoid injection leading to total spinal, epidural block, intravascular injection (especially in the vertebral artery), pneumothorax, and phrenic block.

pg. 42
Brown, DL. Atlas of Regional Anesthesia. Philadelphia: Elsevier, 2006.

29

The ansa cervicalis innervates the:

sternohyoid muscle

The ansa cervicalis, a component of the cervical plexus, provides motor innervation to the sternohyoid and the inferior belly of the omohyoid muscles.

Plate 128
Netter, FH. Atlas of Human Anatomy, 5th Edition. Philadelphia: Saunders Elsevier, 2011.

30

Chassaignac's tubercle may be palpated at: t

the cricoid cartilage at C6

Chassaignac's tubercle is an anatomic landmark for the placement of interscalene and cervical plexus blocks. It is the transverse process of the verterbal body at C6 and may be palpated lateral to the cricoid cartilage.

pg. 1088
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

31

Cerebrospinal fluid flows from the third to the fourth ventricle via the:

cerebral aqueduct of Sylvius

CSF is secreted by the choroid plexus in lateral ventricles 1 and 2, flows through the foramen of Munro to the 3rd ventricle, through aqueduct of Sylvius (A.K.A. cerebral aqueduct) to 4th ventricle and through the foramina of Magendie and Luschka (A.K.A. lateral and medial apertures of 4th ventricle) to the subarachnoid space.

Plate 144
Netter, FH. Atlas of Human Anatomy, 5th Edition. Philadelphia: Saunders Elsevier, 2011.

32

Organs designated as preportal organs include the: (Select 4)

stomach, small intestines, pancreas and spleen

The preportal organs are the stomach, spleen, pancreas, small intestine, and colon.

pg. 1249
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

33

Accessory muscles of respiration involved in forceful exhalation include:

rectus abdominis

During forceful exhalation (e.g. with coughing and the clearing of secretions), the rectus abdominis, the transversus abdominis and the external and internal oblique muscles of the abdomen are active. During forceful inspiration, the sternocleidomastoid and scalene muscles contract in conjunction with the diaphragm and the intercostals.

pg. 515
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

34

In the adult, during placement of a pulmonary artery catheter through the right internal jugular vein, the right ventricle should be entered at approximately:

25 - 35 cm

Cardiac Structure Distance in Centimeters
RA 15 - 25
RV 25 - 35
PA 35 - 45
PA wedge postion 45 - 50
pg. 316
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

35

The dominant motor nerve innervating the biceps brachii is the:

musculocutaneous

The musculocutaneous provides the majority of motor function to the biceps which resides in the anterior compartment of the arm. When performing a brachial plexus block, the "four P's" mnemonic "push, pull, pinch, pinch" is utilized to ascertain block effectiveness. If the patient is unable to pull the forearm towards the upper arm, this would indicate a weakening of the biceps due to local anesthetic effect on the musculocutaneous.

pp. 31-32
Brown, DL. Atlas of Regional Anesthesia. Philadelphia: Elsevier, 2006.

36

A list of anatomic structures is shown below. By dragging & reordering the selections in yellow, match the fetal precursor with the corresponding structure.

A list of anatomic structures is shown below. By dragging & reordering the selections in yellow, match the fetal precursor with the corresponding structure.

37

Motor innervation of the superior oblique muscle of the eye is supplied by the:

trochlear nerve

Although the majority of extraocular muscles receive motor innervation from the oculomotor nerve (CN III), the trochlear nerve (CN IV) provides motor innervation to the superior oblique muscle of the eye. The abducens (CN VI) provides motor innervation to the lateral rectus muscle of the eye.

Plate 120
Netter, FH. Atlas of Human Anatomy, 5th Edition. Philadelphia: Saunders Elsevier, 2011.

Return to Selection Page Next Referenced Answer

38

A plantar view of the foot is shown (Use Exhibit button above to display graphic). By dragging & reordering the selections in yellow, match the area with the corresponding sensory innervation.

A plantar view of the foot is shown (Use Exhibit button above to display graphic). By dragging & reordering the selections in yellow, match the area with the corresponding sensory innervation.

39

Of the following, the therapeutic intervention that causes the least ventilatory compromise in the prone patient is the:

use of a Jackson table

The degree to which pulmonary mechanics are altered are suggested to be frame-dependent and not dependent on body habitus. Use of the Jackson table resulted in the smallest change in pulmonary compliance and peak airway pressures when compared with use of the Wilson frame and chest rolls.

pg. 437
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

40

The body mass index (BMI) classification for adults which correlates with obesity is:

30

Classifications of Obesity
Underweight < 18.4
Ideal 18.5 - 24.9
Overweight 25 - 29.9
Obese 30 - 39.9
Morbid Obesity > 40
pg. 1231
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

Return to Selection Page Next Referenced Answer

41

What is the anatomical location of the dural nerve?

The sural nerve: travels superficially with the saphenous nerve behind the lateral malleolus into the ankle

The sural nerve is formed from the union of a branch of the tibial and the common peroneal nerves. It travels superficially with the short saphenous nerve behind the lateral malleolus into the ankle, where it provides sensory innervation to the posterior portion of the sole of the foot, as well as to the posterior portion of the heel and the portion of the Achilles tendon immediately above the ankle.

pg. 1099
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

42

Components that comprise the thin filament of the contractile apparatus include:

actin, troponin, tropomyosin

The three major proteins that compose the thin filament of the sarcomere are actin, troponin, and tropomyosin.

pg. 785
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

43

According to the Cooley classification of aortic aneurysms, Type B refers to a:

According to the Cooley classification of aortic aneurysms, Type B refers to a: fusiform ascending aorta and proximal arch

Cooley's Classifcation of Aortic Aneurysms
Type A Saccular transverse arch
Type B Fusiform ascending aorta and proximal arch
Type C Fusiform aneurysm extending into the proximal aorta
Type D Fusiform aneurysm involving the entire aorta
pg. 538
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

44

what does the purpose of the pundendal block?

The pudendal block: blocks the distribution of sacral nerves 2,3, and 4

The pudendal block provides analgesia for the second stage of labor by blocking distribution of sacral nerves 2, 3 and 4, which innervate the lower vagina and perineum. It is useful for forceps or vacuum deliveries or episiotomy.

pg. 483
Fleisher, LA and Roizen, MF. Essence of Anesthesia Practice Philadelphia: Saunders, 2011.

45

A list of blocks is shown below. By dragging & reordering the selections in yellow, place the blocks in descending order of peak-plasma concentration following block placement.

A list of blocks is shown below. By dragging & reordering the selections in yellow, place the blocks in descending order of peak-plasma concentration following block placement.

46

Which of the following nerves is located in the groove between the tendons of the anterior tibial and extensor hallucis longus muscles?

Deep peroneal nerve

The deep peroneal nerve is located behind the anterior tibial artery, between the tendons of the anterior tibial and extensor hallucis longus muscles. Five peripheral nerves require block during ankle block. Four are derived from the sciatic nerve: the posterior tibial, sural, superficial and deep peroneal nerves. The saphenous nerve is a terminal branch of the femoral nerve.

pg. 43
Brown, DL. Atlas of Regional Anesthesia. Philadelphia: Elsevier, 2006.

47

The innermost layer of the wall of a blood vessel is known as the:

The innermost layer of the wall of a blood vessel is known as the: tunica intima

The tunica intima comprises the inner layer of blood vessels and serves mainly for the regulation of exchange of material. It consists of endothelial cells, flat cells which border the vascular lumen, and of a thin membrane of fine connective tissue fibers; in arteries, elastic networks are added.

pg. 49
Frick, H, Leonhardt, H, Stark, D. Human Anatomy 1. New York: Thieme, 1991.

48

The sinus which is in close proximity to the optic chiasma and the hypophysis is the:

The sinus which is in close proximity to the optic chiasma and the hypophysis is the: sphenoid sinus

The sphenoid sinuses are paired and may extend into the basal part of the occipital bone. The roof of the sinus has close connections with the optic canal and the chiasmatic groove (upward) as well as to the hypophysis toward the back. Pituitary tumor surgery may be achieved via a trans-nasal approach through the sphenoid sinus. Overall, the paranasal sinuses play an important role as the site of infectious processes.

pg. 688
Frick, H, Leonhardt, H, Stark, D. Human Anatomy 1. New York: Thieme, 1991.

49

Venous drainage from the orbit of the eye is achieved primarily through the:

Venous drainage from the orbit of the eye is achieved primarily through the: superior ophthalmic vein

The venous drainage system for the orbit includes the superior and inferior ophthalmic veins. These veins drain into the cavernous sinus. The venous system of the orbit is valveless and blood flow in this area is determined by pressure gradients and external forces on the globe. The primary vein of the orbit is the superior ophthalmic vein. This vein is entered by the ciliary veins, lacrimal veins and the superior vortex veins which drain the choroid of the globe.

pg. 946
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

Return to Selection Page Next Referenced Answer

50

Complications resulting from the Trendelenburg position include: (Select 3)

Complications resulting from the Trendelenburg position include: (Select 3) edema of the upper airway, inadvertent right mainstem intubation, increased myocardial oxygen consumption

The Trendelenburg position is used to improve exposure of the pelvic organs. It has also been used in the treatment of hypotension because it is assumed to increase venous return and mean arterial pressure. Studies have shown that effects of Trendelenburg on cardiovascular parameters are variable, and overall myocardial work is increased, an effect which may be detrimental to patients with CAD. MAP is either unchanged or decreased. Ocular, facial and pharyngeal edema are associated with the Trendelenburg position as well as inadvertent right mainstem intubation, a result of the cephalad movement of the mediastinum and the carina.

pg. 434
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

51

The fissure forming the boundary between the frontal and temporal lobes of the brain is known as the:

The fissure forming the boundary between the frontal and temporal lobes of the brain is known as the: lateral sulcus

The lateral sulcus (A.K.A. the Sylvian fissure), is the deepest lateral furrow which forms the boundary between the frontal and temporal lobes of the brain. The central sulcus is the border between the frontal and parietal lobes. The parieto-occipital sulcus forms the boundary between the parietal and occipital lobes.

pp. 322-323
Frick, H, Leonhardt, H, Stark, D. Human Anatomy 1. New York: Thieme, 1991.

52

The parietal cells of the stomach are responsible for the secretion of:

hydrochloric acid

Parietal cells in the stomach secrete hydrochloric acid in response to the sight and smell of food; pepsinogen is also secreted by the chief cells at this time. Gastrin is secreted by the G cells in response to gastric distention. Other gastric secretions include serotonin, histamine and mucus. Secretin and pancreatic bicarbonate are released in response to duodenal acidity.

pp. 746-747
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

53

A 76-year-old male is scheduled for fulguration of bladder tumors. In order to achieve complete anesthesia of the bladder dome, it is necessary attain a level of spinal anesthesia of at least:

A 76-year-old male is scheduled for fulguration of bladder tumors. In order to achieve complete anesthesia of the bladder dome, it is necessary attain a level of spinal anesthesia of at least: T10

Urologic procedures may be accomplished with the use of regional anesthetics. When awake and anesthetized to the level of the dome of the bladder (T10), the patient may respond to bladder distention, thereby helping the urologist minimize the potential for bladder rupture.

pg. 721
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

54

The width of the synaptic gap at the motor axon terminal is approximately:

The width of the synaptic gap at the motor axon terminal is approximately: 20 - 50 nm

The motor axon terminal is separated from the muscle cell it innervates by a synaptic gap or cleft of only 20 - 50 nm. A carbohydrate-rich, filamentous material in the synapse holds the nerve ending and its associated muscle cell in close alignment. The neurotransmitter secreted by the motor axon is acetylcholine.

pg. 781
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

55

The secretion of anti-diuretic hormone (ADH) causes the reabsorption of free water in the nephron. The sites of action of ADH include the: (Select 2)

The secretion of anti-diuretic hormone (ADH) causes the reabsorption of free water in the nephron. The sites of action of ADH include the: (Select 2) distal tubule, collecting duct

The late distal tubule reabsorbs 10% of filtered water. This area is permeable to water only in the presence of ADH. The collecting duct is also permeable to water in the presence of ADH and causes the reabsorption of water into the medullary interstitium, thereby reducing the volume of and concentrating the urine.

pg. 698
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

56

Functions of the spleen include

Functions of the spleen include: reservoir for platelets, removal of foreign antigens, removal of aged and damaged erythrocytes

Functions of the spleen include: hematopoiesis in the fetus, blood filtering by splenic sinusoids, removal of foreign antigens by macrophages, IgM production, and removal of aged RBCs and abnormal blood cells. The spleen has a minor role as a reservoir of platelets but has no specific reservoir function for RBCs.

pg. 759
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.

57

The portal triad consists of the: (Select 3)

The portal triad consists of the: (Select 3) hepatic artery, portal vein, bile duct

Portal triads, found throughout the liver, are found at each of the corners of the six-sided liver lobule. The vessels of the portal triads send distributing branches along the sides of the lobules; these branches open up into the liver sinusoids.

58

In the cardiac myocyte, the area which delineates the border between two separate sarcomeres is known as the:

In the cardiac myocyte, the area which delineates the border between two separate sarcomeres is known as the: "Z" band

The "Z" band, named from the German zuckung (twitch) line, bisects each "I" band of the sarcomere. The "I" band represents the region of the sarcomere which contains thin filaments only while the "A" band is characterized by an area of overlap of thick and thin fibers. The "M" band is present centrally within the "A" band and is composed of thick filaments which form a hexagonal matrix of myosin binding with protein C.

pg. 214
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

59

Perioperative vision loss occurs most frequently in anesthetized patients:

Perioperative vision loss occurs most frequently in anesthetized patients: undergoing cardiac surgical procedures

Perioperative vision loss occurs most frequently in patients undergoing cardiac surgical procedures. Patients undergoing extensive spine procedures while in the prone position may develop vision loss, primarily from posterior ischemic optic neuropathy.

pg. 793
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

60

Effects of aging on the cardiovascular system include:

Effects of aging on the cardiovascular system include: decreased response to β-receptor stimulation, stiffening of the myocardium, cardiac conduction system changes

Effects of aging on the cardiovascular system include: 1) decreased response to β-receptor stimulation, 2) stiffening of the myocardium, arteries and veins, 3) changes in the ANS with increased sympathetic and decreased parasympathetic activity, 4) conduction system changes, and 5) defective ischemic preconditioning by volatile anesthetics.

pg. 882
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

61

Nerve fibers involved in the mediation of sharp pain include the:

Nerve fibers involved in the mediation of sharp pain include the: A-delta fibers

Larger myelinated A delta fibers are believed to mediate the transmission of sharp pain. Small, unmyelinated C fibers mediate the transmission of dull pain.

pp. 535-536
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

Return to Selection Page

62

Primary venous drainage of the lower two-thirds of the esophagus occurs via the:

Primary venous drainage of the lower two-thirds of the esophagus occurs via the: azygous vein

The primary venous drainage of the lower two-thirds of the esophagus occurs via the azygous vein which enters the superior vena cava at approximately the 5th intercostal space on the right. Additional esophageal drainage is achieved via submucosal venous plexuses, the hemiazygous and accessory hemiazygous veins. The upper third of the esophagus drains into the inferior thyroid vein.

Plate 232
Netter, FH. Atlas of Human Anatomy, 5th Edition. Philadelphia: Saunders Elsevier, 2011.

63

Direct anastomosis with the internal carotid artery at the circle of Willis occurs with the:

Direct anastomosis with the internal carotid artery at the circle of Willis occurs with the: middle cerebral artery

Plates 136,138
Netter, FH. Atlas of Human Anatomy, 5th Edition. Philadelphia: Saunders Elsevier, 2011.

64

The pneumotaxic center: (Select 3)

The pneumotaxic center: (Select 3) limits the depth of inspiration; is located in the rostral pons; when maximally activated, increases ventilatory frequency

The pneumotaxic respiratory center is in the rostral pons. Its primary function is to limit the depth of inspiration When maximally activated, the pneumotaxic center increases ventilatory frequency; however, it performs no pacemaking function and has no intrinsic rhythmicity.

pp. 239-240
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

65

The neurotransmitter secreted by the motor end-plate which results in the stimulation of nicotinic (N2) receptors is:

The neurotransmitter secreted by the motor end-plate which results in the stimulation of nicotinic (N2) receptors is: acetylcholine

The motor end plate is a specialized portion of the membrane of the muscle fiber where nicotinic acetylcholine receptors are concentrated. When an action potential stimulates the nerve fiber, acetylcholine is released and stimulates nicotinic subtype 2 (N2) receptors, which are ion channels. Upon stimulation, these N2 receptors open, resulting in an increase in membrane potential to threshold potential and ultimately excitation-contraction-coupling of the muscle fiber.

pp. 501-502
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

66

When performing a glossopharyngeal nerve block, the branches of the nerve are most easily accessed via:

the palatoglossal folds bilaterally

The glossopharyngeal nerve provides sensory innervation to the following areas: posterior third of the tongue, the vallecula,the anterior surface of the epiglottis, the walls of the pharynx, and the tonsils. When performing a glossopharyngeal nerve block, the nerves are most easily accessed as they traverse the palatoglossal folds, the soft ridges that extend from the posterior aspect of the soft palate to the base of the tongue bilaterally.

pg. 775
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

67

Primary branches of the trigeminal nerve (CN V) include the: (Select 3)

Primary branches of the trigeminal nerve (CN V) include the: (Select 3) ophthalmic nerve, maxillary nerve, mandibular nerve

The trigeminal nerve, CN V, divides into three primary branches: the uppermost ophthalmic branch (sensory only), the maxillary nerve (sensory only) and the mandibular nerve (mixed motor and sensory), the largest branch of the three.

pp. 962-963
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

68

During the division of the tracheobroncheal tree, loss of cartilage occurs at approximately the:

16th generation

Subdivisions, A.K.A. airway generations, are utilized to classify branching of the tracheobronchial tree. The trachea comprises 0 generation and the airways further divide until the alveolar sacs and alveoli are reached terminally at the 23rd generation. The airways begin to lose cartilage just distal to the small intrasegmental bronchi. This occurs at approximately the 16th airway generation.

Plate 198
Netter, FH. Atlas of Human Anatomy, 5th Edition. Philadelphia: Saunders Elsevier, 2011.

69

Structures contained within the carotid sheath include the: (Select 3)

Structures contained within the carotid sheath include the: (Select 3) common carotid artery, internal jugular vein, vagus nerve

Structures located within the carotid sheath are the common carotid artery, the vagus nerve and the internal jugular vein.

Plate 32
Netter, FH. Atlas of Human Anatomy, 5th Edition. Philadelphia: Saunders Elsevier, 2011.

70

When utilizing the axillary approach to block the brachial plexus, the nerve which most frequently requires supplemental blockade is the:

musculocutaneous nerve

Because the musculocutaneous nerve branches from the brachial plexus relatively early, blockade of this nerve is difficult to achieve via the axillary approach to brachial plexus blockade. Supplemental infiltration of local anesthetic is typically required particularly if surgery is to be performed on the lateral cutaneous region of the forearm.

Plates 462, 462, 467
Netter, FH. Atlas of Human Anatomy, 5th Edition. Philadelphia: Saunders Elsevier, 2011.

pg. 1491
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

71

Nerves arising from the sacral plexus include the:

sciatic nerve

The sciatic nerve arises from the sacral plexus and is derived from the ventral rami of the 4th lumbar to 3rd sacral nerve roots. The three major components of the sciatic nerve are the tibial and the common peroneal nerves, and the posterior femoral cutaneous nerve to the thigh.

pg. 1495
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

72

A 39-week gestation primipara is brought into the OR for cesarean section. Upon laying flat, she becomes diaphoretic and nauseated. The most effective maneuver to rectify these symptoms is:

place the patient in a slight left lateral tilt with a wedge under her right hip

With a patient in the supine position, a mobile abdominal mass such as a tumor or a gravid uterus may compress the great vessels of the abdomen and compromise circulation. This is known as the aortocaval or supine hypotensive syndrome. Perfusion may be restored if the compressive mass is rolled toward the left hemi-abdomen by leftward tilt of the tabletop or by a wedge under the right hip.

pg. 795
Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.

73

Nerves originating from the Edinger-Westphal nucleus include the:

accessory oculomotor nerve

Cranial and certain accessory nerves originate from various nucleii found in the pons and medulla. The accesory oculomotor nerve originates from the Edinger-Westphal nucleus which is located adjacent to the oculomotor nucleus.

Plate 116
Netter, FH. Atlas of Human Anatomy, 5th Edition. Philadelphia: Saunders Elsevier, 2011.

74

Sensory innervation of the larynx below the level of the vocal cords is provided by the:

recurrent laryngeal nerve

The larynx receives innervation from two major nerves. The superior laryngeal nerve branches into two nerves: the internal branch which provides sensory innervation to the larynx above the vocal cords and the external branch which provides motor innervation to the cricothyroid muscle. The recurrent laryngeal nerve provides sensory innervation to the larynx below the vocal cords and motor innervation to all of the muscles of the larynx with the exception of the cricothyroid muscle.

Plate 80
Netter, FH. Atlas of Human Anatomy, 5th Edition. Philadelphia: Saunders Elsevier, 2011.

75

Compartment syndrome has been associated with:

Compartment syndrome has been associated with: elevation of the extremities

Compartment syndrome is a potentially life-threatening complication that causes damage to neural and vascular structures from swelling of tissues within the muscular compartment. Prolonged surgical procedures, operative positions, elevation of the extremities, intraoperative hypotension, increasing age, and extremes of body habitus are reported to contribute to the development of compartment syndrome in surgical patients.

pp. 427-428
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2010.