Exam 1 REVIEW

Question 1

Ion current: Resting phase

Answer 1

Na and K closed, K channels leaking

Question 2

Ion Current Depolarization phase

Answer 2

Na channels open

Question 3

Ion Current: Repolarization phase

Answer 3

Na channels closed, K channels open

Question 4

Ion Current Refractory phase

Answer 4

Slow voltage gated Na channels closed and inactive

Question 5

Methemoglobinemia associated with the use of

Answer 5

Prilocaine

Question 6

Anatomical plane Sagittal plane

Answer 6

left and right

Question 7

Anatomical plane: Coronal plane

Answer 7

Anterior and posterior

Question 8

Anatomical plane: Transverse plane

Answer 8

Superior and inferior

Question 9

Anatomical plane: Oblique

Answer 9

Cuts made diagonally

Question 10

Which of the following locals has the lowest pka?

Answer 10

Mepivacaine = 7.6

Question 11

Appropriate onset of the neuronal blockade

Answer 11

B autonomics 1 st
A delta, fast pain/temp, C< slow pain, autonomics 2 nd
A gamma, muscle tone, motor 3 rd
A beta, sensory touch, pressure 4 th
A alpha, motor skeletal muscle 5 th

Question 12

Match the innervation of the anatomy to the block you would perform o cover that area
a. Suprascapular and axillary nerves to the shoulder joint –

Answer 12

Interscalene block

Question 13

Match the innervation –> Rectus femoris from the femoral nerve, branches of the obturator nerve and quadratus femoris from the sacral plexus to the Hip joint

Answer 13

• SAB/ Epidural

Question 14

Match the innervation –>Branches from the femoral nerve, the posterior division of the Obturator nerve and both division of the sciatic nerve to the Knee joint –

Answer 14

Femoral, Sciatic

Question 15

Match the innervation –>The terminal branches of the Common Peroneal nerves, Tibial Nerve, and Femoral Nerve. Mainly, the entire Ankle Joint can be thought of simply as “innervation of the Sciatic and Femoral nerves”.

Answer 15

– Ankle Block

Question 16

Match the innervation Terminal branches of the Brachial Plexus, including the Radial and Ulnar nerves. -

Answer 16

Wrist Block

Question 17

I’m the following from the highest to the lowest with regards to LA rate of absorption:
TIC PBLSS

Answer 17

a. Tracheal 1 st
b. Intercosta 2 nd
c. Caudal 3 rd
d. Paracervical 4 th
e. Lumbar epidural 5 th
f. Brachial plexus 6 th
g. Subarachnoid 7 th
h. Subcutaneous 8 th

Question 18

The major determinant of duration of action for a given local anesthetic used in a subarachnoid block (SAB) is:

Answer 18

a. The total dose of local anesthetic used

Question 19

CNS toxicity manifest in several ways. Among the most prominent are 4 of the following:

Answer 19

a. Circa Memorial numbness
b. Tinnitus
c. Visual disturbances
e. Lightheadedness

Question 20

Please choose the four correct statements regarding myelin sheaths from those listed below.
c. It is a continuous uninterrupted layer (EXCEPT)

Answer 20

a. It is formed by Schwann cells
b. It decreases capacitance across the axonal membrane
d. And helps spread impulse conduction
e. Not all Schwann cells form myelin sheaths

Question 21

Lidocaine maybe used for all of the following: Choose 3

b. Increasing duration and peripheral nerve blocks (EXCEPT)

Answer 21

a. Infiltration of tissues
c. IV regional (bier) block
d. Epidural block

Question 22

Peripheral nerves are constructed for electrical transmission that leads to a chemical messenger activation. Dendrites extend from the axon and are responsible for impulse transmission over long distances. Interruptions of the myelin sheath allow the axolemma to be exposed to the matrix. These interruptions are known as

Answer 22

c. Nodes of Ranvier

Question 23

From the statements listed below, choose for answers you believe are TRUE:
e. Larger diameter nerves conduct much more slowly than smaller diameter nerves because they tend to be on
myelinated (EXCEPT)

Answer 23

a. A delta fibers – Sharp, prickling pain and temperature
b. C fibers - Throbbing pain and temperature
c. B fibers - Sympathetic and parasympathetic preganglionic neurons
d. Myelinated nerves conduct action potentials faster than unmyelinated nerves

Question 24

How does carbonation affect local anesthetics?

Answer 24

a. Speeds the onset (relative to the use of HCl for pH adjustment)

Question 25

Increasing the dosage of a local anesthetic administered for a nerve block will have 4 of the following effects: b. Increase in onset time (EXCEPT)

Answer 25

a. More side effects and risk of complications c. Prolongation of satisfactory anesthesia d. More profound depth the block e. More profound motor block

Question 26

Match the terms with regard to local anesthetics: a. Lipid solubility - b. Protein binding – c.

Answer 26

- potency - duration of action - shorter onset of action - increases pH of solution, resulting in more drug in the unionize state

Question 27

Which statement regarding pKa is FALSE?

Answer 27

Local anesthetics with higher pKa are more lipid soluble at physiologic pH

Question 28

Amides or esters/ | a. Which are more unstable in solution?

Answer 28

Esters

Question 29

A vs E ? Which are metabolized by plasma cholinesterase?

Answer 29

Esters

Question 30

A vs. E Which group is metabolized in the liver?

Answer 30

Amides

Question 31

A vs. E Which group low allergic potential?

Answer 31

Amides

Question 32

Nodes of Ranvier are: Choose 4 | e. Located only unmyelinated nerves (EXCEPTION

Answer 32

a. Gaps between myelin forming Schwann cells b. Where ion transfer occurs during depolarization c. Where voltage gated sodium channels are concentrated d. The site of local anesthetic action in myelinated nerves

Question 33

Where in the CNS are the cell bodies of sensory neurons located?

Answer 33

a. Dorsal root ganglion

Question 34

Which of the following correctly lists local anesthetic agents in order of longest duration to shortest duration when used for infiltration blocks? BuMeLiChlo

Answer 34

a. Bupivacaine, mepivacaine, lidocaine, chloroprocaine

Question 35

description of each peripheral nerve layer. a. Perineurium - b. Endoneurium - c. Epineurium -

Answer 35

contains nerve fibers in fascicles surrounds each individual axon sheath covering entire nerve

Question 36

If you administer a basic local anesthetic with a pka of 8.2 into physiologic pH, the drug will be?

Answer 36

a. Greater than 50% ionized

Question 37

Match the description with the correct type of nerve covering (answers can be used more than once) a. Surrounds each individual axon________ b. Non-neuronal glial cell________ c. Contains nerve fibers in fascicles _____ d. Semipermeable, acts as a major barrier to diffusion of local anesthetics._________ e. Sheath covering the entire nerve ________ f. Contains nutrient blood vessels ________

Answer 37

Endoneurium Endoneurium (SN) Perineum Perineum (Secon) Epineurium (SHeconu) Epineurium

Question 38

Minimum Blocking Concentration is the lowest concentration of the drug that is needed for blocking impulse propagation. It is analogous to MAC. Match variables affecting the increase or decrease in the CM.

Answer 38

Increase (NMD) Increased nerve fiber diameter Increased myelination Increase Greater distance between the Nodes of Ranvier Decrease pHHighPreg El d. Increased tissue pH e. High frequency of nerve stimulator f. Pregnancy g. Elevated temperature

Question 39

Originates from the ventral rami of C-1 C-5. Branches from this provide sensory innervation to part of the scalp, neck, and upper shoulder. It also contributes motor innervation to some of the muscles of the nectar, thoarcic cavity, and in the skin. –

Answer 39

Cervical Plexus

Question 40

This plexus innervates the pectoral girdle and upper limb. This plexus is formed by five groups that originate from the ventral rami of spinal nerves C-5 T1. –

Answer 40

Brachial Plexus

Question 41

This plexus is formed by the ventral rami of spinal nerves L1-L3 and the superior branch of L4. In some cases there is a contribution from T12. Branches of this plexus are the ileohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous obturator and femoral nerves. –

Answer 41

Lumbar Plexus

Question 42

This arises from the lumbosacral trunk L5-L4 plus the ventral rami of S1-S4. The main nerves include the sciatic, and the pudendal –

Answer 42

Sacral Plexus

Question 43

These fiberss are subdivided in Alpha, Beta, Gamma, and Delta. They are all myelinated, responsible for motor, tactile, proprioception, muscle tone, touch –.

Answer 43

A fibers

Question 44

These fibers are usually my unmyelinated, slow, postganglionic autonomic, responsible for pain and temperature –

Answer 44

C fibers

Question 45

These fibers are myelinated, preganglionic autonomic –

Answer 45

B fibers

Question 46

And a healthy adult the maximum dose of lidocaine without epinephrine is a

Answer 46

``` 175 mg (Dose should not be repeated at intervals of <3hrs and max dose of 400 mg in 24 hrs. should never be exceeded) ```

Question 47

In what state are local anesthetics stored?

Answer 47

Base in acid solution – ionized pH

Question 48

Which of the following preservative free local anesthetic solutions would be a good choice for patient with severe allergy to PABA containing sunscreens?

Answer 48

c. Bupivacaine