Positioning and nerves

Question 1

Which reflex activates the SNS when going from sitting to standing?

Answer 1

baroreceptor

Question 2

How does general anesthesia affect the baroreceptor reflex and SNS tone?

Answer 2

Decreases

Question 3

What does positive pressure ventilation do to intrathoracic pressure and venous return?

Answer 3

Increases intrathoracic pressure and decreases venous return

Same with PEEP

Question 4

Frank starling curve with positions

Answer 4

Question 5

Does placing the patient in Trendelenburg improve hypotension?

Answer 5

Latest evidence says no

Question 6

Should shoulder braces be used?

Answer 6

No

Use a non-slip mattress

Question 7

To prevent a brachial plexus injury, shoulders should be less than?

Answer 7

<90 degrees

Don’t let shoulders sag forward when prone

Question 8

How can you assess for thoracic outlet syndrome?

Answer 8

Have the patient clasp her hands behind her head, if it hurts then you may need to tuck arms when prone

Question 9

Where is an axillary roll placed?

Answer 9

Caudad to the axilla or (distal)

Question 10

Where should a retaining strap be placed across the hip?

Answer 10

Between the iliac crest and the head of the femur. NOT directly over the head of the femur

Question 11

What is the most commonly injured nerve?

Answer 11

Ulnar

Question 12

Two ways the ulnar nerve is injured.

Answer 12

Excessive flexion

External compression

Question 13

best way to position arm to prevent ulnar injury

Answer 13

Question 14

What is claw hand?

Answer 14

Ulnar nerve injury

Impaired sensation to fourth and fifth digits

Inability to ABduct or oppose the pinky finger

Question 15

Are sensory or motor nerve injuries more common? More serious?

Answer 15

Sensory are more common and less serious

Question 16

Which nerve is likely to be injured during an IV insertion in the antecube?

Answer 16

Median nerve

Question 17

Elbow hyperextension can injure which nerve?

Answer 17

Median nerve

Question 18

Hand benediction or ape hand are injuries to which nerve?

Answer 18

Median nerve

Question 19

Sensory for the median nerve includes? Motor?

Answer 19

Sensation to the palmer surface of the thumb, index finger, middle finger, and lateral of the ring finger

Motor - inability to oppose thumb

Question 20

Which nerve is most likely injured by an IV pole pressing on the humerus?

Answer 20

Radial

Question 21

Sheets tucked too tight can cause which nerve injury?

Answer 21

Radial

Question 22

Excessive BP cuff cycling can cause nerve damage to which nerve?

Answer 22

Radial

Question 23

Wrist drop is a sign of which nerve injury?

Answer 23

Radial

Question 24

Dull shoulder pain is a sign of which nerve injury?

Answer 24

Suprascapular nerve

Question 25

Scapular winging is a sign of which nerve injury?

Answer 25

REMEMBER SALT (serratus anterior long thoracic) Long thoracic nerve Innervates the serratus anterior

Question 26

Foot drop is a sign of which nerve injury?

Answer 26

Common peroneal

Question 27

Inability to evert the foot is a sign of which nerve injury?

Answer 27

Common peroneal

Question 28

Inability to extend the toes dorsally is a sign of which nerve injury?

Answer 28

Common peroneal

Question 29

Which nerve is injured in stirrups when the medial aspect of the leg is compressed?

Answer 29

Common peroneal

Question 30

What nerve allows you to adduct the leg?

Answer 30

Obturator

Question 31

The femoral nerve arises from which plexus which roots?

Answer 31

Lumbar Plexus 2,3,4

Question 32

Which nerve is blocked during an adductor canal? Where does the nerve rise from?

Answer 32

Saphenous Branch of the femoral nerve

Question 33

What does the saphenous nerve innervate? What can injure it? Presentation?

Answer 33

Medial aspect of the lower leg Lithotomy - leg pressed against Presentation- reduced sensation on anteromedial aspect of leg (lower leg)

Question 34

Adductor canal is good for which surgeries? What nerve is blocked?

Answer 34

ACL MCL Patella Vein stripping Saphenous nerve

Question 35

Which plexus innervates the ankle except for one nerve?

Answer 35

Question 36

Which LE nerves are only sensory?

Answer 36

Lateral femoral cutaneous Saphenous Sural

Question 37

LE innervation

Answer 37

Question 38

Clinical assessment of LE

Answer 38

Question 39

Which nerve allows for hip flexion?

Answer 39

Femoral

Question 40

Which nerve allows for hip extension?

Answer 40

Sciatic

Question 41

Which nerve allows for knee flexion?

Answer 41

Sciatic

Question 42

Which nerve allows for hip extension?

Answer 42

Femoral

Question 43

Which nerve allows for plantar flexion?

Answer 43

Tibial

Question 44

What happens if a patient's legs are crossed during surgery? Which nerves are injured?

Answer 44

Top leg - sural nerve (it's on the underside of the leg) Bottom leg - superficial peroneal nerve

Question 45

What does the Pudendal nerve innervate? Which plexus does it come from?

Answer 45

Innervates the perineum Comes from sacral plexus

Question 46

Extreme hip flexion can cause injury to which nerve?

Answer 46

Sciatic

Question 47

Extreme external rotation of the legs can injure which nerve?

Answer 47

Sciatic

Question 48

Foot drop is a sign of which nerve injuries?

Answer 48

Common peroneal and sciatic

Question 49

Inability to evert the foot is an injury to which nerve?

Answer 49

Common peroneal

Question 50

Inability to extend the toes dorsally is an injury to which nerve?

Answer 50

Common peroneal

Question 51

Minimizing hip flexion will protect which nerve?

Answer 51

Obturator

Question 52

A popliteal nerve block will block which nerves? Where do they rise from?

Answer 52

It will block the tibial nerve and the common peroneal nerve right as they branch from the sciatic nerve

Question 53

What position is compartment syndrome most seen in? treatment?

Answer 53

Lithotomy Fasciotomy

Question 54

Hyperextension (hyperlordosis) in the supine position can cause what?

Answer 54

paraplegia

Question 55

What causes Midcervical tetraplegia?

Answer 55

Hyperflexion of the neck around C5 Most common in the sitting position 2 fingers should between chin and chest Also seen in tracheal resections

Question 56

What are the 4 T's likely to occur in the anterior mediastinum?

Answer 56

Thymoma Teratoma Thyroid Terrible lymphoma

Question 57

Best way to induce a mediastinal mass?

Answer 57

Spontaneous ventilation awake Sitting position

Question 58

IF the airway collapses during intubation of a mediastinal mass, what steps should you take?

Answer 58

Lay patient lateral or prone Crash onto bypass

Question 59

Which three things worsen tracheobronchial compression?

Answer 59

Supine Induction of GA PPV

Question 60

Which two procedures increase the risk of midcervical tetraplegia?

Answer 60

Tracheal resection Crani in the sitting position

Question 61

Which position increases the risk of suprascapular nerve injury?

Answer 61

Lateral

Question 62

Which position has the highest chance of creating airway edema?

Answer 62

Steep trendelenburg

Question 63

Which positions shift blood towards the central circulation? What about away?

Answer 63

Towards - Trendelenburg and lithotomy Away - sitting, lateral

Question 64

Which way does sitting and lateral shift the frank starling curve?

Answer 64

To the left (more towards the peripheral)

Question 65

Which way does Trendelenburg and lithotomy shift the frank starling curve?

Answer 65

To the right (more towards central)

Question 66

Which positions reduce cardiac output the most?

Answer 66

Sitting Prone