Prodigy- Positioning

Question 1

The normal response to a increase venous return in the trendelenberg position is what 2 things

Answer 1

vasodilation and a decrease in HR

Question 2

On average, the MAP in an extermity is about __ mmHg higher or lower for each inch it is position below or above the level of the heart

Answer 2

2 mmHg/inch

Question 3

During two-lung ventilation in healthy, mechanically ventilated patients, about ____% of the pulmonary blood flow goes to the dependent lung

Answer 3

60%

Question 4

Excessively tight table safety straps have been implicated to damage in what nerve?

Answer 4

lateral femoral cutaneous

Question 5

What is the ultimate causitive factor in both compression and stretch-related nerve damage?

Answer 5

ischemia

Question 6

When can compartment syndrome occur?

Answer 6

in any situation where perfuison to an extremity is signficantly decreased

>ischema > edema > increased pressure in the tissue

Question 7

In pregnant patients, supine hypotensive syndrome is typically most prevalent at around __ - ___ weeks gestation.

Does the risk increase or decrease after this time frame and why?

Answer 7

36-38 weeks

risk decreases after 38 weeks as the head of the fetus descends into the pelvis

Question 8

Another name for “Contoured spine position”

-an alternative way to create this position

Answer 8

lawn chair position

• hip tilt 15 degree upward
• knee tilt 15 degree downward

*placing a pillow under the knees is an alternative way of recreating this position

Question 9

LUD roll should be placed when

Answer 9

2nd and 3rd trimester

-displaces uterus off of vena cava

Question 10

In lithotomy, medially placed straps can impinge the ____ nerve, leading to altered sensation in the _____.

What about laterally placed straps?

Answer 10

medially placed- saphenous nerve
>altered sensation to medial calf

laterally placed - common peroneal nerve
>loss of dorsiflexion of the foot

Question 11

T/F: Rhabdo is associated with the lateral decub position

Answer 11

True

Question 12

In lateral jack-knife position, what part of the patient is placed over the hinge in the OR table?

Answer 12

the dependent iliac crest

Question 13

What is another name for the ventral decubitus position

Answer 13

prone

Question 14

if shoulder braces are used in steep T; they should be placed laterally or medially

Answer 14

laterally

Question 15

label

Answer 15

Top = median

Middle = radial

Bottom = Ulnar

Question 16

The radial nerve orginates from fibers of nerve roots ___ - ____

Answer 16

C5-T1

Question 17

Gold standard for identifying air embolus

Answer 17

TEE

Question 18

most sensitive non-invasive device for monitoring for VAE

Answer 18

doppler

-position at the right sternal borader between the 3rd and 6th intercostal spaces

Question 19

what would you be concerned for with a suddeon drop in ETCO2 during a sitting crani case

Answer 19

air emboli - flood the filed!

Question 20

Midcervical tetralgia results in paralysis below the level of ____

Answer 20

C5

Question 21

why is VAE more likely if the operative site is above the level of the heart?

Answer 21

bc if they are operating lower, it has more time to diffuse before getting into the heart

Question 22

Why is it important to ask patients preoperatively if they ever experience tingling in the hands or fingers?
A. They may have severe, undiagnosed diabetes mellitus
B. It can indicate undiagnosed hyperkalemia
C. 15 percent of the population has undiagnosed Raynaud’s syndrome
D. Many patients have pre-existing ulnar neuropathies

Answer 22

D

Question 23

Which pulmonary parameter will increase in the exaggerated lithotomy position?
A. tidal volumes
B. peak airway pressure
C. functional residual capacity
D. lung compliance

Answer 23

B

Question 24

What surgical position carries the highest risk for compartment syndrome?
A. prone
B. lithotomy
C. lateral
D. supine

Answer 24

B

Question 25

A patient is being placed in lithotomy position in steep Trendelenburg. The surgeon requests that shoulder braces be placed on the patient to prevent the patient from sliding cephalad on the table. You place the braces _____ to reduce the risk of _____ injury. A. medially, long thoracic nerve B. laterally, long thoracic nerve C. laterally, brachial plexus D. medially, brachial plexus

Answer 25

C

Question 26

With what surgical position is rhabdomyolysis associated? A. Lateral decubitus B. Prone C. Supine D. Lithotomy

Answer 26

A

Question 27

Your patient is emerging from a craniotomy in the sitting position. Which postoperative symptom would most likely be attributed to hyperflexing the patient's neck towards the chest? A. trigeminal neuralgia B. postural hypotension C. severe swelling of the tongue D. postoperative blindness

Answer 27

C

Question 28

Excessively tight table straps across the thighs would be most likely to cause damage to which nerve? A. lateral femoral cutaneous B. common peroneal C. genitofemoral D. radial

Answer 28

A

Question 29

Steep reverse Trendelenburg position for surgery on the head is associated with A. an increase in cardiac output B. an increase in mean thoracic pressure C. a risk for air embolus D. an increase in preload

Answer 29

Not D....I actually think it's C.... but maybe B

Question 30

When placed in the Trendelenburg position, the normal response to the associated increase in venous return is _____ and a(n) _____ in the heart rate. A. vasoconstriction, increase B. vasoconstriction, decrease C. vasodilation, increase D. vasodilation, decrease

Answer 30

D

Question 31

You place a pillow under the knees of a patient in the supine position so that they are flexed. Doing this most closely resembles the A. lithotomy position B. contoured supine position C. lateral decubitus position D. lateral displacement position

Answer 31

B

Question 32

Which nerve innervates the muscles that produce pronation and flexion of the wrist and flexion of the thumb, middle, and index fingers? A. median B. ulnar C. spinal accessory D. radial

Answer 32

A

Question 33

Following a prolonged case with the hips in severe flexion, a patient exhibits noticeable bilateral foot drop in PACU. What nerves do you suspect are injured? A. Sciatic B. Lateral femoral cutaneous C. Genitofemoral D. Femoral

Answer 33

A

Question 34

A patient with severe lumbar disc disease would be least able to tolerate the A. lateral position B. prone position C. exaggerated lithotomy position D. low lithotomy position

Answer 34

C

Question 35

What is the most common injury after anesthesia? A. Corneal abrasion B. Brachial plexus injury C. Cerebrovascular accident D. Ulnar nerve injury

Answer 35

A

Question 36

The underlying cause of compartment syndrome is A. flexion of the hips B. decreased hematocrit C. prolonged surgery D. decreased perfusion

Answer 36

D

Question 37

Which statement indicates an incorrect understanding of the precordial doppler? A. Injection of mannitol can result in a false-positive result for venous air embolism B. The doppler should be placed over the right sternal border between the 3rd and 6th intercostal spaces C. The precordial dopper is noninvasive D. The precordial doppler is the single most sensitive device for detecting venous air embolism

Answer 37

C

Question 38

When placing a patient in stirrups for a vaginal hysterectomy, the stirrups should be well padded to help prevent injury to the A. obturator nerve B. pudendal nerve C. common peroneal nerve D. femoral nerve

Answer 38

C

Question 39

A patient undergoing a lumbar spinal fusion has known thoracic outlet syndrome. You know that when positioning this patient prone you should A. use a Jackson table B. turn the head to the side C. position the head using skull pins D. position the arms alongside the torso

Answer 39

D

Question 40

A patient undergoing hysteroscopy is placed in lithotomy position with medially-placed strap supports. In the recovery area, the patient complains of numbness and tingling along the medial aspect of the calves. You suspect there could be damage to the A. sciatic nerve B. obturator nerve C. common peroneal nerve D. saphenous nerve

Answer 40

D

Question 41

What nerve passes between the medial epicondyle of the humerus and the olecranon? A. radial B. musculocutaneous C. median D. ulnar

Answer 41

D

Question 42

Which of the following factors is common in all peripheral nerve injuries due to positioning? A. Compression B. Transection C. Stretch D. Ischemia

Answer 42

D

Question 43

After emergence from a prolonged procedure in the prone position, the patient exhibits conjunctival edema. You know that conjunctival edema A. can lead to postoperative blindness B. is likely a permanent condition C. should be treated by applying pressure to the globe of the eyes D. is typically inconsequential and resolves spontaneously in the head-up position

Answer 43

D