Regional and anatomy

Question 1

Interscalene block blocks where

Answer 1

Shoulder and upper arm

Question 2

Supraclavicular block blocks what

Answer 2

Upper limb distal to shoulder

Question 3

Functions of larynx

Answer 3

Protects tracheobronchial tree 
Sound production 
Coughing 
Straining 
Modification of respiration

Question 4

Location of larynx in adults

Answer 4

Anterior neck base of tongue to cricoid
C4 to C6

C3 and more anterior in neonates

Question 5

Larynx cartilages

Answer 5

3 unpaired cricoid thyroid epiglottic
3 paired cuneiform, arytenoids, corniculate

Hyoid bone technically not part of larynx

Question 6

Ligaments of larynx

Answer 6

Cricothroid ligament attaches cricoid to thyroid and ends superiority as free margin which thickens and becomes val ligament within true cords

Upper border of quadrangular membrane joins the lateral epiglottis with the arytenoid and corniculate cartilage to form aryepiglottic fold. Free lower margin thick’s and becomes vestibular ligament in false cords

Extrinsic ligaments Ie cricothracheal

Question 7

Muscles of larynx

Answer 7

2 tensor muscles are cricothyroid and vocalist
Cricothyroid causes increased pitch phonation and vocalis anataginises that

Posterior cricoarytenoid is THE vocal cord adductor (closes)

Lateral cricoarytenoid, thryoarytenoid and interarytenoid are vocal cord abductors (open)

Question 8

Laryngeal Inervation

Answer 8

Motor and sensory via branches of vagus nerve

Superior laryngeal nerve two branches external supplies cricothyroid muscle
Internal supplies sensation above cords

Recurrent laryngeal nerve motor to all other intrinsic muscles of larynx and sensation below cords

Question 9

Injury to laryngeal nerves

Answer 9

Injury to superior laryngeal nerve
Hoarseness due to paralysis of cricothyroid (cricothyroid normally increases pitch) is unilateral the other one will compensate over time and voice will return but if bilateral hoarseness permenant

Injury to recurrent laryngeal nerve
Paralysis of abductors (opening) is more than adductors (closing via posterior arytenoids) so will be drawn inwards

Question 10

Where does recurrent laryngeal loop

Answer 10

Right loops under SCA

Left loops under aorta

Question 11

Blood supply of larynx

Answer 11

Superior thyroid artery (branch external carotid artery)

Inferior thyroid artery (branch of right subclavian)

Thyroid IMA artery in 3-10% (branch right common carotid)

Question 12

Describe nasal cavity

Answer 12

Pyramidal structure
Cells squamous anterior ans become columnar with glands posterior
Superior middle and inferior turbinate

Boundaries 
Roof sphenoid and ethmoid 
Lateral medial orbit and maxillary sinus 
Medial septum 
Floor hard palate (maxilla and palatine)

Question 13

Blood supply to nasal cavity

Answer 13

Maxillary artery (external carotid branches)

Sphenopalatine main branch
Facial artery

Veins follow artery and drain into cavernous sinus

Question 14

Nerve supply of airways

Answer 14

V1 branches anterior ethmoidal nerve supplies anterior nasal passage and septum
V2 branches nasal lesser palatine and sphenopalatine gums hard palate and posterior nasal cavity
V3 branches lingual nerve supplies tongue

IX glossopharyngeal is posterior third tongue upper pharynx

X superior laryngeal nerve sensation above cords and cricothyroid

X recurrent laryngeal nerve sensation below cords and intrinsic muscles

Question 15

Anterior abdominal wall superior inferior lateral

Answer 15

Superior is costal ligament and costal margin of 12th rib and xiohisternum

Lateral is lat Dorsi

Inferior is Inguinal ligament

Question 16

Fasciae layers

Answer 16

External oblique
Internal oblique
Transverse abdominus

Question 17

Inner action of anterior abdominal wall

Answer 17

T7-t9 above umbilicus
T10 is umbilicus
T11-12 below umbilucus plus minus l1 iliohypogastric and ikioinguinal

Question 18

Indications TAP block

Answer 18

C section 
Open appendix 
Cholecystectomy 
Open inguinal hernia 
Prostate Tommy 
Abdominal hysterectomy

Question 19

Triangle of petit landmarks

Answer 19

Inferior iliac crest posterior lat Dorsi anterior external oblique

Question 20

Complications of TAP block

Answer 20

Intrahepatic injections 
Intraperitoneal injection 
Bowel damage 
Transient femoral nerve palsy 
LAST

Question 21

Draw table of bupivaine and lidocaine for

Pka 
Unionised at physiological ph 7.4 
Plasma protein binding 
Elimination half life 
Relative lipid solubility 
Potency

Answer 21

Pka bupivicaine 8.1 lidocaine 7.9
Unionised at physiological ph 7.4 bup15% lidocaine 25%
Plasma protein binding bupivaine 95% lidocaine 70%
Elimination half life bupivicaine 160mins lidocaine 100mins
Relative lipid solubility bupivaine 1000 lidocaine 150
Potency bupivaine 8 lidocaine 2

Question 22

LAST effects

Answer 22

Cardiovascular 
Arrhytmias
Hypotension 
Chest pain
Cardiac arrest 

Neuro
Agitation
Seizures
Coma

Question 23

Treatment LAST

Answer 23

Secure airways
Stop infusions
Intralipid 20% 1.5ml kg (3 boluses 5 mins apart)
Intralipid infusion 15ml kg hr increased to 30

Max dose 12 ml kg

Question 24

Max dose intralipid

Answer 24

12 ml kg

Question 25

Side effects of too much intralipid

Answer 25

Pancreatitis | Lipidaemia effects in biochemistry

Question 26

Interscalene block for shoulder surgery - how to do

Answer 26

Trained assistance IV access and monitoring stop before you block Position supine head turned to contra lateral side Interscalene groove (cal rifle, posterior border scm, anterior scalene) Needle 50mm stimuplex 10-20ml 0.5% Levo

Question 27

Complications of interscalene block

Answer 27

``` Phrenic nerve Recurrent laryngeal nerve injury Stella the ganglion and Horner’s Rural spread Spinal cord damage LAST Pneumothorax ```

Question 28

Complications of deck chair position

Answer 28

Venous air embolism Stroke Brachial plexus injury Bezold Jarish refresh

Question 29

Benefits of regional techniques on fistula formation

Answer 29

``` Vasodilation increases fistula flow Better surgical outcomes Faster maturation time Motor block Analgesia Avoids risks GA ```

Question 30

Causes of upper limb ischaemia

Answer 30

``` Venous thromboembolism AF and arterial embolism Dissection Trauma Iatrogenic Vasculitis Atherosclerosis ```

Question 31

Thoracic outlet syndrome

Answer 31

Venous arterial nerve symptoms cause by compression or damage of brachial plexus and subclavian vessels as they pass under first rib

Question 32

Treatment thoracic outlet syndrome

Answer 32

Physio Analgesia Surgery

Question 33

Implications of wrong side block

Answer 33

``` Wrong side surgery Loss trust Anxiety Pain LAST ```

Question 34

Stop before you block

Answer 34

Who check inn Stop before needle check mark, confirm with patient and consent form Can be instigated any menber of team

Question 35

Factors leading to wrong sided block

Answer 35

``` Distraction Social activity List changes Mark covered Long time between who and block Moving patient Junior anaesthetist ```