TL - Anatomy Flashcards
(93 cards)
1
Q
What is the purpose of the interscalene block?
A
Targets the brachial plexus at the nerve roots C5-7, sparing C8-T1
Used for procedures involving the upper extremity, including elbow, upper arm, and shoulder; not recommended for hand or medial forearm procedures.
2
Q
What layers are traversed in a midline approach for spinal anesthesia?
A
- Skin
- Subcutaneous tissue
- Supraspinous ligament
- Interspinous ligament
- Ligamentum flavum
- Epidural space
- Dura mater
Medications are deposited in the subarachnoid space.
3
Q
What have continuous perineural catheter blocks been shown to decrease?
A
Opioid consumption
4
Q
What block can be done for tourniquet pain?
A
Intercostobrachial nerve block
Supplies sensory innervation to the inner aspect of the upper arm.
5
Q
Which nerves are targeted by the fascia iliaca block?
A
- Lateral femoral cutaneous nerve
- Femoral nerve
- Genitofemoral nerve (unreliably)
- Obturator nerve (unreliably)
Used for analgesia of the hip, anterolateral thigh, and anterior knee.
6
Q
What is the lumbar sympathetic plexus block used for?
A
- Lower extremity complex regional pain syndrome
- Phantom limb pain
- Postherpetic neuralgia
- Renal colic
- Analgesia for first stage of labor
Position: anterolateral aspect of lumbar vertebral bodies (L1-L5).
7
Q
What are the sonographic features of pneumothorax?
A
- Absence of B lines
- Enhancement of A lines
- Loss of lung sliding
8
Q
What are the complications and side effects of a deep cervical plexus block?
A
- Intravascular injection
- Blockade of phrenic nerve
- Blockade of superior laryngeal nerve
- Spread of local anesthetic into epidural and subarachnoid spaces
9
Q
Which nerves innervate the upper abdomen?
A
- Thoracoabdominal intercostal nerves
- Subcostal nerve
- Iliohypogastric nerve
- Ilioinguinal nerve
10
Q
Which nerve is most likely to be injured by proximal humerus fractures?
A
Axillary nerve
11
Q
How is the obturator block performed?
A
- Between the adductor longus and adductor brevis muscles
- Between the adductor brevis and adductor magnus muscles
12
Q
What is the only vocal cord tensor and its innervation?
A
Cricothyroid muscle, innervated by the superior laryngeal nerve (external branch)
13
Q
What test can differentiate saline from CSF after an epidural?
A
Glucose strip test
Point of care test that gives near immediate results.
14
Q
What provides adequate regional anesthesia for surgery below the knee?
A
- Popliteal nerve block
- Saphenous nerve block
15
Q
Which nerve is blocked at the palatoglossal folds?
A
Glossopharyngeal nerve
16
Q
What provides sensory innervation to the nasal mucosa?
A
Sphenopalatine ganglion
17
Q
What are the effects of nerve injury to the nerve of the larynx?
A
Loss of voice, difficulty swallowing
18
Q
Which nerve roots compose the lateral femoral cutaneous nerve?
A
L2 and L3
19
Q
What is the ideal intensity for stimulation and successful peripheral nerve blockade?
A
0.3-0.5 mA
20
Q
What is the use of ultrasound for regional anesthesia?
A
Increases safety margin and reliability of regional nerve blockade
21
Q
What should you never do in a paravertebral block?
A
Needle should never be redirected medially
22
Q
Which wall of the heart is supplied by the right marginal artery?
A
Free (lateral) wall of the right ventricle
23
Q
Describe manual in-line stabilization.
A
Performed during airway management for patients requiring urgent intubation with suspected cervical spine injury
24
Q
Where is the internal jugular vein located in relation to the carotid artery?
A
Superficial and lateral to the carotid artery
25
What are the afferent and efferent limbs of the oculocardiac reflex?
* Afferent: Trigeminal nerve (cranial nerve V)
* Efferent: Vagus nerve (cranial nerve X)
26
What is the best prevention against post-dural puncture headache?
* Proper patient selection
* Use of a small non-cutting spinal needle
* Operator experience
27
What are the risk factors for post-dural puncture headache?
* Young age
* Pregnancy
* History of headaches
* Smaller gauge cutting needles
* Greater number of dural punctures
* Skill of operator
28
At what level are caudal epidurals performed?
Through the sacral hiatus at level S4-S5
29
What is the diagnostic test of choice for a retained epidural catheter fragment?
CT scan
30
Where can the saphenous nerve be blocked?
Around the great saphenous vein, superiorly and medially to the medial malleolus
31
What are the locations for an ankle block?
Around the ankle joint, targeting specific nerves
32
What is an indication of a functioning femoral nerve block?
Weakness in knee extension against resistance
33
What are the parts of the upper airway?
* Pharynx
* Nasopharynx
* Oropharynx
* Hypopharynx
* Larynx
34
Which nerve supplies sensation to the dorsum of the foot?
Superficial peroneal nerve
35
What anesthetic plan is best for quick and lasting relief for severe labor pain?
Combined spinal-epidural block
36
Where are the anterior and posterior leaflets of the mitral valve located on the echo?
* Anterior leaflet near interventricular septum
* Posterior leaflet towards lateral wall of ventricle
37
Where is the ilioinguinal block performed?
In the transversus abdominis plane between the internal oblique muscle and transversus abdominis muscle
38
What is the most common side effect of an interscalene nerve block?
Ipsilateral phrenic nerve palsy
39
What is the innervation of the upper extremity?
Brachial plexus
40
What are the complications of intercostal nerve block?
* Pneumothorax
* High systemic absorption of local anesthetics
41
What nerves innervate the foot?
* Posterior tibial nerve
* Sural nerve
* Superficial peroneal nerve
* Deep peroneal nerve
42
Which two muscles does the needle travel through when performing an infraclavicular block?
Pectoralis major and minor muscles
43
What is the best regional anesthetic technique for a carotid endarterectomy?
Cervical plexus block (superficial)
44
What is the proper placement of a central venous catheter?
* Below the inferior border of the clavicles
* Above the tracheal carina
* Above the third rib
* Above the T4/T5 interspace
* Above the takeoff of the right mainstem bronchus
45
What are the risks associated with retrobulbar blocks?
* Higher incidence of subarachnoid injection
* Brainstem anesthesia
* Globe perforation
* Retrobulbar hemorrhage
* Absence of eyelid akinesia
46
What nerve can be blocked to alleviate pain in the lateral forearm?
Musculocutaneous nerve
47
What does the lumbar plexus block provide analgesia for?
Various lower extremity surgeries
48
What are the effects of the stellate ganglion block on the ipsilateral face?
* Sympathectomy induced
* Ipsilateral Horner's syndrome
* Injected conjunctiva
* Increased skin temperature
* Nasal congestion
* Vasodilation
49
What are the characteristics of supraclavicular blocks?
Provide fast, reliable surgical anesthesia
50
What is induced by the stellate ganglion block on the ipsilateral face?
Sympathectomy, ipsilateral Horner's syndrome (miosis, ptosis, anhydrosis), increased skin temperature, nasal congestion, vasodilation
51
What is the purpose of supraclavicular blocks?
Provide fast, reliable surgical anesthesia of the upper extremity for procedures at or below the elbow
52
How is the lateral femoral cutaneous nerve anesthetized?
Injecting local anesthetic 2 cm caudal and 2 cm medial to the anterior superior iliac spine (ASIS) in the inguinal crease
53
Which nerve is blocked by transtracheal injection prior to awake intubation?
Recurrent laryngeal nerve
54
Which artery supplies the anterior wall of the left ventricle?
Left anterior descending artery
55
What does the internal branch of the superior laryngeal nerve provide?
Sensory innervation to the base of the tongue, epiglottis, aryepiglottic folds, and arytenoids
56
What movement indicates stimulation of the common peroneal nerve?
Foot eversion
57
What does a complete ankle block involve?
- Deep peroneal
- Posterior tibial
- Saphenous
- Superficial peroneal
- Sural
58
Which nerve is usually missed during an axillary block?
Musculocutaneous nerve
59
What is a common complication after a deep cervical plexus block?
Elevated ipsilateral hemidiaphragm (temporary paralysis of phrenic nerve)
60
What neurologic deficits are seen from conus medullaris injury from spinal anesthesia?
Distribution of multiple peripheral nerves, may be unilateral or bilateral
61
Which nerve needs to be blocked during a transurethral resection of bladder tumor (TURP) on the lateral wall?
Obturator nerve
62
What is the greatest concern when planning airway management for a patient with achondroplasia?
Atlantoaxial instability
63
What anatomical structure overlies the femoral nerve?
Fascia iliaca
64
What is the 3 in 1 block?
Performing a femoral nerve block with enough local anesthetic to block lateral femoral cutaneous nerve and obturator nerve
65
Where does the dural sac end in adults?
S1-S2
66
Which cells make pulmonary surfactant?
Type II alveolar cells
67
What are the nerves involved in a scalp block?
- Supratrochlear
- Supraorbital
- Zygomaticotemporal
- Auriculotemporal
- Lesser and greater occipital
68
Which nerve is most commonly spared by an interscalene brachial plexus block?
Ulnar nerve
69
What is cricoid pressure used for?
To decrease the risk of gastric aspiration during induction of anesthesia
70
What are the two bony landmarks for the sciatic nerve during a block?
Greater trochanter and ischial tuberosity
71
Which spine block location has the highest chance of intravascular injection?
Cervical facet injections
72
What is the difference between retrobulbar and peribulbar blocks?
Retrobulbar produces more dense analgesia and akinesia but has higher risks of complications
73
What is the relation of the brachial plexus trunks to the subclavian artery in supraclavicular blocks?
Lateral
74
What happens when you place a cuffed ETT in the bronchus intermedius?
Excludes the left lung and right upper lobe from ventilation
75
What are the total lung segments in lobectomy or pneumonectomy?
- 10 in left lower lobe
- 10 in left upper lobe
- 12 in right lower lobe
- 4 in right middle lobe
- 6 in right upper lobe
76
What is the artery of Adamkiewicz?
Arises around T9-T12 on the left side of the aorta, supplies anterior 2/3rds of spinal cord
77
What are the blood supplies of the ventricles?
- Left coronary artery: apex of left ventricle, anterolateral LV
- Right coronary artery: anterior and posterior right ventricle, right atrium
78
What movement is preserved following a lumbar plexus block via posterior approach?
Plantar flexion of foot
79
Which two muscles is the brachial plexus found between during an interscalene block?
Anterior and middle scalene muscles
80
What are recommendations for proper technique for regional nerve blocks?
- Aseptic technique
- Use of short bevel insulated needles
- Appropriate needle length
- Surface localization of anatomy
- Slow needle passes
- Smaller volumes with intermittent aspiration
81
What type of injection can be used for regional nerve blocks?
Epidural or intrathecal injection
## Footnote
These injections are commonly utilized in anesthesia for pain management.
82
What is a significant risk during regional nerve blocks?
Intravascular injury
## Footnote
Intravascular injury can lead to serious complications if not avoided.
83
Name a recommendation for proper technique to avoid post-procedural complications.
Aseptic technique for avoidance of infection
## Footnote
Aseptic technique is crucial to prevent infections during procedures.
84
What type of needles are recommended for regional nerve blocks?
Short bevel insulated needles
## Footnote
These needles provide more accuracy in needle placement and help avoid nerve penetration.
85
What should be confirmed before performing a nerve block?
Confirmation of functioning equipment
## Footnote
Ensuring that all equipment is functioning is vital for a successful procedure.
86
What is the effect of using smaller volumes of injectate with intermittent aspiration?
Avoids intravascular injections
## Footnote
This technique helps to ensure that the injectate does not enter the bloodstream.
87
What are symptoms of inadvertent subdural injection during an epidural block?
Minimal or variable motor blockade, excessive sensory blockade, sympathetic blockade
## Footnote
These symptoms indicate that the injection may not have been placed correctly.
88
Where should local anesthetic be injected for a glossopharyngeal nerve block?
At the base of anterior tonsillar pillar
## Footnote
This targets the posterior third of the tongue, soft palate, and area above the epiglottis.
89
What is a key anatomical difference when placing an epidural in the thoracic region compared to the lumbar region?
Thoracic spinous processes are long and project inferiorly
## Footnote
This anatomical difference necessitates different approaches for epidural placement.
90
What is the purpose of a stellate ganglion blockade?
Treats sympathetically mediated pain in head and upper extremities
## Footnote
This block is effective for pain management in specific regions.
91
What nerves are targeted in an axillary block?
* Median nerve
* Radial nerve
* Ulnar nerve
## Footnote
These nerves provide sensation to various parts of the arm and hand.
92
Which nerve is often spared in the axillary block and why?
Musculocutaneous nerve; it does not travel within the axillary sheath
## Footnote
This anatomical consideration affects the success of the block.
93
What structure acts as a barrier keeping local anesthetic around the femoral nerve?
Fascia iliaca
## Footnote
This structure helps prevent the anesthetic from spreading towards the femoral artery and vein.
