Bb Anatomy 2

Front 1

What makes up the superficial cervical plexus and how is it blocked?

Back 1

anterior branches of the first four cervical nerves,
- becomes superficial at the lateral border of the SCM and is blocked at this location with 10cc of 1% lidocaine

Front 2

What are signs of a successful superficial cervical plexus block and what are complications?

Back 2

- horners syndrome and horseness (RLN block)
-complications are paralysis of the phrenic nerve and subarachnoid block

Front 3

where do intercostal nerves arise and what is their relationship to the rib artery and vein?

Back 3

-anterior rami of first 11 thoracic nerves;
-lie in the neurovascular bundle below the corresponding rib with the artery being the most superior then the vein and last the nerve (VAN)

Front 4

What are the branches of the intercostal nerves and what do they supply?

Back 4

1. first branch passes to sympathetic ganglia
2. posterior cutaneous branch - skin and muscle of paravertebral region (arises soon after it leaves the spinal cord)
3. lateral cutaneous branch - midaxillary line - skin of much of the chest and abd wall
4. anterior cutaneous - breast and ant thorax

Front 5

Which intercostal nerves supply sensory innervation of the thorax and which supply abdomen?

Back 5

1. upper 6 thoracic nerves supply thorax
2. lower 5 supply abdomen

Front 6

How could you do intercostal nerve block for extensive intraabdominal surgery

Back 6

intercostal nerve blocks from T4-T12 and the celiac plexus is blocked

Front 7

what makes up the celiac plexus?

Back 7

thoracic sympathetic ganglion and the greater and lesser splanchnic nerves

Front 8

What does the celiac plexus innervate? when do you use it?

Back 8

intraabdominal organs;
- when malignant tumors in pancreas, liver, gall bladder, stomach lead to intractable pain

Front 9

where is the celiac plexus and what is the positioning of the patient for a celiac plexus block?

Back 9

-L1 along the aorta in the retroperitoneal space;
-pt prone with fluoro
-The plexus itself lies clustered around the celiac artery, lateral to the aorta

Front 10

What are complications of the celiac plexus block?

Back 10

1. hypotension,
2. diarrhea (vagal activity leads to increased peristalsis and gut constriction),
3. shoulder pain

Front 11

what is the most effective of all maneuvers for pancreatic cancer pain?

Back 11

alcohol celiac plexus block

Front 12

How can the brachial plexus be injured by positioning?

Back 12

1. stretch by the head of the humerus,
2. compression between the clavicle and first rib

Front 13

How can the median nerve be injured?

Back 13

needles due to superficial location in antecubital fossa

Front 14

What are signs of radial nerve injury?

Back 14

-wrist drop (cannot extend MCP joints),
-weakness of thumb abduction

Front 15

What are signs of median nerve injury? How can it be injured?

Back 15

1. inability to oppose the thumb and little finger,
2. decreased sensation of the palmar surface of the lateral 3.5 fingers
-It runs superficial in the antecubital fossa and may be injured by needles or drugs

Front 16

How is the ulnar nerve injured?

Back 16

compression against post aspect of medial epicondyle of the humerus

Front 17

What are signs of ulnar nerve injury?

Back 17

1. inability to abduct the little finger, and
2. decreased sensation of the dorsum and palmar surface of the medial 1.5 fingers

Front 18

How is the sciatic nerve injured?

Back 18

stretching (lithotomy position), needle injection,

Front 19

How is the common peroneal nerve injured?

Back 19

compression of the nerve between the head of the fibula and the metal brace used in the lithotomy position

Front 20

What are the signs of common peroneal nerve injury?

Back 20

1. foot drop,
2. loss of dorsiflexion,
3. inability to evert the foot

Front 21

How is the anterior tibial nerve injured?

Back 21

feet are dorsiflexed for long periods of time; feet and ankles should be in neutral or slightly extended position

Front 22

How is the femoral nerve injured?

Back 22

at the pelvic brim by a self retaining retractor or by excessive thigh angulation in the lithotomy position

Front 23

What are signs of femoral nerve injury?

Back 23

loss of hip flexion and knee extension,
sensation lost over superior aspect of thigh

Front 24

How can the saphenous nerve injured?

Back 24

foot is suspended lateral to a vertical brace
- will lose sensation to the superior aspect of the thigh

Front 25

How is the obturator nerve injured?

Back 25

difficult forceps delivery,
excessive flexion of the thigh

Front 26

What are the signs of obturator nerve injury?

Back 26

inability to adduct the leg,
decreased sensation over medial aspect of the thigh

Front 27

What nerve innervates the larynx?

Back 27

Vagus nerve (CN X)

Front 28

What are the 5 major cartilages of the larynx?

Back 28

1. Hyoid
2. Thyroid
3. Cricoid
4. Arytenoid
5. Epiglottic

Front 29

What are the 2 branches of the vagus nerve that innervate the larynx and trachea?

Back 29

1. Superior laryngeal nerve
2. Recurrent laryngeal nerve

Front 30

What forms the brachial plexus?

Back 30

The union of the anterior primary divisions of C5-T1 with frequent contributions from C4 and T2

Front 31

How is the brachial plexus divided?

Back 31

"Randy Travis Drinks Cold Beer"
R = Roots
T = Trunks
D = Divisions
C = Cords
B = terminal branches

Front 32

What does each trunk form?

Back 32

An anterior and posterior division

Front 33

What do the lateral and medial cord of the brachial plexus give off?

Back 33

-The lateral and medial cord give off the lateral and medial heads of median nerve
-Medial cord terminates as the ulnar nerve
-Lateral cord terminates as the musculocutaneous nerve

Front 34

What does the posterior cord of the brachial plexus give off?

Back 34

The axillary nerve and continues as the radial nerve

Front 35

What is the innervation of the following colors?
Yellow
Blue arm
Pink
Brown
Green Hand
Blue Hand
Green Arm
Orange and Brown inner arm

Back 35

Yellow - Cervical plexus
Blue arm - Axillary
Pink - Radial
Brown - Musculocutaneous
Green Hand - Median
Blue Hand - Ulnar
Green Arm - Ulnar branch (median antebrachial cutaneous)
Orange and Brown inner arm - median cutaneous and intercostal brachial

Front 36

Where is the axillary vein found in relation to the axillary artery when performing a block?

Back 36

Anterior to the artery

Front 37

Describe the cutaneous innervation of the hand.

Back 37

-Median nerve innervates the index and middle fingers beyond the PIP as well as the radial half of the ring finger
-Ulnar - Half of 4th and entire 5th finger
-Radial - dorsal lateral half of thumb and dorsal surface of thumb

Front 38

What does the median nerve supply in the hand?

Back 38

The thenar eminence and the 1st and 2nd lumbricals

Front 39

Where is the median nerve found in the wrist?

Back 39

Between the flexor carpi radialis and the palmaris longus

Front 40

What nerve covers the posterior portion of the tongue?

Back 40

Glossopharyngeal nerve

Front 41

What is the significance of the lateral cutaneous branch of the 2nd intercostal nerve?

Back 41

This is the intercostobrachial nerve which supples the skin of the medial arm

Front 42

Which block has the highest blood levels of local anesthetic than any other regional anesthetic?

Back 42

Intercostal nerve block

Front 43

How is sciatic nerve injury manifested?

Back 43

1. Weakness below the knee
2. Decreased sensation of all of the foot except the inner arch