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108 Cards in this Set
- Front
- Back
What is the golden rule for anesthesia
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Always be ready to go to sleep!
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What are the 2 types of local anesthestics used
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Esters & Amides
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Where are esters metabolized?
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metabolized by plasma cholinesterases
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Where are amides metabolized
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in the liver
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All Amides have what letter in their prefix?
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"i"
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Does Cocaine prevent/foster reuptake of catecholamines?
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prevent
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What are the two principal side effects of local anesthetics
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allergic reaction
systemic toxicity |
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What causes the allergic reaction to esters?
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PABA (metabolite para-aminobenzoic acid)
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What are the toxicity levels for Bupivacaine, and Lidocaine?
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Bupivacaine = 3mg/kg
Lidocaine = 4mg/kg Lidocaine w/epi = 7mg/kg (because epi causes vasoconstriction it delays release of lidocaine systemically) |
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True allergic reactions are
a) rare, less than 1% b) usually due to excess plasma levels c) both of the above |
both of the above
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What are the two causes of systemic toxicity
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accidental intravascular injection
too high local anesthetic dose |
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What are the symptoms of Systemic toxicity?
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usually present as CNS effects
circumoral numbness lightheadedness tinitis visual disturbance slurring of speech SEIZURES |
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What is treatment for seizure caused by systemic toxicity with LA's
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Protect patient
supplemental O2 Na pentothal BZD's IA's |
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What are the seven sites of placement of LA's
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topical/surface
local infiltration peripheral nerve block (ie axillary block) IV regional (bier block) epidural spinal caudal |
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What does LTA stand for? And can it reduce inhaled anesth. need?
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Local Tracheal Anesthesia
(usually use 4% lidocaine) yes it can decrease inhalation agent requirements, safe in elderly |
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Describe how a Bier Block is performed
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IV inserted for injection of LA, 2 tourniquets placed on extremity, LA injected into IV (LA stays in extremity until tourney released, do it SLOWLY)
pt may have PAIN from tourney |
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Where is a caudal block performed (which area of spine)
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Sacral Hiatus
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With local anesthesia, LA is injected SQ into area to be worked on. The surgeon is using a bovie at the site, for long periods of time. You see a rise in BP & HR what could be going on?
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pt could be exhibiting signs of pain, although he isn't feeling it
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What area of the spine is a spinal anesthesia usually placed?
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around L4-L5
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What area in the spinal column is LA injected for a spinal anesthesia?
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subarachnoid space
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Epidural or Spinal which one has a quicker onset? Why?
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Spinal, because it is closer to the spinal cord ( about 5 minutes compared to Epidural about 15 - 20 minutes)
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Would you expect to see more sympathectomy in a spinal or epidural?
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Spinal
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Which has a higher risk for a post injection headache, spinal or epidural?
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Spinal
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Where does the spinal cord end?
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L1
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what is the number one contraindication for not giving a regional anesthetic?
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Pt Refusal
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Regional anesthesia produces _________anesthesia for a specific site whereas general anesthesia produces ___________body anesthesia
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selective
total |
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You have just performed your regional anesthetic without any problem, now how much muscle relaxant will you need to give your patient?
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None! RELAXATION IS PROFOUND! there is little need for muscle relaxants after a regional anesthetic
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What factors are taken into consideration when selecting a patient for a regional anesthetic?
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cooperation
pt consent fluid status (sympathectomy) experience of provider availability of emergency equipment pt fear of permanent paralysis |
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The spinal cord extends form the foramen magnum to
a) L4-L5 b) L1 - L2 (sacral hiatus) c) cauda equina |
L1 - L2 (sacral hiatus)
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The vertebral column consists of
________ cervical ________thoracic ________lumbar |
7 cervical
12 thoracic 5 lumbar |
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Each vertebra consists of
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a vertebral body
bony arch |
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Each vertebral body consists of
_____anterior pedicles _____posterior laminae |
2 pedicles
2 laminae |
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The laminae of the vertebra are connected by
a) ligament flavum b) cauda equina c) spinal cord |
ligament flavum (dense & fibrous)
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Which of the following is NOT contained in the spinal canal
a) pia mater b) arachnoid mater c) dura mater d) equina mater |
equina mater
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True/False the sacral nerves extend in spinal canal as the cauda equina
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True
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Space between the arachnoid mater and pia mater is known as_____________
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subarachnoid space
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Is the epidural space considered a positive pressure space or negative pressure space?
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negative pressure space
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What is the epidural space normally filled with?
a) fluid b) adipose tissue c) connective tissue d) b & c |
d) adipose & connective tissue
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Landmarks for insertion of a subarachnoid block include
a) midline (spinous process) b) line across iliac crest (L4) c) cauda equina d) a & b |
d)
midline (spinous process) LINE ACROSS ILIAC CREST L4 |
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The typical needle used for spinal (subarachnoid) injections is
a) 22/25 gauge beveled spinal needle b) 22/25 gauge needle c) what ever is handy |
a) 22/25 gauge beveled spinal needle
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True/False When performing a spinal anesthesia the best positions include lateral decubitus or sitting
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True
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Confirmation of correct placement of a spinal injection is identified by
a) no blood when drawing back b) blood when drawing back c) positive CSF when drawing back |
c) positive CSF when drawing back
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When you have flow of CSF what space are you in?
a) cauda equina b) intrathecal c) epidural space d) you will get CSF in any of these places |
b) intrathecal
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What is the FIRST sign of a good spinal injection?
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SYMPATHECTOMY
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If a patient is unable to "flex" back what technique might you use?
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Lateral (paramedian) approach which is 1-2 cm lateral to the midline
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True/False The largest interspace is between L5 - S1
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True
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Distribution of local anesthetic is influenced by what factors
a) baricity of the solution b) contour of the spinal canal c) position of patient during injection d) all of the above |
d) all of the above
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A hyperbaric solution will
a) stay where it's injected b) sink c) rise |
b) sink
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A hypobaric solution will
a) stay where it's injected b) sink c) rise |
c) rise
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A isobaric solution will
a) stay where it's injected b) sink c) rise |
a) stay where it's injected
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True/False migration of of the local anesthetic cephalad in CSF depends on its specific gravity in relation to CSF's specific gravity
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True
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To make a hyperbaric solution you would add
a) sterile water b) dextrose c) CSF |
b) dextrose
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To make a hyperbaric solution you would add
a) sterile water b) dextrose c) CSF |
b) dextrose
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To make a hypobaric solution you would add
a) sterile water b) dextrose c) CSF |
a) sterile water
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When using a hyperbaric solution where will the anesthetic settle when patient is in lateral position?
a) dependent side b) non-dependent side c) it will stay where you put it |
a) dependent side
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When using a hypobaric solution where will the anesthetic settle when patient is in lateral position?
a) dependent side b) non-dependent side c) it will stay where you put it |
b) non-dependent side
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Addition of a vasoconstrictor drug to a local anesthetic can prolong the spinal up to
a) 25% b) 50% c) 75% d) vasonconstrictors don't influence duration of spinal |
b) 50%
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What are the two vasoconstrictors mixed with local anesthetics?
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Epinephrine
Phenylephrine |
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At what level in the spinal column would you find the cardio-acceleratory
fibers a) T-5 - T-7 b) T-1 - T-4 c) L-1 - S-1 |
b) T-1 - T-4 (may have profound hypotension, bradycardia, decreased contractility)
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If your patient develops apnea after a spinal injection what is the most likely cause? ___________________
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Hypotension
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True/False It is appropriate to place patient in trendelenburg when using a hyperbaric solution
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False!!!!
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Why must you use caution when administering a neuraxial block to patients with severe COPD?
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Because patients with severe COPD might rely on accessory muscles (intercostal and abdominal)
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Correlate the following spinal levels with their anatomic position
C8 T1 - T4 T1 - T2 T3 T4-T5 T7 T10 |
C8 = 5th digit ( includes (T1-T4 cardio accelerator)
T1 - T2 inner aspect of arm T3 apex of axilla T4- T5 nipple line T7 tip of xyphoid T10 - umbilicus |
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What are the levels required to have adequate anesthesia for the following surgeries
c-section vag delivery, hip, TURP lower extremity foot surgery Hemorrhoidectomy |
T4 c-section
T10 vag hip TURP L1 lower extremity L2 -L3 foot S2 - S5 Hemorrhoid |
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A C8 level of anesthesia is considered
a) high spinal b) total spinal |
total spinal
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A T4 level of anesthesia is considered
a) high spinal b) total spinal c) low spinal |
high spinal
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A T10 level of anesthesia is considered
a) high spinal b) low spinal c) saddle block |
low spinal
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True/False The sympathetic nerves are 1st to be blocked in a spinal anesthesia
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True
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Sympathetic block may exceed somatic (sensory) block by as much as ____levels (dermatomes) above and below injection site
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2 dermatomes
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Hypotension associated with a spinal anesthesia can be minimized by
a) decreasing amount of LA injected b) increasing preload by hydrating pt with IVF's c) changing the level at which you inject |
increasing preload by hydrating pt with IVF's
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What is the first sign that your patient is hypotensive after a spinal injection?
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NAUSEA
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If your patient starts complaining of "i can't breath what steps should you take
a) reassure pt b) check dermatome c) supplemental O2 d) convert to a general anesthesia e) all of the above |
e) all of the above
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What needle is used for an epidural anesthesia?
a) 17 gauge beveled spinal needle b) 17 gauge tuohy needle c) any small gauge needle, as long as it is beveled will work |
b) tuohy needle tuohy needle
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When performing an epidural loss of resistance is evident when the needle passes through
a) dura b) ligamentum flavum c) subarachnoid septum |
b) ligamentum flavum
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It is important to remember not to withdraw epidural catheter through the needle because
a) you will lose the position of the catheter b) the tip of catheter can be sheared off c) the manufacturer says not to |
b) the tip of catheter can be sheared off
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After placing the needle/ epidural catheter the catheter is threaded how far and then secured for a continuous epidural infusion?
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3-5 cm be sure to note the marks on catheter
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True/False It is important to do a test dose with an epidural catheter placement
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True
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What are you looking for when you do a test dose after placing an epidural catheter?
a) accidental dural puncture b) accidental intravascular injection c) radicularopathy d) both a & b |
d) both a & b
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If you did puncture the dura, how would you know?
a) symptoms would show up in about 2 minutes b) pt would have numbness of buttocks and lower extremities c) the patient is able to get up and walk about d) both a & b |
d) both a & b
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Level and duration of an epidural depends on which factors
a) volume & concentration of LA b) use of epi (1:200,000) c) weight, height, age of pt d) all of the above |
d) all of the above
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What is important to remember to do after placing an epidural catheter?
a) always, always aspirate b) always, always aspirate c) both a & b |
c) both a & b
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With a higher concentration will there be
a) more motor blockade b) less motor blockade c) blockade doesn't depend on concentration |
a) more motor blockade
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True/False Epidural spread has to do with volume of LA
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True
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What is one of the big risks of intravascular injection of Bupivacaine?
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Cardiovascular collapse
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In what order does an epidural spread
a) sensory, motor, sympathectomy b) motor, sensory, sympathectomy c) motor, sympathectomy, sensory d) sympathectomy, sensory, motor |
d) sympathectomy, sensory, motor
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True/False Epidural will have slower onset of sympathectomy than spinal
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True
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An epidural may average how many segments above and below injection site?
a) 4 segments b) 2 segments c) 1 segment d) it doesn't move from injection site |
a) 4 segments
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What are the types of peripheral nerve blocks?
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Cervical plexus
Brachial plexus-interscalene-supraclavicular-axillary medial-ulna-radial nerves sciatic, femoral, ankle,Bier block |
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How many nerve(s) must be blocked for an ankle block?
a) 1 b) 2 c) 5 d) 7 |
c) 5
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What must you always be prepared to do when administering ANY type of anesthesia?
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BE READY TO GO TO SLEEP!
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Which of the following factors affect the level of anesthesia
a) Baricity of LA b) position of pt (during & after injection) c) drug dosage d) site of injection e) all of the above |
e) all of the above
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In adults, what is the generally accepted amount of LA required to achieve a block of ONE segment when administering an epidural?
a) 5-6 ml b) 1-2 ml c) 7-8 ml d) there is no generally accepted guideline |
b) 1-2 ml
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What are the contraindications to peripheral nerve blocks
a) uncooperative pt b) bleeding tendencies c) infection d) all of the above |
d) all of the above
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Potency of LA's correlates with
a) water solubility b) lipid solubility c) both of these d) neither of these |
b) lipid solubility
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Onset of action depends on
a) Pka b) physiological pH c) both of these |
c) both of these
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What Local anesthetics are used for spinal anesthesia
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Procaine, Tetracaine
Bupivacaine, Dibucaine, Lidocaine |
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What local anesthetics are used for epidural anesthesia
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Chloroprocaine, Bupivacaine, Lidocaine, Mepivacaine, Prilocaine
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Which local anesthetics are used for both spinal and epidural anesthetics
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Bupivacaine, Lidocaine
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the space between the arachnoid mater and pia mater is known as
a) epidural space b) subarachnoid space c) ligamen flavum d) none of these |
b) subarachnoid space
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Sacrum & coccyx are distal estensions of _________________
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vertebral column
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Each vertebra consists of
______________ & _____________ |
vertebral body
bony arch |
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With an epidural where will the most intense block be?
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dependent portion
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With an epidural where will the most intense block be?
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dependent portion
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Procaine
a) long acting b) short acting c) intermediate acting |
a) long acting
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Tetracaine
a) long acting b) short acting c) intermediate acting |
a) long acting
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Chloroprocaine
a) long acting b) short acting c) intermediate acting |
c) intermediate acting
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Lidocaine 5% w/ 7.5% dextrose would have what baracity
a) hyperbaric b) hypobaric c) isobaric |
a) hyperbaric
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Which local anesthetic has vasoconstrictor properties
a) lidocaine b) mepivacaine c) Chloroprocaine d) bupivacaine |
b) mepivacaine
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