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175 Cards in this Set
- Front
- Back
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****Cardiac Output to the kidney
a) 10% b) 20% c) 30% d) 50% |
20%
10% of this volume is filtered to produce 180 L/day |
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Kidneys receive their sympathetic innervation from
a) S2 - 4 b) T11- L2 c) T8 - L1 |
T8 - L1
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Where do the kidneys receive their parasympathetic innervation from?
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Vagus
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Ureters receive their sympathetic innervations from
a) S2 - 4 b) T11- L1 c) T8 - L1 |
T8 - L1
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Kidneys are found
a) retroperitoneal space b) center @ L2 c) retropubic space d) center @ L5 |
retroperitoneal space
center @ L2 |
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Bladder
a) found in retropubic space b) sympathetic innervation T11-L2 c) parasympthetic innervation S2 - 4 d) parasympthetic innervation vagus nerve |
found in retropubic space
sympathetic innervation T11-L2 parasympthetic innervation S2 - 4 |
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Kidney filters how many liters/day?
a) 100 L b) 150 L c) 180 L d) 210 L |
180 L
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T/F 99% of fluid filtered by kidney is reabsorbed into circulation
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True
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Normal GFR for female
a) 75 - 115 b) 100 - 150 c) 150 - 180 d) 180 - 200 |
75 - 115
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Normal GFR for male
a) 75 - 115 b) 100 - 150 c) 150 - 180 d) 180 - 200 |
100 - 150
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Chronic Renal Failure
a) GFR < 10% of normal b) GFR < 25% of normal c) GFR < 40% of normal |
GFR < 25% of normal
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****Auto-Regulation of renal blood flow occurs at an arterial mean of
a) 30 mmHg b) 50 mmHg c) 75 mmHg |
50 mmHg
in a patient with Chronic HTN this will be higher |
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Renal Insufficiency
a) 25 - 40% of normal GFR b) 10 - 20% of normal GFR c) 40 - 55% of normal GFR |
25 - 40% of normal GFR
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****Uremic Syndrome
a) most severe form of Chronic Renal Failure b) GFR < 20% of normal c) GFR < 10% of normal d) creatinine level > 3mg/dl |
most severe form of Chronic Renal Failure
GFR < 10% of normal creatinine level > 3mg/dl |
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****What is the fluid of choice in a patient with CRF or ESRD?
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NS (LR is avoided d/t the amount of K found in the solution
4 mEq/L) |
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Of the following volatile agents which may be the best to use in genitourinary cases?
a) Desflurane b) Sevoflurane c) Isoflurane |
Desflurane the others may not be good r/t fluoride ion production
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T/F Although direct anesthetic effects of volatiles are generally not harmful, the indirect effects are what cause renal dysfunction
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True
indirect effects include Hypovolemia Shock Nephrotoxin exposure |
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Sux should be used with caution in CRF patients, why?
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Because Sux can raise K levels 0.5 - 1 mEq
CRF pts usually have a high K level to begin with |
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What muscle relaxants are safe to use in CRF patients?
a) Cisatracurium b) Pavulon c) Vecuronium d) Rocuronium |
Cisatracurium
Vecuronium Rocuronium |
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****What position is most commonly used for Urology procedures?
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Lithotomy
2 people should raise & lower legs simultaneously support straps should be padded nerve injuries may occur |
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Nerve injuries that can occur while patient is in Lithotomy position include
a) common peroneal b) obturator c) post-tibial d) femoral e) saphenous |
common peroneal
obturator femoral saphenous |
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****Lateral thigh resting on strap supports while in Lithotomy position may damage which nerve
a) saphenous b) femoral c) common peroneal d) obturator |
common peroneal
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****Legs resting on the medial side of the strap supports may damage which nerve
a) saphenous b) femoral c) common peroneal d) obturator |
saphenous
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****Damage to the common peroneal nerve
a) numbness along the medial calf b) loss of dorsiflexion of the foot c) inability to flex/extend lower leg |
loss of dorsiflexion of the foot
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****Damage to the saphenous
a) numbness along the medial calf b) loss of dorsiflexion of the foot c) inability to flex/extend lower leg |
numbness along the medial calf
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****Excessive flexion of the thigh against the groin may result in injury to
a) saphenous nerve b) femoral nerve c) common peroneal nerve d) obturator nerve |
femoral nerve
obturator nerve |
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T/F General anesthesia and muscle relaxation but NOT regional anesthesia obliterates the obturator reflex
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True!! the unabolished obturator reflex can cause the patient to kick the surgeon in the head (oops sorry about that doctor..)
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Which type of anesthesia reduces surgical blood loss, decreases incidence of venous thrombosis and is less likely to mask TURP syndrome
a) general b) regional |
regional
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T/F Acute hyponatremia from irrigating fluid overload may delay or prevent emergence from general anesthesia
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True
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****Physiologic changes r/t Lithotomy postion include
a) decreased FRC b) increased venous return c) increased FRC d) decreased venous return |
decreased FRC
increased venous return be sure to check BP after legs are lowered HOTN can be exaggerated with anesthesia |
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What dermatome level is needed in order to do a cytoscopy or ureteroscopy
a) T4 b) T10 c) L1 |
T10
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****When a Lithotripsy is performed shock waves are syncronized with
a) P wave b) QRS complex c) R wave d) T wave |
R-wave so that the risk of arrhythmias is DECREASED
patients with a cardiac history or pacemaker are at risk for arrhythmias during a lithotripsy procedure |
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Lithotripsy requires what dermatome level?
a) T-10 b) T-6 c) T-4 |
T-6
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Of the following lasers which is the most commonly used
a) CO2 Laser b) Argon Laser c) KTP laser d) YAG laser |
YAG laser
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****The advantages of Laser surgery include
a) minimal blood loss b) minimal post-op pain c) tissue denaturation |
minimal blood loss
minimal post-op pain tissue denaturation (this decreases risk of tumor implantation) |
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****T/F Laser procedure should not be started until EVERYONE in the room has protective eye wear on
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True, pt and staff alike
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Is CO2 absorption greater in an intraperitoneal laparoscopic procedure or in extra peritoneal laparoscopic procedures?
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extra peritoneal laparoscopic procedures
studies show there is a 76% increase in CO2 as compared to a 15% increase with intraperitoneal procedure |
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Your patient who has a hx of CHF is undergoing a prolonged laparoscopic procedure you notice that there a decrease in urine output
a) you give them a bolus of fluids b) consider this may be normal r/t procedure before doing anything else c) give them a dose of lasix |
consider this may be normal r/t procedure before doing anything else
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****Complications r/t Resection of the Prostate include
a) Hemorrhage b) TUR Syndrome c) bladder perforation d) DIC |
Hemorrhage
TUR Syndrome bladder perforation DIC as well as hypothermia & septicemia |
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What is the number one complication of Resection of the Prostate
a) TUR Syndrome b) Hemorrhage c) DIC d) Hypothermia |
Hemorrhage
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Common Co-morbs of a Resection of the Prostate patient include
a) Cardiac b) Pulmonary c) Renal dysfunction d) PVD |
Cardiac
Pulmonary Renal dysfunction (r/t to obstruction of bladder by prostate) |
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The solutions used for TURP surgery are typically
a) isotonic, non-electroyte b) hypertonic c) hypotonic, non-electrolyte |
hypotonic, non-electrolyte
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TURP requires what dermatome level
a) T-4 b) T-8 c) T-10 d) L-1 |
T-10
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Irrigating fluids that are ________
can have significant absorption a) isotonic b) hypertonic c) hypotonic |
hypotonic
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****Which of the following irrigating fluids can lead to circulatory depression and CNS toxicity?
a) Sorbitol b) Glycine c) Mannitol d) H2O |
Glycine
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****Which of the following irrigation fluids is an inhibitory neurotransmitter in the CNS
a) Sorbitol b) Glycine c) Mannitol d) H2O |
Glycine
associated with transient blindness |
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****Hyperammonemia can be caused by which irrigation fluid
a) Sorbitol b) Glycine c) Mannitol d) H2O |
Sorbitol (according to ppt)
and according to M&M so does glycine |
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****Sorbitol + Dextrose irrigation fluids can lead to _____________
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Hyperglycemia
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Which chemotherapy often given for prostatic CA can lead to pulmonary fibrosis
a) Cisplatin b) Adriamycin c) Bleomycin |
Bleomycin
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Which chemotherapy often given for prostatic CA can lead to renal failure
a) Cisplatin b) Adriamycin c) Bleomycin |
Cisplatin
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Which chemotherapy often given for prostatic CA can lead to cardiomyopathy
a) Cisplatin b) Adriamycin c) Bleomycin |
Adriamycin
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Pts who have received Bleomycin require
a) a decreased preload b) use of FiO2 < 30% c) use of PEEP |
use of FiO2 < 30%
use of PEEP |
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In a radical prostatectomy why would you be concerned about air embolism?
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Because patient will be in an exaggerated lithotomy and trendelenburg position and the venous sinuses will be open
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Why is it important to keep FiO2 < 30% and limit fluid administration in a patient who has received Bleomycin?
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It may lead to ARDS
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A patient has received chemotherapy for their prostate cancer, why would you want to avoid N2O use during the case?
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Because N2O can cause bone marrow suppression
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T/F It is important to do a motor function assessment pre-operatively for a radical prostatectomy
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True, there is a chance of ligation of the intercostal arteries during left sided dissections that has been known to cause paraplegia
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****T/F Neuraxial anesthesia which can be used during a cystectomy can produce unopposed parasympathetic activity d/t sympathetic blockade
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True, this can lead to hyperactive bowel (severely contracted) which can make it difficult to construct a ileal reservoir
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****What medications can be given to reverse the unopposed parasympathetic activity causing hyperactive bowel during a cystectomy when a spinal anesthetic is used
a) Robinul b) Papaverine c) glucagon d) atropine |
Robinul (1 mg)
Papaverine (50 - 100 mg) glucagon atropine (just like treating for spasm of the sphincter of odi, anticholinergics) |
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Absolute contraindications for a renal transplant include
a) age > 60 b) Cancer c) Infection d) cerebrovascular disease |
Cancer
Infection |
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Relative contraindications for a renal transplant include
a) age > 60 b) Cancer c) Infection d) cerebrovascular disease |
age > 60
cerebrovascular disease |
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****Why would you want to monitor electrolytes (specifically K level) right after a transplanted kidney has been placed?
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Because the transplanted kidney has been preserved in a K solution which can increase the K levels in the recipient
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Monitors & medications used for a renal transplant include
a) A-line b) CVP c) dopamine d) neo-synephrine |
CVP
dopamine No A-line pt will NOT have big swings in BP NO Neo it is a direct vasoconstrictor!! |
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The astute CRNA knows to watch for s/s of TUR Syndrome in which of the following surgeries
a) TURP b) TURBT c) Percutaneous Nephrostomy d) Radical Prostatectomy |
TURP
TURBT Percutaneous Nephrostomy TUR Syndrome can happen in ANY urological procedure that uses irrigation fluids |
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****T/F TUR Syndrome is a general term used to describe neurological and cardiopulmonary symptoms that can occur when irrigating fluids are absorbed during TUR procedures
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True
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****What is the BEST way to monitor for TUR Syndrome & bladder perforation in the AWAKE patient?
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Mental Status
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****In an attempt to limit fluid absorption during a TUR procedure resection time is limited to
a) < 2 hours b) < 1 hour c) its not the time but the amount of fluids used that effects fluid absorption |
< 1 hour
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****When trying to limit fluid absorption during a TUR procedure what is the maximum height that the irrigation fluids should be suspended from the OR table?
a) no more than 30 cm b) no more than 30 inches c) no more than 60 inches d) no more than 60 cm |
no more than 60 cm
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****Why can absorption of irrigation fluids occur in TUR procedures?
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Because venous sinuses are open which sets up potential for SYSTEMIC absorption of large amounts of irrigating fluids
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****Absorption of irrigating fluids can lead to
a) circulatory overload b) water intoxication c) toxicity r/t solutes in fluids |
circulatory overload
water intoxication toxicity r/t solutes in fluids |
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****Symptoms of TUR Syndrome in the patient with a neuraxial anesthetic include
a) restlessness b) cyanosis c) dyspnea d) HOTN e) seizures |
restlessness
cyanosis dyspnea HOTN seizures |
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****Under general anesthesia what might be an EARLY sign of TUR Syndrome?
a) light anesthesia b) decreased arterial oxygen saturation c) seizures |
decreased arterial oxygen saturation
CNS symptoms are hidden under general anesthesia |
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Differential diagnosis of HOTN after a TURP should include
a) Hemorrhage b) TUR Syndrome c) Bladder perforation d) MI or ischemia e) Septicemia f) DIC |
Hemorrhage
TUR Syndrome Bladder perforation MI or ischemia Septicemia DIC |
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****Glycine irrigating solutions can cause
a) hyponatremia b) hypo-osmolality c) fluid overload d) Hemolysis |
hyponatremia
hypo-osmolality fluid overload (CHF, Pulmonary Edema, HOTN) Hemolysis |
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****On the average irrigating fluids in a TUR procedure can be absorbed at what rate?
a) 10 ml/min b) 20 ml/min c) 30 ml/min |
20 ml/min
note on record what time irrigation starts & stops throughout procedure |
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****Symptoms of HypoNatremia begin to manifest themselves at what Na level
a) 130 mEq/dl b) 120 mEq/dl c) 110 mEq/dl |
120 mEq/dl
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****Formula for determining Na deficit
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Total Body Water x kg x (desired Na - present Na)
Male TBW 60% Female TBW 50% ie: .5 x 80 kg (130 - 118) = 480 (desired Na level is 130) |
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****Rapid correction of hyponatremia may result in? _______________
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Central Pontine Myelinosis
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****Progressive increases in blood pressure, CVP or PA pressures may be suggestive of ________
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Hypervolemia
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****QRS widening is seen when Na level is
a) 100 mEq/dl b) 115 mEq/dl c) 120 mEq/dl |
115 mEq/dl
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****V-tach or V-fib is seen when Na level is
a) 100 mEq/dl b) 115 mEq/dl c) 120 mEq/dl |
100 mEq/dl
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****RAPID correction hyponatremia should occur at what level?
a) < 105 mEq/dl b) < 110 mEq/dl c) < 115 mEq/dl d) < 120 mEq/dl |
< 110 mEq/dl
most patients can be managed with loop diuretics &/or water restrictions |
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****One liter of Normal Saline has how many mEq of sodium?
a) 134 mEq b) 144 mEq c) 154 mEq d) 164 mEq |
154 mEq
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If your patients Na deficit is 480 how many liters of Normal Saline should be given over a 24 hour period?
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3.12 L
(480 mEq / 154 mEq) = 3.12 L 154 mEq is the amount of Na in a one liter bag of NS |
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****A patient exhibiting mild symptoms of hyponatremia should be corrected at
a) 0.5 mEq/L b) 1 mEq/L c) 1.5 mEq/L |
0.5 mEq / L
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****A patient exhibiting moderate symptoms of hyponatremia should be corrected at
a) 0.5 mEq/L b) 1 mEq/L c) 1.5 mEq/L |
1 mEq /L
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****A patient exhibiting severe symptoms of hyponatremia should be corrected at
a) 0.5 mEq/L b) 1 mEq/L c) 1.5 mEq/L |
1.5 mEq / L
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****When correcting hyponatremia what is the max/hour that 3% NS can be given?
a) 50 ml/hr b) 75 mlhr c) 100 ml/hr d) 125 ml/hr |
100 ml/hr
otherwise can precipitate pulmonary edema |
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Your patient with hyponatremia is having seizures how do you treat them?
a) Versed 2 - 4 mg b) Valium 3 - 5mg c) Pentathol 50 - 100 mg d) Phenytoin 10 - 20 mg/kg |
Versed 2 - 4 mg
Valium 3 - 5mg Pentathol 50 - 100 mg Phenytoin 10 - 20 mg/kg (but no faster than 50 mg/min) |
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Besides medication for seizures r/t hyponatremia (TUR Syndrome) what other treatment modalities should be included?
a) Assure oxygenation and circulatory support b) Notify surgeon and stop procedure ASAP c) Labs for ABG & electrolytes d) 12 lead EKG |
Assure oxygenation and circulatory support
Notify surgeon and stop procedure ASAP Labs for ABG & electrolytes 12 lead EKG |
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T/F Shivering can lead to clot dislodgment and increased cardiac output
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True
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T/F Most bladder perforations are extraperitoneal and are signaled by poor return of irrigating fluids
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True
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****Signs & Symptoms of Bladder perforation in a patient with a neuraxial anesthetic include
a) nausea b) diaphoresis c) retropubic or abd pain d) shoulder pain |
nausea
diaphoresis retropubic or abd pain shoulder pain (referred) |
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T/F Thromboplastin is released from the prostate and can cause DIC
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True
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T/F Dilutional Thrombocytopenia can be caused by absorption of irrigation fluid
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True
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T/F Treatment of DIC may include Amicar, heparin therapy, and replacement of clotting factors and platelets
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True Amicar dose is 5 gm followed by 1 gm/hr
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Your TURP patient starts exhibiting symptoms of septicemia post-op why do you think this happening?
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Because bacteria is often colonized in the prostate and during the procedure there is the possibility of a bacterial shower
To prevent this Gentamycin is often given prophylactically |
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What are the goals of Opthalmic surgery?
a) Control of IOP b) Akinesis c) Avoidence of oculocardiac reflex d) Emergence without coughing & nausea/vomiting |
Control of IOP
Akinesis Avoidence of oculocardiac reflex Emergence without coughing & nausea/vomiting |
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Oculcardiac Reflex is characterized by what drop in heart rate?
a) 10% b) 10 - 20% c) 30 - 40% d) 10 - 50% |
10 - 50 %
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Actions that cause the oculocardiac reflex
a) External pressure on the globe b) coughing c) traction on the muscles |
External pressure on the globe
traction on the muscles |
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Corneal Abrasions typically occur where?
a) inferior 1/3 of the cornea b) external 1/3 of the cornea c) center of the cornea |
inferior 1/3 of the cornea
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Prevention of corneal abrasions involves
a) placement of goggles b) artificial tears c) mechanical closure of the lids |
placement of goggles
artificial tears mechanical closure of the lids |
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Use of N2O may cause a increased incidence of nausea & vomiting what is this attributed to?
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Nitrous induced negative pressure in the middle ear
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What Peds airway emergencies lead to rapid respiratory failure
a) croup b) epiglotitis c) foreign body aspiration d) all of the above |
croup
epiglotitis foreign body aspiration |
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The most important action of a CRNA during shared airway cases is ____________?
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COMMUNICATION
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75% of all tonsillar bleeds happen when?
a) in the first 0 - 6 hours post-op b) 72 hours post op c) 7 - 10 days post -op when scab falls off |
0 - 6 hours post-op
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Which type of surgery is a nasal intubation preferred in?
a) shared airway cases b) tonsillectomy c) dental procedures d) fractured mandible |
dental procedures
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What is the maximum safe dose of Epinephrine?
a) 100 mcg b) 200 mcg c) 300 mcg |
200 mcg
(1:1000 = 1000 mcg/ml or 1 mg/ml or 0.1%) 1: 100,000 = 10 mcg/ml or 0.01mg/ml or 0.001% ) 1:200,000 = 5 mcg/ml or 0.005mg/ml or 0.0005%) |
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What is the dose used for nasal cocaine?
a) 1mg/kg b) 2 mg/kg c) 3 mg/kg d) 4 mg/kg |
3 mg/kg
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What drug used for nausea & vomiting is also used to decrease swelling? ________________
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decadron
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Reglan may decrease the incidence of post-op nausea & vomiting by___________
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speeding gastric emptying
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Which of the following pertaining to laser surgery is false
a) should use low FiO2 b) tube cuff should be filled with methylene blue/saline instead of air c) N2O should be replaced with air d) Laser intensity/duration is not a consideration |
Laser intensity/duration is not a consideration
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T/F chemoreceptor trigger zone is stimulated by peripheral receptors during GI surgery, Eye surgery, Ear Surgery
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True
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What is the 1st step in an airway fire protocol?
a) turn off FiO2 b) remove ETT immediately c) stop ventilation d) douse the drapes with H2O to prevent spread of fire |
stop ventilation
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The number one sign that you are in the trachea is
a) ETCO2 confirmation b) Bilateral chest rise c) visualization of ETT passing through cords d) Bilateral Breath Sounds |
visualization of ETT passing through cords
the others are also helpful in confirmation but #1 sign is visualization |
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The number one fear in LASER cases is________________
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Fire
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Your patient has an obstructed airway caused by a neck tumor, what is best way to intubate patient?
a) nasal b) fiberoptic c) trach d) orally with bouge |
fiberoptic
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Pt coming in for laryngectomy, what co-morbs do these patients usually have? ______
So…….. RIGHT after intubation you have an ↑ in peak airway pressures what caused this? _____________________ |
Smoker(COPD), ETOH, CAD, Radiation, Chemo
Right mainstem intubation!! (if you have ↑ airway pressures it’s NOT an inadvertent extubation) |
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What is the most important thing during LASER surgery?
a) use of eye protection b) low FiO2 c) masks for laser of condyloma |
low FiO2
the other things are also important but LOW FiO2 is the MOST important thing |
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Your patient has inspiratory stridor where is airway problem located?
a) lower airway b) upper airway c) could be both upper & lower |
upper airway
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#1 complication with jet ventilation?
a) Tracheal Mucosal Damage b) inadequate ventilation c) sub-q emphysema |
Tracheal Mucosal Damage
the others are also a problem but mucosal damage is the #1 complication |
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Radical neck procedure (HTN, smoker) what kind of lines will you want to use for this case?
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Aline, CVP maybe but for sure →2 lg bore IV’s, Foley, Airway Cart in room, TXC for sure (may have blood in room)
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Which type of case requires PROFOUND vasoconstriction to control bleeding?
a) liver b) kidney c) nasal d) genitourinary |
nasal
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You are doing an upper GI on a kid he is on Pepcid for reflux, what technique are you going to use to induce him? ______________
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RSI + ETT
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What is the best way to secure airway of a patient with Ludwig Angina?
a) asleep fiberoptic b) awake fiberoptic c) asleep trach d) awake trach |
awake trach
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Your patient has long standing airway obstruction (ie:OSA or Cor Pulmonale) what can happen to heart?
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Right sided Heart Failure (this stems from long standing hypoxemia, hypercarbia = ↑ airway resistance = pulmonary arteriole/vein constriction = Pulm HTN = Right sided Heart Failure)
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You have a 2 year old who swallowed a penny how are you going to induce them?
a) IV induction + ETT b) inhalation induction + ETT c) RSI induction + ETT d) inhalation induction but no ETT surgeon will place fiberoptic scope to retrieve the coin |
inhalation induction + ETT
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Intraoral tumor debulking what kind of induction for this patient?
a) asleep, fiberoptic, oral b) asleep, fiberoptic, nasal c) awake, fiberoptic, oral d) awake, fiberoptic, nasal |
awake, fiberoptic, nasal
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Your patient has just had a trach placed, how do you know you are in the trachea & not the false tract?
a) ETCO2 b) Bilateral Breath Sounds c) SaO2 of 97% d) Bilateral chest rise e) adequate tidal volume |
ETCO2
Bilateral Breath Sounds |
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Interscalene block
a) Blocks C5 - C7 reliably b) Blocks C8 & T1 reliably c) Is ulnar nerve sparing 10 - 20% of time d) used for shoulder & upper arm surgeries |
Blocks C5 - C7 reliably
Is ulnar nerve sparing 10 - 20% of time (meaning not blocked) used for shoulder & upper arm surgeries |
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Cricoid located
a) C5 b) C6 c) C7 d) C8 |
C6
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Brachial Plexus
a) C5 - T1 b) C5 - C7 c) C6- T1 d) C6 - T2 |
C5 - T1
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Landmarks for Interscalene block
border of ____________ head of sternocleidomastoid. |
clavicular (@ the level of cricoid in groove between anterior & middle scalene muscles)
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Why would you want to use caution when giving a interscalene block to a COPD pt or a pt with Respiratory insufficiency?
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b/c the phrenic nerve is almost ALWAYS effected by block which would make it difficult for these types of pts to breath adequately
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Possible complications with interscalene blocks include
a) phrenic nerve palsy b) pneumothorax c) Recurrent laryngeal nerve palsy d) brachial plexus injury |
phrenic nerve palsy
pneumothorax Recurrent laryngeal nerve palsy brachial plexus injury |
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What nerve bifurcates into the tibial nerve & common peroneal nerve in the popliteal fossa?
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Sciatic
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T/F The sides of the popliteal fossa are formed by the biceps femoris laterally and the semitendinosus medially
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True
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T/F With a popliteal fossa block if you see plantar eversion and flexion you are exactly where you need to be
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FALSE!! you don't want Eversion! you want PLANTAR FLEXION & INVERSION
(eversion means you are going to block the common peroneal) |
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Saphenous Nerve is a continuation of what nerve
a) femoral b) sciatic c) iliac d) bracheal plexus |
femoral (found @ medial knee)
it is the only nerve in the foot that is not part of a sciatic branch |
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Cervical plexus block
a) used for awake carotids b) Blocks C2 - C4 c) is a "field block" |
used for awake carotids
Blocks C2 - C4 is a "field block" |
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When doing airway anesthesia for an awake intubation it would be important to give what drugs?
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robinul (antisialogogue)
Reglan ( aspiration prevention) Propofol (Sedation) these help prevent response to DL = laryngospasm, cough, SNS response |
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For nasal mucosa
a) submucosal injection b) phenylephrine c) cetacaine spray |
phenylephrine
cetacaine spray |
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Oropharynx
a) submucosal injection b) phenylephrine c) cetacaine spray |
submucosal injection (tonsillar pillar)
cetacaine spray (gargle, swallow) |
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Superior Laryngeal nerve
a) below cords b) above cords c) branch of the vagus |
above cords (includes cords, epiglottis, arytenoids)
branch of the vagus |
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Recurrent laryngeal nerve
a) below cords b) above cords c) branch of the vagus |
below cords
branch of the vagus Anesthesia for the trachea SENSORY Below cords!!! |
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Airway Anesthesia takes away
a) motor only b) sensory only c) both motor & sensory |
both motor & sensory
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The Recurrent laryngeal nerve
a) provides motor innervation to all muscles except cricothyroid b) provides sensory innervation to vocal cords and above c) provides sensory innervation below the vocal cords d) abducts the vocal cords |
provides motor innervation to all muscles except cricothyroid
provides sensory innervation below the vocal cords |
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Superior Laryngeal nerve provides sensory innervation
a) below the cords b) above the cords c) does not function as a sensory nerve |
above the cords
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Brachial Plexus has _____ nerve roots
a) 3 b) 4 c) 5 d) 6 |
5
C5, C6, C7, C8, T1 |
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Pneumothorax is the most serious complication of a
a) Supraclavicular brachial plexus block b) Interscalene brachial plexus block c) Intercostal block |
Supraclavicular brachial plexus block
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During a Supraclavicular block what artery must be avoided when injecting local?
a) subclavian b) superior vena cava c) jugular d) carotid |
subclavian (b/c the location of injection is where the nerves pass over the first rib which is where subclavian is)
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In an axillary block the median nerve is found where in regards to the axillary artery
a) above b) behind c) below |
above
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In an axillary block the radial nerve is found where in regards to the axillary artery
a) above b) behind c) below |
behind
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In an axillary block the ulnar nerve is found where in regards to the axillary artery
a) above b) behind c) below |
below ("U"nder "U"lnar)
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T/F The median, radial & ulnar nerves may be blocked @ the elbow as well as the wrist
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True
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Blocking of medial, radial, ulnar nerves is used for
a) supplement for brachial plexus b) sole anesthetics c) post-op analgesia |
supplement for brachial plexus
sole anesthetics post-op analgesia |
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When doing a Bier Block it is important to wait _________ before allowing surgeon to start procedure
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5 minutes (@ least) that way the local makes it to the tissue
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Which of the following blocks has been replaced (used more commonly) by the thoracic epidural?
a) subclavicular b) interscalene c) intercostal |
intercostal
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When doing an intercostal block how many ribs need to have local anesthetic injected into their corresponding nerve? ________
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6 - 10
can provide anesthesia for 8 - 15 hrs caution oversedation in supine position is common |
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Which sympathetic block is done @ C7 for arm pain?
a) Celiac Plexus b) Stellate c) Brachial Plexus |
Stellate
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Which sympathetic block is done @ L1 for abdominal pain?
a) Celiac Plexus b) Stellate c) Brachial Plexus d) Lumbar |
Celiac Plexus
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Which sympathetic block is done @ L2 - L3 for leg pain?
a) Celiac Plexus b) Stellate c) Brachial Plexus d) Lumbar |
Lumbar
(pain docs ie: Dr. Romanoff usually do these) |
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What 4 nerves cross the upper leg that would be blocked for knee surgery?
a) Sciatic b) Lateral Femoral cutaneous c) Femoral d) Sural e) Common Peroneal f) Obturator |
Sciatic
Lateral Femoral cutaneous Femoral Obturator |
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The Sciatic nerve numbs
a) lateral thigh b) sole of foot & lower leg c) medial thigh & knee |
sole of foot & lower leg
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The Lateral Femoral Cutaneous nerve numbs
a) lateral thigh b) sole of foot & lower leg c) medial thigh & knee |
lateral thigh
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Femoral nerve numbs
a) lateral thigh b) sole of foot & lower leg c) medial thigh & knee |
medial thigh & knee
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The "three in one-block" involves blocking
a) femoral b) lateral femoral cutaneous c) sciatic d) obturator |
femoral
lateral femoral cutaneous obturator |
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Which of the following nerves is not part of the sciatic nerve?
a) Superficial peroneal b) Deep peroneal c) Saphenous d) Sural e) Tibial |
Saphenous
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The sciatic nerve bifurcates into (choose 2)
a) Saphenous b) Common Peroneal c) Tibial d) Deep Peroneal |
Common Peroneal
Tibial (this occurs in the popliteal fossa) |
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Blocking which of the following nerves is considered a "field block"
a) Deep peroneal b) Sural c) Superficial peroneal d) Saphenous e) Tibial |
Sural
Superficial peroneal Saphenous "the 3 S's" |
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A complete ankle block involves how many nerves?
a) 4 b) 5 c) 6 |
5
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The Saphenous nerve is a terminal branch of what nerve?
a) Sciatic b) Femoral c) Tibial d) Peroneal |
Femoral
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The Saphenous nerve provides sensation to
a) dorsum of foot b) heel & medial sole c) antero-medial foot d) lateral foot |
antero-medial foot
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The Superficial Peroneal nerve provides sensation to
a) dorsum of foot b) heel & medial sole c) antero-medial foot d) lateral foot |
dorsum of foot
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The Sural nerve provides sensation to
a) dorsum of foot b) heel & medial sole c) antero-medial foot d) lateral foot |
lateral foot
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The Tibial nerve provides sensation to
a) dorsum of foot b) heel & medial sole c) antero-medial foot d) lateral foot |
heel & medial sole
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