Regional Exam 3

1. Stimulation of the oculocardiac reflex will result in which of the following?

Bradycardia

Hypertension

PVC’s

Tachycardia

2. What monitoring is required when performing a Retrobulbar block on a pt?

ECG, O2 sat, and BP cuff

A-line, CVP, pulse ox, ECG

ECG and O2 sat only

BP cuff only

3. Which of the following is the proper sequence, from proximal to distal, for the composition of the brachial plexus?

Trunks, Cords, Roots, Divisions, Branches

Cords, Roots, Branches, Trunks, Divisions

Roots, Trunks, Divisions, Cords, Branches

Branches, Divisions, Trunks, Roots, Cords

4. Idenity nerve #3 in the photo below.

Femoral

Saphenous

Sciatic

Lateral Femoral Cutaneous

5.

In above picture, what is nerve #2?

Ulnar

Median

Radial

None of Above

6. What is the largest nerve in the body?

Sciatic nerve

Brachial Plexus nerve

Femoral nerve

Spinal cord

7. Which of the following nerves does not play a role in lower extremity nerve blockade?

Lateral femoral cutaneous

Ilioinguinal

Obturator

Femoral

8. The Sciatic Nerve divides to form which two nerves of lower leg? (more than one answer)

Medial Fibial Nerve

Dorsal Digital Nerve

Tibial Nerve

Common Peroneal Nerve

Submit

9. The brachial plexus is formed by the nerve roots of which vertebrae in the majority of people?

C5-C8

C2-T2

T1-T2

C1-C4

10. Where is the proper insertion point for a femoral block (after having identified other landmarks, of course)?

2 cm medial from femoral pulse

2 cm caudad from femoral pulse

2 cm distal from femoral pulse

2 cm lateral from femoral pulse

11. Blocking the lumbar plexus will block all sensory nerves of the leg and is sufficient for surgery.

True

False

12. When injecting local anesthetic for a femoral block you should stop and re-aspirate every…

5 ml’s

2-3 ml’s

10 ml’s

You don’t have to after the initial aspiration.

13. How many nerves must be blocked for a properly performed ankle block?

5

4

1

3

14. Which of the following is not a landmark used when performing a Sciatic Block?

Superior Lateral corner of Pubic Tubercle

Posterior superior iliac spine

Greater Trochanter of hip

Sacral Hiatus

15. You are delivering regional anesthetic to a patient when they begin to complain of feeling light headed and ringing in their ears. What should you do?

Slow down your rate of injection, and then administer rest of anesthetic.

Immediately notify MD and prepare pt for cardiac bypass, your plasma concentration is most likely too high now.

Immediately stop injection, start lipid infusion, monitor patient, your plasma concentration should still be low enough to reverse this.

Comfort the patient that this is normal to experience and deliver rest of anesthetic quickly.

16. A retrobulbar block typically involves use of what gauge of needle?

25

22

20

18

17. Stimulation of the radial nerve at level of elbow would result in which of the following?

Extension of wrist and fingers

Pronation of forearm and flexion of wrist

Flexion of pinky finger and ulnar wrist deviation

Contraction of deltoid muscle

18. Stimulation of the ulnar nerve would result in which of following actions?

Flexion of pinky finger and ulnar wrist deviation

Extension of wrist and fingers

Pronation of forearm and flexion of wrist

Contraction of deltoid muscle

19. Which nerve supplies sensation to the lateral aspect of the thigh down to the knee?

Femoral

Sciatic

Lateral Femoral Cutaneous

Ilioinguinal

20. Which of the following is not a complication commonly associated with interscalane blocks?

Phrenic Nerve blockade

Accidental vertebral artery injection

Horners Syndrome

All are associated with interscalane blocks

21. You are the SRNA for Mr. Pret who is having a carpal tunnel release today. The beir block was done and surgeon was done within 5 minutes. Trying to be helpful, the tech deflates your cuff for you once the procedure is finished. You are now crapping your pants because what might happen?

Increased risk for Malignant hyperthermia

Increases risk of permament nerve damage to arm

Increases risk of local anesthetic toxicity

All the above

22. COMIC RELIEF: Extreme sheep herding

Well, at least the bored shephards aren't doing *other* terrible things to the sheep...

PONG!!

He he he! Cute!

All the Above

23. Which of the following describes the anatomical landmarks used when doing an interscalene block?

Axillary artery below the pectoralis major muscle at the insertion of the bicep muscle.

The brachial pulse and medial epicondyle

The coracoid process, distal portion of the clavicle

The interscalene groove, located posterior to the clavicular insertion of the SCM.

24. Which of the following describes the landmarks used when performing an axillary block?

Axillary artery below the pectoralis major muscle at the insertion of the bicep muscle.

The brachial pulse and medial epicondyle

The coracoid process, distal portion of the clavicle

The interscalene groove, located posterior to the clavicular insertion of the SCM.

25. Which of the following nerves provides motor enervation to the quadriceps muscle and sensation to the anterior thigh?

Ilioinguinal

Obturator

Lateral Femoral Cutaneous

Femoral

26. Idenity nerve #5 in the photo below.

Tibial

Sural

Saphenous

Common Peroneal

27. You are performing a femoral block and are giving a test dose of Lidocaine 2% with epi. What would you expect to be the first signs of accidental intravascular injection?

Increase in pt HR

Pt c/o ringing in ears

Seizures

Pt C/o numbness in extremity

28. A patient experiencing numbness of posterior forearm, thumb, and first two digits would most have a block of which nerve?

Ulnar

Radial

Medial

Obturator

29. Which of the following nerve blocks is most effective for treatment of pain from knee surgery?

Sciatic

Lateral Femoral Cutaneous

Femoral

Obturator

30. What would be the appropriate choice of LA to use for a Bier Block?

Lidocaine 0.5% with epi

Bupivacaine 0.75% plain

Lidocaine 0.5% plain

Bupivacaine 0.75% with epi

31. Idenity nerve #1 in the photo below.

Saphenous

Laterial Femoral Cutaneous

Sciatic

Femoral

32.

In above picture, what is nerve #3?

Ulnar

Median

Radial

None of Above

33. Which of the following is not one of anatomical landmarks required to perform a femoral block?

Anterior Superior Iliac spine

Sacral Hiatus

The femoral artery

Superior lateral corner of pubic tubercle

34. Which of the following complications would not be due to technique of the anesthesia provider?

Neurapraxia

Pneumothorax

Vasovagal response

Compartment syndrome

35. Which of the following properly describes the musculocutaneous nerve?

Stimulation of the nerve causes extension of the wrist.

Provides motor enervation to biceps and coracobrachialis, sensory to lateral aspect of forearm.

36. Which of the following would confirm successful exsanguination of the arm following Eschmark wrap?

Pale blotchy extremity, cool to touch

Loss of radial pulse and capillary refill

Pt stating arm is numb

Loss of motor control of wrist

37. The sciatic nerve arises from which nerve roots?

L1-L3

L4-S3

S3-S5

T12-L2

38. In the cervical region nerve roots exit _ the vertebrae for which they are named, but starting in the Thoracic region nerve roots exit _ the vertebrae for which they are names.

Below, above

Above, below

Beside, above

Below, Beside

39.

In above picture, what is nerve #1?

Ulnar

Median

Radial

None of Above

40. When blocking the sciatic nerve at the popilteal fossa, where should you aim to inject the local anesthetic?

2-5 cm above the posterior crease of knee

7-10 cm above the posterior crease of knee

10-12 cm above the patella on anterior portion of thigh

2-3 cm below the posterior crease of knee

41. After a Bier Block has been successfully done, how long must you wait before deflating the tourniquet?

10 minutes

45 minutes

20 minutes

30 minutes

42. Which of the following is not one of the nerves blocked during an ankle block?

Deep Peroneal nerve

Dorsal Digital nerve

Sural Nerve

Saphenous Nerve

43. What is the most common complication associated with a retrobulbar block?

Globe Perforation

Neurogenic Apnea

Optic Nerve Atrophy

Retrobulbar Hemorrhage

44. When performing an eschmark wrap for a bier block you would first inflate the cuff of the tourniquet and then the cuff.

Distal, Proximal

Inflate both at the same time

Proximal, Distal

45. What would you expect to hear your patient say if you accidentally give a direct intraneural injection of local anesthetic?

“You said for me to tell if my ears started ringing ,well….. they just started ringing really bad”

“Wow, My whole arm feels totally numb now”

Nothing, it’s hard to talk when you’re having a seizure

“OW! OW! OWWWW!!!! That REALLY Hurts!!!!!!”

46. Idenity nerve #6 in the photo below.

Tibial

Common Peroneal

Sciatic

Femoral

47. The Ulnar nerve arises from the inferior roots of which vertebrae?

C5-C6

C6-C8

C2-C4

C8-T1

48. Which of the following provides sensory and motor enervation to the deltoid muscle?

Scalene nerve

Axillary nerve

Median nerve

Musculocutaneous nerve

49. Where would you perform a transtracheal block?

2 cm caudad to Styloid process posterior to angle of jaw

Directly above greater cornu of Hyoid bone

Posterior to Tonsillar pillars

Through the Cricothyrohyoid membrane

50. Stimulation of the tibial nerve will result in what action?

Wrist and thumb flexion

Foot dorsiflexion

Twitching of lateral thigh

Plantar flexion

51. Which of the following technique would be inappropriate to use IV regional anesthesia?

Carpal Tunnel release

Removal of hardware from elbow and humerus

Trigger Finger Release

Repair of Flexor tendon in forearm

52. Which nerve passes behind humerus and laterally at the epicondyle?

Median Nerve

Ulnar Nerve

Scalene Nerve

Radial Nerve

53. Which nerve can be located posterior to the medial epicondyle and the elbow?

Median

Scalene

Radial

Ulnar

54. How will pregnancy affect pt sensitivity to LA’s when performing an Ankle Block?

No effect, pregnant pts only have increased response to epidural anesthesia due to increased abdominal pressure

Need to use higher dose

Contraindicated for pregnant pts

Need to use lower dose

55. Which of the following nerves cannot be blocked by inserting a needle into the groove formed by the extensor hallicus longus tendon and extensor digitorum longus tendon?

Deep Peroneal nerve

Saphenous Nerve

Sural Nerve

Superficial peroneal Nerve

56. Lumbar plexus blocks are almost always done with the patient in the _______ position.

Sitting

Lateral

Prone

Supine

57. Innervation of the larynx is provided by which nerve?

Trigeminal

Glosspharyngeal

Spinal Accessory

Vagus

58. What gauge needle would be appropriate to use to do a femoral or sciatic nerve block?

24

22

27

25

59. Which of the following nerves produces dorsiflexion of the foot?

Tibial Nerve

Saphenous Nerve

Peroneal nerve

Radial nerve

60. What gauge needle would be appropriate to use for an ankle block?

22

27

25

20

61. Which of the following approaches to an axillary block carries the greatest risk of neurological damage?

Ultrasound guided approach

Use of insulated needle and nerve stimulator

Transarterial approach

Parasthesia Approach

62. Which nerve may be hardest to anesthetize when performing an interscalene block?

Radial

Ulnar

Axillary

Medial

63. A successful retrobulbar block will result in….

Loss of ocucephalic reflex

Loss of oculocardiac reflex

Patient sedation

All the above

64. Which of the following describes proper injection technique for a retrobulbar block?

65. Which of the following pts is able to receive a retrobulbar block?

Pt currently taking daily Coumadin

Pt with advanced CHF and CAD

Pt with severe myopia

Pt with open corneal abrasion

66. Accidental injection of a retrobulbar dose of LA into the ophthalmic artery will result in which of the following?

Pt c/o ringing in ears and metallic taste in mouth

Permanent pt blindness

Pt unconsciousness and seizures

Retrobulbar hemorrhage

67. Which of the following is not true regarding the Sciatic nerve?

Provides motor enervation to all muscles distal to knee

Supplies sensory fibers to posterior hip

Supplies all sensory enervation to lower extremity(below knee) and foot

Provides motor enervation to hamstring

68. Which of the following would not be a contraindication for a pt to receive an ankle block?

A diabetic pt with peripheral neuropathy

A pt with aortic stenosis

A sickle cell pt

An awake pediatric patient

69. Which landmark is used when performing an SLN block?

Styloid process posterior to angle of jaw

Greater cornu of Hyoid bone

Tonsillar pillar

Cricothyrohyoid membrane

70. What is the largest terminal branch of the brachial plexus?

Radial Nerve

Ulnar Nerve

Medial Nerve

Musculocutaneous nerve

71. What percentage of pts will experience long term nerve damage following peripheral blockade?

2%

0.0015%

0.4%

0.7-1%

72. Regional innervation for the eye, orbit and periorbital structures is supplied by the ______ nerve.

Trigeminal

Facial

Opthalmic

Oculomotor

73. What is the most common nerve injury following administration of a peripheral block?

Parasthesia

Neurapraxia

Axonotmesis

Neurotmesis

74. A block of the radial nerve at the level of the elbow would generally require what volume of anesthetic?

40 ml

10 ml

25 ml

2-5 ml

75. It appears you may have accidentally done an intraneural injection on a pt yesterday. You are now going up to the floor to assess the pt for the hallmark sign of neurological damage and expect to see…

Hematoma and edema at site

Pt writhing in pain talking about the worst pins and needles ever

Nothing, signs do not show up until 5-6 days later

Pt lying flat in bed, complaining of a severe headache

Regional Exam 3

1. Stimulation of the oculocardiac reflex will result in which of the following?

2.

What first name or nickname would you like us to use?

2. What monitoring is required when performing a Retrobulbar block on a pt?

3. Which of the following is the proper sequence, from proximal to distal, for the composition of the brachial plexus?

4. Idenity nerve #3 in the photo below.

5. In above picture, what is nerve #2?

6. What is the largest nerve in the body?

7. Which of the following nerves does not play a role in lower extremity nerve blockade?

8. The Sciatic Nerve divides to form which two nerves of lower leg? (more than one answer)

9. The brachial plexus is formed by the nerve roots of which vertebrae in the majority of people?

10. Where is the proper insertion point for a femoral block (after having identified other landmarks, of course)?

11. Blocking the lumbar plexus will block all sensory nerves of the leg and is sufficient for surgery.

12. When injecting local anesthetic for a femoral block you should stop and re-aspirate every…

13. How many nerves must be blocked for a properly performed ankle block?

14. Which of the following is not a landmark used when performing a Sciatic Block?

15. You are delivering regional anesthetic to a patient when they begin to complain of feeling light headed and ringing in their ears. What should you do?

16. A retrobulbar block typically involves use of what gauge of needle?

17. Stimulation of the radial nerve at level of elbow would result in which of the following?

18. Stimulation of the ulnar nerve would result in which of following actions?

19. Which nerve supplies sensation to the lateral aspect of the thigh down to the knee?

20. Which of the following is not a complication commonly associated with interscalane blocks?

21. You are the SRNA for Mr. Pret who is having a carpal tunnel release today. The beir block was done and surgeon was done within 5 minutes. Trying to be helpful, the tech deflates your cuff for you once the procedure is finished. You are now crapping your pants because what might happen?

22. COMIC RELIEF: Extreme sheep herding

23. Which of the following describes the anatomical landmarks used when doing an interscalene block?

24. Which of the following describes the landmarks used when performing an axillary block?

25. Which of the following nerves provides motor enervation to the quadriceps muscle and sensation to the anterior thigh?

26. Idenity nerve #5 in the photo below.

27. You are performing a femoral block and are giving a test dose of Lidocaine 2% with epi. What would you expect to be the first signs of accidental intravascular injection?

28. A patient experiencing numbness of posterior forearm, thumb, and first two digits would most have a block of which nerve?

29. Which of the following nerve blocks is most effective for treatment of pain from knee surgery?

30. What would be the appropriate choice of LA to use for a Bier Block?

31. Idenity nerve #1 in the photo below.

32. In above picture, what is nerve #3?

33. Which of the following is not one of anatomical landmarks required to perform a femoral block?

34. Which of the following complications would not be due to technique of the anesthesia provider?

35. Which of the following properly describes the musculocutaneous nerve?

36. Which of the following would confirm successful exsanguination of the arm following Eschmark wrap?

37. The sciatic nerve arises from which nerve roots?

38. In the cervical region nerve roots exit _____ the vertebrae for which they are named, but starting in the Thoracic region nerve roots exit _____ the vertebrae for which they are names.

39. In above picture, what is nerve #1?

40. When blocking the sciatic nerve at the popilteal fossa, where should you aim to inject the local anesthetic?

41. After a Bier Block has been successfully done, how long must you wait before deflating the tourniquet?

42. Which of the following is not one of the nerves blocked during an ankle block?

43. What is the most common complication associated with a retrobulbar block?

44. When performing an eschmark wrap for a bier block you would first inflate the ____ cuff of the tourniquet and then the ____ cuff.

45. What would you expect to hear your patient say if you accidentally give a direct intraneural injection of local anesthetic?

46. Idenity nerve #6 in the photo below.

47. The Ulnar nerve arises from the inferior roots of which vertebrae?

48. Which of the following provides sensory and motor enervation to the deltoid muscle?

49. Where would you perform a transtracheal block?

50. Stimulation of the tibial nerve will result in what action?

51. Which of the following technique would be inappropriate to use IV regional anesthesia?

52. Which nerve passes behind humerus and laterally at the epicondyle?

53. Which nerve can be located posterior to the medial epicondyle and the elbow?

54. How will pregnancy affect pt sensitivity to LA’s when performing an Ankle Block?

55. Which of the following nerves cannot be blocked by inserting a needle into the groove formed by the extensor hallicus longus tendon and extensor digitorum longus tendon?

56. Lumbar plexus blocks are almost always done with the patient in the _______ position.

57. Innervation of the larynx is provided by which nerve?

58. What gauge needle would be appropriate to use to do a femoral or sciatic nerve block?

59. Which of the following nerves produces dorsiflexion of the foot?

60. What gauge needle would be appropriate to use for an ankle block?

61. Which of the following approaches to an axillary block carries the greatest risk of neurological damage?

62. Which nerve may be hardest to anesthetize when performing an interscalene block?

63. A successful retrobulbar block will result in….

64. Which of the following describes proper injection technique for a retrobulbar block?

65. Which of the following pts is able to receive a retrobulbar block?

66. Accidental injection of a retrobulbar dose of LA into the ophthalmic artery will result in which of the following?

67. Which of the following is not true regarding the Sciatic nerve?

68. Which of the following would not be a contraindication for a pt to receive an ankle block?

69. Which landmark is used when performing an SLN block?

70. What is the largest terminal branch of the brachial plexus?

71. What percentage of pts will experience long term nerve damage following peripheral blockade?

72. Regional innervation for the eye, orbit and periorbital structures is supplied by the ______ nerve.

73. What is the most common nerve injury following administration of a peripheral block?

74. A block of the radial nerve at the level of the elbow would generally require what volume of anesthetic?

75. It appears you may have accidentally done an intraneural injection on a pt yesterday. You are now going up to the floor to assess the pt for the hallmark sign of neurological damage and expect to see…

5.

In above picture, what is nerve #2?

32.

In above picture, what is nerve #3?

38. In the cervical region nerve roots exit _ the vertebrae for which they are named, but starting in the Thoracic region nerve roots exit _ the vertebrae for which they are names.

39.

In above picture, what is nerve #1?

44. When performing an eschmark wrap for a bier block you would first inflate the cuff of the tourniquet and then the cuff.