Interactive Nerve Anatomy Guide
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A review to material for test 3 on peripheral nerve blocks.
- 1.The brachial plexus is formed by the nerve roots of which vertebrae in the majority of people?
- A.
C5-C8
- B.
C2-T2
- C.
T1-T2
- D.
C1-C4
- 2.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.
- A.
Below, above
- B.
Above, below
- C.
Beside, above
- D.
Below, Beside
- 3.Which of the following is the proper sequence, from proximal to distal, for the composition of the brachial plexus?
- A.
Trunks, Cords, Roots, Divisions, Branches
- B.
Cords, Roots, Branches, Trunks, Divisions
- C.
Roots, Trunks, Divisions, Cords, Branches
- D.
Branches, Divisions, Trunks, Roots, Cords
- 4.Which nerve passes behind humerus and laterally at the epicondyle?
- A.
Median Nerve
- B.
Ulnar Nerve
- C.
Scalene Nerve
- D.
Radial Nerve
- 5.Stimulation of the radial nerve at level of elbow would result in which of the following?
- A.
Extension of wrist and fingers
- B.
Pronation of forearm and flexion of wrist
- C.
Flexion of pinky finger and ulnar wrist deviation
- D.
Contraction of deltoid muscle
- 6.A patient experiencing numbness of posterior forearm, thumb, and first two digits would most have a block of which nerve?
- A.
Ulnar
- B.
Radial
- C.
Medial
- D.
Obturator
- 7.Stimulation of the median nerve would result in which of following actions?
- A.
Extension of wrist and fingers
- B.
Flexion of pinky finger and ulnar wrist deviation
- C.
Pronation of forearm and flexion of wrist
- D.
Contraction of deltoid muscle
- 8.The Ulnar nerve arises from the inferior roots of which vertebrae?
- A.
C5-C6
- B.
C6-C8
- C.
C2-C4
- D.
C8-T1
- 9.
![In above picture, what is nerve #2? - ProProfs]( "In above picture, what is nerve #2?")
In above picture, what is nerve #2?- A.
Ulnar
- B.
Median
- C.
Radial
- D.
None of Above
- 10.
![In above picture, what is nerve #1? - ProProfs]( "In above picture, what is nerve #1?")
In above picture, what is nerve #1?- A.
Ulnar
- B.
Median
- C.
Radial
- D.
None of Above
- 11.
![In above picture, what is nerve #3? - ProProfs]( "In above picture, what is nerve #3?")
In above picture, what is nerve #3?- A.
Ulnar
- B.
Median
- C.
Radial
- D.
None of Above
- 12.Which nerve can be located posterior to the medial epicondyle at the elbow?
- A.
Median
- B.
Scalene
- C.
Radial
- D.
Ulnar
- 13.Stimulation of the ulnar nerve would result in which of following actions?
- A.
Flexion of pinky finger and ulnar wrist deviation
- B.
Extension of wrist and fingers
- C.
Pronation of forearm and flexion of wrist
- D.
Contraction of deltoid muscle
- 14.Which of the following provides sensory and motor enervation to the deltoid muscle?
- A.
Scalene nerve
- B.
Axillary nerve
- C.
Median nerve
- D.
Musculocutaneous nerve
- 15.A patient with a MCN block would not be able to perform which of the following actions?
- A.
Closing their hand
- B.
Leg Lunges
- C.
Bicep Curl
- D.
Wrist dorsiflexion
- 16.Which of the following properly describes the musculocutaneous nerve?
- A.
It supplies motor enervation to the deltoid muscle it also supplies sensory enervation to the same area both anteriorly and posteriorly
- B.
Sensory it supplies the thumb, index, middle and half of the ring finger on the palmar(bolar) side on the dorsum of the hand it supplies the distal 3rd of the thumb and index fingers.
- C.
Stimulation of the nerve causes extension of the wrist.
- D.
Provides motor enervation to biceps and coracobrachialis, sensory to lateral aspect of forearm.
- 17.An interscalene block will generally require what volume of anesthetic?
- A.
40 ml
- B.
10 ml
- C.
25 ml
- D.
5 ml
- 18.A block of the radial nerve at the level of the elbow would generally require what volume of anesthetic?
- A.
40 ml
- B.
10 ml
- C.
25 ml
- D.
2-5 ml
- 19.The lumbar plexus is derived from the ventral rami of…
- A.
L5-S3
- B.
T10-T12
- C.
L1-L4
- D.
C7-T3
- 20.The lumbar plexus forms all of the following except what?
- A.
Lateral femoral cutaneous nerve
- B.
Femoral nerve
- C.
Obturator nerve
- D.
Sciatic Nerve
- 21.What is the largest nerve in the body?
- A.
Sciatic nerve
- B.
Brachial Plexus nerve
- C.
Femoral nerve
- D.
Spinal cord
- 22.Which of the following nerves does not play a role in lower extremity nerve blockade?
- A.
Lateral femoral cutaneous
- B.
Ilioinguinal
- C.
Obturator
- D.
Femoral
- 23.Which nerve supplies sensation to the lateral aspect of the thigh down to the knee?
- A.
Femoral
- B.
Sciatic
- C.
Lateral Femoral Cutaneous
- D.
Ilioinguinal
- 24.Which of the following nerves provides motor enervation to the quadriceps muscle and sensation to the anterior thigh?
- A.
Ilioinguinal
- B.
Obturator
- C.
Lateral Femoral Cutaneous
- D.
Femoral
- 25.Which of the following supplies motor and sensory to the inner aspect of the thigh?
- A.
Obturator
- B.
Femoral
- C.
Lateral Femoral Cutaneous
- D.
Ilioinguinal
- 26.Blocking the lumbar plexus will block all sensory nerves of the leg and is sufficient for surgery.
- A.
True
- B.
False
- 27.Lumbar plexus blocks are almost always done with the patient in the _______ position.
- A.
Sitting
- B.
Lateral
- C.
Prone
- D.
Supine
- 28.Which of the following nerve blocks is most effective for treatment of pain from knee surgery?
- A.
Sciatic
- B.
Lateral Femoral Cutaneous
- C.
Femoral
- D.
Obturator
- 29.Where is the proper insertion point for a femoral block (after having identified other landmarks, of course)?
- A.
2 cm medial from femoral pulse
- B.
2 cm caudad from femoral pulse
- C.
2 cm distal from femoral pulse
- D.
2 cm lateral from femoral pulse
- 30.When injecting local anesthetic for a femoral block you should stop and re-aspirate every…
- A.
5 ml’s
- B.
2-3 ml’s
- C.
10 ml’s
- D.
You don’t have to after the initial aspiration.
- 31.Which of the following is not one of anatomical landmarks required to perform a femoral block?
- A.
Anterior Superior Iliac spine
- B.
Sacral Hiatus
- C.
The femoral artery
- D.
Superior lateral corner of pubic tubercle
- 32.Which of the following is not true regarding the Sciatic nerve?
- A.
Provides motor enervation to all muscles distal to knee
- B.
Supplies sensory fibers to posterior hip
- C.
Supplies all sensory enervation to lower extremity(below knee) and foot
- D.
Provides motor enervation to hamstring
- 33.What is the advantage of doing a lower extremity block as opposed to a spinal block?
- A.
Fewer needle sticks for pt
- B.
Decreased risk of infection
- C.
Easier to perform for anesthesia provider
- D.
Fewer hemodynamic effects
- 34.Which of the following is not a landmark used when performing a Sciatic Block?
- A.
Superior Lateral corner of Pubic Tubercle
- B.
Posterior superior iliac spine
- C.
Greater Trochanter of hip
- D.
Sacral Hiatus
- 35.When blocking the sciatic nerve at the popilteal fossa, where should you aim to inject the local anesthetic?
- A.
2-5 cm above the posterior crease of knee
- B.
7-10 cm above the posterior crease of knee
- C.
10-12 cm above the patella on anterior portion of thigh
- D.
2-3 cm below the posterior crease of knee
- 36.Which of the following nerves produces dorsiflexion of the foot?
- A.
Tibial Nerve
- B.
Saphenous Nerve
- C.
Peroneal nerve
- D.
Radial nerve
- 37.Stimulation of the tibial nerve will result in what action?
- A.
Wrist and thumb flexion
- B.
Foot dorsiflexion
- C.
Twitching of lateral thigh
- D.
Plantar flexion
- 38.What is the most frequently used lower extremity block?
- A.
Ankle Block
- B.
Sciatic Block
- C.
Lumbar Plexus Block
- D.
Femoral Block
- 39.Which of the following is not one of the nerves blocked during an ankle block?
- A.
Deep Peroneal nerve
- B.
Dorsal Digital nerve
- C.
Sural Nerve
- D.
Saphenous Nerve
- 40.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?
- A.
Deep Peroneal nerve
- B.
Saphenous Nerve
- C.
Sural Nerve
- D.
Superficial peroneal Nerve
- 41.For each of the nerves to be blocked in an ankle block, you should inject approximately what volume of local anesthetic?
- A.
12-15 ml
- B.
1-3 ml
- C.
20-25 ml
- D.
5-8 ml
- 42.Regional innervation for the eye, orbit and periorbital structures is supplied by the ______ nerve.
- A.
Trigeminal
- B.
Facial
- C.
Opthalmic
- D.
Oculomotor
- 43.Which of the following describes proper injection technique for a retrobulbar block?
- A.
Site of injection is just below the superior orbital rim, where an angled needle is passed into the intraconal region with the patient gazing supranasally.
- B.
Site of injection is just above the inferior orbital rim, where an angled needle is passed into the intraconal region with the patient gazing supranasally.
- C.
Site of injection is just below the superior orbital rim, where an angled needle is passed into the intraconal region with the patient gazing infranasally.
- D.
Site of injection is just above the inferior orbital rim, where an angled needle is passed into the intraconal region with the patient gazing to the left.
- 44.Which of the following would be a proper dose of LA for a retrobulbar block?
- A.
1 ml of 2% lidocaine with epi
- B.
15 ml of 0.75% bupivacaine plain
- C.
5 ml of 0.75 % bupivacaine with epi
- D.
6 ml of Tetracaine 0.5% plain
- 45.What is the most common complication associated with a retrobulbar block?
- A.
Globe Perforation
- B.
Neurogenic Apnea
- C.
Optic Nerve Atrophy
- D.
Retrobulbar Hemorrhage
- 46.Stimulation of the oculocardiac reflex will result in which of the following?
- A.
Bradycardia
- B.
Hypertension
- C.
PVC’s
- D.
Tachycardia
- 47.Which of the following pts is able to receive a retrobulbar block?
- A.
Pt currently taking daily Coumadin
- B.
Pt with advanced CHF and CAD
- C.
Pt with severe myopia
- D.
Pt with open corneal abrasion
- 48.A successful retrobulbar block will result in….
- A.
Loss of ocucephalic reflex
- B.
Loss of oculocardiac reflex
- C.
Patient sedation
- D.
All the above
- 49.Accidental injection of a retrobulbar dose of LA into the ophthalmic artery will result in which of the following?
- A.
Pt c/o ringing in ears and metallic taste in mouth
- B.
Permanent pt blindness
- C.
Pt unconsciousness and seizures
- D.
Retrobulbar hemorrhage
- 50.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?
- A.
Slow down your rate of injection, and then administer rest of anesthetic.
- B.
Immediately notify MD and prepare pt for cardiac bypass, your plasma concentration is most likely too high now.
- C.
Immediately stop injection, start lipid infusion, monitor patient, your plasma concentration should still be low enough to reverse this.
- D.
Comfort the patient that this is normal to experience and deliver rest of anesthetic quickly.
- 51.Innervation of the larynx is provided by which nerve?
- A.
Trigeminal
- B.
Glosspharyngeal
- C.
Spinal Accessory
- D.
Vagus
- 52.A retrobulbar block typically involves use of what gauge of needle?
- A.
25
- B.
22
- C.
20
- D.
18
- 53.Which landmark is used when performing an SLN block?
- A.
Styloid process posterior to angle of jaw
- B.
Greater cornu of Hyoid bone
- C.
Tonsillar pillar
- D.
Cricothyroid membrane
- 54.Where would you perform a transtracheal block?
- A.
2 cm caudad to Styloid process posterior to angle of jaw
- B.
Directly above greater cornu of Hyoid bone
- C.
Posterior to Tonsillar pillars
- D.
Through the Cricothyroid membrane
- 55.What is the largest terminal branch of the brachial plexus?
- A.
Radial Nerve
- B.
Ulnar Nerve
- C.
Medial Nerve
- D.
Musculocutaneous nerve
- 56.Which nerve may be hardest to anesthetize when performing an interscalene block?
- A.
Radial
- B.
Ulnar
- C.
Axillary
- D.
Medial
- 57.What would be the appropriate choice of LA to use for a Bier Block?
- A.
Lidocaine 0.5% with epi
- B.
Bupivacaine 0.75% plain
- C.
Lidocaine 0.5% plain
- D.
Bupivacaine 0.75% with epi
- 58.Which of the following describes the anatomical landmarks used when doing an interscalene block?
- A.
Axillary artery below the pectoralis major muscle at the insertion of the bicep muscle.
- B.
The brachial pulse and medial epicondyle
- C.
The coracoid process, distal portion of the clavicle
- D.
The interscalene groove, located posterior to the clavicular insertion of the SCM.
- 59.Which of the following describes the landmarks used when performing an axillary block?
- A.
Axillary artery below the pectoralis major muscle at the insertion of the bicep muscle.
- B.
The brachial pulse and medial epicondyle
- C.
The coracoid process, distal portion of the clavicle
- D.
The interscalene groove, located posterior to the clavicular insertion of the SCM.
- 60.Which of the following would not be a contraindication for a pt to receive an ankle block?
- A.
A diabetic pt with peripheral neuropathy
- B.
A pt with aortic stenosis
- C.
A sickle cell pt
- D.
An awake pediatric patient
- 61.After a Bier Block has been successfully done, how long must you wait before deflating the tourniquet?
- A.
10 minutes
- B.
45 minutes
- C.
20 minutes
- D.
30 minutes
- 62.Which of the following is not a complication commonly associated with interscalane blocks?
- A.
Phrenic Nerve blockade
- B.
Accidental vertebral artery injection
- C.
Horners Syndrome
- D.
All are associated with interscalane blocks
- 63.What monitoring is required when performing a Retrobulbar block on a pt?
- A.
ECG, O2 sat, and BP cuff
- B.
A-line, CVP, pulse ox, ECG
- C.
ECG and O2 sat only
- D.
BP cuff only
- 64.Which of the following would confirm successful exsanguination of the arm following Eschmark wrap?
- A.
Pale blotchy extremity, cool to touch
- B.
Loss of radial pulse and capillary refill
- C.
Pt stating arm is numb
- D.
Loss of motor control of wrist
- 65.What percentage of pts will experience long term nerve damage following peripheral blockade?
- A.
2%
- B.
0.0015%
- C.
0.4%
- D.
0.7-1%
- 66.How will pregnancy affect pt sensitivity to LA’s when performing an Ankle Block?
- A.
No effect, pregnant pts only have increased response to epidural anesthesia due to increased abdominal pressure
- B.
Need to use higher dose
- C.
Contraindicated for pregnant pts
- D.
Need to use lower dose
- 67.When performing an eschmark wrap for a bier block you would first inflate the ____ cuff of the tourniquet and then the ____ cuff.
- A.
Distal, Proximal
- B.
Inflate both at the same time
- C.
Proximal, Distal
- 68.What is the most common nerve injury following administration of a peripheral block?
- A.
Parasthesia
- B.
Neurapraxia
- C.
Axonotmesis
- D.
Neurotmesis
- 69.Which of the following complications would not be due to technique of the anesthesia provider?
- A.
Neurapraxia
- B.
Pneumothorax
- C.
Vasovagal response
- D.
Compartment syndrome
- 70.Which of the following approaches to an axillary block carries the greatest risk of neurological damage?
- A.
Ultrasound guided approach
- B.
Use of insulated needle and nerve stimulator
- C.
Transarterial approach
- D.
Parasthesia Approach
- 71.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?
- A.
Increase in pt HR
- B.
Pt c/o ringing in ears
- C.
Seizures
- D.
Pt C/o numbness in extremity
- 72.Which of the following technique would be inappropriate to use IV regional anesthesia?
- A.
Carpal Tunnel release
- B.
Removal of hardware from elbow and humerus
- C.
Trigger Finger Release
- D.
Repair of Flexor tendon in forearm
- 73.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?
- A.
Increased risk for Malignant hyperthermia
- B.
Increases risk of permament nerve damage to arm
- C.
Increases risk of local anesthetic toxicity
- D.
All the above
- 74.What would you expect to hear your patient say if you accidentally give a direct intraneural injection of local anesthetic?
- A.
“You said for me to tell if my ears started ringing ,well….. they just started ringing really bad”
- B.
“Wow, My whole arm feels totally numb now”
- C.
Nothing, it’s hard to talk when you’re having a seizure
- D.
“OW! OW! OWWWW!!!! That REALLY Hurts!!!!!!”
- 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…
- A.
Hematoma and edema at site
- B.
Pt writhing in pain talking about the worst pins and needles ever
- C.
Nothing, signs do not show up until 5-6 days later
- D.
Pt lying flat in bed, complaining of a severe headache
- 76.The sciatic nerve arises from which nerve roots?
- A.
L1-L3
- B.
L4-S3
- C.
S3-S5
- D.
T12-L2
- 77.The Sciatic Nerve divides to form which two nerves of lower leg? (more than one answer)
- A.
Medial Fibial Nerve
- B.
Dorsal Digital Nerve
- C.
Tibial Nerve
- D.
Common Peroneal Nerve
- 78.How many nerves must be blocked for a properly performed ankle block?
- A.
5
- B.
4
- C.
1
- D.
3
- 79.What gauge needle would be appropriate to use to do a femoral or sciatic nerve block?
- A.
24
- B.
22
- C.
27
- D.
25
- 80.What gauge needle would be appropriate to use for an ankle block?
- A.
22
- B.
27
- C.
25
- D.
20
- 81.
![Idenity nerve #1 in the photo below.
- ProProfs]( "Idenity nerve #1 in the photo below.")
Idenity nerve #1 in the photo below.- A.
Saphenous
- B.
Laterial Femoral Cutaneous
- C.
Sciatic
- D.
Femoral
- 82.
![Idenity nerve #2 in the photo below.
- ProProfs]( "Idenity nerve #2 in the photo below.")
Idenity nerve #2 in the photo below.- A.
Saphenous
- B.
Sciatic
- C.
Femoral
- D.
Common Peroneal
- 83.
![Idenity nerve #3 in the photo below.
- ProProfs]( "Idenity nerve #3 in the photo below.")
Idenity nerve #3 in the photo below.- A.
Femoral
- B.
Saphenous
- C.
Sciatic
- D.
Lateral Femoral Cutaneous
- 84.
![Idenity nerve #5 in the photo below.
- ProProfs]( "Idenity nerve #5 in the photo below.")
Idenity nerve #5 in the photo below.- A.
Tibial
- B.
Sural
- C.
Saphenous
- D.
Common Peroneal
- 85.
![Idenity nerve #6 in the photo below.
- ProProfs]( "Idenity nerve #6 in the photo below.")
Idenity nerve #6 in the photo below.- A.
Tibial
- B.
Common Peroneal
- C.
Sciatic
- D.
Femoral
- 86.COMIC RELIEF: Extreme sheep herding
- A.
Well, at least the bored shephards aren't doing *other* terrible things to the sheep...
- B.
PONG!!
- C.
He he he! Cute!
- D.
All the Above
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