Interactive Nerve Anatomy Guide

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Interactive Nerve Anatomy Guide - Quiz

A review to material for test 3 on peripheral nerve blocks.


Questions and Answers
  • 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

    Correct Answer
    A. C5-C8
    Explanation
    The brachial plexus is a network of nerves that originates from the nerve roots of C5, C6, C7, and C8 in the majority of people. These nerve roots exit the spinal cord in the neck region and form a complex network that supplies motor and sensory innervation to the upper limb. The answer C5-C8 correctly identifies the nerve roots involved in the formation of the brachial plexus.

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  • 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

    Correct Answer
    B. Above, below
    Explanation
    In the cervical region, nerve roots exit above the vertebrae for which they are named. However, in the thoracic region, nerve roots exit below the vertebrae for which they are named.

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  • 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

    Correct Answer
    C. Roots, Trunks, Divisions, Cords, Branches
    Explanation
    The brachial plexus is composed of five components: roots, trunks, divisions, cords, and branches. The proper sequence, from proximal to distal, for the composition of the brachial plexus is roots, trunks, divisions, cords, branches. This means that the nerve fibers first emerge from the spinal cord as roots, then merge to form trunks, which further divide into divisions, and then combine to form cords. Finally, the cords give rise to various branches that innervate different muscles and areas of the upper limb.

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  • 4. 

    Which nerve passes behind humerus and laterally at the epicondyle?

    • A.

      Median Nerve

    • B.

      Ulnar Nerve

    • C.

      Scalene Nerve

    • D.

      Radial Nerve

    Correct Answer
    D. Radial Nerve
    Explanation
    The radial nerve passes behind the humerus and laterally at the epicondyle. It is responsible for providing motor innervation to the muscles of the posterior compartment of the arm and forearm, as well as sensory innervation to the skin on the posterior aspect of the arm, forearm, and hand.

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  • 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

    Correct Answer
    A. Extension of wrist and fingers
    Explanation
    Stimulation of the radial nerve at the level of the elbow would result in the extension of the wrist and fingers. The radial nerve is responsible for innervating the extensor muscles of the forearm, which are responsible for extending the wrist and fingers. Therefore, when the radial nerve is stimulated at the level of the elbow, it would cause the extension of the wrist and fingers.

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  • 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

    Correct Answer
    B. Radial
    Explanation
    A patient experiencing numbness of the posterior forearm, thumb, and first two digits would most likely have a block of the radial nerve. The radial nerve supplies sensation to these areas, and a blockage of this nerve can result in numbness or loss of sensation in these specific regions.

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  • 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

    Correct Answer
    C. Pronation of forearm and flexion of wrist
    Explanation
    Stimulation of the median nerve would result in pronation of the forearm and flexion of the wrist. The median nerve innervates the muscles that are responsible for these actions. Pronation of the forearm refers to the rotation of the forearm so that the palm faces downwards, while flexion of the wrist refers to bending the wrist towards the palm.

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  • 8. 

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

    • A.

      C5-C6

    • B.

      C6-C8

    • C.

      C2-C4

    • D.

      C8-T1

    Correct Answer
    D. C8-T1
    Explanation
    The ulnar nerve arises from the inferior roots of the C8 and T1 vertebrae.

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  • 9. 

    In above picture, what is nerve #2?

    • A.

      Ulnar

    • B.

      Median

    • C.

      Radial

    • D.

      None of Above

    Correct Answer
    A. Ulnar
    Explanation
    In the given picture, nerve #2 is identified as the ulnar nerve. This can be determined by comparing the image with anatomical diagrams and recognizing the specific characteristics and location of the ulnar nerve.

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  • 10. 

    In above picture, what is nerve #1?

    • A.

      Ulnar

    • B.

      Median

    • C.

      Radial

    • D.

      None of Above

    Correct Answer
    B. Median
    Explanation
    In the given picture, nerve #1 is identified as the median nerve.

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  • 11. 

    In above picture, what is nerve #3?

    • A.

      Ulnar

    • B.

      Median

    • C.

      Radial

    • D.

      None of Above

    Correct Answer
    C. Radial
    Explanation
    In the given picture, nerve #3 is identified as the radial nerve. This can be determined by comparing the image with anatomical references and identifying the nerve that corresponds to the radial nerve. The other options, ulnar and median nerves, are not depicted in the picture. Therefore, the correct answer is radial.

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  • 12. 

    Which nerve can be located posterior to the medial epicondyle at the elbow?

    • A.

      Median

    • B.

      Scalene

    • C.

      Radial

    • D.

      Ulnar

    Correct Answer
    D. Ulnar
    Explanation
    The ulnar nerve can be located posterior to the medial epicondyle at the elbow. This nerve travels along the inner side of the forearm and can be easily palpated behind the elbow joint. It is responsible for providing sensation to the little finger and part of the ring finger, as well as controlling certain muscles in the hand.

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  • 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

    Correct Answer
    A. Flexion of pinky finger and ulnar wrist deviation
    Explanation
    Stimulation of the ulnar nerve would result in flexion of the pinky finger and ulnar wrist deviation. The ulnar nerve is responsible for innervating the muscles that control these movements. Flexion of the pinky finger refers to bending the finger towards the palm, while ulnar wrist deviation refers to moving the wrist towards the ulnar side of the forearm. This action is controlled by the ulnar nerve, which runs along the ulnar side of the forearm and hand.

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  • 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

    Correct Answer
    B. Axillary nerve
    Explanation
    The axillary nerve provides sensory and motor enervation to the deltoid muscle. It is a branch of the brachial plexus and innervates the shoulder joint and deltoid muscle, allowing for movement and sensation in the shoulder. The other options listed, such as the scalene nerve, median nerve, and musculocutaneous nerve, do not specifically provide enervation to the deltoid muscle.

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  • 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

    Correct Answer
    C. Bicep Curl
    Explanation
    A patient with a MCN block would not be able to perform a Bicep Curl because the Musculocutaneous nerve (MCN) innervates the muscles responsible for flexing the elbow, including the biceps brachii. If the MCN is blocked or damaged, the patient would experience weakness or paralysis in the biceps, making it difficult or impossible to perform a Bicep Curl.

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  • 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.

    Correct Answer
    D. Provides motor enervation to biceps and coracobrachialis, sensory to lateral aspect of forearm.
    Explanation
    The musculocutaneous nerve provides motor innervation to the biceps and coracobrachialis muscles, as well as sensory innervation to the lateral aspect of the forearm. It does not supply motor innervation to the deltoid muscle or cause extension of the wrist. It also does not supply sensory innervation to the thumb, index, middle, and half of the ring finger on the palmar side or the dorsum of the hand.

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  • 17. 

    An interscalene block will generally require what volume of anesthetic?

    • A.

      40 ml

    • B.

      10 ml

    • C.

      25 ml

    • D.

      5 ml

    Correct Answer
    A. 40 ml
    Explanation
    An interscalene block is a regional anesthesia technique used for surgeries involving the shoulder and upper arm. It involves injecting an anesthetic agent near the brachial plexus, which provides anesthesia to the shoulder and upper arm. The volume of anesthetic required for an interscalene block is typically around 40 ml. This amount is necessary to ensure adequate coverage of the brachial plexus and to provide effective anesthesia for the procedure.

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  • 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

    Correct Answer
    D. 2-5 ml
    Explanation
    A block of the radial nerve at the level of the elbow would generally require a small volume of anesthetic, typically between 2-5 ml. This is because the radial nerve is a relatively small nerve that innervates the forearm and hand, and a smaller volume of anesthetic is sufficient to block its function at the elbow level. Using a larger volume of anesthetic may increase the risk of complications or spread of the anesthetic to unintended areas.

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  • 19. 

    The lumbar plexus is derived from the ventral rami of…

    • A.

      L5-S3

    • B.

      T10-T12

    • C.

      L1-L4

    • D.

      C7-T3

    Correct Answer
    C. L1-L4
    Explanation
    The lumbar plexus is derived from the ventral rami of spinal nerves L1-L4. This means that the nerves originating from these levels of the spinal cord come together to form the lumbar plexus. The lumbar plexus is responsible for innervating various muscles and structures in the lower abdomen, pelvis, and lower limbs.

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  • 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

    Correct Answer
    D. Sciatic Nerve
    Explanation
    The lumbar plexus is a network of nerves that originates from the lower back and supplies the lower abdomen, pelvis, and legs. It is responsible for innervating various muscles and providing sensory information from these areas. The lateral femoral cutaneous nerve, femoral nerve, and obturator nerve are all branches of the lumbar plexus. However, the sciatic nerve is not a part of the lumbar plexus. It is formed by the fusion of nerve roots from the lumbar and sacral plexuses and primarily innervates the muscles of the posterior thigh and leg.

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  • 21. 

    What is the largest nerve in the body?

    • A.

      Sciatic nerve

    • B.

      Brachial Plexus nerve

    • C.

      Femoral nerve

    • D.

      Spinal cord

    Correct Answer
    A. Sciatic nerve
    Explanation
    The sciatic nerve is the largest nerve in the body. It is a major nerve that originates from the lower back and extends down the back of each leg. It is responsible for providing motor and sensory functions to the lower limbs. Due to its size and importance, any damage or compression of the sciatic nerve can cause severe pain and affect mobility.

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  • 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

    Correct Answer
    B. Ilioinguinal
    Explanation
    The ilioinguinal nerve does not play a role in lower extremity nerve blockade. This nerve primarily provides sensory innervation to the upper medial thigh and the genital region. In contrast, the other three nerves listed (lateral femoral cutaneous, obturator, and femoral) all contribute to innervation of the lower extremity and can be targeted for nerve blockade to provide pain relief or anesthesia in this region.

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  • 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

    Correct Answer
    C. Lateral Femoral Cutaneous
    Explanation
    The nerve that supplies sensation to the lateral aspect of the thigh down to the knee is the Lateral Femoral Cutaneous nerve. This nerve is responsible for transmitting sensory information from the outer side of the thigh to the brain. It does not supply sensation to the knee joint itself, but rather to the skin and underlying tissues of the lateral thigh.

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  • 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

    Correct Answer
    D. Femoral
    Explanation
    The femoral nerve provides motor innervation to the quadriceps muscle and sensation to the anterior thigh.

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  • 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

    Correct Answer
    A. Obturator
    Explanation
    The obturator nerve supplies motor and sensory innervation to the inner aspect of the thigh.

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  • 26. 

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

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Blocking the lumbar plexus will not block all sensory nerves of the leg. While it will provide some sensory blockage, there are other nerves, such as the sciatic nerve, that innervate the leg and are not affected by blocking the lumbar plexus. Therefore, blocking the lumbar plexus alone is not sufficient for surgery involving the leg.

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  • 27. 

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

    • A.

      Sitting

    • B.

      Lateral

    • C.

      Prone

    • D.

      Supine

    Correct Answer
    B. Lateral
    Explanation
    Lumbar plexus blocks are almost always done with the patient in the lateral position. This position allows for better access to the lumbar plexus and improves the accuracy of the block. It also provides a comfortable and stable position for the patient during the procedure.

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  • 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

    Correct Answer
    C. Femoral
    Explanation
    The femoral nerve block is the most effective for treating pain from knee surgery. The femoral nerve supplies sensation to the front of the thigh and knee, and blocking this nerve can provide significant pain relief. This block is commonly used for postoperative pain management after knee surgery, as it can provide analgesia to the surgical site and allow for early mobilization and rehabilitation. By targeting the femoral nerve, patients can experience decreased pain and improved overall recovery following knee surgery.

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  • 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

    Correct Answer
    D. 2 cm lateral from femoral pulse
    Explanation
    The proper insertion point for a femoral block is 2 cm lateral from the femoral pulse. This means that the needle should be inserted 2 cm to the side of the femoral pulse, away from the midline of the body. This is the correct location to ensure that the block is administered in the correct area and will effectively numb the necessary nerves.

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  • 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.

    Correct Answer
    A. 5 ml’s
    Explanation
    When injecting local anesthetic for a femoral block, it is recommended to stop and re-aspirate every 5 ml's. This is done to ensure that the needle is not in a blood vessel, as injecting the anesthetic into a blood vessel can lead to complications. By stopping and re-aspirating, the healthcare provider can confirm that the needle is in the correct position before continuing with the injection.

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  • 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

    Correct Answer
    B. Sacral Hiatus
    Explanation
    The Sacral Hiatus is not one of the anatomical landmarks required to perform a femoral block. The femoral block is a regional anesthesia technique used to provide pain relief in the lower limb. The anatomical landmarks required for this procedure include the Anterior Superior Iliac spine, the femoral artery, and the superior lateral corner of the pubic tubercle. The Sacral Hiatus is not relevant to this procedure as it is a landmark used for other purposes, such as performing a caudal epidural block.

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  • 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

    Correct Answer
    C. Supplies all sensory enervation to lower extremity(below knee) and foot
    Explanation
    The given answer is not true because the sciatic nerve does not supply all sensory enervation to the lower extremity below the knee and foot. It actually supplies sensory fibers to the posterior hip, as mentioned in one of the other options. The sciatic nerve provides motor enervation to the hamstring and motor enervation to all muscles distal to the knee, but it does not supply all sensory enervation to the lower extremity and foot.

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  • 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

    Correct Answer
    D. Fewer hemodynamic effects
    Explanation
    A lower extremity block has the advantage of causing fewer hemodynamic effects compared to a spinal block. This means that the block has less impact on the patient's blood pressure, heart rate, and overall cardiovascular system. This can be beneficial for patients who may be more sensitive to changes in their hemodynamic status, such as those with cardiovascular disease or other medical conditions. By choosing a lower extremity block instead of a spinal block, the anesthesia provider can minimize the potential hemodynamic complications and ensure a safer and more stable anesthesia experience for the patient.

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  • 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

    Correct Answer
    A. Superior Lateral corner of Pubic Tubercle
    Explanation
    The superior lateral corner of the pubic tubercle is not a landmark used when performing a Sciatic Block. The landmarks typically used for this procedure include the posterior superior iliac spine, the greater trochanter of the hip, and the sacral hiatus. The superior lateral corner of the pubic tubercle is not relevant to the placement of a sciatic block.

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  • 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

    Correct Answer
    B. 7-10 cm above the posterior crease of knee
    Explanation
    To block the sciatic nerve at the popliteal fossa, the aim should be to inject the local anesthetic 7-10 cm above the posterior crease of the knee. This location is chosen because it is close to the site where the sciatic nerve branches into its tibial and common peroneal components. By injecting the local anesthetic at this specific location, the nerve can be effectively blocked, providing anesthesia to the lower leg and foot.

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  • 36. 

    Which of the following nerves produces dorsiflexion of the foot?

    • A.

      Tibial Nerve

    • B.

      Saphenous Nerve

    • C.

      Peroneal nerve

    • D.

      Radial nerve

    Correct Answer
    C. Peroneal nerve
    Explanation
    The peroneal nerve produces dorsiflexion of the foot. Dorsiflexion is the movement that brings the top of the foot towards the shin. The peroneal nerve innervates the muscles responsible for dorsiflexion, such as the tibialis anterior muscle. This nerve also controls other movements, such as eversion of the foot and extension of the toes.

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  • 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

    Correct Answer
    D. Plantar flexion
    Explanation
    Stimulation of the tibial nerve will result in plantar flexion. The tibial nerve is a branch of the sciatic nerve and innervates the muscles in the posterior compartment of the leg, including the gastrocnemius and soleus muscles. When the tibial nerve is stimulated, it causes these muscles to contract, leading to plantar flexion of the foot. Plantar flexion is the movement of pointing the foot downward, as in standing on tiptoes.

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  • 38. 

    What is the most frequently used lower extremity block?

    • A.

      Ankle Block

    • B.

      Sciatic Block

    • C.

      Lumbar Plexus Block

    • D.

      Femoral Block

    Correct Answer
    A. Ankle Block
    Explanation
    The most frequently used lower extremity block is the Ankle Block. This block is commonly used for surgical procedures involving the foot and ankle, as it provides effective anesthesia to this area. It involves injecting local anesthetic around the ankle joint, targeting the nerves that supply sensation to the foot and ankle. The Ankle Block is preferred due to its simplicity, safety, and effectiveness in providing pain relief during foot and ankle surgeries.

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  • 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

    Correct Answer
    B. Dorsal Digital nerve
    Explanation
    The dorsal digital nerve is not one of the nerves blocked during an ankle block. An ankle block is a regional anesthesia technique used to numb the foot and ankle for surgical procedures or pain management. The nerves typically blocked during an ankle block include the deep peroneal nerve, sural nerve, and saphenous nerve. The dorsal digital nerve, on the other hand, is a branch of the dorsal cutaneous nerve and is not specifically targeted during an ankle block.

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  • 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

    Correct Answer
    C. Sural Nerve
    Explanation
    The sural nerve cannot be blocked by inserting a needle into the groove formed by the extensor hallicus longus tendon and extensor digitorum longus tendon. This is because the sural nerve is located more posteriorly and is not accessible through this particular approach.

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  • 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

    Correct Answer
    D. 5-8 ml
    Explanation
    To perform an ankle block, it is recommended to inject approximately 5-8 ml of local anesthetic for each of the nerves to be blocked. This volume is sufficient to provide effective anesthesia for the ankle region.

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  • 42. 

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

    • A.

      Trigeminal

    • B.

      Facial

    • C.

      Opthalmic

    • D.

      Oculomotor

    Correct Answer
    A. Trigeminal
    Explanation
    The regional innervation for the eye, orbit, and periorbital structures is supplied by the Trigeminal nerve. The Trigeminal nerve is the largest cranial nerve and has three main branches: ophthalmic, maxillary, and mandibular. The ophthalmic branch specifically innervates the eye, orbit, and periorbital structures, providing sensory information such as touch, pain, and temperature. The other options, Facial, Oculomotor, and Ophthalmic, do not innervate these specific structures.

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  • 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.

    Correct Answer
    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.
    Explanation
    The proper injection technique for a retrobulbar block involves injecting the medication just above the inferior orbital rim. An angled needle is used to pass into the intraconal region, and the patient should be gazing supranasally. This technique ensures accurate placement of the medication and minimizes the risk of complications.

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  • 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

    Correct Answer
    C. 5 ml of 0.75 % bupivacaine with epi
  • 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

    Correct Answer
    D. Retrobulbar Hemorrhage
    Explanation
    Retrobulbar hemorrhage is the most common complication associated with a retrobulbar block. This occurs when there is bleeding behind the eye, which can lead to increased pressure within the confined space of the orbit. This can cause symptoms such as severe eye pain, decreased vision, and proptosis (bulging of the eye). Immediate medical intervention is necessary to prevent further damage to the eye and potential vision loss.

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  • 46. 

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

    • A.

      Bradycardia

    • B.

      Hypertension

    • C.

      PVC’s

    • D.

      Tachycardia

    Correct Answer
    A. Bradycardia
    Explanation
    Stimulation of the oculocardiac reflex refers to the reflex that occurs when pressure is applied to the eyeball, leading to a decrease in heart rate. This reflex is mediated by the vagus nerve, which when stimulated, causes a decrease in the heart's electrical activity and subsequently results in bradycardia. Therefore, the correct answer is bradycardia.

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  • 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

    Correct Answer
    B. Pt with advanced CHF and CAD
    Explanation
    Patients with advanced CHF (Congestive Heart Failure) and CAD (Coronary Artery Disease) are able to receive a retrobulbar block. Retrobulbar block is a type of anesthesia used during eye surgeries. It involves injecting a local anesthetic behind the eye to numb the area and provide pain relief during the procedure. Patients with advanced CHF and CAD can safely receive this block because it does not pose a significant risk to their cardiovascular system. However, patients taking daily Coumadin (an anticoagulant) may have an increased risk of bleeding, patients with severe myopia may have anatomical variations that make the procedure more challenging, and patients with an open corneal abrasion may have an increased risk of infection.

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  • 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

    Correct Answer
    A. Loss of ocucephalic reflex
    Explanation
    A successful retrobulbar block will result in loss of ocucephalic reflex. This reflex involves movement of the eyes in response to movement of the head. When the retrobulbar block is performed correctly, the anesthetic medication blocks the sensory nerves in the eye, leading to decreased sensation and movement. As a result, the ocucephalic reflex is lost, meaning that the eyes no longer move in response to head movement. This is a desired outcome as it allows for a more effective and comfortable surgical procedure on the eye.

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  • 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

    Correct Answer
    C. Pt unconsciousness and seizures
    Explanation
    Accidental injection of a retrobulbar dose of local anesthesia (LA) into the ophthalmic artery can cause the LA to enter the systemic circulation and reach the brain. This can lead to central nervous system toxicity, resulting in unconsciousness and seizures in the patient.

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  • 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.

    Correct Answer
    C. Immediately stop injection, start lipid infusion, monitor patient, your plasma concentration should still be low enough to reverse this.
    Explanation
    The correct answer suggests that the patient is experiencing symptoms of local anesthetic systemic toxicity (LAST), which can occur when the plasma concentration of the anesthetic is too high. Stopping the injection and starting a lipid infusion can help to reverse the effects of LAST. Monitoring the patient is important to ensure their condition improves.

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