You have just performed spinal anesthesia and found you have a sympathetic blockade at the level of T6. Is this safe for your patient?

Yes, this is considered a safe level of sympathetic blockade.

No, they are at increases risk for dural puncture headache.

Yes, this is considered a safe level of sympathetic blockade.

No, the patient is at risk for profound bradycardia

No, the level of blockade. is inadequate.

You have just performed spinal anesthesia and found you have a motor blockade at the level of T6. Is this safe for your patient?

No, the patient is at risk for profound bradycardia.

No, they are at increases risk for dural puncture headache.

Yes, this is considered a safe level of sympathetic blockade.

No, the patient is at risk for profound bradycardia.

No, the level of blockade is inadequate.

You are performing an epidural on a with a large abdominal tumor, would you expect this to change your dose of anesthetic used?

I would expect to use less anesthetic.

Nope, amount of anesthetic used will stay the same.

You will require more anesthetic to reach the desired effect.

This is a contraindication to epidural anesthesia, I would not do the block.

I would expect to use less anesthetic.

Which of the following patients is an Absolute contraindication to spinal anesthesia?

Mrs. A what has severe mitral stenosis.

Mr. B who has advanced HIV disease.

Mrs. C who suffers from scoliosis.

Mr. D who will have a long procedure.

Where is CSF produced?

Ependymal cells of choroid plexus

Enterochromatic cells in ventricular system

In the aquaduct of Sylvius in the 4th ventricle

Which of the following carries all efferent signals heading out to the periphery?

Unmyelinated fibers of White Matter

How would you mix a hyperbaric solution of bupivicaine?

By adding glucose to increase the density

By mixing equal parts LA and CSF

By adding 6-8ml of sterile water

How would you expect ascites to effect your level of blockade when giving spinal anesthesia?

The level of blockade will be higher due to increased intrabdominal pressure

The level of your blockade will be lower due to increased intrabdominal pressure

Level of blockade will not be effected

Spinal anesthesia is contraindicated for this patient

The level of blockade will be higher due to increased intrabdominal pressure

How would you prepare your OR for a patient undergoing spinal anesthesia?

Prepare your room exactly as you would for a GA case

Prepare your standard monitors, but you do not need your GA drugs drawn up

Draw up only the medications necessary for a MAC case

Prepare your room exactly as you would for a GA case

Which of the following properly describes the midline approach to spinal anesthesia?

Identify Tuffiers line and insert needle in center of back at 50-60 degree angle

Make a skin wheal with lidocaine 1-2 cm lateral to chosen interspace, then direct needle medial and cephalad at 15-20 degrees pointing toward midline

Use a lateral approach to use the largest interspace L5-S1

Which of the following properly describes the Taylor approach?

Use a lateral approach to use the largest interspace L5-S1

Identify Tuffiers line and insert needle in center of back at 50-60 degree angle

Make a skin wheal with lidocaine 1-2 cm lateral to chosen interspace, then direct needle medial and cephalad at 15-20 degrees pointing toward midline

Use a lateral approach to use the largest interspace L5-S1

Regional Quiz 2 - Spinal And Epidural Study Test

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Regional Quiz 2 - Spinal And Epidural Study Test - Quiz

The spinal cord functions primarily in the transmission of nerve signals from the motor cortex to the body, and from the afferent fibers of the sensory neurons to the sensory cortex. It is also a center for coordinating many reflexes and contains reflex arcs that can independently control reflexes.

Questions and Answers

1.

Where would you expect the spinal canal to end on an adult patient?
- A.
  
  L1- L2
- B.
  
  L3
- C.
  
  L5
- D.
  
  Sacral Hiatus
Correct Answer
D. Sacral Hiatus

Explanation
The spinal canal is a hollow space within the vertebral column that houses the spinal cord. In an adult patient, the spinal canal typically ends at the sacral hiatus. The sacral hiatus is a small opening located at the base of the sacrum, which is the triangular bone at the lower end of the vertebral column. This is where the spinal cord tapers off into a bundle of nerves known as the cauda equina.

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1
1
2.

Where you expect the Spinal Cord to end on an adult patient?
- A.
  
  L1-L2
- B.
  
  L3
- C.
  
  L5
- D.
  
  Sacral Hiatus
Correct Answer
A. L1-L2

Explanation
The spinal cord is a long, cylindrical structure that extends from the base of the brain to the lower back. In an adult patient, the spinal cord typically ends around the level of the first lumbar vertebra (L1) or the second lumbar vertebra (L2). Therefore, the correct answer is L1-L2.

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3.

You have just performed spinal anesthesia and found you have a sympathetic blockade at the level of T6. Is this safe for your patient?
- A.
  
  No, they are at increases risk for dural puncture headache.
- B.
  
  Yes, this is considered a safe level of sympathetic blockade.
- C.
  
  No, the patient is at risk for profound bradycardia
- D.
  
  No, the level of blockade. is inadequate.
Correct Answer
B. Yes, this is considered a safe level of sympathetic blockade.

Explanation
A sympathetic blockade at the level of T6 is considered safe for the patient because it does not pose any immediate or significant risks. The sympathetic nerves control various functions in the body, including heart rate, blood pressure, and sweating. However, a blockade at T6 does not affect the vital functions controlled by the sympathetic nervous system. Therefore, the patient is not at risk for dural puncture headache, bradycardia, or inadequate blockade at this level.

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4.

You have just performed spinal anesthesia and found you have a motor blockade at the level of T6. Is this safe for your patient?
- A.
  
  No, they are at increases risk for dural puncture headache.
- B.
  
  Yes, this is considered a safe level of sympathetic blockade.
- C.
  
  No, the patient is at risk for profound bradycardia.
- D.
  
  No, the level of blockade is inadequate.
Correct Answer
C. No, the patient is at risk for profound bradycardia.

Explanation
A motor blockade at the level of T6 indicates that the spinal anesthesia has affected the sympathetic nerves at that level. Sympathetic blockade can lead to a decrease in heart rate and blood pressure, potentially resulting in profound bradycardia. Therefore, this is not safe for the patient as they are at risk for profound bradycardia.

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5.

You are performing an epidural on a with a large abdominal tumor, would you expect this to change your dose of anesthetic used?
- A.
  
  Nope, amount of anesthetic used will stay the same.
- B.
  
  You will require more anesthetic to reach the desired effect.
- C.
  
  This is a contraindication to epidural anesthesia, I would not do the block.
- D.
  
  I would expect to use less anesthetic.
Correct Answer
D. I would expect to use less anesthetic.

Explanation
In this scenario, the presence of a large abdominal tumor can affect the spread and distribution of the anesthetic. The tumor may compress the nerves in the epidural space, resulting in a decreased volume of the space available for the anesthetic to spread. As a result, a smaller amount of anesthetic may be required to achieve the desired effect. Therefore, the correct answer is "I would expect to use less anesthetic."

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6.

After performing Spinal anesthesia you have a Sensory blockade at the level of T 10. You would expect to see a sympathetic blockade at the level of _____ and a motor blockade at the level of _____.
- A.
  
  T8, T12
- B.
  
  T 6, T8
- C.
  
  T12, L2
- D.
  
  T12, T8
Correct Answer
A. T8, T12

Explanation
After performing spinal anesthesia, the sensory blockade at the level of T10 indicates that the nerves responsible for sensory perception below this level are temporarily blocked. The sympathetic blockade is expected to occur at a higher level, specifically at T8, which means that sympathetic nerve activity will be reduced or blocked in the areas below T8. On the other hand, the motor blockade is expected to occur at a lower level, specifically at T12, which means that motor function will be temporarily impaired below this level. Therefore, the correct answer is T8, T12.

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7.

Which of the following patients is an Absolute contraindication to spinal anesthesia?
- A.
  
  Mrs. A what has severe mitral stenosis.
- B.
  
  Mr. B who has advanced HIV disease.
- C.
  
  Mrs. C who suffers from scoliosis.
- D.
  
  Mr. D who will have a long procedure.
Correct Answer
A. Mrs. A what has severe mitral stenosis.

Explanation
Patients with severe mitral stenosis have an absolute contraindication to spinal anesthesia. Mitral stenosis is a condition characterized by narrowing of the mitral valve in the heart, which can lead to impaired blood flow. Spinal anesthesia involves injecting medication into the spinal canal, which can cause a drop in blood pressure. In patients with severe mitral stenosis, this drop in blood pressure can be dangerous and potentially life-threatening. Therefore, spinal anesthesia should be avoided in these patients to prevent complications.

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8.

The angle of the scapula roughly correlates to which vertebrae?
- A.
  
  C7
- B.
  
  T7
- C.
  
  L3
- D.
  
  L1
Correct Answer
B. T7

Explanation
The angle of the scapula roughly correlates to the T7 vertebrae. This means that the angle of the scapula is located around the level of the seventh thoracic vertebrae in the spine.

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9.

Where is CSF produced?
- A.
  
  Ependymal cells of choroid plexus
- B.
  
  Enterochromatic cells in ventricular system
- C.
  
  In the aquaduct of Sylvius in the 4th ventricle
- D.
  
  In the lymphatic system
Correct Answer
A. Ependymal cells of choroid plexus

Explanation
CSF (cerebrospinal fluid) is produced by ependymal cells of the choroid plexus. The choroid plexus is a network of blood vessels located in the ventricles of the brain. Ependymal cells line the ventricles and are responsible for producing CSF. These cells actively transport substances from the blood into the ventricles, creating the composition of CSF. CSF plays a crucial role in protecting and nourishing the brain and spinal cord, as well as maintaining a stable environment for neural function.

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10.

Which area of the brain is responsible for motor function and movement away from painful stimuli?
- A.
  
  Post Central Gyrus
- B.
  
  White matter of spinal cord
- C.
  
  Precentral Gyrus
- D.
  
  Dorsal Root
Correct Answer
C. Precentral Gyrus

Explanation
The precentral gyrus is responsible for motor function and movement away from painful stimuli. This area of the brain is located in the frontal lobe, just in front of the central sulcus. It contains the primary motor cortex, which controls voluntary movements of the body. When the body experiences pain, signals are sent to the precentral gyrus to initiate a response to move away from the painful stimuli.

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11.

How many pairs of spinal nerves do we have?
- A.
  
  24
- B.
  
  29
- C.
  
  30
- D.
  
  31
Correct Answer
D. 31

Explanation
We have 31 pairs of spinal nerves. The spinal nerves are part of the peripheral nervous system and are formed by the combination of dorsal and ventral roots. There are 31 pairs of spinal nerves in total, with each pair connected to a specific segment of the spinal cord. These nerves are responsible for transmitting sensory information from the body to the brain and carrying motor commands from the brain to the muscles and organs.

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12.

Which of the following carries all efferent signals heading out to the periphery?
- A.
  
  Ventral Root
- B.
  
  Dorsal Root
- C.
  
  Unmyelinated fibers of White Matter
- D.
  
  Epineurium
Correct Answer
A. Ventral Root

Explanation
The ventral root carries all efferent signals heading out to the periphery. Efferent signals are motor signals that travel from the central nervous system to the peripheral nervous system, allowing for movement and response in the body. The ventral root is responsible for transmitting these signals from the spinal cord to the muscles and glands in the body. The dorsal root, on the other hand, carries afferent signals, which are sensory signals that travel from the periphery to the central nervous system. Unmyelinated fibers of white matter and epineurium are not specifically involved in carrying efferent signals.

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13.

Where do preganglionic fibers of the parasympathetic nervous system end?
- A.
  
  Sympathetic chain
- B.
  
  In the organ they innervate
- C.
  
  Intermediolateral gray matter
- D.
  
  Sacral nerves
Correct Answer
B. In the organ they innervate

Explanation
Preganglionic fibers of the parasympathetic nervous system end in the organ they innervate. Unlike the sympathetic nervous system, which has a chain of ganglia outside the target organs, the parasympathetic fibers have shorter preganglionic fibers that directly synapse with postganglionic neurons in the target organ. This allows for more specific and localized control of the parasympathetic response within the organ itself.

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14.

What is the primary neurotransmitter of the parasympathetic nervous system?
- A.
  
  Norepinephrine
- B.
  
  Glutamate
- C.
  
  Dopamine
- D.
  
  Acetylcholine
Correct Answer
D. Acetylcholine

Explanation
Acetylcholine is the primary neurotransmitter of the parasympathetic nervous system. It is responsible for transmitting signals between nerve cells and plays a crucial role in regulating various bodily functions, such as digestion, heart rate, and relaxation. Acetylcholine acts as a chemical messenger, binding to receptors on target cells and initiating a response. It is released by parasympathetic neurons and helps in promoting rest and digestion, as opposed to the fight-or-flight response mediated by norepinephrine.

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15.

You are the SRNA for a patient who has just been given Spinal anesthesia. The spinal goes higher than expected and the patient becomes profoundly bradycardic. What should you do first?
- A.
  
  Administer 100% O2
- B.
  
  Administer Atropine
- C.
  
  Administer Glycopyrolate
- D.
  
  Administer Epinephrine
Correct Answer
B. Administer Atropine

Explanation
In this scenario, the patient experiences profound bradycardia due to the spinal anesthesia going higher than expected. Administering atropine as the first step is appropriate because it is a medication commonly used to treat bradycardia. Atropine works by blocking the action of the vagus nerve, which helps to increase heart rate. Administering 100% oxygen may also be beneficial, but it is not the first priority in this situation. Glycopyrrolate is another medication that can be used to treat bradycardia, but atropine is typically the first-line treatment. Epinephrine is not the initial choice for bradycardia and is usually reserved for more severe cases.

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16.

When the CSF if heavier then the LA injected, causing the LA to float up. The local anesthetic solution is said to be…
- A.
  
  Isobaric
- B.
  
  Semibaric
- C.
  
  Hyperbaric
- D.
  
  Hypobaric
Correct Answer
D. Hypobaric

Explanation
When the CSF is heavier than the LA injected, it causes the LA to float up. This means that the local anesthetic solution is less dense than the cerebrospinal fluid, resulting in it being distributed in a higher position within the spinal canal. This phenomenon is known as hypobaric.

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17.

How would you mix a hyperbaric solution of bupivicaine?
- A.
  
  By adding glucose to increase the density
- B.
  
  By mixing equal parts LA and CSF
- C.
  
  By adding 6-8ml of sterile water
- D.
  
  None of above
Correct Answer
A. By adding glucose to increase the density

Explanation
Adding glucose to the bupivicaine solution increases its density, resulting in a hyperbaric solution. This can be achieved by dissolving a certain amount of glucose in the solution, which increases its specific gravity. The increased density allows for better distribution and prolonged effect of the medication when used in certain medical procedures, such as spinal anesthesia. Mixing equal parts LA (local anesthetic) and CSF (cerebrospinal fluid) or adding sterile water would not achieve the desired hyperbaric solution. Therefore, the correct method is to add glucose to increase the density.

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18.

After administering a hyperbaric solution of Local anesthetic for spinal anesthesia, what position would you place the pt into in order to achieve a level of T6-7 blockade?
- A.
  
  Supine with head slightly up
- B.
  
  Supine with head slightly down
- C.
  
  Supine level
- D.
  
  Lateral decubitus position
Correct Answer
C. Supine level

Explanation
Placing the patient in a supine level position after administering a hyperbaric solution of local anesthetic for spinal anesthesia would help achieve a level of T6-7 blockade. This position ensures that the anesthetic solution spreads evenly in the cerebrospinal fluid, allowing it to reach the desired level of T6-7. Placing the head slightly up or down may cause uneven distribution of the anesthetic, leading to an inadequate blockade. The lateral decubitus position is not preferred in this case as it may also result in uneven distribution of the anesthetic.

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19.

How would you expect ascites to effect your level of blockade when giving spinal anesthesia?
- A.
  
  The level of your blockade will be lower due to increased intrabdominal pressure
- B.
  
  Level of blockade will not be effected
- C.
  
  Spinal anesthesia is contraindicated for this patient
- D.
  
  The level of blockade will be higher due to increased intrabdominal pressure
Correct Answer
D. The level of blockade will be higher due to increased intrabdominal pressure

Explanation
Ascites refers to the accumulation of fluid in the abdominal cavity. When there is increased intrabdominal pressure due to ascites, it can cause compression of the spinal nerves and result in a higher level of blockade during spinal anesthesia. This is because the increased pressure can cause the local anesthetic to spread higher in the spinal canal, leading to a higher level of numbness or paralysis.

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20.

How would you prepare your OR for a patient undergoing spinal anesthesia?
- A.
  
  Prepare your standard monitors, but you do not need your GA drugs drawn up
- B.
  
  Draw up only the medications necessary for a MAC case
- C.
  
  Prepare your room exactly as you would for a GA case
Correct Answer
C. Prepare your room exactly as you would for a GA case

Explanation
When preparing for a patient undergoing spinal anesthesia, it is important to prepare the room in the same way as for a general anesthesia (GA) case. This includes setting up the standard monitors and ensuring that all necessary equipment and supplies are available. While the other options mention not needing GA drugs or only drawing up medications for a MAC case, these are not appropriate for a patient undergoing spinal anesthesia. Therefore, preparing the room exactly as for a GA case is the correct answer.

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21.

Which of the following is most frequently added to local anesthetic in order to prolong their duration of action?
- A.
  
  Epinephrine 0.1-0.2 mg
- B.
  
  Phenylephrine 2-5mg
- C.
  
  Ephedrine 5mg
- D.
  
  Atropine .3-.5 mg
Correct Answer
A. Epinephrine 0.1-0.2 mg

Explanation
Epinephrine is frequently added to local anesthetics to prolong their duration of action. Epinephrine is a vasoconstrictor that reduces blood flow to the area where the anesthetic is injected. This helps to slow down the absorption of the anesthetic, allowing it to stay in the area for a longer period of time and prolonging its effects. By constricting blood vessels, epinephrine also reduces bleeding at the site of injection, which can further enhance the duration of the anesthetic's action.

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22.

Local anesthetics produce conduction blockade of neural impulses by preventing passage of chloride ions through selective ion chloride channels in nerve membranes.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
Local anesthetics produce conduction blockade of neural impulses by preventing passage of sodium ions through selective sodium channels in nerve membranes, not chloride ions through selective chloride channels. Therefore, the statement is false.

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23.

Which of the following properly describes the midline approach to spinal anesthesia?
- A.
  
  Identify Tuffiers line and insert needle in center of back at 50-60 degree angle
- B.
  
  Make a skin wheal with lidocaine 1-2 cm lateral to chosen interspace, then direct needle medial and cephalad at 15-20 degrees pointing toward midline
- C.
  
  Use a lateral approach to use the largest interspace L5-S1
- D.
  
  None of above
Correct Answer
A. Identify Tuffiers line and insert needle in center of back at 50-60 degree angle

Explanation
The midline approach to spinal anesthesia involves identifying Tuffier's line, which is a horizontal line connecting the highest points of the iliac crests. The needle is then inserted in the center of the back at a 50-60 degree angle. This technique ensures accurate placement of the needle in the midline of the spine, allowing for proper administration of anesthesia.

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24.

Which of the following properly describes the Taylor approach?
- A.
  
  Identify Tuffiers line and insert needle in center of back at 50-60 degree angle
- B.
  
  Make a skin wheal with lidocaine 1-2 cm lateral to chosen interspace, then direct needle medial and cephalad at 15-20 degrees pointing toward midline
- C.
  
  Use a lateral approach to use the largest interspace L5-S1
- D.
  
  None of above
Correct Answer
C. Use a lateral approach to use the largest interspace L5-S1
25.

You are the SRNA for Mr. Goldman who is coming in for emergent repair of a dissecting aortic aneurysm. After the surgery is over he complains of weakness in his legs and urinary incontinence. What artery branches off the aorta and may have been damaged during the procedure to cause Mr. Goldman’s symptoms?
- A.
  
  Artery of Adamkiewicz
- B.
  
  Anterior Spinal Artery
- C.
  
  Posterior Spinal Arteries
- D.
  
  Posterolateral spinal vein
Correct Answer
A. Artery of Adamkiewicz

Explanation
During the emergent repair of a dissecting aortic aneurysm, the artery of Adamkiewicz may have been damaged, leading to Mr. Goldman's symptoms of leg weakness and urinary incontinence. The artery of Adamkiewicz, also known as the great anterior radiculomedullary artery, is a critical artery that supplies blood to the lower spinal cord. Damage to this artery can result in ischemia and compromise the blood supply to the spinal cord, leading to neurological deficits such as weakness and loss of bladder control.

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26.

The posterior 1/3 of the spinal cord is supplied by…
- A.
  
  Artery of Adamkiewicz
- B.
  
  Anterior Spinal Artery
- C.
  
  Posterior Spinal Arteries
- D.
  
  Posterolateral spinal vein
Correct Answer
C. Posterior Spinal Arteries

Explanation
The posterior 1/3 of the spinal cord is supplied by the posterior spinal arteries. These arteries run along the back of the spinal cord and provide blood supply to the posterior portion of the cord. The anterior spinal artery supplies the anterior 2/3 of the spinal cord, while the artery of Adamkiewicz is a larger artery that supplies the lower thoracic and lumbar regions of the spinal cord. The posterolateral spinal vein is not involved in the blood supply of the spinal cord.

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27.

Identify ligament #1 in the above photo.
- A.
  
  Ligamentum Flavum
- B.
  
  Supraspinous ligament
- C.
  
  Interspinous ligament
- D.
  
  Dura Mater
Correct Answer
B. Supraspinous ligament

Explanation
The correct answer is the supraspinous ligament. This ligament can be identified based on its location in the photo and its characteristic appearance. It is a strong fibrous band that connects the spinous processes of adjacent vertebrae in the spine. It runs along the posterior aspect of the vertebral column, from the base of the skull to the sacrum. The supraspinous ligament helps to stabilize the spine and limit excessive flexion (forward bending) of the vertebral column.

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28.

Identify ligament #2 in the above photo.
- A.
  
  Ligamentum Flavum
- B.
  
  Supraspinous ligament
- C.
  
  Interspinous ligament
- D.
  
  Dura Mater
Correct Answer
C. Interspinous ligament

Explanation
The correct answer is the interspinous ligament. This ligament is located between the spinous processes of adjacent vertebrae in the spine. It helps to limit excessive flexion and rotation of the spine. The ligamentum flavum is located between the laminae of adjacent vertebrae and helps to maintain the upright posture. The supraspinous ligament is located above the spinous processes and connects them together. The dura mater is the outermost layer of the spinal cord and does not refer to a specific ligament in this context.

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29.

Which of the following is not included in the epidural space?
- A.
  
  Spinal Nerve roots
- B.
  
  Fatty connective tissue
- C.
  
  Lymphatics
- D.
  
  Muscle tissue
Correct Answer
D. Muscle tissue

Explanation
The epidural space is the area between the outermost layer of the spinal cord and the vertebral column. It contains various structures, including spinal nerve roots, fatty connective tissue, and lymphatics. However, muscle tissue is not typically found in the epidural space.

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30.

Which of the following will not affect the level of epidural blockade?
- A.
  
  Baricity of drug
- B.
  
  Volume of drug
- C.
  
  Dose of drug
- D.
  
  Age of patient
Correct Answer
A. Baricity of drug

Explanation
The level of epidural blockade is not affected by the baricity of the drug. Baricity refers to the density of the drug compared to the density of cerebrospinal fluid. In an epidural blockade, the drug is injected into the epidural space, which is outside the spinal cord. The level of blockade is determined by the spread of the drug within the epidural space, which is not influenced by the baricity of the drug. Therefore, the baricity of the drug will not affect the level of epidural blockade.

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31.

If you wanted to increase the density of a block without effecting the spread, what could you do?
- A.
  
  Give a higher volume of drug
- B.
  
  Give a higher dose of drug
- C.
  
  Give a higher concentration of drug
- D.
  
  All the above
Correct Answer
C. Give a higher concentration of drug

Explanation
To increase the density of a block without affecting the spread, giving a higher concentration of drug would be the most suitable option. Increasing the concentration means adding more drug molecules to a given volume, which would increase the density of the block. This can be achieved without changing the spread of the drug, as the volume and dose remain the same. Giving a higher volume or a higher dose of the drug would not necessarily increase the density without affecting the spread.

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32.

You have performed a thoracic epidural at level of T8 and want to achieve a T4 sensory block, how much volume of local anesthetic would you give?
- A.
  
  6 ml, with initial volume of 10 ml
- B.
  
  4 ml, with initial volume of 20 ml
- C.
  
  6 ml, with initial volume of 20 ml
- D.
  
  4 ml, with initial volume of 10 ml
Correct Answer
D. 4 ml, with initial volume of 10 ml

Explanation
To achieve a T4 sensory block, the volume of local anesthetic needed is 4 ml. This is because the initial volume of 10 ml is already sufficient, and reducing it by 6 ml would result in the desired 4 ml volume.

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33.

You have performed an epidural at the level of L5 and want to achieve a sensory blockade up to level of T6. How much volume of local anesthetic would you give to achieve this?
- A.
  
  16 ml, with initial dose of 20 ml
- B.
  
  11 ml, with initial dose of 10 ml
- C.
  
  16 ml, with initial dose of 10 ml
- D.
  
  11 ml, with initial dose of 20 ml
Correct Answer
A. 16 ml, with initial dose of 20 ml

Explanation
To achieve a sensory blockade up to the level of T6, a total volume of 16 ml of local anesthetic is required. The initial dose of 20 ml is given to ensure adequate spread of the local anesthetic to the desired level. This initial dose helps to establish the sensory blockade at the desired level, and then additional volume can be administered to maintain the blockade if needed. Therefore, the correct answer is 16 ml, with an initial dose of 20 ml.

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34.

What could you do, when performing an epidural block for a pt in labor, to differentially block sensory and pain fibers over larger muscle fibers?
- A.
  
  Use a lower dose of your drug
- B.
  
  Use a lower concentration of your drug
- C.
  
  Use a higher volume to increase spread
- D.
  
  Keep pt in sitting position after injection
Correct Answer
B. Use a lower concentration of your drug

Explanation
Using a lower concentration of the drug can help in differentially blocking sensory and pain fibers over larger muscle fibers. Lower concentration means that there is less drug present in the solution, which can result in a more selective effect on the sensory and pain fibers. This can help in achieving the desired outcome of blocking those fibers while minimizing the effect on the larger muscle fibers.

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35.

How will increased age effect epidural anesthesia?
- A.
  
  How will increased age effect epidural anesthesia?
- B.
  
  There will be decreased spread
- C.
  
  There will be increased spread
- D.
  
  There will be decreased duration of block
Correct Answer
C. There will be increased spread

Explanation
As a person ages, there are certain physiological changes that occur in their body. These changes can affect the way medications, including anesthesia, are distributed and metabolized. In the case of epidural anesthesia, increased age can lead to a decrease in the elasticity and permeability of the spinal tissues. This can cause the anesthesia to spread further along the spinal cord, leading to an increased spread of the block. Therefore, the correct answer is that increased age will result in increased spread of epidural anesthesia.

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36.

What is the proper technique for injection of anesthetic into epidural space?
- A.
  
  Once you see CSF flow from needle, inject anesthetic rapidly to increase level of spread.
- B.
  
  Once you see CSF flow from needle, inject anesthetic slowly into the epidural space
- C.
  
  Aspirate prior to injection to make sure you do not get CSF, then inject rapidly(over 3 minutes) to increase level of spread
- D.
  
  Aspirate prior to injection to make sure you do not get CSF, then inject anesthetic slowly(3-5 cc every 3 minutes) to avoid increase in CSF pressure and headache.
Correct Answer
D. Aspirate prior to injection to make sure you do not get CSF, then inject anesthetic slowly(3-5 cc every 3 minutes) to avoid increase in CSF pressure and headache.

Explanation
The proper technique for injection of anesthetic into the epidural space is to aspirate prior to injection to make sure you do not get cerebrospinal fluid (CSF), and then inject the anesthetic slowly at a rate of 3-5 cc every 3 minutes. This slow injection helps to avoid an increase in CSF pressure, which can lead to a headache.

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37.

Which of the following has been almost eliminated from use in epidural and spinal anesthesia due to it’s tendency to cause a differential blockade via profound muscle relaxation but weak sensory effects?
- A.
  
  Etidocaine
- B.
  
  Halocaine
- C.
  
  Chloroprocaine
- D.
  
  Tetracaine
Correct Answer
A. Etidocaine

Explanation
Etidocaine has been almost eliminated from use in epidural and spinal anesthesia due to its tendency to cause a differential blockade. This means that it causes profound muscle relaxation but has weak sensory effects.

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38.

How will you know you are actually in the epidural space when inserting an epidural needle?
- A.
  
  When you obtain free flow of CSF
- B.
  
  By using the loss of resistance technique
- C.
  
  You will always feel a ‘pop’ as you pass through ligamentum flavum and this tells you that you now have proper placement
- D.
  
  None of above
Correct Answer
B. By using the loss of resistance technique

Explanation
The loss of resistance technique is commonly used to determine if the epidural needle is in the epidural space. This technique involves applying pressure to the plunger of the syringe while advancing the needle. Once the needle enters the epidural space, the resistance to the plunger decreases, indicating that the needle is in the correct position. This technique is preferred over relying solely on the feeling of a "pop" or the presence of cerebrospinal fluid flow, as these factors can be unreliable indicators of proper needle placement.

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39.

You are doing an epidural on a 30 yr old male prior to procedure. When you administer the test dose of lido with epi the pt complains of ringing in his ears and you see and increased HR on the monitor. Is it ok to proceed with the injection?
- A.
  
  These are expected side effects, OK to proceed
- B.
  
  Wait 3 minutes, see if ear ringing subsides, then continue injection
- C.
  
  Stop injection as these are signs of intravascular injection
- D.
  
  This is a sign of accidental dural puncture, just give a smaller dose.
Correct Answer
C. Stop injection as these are signs of intravascular injection

Explanation
The patient complaining of ringing in the ears and an increased heart rate after administering the test dose of lidocaine with epinephrine indicates signs of intravascular injection. Intravascular injection can lead to systemic toxicity and should be stopped immediately to prevent any further complications.

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40.

You are performing an epidural on a patient in labor. As you begin to administer your test dose you see pts heart rate go up. She is now breathing deeply and rubbing her stomach. Is it OK to proceed?
- A.
  
  No, elevated HR is a sign of intravascular injection. Stop injection.
- B.
  
  Elevated HR is an expected side effect and It is OK to proceed.
- C.
  
  This is a sign of accidental dural puncture, just give a smaller dose.
- D.
  
  She is probably having a contraction, wait a few minutes and see.
Correct Answer
D. She is probably having a contraction, wait a few minutes and see.
41.

You are giving a test dose of lido with epi to a patient receiving an epidural. Within 3 minutes of injection the pt complains of numbness in their lower extremities. Is it OK to proceed with the injection?
- A.
  
  This is a sign of accidental dural puncture, you will need to adjust your dose.
- B.
  
  The epidural is *supposed* to produce numbess, continue with injection
- C.
  
  This is a sign of intravascular injection, stop injection.
- D.
  
  None of above
Correct Answer
A. This is a sign of accidental dural puncture, you will need to adjust your dose.

Explanation
The patient experiencing numbness in their lower extremities within 3 minutes of injection suggests an accidental dural puncture. This can occur when the needle used for the epidural accidentally punctures the dura mater, the protective covering of the spinal cord. Adjusting the dose is necessary to prevent potential complications and ensure the safety of the patient.

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42.

You are giving an epidural to a pt up on the OB floor. As you insert the catheter the patient complains of feeling an electric shock sensation. What do you do?
- A.
  
  Pull the catheter back then reinsert
- B.
  
  This is to be expected when inserting the catheter
- C.
  
  Stop the catheter, you have gone too far
- D.
  
  You have inserted the catheter intravascularly, pull out needle and cather.
Correct Answer
B. This is to be expected when inserting the catheter
43.

Where would proper needle insertion be for a caudal block?
- A.
  
  At Tuffiers line
- B.
  
  At T 7
- C.
  
  At the Sacral Hiatus
- D.
  
  Caudal block can be performed at any level
Correct Answer
C. At the Sacral Hiatus

Explanation
The proper needle insertion for a caudal block is at the Sacral Hiatus. The Sacral Hiatus is a small opening at the base of the sacrum, which is the triangular bone at the base of the spine. This is the ideal location for needle insertion because it allows for the administration of medication directly into the caudal epidural space, which is the area surrounding the sacral nerves. This technique is commonly used for pain management during childbirth or for lower abdominal and pelvic surgeries.

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44.

Which of the following techniques involves first insertion of epidural catheter, then the spinal being done one or two interspaces below the epidural?
- A.
  
  Single Level Insertion
- B.
  
  Sequential Technique
- C.
  
  Combined Technique
- D.
  
  Two Level technique
Correct Answer
D. Two Level technique

Explanation
The two-level technique involves the insertion of an epidural catheter first, followed by the placement of a spinal needle one or two interspaces below the epidural. This technique allows for both epidural and spinal anesthesia to be administered simultaneously, providing a combination of pain relief and surgical anesthesia.

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2
1
45.

Which of the following involves the ‘needle-through-needle technique’ and injection of spinal through a smaller spinal needle inserted through the epidural needles?
- A.
  
  Single Level Insertion
- B.
  
  Combined Technique
- C.
  
  Two Level Insertion
- D.
  
  All above use this method
Correct Answer
A. Single Level Insertion

Explanation
The correct answer is Single Level Insertion. This technique involves using a smaller spinal needle inserted through the epidural needle to inject the spinal anesthesia. This method is used for procedures that only require anesthesia at a single level. The combined technique involves both epidural and spinal anesthesia, while the two level insertion is used for procedures that require anesthesia at two different levels.

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46.

You are going to do a second dose of bupivacaine through an epidural catheter for a woman in labor whose first epidural is starting to wear off. You aspirate the epidural catheter and get about 0.5 ml of a clear fluid. You mix the fluid with STP and find no precipitation…. Do you think it is safe to proceed with your planned dose?
- A.
  
  No, this is CSF. Catheter has migrated and I must change my dose
- B.
  
  This most likely just the bit of fluid left in catheter after my last injection. Ok to proceed.
- C.
  
  Not enough information to make a safe judgement.
Correct Answer
B. This most likely just the bit of fluid left in catheter after my last injection. Ok to proceed.

Explanation
The answer "This most likely just the bit of fluid left in catheter after my last injection. Ok to proceed." is correct because the clear fluid obtained from aspirating the epidural catheter is most likely residual fluid from the previous injection. If there were any concerns about the catheter migration or presence of cerebrospinal fluid (CSF), there would be a possibility of precipitation when mixed with STP. Since no precipitation is observed, it is safe to proceed with the planned dose.

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47.

When injecting into an epidural catheter, how often do you need to aspirate?
- A.
  
  Every 10 mls
- B.
  
  Every 1-2 mls
- C.
  
  Every 3-5 mls
- D.
  
  Once you have aspirated and confirmed placement after initial placement you do not need to repeat.
Correct Answer
C. Every 3-5 mls

Explanation
When injecting into an epidural catheter, it is necessary to aspirate every 3-5 mls. This is done to ensure proper placement of the catheter and to prevent any accidental injection into a blood vessel or the subarachnoid space. Aspiration helps to confirm that the needle is in the correct position and that the medication will be delivered to the desired location. By aspirating regularly during the injection, any potential complications can be identified and addressed promptly.

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48.

Which of the following is used generally for spinal component of combined technique but not for epidural component?
- A.
  
  Lidocaine
- B.
  
  Chloroprocaine
- C.
  
  Bupivacaine
- D.
  
  Ropivacaine
Correct Answer
D. Ropivacaine

Explanation
Ropivacaine is generally used for the spinal component of a combined technique, but not for the epidural component. This suggests that while Ropivacaine may be effective for spinal anesthesia, it may not be the preferred choice for epidural anesthesia. The other options, Lidocaine, Chloroprocaine, and Bupivacaine, may be used for both spinal and epidural anesthesia.

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49.

Combined Spinal / Epidural can only be used safely for procedures in which a spinal was planned, but not in procedures which call for epidurals.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
Combined Spinal/Epidural (CSE) is a technique that combines the benefits of both spinal anesthesia and epidural anesthesia. It involves inserting a small spinal needle into the subarachnoid space to deliver a single dose of medication, and then placing an epidural catheter for continuous medication delivery. CSE can be used for procedures that require either spinal or epidural anesthesia, providing flexibility in anesthesia management. Therefore, the given statement is false, as CSE can be used for procedures that call for epidurals.

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50.

Which of the following is not a complication associated with the CSE technique?
- A.
  
  Severe Hypertension
- B.
  
  Catheter migration into spine
- C.
  
  Higher incidence of infection
- D.
  
  Pt may not safely ambulate
Correct Answer
A. Severe Hypertension

Explanation
Severe hypertension is not a complication associated with the CSE technique. The CSE technique, also known as combined spinal-epidural anesthesia, involves the administration of a spinal block followed by an epidural catheter placement. Complications commonly associated with this technique include catheter migration into the spine, a higher incidence of infection, and the possibility that the patient may not be able to safely ambulate. However, severe hypertension is not typically a complication of this technique.

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Regional Quiz 2 - Spinal And Epidural Study Test

Where would you expect the spinal canal to end on an adult patient?

Where you expect the Spinal Cord to end on an adult patient?

You have just performed spinal anesthesia and found you have a sympathetic blockade at the level of T6. Is this safe for your patient?

You have just performed spinal anesthesia and found you have a motor blockade at the level of T6. Is this safe for your patient?

You are performing an epidural on a with a large abdominal tumor, would you expect this to change your dose of anesthetic used?

After performing Spinal anesthesia you have a Sensory blockade at the level of T 10. You would expect to see a sympathetic blockade at the level of _____ and a motor blockade at the level of _____.

Which of the following patients is an Absolute contraindication to spinal anesthesia?

The angle of the scapula roughly correlates to which vertebrae?

Where is CSF produced?

Which area of the brain is responsible for motor function and movement away from painful stimuli?

How many pairs of spinal nerves do we have?

Which of the following carries all efferent signals heading out to the periphery?

Where do preganglionic fibers of the parasympathetic nervous system end?

What is the primary neurotransmitter of the parasympathetic nervous system?

You are the SRNA for a patient who has just been given Spinal anesthesia. The spinal goes higher than expected and the patient becomes profoundly bradycardic. What should you do first?

When the CSF if heavier then the LA injected, causing the LA to float up. The local anesthetic solution is said to be…

How would you mix a hyperbaric solution of bupivicaine?

After administering a hyperbaric solution of Local anesthetic for spinal anesthesia, what position would you place the pt into in order to achieve a level of T6-7 blockade?

How would you expect ascites to effect your level of blockade when giving spinal anesthesia?

How would you prepare your OR for a patient undergoing spinal anesthesia?

Which of the following is most frequently added to local anesthetic in order to prolong their duration of action?

Local anesthetics produce conduction blockade of neural impulses by preventing passage of chloride ions through selective ion chloride channels in nerve membranes.

Which of the following properly describes the midline approach to spinal anesthesia?

Which of the following properly describes the Taylor approach?

The posterior 1/3 of the spinal cord is supplied by…

Identify ligament #1 in the above photo.

Identify ligament #2 in the above photo.

Which of the following is not included in the epidural space?

Which of the following will not affect the level of epidural blockade?

If you wanted to increase the density of a block without effecting the spread, what could you do?

You have performed a thoracic epidural at level of T8 and want to achieve a T4 sensory block, how much volume of local anesthetic would you give?

You have performed an epidural at the level of L5 and want to achieve a sensory blockade up to level of T6. How much volume of local anesthetic would you give to achieve this?

What could you do, when performing an epidural block for a pt in labor, to differentially block sensory and pain fibers over larger muscle fibers?

How will increased age effect epidural anesthesia?

What is the proper technique for injection of anesthetic into epidural space?

Which of the following has been almost eliminated from use in epidural and spinal anesthesia due to it’s tendency to cause a differential blockade via profound muscle relaxation but weak sensory effects?

How will you know you are actually in the epidural space when inserting an epidural needle?

You are doing an epidural on a 30 yr old male prior to procedure. When you administer the test dose of lido with epi the pt complains of ringing in his ears and you see and increased HR on the monitor. Is it ok to proceed with the injection?

You are performing an epidural on a patient in labor. As you begin to administer your test dose you see pts heart rate go up. She is now breathing deeply and rubbing her stomach. Is it OK to proceed?

You are giving a test dose of lido with epi to a patient receiving an epidural. Within 3 minutes of injection the pt complains of numbness in their lower extremities. Is it OK to proceed with the injection?

You are giving an epidural to a pt up on the OB floor. As you insert the catheter the patient complains of feeling an electric shock sensation. What do you do?

Where would proper needle insertion be for a caudal block?

Which of the following techniques involves first insertion of epidural catheter, then the spinal being done one or two interspaces below the epidural?

Which of the following involves the ‘needle-through-needle technique’ and injection of spinal through a smaller spinal needle inserted through the epidural needles?

When injecting into an epidural catheter, how often do you need to aspirate?

Which of the following is used generally for spinal component of combined technique but not for epidural component?

Combined Spinal / Epidural can only be used safely for procedures in which a spinal was planned, but not in procedures which call for epidurals.

Which of the following is not a complication associated with the CSE technique?

After performing Spinal anesthesia you have a Sensory blockade at the level of T 10. You would expect to see a sympathetic blockade at the level of _ and a motor blockade at the level of _.