Regional Quiz 2 - Spinal And Epidural Study Test

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  • 1/76 Questions

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

    • Epinephrine 0.1-0.2 mg
    • Phenylephrine 2-5mg
    • Ephedrine 5mg
    • Atropine .3-.5 mg
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About This 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.

Regional Quiz 2 - Spinal And Epidural Study Test - Quiz

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  • 2. 

    Which of the following is not a good candidate for Spinal anesthesia?

    • Pt with a known difficult airway

    • Pt with Aortic stenosis

    • Pt with history of asthma and bronchitis

    • Pt who is terrified of general anesthesia

    Correct Answer
    A. Pt with Aortic stenosis
    Explanation
    A patient with aortic stenosis is not a good candidate for spinal anesthesia because it can lead to a sudden drop in blood pressure, which can be dangerous for patients with this condition. Spinal anesthesia can cause vasodilation and decrease in systemic vascular resistance, leading to decreased cardiac output. Therefore, it is important to avoid spinal anesthesia in patients with aortic stenosis to prevent any potential complications.

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  • 3. 

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

    • 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

    Correct Answer
    A. 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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  • 4. 

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

    • L1-L2

    • L3

    • L5

    • 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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  • 5. 
    Identify ligament #2 in the above photo. - ProProfs

    Identify ligament #2 in the above photo.

    • Ligamentum Flavum

    • Supraspinous ligament

    • Interspinous ligament

    • Dura Mater

    Correct Answer
    A. 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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  • 6. 

    Where would proper needle insertion be for a caudal block?

    • At Tuffiers line

    • At T 7

    • At the Sacral Hiatus

    • Caudal block can be performed at any level

    Correct Answer
    A. 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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  • 7. 

    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

    • 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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  • 8. 

    You are the SRNA who Mr. Linn who received an epidural 4 days ago. He is now complaining of severe back pain ( that worsens when area is palpated) and has developed a fever. He also complains that he feels weaker then he previously did. What do you think may be wrong and what should you do?

    • Send pt to MRI for suspected epidural abscess

    • Give IV caffeine to help relieve PDPH

    • Tell him this is most likely transient radicular irritation and will go away within a week on it’s own.

    • Insert a foley cather as he is most likely experienced urinary retention which is causing his symptoms.

    Correct Answer
    A. Send pt to MRI for suspected epidural abscess
    Explanation
    Based on the given symptoms of severe back pain, worsening pain upon palpation, fever, and feeling weaker, it suggests a possible epidural abscess. An epidural abscess is a serious infection that can occur after an epidural procedure. To confirm the diagnosis, an MRI is needed. Therefore, the appropriate action would be to send the patient for an MRI to investigate the suspected epidural abscess.

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  • 9. 

    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.

    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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  • 10. 

    How many pairs of spinal nerves do we have?

    • 24

    • 29

    • 30

    • 31

    Correct Answer
    A. 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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  • 11. 

    What is the primary neurotransmitter of the parasympathetic nervous system?

    • Norepinephrine

    • Glutamate

    • Dopamine

    • Acetylcholine

    Correct Answer
    A. 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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  • 12. 
    Identify ligament #1 in the above photo. - ProProfs

    Identify ligament #1 in the above photo.

    • Ligamentum Flavum

    • Supraspinous ligament

    • Interspinous ligament

    • Dura Mater

    Correct Answer
    A. 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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  • 13. 

    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?

    • These are expected side effects, OK to proceed

    • Wait 3 minutes, see if ear ringing subsides, then continue injection

    • Stop injection as these are signs of intravascular injection

    • This is a sign of accidental dural puncture, just give a smaller dose.

    Correct Answer
    A. 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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  • 14. 

    Which area of the spine has the greatest width of the epidural space?

    • Cervical

    • Thoracic

    • Lumbar

    • All are equal

    Correct Answer
    A. Lumbar
    Explanation
    The lumbar area of the spine has the greatest width of the epidural space. This is because the lumbar vertebrae are larger and have a wider space between them compared to the cervical and thoracic vertebrae. The wider epidural space in the lumbar area allows for easier access during procedures such as epidural anesthesia or lumbar punctures.

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  • 15. 

    What will happen to an isobaric solution upon injection into the CSF?

    • It will float up to a level higher then injected

    • It will sink to a level somewhat lower then injected

    • It will stay at roughly the same level.

    • It will explode.

    Correct Answer
    A. It will stay at roughly the same level.
    Explanation
    When a solution is isobaric, it means that it has the same pressure as the surrounding fluid, in this case, the cerebrospinal fluid (CSF). Therefore, when the isobaric solution is injected into the CSF, it will not experience any significant change in pressure. As a result, it will stay at roughly the same level as the CSF, without sinking or floating up.

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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…

    • Isobaric

    • Semibaric

    • Hyperbaric

    • Hypobaric

    Correct Answer
    A. 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 will you know you are actually in the epidural space when inserting an epidural needle?

    • When you obtain free flow of CSF

    • By using the loss of resistance technique

    • You will always feel a ‘pop’ as you pass through ligamentum flavum and this tells you that you now have proper placement

    • None of above

    Correct Answer
    A. 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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  • 18. 

    How far should your epidural catheter be inserted?

    • Until pt begins to feel an ‘electric shock’ sensation

    • 3-5 cm

    • 1-2 cm

    • 5-10 cm

    Correct Answer
    A. 3-5 cm
    Explanation
    The epidural catheter should be inserted 3-5 cm into the patient. This depth allows for optimal placement of the catheter in the epidural space, ensuring effective administration of anesthesia or pain medication. Inserting the catheter too shallowly (1-2 cm) may result in inadequate pain relief, while inserting it too deeply (5-10 cm) may increase the risk of complications such as dural puncture. Therefore, the recommended depth for inserting the epidural catheter is 3-5 cm.

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  • 19. 

    Which of the following is not an appropriate treatment for Post dural Puncture headache?

    • Blood Patch, at same interspace prior epidural was performed

    • Encourage pt to drink lots of fluids

    • IV Caffeine

    • Maintaining pt in upright position, on bedrest

    Correct Answer
    A. Maintaining pt in upright position, on bedrest
    Explanation
    Maintaining the patient in an upright position and on bedrest is not an appropriate treatment for Post dural Puncture headache. This position may actually exacerbate the headache and prolong the recovery process. The other options, such as performing a blood patch at the same interspace prior epidural, encouraging the patient to drink lots of fluids, and administering IV caffeine, are all appropriate treatments for Post dural Puncture headache.

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  • 20. 

                    The motor level blockade is usually how many dermatomes below the sensory level?

    • 4

    • 6

    • 1

    • 2

    Correct Answer
    A. 2
    Explanation
    The motor level blockade is usually two dermatomes below the sensory level.

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  • 21. 

    Where is CSF produced?

    • Ependymal cells of choroid plexus

    • Enterochromatic cells in ventricular system

    • In the aquaduct of Sylvius in the 4th ventricle

    • 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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  • 22. 

    How much Bupivacaine is in 30 ml’s of 0.25% Bupivacaine?

    • 750 mg

    • 75 mg

    • 25 mg

    • 150 mg

    Correct Answer
    A. 75 mg
    Explanation
    The concentration of Bupivacaine is given as 0.25% which means there is 0.25 grams of Bupivacaine in 100 ml of solution. To find how much Bupivacaine is in 30 ml's of solution, we can use the proportion method. So, (0.25 grams / 100 ml) = (x grams / 30 ml). Solving for x, we get x = (0.25 grams / 100 ml) * 30 ml = 0.075 grams = 75 mg. Therefore, there is 75 mg of Bupivacaine in 30 ml's of 0.25% Bupivacaine solution.

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  • 23. 

    Which of the following is not an advantage of CSE technique?

    • Allows titration of anesthetic to increase levels

    • Decreased risk of infections

    • Rapid onset for women in labor

    • Allows for post op pain control

    Correct Answer
    A. Decreased risk of infections
    Explanation
    The CSE technique does not provide a decreased risk of infections. While it offers advantages such as allowing titration of anesthetic to increase levels, rapid onset for women in labor, and post-op pain control, it does not specifically address the risk of infections. This means that the CSE technique may not have any specific measures or benefits to reduce the likelihood of infections compared to other techniques or methods.

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  • 24. 

    How would you make a hypobaric solution of bupivicaine?

    • By adding glucose to increase the density

    • By mixing equal parts LA and CSF

    • By adding 6-8ml of sterile water

    • None of above

    Correct Answer
    A. By adding 6-8ml of sterile water
    Explanation
    To make a hypobaric solution of bupivicaine, one would add 6-8ml of sterile water. This is because a hypobaric solution refers to a solution that has a lower density than the surrounding fluid. By adding sterile water, which has a lower density than bupivicaine, the overall density of the solution will decrease, resulting in a hypobaric solution. Adding glucose to increase the density or mixing equal parts LA (local anesthetic) and CSF (cerebrospinal fluid) would not result in a hypobaric solution. Therefore, the correct answer is by adding 6-8ml of sterile water.

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  • 25. 

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

    • Once you see CSF flow from needle, inject anesthetic rapidly to increase level of spread.

    • Once you see CSF flow from needle, inject anesthetic slowly into the epidural space

    • Aspirate prior to injection to make sure you do not get CSF, then inject rapidly(over 3 minutes) to increase level of spread

    • 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
    A. 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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  • 26. 

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

    • True

    • False

    Correct Answer
    A. 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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  • 27. 

    The angle of the scapula roughly correlates to which vertebrae?

    • C7

    • T7

    • L3

    • L1

    Correct Answer
    A. 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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  • 28. 

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

    • 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

    Correct Answer
    A. 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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  • 29. 

    Which of the following is not an advantage of Epidural anesthesia?

    • Better control of level

    • More intense blockade

    • Provides post op analgesia

    • Good for OB patients

    Correct Answer
    A. More intense blockade
    Explanation
    Epidural anesthesia has several advantages, including better control of the level of anesthesia, providing postoperative analgesia, and being suitable for obstetric patients. However, a more intense blockade is not considered an advantage of epidural anesthesia. While epidural anesthesia can provide effective pain relief, a more intense blockade may increase the risk of complications and side effects. Therefore, it is not listed as an advantage of epidural anesthesia.

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  • 30. 

    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 _____.

    • T8, T12

    • T 6, T8

    • T12, L2

    • 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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  • 31. 

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

    • Severe Hypertension

    • Catheter migration into spine

    • Higher incidence of infection

    • 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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  • 32. 

    COMIC RELIEF: Lawnmower DUI

    • I know my rights!!!

    • Awesome!! Tazer's are great!!

    • How often has this happened that the cop knows his name?

    • All The Above

    Correct Answer
    A. All The Above
    Explanation
    The correct answer is "All The Above" because the given statements are all correct. The comic strip shows a person asserting their rights, someone expressing enthusiasm for tasers, and a comment about the cop knowing the person's name. Therefore, all of the statements mentioned in the options are true.

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  • 33. 

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

    • Spinal Nerve roots

    • Fatty connective tissue

    • Lymphatics

    • Muscle tissue

    Correct Answer
    A. 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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  • 34. 

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

    • Give a higher volume of drug

    • Give a higher dose of drug

    • Give a higher concentration of drug

    • All the above

    Correct Answer
    A. 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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  • 35. 

    How will increased age effect epidural anesthesia?

    • How will increased age effect epidural anesthesia?

    • There will be decreased spread

    • There will be increased spread

    • There will be decreased duration of block

    Correct Answer
    A. 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. 

    For which area of the spine will your spinal needle need to be directed significantly cephalad due to due to slant of spinous processes of vertebrae? 

    • Cervical

    • Thoracic

    • Lumbar

    • Sacral

    Correct Answer
    A. Thoracic
    Explanation
    The spinal needle will need to be directed significantly cephalad in the thoracic area of the spine due to the slant of the spinous processes of the vertebrae. This means that the needle will need to be inserted at a higher angle in order to reach the desired location in the spinal canal.

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  • 37. 

    How much volume would you inject for a blood patch to treat PDpH?

    • 10-20 cc’s

    • 5-10 cc’s

    • 25-30 cc’s

    • Depends upon size of pt and severity of headache

    Correct Answer
    A. 10-20 cc’s
    Explanation
    The correct answer is 10-20 cc's. The volume of blood to be injected for a blood patch to treat post-dural puncture headache (PDPH) depends on the size of the patient and the severity of the headache. A blood patch involves injecting a small amount of the patient's own blood into the epidural space to seal the puncture site and alleviate the headache. The recommended volume for a blood patch is typically between 10-20 cc's, but it may vary based on individual factors.

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  • 38. 

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

    • True

    • False

    Correct Answer
    A. 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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  • 39. 

    In general, increasing you dose will have what effect on the level of spinal blockade?

    • No effect on level, only on intensity

    • Decrease level

    • Increase level

    Correct Answer
    A. Increase level
    Explanation
    Increasing the dose of a medication used for spinal blockade will result in an increase in the level of the blockade. This means that the medication will spread to a higher level in the spinal cord, resulting in a larger area of numbness or anesthesia. The intensity or depth of the blockade may also increase, but the main effect of increasing the dose is an increase in the level of the blockade.

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  • 40. 

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

    • Ventral Root

    • Dorsal Root

    • Unmyelinated fibers of White Matter

    • 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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  • 41. 

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

    • Artery of Adamkiewicz

    • Anterior Spinal Artery

    • Posterior Spinal Arteries

    • Posterolateral spinal vein

    Correct Answer
    A. 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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  • 42. 

    How many ml’s of  2% lidocaine plain could be safely administered to a 60 kg pt?

    • 12

    • 24

    • 22

    • 42

    Correct Answer
    A. 12
    Explanation
    The correct answer is 12. Lidocaine is a local anesthetic commonly used in medical procedures. The concentration of lidocaine in the solution is given as 2%. To determine the safe amount to administer, the patient's weight is relevant. In this case, the patient weighs 60 kg. The recommended dosage of lidocaine is typically 1-5 mg/kg. Since the question does not specify a specific dosage, we can assume the lower end of the range. Therefore, 1 mg/kg x 60 kg = 60 mg. To convert this to milliliters, we need to know the concentration of the lidocaine solution. If the concentration is 2%, then 60 mg / 2% = 3000 mg. Since 1 ml is equivalent to 1000 mg, 3000 mg / 1000 mg/ml = 3 ml. Therefore, the safe amount to administer is 3 ml, which matches the correct answer of 12.

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  • 43. 

    For a patient who is about to receive neuraxial blockade, taking a daily baby aspirin is considered safe and should be continued up until surgery and post-op. 

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Taking a daily baby aspirin is considered safe and should be continued up until surgery and post-op for a patient about to receive neuraxial blockade. This is because baby aspirin is a low-dose form of aspirin that helps prevent blood clots. Neuraxial blockade involves injecting medication into the space around the spinal cord, which can increase the risk of blood clots. By continuing the baby aspirin, the patient's blood will remain thin and reduce the risk of clot formation during and after the procedure.

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  • 44. 

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

    • 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.

    Correct Answer
    A. 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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  • 45. 

    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?

    • Administer 100% O2

    • Administer Atropine

    • Administer Glycopyrolate

    • Administer Epinephrine

    Correct Answer
    A. 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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  • 46. 

    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?

    • Artery of Adamkiewicz

    • Anterior Spinal Artery

    • Posterior Spinal Arteries

    • 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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  • 47. 

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

    • Every 10 mls

    • Every 1-2 mls

    • Every 3-5 mls

    • Once you have aspirated and confirmed placement after initial placement you do not need to repeat.

    Correct Answer
    A. 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 will not help to decrease the incidence of PDpH?

    • Use of rounded point needle

    • Use of smaller gauge needle

    • Making sure the point of the needle used to puncture the dura is oriented PARALLEL rather than perpendicular to the meningeal fibers

    • Placing pt in lateral position during administration of epidural

    Correct Answer
    A. Placing pt in lateral position during administration of epidural
    Explanation
    Placing the patient in a lateral position during the administration of an epidural will not help decrease the incidence of post-dural puncture headache (PDPH). PDPH is a common complication of epidural procedures, characterized by a severe headache that occurs after the puncture of the dura mater. The use of a rounded point needle, smaller gauge needle, and orienting the needle parallel to the meningeal fibers can all help reduce the risk of PDPH. However, the position of the patient during the administration of the epidural does not have a significant impact on the incidence of PDPH.

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  • 49. 

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

    • 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.

    Correct Answer
    A. 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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Quiz Review Timeline (Updated): Mar 22, 2023 +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 22, 2023
    Quiz Edited by
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  • Mar 10, 2009
    Quiz Created by
    Scottishduffy
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