Regional - Quiz 2

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Regional - Quiz 2

A review of material for test 3. Contains spinal, epidural and combined technique. Not a whole lot from the last week's ppt as Vince really didn't cover it.


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

  • 2. 
    Where you expect the Spinal Cord to end on an adult patient?
    • A. 

      L1-L2

    • B. 

      L3

    • C. 

      L5

    • D. 

      Sacral Hiatus

  • 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.

  • 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.

  • 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.

  • 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

  • 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.

  • 8. 
    The angle of the scapula roughly correlates to which vertebrae?
    • A. 

      C7

    • B. 

      T7

    • C. 

      L3

    • D. 

      L1

  • 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

  • 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

  • 11. 
    How many pairs of spinal nerves do we have?
    • A. 

      24

    • B. 

      29

    • C. 

      30

    • D. 

      31

  • 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

  • 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

  • 14. 
    What are the primary neurotransmitters of the sympathetic nervous system? (two answers)
    • A. 

      Norepinephrine

    • B. 

      Acetylcholine

    • C. 

      Serotonin

    • D. 

      Dopamine

  • 15. 
    What is the primary neurotransmitter of the parasympathetic nervous system?
    • A. 

      Norepinephrine

    • B. 

      Glutamate

    • C. 

      Dopamine

    • D. 

      Acetylcholine

  • 16. 
    Upon injection of local anesthetic for spinal anesthesia, which fibers are blocked first?
    • A. 

      C fibers of sympathetic system

    • B. 

      Alpha delta fibers of sympathetic system

    • C. 

      B fibers of sympathetic system

    • D. 

      Alpha delta fibers of parasympathetic system

  • 17. 
    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

  • 18. 
    Which of the following will not effect the level of spinal anesthesia?
    • A. 

      Contour of Spinal Cord

    • B. 

      Dosage of LA used

    • C. 

      Cardiac status of pt

    • D. 

      Intrabdominal pressure

  • 19. 
    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

  • 20. 
    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

  • 21. 
    How would you make an isobaric 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

  • 22. 
    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

  • 23. 
    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

  • 24. 
    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

  • 25. 
    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

  • 26. 
    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

  • 27. 
    How do vasoconstrictors prolong spinal anesthesia?
    • A. 

      By blocking passage of sodium ions into nerve cells

    • B. 

      Through beta1 agonistic effects

    • C. 

      Through vasoconstriction and decreasing vascular absorption

    • D. 

      All the above

  • 28. 
    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

  • 29. 
    Which of the following properly describes the paramedian 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

  • 30. 
    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

  • 31. 
    Which of the following is not a good candidate for spinal anesthesia?
    • A. 

      Patient with severe COPD and history of smoking

    • B. 

      Patient with history of DVT undergoing a hip fx repair

    • C. 

      OB patient undergoing a C-section

    • D. 

      A hypovolemic patient undergoing repair of leg fx’s

  • 32. 
    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

  • 33. 
    The anterior two thirds of the spinal cord is supplied by the _______ which if formed from the vertebral artery at the base of the skull.
    • A. 

      Artery of Adamkiewicz

    • B. 

      Anterior Spinal Artery

    • C. 

      Posterior Spinal Arteries

    • D. 

      Posterolateral spinal vein

  • 34. 
    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

  • 35. 
    Identify ligament #1 in the above photo.
    • A. 

      Ligamentum Flavum

    • B. 

      Supraspinous ligament

    • C. 

      Interspinous ligament

    • D. 

      Dura Mater

  • 36. 
    Identify ligament #2 in the above photo.
    • A. 

      Ligamentum Flavum

    • B. 

      Supraspinous ligament

    • C. 

      Interspinous ligament

    • D. 

      Dura Mater

  • 37. 
    Identify ligament #3 in the above photo.
    • A. 

      Ligamentum Flavum

    • B. 

      Supraspinous ligament

    • C. 

      Interspinous ligament

    • D. 

      Dura Mater

  • 38. 
    Which of the following is not included in the epidural space?
    • A. 

      Spinal Nerve roots

    • B. 

      Fatty connective tissue

    • C. 

      Lymphatics

    • D. 

      Muscle tissue

  • 39. 
    The initial blockade from an epidural is probably a result of anesthetic blockade at spinal root within the dural sleeves
    • A. 

      True

    • B. 

      False

  • 40. 
    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

  • 41. 
    What is the most important determinant of the spread of an epidural block?
    • A. 

      Volume of drug

    • B. 

      Injection site

    • C. 

      Position of patient

    • D. 

      Concentration of drug

  • 42. 
    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

  • 43. 
    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

  • 44. 
    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

  • 45. 
    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

  • 46. 
    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

  • 47. 
    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.

  • 48. 
    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

  • 49. 
    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

  • 50. 
    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.

  • 51. 
    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.

  • 52. 
    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

  • 53. 
    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.

  • 54. 
    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

  • 55. 
    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

  • 56. 
    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

  • 57. 
    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.

  • 58. 
    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.

  • 59. 
    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

  • 60. 
    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

  • 61. 
    When converting an epidural into a c-section(non-emergent) what should you do first?
    • A. 

      Start bupivacaine 0.125% infusion at 10-12 ml hour

    • B. 

      Administer chloroprocaine 3%

    • C. 

      Administer fentanyl 25-50 mcg intrathecally

    • D. 

      Administer 3ml of 1.5% lidocaine with epi

  • 62. 
    How would you make a hypobaric 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

  • 63. 
    Which of the following is not a good candidate for Spinal anesthesia?
    • A. 

      Pt with a known difficult airway

    • B. 

      Pt with Aortic stenosis

    • C. 

      Pt with history of asthma and bronchitis

    • D. 

      Pt who is terrified of general anesthesia

  • 64. 
    How many ml’s of  2% lidocaine plain could be safely administered to a 60 kg pt?
    • A. 

      12

    • B. 

      24

    • C. 

      22

    • D. 

      42

  • 65. 
    How much Bupivacaine is in 30 ml’s of 0.25% Bupivacaine?
    • A. 

      750 mg

    • B. 

      75 mg

    • C. 

      25 mg

    • D. 

      150 mg

  • 66. 
    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. 
    • A. 

      True

    • B. 

      False

  • 67. 
    A patient taking Coumadin should have the drug discontinued a minimum of how many days prior to receiving nueraxial blockade?
    • A. 

      14 days

    • B. 

      7 days

    • C. 

      5 days

    • D. 

      3 days

  • 68. 
    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?
    • A. 

      Send pt to MRI for suspected epidural abscess

    • B. 

      Give IV caffeine to help relieve PDPH

    • C. 

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

    • D. 

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

  • 69. 
    COMIC RELIEF: Lawnmower DUI
    • A. 

      I know my rights!!!

    • B. 

      Awesome!! Tazer's are great!!

    • C. 

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

    • D. 

      All The Above

  • 70. 
    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? 
    • A. 

      Cervical

    • B. 

      Thoracic

    • C. 

      Lumbar

    • D. 

      Sacral

  • 71. 
    In general, increasing you dose will have what effect on the level of spinal blockade?
    • A. 

      No effect on level, only on intensity

    • B. 

      Decrease level

    • C. 

      Increase level

  • 72. 
    How much CSF is in the spinal cord at any given time?
    • A. 

      30-50 cc’s

    • B. 

      150 cc’s

    • C. 

      80 cc’s

    • D. 

      None of above

  • 73. 
    Which area of the spine has the greatest width of the epidural space?
    • A. 

      Cervical

    • B. 

      Thoracic

    • C. 

      Lumbar

    • D. 

      All are equal

  • 74. 
    How far should your epidural catheter be inserted?
    • A. 

      Until pt begins to feel an ‘electric shock’ sensation

    • B. 

      3-5 cm

    • C. 

      1-2 cm

    • D. 

      5-10 cm

  • 75. 
    Which of the following will not help to decrease the incidence of PDPH?
    • A. 

      Use of rounded point needle

    • B. 

      Use of smaller gauge needle

    • C. 

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

    • D. 

      Placing pt in lateral position during administration of epidural

  • 76. 
    How much volume would you inject for a blood patch to treat PDPH?
    • A. 

      10-20 cc's

    • B. 

      5-10 cc's

    • C. 

      25-30 cc's

    • D. 

      Depends upon size of pt and severity of headache

  • 77. 
    Which of the following is not an advantage of Epidural anesthesia?
    • A. 

      Better control of level

    • B. 

      More intense blockade

    • C. 

      Provides post op analgesia

    • D. 

      Good for OB patients

  • 78. 
    After accidental administration of total spinal anesthesia, if the patients vital signs are stable then surgery may proceed. 
    • A. 

      True

    • B. 

      False

  • 79. 
    When taking the thoracic approach to epidural anesthesia you should reduce your volume by roughly how much due to smaller epidural space?
    • A. 

      15-20%

    • B. 

      30-50%

    • C. 

      60-70%

    • D. 

      No need to reduce volume, just use a hyperbaric solution

  • 80. 
    Where would you place your epidural catheter for a labor epidural?
    • A. 

      L2

    • B. 

      T 12

    • C. 

      L3

    • D. 

      L5

  • 81. 
    Where would you place your epidural catheter for a pt having a cholecystectomy?
    • A. 

      L2

    • B. 

      L3

    • C. 

      T 12

    • D. 

      L5

  • 82. 
    What will happen to an isobaric solution upon injection into the CSF?
    • A. 

      It will float up to a level higher then injected

    • B. 

      It will sink to a level somewhat lower then injected

    • C. 

      It will stay at roughly the same level.

    • D. 

      It will explode.