Regional Exam 1 - Anatomy & Physiology
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Questions and Answers

Which of the following is NOT a characteristic of peripheral nerves?

  • They are bundles of nerve fibers.
  • They are all similar in structure.
  • They are always myelinated. (correct)
  • They conduct impulses from one part of the body to another.

    • What is the basic unit of all nerves?

  • Axon
  • Neuron (correct)
  • Schwann cell
  • Myelin sheath

    • What is the function of the neurotransmitters released at the terminal enlargements of nociceptive afferent neurons?

  • To prevent the release of sensitizing chemicals
  • To conduct impulses to the CNS
  • To activate effector organs (correct)
  • To provide structural support for the neuron

    • What are the three types of fibers found in peripheral nerves?

    <p>Sensory, motor, autonomic (C)</p> Signup and view all the answers

    Which of the following is NOT a type of peripheral nerve based on anatomical location?

    <p>Cerebral (A)</p> Signup and view all the answers

    Which of the following statements accurately describes the role of the Na+/K+ pump in maintaining the resting membrane potential?

    <p>The Na+/K+ pump actively transports Na+ into the cell and K+ out of the cell, contributing to the negative charge inside the cell. (B)</p> Signup and view all the answers

    What is the primary function of the proteins embedded within the lipid bilayer of a nerve cell membrane?

    <p>To regulate the flow of ions across the membrane, facilitating the transmission of nerve impulses. (B)</p> Signup and view all the answers

    What happens during the depolarization phase of an action potential?

    <p>The membrane potential becomes more positive as sodium ions flow into the cell. (B)</p> Signup and view all the answers

    What is the threshold level in the context of an action potential?

    <p>The minimum level of depolarization required to trigger an action potential. (D)</p> Signup and view all the answers

    How do local anesthetics work to block the propagation of nerve impulses?

    <p>They directly block the flow of ions through the ion channels, preventing the transmission of nerve impulses. (A)</p> Signup and view all the answers

    Which ion movement is responsible for the depolarization phase of an action potential?

    <p>Inward movement of sodium ($Na^+$) ions (D)</p> Signup and view all the answers

    What is the primary role of the inward sodium ($Na^+$) current in the action potential?

    <p>To cause the rapid depolarization phase (C)</p> Signup and view all the answers

    Which of the following is TRUE regarding the repolarization phase of an action potential?

    <p>It is typically followed by a hyperpolarization phase (A), It is characterized by a decrease in the membrane potential (D)</p> Signup and view all the answers

    What is the relationship between the outward potassium ($K^+$) current and the rate of repolarization?

    <p>A weaker outward potassium current results in a slower repolarization (B)</p> Signup and view all the answers

    What is the main difference between the inward sodium ($Na^+$) current and the outward potassium ($K^+$) current in terms of their role in the action potential?

    <p>The sodium current causes depolarization, while the potassium current causes repolarization (D)</p> Signup and view all the answers

    Which of these local anesthetics is classified as an amide?

    <p>Ropivacaine (B)</p> Signup and view all the answers

    Which of the following is NOT a factor influencing plasma concentration of local anesthetics?

    <p>Patient's blood type (D)</p> Signup and view all the answers

    What is the maximum safe dose of bupivacaine for a 70 kg patient?

    <p>210 mg (A)</p> Signup and view all the answers

    Which of the following is an early sign of local anesthetic systemic toxicity (LAST)?

    <p>Numbness of the tongue (D)</p> Signup and view all the answers

    What is the recommended treatment for hypotension associated with spinal anesthesia?

    <p>Elevation of the legs (A)</p> Signup and view all the answers

    Which of the following is a common complication of spinal anesthesia?

    <p>All of the above (D)</p> Signup and view all the answers

    How long should a patient discontinue taking clopidogrel (Plavix) before undergoing a neuraxial block?

    <p>5-7 days (D)</p> Signup and view all the answers

    What is the mechanism by which spinal anesthesia causes hypotension?

    <p>Decreased systemic vascular resistance (A)</p> Signup and view all the answers

    What is the recommended hold time for low-dose LMWH (Lovenox) before placing or removing a neuraxial catheter?

    <p>12 hours (A)</p> Signup and view all the answers

    Which of the following is a true statement regarding the Bezold-Jarisch reflex?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following medications is contraindicated within 4 weeks of surgery due to its potential for bleeding complications?

    <p>Tirofiban (Aggrastat) (D)</p> Signup and view all the answers

    What is the recommended dose of lidocaine for a spinal anesthetic to T10?

    <p>50-75 mg (B)</p> Signup and view all the answers

    What is the recommended hold time for intravenous heparin (high dose >20,000 daily) before placing a neuraxial catheter?

    <p>24 hours (A)</p> Signup and view all the answers

    What is the typical onset of sensory block with a 3% chloroprocaine epidural?

    <p>Fast (D)</p> Signup and view all the answers

    Which of the following signs or symptoms is NOT typically associated with inadvertent intrathecal placement of lidocaine during a spinal injection?

    <p>Increased heart rate (HR) ≥ 20–30 bpm within 30–60 seconds (B)</p> Signup and view all the answers

    Which of the following medications is contraindicated in the treatment of LAST?

    <p>Calcium channel blockers (A)</p> Signup and view all the answers

    What is the recommended hold time for ginseng before a regional anesthesia procedure?

    <p>34 hours (C)</p> Signup and view all the answers

    What is the recommended initial dose for an epidural anesthetic?

    <p>1-2 mL/segment to be blocked (A)</p> Signup and view all the answers

    What is the purpose of a test dose for epidural anesthesia?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the recommended hold time for dabigatran (Pradaxa) before placing a neuraxial catheter?

    <p>5 days (D)</p> Signup and view all the answers

    What is the recommended restarting time for low-dose LMWH after removal of a neuraxial catheter?

    <p>12 hours (D)</p> Signup and view all the answers

    Which of the following is a common treatment for postdural puncture headache?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the recommended dose of intralipid for a 60 kg patient with LAST who is unresponsive to standard resuscitation procedures?

    <p>90 mL (D)</p> Signup and view all the answers

    Which of the following medications is associated with an increased risk of bleeding when used in conjunction with neuraxial blocks?

    <p>Warfarin (B)</p> Signup and view all the answers

    What is the appropriate action if blood is found in the catheter during neuraxial placement?

    <p>Delay the procedure for 24 hours. (D)</p> Signup and view all the answers

    What is the primary mechanism of hypotension associated with spinal anesthesia?

    <p>All of the above (D)</p> Signup and view all the answers

    Which local anesthetic is typically used for short-acting spinal anesthesia at a 10% concentration?

    <p>Procaine (C)</p> Signup and view all the answers

    Which local anesthetic is known for its rapid onset and long duration of action, particularly when administered for spinal anesthesia?

    <p>Tetracaine (D)</p> Signup and view all the answers

    What is the primary application of Chloroprocaine, as mentioned in the text?

    <p>Epidural anesthesia for short procedures (A)</p> Signup and view all the answers

    Which local anesthetic is the most widely used and has a broad range of applications, including infiltration, peripheral nerve blocks, spinal, and epidural anesthesia?

    <p>Lidocaine (B)</p> Signup and view all the answers

    Which local anesthetic is known for its low potency, slow onset, and short duration of action, making it less frequently utilized for peripheral nerve blocks or epidurals?

    <p>Procaine (D)</p> Signup and view all the answers

    Which of these local anesthetics is a hyperbaric solution that requires mixing with 10% glucose?

    <p>Tetracaine (D)</p> Signup and view all the answers

    What is the reason all local anesthetics have a faster onset when administered for spinal anesthesia, compared to other methods like peripheral nerve blocks?

    <p>Both A and B (A)</p> Signup and view all the answers

    Which local anesthetic is commonly used for urologic procedures, as mentioned in the text?

    <p>Lidocaine (B)</p> Signup and view all the answers

    Study Notes

    Regional Exam 1 Objectives - Anatomy and Physiology

    • Identify anatomical landmarks for neuraxial anesthesia (spinal, epidural, caudal).
      • C7: Most prominent cervical spinal process.
      • T7: Opposite the inferior angle of the scapula.
      • L4-L5: Line connecting the iliac crests (Tuffier's line).
    • Lumbar region (midline): Skin to Tuffier's line = 4-6 cm.
    • Tuffier's line = 5-6 mm (0.5 cm) thick.
    • Epidural space in the sacral region (caudal space): Sacral portion of the epidural space.
    • Needle inserted through sacrococcygeal ligament into the sacral hiatus.
    • Sacral hiatus: Notch above the coccyx, between sacral cornua.
    • Landmarks for caudal epidural space: Easier in children, more difficult/impossible in adults (calcification).

    Spinal Anatomy: Midline Approach

    • Skin.
    • Subcutaneous tissue.
    • Supraspinous ligament.
    • Intraspinous ligament.
    • Ligamentum flavum.
    • Dura mater.
    • Subdural space.
    • Subarachnoid space.
    • Arachnoid mater.

    Spinal Anatomy: Paramedian Approach

    • Similar to midline approach but from a paramedian position.
    • Stops at ligamentum flavum, before the dura mater.

    Spinal Curvature and Neuraxial Anesthesia

    • Spinal curvature in supine position:

      • High points/apex (lordosis): C5 and L3-L5.
      • Low points/trough (kyphosis): T4-T7 and S2.

    • Scoliosis: Lateral curvature of the spine.

    • Kyphosis: Excessive posterior curve.

    • Lordosis: Hollowing of the back (in obesity/pregnancy).

    Spinal Anesthesia - Factors Affecting Local Anesthetic Spread

    • Local anesthetic uptake from the subarachnoid space into neuronal tissue affected by 4 factors.
      • Concentration in CSF.
      • Dose of Local Anesthetic (LA).
      • Density of LA in relation to CSF (hypobaric, isobaric, hyperbaric).
      • Flow in CSF column.

    Spinal Anesthesia - Dermatomal Levels and Clinical Relevance

    • Dermatomes: Area of skin innervated by a single spinal nerve.
    • T10: Umbilicus.
    • T6: Xiphoid process.
    • T4: Nipples.

    Peripheral Nerve Anatomy

    • Peripheral nerves are bundles of nerve fibers (axons).
    • Connective tissue layers organize nerve fibers into fascicles.
    • Endoneurium: Surrounds individual nerve fibers.
    • Perineurium: Surrounds fascicles.
    • Epineurium: Covers the entire nerve.

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    Anatomy and Physiology Past Paper Objectives Notes PDF

    Description

    Test your knowledge on anatomical landmarks crucial for neuraxial anesthesia. This quiz covers key spinal anatomy and identification of specific region landmarks, including lumbar and sacral spaces. Perfect for students in medical or nursing programs focusing on anatomy and physiology.

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