Regional Anesthesia

Questions

DIRECTIONS (Questions 64-93): Each of the numbered items or incomplete statements in this section is followed by answers or by completions of the statement. Select the ONE lettered answer or completion that is BEST in each case.

64. A 73-year-old man undergoes a descending thoracic aortic aneurism repair. Following the surgical repair, the patient is unable to move his legs. Perfusion to the spinal cord appears to have been compromised during the repair. Which one of the following does NOT supply blood to the spinal cord?

(A) Anterior spinal artery

(B) Posterior spinal arteries

(D) Anterior radicular arteries

(E) Vertebral arteries

65. A 52-year-old female undergoes a right total knee arthroplasty. Her preference is to have an epidural catheter placed for postoperative analgesia. When threading a catheter into the epidural space, the anterior border of the epidural space may be encountered. The tissue creating the anterior border of the epidural space is

(A) anterior longitudinal ligament

(B) posterior longitudinal ligament

(D) dura

(E) transverse process

66. A lumbar plexus block is performed in a 72-year-old man scheduled to undergo a total hip arthroplasty. Which nerve does NOT originate from the lumbar plexus?

(A) Iliohypogastic

(B) Ilioinguinal

(D) Genitofemoral

(E) Sural

67. A 25-year-old female undergoing an elective cesarean section agrees to a spinal anesthetic. When performing a spinal anesthetic, the anesthesiologist must be knowledgeable of the fact that cerebral spinal fluid (CSF) is located between which two tissue layers?

(A) Pia and arachnoid

(B) Pia and dura

(D) Dura and arachnoid

(E) Dura and spinal cord

68. A 44-year-old female undergoes a right infraclavicular block for a right ulnar nerve transposition surgery at the elbow. The musculocutaneous nerve appears to have been missed. The musculocutaneous nerve usually emerges from the

(A) lateral cord

(B) inferior cord

(D) posterior division

(E) axillary nerve

69. A 22-year-old male presents for left hand reconstructive surgery. You discuss performing an axillary brachial plexus block. After performing an axillary brachial plexus block for forearm surgery, the nerve that will most likely need to be blocked by a separate injection is the

(A) axillary nerve

(B) suprascapular nerve

(D) musculocutaneous nerve

(E) median nerve

70. The normal bony vertebral column is made up of how many total vertebrae?

(A) 27

(B) 29

(D) 33

(E) 35

71. A 72-year-old man presents for a total shoulder arthroplasty. He undergoes a continuous interscalene block utilizing a traditional landmark technique. Bone is contacted within 2 cm of the skin that likely represents the

(A) first rib

(B) clavicle

(D) transverse process

(E) vertebral body

DIRECTIONS: Use the following scenario to answer Questions 72-74: An 18-year-old male sustained an open right ulna forearm fracture after slipping on ice. He presented for open reduction and internal fixation. He undergoes a peripheral nerve block for surgical anesthesia with 20 mL of 0.5% bupivacaine. The following ultrasound image is obtained:

72. After successful completion of the block, all of the following are expected to occur on the ipsilateral side EXCEPT inability to

(A) flex the wrist

(B) shrug the shoulder

(D) flex the arm at the elbow

(E) extend the arm at the elbow

73. The patient reports pain during skin incision on the ulnar side of his distal forearm. The most likely reason is the failure to

(A) anesthetize the lateral antebrachial cutaneous nerve

(B) advance the needle to the area represented by the “X”

(D) anesthetize the medial brachial cutaneous nerve

(E) advance the needle to the area represented by the arrow

74. If the needle is advanced to the area depicted by the arrow, which one of the following may occur?

(A) Inability to further advance the needle

(B) A complete and dense surgical block

(D) An intravascular injection

(E) Successful blockade of the inferior trunk of the brachial plexus

75. A 42-year-old male presents with neck pain of 1-year duration. He undergoes a cervical epidural steroid injection for what is presumed to be herniation of the inner contents of the intervertebral disk that resulted in inflammation. The inner contents of the intervertebral disk called is also called the

(A) annulus fibrosus

(B) ligamentum flavum

(D) posterior longitudinal ligament

(E) facet joint

76. A 41-year-old female undergoes right shoulder arthroscopy utilizing an interscalene block as the surgical anesthetic. Upon making a small skin incision on the cape of the shoulder, the patient reports feeling the painful incision. The skin on the top of the shoulder is innervated by which nerve?

(A) Radial

(B) Supraclavicular

(D) Median

(E) Ulnar

77. A 72-year-old male presents for repair of a distal humerus fracture. The patient prefers a regional anesthetic for surgery and a brachial plexus block is performed. The organization of the brachial plexus starting proximally in the neck and traveling distally to the axilla is

(A) trunks, divisions, roots, cords, branches

(B) divisions, trunks, roots, cords, branches

(D) roots, trunks, cords, divisions, branches

(E) roots, trunks, divisions, cords, branches

78. All of the following nerves provide exclusively cutaneous innervation to the foot EXCEPT the

(A) sural nerve

(B) saphenous nerve

(D) superficial peroneal nerve

79. An 18-year-old female sustained a closed right ankle fracture while skating. She presents five days later for open reduction and internal fixation of the ankle. She agrees to a regional anesthetic for surgical anesthesia as well for postoperative analgesia. Which nerve innervates the skin over the medial aspect of the lower leg?

(A) Saphenous

(B) Sciatic

(D) Common peroneal

(E) Ilioinguinal

80. A 54-year-old male is scheduled to undergo a right total hip arthroplasty. You perform a lumbar plexus block as well as a gluteal sciatic block for postoperative analgesia. The sciatic nerve is composed of the ventral rami of

(A) L4 – S3

(B) T12 – L4

(D) S1-S3

(E) T10-S3

81. You are performing an ultrasound-guided supraclavicular block in a 15-year-old female for left hand surgery. You encounter bone with needle advancement. You suspect that the needle has most likely encountered the

(A) clavicle

(B) second rib

(D) vertebral body of C6

(E) first rib

82. A 72-year-old female undergoes a transmetatarsal amputation of the left foot for peripheral vascular disease. All of the following are suitable regional anesthetics EXCEPT a(n)

(A) ankle block

(B) femoral and popliteal sciatic block

(D) femoral and saphenous nerve block

(E) spinal block

83. You are obtaining informed consent from 46-year-old lawyer for a femoral nerve block for a right ACL repair. You explain that you will be using ultrasound as the means of nerve localization. All of the following are true when using ultrasound in regional anesthesia EXCEPT that it

(A) decreases the incidence of unintentional vascular punctures

(B) decreases the number of needle passes

(D) decreases the onset time of a block

(E) has not been shown to facilitate the placement of epidural blocks in difficult patients

DIRECTIONS: Use the following scenario to answer Questions 84-85: A 25-year-old male undergoes ACL repair of the right knee utilizing a hamstring tendon. In the PACU, the patient reports intense pain and requests a peripheral nerve block. Utilizing ultrasound for the nerve block, 25 mL of 0.5% ropivacaine was administered and the following ultrasound-guided image was obtained:

84. During the ultrasound-guided block shown above, anesthetizing the nerve depicted by the white arrow would result in inability to

(A) dorsiflex the foot

(B) plantarflex the foot

(D) flex the lower leg at the knee joint

(E) flex the hip joint

85. After a successful block, the patient would be expected to have loss of sensation to the

(A) lateral aspect of the right thigh

(B) medial aspect of the right lower leg

(D) posterior aspect of the thigh

(E) dorsum of the foot

86. A brachial plexus block is performed in a 26-year-old man for open reduction and internal fixation of the left elbow. A supraclavicular block is performed to anesthetize the entire brachial plexus. The brachial plexus is primarily derived from the nerve roots of

(A) C5-C8

(B) C5-T1

(D) C6-T2

(E) C2-C4

87. A 66-year-old female with severe COPD presents for left upper extremity surgery. She prefers a regional anesthetic in order to avoid intraoperative intubation and wants to avoid the need for postoperative intubation. Which one of the following upper extremity blocks should be avoided because it typically results in phrenic nerve blockade with resulting ipsilateral diaphragm paralysis?

(A) Supraclavicular

(B) Interscalelene

(D) Axillary

(E) Suprascapular

88. During a barroom fight, a man fractured his 5th metacarpal after throwing a punch. The following day he underwent a surgical repair of the 5th metacarpal. Which one of the following nerve(s) would need to be anesthetized to ensure adequate postoperative analgesia?

(A) Ulnar nerve

(B) Ulnar and radial nerves

(D) Median, radial, and ulnar nerves

(E) Musculocutaneous, median, radial, and ulnar nerves

89. A popliteal sciatic nerve block was performed for open reduction and internal fixation of the ankle. The patient reported feeling the painful surgical incision made on the medial aspect of the ankle. The nerve most likely missed was

(A) sural nerve

(B) saphenous nerve

(D) superficial peroneal nerve

(E) tibial nerve

DIRECTIONS (Questions 90-91): Each group of items below consists of lettered headings followed by a list of numbered phrases or statements. For each numbered phrase or statement, select the ONE lettered heading or component that is most closely associated with it. Each lettered heading or component may be selected once, more than once, or not at all.

(A) Sciatic

(B) Femoral

(D) Tibial

(E) Saphenous

(F) Infraclavicular

(G) Superficial Cervical Plexus

(H) Suprascapular

For each patient, select the best peripheral nerve block.

90. A 62-year-old morbidly obese patient sustained an open ankle fracture after falling. She undergoes general anesthesia for open reduction and internal fixation. In the PACU she reports intense pain not alleviated with opioids.

91. A 50-year-old gentleman is scheduled for elective rotator cuff repair of the left shoulder. You decide to perform an interscalene nerve block; however, you are unable to obtain an adequate ultrasound image. For complete surgical anesthesia, the most appropriate alternative technique is needed.

DIRECTIONS (Questions 92-93): Each group of items below consists of lettered headings followed by a list of numbered phrases or statements. For each numbered phrase or statement, select the ONE lettered heading or component that is most closely associated with it. Each lettered heading or component may be selected once, more than once, or not at all.

(A) Ulnar nerve block

(B) Musculocutaneous nerve block

(D) Radial nerve block

(E) Obturator nerve block

(F) Suprascapular nerve Block

(G) Medial brachial cutaneous nerve block

(H) Medial antebrachial cutaneous nerve block

For each patient, select the best rescue block.

92. A 26-year-old male sustained a left elbow fracture. After the performance of an infraclavicular block, you note that sensation is still intact on the ventral and lateral aspects of the forearm.

93. A supraclavicular nerve block is performed for surgical anesthesia of the hand. Upon testing the success of the block prior to surgery you notice that there is a lack of sensation on the volar and lateral aspect of the forearm but intact sensation on the medial side.

Only gold members can continue reading. Log In or Register to continue