Local Anesthetics
What is the primary determinant of local anesthetic potency?
A. PKa
B. Molecular weight
C. Lipid solubility
D. Concentration
E. Protein binding
C. Lipid solubility
Which of the following conditions is MOST likely to increase the cardiac toxicity of bupivacaine?
(A) Bradycardia
(B) Hypokalemia
(C) Hyperthermia
(D) Acidosis
(D) Acidosis
What are the nerves at the level of a supraclavicular nerve block?
A. Brachial plexus
B. Trunks
C. Cords
D. Roots
B. Trunks
What is a side effect when the common peroneal is damaged?
A. Foot drop
B. Foot pain
C. Complex regional pain syndrome
D. Loss of plantar flexion
A. Foot drop
Between these the two muscles is where local anesthetic deposited for TAP Block:
A. internal oblique and transversus abdominis muscles
B. external oblique and transversus abdominis muscles
C. internal oblique and external oblique
D. quadratus lumborum and transversus abdominis muscles
A. internal oblique and transversus abdominis muscles
Apart from Benzocaine, this local anesthetic is known to cause allergic reactions due to its metabolism to para-amino benzoic acid (PABA)
A. Procaine
B. Prilocaine
C. Articaine
D. Iocaine
A. Procaine
An axillary block is performed on a healthy 19-year-old athlete. Thirty mL of 0.75% bupivacaine is injected incrementally. Fifteen minutes after the bupivacaine injection, the patient has a seizure and experiences a ventricular fibrillation arrest. Which of the measures below is NOT indicated?
A. Begin chest compressions at 100 per minute
B. Ventilate with 100% oxygen
C. Bolus propofol to bind local anesthetic
D. Infuse 20% lipid emulsion
E. Repeat emulsion infusion if fibrillation continues
C. Bolus propofol to bind local anesthetic
What nerve travels within the belly of the coracobrachialis muscle?
A. Axillary
B. Radial
C. Musculocutaneous
D. Median
C. Musculocutaneous
What is located superficially between the lateral malleolus and the achilles tendon?
A. Posterior tibial nerve
B. Superficial peroneal nerve
C. Deep peroneal nerve
D. Sural Nerve
D. Sural Nerve
Which of the following is NOT a method to confirm epidural catheter position?
A. Ultrasonography
B. ECG
C. Electrical stimulation
D. Loss of resistance to saline
D. Loss of resistance to saline
The following are true statements concerning the physiochemical properties of local anesthetic agents EXCEPT:
A. The degree of protein binding correlates positively with the duration of action
B. Lipid solubility correlates with potency
C. The ionized form diffuses through the epineurium
D. The pKa partially determines the speed of onset
C. The ionized form diffuses through the epineurium
The correct arrangement of local anesthetics in order of their ability to produce cardiotoxicity from most to least is:
A. Bupivacaine, lidocaine, ropivacaine
B. Bupivacaine, ropivacaine, lidocaine
C. Lidocaine, bupivacaine, ropivacaine
D. Ropivacaine, bupivacaine, lidocaine
E. Lidocaine, ropivacaine, bupivacaine
B. Bupivacaine, ropivacaine, lidocaine
What lies along the anterior scalene muscle?
A. C4 nerve root
B. C5 nerve root
C. Superficial cervical plexus
D. Phrenic nerve
D. Phrenic nerve
What nerve is more medial during a popliteal nerve block?
A. Common peroneal nerve
B. Tibial nerve
C. Sciatic nerve
D. Saphenous nerve
B. Tibial nerve
Which of the following characteristics is an advantage of a quadratus lumborum (QL) block compared to a transversus abdominis plane (TAP) block?
A. Density of motor block
B. Local anesthetic dose
C. Sensory blockade distribution
D. Presence of visceral analgesia
C. Sensory blockade distribution
Which of the following local anesthetic adjuvants is MOST effective in prolonging the analgesia provided by brachial plexus blockade?
A. Neostigmine
B. Ketamine
C. Midazolam
D. Dexmedetomidine
D. Dexmedetomidine
In addition to acting as a lipid sink, which of the following is a proposed mechanism by which lipid emulsion reverses local anesthetic systemic toxicity (LAST)?
A. Increasing free concentration of local anesthetic
B. Providing an energy source to intoxicated tissue
C. Indirectly stimulating the cardiovascular system
D. Increasing cellular metabolic rate
B. Providing an energy source to intoxicated tissue
What nerve is blocked if a patient has a hoarse voice after an interscalene block?
A. Recurrent laryngeal nerve
B. Phrenic nerve
C. Superior laryngeal nerve
D. Vagus nerve
A. Recurrent laryngeal nerve
What muscle makes up the medial border of adductor canal?
A. Adductor longus
B. Sartorius muscle
C. Vastus medialis
D. Vastus intermedius
A. Adductor longus
A sensory level of T2 is achieved after administration of spinal anesthesia. Which of the following lung volumes is LEAST likely to be affected?
(A) Expiratory reserve volume
(B) Inspiratory reserve volume
(C) Inspiratory capacity
(D) Tidal volume
(E) Vital capacity
(D) Tidal volume
Apart from Benzocaine, this local anesthetic can cause methemoglobinemia:
A. Procaine
B. Prilocaine
C. Pontocaine
D. Cocaine
B. Prilocaine
A 45-year-old woman undergoes popliteal nerve blockade with 30 mL of 0.5% bupivacaine and develops tinnitus followed by disorientation, which resolves after infusion of a lipid emulsion bolus. How long should cardiovascular monitoring be continued after the resolution of symptoms?
A. 30 minutes
B. 2-3 hours
C. 4-6 hours
D. 10-12 hours
C. 4-6 hours
Which upper extremity block has the highest rate of chylothorax?
A. PECs block
B. Supraclavicular block
C. Infraclavicular block
D. Suprascapular nerve block
C. Infraclavicular block
When doing a femoral block with nerve stimulator, what is the key twitch to assure the optimum needle placement?
A. Intraneural
B. Patellar
C. Flexion
D. Sartorius
B. Patellar
The three borders of the Triangle of Petit include the following EXCEPT?
A. latissimus dorsi muscle
B. external oblique muscle
C. costal margin
D. iliac crest
C. costal margin