Upper Extra Hard Questions
The most common complication associated with a supraclavicular brachial plexus block is
A. Pneumothorax
B. Intravascular injection into the vertebral artery
C. Spinal blockade
D. Blockade of the recurrent laryngeal nerve
E. Blockade of the phrenic nerve
Following a brachial plexus block, a patient complains of shortness of breath. Which of the following approaches to the brachial plexus is MOST likely to result in hemidiaphragmatic paresis?
A. Interscalene
B. Supraclavicular
C. Infraclavicular
D. Axillary
A 63-year-old woman is scheduled to undergo a right carotid endarterectomy. Which of the following is an appropriate anatomic landmark for a superficial cervical plexus block?
A. Chassaignac's tubercle
B. Interscalene groove
C. Sternal notch
D. Posterior border of sternocleidomastoid muscle
Which of the following nerves should be blocked for an operation at the medial aspect of the lower leg?
(A) Femoral
(B) Sciatic
(C) Obturator
(D) Common peroneal
(E) Tibial
During axillary block of the brachial plexus, which nerve is most likely to be encountered if the needle is inserted through the posterior wall of the artery?
(A) Intercostobrachial
(B) Median
(C) Musculocutaneous
(D) Radial
(E) Ulnar Axillary Brachial Plexus block
Which surface area of the upper extremity is most likely to be unanesthetized by an interscalene brachial plexus block?
(A) Hypothenar eminence
(B) Thenar eminence
(C) Dorsolateral surface of the hand
(D) Lateral aspect of the forearm
(E) Lateral surface of the upper arm
Conditions that increase the cardiovascular toxicity of bupivacaine include all EXCEPT
A. hypoxia
B. acidosis
C. hypokalemia
D. pregnancy
A 27-year-old man receives a Supraclavicular brachial plexus block for elbow surgery. Supplemental blockade of which of the following nerves would be the MOST effective in preventing development of pain at the tourniquet application site during surgery?
A. Axillary
B. Intercostobrachial
C. Musculocutaneous
D. Radial
Nerves that must be blocked to produce anesthesia for amputation of the second toe include all EXCEPT
(A) superficial peroneal
(B) posterior tibial
(C) deep peroneal
(D) sural
Shortly after undergoing a supraclavicular block a patient becomes acutely dyspneic. Which statement about the complications of supraclavicular block is MOST likely true?
(A) Hemidiaphragmatic paresis is more likely to occur after a supraclavicular block than after an interscalene block.
(B) Hemidiaphragmatic paresis occurs in upto 50% of patients undergoing supraclavicular block.
(C) The risk of pneumothorax as a result of supraclavicular block is approximately 0.1%.
(D) Pneumothorax associated with supraclavicular block is uniformly evident within 60 minutes of the block.
A 42-year-old woman with a morbid fear of general anesthesia receives an interscalene block for shoulder arthroscopy consisting of 20 mL 0.5% ropivacaine. Much of her arm, shoulder and hand are numb, but the patient complains of pain as the incision is made at the upper portion of the shoulder. The most appropriate next step is
A. Repeat block
B. Perform intercostobrachial block
C. Perform superficial cervical plexus block
D. Perform a deep cervical plexus block
E. Induce general anesthesia
A 30 y woman has difficulty talking 15 minutes after initiation of interscalene block for closed reduction of a dislocated shoulder. The most likely cause is?
(A) cervical sympathetic block
(B) delayed systemic toxicity
(C) phrenic n paralysis
(D) Pneumothorax
(E) Recurrent laryngeal nerve block
A 25-year-old man is scheduled to undergo open repair of a radius fracture under infraclavicular brachial plexus block. Sensation in which of the following regions of the arm is MOST likely to remain intact?
A. Medial upper arm
B. Lateral forearm
C. Dorsal surface of the hand
D. Ventral surface of the hand
Which of the following nerves can be electrically stimulated at the ankle to produce flexion of the toes?
A. Posterior tibial nerve
B. Saphenous nerve
C. Deep peroneal nerve
D. Superficial peroneal nerve
E. Sural nerve
Following axillary block for insertion of an arteriovenous fistula in the forearm, a patient has pain on surgical incision. Which of the following nerves should be blocked to relieve this
(A) Axillary
(B) Median
(C) Musculocutaneous
(D) Radial
(E) Ulnar Axillary Brachial Plexus block
During placement of an interscalene block the patient becomes hypotensive, bradycardic and cyanotic. Most likely cause is
A. Vertebral artery injection
B. Carotid artery injection
C. Phrenic nerve blockade
D. Total spinal
E. Stellate ganglion block
When performing an interscalene block with a peripheral nerve stimulator you note diaphragmatic movement. You should now
A. Inject the local anesthetic as the needle is in an appropriate location
B. Redirect the needle in an anterior direction
C. Redirect the needle in a more cephalad direction
D. Redirect the needle in a posterior direction
E. Advance the needle about 0.5 cm more and inject
An axillary brachial plexus block is performed for a scaphoid fracture fixation with ultrasound. Postoperatively, the patient reports only partial coverage of his wrist. Which of the following nerves was MOST likely misidentified due to an acoustic enhancement artifact?
A. Radial
B. Ulnar
C. Median
D. Musculocutaneous
A 63-year-old patient undergoes repair of a femoral nonunion using autograft harvested from the anterior iliac crest. Postoperatively, the patient experiences severe pain at the iliac crest. Blockade of which of the following nerves would provide the BEST analgesia to the anterior iliac crest?
A. Genitofemoral
B. Lateral femoral cutaneous
C. Iliohypogastric
D. Obturator
A patient undergoes axillary block for placement of an arteriovenous shunt in the forearm. Blockade of the musculocutaneous nerve is not achieved. Injection of a local anesthetic at which of the following sites will provide the required sensory block?
(A) Between the tendon of the palmaris longus and flexor carpi radialis
(B) Body of coracobrachialis muscle
(C) Medial to the brachial artery at the elbow
(D) Proximal to the medial epicondyle against the medial surface of the humerus
(E) Superficial to the pulse of the axillary artery Axillary Brachial Plexus block
Which of the following can cause methemoglobinemia?
A. Procaine
B. Prilocaine
C. Articaine
D. Iocaine
The structure LEAST likely to be encountered during placement of interscalene block is
A. Phrenic nerve
B. Vertebral artery
C. Recurrent laryngeal nerve
D. Subarachnoid space
E. Vagus nerve
The muscle least likely to be affected by an interscalene brachial block is the?
(A) brachialis
(B) brachioradialis
(C) biceps
(D) flexor carpi radialis
(E) interosseous
In placing a landmark-based, nerve stimulator-guided lumbar plexus block, no paresthesia occurred, and an appropriate quadriceps twitch was noted at 0.6 mA. Injection of local anesthetic at this site requires 25 psi pressure. Continued injection is MOST likely to result in which of the following effects?
A. Epidural spread of the local anesthesic
B. Intraneural injection
C. Spinal anesthesia
D. The anticipated lumbar plexus block
The Triangle of Petit is a landmark for which block?
A. QL block
B. PECS block
C. Rectus sheath block
D. TAP block