DNAP 2027 > Fall_25_Lower_Part1 > Flashcards

Fall_25_Lower_Part1 Flashcards

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1
Q

What procedures are best suited for a femoral nerve block?

A

Quadriceps muscle or tendon repair and knee surgery.

Femoral block provides anesthesia from the anterior thigh to the knee, ideal for surgeries in this region 【90†T2_W8_LE_1.pdf】.

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2
Q

What is the typical volume of local anesthetic for a femoral block?

A

10–20 mL.

Adequate to surround the femoral nerve under the fascia iliaca for effective anesthesia 【90†T2_W8_LE_1.pdf】.

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3
Q

What is the objective of the femoral nerve block?

A

Deposit local anesthetic around the femoral nerve.

Ensures blockade of sensory and motor fibers to anterior thigh and knee 【90†T2_W8_LE_1.pdf】.

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4
Q

What are key risks associated with a femoral block?

A

Postoperative falls and long-term nerve injury.

Because the femoral nerve is a major motor branch, injury can cause significant disability 【90†T2_W8_LE_1.pdf】.

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5
Q

Why is postoperative fall risk increased with femoral nerve block?

A

Due to quadriceps weakness from motor blockade.

Motor block limits ambulation; alternative motor-sparing blocks may be preferred for early mobility 【90†T2_W8_LE_1.pdf】.

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6
Q

What is an advantage of the femoral nerve block for time-limited cases?

A

Quick onset and reliable analgesia for anterior thigh to knee.

It is one of the fastest, most effective lower-extremity blocks 【90†T2_W8_LE_1.pdf】.

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7
Q

What is the recommended patient position for femoral block?

A

Supine with access to the inguinal region.

Allows easy probe placement and needle advancement toward the femoral nerve 【90†T2_W8_LE_1.pdf】.

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8
Q

How should obese patients be positioned or prepared for femoral block?

A

Tape redundant tissue away from the groin.

Improves probe contact and visualization of inguinal anatomy 【90†T2_W8_LE_1.pdf】.

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9
Q

What ultrasound transducer and depth are recommended for femoral block?

A

High-frequency linear transducer, 2–4 cm depth.

Provides clear imaging of the femoral nerve and artery at the inguinal crease 【90†T2_W8_LE_1.pdf】.

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10
Q

What is the landmark mnemonic for identifying structures at the femoral crease?

A

NAVEL: Nerve, Artery, Vein, Empty space, Ligament (from lateral to medial).

Assists in identifying femoral nerve lateral to the artery 【90†T2_W8_LE_1.pdf】.

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11
Q

What muscle and fascia surround the femoral nerve?

A

It lies between fascia iliaca (superficial) and iliacus muscle (deep).

Proper injection plane lies just under fascia iliaca for safe block 【90†T2_W8_LE_1.pdf】.

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12
Q

What muscle twitch confirms femoral nerve stimulation?

A

Patellar (quadriceps) twitch.

Quadriceps contraction signifies correct proximity to the femoral nerve 【90†T2_W8_LE_1.pdf】.

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13
Q

What direction should the needle be advanced for femoral block?

A

From lateral to medial under ultrasound guidance.

This orientation improves visualization and reduces arterial puncture risk 【90†T2_W8_LE_1.pdf】.

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14
Q

What is the hydrodissection goal during femoral block?

A

Separate fascia iliaca from iliacus and confirm needle tip placement.

Hydrodissection confirms correct plane before full anesthetic injection 【90†T2_W8_LE_1.pdf】.

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15
Q

What is the RAPT safety method used during femoral block?

A

Response loss <0.5 mA, Aspiration negative, Pressure <15 psi, Total 10–20 mL.

Ensures safe, effective nerve block with minimal risk of intraneural injection 【90†T2_W8_LE_1.pdf】.

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16
Q

What ultrasound view optimizes femoral nerve visualization?

A

Tilting the probe cranio-caudally.

Improves contrast between fascia layers and neural structures 【90†T2_W8_LE_1.pdf】.

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17
Q

What sign suggests femoral artery bifurcation on ultrasound?

A

Double arterial images at the inguinal crease.

Move the probe cephalad to locate the single, unforked artery before injection 【90†T2_W8_LE_1.pdf】.

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18
Q

What is the objective of the fascia iliaca block?

A

Spread local anesthetic under the fascia iliaca to block femoral, lateral femoral cutaneous, and obturator nerves.

Fascial plane spread provides wide lumbar plexus coverage 【90†T2_W8_LE_1.pdf】.

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19
Q

What is the usual volume for fascia iliaca block?

A

10–20 mL (suprainguinal approach may require more).

Adequate volume ensures cephalad and lateral spread beneath fascia iliaca 【90†T2_W8_LE_1.pdf】.

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20
Q

What are the risks of fascia iliaca block?

A

Low risk of intravascular or neurologic injury; rare pneumoperitoneum or bladder puncture.

As a fascial plane block, direct neural trauma risk is minimal 【90†T2_W8_LE_1.pdf】.

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21
Q

What consideration improves efficacy for hip and thigh analgesia with fascia iliaca block?

A

Use the suprainguinal technique for greater cephalad spread.

Enhances blockade of additional lumbar plexus branches 【90†T2_W8_LE_1.pdf】.

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22
Q

What is the recommended patient position for fascia iliaca block?

A

Supine with access to the inguinal region.

Same setup as femoral block for probe placement and access 【90†T2_W8_LE_1.pdf】.

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23
Q

What ultrasound transducer and depth are used for fascia iliaca block?

A

High-frequency linear probe, 2–4 cm depth.

Provides high-resolution images of fascia planes near the femoral crease 【90†T2_W8_LE_1.pdf】.

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24
Q

What ultrasound landmark helps identify the fascia iliaca plane?

A

The ‘bow tie’ formed by sartorius and transverse abdominis muscles.

Characteristic pattern marks the suprainguinal window for injection 【90†T2_W8_LE_1.pdf】.

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25
What muscle lies deep to the fascia iliaca and serves as an injection target?
Iliopsoas muscle. Hydrodissection should spread local anesthetic just above this muscle plane 【90†T2_W8_LE_1.pdf】.
26
How can you optimize spread to include the obturator nerve?
Advance the needle more medially during injection. Improves cephalad distribution and likelihood of obturator blockade 【90†T2_W8_LE_1.pdf】.
27
What is a benefit of fascia iliaca block for postoperative pain control?
Effective hip and knee analgesia with lower motor block risk. Motor-sparing property supports early ambulation 【90†T2_W8_LE_1.pdf】.
28
Why is the fascia iliaca block safer than direct femoral block?
It targets a fascial plane rather than the nerve itself. Reduces risk of nerve injury and vascular puncture 【90†T2_W8_LE_1.pdf】.
29
What troubleshooting tip helps in obese patients during fascia iliaca scanning?
Tape away redundant tissue to improve probe contact. Enhances visualization of deep fascial layers and iliopsoas 【90†T2_W8_LE_1.pdf】.
30
What indicates correct local anesthetic spread during fascia iliaca block?
Hydrodissection lifting fascia iliaca off the iliopsoas muscle. Visual separation confirms correct injection plane 【90†T2_W8_LE_1.pdf】.
31
Why is fascia iliaca block suitable for catheter placement?
Stable fascial plane allows secure catheter fixation. Continuous infusion provides extended analgesia for hip and thigh surgery 【90†T2_W8_LE_1.pdf】.
32
What complication may occur if needle placement is too deep in fascia iliaca block?
Penetration of peritoneum or bladder puncture. Needle should remain superficial to iliacus to prevent visceral injury 【90†T2_W8_LE_1.pdf】.
33
What is the purpose of an adductor canal block?
Provide sensory analgesia for knee surgery while sparing quadriceps strength. Targets saphenous nerve within the adductor canal for motor-sparing pain control 【90†T2_W8_LE_1.pdf】.
34
What local anesthetic volume is typically used for adductor canal block?
10–20 mL. Sufficient for circumferential spread around femoral artery in canal 【90†T2_W8_LE_1.pdf】.
35
What structures define the adductor canal compartment?
Sartorius muscle superficially, adductor longus medially, vastus medialis laterally. Femoral artery and saphenous nerve lie within this triangular fascial space 【90†T2_W8_LE_1.pdf】.
36
Why is adductor canal block considered motor-sparing?
It targets primarily sensory fibers of the saphenous nerve. Preserves quadriceps strength for early ambulation 【90†T2_W8_LE_1.pdf】.
37
What risk remains despite adductor canal being motor-sparing?
Possible quadriceps weakness and postoperative fall risk. High or proximal blocks may inadvertently affect motor fibers 【90†T2_W8_LE_1.pdf】.
38
What patient positioning is optimal for adductor canal block?
Supine with knee slightly flexed and externally rotated. Exposes medial thigh and facilitates access to adductor canal 【90†T2_W8_LE_1.pdf】.
39
Where should ultrasound probe be placed for adductor canal block?
Transverse on medial mid-thigh over femoral artery. Depth 3–5 cm; use high-frequency linear transducer 【90†T2_W8_LE_1.pdf】.
40
What structures should be visualized during adductor canal scanning?
Femoral artery, saphenous nerve, sartorius, adductor longus, and vastus medialis. Ensures proper identification of canal contents 【90†T2_W8_LE_1.pdf】.
41
What technique reduces risk of quadriceps weakness during adductor canal block?
Use lower anesthetic volumes and distal (caudal) injection site. Limits cephalad spread to motor fibers of femoral nerve 【90†T2_W8_LE_1.pdf】.
42
What are general risks of adductor canal block?
Normal regional risks plus arterial puncture. Artery lies close to needle path; use color Doppler to avoid injury 【90†T2_W8_LE_1.pdf】.
43
Why is the adductor canal block preferred by many providers for knee analgesia?
Provides excellent pain relief with less motor impairment. Facilitates early mobilization after total knee arthroplasty 【90†T2_W8_LE_1.pdf】.
44
What ultrasound depth is recommended for adductor canal scanning?
3–5 cm. Balances visualization quality and needle control in the mid-thigh 【90†T2_W8_LE_1.pdf】.
45
What ultrasound adjustment can improve artery visualization in adductor canal block?
Apply color Doppler and adjust probe tilt. Enhances identification of vascular anatomy to avoid puncture 【90†T2_W8_LE_1.pdf】.
46
How can injection spread be confirmed under ultrasound in adductor canal block?
Visualize local anesthetic enveloping femoral artery within canal. Confirms correct fascial plane deposition 【90†T2_W8_LE_1.pdf】.
47
What approach minimizes risk of intraneural injection during adductor canal block?
In-plane technique with continuous needle tip visualization. Prevents accidental nerve puncture or arterial trauma 【90†T2_W8_LE_1.pdf】.
48
What are practical troubleshooting tips for adductor canal block?
Slide or tilt probe cranio-caudally to improve visualization; adjust color Doppler gain. Enhances image quality and avoids misidentifying structures 【90†T2_W8_LE_1.pdf】.
49
What block combination provides complete knee analgesia?
Adductor canal + popliteal sciatic block. Together they cover anterior (saphenous) and posterior knee innervation 【90†T2_W8_LE_1.pdf】.
50
Which block is best for rapid anesthesia when time is limited?
Femoral nerve block. Provides broad coverage with quick onset but includes motor blockade 【90†T2_W8_LE_1.pdf】.
51
Which block offers hip and anterior thigh analgesia with reduced motor block risk?
Fascia iliaca block. Targets fascial plane to spare motor fibers while providing analgesia 【90†T2_W8_LE_1.pdf】.
52
Which block is most motor-sparing for knee surgery?
Adductor canal block. Aims for sensory-only block of saphenous nerve 【90†T2_W8_LE_1.pdf】.
53
Which block carries the highest risk of nerve injury due to direct needle proximity?
Femoral nerve block. Direct contact with major nerve trunk increases injury potential 【90†T2_W8_LE_1.pdf】.
54
Which block is least invasive and safest for inexperienced practitioners?
Fascia iliaca block. Fascial plane injection minimizes risk of vascular or neural puncture 【90†T2_W8_LE_1.pdf】.
55
What is the order of lateral-to-medial structures in the femoral crease?
Nerve, Artery, Vein, Empty space, Ligament (NAVEL). Mnemonic aids correct orientation to identify nerve position 【90†T2_W8_LE_1.pdf】.
56
Which block provides hip fracture analgesia with minimal systemic risk?
Suprainguinal fascia iliaca block. Extends cephalad under fascia iliaca to reach lumbar plexus components 【90†T2_W8_LE_1.pdf】.
57
Which block can be performed quickly in the emergency setting for anterior thigh pain?
Femoral nerve block. Fast and reliable even without complete ultrasound setup 【90†T2_W8_LE_1.pdf】.
58
What simple probe motion often improves femoral or adductor canal imaging quality?
Tilting cranially or caudally. Adjusts beam angle for clearer tissue and vascular definition 【90†T2_W8_LE_1.pdf】.
59
What common safety measure applies to all lower-extremity blocks?
Aspirate before each injection and visualize spread in real time. Reduces risk of intravascular or intraneural injection 【90†T2_W8_LE_1.pdf】.
60
What sonographic feature distinguishes the femoral nerve from surrounding tissue?
It appears hyperechoic, triangular, or oval lateral to the femoral artery. The nerve’s honeycomb texture contrasts with surrounding fascia and muscle on ultrasound.
61
How can the femoral nerve be differentiated from the fascia iliaca on ultrasound?
The nerve lies deep to the fascia iliaca and superficial to iliacus muscle. Identifying these layers prevents injecting too superficial or too deep.
62
What happens if injection occurs above the fascia iliaca during femoral block?
Anesthetic will not reach the femoral nerve and block will fail. Correct needle tip position under the fascia is essential for success.
63
What indicator confirms correct hydrodissection plane for femoral block?
Separation of fascia iliaca from iliacus muscle with visible fluid spread. Confirms needle tip is in the correct perineural compartment.
64
What ultrasound setting adjustment improves femoral nerve visualization?
Increase frequency and reduce depth to enhance near-field resolution. Higher frequencies provide sharper definition of superficial structures.
65
What is the key ultrasound landmark for fascia iliaca block at the inguinal level?
The 'bow tie' configuration formed by sartorius and internal oblique muscles. Represents the fascial crossing where injection under fascia iliaca achieves optimal spread.
66
How can you confirm local anesthetic spread under the fascia iliaca?
Visualize anterior displacement of the fascia as fluid collects over iliacus muscle. The lifted fascia indicates correct deposition plane and spread.
67
Why is a suprainguinal approach advantageous under ultrasound?
It directs local anesthetic cephalad toward the lumbar plexus roots. Suprainguinal injection covers more branches for hip analgesia.
68
What ultrasound artifact can help differentiate fascia layers during injection?
Anisotropy—fascial layers brighten or darken with probe tilt. Changing probe angle clarifies tissue planes and needle location.
69
What scanning technique helps track cephalad spread of local anesthetic in fascia iliaca block?
Slowly slide the probe cranially while injecting to follow fluid tracking under the fascia. Real-time tracking ensures continuous cephalad distribution.
70
How does the saphenous nerve appear on ultrasound in the adductor canal?
Small, hyperechoic, and anterolateral to the femoral artery. Its bright echogenic texture distinguishes it from the surrounding tissue.
71
How can you differentiate the femoral artery from the vein in adductor canal scanning?
Use color Doppler: the artery is pulsatile and non-compressible, the vein is compressible. Vascular differentiation is essential to avoid arterial puncture.
72
What is the best transducer orientation for visualizing the adductor canal?
Transverse probe over mid-thigh, perpendicular to femur. Provides the clearest cross-sectional view of canal structures.
73
What does proper injectate spread look like in an adductor canal block?
Local anesthetic encircles the femoral artery within the fascial tunnel. Confirms placement in the correct perivascular plane.
74
What technique improves visualization in deep or obese patients during adductor canal scanning?
Apply gentle probe pressure and increase depth to 5–6 cm. Enhances contact and brings deep structures into view.
75
What is a reliable visual endpoint for successful adductor canal injection?
Circumferential spread around the artery without vascular compression. Demonstrates appropriate fascial distention and safety.
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