Fall_25_Lower_Part2

Question 1

1. What is the objective of the proximal sciatic nerve block?

Answer 1

✅ Place local anesthetic around the sciatic nerve for posterior thigh to below-knee coverage.
💡 Provides anesthesia except for the medial calf (saphenous nerve).

Question 2

2. Which is NOT a typical consideration for proximal sciatic block?

Answer 2

✅ Motor-sparing for early ambulation.
💡 The block causes motor paralysis, increasing fall risk.

Question 3

3. Recommended position for subgluteal sciatic block?

Answer 3

✅ Lateral decubitus with hip and knee flexed.
💡 Exposes gluteal crease and stabilizes limb for ultrasound access.

Question 4

4. Appropriate ultrasound setup for subgluteal sciatic block?

Answer 4

✅ High-frequency linear probe, depth 4–6 cm.
💡 Provides optimal visualization of the sciatic nerve between gluteus maximus, biceps femoris, and adductor magnus.

Question 5

5. Which motor responses confirm correct needle placement?

Answer 5

✅ Hamstring, calf, or foot/toe twitches.
💡 These confirm proximity to the sciatic nerve under stimulation.

Question 6

6. What principle helps differentiate the sciatic nerve from tendons?

Answer 6

✅ Anisotropy.
💡 Tilting the probe changes nerve echogenicity, helping distinguish it from tendons.

Question 7

7. Direction of needle insertion for subgluteal sciatic block?

Answer 7

✅ Lateral to medial.
💡 Allows clear visualization and avoids vascular structures.

Question 8

8. In the RAPT method, what does ‘P’ represent?

Answer 8

✅ Opening pressure <15 psi.
💡 Ensures injectate is not intraneural or intravascular.

Question 9

9. Typical local anesthetic volume for proximal sciatic block?

Answer 9

✅ 10–20 mL.
💡 Provides adequate spread around the sciatic nerve.

Question 10

10. Limitation of gluteal approach to sciatic block?

Answer 10

✅ Technically difficult in obese patients.
💡 Deep nerve location and adipose tissue complicate visualization.

Question 11

11. The popliteal sciatic block provides anesthesia for:

Answer 11

✅ Knee, foot, and ankle.
💡 Targets tibial and common peroneal branches within Vloka’s sheath.

Question 12

12. Local anesthetic volume for popliteal block?

Answer 12

✅ 15–20 mL.
💡 Ensures spread within Vloka’s sheath for complete coverage below the knee.

Question 13

13. Acceptable positions for popliteal block?

Answer 13

✅ Lateral, prone, or supine.
💡 Versatile approach depending on access and comfort.

Question 14

14. True statement about popliteal block?

Answer 14

✅ Produces complete motor block below the knee.
💡 Affects tibial and peroneal branches, hindering ambulation.

Question 15

15. Transducer position for popliteal block?

Answer 15

✅ Transverse on popliteal crease scanning cephalad.
💡 Used to locate where tibial and common peroneal merge.

Question 16

16. Anechoic landmarks at the popliteal crease?

Answer 16

✅ Popliteal artery and vein.
💡 Serve as primary references for nerve identification.

Question 17

17. Recommended needle length for popliteal block?

Answer 17

✅ 80–100 mm.
💡 Ensures reach to nerve structures in deeper planes.

Question 18

18. If performed too low, what risk occurs?

Answer 18

✅ Loss of visualization of the common peroneal nerve.
💡 May lead to incomplete block or nerve trauma.

Question 19

19. Twitch confirming correct placement in popliteal block?

Answer 19

✅ Foot twitch.
💡 Indicates proximity to tibial or peroneal nerve.

Question 20

20. iPACK block best described as:

Answer 20

✅ Motor-sparing field block for posterior knee sensory branches.
💡 Blocks articular sciatic branches, preserving motor function.

Question 21

21. Local anesthetic volume for iPACK block?

Answer 21

✅ 15–20 mL.
💡 Adequate for diffusion between femur and popliteal artery.

Question 22

22. Key advantage of iPACK block?

Answer 22

✅ Avoids tibial and common peroneal motor blockade.
💡 Provides analgesia while preserving mobility.

Question 23

23. Injection site for iPACK block?

Answer 23

✅ Between femur and popliteal artery.
💡 Targets posterior capsule sensory branches.

Question 24

24. Recommended transducer for iPACK block?

Answer 24

✅ Curved low-frequency probe.
💡 Deeper structures (4–8 cm) require better penetration.

Question 25

25. Easiest patient position for iPACK block?

Answer 25

✅ Supine with knee flexed. 💡 Exposes popliteal fossa and simplifies needle alignment.

Question 26

26. Major risk of iPACK block?

Answer 26

✅ Inadvertent injection into tibial or common peroneal nerve. 💡 May cause nerve injury or unwanted motor block.

Question 27

27. The iPACK block is:

Answer 27

✅ A field block targeting tissue planes. 💡 Local diffuses to sensory articular branches, not direct nerve contact.

Question 28

28. Ankle block used for:

Answer 28

✅ Distal foot and toe procedures. 💡 Ideal for amputations and forefoot surgeries.

Question 29

29. Local anesthetic volume per nerve in ankle block?

Answer 29

✅ 3–5 mL. 💡 Minimizes systemic toxicity while ensuring effectiveness.

Question 30

30. Which nerve is NOT targeted in ankle block?

Answer 30

✅ Obturator nerve. 💡 Innervates medial thigh, not foot or ankle.

Question 31

31. Patient position for ankle block?

Answer 31

✅ Supine with foot supported or elevated. 💡 Allows full access around the ankle.

Question 32

32. Probe position for tibial nerve?

Answer 32

✅ Between medial malleolus and Achilles tendon. 💡 Locate posterior tibial artery/vein and nearby nerve.

Question 33

33. Ultrasound setup for ankle block?

Answer 33

✅ High-frequency linear probe, depth 3 cm. 💡 Provides clear visualization of superficial nerves.

Question 34

34. Landmark vessel for deep peroneal nerve?

Answer 34

✅ Anterior tibial artery. 💡 Nerve lies lateral and superficial to it.

Question 35

35. Location for superficial peroneal nerve scan?

Answer 35

✅ 10–15 cm proximal to lateral malleolus. 💡 Found in intramuscular septum with hyperechoic rim.

Question 36

36. Nerve between lateral malleolus and Achilles tendon?

Answer 36

✅ Sural nerve. 💡 Lies beside small saphenous vein, both visualized by Doppler.

Question 37

37. Benefit of ultrasound for ankle block?

Answer 37

✅ Direct visualization of individual nerves. 💡 Improves accuracy and reduces vascular puncture.

Question 38

38. Troubleshooting when nerves not visible?

Answer 38

✅ Tilt probe to adjust for anisotropy. 💡 Aligns beam with nerve fibers for clearer image.

Question 39

39. Safety step before each injection?

Answer 39

✅ Aspirate to confirm no blood. 💡 Prevents intravascular injection and LAST.

Question 40

40. Effect of excessive probe pressure?

Answer 40

✅ Collapses vessels, obscuring landmarks. 💡 Use gentle pressure to maintain image quality.

Question 41

41. Block covering posterior thigh to below knee (except medial calf)?

Answer 41

✅ Proximal sciatic block. 💡 Complements femoral/saphenous for full lower-limb coverage.

Question 42

42. Main outpatient limitation of proximal sciatic block?

Answer 42

✅ Motor block limiting ambulation. 💡 Causes leg weakness, increasing fall risk.

Question 43

43. Muscles identifying sciatic nerve subgluteally?

Answer 43

✅ Gluteus maximus, biceps femoris, adductor magnus. 💡 Define the fascial plane containing the sciatic nerve.

Question 44

44. In RAPT method, 'T' means:

Answer 44

✅ Total volume 10–20 mL. 💡 Ensures safe and effective injection amount.

Question 45

45. Additional block for complete knee anesthesia with popliteal block?

Answer 45

✅ Saphenous (adductor canal) block. 💡 Completes medial knee and leg coverage.

Question 46

46. Tibial nerve relation to popliteal artery?

Answer 46

✅ Superficial and lateral. 💡 Key spatial reference for safe needle placement.

Question 47

47. Depth setting for popliteal block ultrasound?

Answer 47

✅ 2–4 cm. 💡 Nerves are superficial and well visualized at this depth.

Question 48

48. iPACK block spares what?

Answer 48

✅ Motor function of tibial and common peroneal nerves. 💡 Provides analgesia without impairing movement.

Question 49

49. Nerve adjacent to small saphenous vein?

Answer 49

✅ Sural nerve. 💡 Appears hyperechoic near anechoic vein on ultrasound.

Question 50

50. Combination giving complete anesthesia from knee down?

Answer 50

✅ Popliteal sciatic + saphenous (adductor canal) block. 💡 Covers posterior, lateral, and medial aspects effectively.

Question 51

1. In the subgluteal sciatic block, the sciatic nerve lies between which muscles?

Answer 51

✅ Biceps femoris and adductor magnus. 💡 The nerve runs deep to the gluteus maximus between these two muscles.

Question 52

2. During a subgluteal sciatic block, which muscle is superficial to the sciatic nerve?

Answer 52

✅ Gluteus maximus. 💡 The gluteus maximus overlies the sciatic nerve in the subgluteal region.

Question 53

3. In the popliteal fossa, the tibial nerve lies in relation to the popliteal artery as:

Answer 53

✅ Superficial and lateral. 💡 The tibial nerve is superficial and slightly lateral to the popliteal artery.

Question 54

4. In the popliteal region, the common peroneal nerve is located:

Answer 54

✅ Lateral and more superficial to the tibial nerve. 💡 This relationship helps identify the bifurcation of the sciatic nerve.

Question 55

5. During an iPACK block, local anesthetic is deposited between which structures?

Answer 55

✅ Femur and popliteal artery. 💡 Targets the sensory articular branches around the posterior knee capsule.

Question 56

6. In the ankle block, the tibial nerve is found between which structures?

Answer 56

✅ Medial malleolus and Achilles tendon. 💡 Lies near the posterior tibial artery and vein.

Question 57

7. The deep peroneal nerve lies lateral and superficial to which artery?

Answer 57

✅ Dorsalis pedis (anterior tibial) artery. 💡 Landmark for anterior ankle injections.

Question 58

8. The superficial peroneal nerve lies:

Answer 58

✅ In the intramuscular septum between peroneus longus and brevis. 💡 Best seen 10–15 cm above the lateral malleolus.

Question 59

9. The sural nerve runs adjacent to which vein?

Answer 59

✅ Small saphenous vein. 💡 Found between the lateral malleolus and Achilles tendon.

Question 60

10. Which muscles form the popliteal fossa boundaries where the sciatic divides?

Answer 60

✅ Biceps femoris (lateral) and semimembranosus (medial). 💡 They define the fossa containing the tibial and peroneal nerves.

Question 61

11. In the subgluteal sciatic block, which muscle appears most superficial on ultrasound?

Answer 61

✅ Gluteus maximus. 💡 It covers the sciatic nerve and serves as a clear sonographic landmark.

Question 62

12. Which muscle forms the floor of the popliteal fossa?

Answer 62

✅ Popliteus. 💡 Lies deep to the tibial and peroneal nerves and the popliteal vessels.

Question 63

13. During an iPACK block, which muscle is superficial to the needle path?

Answer 63

✅ Gastrocnemius. 💡 The needle passes deep to it to reach the femur-popliteal artery plane.

Question 64

14. The sciatic nerve exits the pelvis through which foramen?

Answer 64

✅ Greater sciatic foramen. 💡 It emerges below the piriformis muscle before entering the gluteal region.

Question 65

15. In the ankle block, which nerve runs posterior to the lateral malleolus?

Answer 65

✅ Sural nerve. 💡 Provides sensation to the lateral foot and heel.

Question 66

16. The deep peroneal nerve supplies which region of the foot?

Answer 66

✅ The first web space between the great and second toes. 💡 Important sensory target in the ankle block.

Question 67

17. Which muscle helps locate the sciatic nerve in the subgluteal approach?

Answer 67

✅ Gluteus maximus. 💡 The nerve lies deep to this muscle between biceps femoris and adductor magnus.

Question 68

18. In the popliteal fossa, which structure is most superficial?

Answer 68

✅ Common peroneal nerve. 💡 Lies superficial and lateral compared to tibial nerve and vessels.

Question 69

19. Which muscle separates the posterior tibial bundle from the Achilles tendon?

Answer 69

✅ Tibialis posterior. 💡 Helps identify the tibial nerve during ankle block imaging.

Question 70

20. Which vascular landmarks identify the tibial nerve on ultrasound?

Answer 70

✅ Posterior tibial artery and vein. 💡 The nerve lies just beside these vessels at the medial ankle.

Question 71

21. Which muscle forms the lateral wall of the popliteal fossa?

Answer 71

✅ Biceps femoris. 💡 The semimembranosus forms the medial wall.

Question 72

22. Which nerve supplies the lateral aspect of the foot and heel?

Answer 72

✅ Sural nerve. 💡 Provides sensory innervation to the posterolateral foot.

Question 73

23. The popliteal sciatic block targets the nerve proximal to its bifurcation into:

Answer 73

✅ Tibial and common peroneal branches. 💡 Ensures full sensory coverage below the knee.

Question 74

24. In the subgluteal region, the sciatic nerve lies on the surface of which deep muscle?

Answer 74

✅ Quadratus femoris. 💡 The nerve runs superficial to this muscle, deep to gluteus maximus.

Question 75

25. The saphenous nerve travels with which vessel at the knee and medial leg?

Answer 75

✅ Great saphenous vein. 💡 Supplies the medial lower leg and ankle, complementing the popliteal block.