Regional Anesthesia — MCQs
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All are correct about the regional anesthesia provided to the patient except:
Which finding indicates correct placement of needle in this nerve block? (Recent NEET Pattern 2016-17)
All are contraindications of this anesthesia technique except: (Recent NEET Pattern 2016-17)
All are complications of this anesthesia technique except: (Recent NEET Pattern 2016-17)
Name the spinal needle shown in the image:
Which is not true regarding the procedure done with the needle shown below?
The following position of the patient is maintained during \qquad anaesthesia:
Contraindications to epidural analgesia include the following except
What is the name of the nerve block technique shown in the image?
The duration of spinal anaesthesia is based directly on:
Regional Anesthesia Indian Medical PG Practice Questions and MCQs
Question 131: All are correct about the regional anesthesia provided to the patient except:
- A. Bier's block
- B. Provides intense surgical anesthesia for 120 minutes (Correct Answer)
- C. Extremity exsanguinated with esmark elastic bandage tied from distal to proximal end
- D. Can lead to seizures
Explanation: *Provides intense surgical anesthesia for 120 minutes* - The image depicts a technique strongly resembling a **Bier block**, a form of intravenous regional anesthesia. While it provides intense surgical anesthesia, its duration is limited, typically to **60-90 minutes**, to minimize tourniquet-related complications and systemic local anesthetic toxicity post-release. - Suggesting it lasts for 120 minutes is generally **incorrect** as safe practice dictates a shorter duration for the tourniquet application in this type of block. *Bier's block* - The image shows a **tourniquet** applied to the upper arm and an intravenous catheter in the forearm. This setup is characteristic of a **Bier block** (intravenous regional anesthesia), which involves exsanguinating the limb, applying a tourniquet, and then injecting a local anesthetic intravenously into the isolated limb. - This method provides **anesthesia to the limb distal to the tourniquet** for short surgical procedures. *Extremity exsanguinated with esmark elastic bandage tied from distal to proximal end* - Before injecting the local anesthetic in a Bier block, the limb is typically **exsanguinated** (emptied of blood) to ensure the anesthetic remains confined and to improve its effectiveness. - This is commonly achieved by raising the limb and wrapping it with an **Esmarch elastic bandage from distal to proximal**, pushing blood out of the limb. *Can lead to seizures* - Should the **tourniquet fail or be prematurely deflated**, the local anesthetic can rapidly enter the systemic circulation. - This sudden systemic influx of local anesthetic can lead to **central nervous system toxicity**, manifesting as **seizures**, cardiac arrhythmias, and potentially cardiac arrest.
Question 132: Which finding indicates correct placement of needle in this nerve block? (Recent NEET Pattern 2016-17)
- A. Increase in skin temperature of ipsilateral arm (Correct Answer)
- B. Decrease in skin temperature of ipsilateral arm
- C. Increase in sweating of ipsilateral arm
- D. Decrease in sweating of ipsilateral arm
Explanation: ***Increase in skin temperature of ipsilateral arm*** - A successful **stellate ganglion block** interrupts the **sympathetic efferent fibers** that innervate the ipsilateral arm. - This interruption leads to **vasodilation** in the blood vessels of the arm, resulting in increased blood flow and thus, a rise in skin temperature. *Decrease in skin temperature of ipsilateral arm* - A decrease in skin temperature would indicate **vasoconstriction**, which is the opposite effect of a successful sympathetic block. - This would suggest either an ineffective block or stimulation of sympathetic activity. *Increase in sweating of ipsilateral arm* - The stellate ganglion also carries **sympathetic fibers** to the sweat glands. A successful block would inhibit sweat gland activity. - Increased sweating (known as **diaphoresis**) would indicate an inadequate block or irritation of the ganglion, leading to increased sympathetic outflow. *Decrease in sweating of ipsilateral arm* - While a **decrease in sweating** (anhidrosis) is indeed a sign of effective sympathetic blockade to the arm, it is typically less immediate and less clinically observable than the change in skin temperature. - The most easily and consistently observed sign of sympathetic denervation in the arm is the increase in skin temperature due to vasodilation.
Question 133: All are contraindications of this anesthesia technique except: (Recent NEET Pattern 2016-17)
- A. Bleeding diathesis
- B. Severe aortic stenosis
- C. Aortic aneurysm (Correct Answer)
- D. Uncooperative patient
Explanation: ***Aortic aneurysm*** - An **aortic aneurysm** is not a contraindication for **epidural anesthesia**. In fact, epidural anesthesia can be beneficial for patients with aortic aneurysms during surgical repair as it can help stabilize hemodynamics and provide effective pain control. - The image shows a needle entering the **epidural space**, indicating this question pertains to epidural anesthesia. *Bleeding diathesis* - **Bleeding diathesis** is a **relative contraindication** for **epidural anesthesia** due to the increased risk of **epidural hematoma**, which can cause neurological damage. - The formation of an **epidural hematoma** can lead to spinal cord compression. *Severe aortic stenosis* - **Severe aortic stenosis** is a **contraindication** for **epidural anesthesia** because the associated **vasodilation** from regional anesthesia can lead to a drastic drop in blood pressure, which these patients cannot tolerate as their fixed cardiac output relies on adequate preload. - Patients with **severe aortic stenosis** are highly susceptible to **hypotension** and cardiac collapse. *Uncooperative patient* - An **uncooperative patient** is a **contraindication** for **epidural anesthesia** as proper positioning and patient cooperation are crucial for safe needle placement. - Lack of cooperation increases the risk of **neurological injury** during the procedure.
Question 134: All are complications of this anesthesia technique except: (Recent NEET Pattern 2016-17)
- A. Bradycardia
- B. Sudden cardiac arrest
- C. Decrease in vital capacity
- D. Paralytic ileus (Correct Answer)
Explanation: **SPINAL ANESTHESIA COMPLICATIONS ANALYSIS:** ***Paralytic ileus*** - While spinal anesthesia can cause some **decreased bowel motility** due to sympathetic blockade, true **paralytic ileus** is primarily associated with **abdominal surgery**, **prolonged opioid use**, **electrolyte imbalances**, or **systemic illness**. - **Paralytic ileus** is not considered a direct complication of spinal anesthesia technique itself, making it the exception among the given options. *Bradycardia* - Direct result of **sympathetic blockade** affecting **cardiac accelerator fibers**, leading to unopposed **vagal activity**. - Common complication of spinal anesthesia due to blocked sympathetic innervation that normally maintains heart rate. *Sudden cardiac arrest* - Rare but serious complication from severe **bradycardia** and **hypotension**, especially with **high spinal blocks**. - Can occur when sympathetic blockade extends too high, affecting critical **cardiovascular control mechanisms**. *Decrease in vital capacity* - Results from **motor blockade** of **intercostal muscles** and potentially **phrenic nerve** with high spinal blocks. - Respiratory compromise can be significant, particularly in patients with pre-existing **pulmonary disease**. **Conclusion:** Paralytic ileus is the exception as it is not a direct complication of spinal anesthesia, unlike the other cardiovascular and respiratory complications listed.
Question 135: Name the spinal needle shown in the image:
- A. A= Quincke, B= Sprotte (Correct Answer)
- B. A= Quincke, B= Whitacre
- C. A= Sprotte, B= Whitacre
- D. A= Sprotte, B= Quincke
Explanation: ***A= Quincke, B= Sprotte*** - Image A shows a **Quincke needle**, characterized by a **sharp, beveled tip** with an opening at the bevel. This design cuts through tissue rather than separating it. - Image B depicts a **Sprotte needle**, which is a **pencil-point needle** with a non-cutting tip and a side opening. This design aims to spread dural fibers rather than cut them, potentially reducing the risk of post-dural puncture headache. *A= Quincke, B= Whitacre* - While A correctly identifies the **Quincke needle**, B is incorrectly identified as a Whitacre needle. - A **Whitacre needle** is also a pencil-point needle, but its side opening is narrower and closer to the tip compared to the Sprotte needle. *A= Sprotte, B= Whitacre* - This option incorrectly identifies needle A as a **Sprotte needle**. The beveled tip is characteristic of a Quincke. - It also incorrectly identifies needle B as a Whitacre; B's side opening is more elongated and further from the tip than a typical Whitacre. *A= Sprotte, B= Quincke* - This option completely reverses the correct identification. Needle A is clearly a **Quincke** due to its sharp bevel. - Needle B is a **Sprotte** type with its pencil-point design and side opening, not a Quincke.
Question 136: Which is not true regarding the procedure done with the needle shown below?
- A. Breath holding is not necessary (Correct Answer)
- B. Bevel should be facing upwards while inserting the needle
- C. To be done in lateral recumbent position
- D. Coagulopathy is not an absolute contraindication
Explanation: ***Breath holding is not necessary*** - This statement is **FALSE** - breath holding **IS necessary** during lumbar puncture to maximize **opening pressure** measurement and reduce **CSF pressure variations**. - Patients are typically instructed to hold their breath in **expiration** to minimize movement artifacts and obtain accurate pressure readings. *Coagulopathy is not an absolute contraindication* - This statement is **TRUE** - coagulopathy is considered a **relative contraindication**, not an absolute one for lumbar puncture. - The procedure can often be performed safely after **correcting clotting abnormalities** or with careful risk-benefit assessment and meticulous technique. *Bevel should be facing upwards while inserting the needle* - This statement is **TRUE** - the needle should be inserted with the **bevel facing upwards** (or laterally in lateral position) to minimize **dural trauma**. - This orientation allows dural fibers to **spread rather than cut**, reducing the risk of **post-dural puncture headache (PDPH)**. *To be done in lateral recumbent position* - This statement is **TRUE** - **lateral recumbent position** is one of the standard positions for lumbar puncture, especially for measuring **opening pressure** accurately. - Alternative **sitting position** may be used for obese patients or those with difficult anatomical landmarks, but lateral recumbent remains a correct approach.
Question 137: The following position of the patient is maintained during \qquad anaesthesia:
- A. Spinal anaesthesia (Correct Answer)
- B. Bier's block
- C. Caudal anaesthesia
- D. Stellate block
Explanation: ***Spinal anaesthesia*** - The image depicts the **lateral decubitus position** with the patient's back arched, which is a common position for administering **spinal anesthesia**. - This position helps to open the intervertebral spaces, making it easier to insert the needle into the **subarachnoid space** for drug delivery. *Bier's block* - A Bier's block (intravenous regional anesthesia) involves isolating the blood flow to a limb with a **tourniquet** and injecting local anesthetic directly into a peripheral vein. - The patient typically lies supine, and the limb to be anesthetized is elevated to exsanguinate it before tourniquet inflation. *Caudal anaesthesia* - Caudal anesthesia involves injecting local anesthetic into the **caudal epidural space** via the sacral hiatus. - Patients are usually positioned in the **prone** position or **lateral decubitus** with hips flexed to facilitate access to the sacral hiatus. *Stellate block* - A stellate ganglion block is performed to block the sympathetic nerves in the neck, typically for conditions affecting the head, neck, or upper extremities. - The patient is typically positioned **supine** with the neck slightly extended, allowing access to the anterior cervical spine area.
Question 138: Contraindications to epidural analgesia include the following except
- A. Hypertension (Correct Answer)
- B. Infection over the back
- C. Raised intracranial pressure
- D. Coagulopathy
Explanation: ***Hypertension*** - While careful monitoring is needed, **uncontrolled hypertension** is not an absolute contraindication to epidural analgesia. - Epidural analgesia can sometimes even help to lower blood pressure, which might be beneficial in certain hypertensive patients. *Infection over the back* - This is a significant contraindication due to the risk of introducing bacteria into the **epidural space**, leading to severe infections like **epidural abscess** or **meningitis**. - A local infection could spread to the central nervous system, causing grave complications. *Raised intracranial pressure* - This is a contraindication because a sudden decrease in **cerebrospinal fluid pressure** from epidural needle insertion can exacerbate herniation in patients with **raised ICP**. - The procedure itself can further alter intracranial dynamics, posing a significant risk. *Coagulopathy* - **Coagulopathy**, whether due to medication (e.g., anticoagulants) or a pre-existing medical condition, is a major contraindication. - There is an increased risk of **epidural hematoma**, which can compress the spinal cord and lead to permanent neurological damage.
Question 139: What is the name of the nerve block technique shown in the image?
- A. Intra-arterial anesthesia (Correct Answer)
- B. Bier's block
- C. Regional anesthesia
- D. Axillary block
Explanation: ***Intra-arterial anesthesia*** - The image shows a **cannula inserted directly into an artery**, indicated by the blood reflux and the context of anesthesia, suggesting direct drug delivery into the arterial system. - This method is used for specific types of regional pain management or diagnostic procedures where direct arterial access is required for **localized drug distribution**. *Bier's block* - A Bier's block, or **intravenous regional anesthesia**, involves injecting local anesthetic into a **vein** in an extremity after it has been exsanguinated and isolated by a tourniquet. - The image clearly shows a **bright red blood flash**, characteristic of arterial cannulation, not venous. *Regional anesthesia* - This is a broad term referring to the **anesthesia of a specific region** of the body and encompasses various techniques. - While intra-arterial anesthesia is a type of regional anesthesia, "regional anesthesia" itself is too general to specifically describe the technique shown. *Axillary block* - An **axillary block** is a type of peripheral nerve block targeting the brachial plexus in the axilla to anesthetize the arm. - The image does not depict the axillary region or the characteristic needle placement for an axillary block; instead, it shows direct vascular access.
Question 140: The duration of spinal anaesthesia is based directly on:
- A. Height
- B. Total body fat
- C. Dose (Correct Answer)
- D. Age
Explanation: ***Dose*** - The **total mass** (dose) of the local anesthetic administered directly influences the number of nerve fibers blocked and the duration of block. - A higher dose of a given local anesthetic generally leads to a **longer duration** of action in spinal anesthesia. *Height* - While patient height can influence the **spread** of spinal anesthesia due to differences in spinal column length, it does not directly determine the **duration** of the block. - The **volume** of the injectate, rather than the patient's height alone, affects the cranial spread of the anesthetic. *Total body fat* - Total body fat has **minimal direct impact** on the duration of spinal anesthesia since local anesthetics are injected directly into the cerebrospinal fluid, largely bypassing systemic fat distribution initially. - **Lipid solubility** of the drug affects its potency and duration within the neuraxis, not external body fat. *Age* - **Age** can influence the **spread** and **onset** of spinal anesthesia due to changes in cerebrospinal fluid volume and spinal cord compliance, but it is not the primary determinant of **duration**. - Older patients may experience a greater spread for a given dose, but the primary factor for duration remains the total drug dose.
Practice by Chapter
Neuraxial Anatomy
Practice Questions
Spinal Anesthesia
Practice Questions
Epidural Anesthesia
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Combined Spinal-Epidural Anesthesia
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Peripheral Nerve Blocks: Upper Extremity
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Peripheral Nerve Blocks: Lower Extremity
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Truncal Blocks
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Ultrasound-Guided Regional Anesthesia
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Complications of Regional Anesthesia
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Regional Anesthesia in Pediatric Patients
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Regional Anesthesia in Obstetrics
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Continuous Peripheral Nerve Catheters
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