Welcome to your Test 21 In a classical lateral TAP block, the local anesthetic is deposited between which two muscles? External oblique and internal oblique Internal oblique and transversus abdominis Transversus abdominis and peritoneum Rectus abdominis and transversus abdominis None Which dermatomes are typically covered by a lateral TAP block? T4–T6 T6–L1 T2–T8 L1–S1 None What is the main limitation of the classical TAP block? Inadequate visceral analgesia High motor block Deep sedation required Risk of nerve injury None Which abdominal block provides both somatic and visceral analgesia? Subcostal TAP Rectus sheath block Ilioinguinal block Quadratus lumborum block None In which plane is the rectus sheath block performed? Between rectus abdominis and peritoneum Between skin and fascia Between anterior and posterior rectus sheath Between internal oblique and transversus abdominis None The ilioinguinal and iliohypogastric nerves originate from: T6–T8 T12–L1 L1–L2 L2–L3 None The ilioinguinal-iliohypogastric block is commonly used for: Umbilical hernia repair Appendectomy Inguinal hernia repair Midline laparotomy None Which QLB type places local anesthetic posterior to the quadratus lumborum muscle? Type 1 (lateral) Type 2 (posterior) Type 3 (anterior/transmuscular) Type 4 (intramuscular) None Which landmark helps identify the transversus abdominis plane during TAP block? Inferior vena cava Rectus abdominis “Three-muscle” abdominal wall appearance Diaphragm None Which block is best suited for analgesia after cesarean section? Rectus sheath block Subcostal TAP block Lateral TAP or QLB Iliohypogastric block None Which block targets the nerves between the internal oblique and transversus abdominis muscle near the subcostal margin? Subcostal TAP block Classic TAP block Ilioinguinal block Rectus sheath block None Which local anesthetic property is most desirable for TAP block in day-care surgery? Long duration of action Fast onset and low toxicity High protein binding High lipid solubility None Which nerves are consistently blocked in lateral TAP block? Ilioinguinal and iliohypogastric T10–T12 intercostal nerves Femoral nerve Genitofemoral nerve None What is the risk of bilateral TAP blocks with high-volume LA in a thin adult? Pneumothorax Local anesthetic systemic toxicity (LAST) Motor block of lower limbs Epidural spread None Which ultrasound transducer is preferred for abdominal wall blocks? Curvilinear 3–5 MHz Linear 6–13 MHz Phased-array 1–5 MHz Endocavitary probe None Which block is best for umbilical hernia repair? Ilioinguinal block Rectus sheath block Lateral TAP block Quadratus lumborum block None Which muscle lies deepest in the lateral abdominal wall? Rectus abdominis Internal oblique External oblique Transversus abdominis None In a QL block, where is the “shamrock sign” observed? Inguinal canal Transversus abdominis plane Posterior abdominal wall (lumbar region) Intercostal space None Which of the following blocks is NOT part of the abdominal wall blocks? TAP block Rectus sheath block Ilioinguinal block Paravertebral block None The quadratus lumborum muscle is innervated by: Ilioinguinal nerve T12–L4 anterior rami Femoral nerve Genitofemoral nerve None What does the “double-pop” sensation during TAP block indicate? Entry into peritoneum Entry through skin and fascia Piercing external and internal oblique Puncture of bowel None Which abdominal wall block has the longest duration of analgesia? Iliohypogastric block TAP block Rectus sheath block Quadratus lumborum block None The anterior branch of T12 lies within which plane? Between peritoneum and transversus abdominis Between internal oblique and transversus abdominis Within rectus sheath Under external oblique None What is the maximum safe dose of ropivacaine for bilateral TAP blocks in a 70 kg adult? 100 mg 200 mg 300 mg 400 mg None Which abdominal block is most suitable for laparoscopic cholecystectomy analgesia? Lateral TAP block Subcostal TAP block Rectus sheath block Iliohypogastric block None Which statement is TRUE about QL3 block (transmuscular)? LA is injected posterior to QL LA is injected anterior to QL, between QL and psoas major Used only for obstetric surgery Causes motor block in lower limbs None Which abdominal block targets the lower intercostal nerves before they enter the rectus sheath? Rectus sheath block Lateral TAP block QL block Ilioinguinal block None Which plane is targeted in an ilioinguinal block under US guidance? Between external and internal oblique Between internal oblique and transversus abdominis Between rectus abdominis and peritoneum Subfascial space of gluteus medius None Which complication is MOST likely with improper QLB needle placement? Horner’s syndrome Epidural spread Bowel injury Pneumothorax None The fascia transversalis lies deep to which muscle? External oblique Internal oblique Transversus abdominis Rectus abdominis None Which of the following blocks provides dermatomal coverage for Pfannenstiel incisions? Subcostal TAP Ilioinguinal–iliohypogastric block Rectus sheath block Lateral TAP block None What is a common ultrasound landmark for the ilioinguinal block? ASIS (anterior superior iliac spine) Umbilicus Xiphoid process Pubic symphysis None What LA volume is typically used per side for a TAP block in adults? 2–4 mL 15–20 mL 25–30 mL None Which plane carries the lateral cutaneous branches of T12–L1 nerves? Between fascia transversalis and peritoneum Between internal oblique and transversus abdominis Between skin and external oblique Below rectus sheath None Which block is best suited for laparoscopic appendectomy pain? Lateral TAP Subcostal TAP Rectus sheath block Ilioinguinal block None Which muscle is anterior to the quadratus lumborum? Erector spinae Psoas major Transversus abdominis Iliacus None Which block may result in sympathetic chain blockade due to paravertebral spread? Ilioinguinal block Lateral TAP block Quadratus lumborum block Rectus sheath block None Which block carries highest risk of peritoneal puncture? Subcostal TAP Rectus sheath block Ilioinguinal block QLB Type 3 None Which block may result in LA spread to thoracic paravertebral space? Rectus sheath block Ilioinguinal block Lateral TAP block QLB Type 2 or 3 None What’s the clinical implication of LA spread to lumbar plexus during QLB? Absent analgesia Lower limb weakness Intra-abdominal bleeding Urinary retention None Which block is most appropriate for periumbilical laparoscopy? Ilioinguinal block Rectus sheath block Lateral TAP block Subcostal TAP block None The posterior QLB (Type 2) is performed by depositing LA: Anterior to QL Posterior to QL Within psoas major Between fascia and skin None Which block may result in hypotension due to sympathetic blockade? TAP block Rectus sheath block Ilioinguinal block QLB (Types 2 or 3) None Which of these blocks has least variability in dermatomal coverage? QLB TAP block Rectus sheath block Paravertebral block None In subcostal TAP block, which direction is probe placed? Vertical in midline Oblique parallel to costal margin Transverse in lower abdomen Parasagittal at iliac crest None In a neonate, which TAP approach is most appropriate? Posterior approach with high-volume LA Subcostal TAP with bupivacaine 0.5% Lateral TAP with 0.2 mL/kg of 0.25% bupivacaine QLB type 3 with 2 mg/kg ropivacaine None What is the most likely complication of rectus sheath block? Femoral nerve palsy Hematoma from epigastric artery injury Motor blockade of abdominal wall None Which dermatomes are most commonly missed with TAP block alone? T6–T8 T10–T12 L1–S1 T12–L2 None What is the key advantage of QLB over TAP in abdominal surgery? Less needle visualization Better visceral and somatic analgesia Faster onset Shorter duration of action None What is the ideal timing for abdominal wall blocks in ERAS (enhanced recovery)? In PACU Before surgical incision (preemptive) Postoperative day 1 Only if pain score >7 None Time's up
