Following a vaginal hysterectomy in the lithotomy position under general anesthesia, a patient has numbness of the lateral aspect of the left calf and medial half of the dorsum of the left foot. On physical examination she has footdrop and the toes cannot be extended. Which nerve is most likely to be involved?

Compared with epidural morphine, intrathecal morphine produces

A 26-year-old woman comes to a pain clinic because of pain, swelling and limitation of motion in the right knee for six months following a blow to the knee. Findings on knee arthroscopy and leg roentgenograms are normal. The best trial of therapy is

Spinal anesthesia at a T6 sensory level is most likely to improve cardiac output in patients with

The last muscle to be affected by an interscalene brachial plexus block is the

During axillary brachial plexus anesthesia, motor block frequently precedes sensory block because of

Epidural block is safer at the L3-L4 interspace than at the T12-L1 interspace because of the location of the

In a patient with peripheral vascular disease, the most likely result of lumbar sympathetic block is

Compared with morphine, a single epidural administration of fentanyl is associated with

Block of each of the following nerves is required for inguinal herniorrhaphy EXCEPT the

A 75-year-old man received an uneventful epidural anesthetic for total knee arthroplasty. Twenty-four hours later he has a painless flaccid paralysis in both legs. This clinical presentation is most consistent with

The most likely effect of a celiac plexus block for an abdominal operation is

Compared with adults, caudal anesthesia in children is associated with

Which of the following statements concerning the use of epidural anesthesia for extracorporeal shock wave lithotripsy is true?

With an interscalene brachial plexus block

After brachial plexus block, a patient has sensation over the inner aspect of the upper arm. Block of which of the following nerves would obtund this sensation?

If both recurrent laryngeal nerves were severed during a difficult thyroidectomy for cancer, the most likely finding would be

After termination of an inhalation anesthetic, patient-controlled analgesia will

The most medial of the following components in the antecubital fossa is the

A patient receiving monoamine oxidase inhibitor therapy for depression undergoes an emergency cholecystectomy. Which of the following is the best means of providing postoperative analgesia in this patient?

In a patient receiving an epidural analgesic infusion postoperatively, clear fluid is noted to drip back freely from the epidural catheter. Each of the following findings correctly identifies the associated fluid EXCEPT

A 30-year-old primiparous woman delivered a healthy infant by cesarean section during uneventful spinal anesthesia with tetracaine 10 mg in 2 ml of 5% dextrose solution. Twelve hours after delivery she has bilateral loss of pain and temperature sensibility, but not touch, below T8 and paralysis of both legs. The most likely cause of this complication is

A 31-year-old man received an uneventful epidural anesthetic for arthroscopy of the knee and meniscectomy. Twenty-four hours later he still has painless flaccid paralysis in both legs. This clinical presentation is most consistent with

Which of the following is most indicative of reflex sympathetic dystrophy?

Prompt control of seizures induced by bupivacaine is necessary because

Block of the superficial cervical plexus is performed at which location?

Following completion of an ankle block, the patient reports intact sensation on the tips of the toes. Which of the following nerves was blocked inadequately?

Intractable pain due to unresectable pancreatic carcinoma is most effectively treated with

Two months ago a 68-year-old man with insulin-dependent diabetes mellitus had a transurethral resection of the prostate under spinal anesthesia with tetracaine plus epinephrine. He now has numbness and tingling in both feet and disturbance of gait. Physical examination demonstrates stocking-type hypesthesia of both feet and ankles. The most likely diagnosis is

An axillary block is administered to a 60-kg patient using 40 ml of 0.5% bupivacaine. Ten minutes after placement of the block, the patient has a seizure. Which of the following statements is true?

A patient has seizure activity 30 seconds after injection of 0.25% bupivacaine 2 ml with epinephrine 1:200,000 for stellate ganglion block. The most likely cause is

Each of the following is a complication of celiac plexus block with 0.5% lidocaine 40 ml EXCEPT

The condition LEAST likely to be associated with sustained pain relief following a nerve block is

Neurolytic block is most appropriate for

Which of the following statements concerning postspinal headache is true?

Which of the following is the most appropriate pharmacologic therapy for trigeminal neuralgia?

A patient with lumbar disk disease requires lumbar epidural injection of a corticosteroid for control of low back pain. Which of the following statements concerning this treatment is true?

A 45-kg, 80-year-old woman undergoes pin fixation of the right hip in the lateral decubitus position under spinal anesthesia. One day after the operation, she cannot move her left ankle or foot actively. The most likely cause is

During postoperative indirect laryngoscopy, the vocal cords appear symmetric during quiet breathing and approximate to the left of midline during phonation. The most likely cause is

The muscular action most likely to remain intact following an axillary brachial plexus block is

Which of the following nerves is most likely to be injured by a fracture of the shaft of the humerus?

Which of the following is most responsible for the duration of action of local anesthetics?

Diplopia following lumbar puncture with a 25-gauge, 3 1/2-inch needle is the result of

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 pain?

Epinephrine is less effective in prolonging epidural anesthesia with bupivacaine than epidural anesthesia with lidocaine because

The plasma concentration of equal doses of a local anesthetic is highest when the site of administration is

Which of the following statements concerning interscalene brachial plexus block is true?

A 65-kg man is scheduled for wrist surgery with intravenous regional anesthesia with 0.5% lidocaine 50 ml. Which of the following statements is true?

A 70-year-old man with stable angina is scheduled for cataract removal with a retrobulbar block. After injection of 5 ml of 0.75% bupivacaine, heart rate decreases from 90 to 55 bpm, and frequent premature ventricular contractions are noted on the EKG. These changes are most likely caused by

Which of the following additives accelerates the onset of lidocaine axillary block without shortening duration?

The physiologic function most likely to be spared when a local anesthetic differential nerve block is administered is

A 28-year-old woman receives a lumbar epidural anesthetic for uncomplicated labor and delivery. During removal of the catheter, 1 cm breaks off and remains in her back. After informing the patient, the most appropriate management is

One day after a vaginal hysterectomy under epidural anesthesia, a patient has numbness and inability to dorsiflex the right foot. Her legs were placed in leg holders during the operation. The most likely cause is

Compared with morphine 5 mg administered epidurally at T12, morphine 5 mg administered intravenously is associated with

Percutanous cordotomy is being considered for a patient with severe pain that has persisted for three months after amputation of the arm for osteogenic sarcoma. Which of the following statements is true?

In an Infant, spinal anesthesia to a sensory level of T8 is achieved with tetracaine administered at the L2-3 interspace. Compared with spinal anesthesia to the same sensory level in an adult, this anesthetic is associated with a

An obese, 75-year-old woman is scheduled for open reduction of a left forearm fracture. Thirty minutes after successful interscalene block using 20 ml of 2% lidocaine, she becomes dyspneic. The dyspnea is most likely related to

The test dose of local anesthetic administered through an epidural needle or catheter should be sufficient to produce

A 32-year-old man who is addicted to opioids complains of pain in the PACU one hour after fixation of a mandibular fracture. He has received intravenous morphine 30 mg during the past hour. The most appropriate management is

Which of the following spirometric tests is most likely to be accurate in a patient with severe pain?

A woman has weakness of the right quadriceps and a decreased knee jerk reflex on the right one day after forceps delivery under epidural anesthesia. The most likely cause is

A bilateral superior laryngeal nerve block performed to facilitate fiberoptic intubation will provide anesthesia of the

To eliminate involuntary expulsive effort with contraction in the second stage of labor, a nerve block must include at least

Bupivacaine 30 ml injected into the inguinal perivascular space will usually block the

Compared with epidural administration of hydrophilic opioids, epidural administration of lipophilic opioids is associated with

Five minutes after a stellate ganglion block is performed, a patient becomes restless, then apneic. The most likely cause is

When performed with identical doses, which of the following types of regional block is associated with the highest plasma concentration of the drug?

An otherwise healthy 42-year-old woman is referred for management of pain associated with adenocarcinoma of the breast and metastasis to the anterior body of L3. She perceives the pain as moderate and currently takes no pain medication. Her oncologist estimates her life expectancy to be 18 months. The most appropriate initial management is

Which of the following is characteristic of low back pain associated with myofascial pain syndrome but not of pain associated with a herniated lumbar disk?

Which of the following statements concerning the use of epidural opioids during labor is true?

A 70-kg patient experiences pain on incision of a thigh abscess. The area around the abscess had been infiltrated with 30 ml of 1% lidocaine in 1:200,000 epinephrine. The local anesthetic was most likely ineffective because of

Immediately after a retrobulbar block for cataract surgery, the eye grossly protrudes and the patient has the sensation of pressure in the eye. The most appropriate initial intervention is

Compared with lidocaine, bupivacaine is more likely to cause dysrhythmias because it

A successful celiac plexus block can be expected to

A sensory level of T2 is achieved after administration of spinal anesthesia. Which of the following lung volumes is LEAST likely to be affected?

A subarachnoid block to a sensory level of the second thoracic dermatome is associated with each of the following EXCEPT

A 35-year-old man has acute onset of low back pain, lower extremity weakness, and bladder dysfunction. He had a lumbar laminectomy two years ago. A myelogram shows disk herniation at L4-5. The most appropriate management is

Myofascial pain is an example of

A 30-year-old woman has difficulty talking 15 minutes after initiation of interscalene block for closed reduction of a dislocated shoulder. The most likely cause is

Which of the following complications of caudal anesthesia with 0.25% bupivacaine is more likely in children than in adults?

Surgery is cancelled 10 minutes after initiation of intravenous regional anesthesia with 50 ml of lidocaine 0.5%. To terminate anesthesia safely, what is the most appropriate timing for deflating the tourniquet?

A patient with chronic obstructive pulmonary disease is undergoing spinal anesthesia to a T6 sensory level. The most pronounced effect on pulmonary function will be a decrease in

Which of the following is the most likely sequela of interscalene brachial plexus block?

After an axillary brachial plexus block, the patient feels pain when the surgeon clips the skin over the thenar eminence. The most likely cause is inadequate anesthesia in the distribution of the

Which of the following statements concerning the cardiovascular effects of intravenous bupivacaine is true?

Which of the following statements concerning the superior laryngeal nerve is true?

A successful ankle block for transmetatarsal amputation of the first and second toes should include each of the following nerves EXCEPT the

Which of the following is a cardiorespiratory effect of epidural block to a T4 sensory level?

A 67-year-old man undergoes spinal anesthesia with hyperbaric tetracaine 10 mg for transurethral resection of the prostate. At the end of the 50-minute procedure, the level of anesthesia is T6 and blood pressure is 120/70 mmHg. Within two minutes after transfer to a stretcher, the patient has nausea and blood pressure decreases to 76/42 mmHg. Which of the following is the most likely cause of the acute hypotension?

An 8-kg, 1-year-old boy is scheduled for a bilateral inguinal hernia repair. If regional anesthesia is to be used for post-operative analgesia, which of the following statements is true?

Which of the following is decreased by alkalinization of a 1.5% lidocaine solution?

Which of the following is the most likely cause of apnea occurring after a retrobulbar block?

The best premedication regimen for a known active narcotic addict would include

Five minutes after intrathecal administration of tetracaine 12 mg in hyperbaric solution, a 60-year-old man has a weak hand grasp. Respirations are normal, heart rate has decreased from 80 to 45 bpm, and blood pressure has decreased from 150/80 to 90/50 mmHg. The most appropriate management at this time is

A 40-year-old woman has continuous nondermatomal burning pain of the distal foot four weeks after sustaining a metatarsal fracture. On examination, the foot is mildly swollen, tender, and cool. Which of the following statements concerning this condition is true?

At equipotent doses, which of the following opioids is most likely to migrate cephalad in cerebrospinal fluid after epidural administration?

Which of the following statements concerning caudal anesthesia in children is true?

A patient has pain in the left thoracic wall associated with metastatic rib lesions. An intrathecal neurolytic block with 6% phenol in glycerin is planned for pain relief. Prior to performing the block, the patient should be placed in which of the following positions?

Mepivacaine 40 ml of a 1% solution with epinephrine 1:200,000 is injected into the brachial plexus sheath at the axilla after eliciting a paresthesia in the ulnar nerve distribution. Which of the following is most likely to remain intact?

Which of the following statements concerning intercostal nerve block for postoperative pain is true?

A tourniquet with dual bladders is being used for intravenous regional anesthesia of the upper extremity. At what point in the procedure should the distal tourniquet be inflated?

A 65-year-old man undergoes prostatectomy in the lithotomy position under spinal anesthesia using bupivacaine 12 mg. Ten hours later, he reports that his left foot is numb. Examination shows decreased pinprick sensation over the lateral dorsal aspect of the left foot; dorsiflexion is limited. Which of the following is the most likely cause?

Which of the following is the most likely cause of dyspnea during spinal anesthesia to a T3 sensory level?

A patient is scheduled for amputation of the third metatarsal. A tourniquet will not be used during the procedure. The most effective anesthesia will be provided by block of which of the following nerves?

A patient who has severe pain from unresectable cancer of the base of the tongue is referred for a neurolytic block. A block of which of the following will be effective?

Twenty minutes after an axillary block, the patient reports feeling over the "back of the hand." Examination shows normal sensation over the lateral aspect of the dorsum of the hand and the dorsal base of the thumb and index finger. Supplementary anesthesia of this area can be provided by blocking which of the following nerves?

Transcutaneous electrical nerve stimulation is LEAST likely to be effective in which of the following pain syndromes?

Each of the following is a complication of stellate ganglion block EXCEPT

A celiac plexus block provides effective relief of pain associated with primary cancers at each of the following locations EXCEPT the

A patient receives 1.5% bupivacaine 40 ml and epinephrine 1:200,000 for axillary brachial plexus block for reduction of a forearm fracture. The tourniquet is inflated to 300 mmHg; 45 minutes later, the patient has pain that radiates to the posteromedial elbow. Which of the following nerves is NOT adequately blocked?

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?

Which of the following is the correct sequence of anatomic structures encountered when using a paramedian approach for lumbar spinal anesthesia?

Which of the following neural functions demonstrates the highest segmental block after spinal anesthesia?

During open reduction of a tibial fracture, a tourniquet cuff is applied around the proximal thigh and inflated to 300 mmHg. Which of the following is most likely to prevent pain and hypertension caused by the tourniquet?

A 46-year-old man is scheduled for repair of an inguinal hernia. Six years ago, he had an episode of malignant hyperthermia during cholecystectomy. Which of the following is the most appropriate perioperative management?

Forty-eight hours after thoracotomy, a patient's T6-7 epidural catheter is removed and the distal 2 cm is noted to be missing. The patient felt no pain during removal and neurologic examination shows no abnormalities. After informing the patient, which of the following is the most appropriate next step in management?

A patient has a seizure within seconds after receiving a retrobulbar injection of 0.5% bupivacaine with epinephrine 1:200,000. Which of the following is the most likely cause?

A 67-year-old man undergoes a perineal procedure under epidural anesthesia in the lithotomy position with extreme flexion of the thigh at the hip. No sedatives are used, and the surgery is uneventful. Forty-eight hours later, the patient cannot flex his left knee. Which of the following is the most likely cause?

A 70-kg, 50-year-old man is scheduled for muscle flap closure of a decubitus ulcer over the sacrum. He has been quadriplegic at the level of C6-7 for six years. Which of the following is most likely to result from subarachnoid anesthesia with tetracaine 10 mg for this procedure?

Properly performed local anesthetic block of the celiac plexus

A healthy 24-year-old woman is undergoing knee arthroscopy with spinal anesthesia to a level of T4. Which of the following findings is LEAST likely?

Which of the following factors is the LEAST important determinant of postdural puncture headache?

Each of the following is an effect of intravascular radiographic contrast media EXCEPT

A 54-year-old man receives 25 ml of a 50% alcohol and 0.25% bupivacaine solution for celiac plexus block. During the next 20 minutes, blood pressure decreases from 130/75 mmHg to 85/55 mmHg. Which of the following is the most likely cause?

Six months after repair of a lacerated peroneal nerve, a patient has electric-shock-like pain when pressure is applied to the middle of the gastrocnemius muscle. The most appropriate initial management is

Which of the following statements concerning postherpetic neuralgia is true?

After receiving an axillary block for carpal tunnel release, a patient has pain on incision. Which of the following nerves should be blocked at the level of the elbow to relieve the pain?

Which of the following procedures is most specific for diagnosing reflex sympathetic dystrophy in a patient with pain of the lower extremity?

An 18-year-old woman has knee pain during arthroscopy performed with femoral and sciatic nerve blocks for repair of a torn medial meniscus. The most appropriate management is addition of which of the following nerve blocks?

A 75-year-old man in the PACU complains of severe pain following thoracotomy. Respiratory rate is 30/min; arterial blood gas values are PaO2 70 mmHg, PaCO2 56 mmHg, and pH 7.28 at an FiO2 of 0.6. The patient has a thoracic epidural catheter and received epidural morphine 2 mg 45 minutes earlier. Which of the following is the most appropriate immediate management?

A 64-year-old patient with chronic obstructive pulmonary disease sustained fractures of ribs 4 through 8 on the left one hour ago. Examination shows agitation, heart rate of 120 bpm, respiratory rate of 30/min, and blood pressure of 180/100 mmHg. PaO2 is 70 mmHg and PaCO2 is 35 mmHg on room air. Radiographs of the chest show no abnormalities. Which of the following is the most appropriate immediate management?

A patient is placed in the prone jackknife position for lumbar subarachnoid injection of tetracaine 10 mg in 10 ml of preservative-free sterile water. Which of the following results is most likely?

Which of the following correctly describes the anatomic location of the stellate ganglion?

Each of the following landmarks is used in performing wrist block to remove a cystic mass on the fourth digit EXCEPT the

Perception of pain from cutaneous sources involves each of the following EXCEPT

Block of each of the following nerves is required for inguinal herniorrhaphy EXCEPT the

Epidural administration of corticosteroids is most effective in relieving pain in patients with which of the following conditions?

During attempted awake intubation, the patient gags when the laryngoscope presses on the base of the tongue. Which of the following cranial nerves is responsible for the afferent limb of this reflex?

Which of the following statements concerning the innervation of the larynx is true?

Which of the following correctly describes the anatomical location of the brachial plexus?

Tingling in the fifth finger during spinal anesthesia is associated with anesthesia at which of the following dermatomes?

Retrobulbar block for ophthalmologic surgery can be administered safely to patients with which of the following conditions?

The condition LEAST likely to be associated with sustained pain relief following a nerve block is

Each of the following is a complication of celiac plexus block with 0.5% lidocaine 40 ml EXCEPT

Coughing that occurs during awake intubation is prevented by local anesthetic block of which of the following nerves?

Which of the following will most closely mimic the effects of stellate ganglion block?

Which of the following statements regarding innervation of the upper extremity is true?

A patient receives remifentanil 25 mcg just before retrobulbar block with 0.25% bupivacaine 4 mL. Over the next 10 minutes, he develops apnea and loses consciousness. Which of the following is the most likely explanation?

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 40-year-old man who is scheduled to undergo repair of a tendon laceration of the left hand has complete anesthesia in the median, radial, and ulnar nerve distributions after supraclavicular block. Two hours of tourniquet inflation are required for completion of the procedure. The most appropriate next step is an additional block of which of the following?

A patient has hoarseness after undergoing surgery involving the aortic arch. The most likely cause is an injury to which of the following nerves?

A patient undergoes differential spinal block for evaluation of persistent foot pain. If the pain returns coincident with a decrease in skin temperature, which of the following is the most appropriate conclusion?

During surgery of the forearm under axillary block, a patient has pain in the lateral aspect of the forearm and responds by flexing the elbow. The most likely cause is inadequate block of which of the following nerves?

Nine months after sustaining an injury to the left forearm, a 30-year-old woman has diffuse, burning pain on the anterior aspect of the forearm and posterior aspect of the hand and discoloration of the skin in the affected areas. The patient should be informed that

Neurolytic block is most appropriate for

A 65-year-old woman has respiratory distress and loss of consciousness immediately following superficial and deep cervical plexus block for right carotid endarterectomy. Which of the following is the most likely cause?

Which of the following anesthetic techniques is most appropriate for a woman in the second stage of labor?

Which of the following treatments is LEAST effective in patients with acute herpes zoster?

A 58-year-old woman with rheumatoid arthritis and hyperactive gag reflex requires awake intubation prior to cervical spine stabilization. Which of the following regional nerve blocks is most appropriate?

A patient is undergoing exploration of a stab wound to the left side of the neck. On awake laryngoscopy, the left vocal cord is in midposition and the right vocal cord is abducted during inspiration. The most likely cause of these findings is trauma to which of the following structures on the left?

In patients with reflex sympathetic dystrophy affecting the arm, which of the following findings indicates a therapeutic block?

Which of the following statements concerning use of amitriptyline to treat chronic pain is true?

A 60-year-old man undergoes transurethral resection of a bladder tumor in the lithotomy position with spinal anesthesia. During the procedure the surgeon reports that the patient's right leg is "jumping." This movement is most likely caused by stimulation of which of the following nerves?

Which of the following statements about patient-controlled analgesia using opioids is true?

Which of the following is associated with the application of a transdermal fentanyl patch?

Which of the following findings best indicates complete resolution of spinal anesthesia?

In an infant, spinal anesthesia to a sensory level of T8 is achieved with tetracaine administered at the L2-3 interspace. Compared with spinal anesthesia to the same sensory level in an adult, this anesthetic is associated with a

Which surface area of the upper extremity is most likely to be unanesthetized by an interscalene brachial plexus block?

A 30-year-old man receives spinal anesthesia to the level of T4. Ten minutes later, heart rate and blood pressure abruptly decrease to 30 bpm and 60/25 mmHg, respectively. The most appropriate management is administration of which of the following drugs?

A 30-year-old man has had burning pain, allodynia, and edema of the hand for six weeks after sustaining a forearm fracture. Appropriate treatment includes each of the following EXCEPT

Each of the following is a complication or side effect of neurolytic celiac plexus blockade EXCEPT

In performing a diagnostic left lumbar sympathetic block for lower extremity claudication, the tip of the needle ideally should lie at point