36 questions match your search.
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?
(B) Lateral femoral cutaneous
Compared with morphine, a single epidural administration of fentanyl is associated with
(A) delayed onset of analgesia
(B) increased incidence of pruritus
(C) increased incidence of respiratory depression
(D) longer duration of action
(E) more restricted segmental spread
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
(A) acidosis at the site of the injection
(B) epinephrine-induced limitation of drug diffusion
(C) insufficient dose
(D) low ionization of lidocaine
(E) protein binding of lidocaine
Tingling in the fifth finger during spinal anesthesia is associated with anesthesia at which of the following dermatomes?
Epinephrine is less effective in prolonging epidural anesthesia with bupivacaine than epidural anesthesia with lidocaine because
(A) peak bupivacaine concentrations are decreased less than peak lidocaine concentrations
(B) the acidic pH of epinephrine decreases the concentration of the nonionized bupivacaine
(C) bupivacaine produces more vasoconstriction than lidocaine
(D) the duration of action of bupivacaine is independent of local blood flow
(E) bupivacaine antagonizes the vasoconstrictor activity of epinephrine
Spinal anesthesia at a T6 sensory level is most likely to improve cardiac output in patients with
(A) aortic stenosis
(B) asymmetric septal hypertrophy (IHSS)
(C) chronic constrictive pericarditis
(D) cor pulmonale
(E) mitral regurgitation
Perception of pain from cutaneous sources involves each of the following EXCEPT
(A) frontal lobe gyri
(B) lateral spinothalamic tracts
(C) periaqueductal gray matter
(D) spinal dorsal horn lamina V
(E) unmyelinated C fibers
At equipotent doses, which of the following opioids is most likely to migrate cephalad in cerebrospinal fluid after epidural administration?
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 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) Epidural hematoma
(B) L5 nerve root injury
(C) Obturator nerve injury
(D) Peroneal nerve injury
(E) Sciatic nerve injury
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?
(A) Decreased heart rate
(B) Decreased hepatic blood flow
(C) Decreased mean arterial pressure
(D) Decreased tidal volume
Which of the following statements concerning the innervation of the larynx is true?
(A) The glossopharyngeal nerve provides motor innervation to the vocal cords
(B) The recurrent laryngeal nerve provides sensory innervation to the mucosa of the larynx above the vocal cords
(C) The hypoglossal nerve provides sensory innervation to the aryepiglottic folds
(D) Unilateral recurrent laryngeal nerve injury results in an abducted vocal cord on the injured side
(E) The vagus nerve provides innervation to all structures below the vocal cords
Epidural block is safer at the L3-L4 interspace than at the T12-L1 interspace because of the location of the
(A) anterolateral epidural veins
(B) inferior border of the cauda equina
(C) inferior border of the conus medullaris
(D) inferior border of the subarachnoid space
(E) blood supply to the anterior spinal cord
A subarachnoid block to a sensory level of the second thoracic dermatome is associated with each of the following EXCEPT
(A) total sympathetic block
(B) decreased gastrointestinal smooth muscle tone
(D) relaxation of gastrointestinal sphincters
(E) decreased renal blood flow
Which of the following neural functions demonstrates the highest segmental block after spinal anesthesia?
(A) Afferent sympathetic activity
(C) Sharp pain perception
(D) Temperature sensation
(E) Touch sensation
Which of the following is most responsible for the duration of action of local anesthetics?
(C) Molecular weight
(D) Tissue protein binding
(E) Volume injected
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
(A) minute ventilation
(B) peak expiratory flow
(c) physiologic dead space
(D) tidal volume
(E) vital capacity
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) Expiratory reserve volume
(B) Inspiratory reserve volume
(C) Inspiratory capacity
(D) Tidal volume
(E) Vital capacity
Which of the following is the correct sequence of anatomic structures encountered when using a paramedian approach for lumbar spinal anesthesia?
(A) Ligamentum flavum — dura mater — arachnoid mater
(B) Interspinous ligament — ligamentum flavum — dura mater — arachnoid mater
(C) Posterior longitudinal ligament — ligamentum flavum — dura mater — arachnoid mater
(D) Anterior longitudinal ligament — ligamentum flavum — dura mater — arachnoid mater
(E) Ligamentum flavum — dura mater — pia mater — arachnoid mater
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?
(A) Acute congestive heart failure
(B) Decreased venous return
(C) Dilutional hyponatremia
(D) Progression of sympathetic block
(E) Unrecognized bladder perforation
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
(A) continued intravenous administration of morphine until the pain resolves
(B) intravenous administration of nalbuphine in 5-mg increments until the pain resolves
(C) intramuscular administration of hydroxyzine 75 mg
(D) evaluation for entrapment of the mandibular nerve
(E) evaluation for drug-seeking behavior
Which of the following statements concerning the superior laryngeal nerve is true?
(A) It provides sensory innervation to the subglottic surface of the vocal cord
(B) It provides sensory innervation to the inferior surface of the epiglottis
(C) It is a branch of the glossopharyngeal nerve
(D) It is blocked by injection of anesthetic near the lateral portion of the cricothyroid membrane
(E) It is the most commonly injured nerve during thyroid surgery
Compared with morphine 5 mg administered epidurally at T12, morphine 5 mg administered intravenously is associated with
(A) greater incidence of urinary retention
(B) less intense analgesia
(C) less nausea and vomiting
(D) longer duration of analgesia
(E) longer time to maximum analgesia
The most medial of the following components in the antecubital fossa is the
(A) brachial artery
(B) brachioradialis muscle
(C) cephalic vein
(D) median nerve
(E) radial nerve
Which of the following is decreased by alkalinization of a 1.5% lidocaine solution?
(A) Concentration of free base
(B) Dose required for anesthesia
(C) Duration of anesthesia
(D) Intracellular concentration of ionized lidocaine
(E) Time to onset of anesthesia
The test dose of local anesthetic administered through an epidural needle or catheter should be sufficient to produce
(B) seizure activity
(D) segmental analgesia
(E) spinal anesthesia
Compared with lidocaine, bupivacaine is more likely to cause dysrhythmias because it
(A) enhances potassium-hydrogen ion exchange
(B) is less soluble in lipids
(C) produces more prolonged block of sodium channels
(D) sensitizes the myocardium to catecholamines
(E) sustains calcium channels open
A bilateral superior laryngeal nerve block performed to facilitate fiberoptic intubation will provide anesthesia of the
(A) base of the tongue
(B) larynx above the vocal cords
(C) superior surface of the epiglottis
(D) tonsillar pillars
(E) upper trachea
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?
(A) Administration of a regional anesthetic
(B) Administration of dantrolene orally for two days prior to surgery
(C) Avoidance of all inhalational anesthetics except isoflurane
(D) Avoidance of ester local anesthetics
(E) Flushing the anesthesia machine with oxygen 10 L/min for a minimum of 12 hours
Which of the following is the most likely cause of dyspnea during spinal anesthesia to a T3 sensory level?
(A) Decreased abdominal muscle tone
(B) Decreased afferent input from the thoracic wall
(C) Increased dead space ventilation
(D) Increased intrapulmonary shunting
(E) Partial diaphragmatic paralysis
Which of the following statements concerning the cardiovascular effects of intravenous bupivacaine is true?
(A) Intralipid is effective in treating bupivacaine-induced ventricular arrhythmias
(B) Cardiovascular toxicity is decreased during pregnancy
(C) Cardiovascular toxicity occurs at lower blood levels than central nervous system toxicity
(D) Systemic vascular resistance is unchanged
(E) The rate of impulse conduction through the heart is increased
Which of the following correctly describes the anatomical location of the brachial plexus?
(A) Adjacent to the subclavian vein as it passes between the scalene muscles
(B) Between the middle and posterior scalene muscles
(C) Posterior to the first rib
(D) Posterior to the subclavian artery
(E) Posterior to the vertebral artery
The best premedication regimen for a known active narcotic addict would include
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?
(A) C7-8 nerve root
(B) Stellate ganglion
(C) Glossopharyngeal nerve
(D) Superior laryngeal nerve
(E) Vagus nerve
Which of the following spirometric tests is most likely to be accurate in a patient with severe pain?
(A) Forced expiratory volume in one second
(B) Peak expiratory flow rate
(C) Maximum midexpiratory flow
(D) Maximum breathing capacity
(E) Negative inspiratory pressure
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?