Em Anesthesia & Analgesia Via Pretest

Front 1

16. Which of the following agents is LEAST likely to
cause hypotension at standard doses?
(A) Morphine
(B) Meperidine
(C) Fentanyl
(D) Midazolam
(E) Propofol

Back 1

16. The answer is C. (Chapter 33) Fentanyl is a potent, synthetic opioid. Because it does
not trigger histamine release like other opioid analgesics, it causes little hemodynamic
compromise. All the other agents listed cause dose-dependent hypotension.

Front 2

17. Which of the following agents may cause truncal and
jaw muscle rigidity?
(A) Morphine
(B) Meperidine
(C) Ketamine
(D) Fentanyl
(E) Etomidate

Back 2

17. The answer is D. (Chapter 33) Truncal and jaw muscle rigidity are rare side effects
of fentanyl that can lead to impaired ventilation. This rigidity most often occurs at high
doses (
10–15 g/kg) and may be reversed by parenteral naloxone. If naloxone is
unsuccessful, paralysis and endotracheal intubation may be necessary.

Front 3

18. Which of the following agents may precipitate bronchospasm
in patients with reactive airway disease?
(A) Midazolam
(B) Etomidate
(C) Ketamine
(D) Propofol
(E) Methohexital

Back 3

18. The answer is E. (Chapter 15) Methohexital is an ultra-short-acting barbiturate that
provides sedation and amnesia for short, invasive procedures. Barbiturate administration
may precipitate bronchospasm in patients with moderate to severe reactive airway disease,
thus limiting its use in those patients. There is some evidence that ketamine may
have a mild, transient bronchodilatory effect. Midazolam, etomidate, and propofol have
no clinically significant effect on bronchial smooth muscle tone. Of the listed agents,
only ketamine provides analgesia in addition to sedation.

Front 4

19. Which of the following statements regarding local
anesthetics is FALSE?
(A) Lidocaine and bupivicaine are both amide
anesthetics
(B) Warming and buffering has been shown to
reduce the pain of injection
(C) The duration of anesthesia is twice as long
with bupivicaine as with lidocaine
(D) Duration of anesthesia is prolonged
with epinephrine
(E) Epinephrine can damage local tissue defenses

Back 4

19. The answer is C. (Chapter 32) The duration of anesthesia after bupivicaine is nearly
four times longer than that for lidocaine. With either agent, the duration of action is prolonged
when combined with epinephrine. However, the local vasoconstrictive action of
epinephrine may result in local hypoxia that impairs white blood cell function, thereby
damaging local tissue defenses. Both lidocaine and bupivicaine are amide anesthetics.

Front 5

20. EMLA is appropriate for all of the following procedures
EXCEPT
(A) venipuncture
(B) laceration repair
(C) lumbar puncture
(D) myringotomy
(E) cautery of genital warts

Back 5

20. The answer is B. (Chapter 32) EMLA (eutectic mixture of local anesthetics) is a
eutectic mixture of 5 percent lidocaine and prilocaine that is used to produce anesthesia
over intact skin. In the ED, its primary use is to produce anesthesia before venipuncture
and lumbar puncture. In other settings, this cream has been used for anesthesia of
split-thickness graft donor sites, curettage of molluscum contagiosum, cautery of genital
warts, and myringotomy. EMLA is not recommended for topical anesthesia of
lacerations because it induces an exaggerated inflammatory response, thereby damaging
host defenses and inviting the development of infection.