Chapter 2, Analgesia, Anesthesia, and Sedation Video Solutions, Emergency Medicine Examination & Board Review

Problem 1

A 26-year-old male has just had a successful reduction of a nondisplaced distal radial fracture. He also sustained rib fractures and a shoulder contusion in a construction accident. The patient still has significant pain, rated as 8 out of 10 after $800 \mathrm{mg}$ of ibuprofen. Which of the following medication regimens is a reasonable choice for treating this patient's pain?
(A) Codeine $30 \mathrm{mg}$ orally every 4 hours.
(B) Acetaminophen $325 \mathrm{mg} /$ codeine $5 \mathrm{mg}$ orally every 6 hours.
(C) Ibuprofen $600 \mathrm{mg}$ every 6 hours and oxycodone $5 \mathrm{mg}$ orally every 6 hours.
(D) Rofecoxib $25 \mathrm{mg}$ orally once a day.

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01:17

Problem 2

An opioid agonist-antagonist is associated with which of the following effects?
(A) Dose-related respiratory depression.
(B) Possible induction of withdrawal in opioid-dependent patients.
(C) Higher dosage requirements in opioid-naive patients.
(D) Lover dosage requirements than similar opioid agonists.

Asma Venkitta

Numerade Educator

01:10

Problem 3

In which of the following situations should ketamine be used with caution?
(A) Children without intravenous access.
(B) Patients with history of asthma.
(C) Patients in whom other analgesics were not fully effective in controlling pain.
(D) Patients with suspected increased intracranial pressure.

Lottie Adams

Numerade Educator

Problem 4

What is the maximum dose of Lidocaine with epinephrine that can be administered peripherally?
(A) $300 \mathrm{mg}$.
(B) $4.5 \mathrm{mg} / \mathrm{kg}$.
(C) $7 \mathrm{mg} / \mathrm{kg}$.
(D) $1.5 \mathrm{mg} / \mathrm{kg}$.

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Problem 5

A 35-year-old female patient drove herself to the emergency department because she sustained a small laceration to her finger. She reports the last time she received a subcutaneous injection of lidocaine she "broke out in hives" and her "throat became swollen." What is a reasonable alternative for local anesthesia in this patient?
(A) Subcutaneous administration of prilocaine.
(B) Administration of diphenhydramine 30 minutes prior to lidocaine injection.
(C) Oral diphenhydramine.
(D) Subcutaneous administration of procaine.

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Problem 6

A 35-year-old male presents with a 4-cm laceration to his left cheek 2 cm below his lower eyelid, You explain to him that you would like to perform regional anesthesia to numb his face. Which of the following describes the appropriate procedure?
(A) A mental block can be performed by injecting $2 \mathrm{cc}$ of lidocaine with epinephrine near the mental foramen.
(B) An infraorbital block can be performed by injecting $8 \mathrm{cc}$ of lidocaine with epinephrine near the infraorbital foramen.
(C) A mental block can be performed by injecting 6 co of lidocaine with epinephrine near the mental foramen.
(D) An infraorbital block can be performed by injecting $3 \mathrm{cc}$ of lidocaine near the infraorbital foramen.

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Problem 7

A 21-year-old unrestrained driver with a past medical history significant for asthma was involved in a single-vehicle automobile accident and has severe pain from an open fracture of his left tibia and fractured ribs. He is hypotensive with an initial blood pressure of $80 / 50 \mathrm{mmHg}$. The patient is currently receiving a liter bolus of lactated Ringer's solution. Which of the following analgesic agents is a reasonable choice in this setting of hypotension?
(A) Meperidine $50 \mathrm{mg}$ intravenously.
(B) Morphine $10 \mathrm{mg}$ intravenously.
(C) Fentanyl $100 \mathrm{mcg}$ intravenously.
(D) Propofol $50 \mathrm{mg}$ intravenously.

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01:30

Problem 8

Which of the following is NOT one of the pharmacologic properties of etomidate?
(A) Devoid of analgesic properties.
(B) Amnestic properties.
(C) Dose-dependent cardiovascular depression.
(D) Reliable hypnosis in a short period of time.

Maryam Riaz

Numerade Educator

Problem 9

After successful reduction of a shoulder dislocation using procedural sedation, a patient can be safely discharged from the ED upon satisfying which of the following sets of conditions?
(A) The patient can count backwards from 100 and walk in a straight 1 ine.
(B) The patient is awake and alert, can recite discharge instructions after tolerating a beverage, and has a reliable adult to accompany him or her home.
(C) The patient, although drowsy, can follow instructions.
(D) The patient is nauseous but awake and alert and can recite discharge instructions.

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01:10

Problem 10

Which of the following agents is contraindicated in patients with head injury?
(A) Etomidate.
(B) Eentany1.
(C) Nitrous oxide.
(D) Propofol.

Lottie Adams

Numerade Educator