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McGraw-Hill Specialty Board Review Pain Medicine

Salahadin Abdi, Pradeep Chopra, Howard Smith

Chapter 10

Interdisciplinary Pain Management - all with Video Answers

Educators


Chapter Questions

Problem 698

Flail chest because of multiple rib fractures may result in
(A) changes in oxygenation, but not in ventilation status
(B) mild pain that usually does not results in splinting or atelectasis
(C) increase in shunt fraction
(D) increase in ventilation and hypocarbia
(E) shunt, but no ventilation and perfusion mismatch

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Problem 763

The second most common cause of pain in the elderly is
(A) musculoskeletal
(B) cancer
(C) temporal arteritis
(D) postherpetic neuralgia
(E) diabetic neuropathy

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Problem 764

Pain assessment in the elderly is usually more difficult than in the young because it is often complicated by
(A) good health status which may confuse the physician
(B) poor memory
(C) depression, which is only seen in cancer pain patients
(D) most complains are psychiatric as opposed to organic
(E) none of the above

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Problem 765

Which of the following includes recommendations by the American Geriatric Society for pain patients?
(A) Pain and its response to treatment do not necessarily need to be measured
(B) Nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated in older patients
(C) Acetaminophen is the drug of choice for relieving mild to moderate pain
(D) Nonopioid analgesic medications may be appropriate for some patients with neuropathic pain and other chronic pain syndromes
(E) Nonpharmacologic approaches (eg, patient and caregiver education, cognitive-behavioral therapy, exercise) have no role in the management of geriatric pain

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Problem 766

The functional pain scale has been standardized for the older population. Which of the following includes levels of assessment in this scale?
(A) Rating pain as tolerable or intolerable
(B) A functional component that adjusts the score depending on whether a person can respond verbally
(C) A 0 to 5 scale that allows rapid comparison with previous pain levels
(D) Only $\mathrm{A}$ and $\mathrm{C}$ are correct
(E) A, B, and C are correct

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01:55

Problem 767

Which of the following is a major concern regarding antiepileptic agents when used to treat neuropathic pain in the elderly patient?
(A) Propensity to interfere with vitamin D metabolism
(B) Need to use higher doses than those used in the young adult
(C) May disrupt balance
(D) Only A and C are correct
(E) A, B, and C are correct

Qudsiya Anis
Qudsiya Anis
Numerade Educator

Problem 768

Which of the following is true regarding opioid use in the geriatric patient?
(A) Use of long-acting opioids may facilitate tolerance and lead to higher opioid dosage requirements for adequate pain control
(B) $\mu$-Receptor antagonists are less desirable in the elderly
(C) Meperidine is an excellent choice alone or in combination with adjuvant medications for intractable pain
(D) Moderate to severe pain responds well to agonists-antagonists agents
(E) The transdermal route of fentanyl should be used as the first choice in the elderly, in order to increase compliance with the treatment

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02:48

Problem 769

Which of the following is true about the elderly and pain?
(A) Incidence of chronic pain in the community-dwelling elderly is the same as in nursing home residents
(B) The prevalence of pain in patients older than 60 years of age is twice the incidence of those younger than 60 years of age
(C) The geriatric population in the United States consumes more than $50 \%$ of all prescription drugs
(D) The elderly often report pain differently from other patients because of decreased pain threshold
(E) None of the above

Sarah Howell
Sarah Howell
Numerade Educator
06:08

Problem 770

When referring to pharmacokinetics in the elderly, which of the following variables is altered in the elderly?
(A) Volume of distribution (Vd)
(B) Clearance of drugs (Cl)
(C) Elimination half-life $\left(t_{1 / 2} \beta\right)$
(D) Receptor binding affinity
(E) All of the above

Noah Boudrie
Noah Boudrie
Numerade Educator
02:48

Problem 771

Which of the following is true regarding pharmacodynamics in the elderly?
(A) Pharmacodynamic changes in the elderly are closely associated with agerelated decline in central nervous system (CNS) function
(B) Decreased sensitivity to benzodiazepines
(C) Increased sensitivity to $\beta$-blockers
(D) Decreased sensitivity to opioids
(E) When compared to the young adult, there are no changes in pharmacodynamics in the elderly

Sarah Howell
Sarah Howell
Numerade Educator

Problem 772

Which of the following includes factors with clear associations contributing to poor compliance in the elderly?
(A) Race
(B) Religious beliefs
(C) Physician-patient communication
(D) Only $\mathrm{A}$ and $\mathrm{C}$ are correct
(E) A, B, and C are correct

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Problem 773

An 82-year-old male suffers from low back pain caused by facet arthropathy. His pain has been well under control with weak opioids for several years. Over the last year pain has increased in severity and current pain medications, although still make him slightly drowsy, do not provide adequate pain relief. The next step in the management of this patient's pain should be
(A) switching to strong opioids
(B) diagnostic lumbar facet blocks
(C) radiofrequency lesions to the lumbar medial branches
(D) using a combination of two different weak opioids
(E) intrathecal opioids

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Problem 774

Chronic use of NSAIDs in the geriatric patient should be accompanied by
(A) monitoring liver function test when appropriate
(B) monitoring renal function
(C) concomitant use of medications such as misoprostol or histamine-2 $\left(\mathrm{H}_2\right)$-blockers
(D) occasional testing for occult blood in stool
(E) all of the above

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Problem 775

When opioid therapy is first begun in the geriatric patient which of the following should be considered?
(A) It is desirable to use drugs with short half-life $\left(t_{1 / 2}\right)$
(B) Close monitoring of side effects should occur for the first three $t_{1 / 2}$ while a therapeutic blood level is obtained
(C) Meperidine would be a better choice as an initial opioid than hydromorphone
(D) Methadone is an excellent choice owing to its $\mathrm{t}_{1 / 2}$
(E) If pain control with minimal side effects has been established with a short-acting opioid, it is never recommended to switch to a controlled-release formulation of the opioid

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Problem 776

Which of the following is an important goal for the elderly patient undergoing physical therapy for pain management?
(A) Obtaining a gainful employment
(B) Live a more independent life with enhanced dignity
(C) Improve sleeping pattern
(D) Gain back the physical skills they had as a young adult
(E) None of the above

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Problem 777

Prior to a chemical neurolysis to be performed in an 80-year-old male for trigeminal neuralgia, potential risks must be explained to the patient. Which of the following is a potential hazard?
(A) Motor weakness
(B) Neuritis
(C) Deafferentation pain
(D) Persistent pain at the site of injection
(E) All of the above

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Problem 778

Which of the following best describes the definition of recurrent abdominal pain in childhood and adolescence?
(A) Abdominal pain resulting from gastrointestinal disease occurring on at least three occasions over a 3-month period
(B) Abdominal pain resulting from gastrointestinal disease, gynecologic conditions, or congenital anomalies, occurring on at least three occasions over a 3-month period
(C) Abdominal pain with no organic cause occurring on at least three occasions over a 3-month period that is severe enough to alter the child's normal activity
(D) Abdominal pain with an organic cause, such as metabolic disease, neurologic disorders, hematologic disease, gastrointestinal disease, gynecologic condition, or other, that occurs at least in three occasions over a 3-month period
(E) Acute abdominal pain from intestinal, renal, and gynecologic disorders, which can be treated surgically

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Problem 779

Which of the following is true regarding migraine headaches in the pediatric population?
(A) Incidence of migraine is higher in prepubertal children when compared to those who have reached puberty
(B) In children with common migraine, there is unilateral localization of pain which is mostly preceded by an aura
(C) Classic migraine usually present in children with an aura, followed by a bifrontal or bitemporal pain
(D) Most children with common migraine present with abdominal pain
(E) Ophthalmoplegic migraine is fairly common in children younger than 4 years of age, and is usually accompanied by miosis

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Problem 780

Which of the following best describes chest pain during childhood?
(A) Cardiac involvement is extremely rare; an electrocardiogram (ECG) is indicated but mainly for reassurance of the parents, since it will be normal in most cases
(B) It is seen more often in children younger than 10 years of age
(C) It is more common than abdominal pain or headaches
(D) Costochondritis ranks second to cardiac involvement in being the most common cause of chest pain in this population
(E) Muscle strain is the most common cause of chest pain in children

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04:00

Problem 781

Which of the following is false regarding sickle cell anemia in children?
(A) Pain occurs when and where there is occlusion of small blood vessels by sickled erythrocytes, usually small bones of the extremities in smaller children and abdomen, chest, long bones, and lower back in older children
(B) Tricyclic antidepressants are recommended for analgesia during the acute phase of a vasoocclusive crisis
(C) Use of opioids is indicated in patients with severe pain
(D) Painful crisis can be triggered by hypoxemia, cold, infection, and hypovolemia
(E) In children with excruciating pain that does not respond to nonnarcotic analgesics, and inadequate treatment of the painful crisis can lead to drug-seeking behavior and profound psychosocial problems

Sheryl Ezze
Sheryl Ezze
Numerade Educator
00:23

Problem 782

Which of the following is the best choice for management of the painful hemarthroses in children suffering from hemophilia?
(A) Aspirin
(B) Pentazocine
(C) Cortisone
(D) Ibuprofen
(E) Acetaminophen

Nicole Smina
Nicole Smina
Numerade Educator

Problem 783

Which of the following is false regarding complex regional pain syndrome type I (CRPS I) in children?
(A) The affected area is usually the upper limb as opposed to the lower limb in adults
(B) Physical therapy is withheld for cases that do not respond to oral medication and/or sympathetic blocks in the first place
(C) Multidisciplinary treatment combining transcutaneous electrical nerve stimulation (TENS), physical therapy, psychotherapy using behavior modification techniques, and oral medications is effective in most children
(D) Typical children with CRPS I or CRPS II show a profile of being intelligent, driven overachievers who are involved in very competitive activities and who often react to the loss of this activity with depression
(E) Sympathetic blocks are indicated to permit more vigorous physical therapy if pain prevents the start of these therapies

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Problem 784

Which of the following is true regarding sport injuries in the pediatric patient?
(A) The injuries encountered are overuse injuries similar to those found in the adult recreational athlete who does not train correctly, usually doing too much in too short a time
(B) Growth is not an important factor in these injuries
(C) Growth spurts in children cause tendon and muscle tightness, both of which minimize the chances of a sport injury
(D) Treatment options such as oral acetaminophen, NSAIDs and aspirin do not provide adequate pain relief and should not be used in these cases
(E) Sport injuries are responsible for less than $10 \%$ of the cases of low back pain in children

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Problem 785

Which of the following statements is false regarding pediatric cancer pain?
(A) Phantom sensations and phantom limb pain are common among children following amputation for cancer in an extremity
(B) Phantom pain in children tends to increase with time
(C) Some patients have chronic lower extremity pain caused by avascular necrosis of multiple joints
(D) An example of a neuropathic pain syndrome in pediatric cancer patients is postherpetic neuralgia
(E) Children with cancer pain often present with longstanding myofascial pain

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Problem 786

Which of the following statements is false regarding interventional approaches for pediatric cancer pain management?
(A) In the pediatric cancer population, many children and parents are reluctant to consider procedures with the potential for irreversible loss of somatic function
(B) Dose requirements vary dramatically for spinal infusions in children, and they require individualized attention
(C) For pediatric spinal infusions, the process of converting from systemic to spinal drug is often quite unpredictable, with the potential for either oversedation or withdrawal symptoms
(D) As opposed to the adult population, celiac plexus blockade barely produces pain relief for children with severe pain caused by massively enlarged upper abdominal viscera owing to tumor
(E) In pediatric patients, it is recommended to place catheters while patients are under general anesthesia or deep sedation, not awake

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Problem 787

In the immediate postoperative period, why are parenteral pain medications best given by continuous infusion rather than intermittent intravenous (IV)/intramuscular (IM) boluses?
(A) Opioid infusions do not cause nausea or vomiting
(B) Continuous infusions are associated with higher serum concentrations of the drug
(C) Opioid infusions are not associated with somnolence or respiratory depression, as opposed to intermittent opioid dosing
(D) No need of monitoring pediatric patients with continuous opioid infusions as opposed to constant monitoring in patients with intermittent boluses
(E) Boluses are associated with frequent periods of inadequate pain relief

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01:01

Problem 788

Which of the following is an acceptable alternative for postoperative pain management in children when able to tolerate the oral route?
(A) Codeine
(B) Acetaminophen
(C) Methadone
(D) Immediate-release morphine
(E) All of the above

Narayan Hari
Narayan Hari
Numerade Educator

Problem 789

Which of the following is true regarding pediatric regional anesthesia?
(A) Epidural catheters placed in the thoracic or lumbar spine should not be left in place for more than 2 days because of concerns about infection, displacement, or discomfort
(B) Caudal epidural catheters are contraindicated for postoperative pain management in small children because of the high incidence of infection
(C) Spinal anesthesia has had limited indications in children and adolescents because of the incidence of postspinal headache in this age group
(D) In newborns and infants, spinal anesthesia provides anesthesia with a profound motor block for a prolonged period of time, making it a useful alternative for postoperative pain relief
(E) All of the above

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Problem 790

In pediatric patients taking high doses of opioids, it is advised that an opioid contract should be signed by all parties involved. Which of the following should be included in this contract?
(A) Use of multiple prescriptions for all pain-related medications
(B) Use of as many pharmacies as possible
(C) A statement specifying that there is no need for monitoring compliance of treatment since this does not apply to pediatric patients
(D) Need for random urine or serum medication levels screening, regardless that the patient is a child
(E) None of the above

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Problem 791

Which of the following includes common misconceptions regarding pediatric pain?
(A) It appears that adults are more likely to be believed than children when they complain of pain or discomfort
(B) Neonates and young children do not display learned pain behavior and therefore do not express pain in an adult fashion
(C) Silence is interpreted as a sign of being comfortable
(D) Immobility without facial grimace or focus on the pain source is interpreted as absence of pain
(E) All of the above

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Problem 792

Differences between opioid abuse and opioid physical dependence include
(A) physical dependence involves loss of control and compulsive use regardless of the adverse consequences
(B) opioid abuse is characterized by presence of withdrawal symptoms during abstinence
(C) physical dependence is a physiologic state characterized by the presence of withdrawal symptoms during abstinence
(D) physical dependence and addiction are synonymous
(E) patients presenting opioid abuse are not likely to develop addiction in the future

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01:10

Problem 793

The term "whiplash injury" that results in chronic neck pain describes the resultant injury caused by an abrupt
(A) hyperflexion of the neck from a direct force
(B) hyperextension of the neck from an indirect force
(C) hyperflexion of the neck from an indirect force
(D) hyperextension of the neck from a direct force
(E) rotation of the neck from a direct force

Mayukh Banik
Mayukh Banik
Numerade Educator
01:56

Problem 794

After sustaining a rear-end collision in a car accident, a 25-year-old male patient complains of neck pain. Which of the following are the cervical structures involved in this whiplash injury?
(A) Sternocleidomastoid muscle
(B) Longus colli muscle
(C) Scalene muscles
(D) Only $\mathrm{A}$ and $\mathrm{C}$ are correct
(E) A, B, and C are correct

Prabhu Ramji
Prabhu Ramji
Numerade Educator

Problem 795

Which of the following is a prognostic indicator of chronic symptoms after sustaining a whiplash injury?
(A) Use if a cervical collar for more than 12 weeks
(B) Physical therapy restarted more than once
(C) Numbness and pain in the upper extremity
(D) Requirement of home traction
(E) All of the above

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Problem 796

A 32-year-old male sustained a blunt trauma to the left supraorbital area of his face. The patient manifests burning pain, occasional tingling, and intermittent stabbing. Which of the following is true about this patient's pain?
(A) This is a self-limiting condition that generally resolves spontaneously within several years
(B) With trophic changes, edema, and redness, CRPS I should be suspected
(C) Sympathetic blockade of the stellate ganglion may be effective
(D) Amitriptyline may reduce pain
(E) All of the above

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06:10

Problem 797

Which of the following variables may improve significantly in a patient with multiple rib fractures and an epidural infusion of epidural bupivacaine?
(A) Vital capacity (VC)
(B) Hematocrit
(C) Expiratory reserve volume (ERV)
(D) Platelet aggregation
(E) Hemoglobin oxygen saturation

Norma Kimmel
Norma Kimmel
Numerade Educator
02:04

Problem 799

When sustaining trauma to the spine, which of the following statements regarding elements injured is correct?
(A) Disc injuries are common in the thoracic spine
(B) Vertebral end-plate fractures are common in the cervical spine
(C) Injury to the thoracic facets is more common than to the cervical facets
(D) Disc injuries are predominant in the cervical spine
(E) The posterior elements of the vertebral fractures are never involved

Bryan Valdivia
Bryan Valdivia
Numerade Educator

Problem 800

Which of the following is true regarding the management of pain in the traumatic injury pain patients?
(A) Obtaining hemodynamic stability is one of the main goals
(B) It is important to sustain sympathetic hyperactivity
(C) Uncontrolled pain may contribute to the development of posttraumatic stress disorder
(D) When pain is adequately treated, these patients will always present with impairment of consciousness
(E) None of the above

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Problem 801

Techniques in the management of pain in patients with spinal cord injury (SCI) include
(A) opioid analgesics via IV patientcontrolled analgesia (PCA)
(B) bedside placement of epidural catheters for continuous infusion
(C) bedside placement of intrathecal catheters for continuous infusion
(D) no need for oral adjuvant medications besides opioids
(E) all of the above

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Problem 802

Which of the following is a good alternative for pain control in the patient with post-burn injury pain?
(A) Scheduled around-the-clock opioid boluses
(B) Continuous IV infusion of hydromorphone
(C) Transdermal fentanyl
(D) Intramuscular morphine given only as needed
(E) None of the above

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Problem 803

In the patient with trauma injuries involving an extremity it is important to monitor for compartment syndrome. When using a regional technique for pain control, methods that may help monitoring compartment syndrome include
(A) use of epidural infusion containing local anesthetics at doses where motor block is present
(B) continuous plexus catheter using high concentration of local anesthetics to avoid incidental pain with movement
(C) continuous peripheral nerve catheter using low-dose local anesthetic
(D) continuous IV local anesthetic infusion
(E) all of the above

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Problem 804

In the trauma patient with chest injury, epidural analgesia has been proven to provide excellent pain control and to
(A) avoid endotracheal intubation is some cases
(B) shorten the stay at the intensive care unit (ICU)
(C) decrease ventilator dependence
(D) shorten hospital stay
(E) all of the above

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01:08

Problem 805

Types of pain commonly treated after major abdominal surgery for patients with a wellknown history SCI are
(A) musculoskeletal pain
(B) visceral pain
(C) at-level neuropathic pain
(D) below-level neuropathic pain
(E) all of the above

Cody Delk
Cody Delk
Numerade Educator

Problem 806

Characteristics of below-level neuropathic pain in patients with SCI include
(A) spontaneous pain cephalad to the level of SCI
(B) not related to position or activity
(C) only present in patients with partial injuries to the spinal cord
(D) associated to sensation of dull ache
(E) intermittent, but never constant

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01:01

Problem 807

Which of the following medications have proven to be useful in the treatment of neuropathic pain of patients with $\mathrm{SCI}$ ?
(A) IV propofol infusion
(B) IV ketamine infusion
(C) Intrathecal clonidine
(D) Only $\mathrm{A}$ and $\mathrm{C}$ are correct
(E) A, B, and C are correct

Narayan Hari
Narayan Hari
Numerade Educator

Problem 808

Drug exposure prior to organogenesis (before the fourth menstrual week) usually results in
(A) an all-or-none effect; either the embryo does not survive, or it develops without abnormalities
(B) single-organ abnormalities
(C) multiple-organ abnormalities
(D) developmental syndromes
(E) intrauterine growth retardation

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05:19

Problem 809

The US Food and Drug Administration (FDA) have developed a five-category labeling system for all approved drugs in the United States. Which if the following is not a category in the mentioned system?
(A) Category A: controlled human studies indicate no apparent risk to fetus. The possibility of harm to the fetus seems remote (eg, multivitamins)
(B) Category B: Animal studies do not indicate a fetal risk or animal studies do indicate a teratogenic risk, but well-controlled human studies have failed to demonstrate a risk (eg, acetaminophen, caffeine, fentanyl, hydrocodone)
(C) Category C: studies indicate teratogenic or embryocidal risk in animals, but no controlled studies have been done in women or there are no controlled studies in animals or humans (eg, aspirin, ketorolac, codeine, gabapentin)
(D) Category D: there is positive evidence of human fetal risk, but in certain circumstances, the benefits of the drug may outweigh the risks involved (eg, amitriptyline, imipramine, diazepam, phenobarbital, phenytoin)
(E) Category E: there is positive evidence of significant fetal risk, and the risk clearly outweighs any possible benefit (eg, ergotamine)

Beth Stone
Beth Stone
Numerade Educator
00:23

Problem 810

Acetaminophen falls in which of the following FDA labeling categories regarding risk of teratogenic or embryotoxic effects?
(A) Category A
(B) Category B
(C) Category C
(D) Category D
(E) Category $\mathrm{X}$

Nicole Smina
Nicole Smina
Numerade Educator
01:11

Problem 811

During pregnancy, NSAIDs may
(A) accelerate the onset of labor
(B) increase amniotic fluid volume
(C) decrease the newborn's risk for pulmonary hypertension
(D) increase the risk of renal injury
(E) all of the above

Joanna Quigley
Joanna Quigley
Numerade Educator

Problem 812

Which of the following is true regarding use of opioids during pregnancy?
(A) Mixed agonist-antagonist opioid analgesic agents are superior to pure opioid agonists in providing analgesia
(B) Opioids are excreted into breast milk in negligible amounts
(C) Methadone is not compatible with breast-feeding
(D) Significant accumulation of normeperidine is unlikely in the parturient who receives single or infrequent doses
(E) All of the above

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02:02

Problem 813

A 25-year-old primigravida just gave birth to a healthy baby boy. She had an epidural infusion containing lidocaine for labor analgesia. She asks you how long does she has to wait
after the infusion is turned off in order to be able to breast-feed her son. Your answer is
(A) she should wait at least 24 hours since concentration of lidocaine in breast milk may be toxic at this time
(B) it is safe to breast-feed her son since concentration of lidocaine is minimal in breast milk after an epidural infusion
(C) it would be safer to breast-feed if the infusion had bupivacaine, but since lidocaine was used, she will need to wait 36 hours
(D) mothers who had an epidural infusion for labor should not be allowed to breast-feed until 1 week postpartum
(E) none of the above

Jerrah Biggerstaff
Jerrah Biggerstaff
Numerade Educator

Problem 814

A 23-year-old female patient with chronic low back pain as a result of a motor vehicle accident becomes pregnant. For the past 4 years she has been taking diazepam for muscle spasms and to help her sleep at night. She asks for your advice in terms of continuing or quitting diazepam during her pregnancy. Your answer should be
(A) second-trimester exposure to benzodiazepines may be associated with an increased risk of congenital malformations
(B) diazepam's association with cleft lip, cleft palate, and congenital inguinal hernia has been disregarded recently
(C) neonates who are exposed to benzodiazepines in utero usually do not experience withdrawal symptoms after birth since the amount that crosses the placenta is negligible
(D) it appears most prudent to avoid any use of benzodiazepines during organogenesis, near the time of delivery, and during lactation
(E) all of the above

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Problem 815

A 28-year-old female with myofascial pain is taking tricyclic antidepressants for pain control with good results. She is planning to become pregnant in the next few months. Which of the following is true regarding use of tricyclic antidepressants during pregnancy?
(A) Amitriptyline, nortriptyline, and imipramine are all safe to use since they are rated risk Category D by the FDA
(B) Amitriptyline, nortriptyline, and desipramine are found in high quantities in breast milk, and are not safe to use while breast-feeding
(C) The selective serotonin reuptake inhibitors (SSRIs) fluoxetine and paroxetine are rated FDA risk Category B. These are safe to administer while breast-feeding
(D) Withdrawal syndromes have not been reported in neonates born to mothers using nortriptyline, imipramine, and desipramine
(E) All of the above

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Problem 816

Which of the following is true regarding the use of anticonvulsants for neuropathic pain during pregnancy?
(A) In general, the use of anticonvulsants during lactation does not seem to be harmful to infants
(B) Frequent monitoring of serum anticonvulsant levels and folate supplementation should be initiated, and maternal $\alpha$ fetoprotein screening may be considered to detect fetal neural tube defects
(C) Pregnant women taking anticonvulsants for chronic pain have a lower risk of fetal malformations than patients taking the same medications for seizure control
(D) Women who are taking anticonvulsants for neuropathic pain should strongly consider discontinuation during pregnancy, particularly during the first trimester
(E) All of the above

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Problem 817

Caffeine is found in many over-the-counter pain medications. Pregnant women should be careful because
(A) caffeine ingestion of more than $300 \mathrm{mg} / \mathrm{d}$ is associated with decreased birth weight
(B) caffeine ingestion combined with tobacco use increases the risk for delivery of a low-birth-weight infant
(C) caffeine ingestion is associated with an increased incidence of tachyarrhythmias in the newborn
(D) moderate caffeine ingestion during lactation does not appear to affect the infant
(E) all of the above

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Problem 818

A 23-year-old female at 24 weeks of gestation shows to the clinic with low back pain of sudden onset. She describes her pain as originating lateral to the left lumbosacral junction. The pain radiates to the posterior part of the left thigh and does not extend below the knee. Which of the following is the most likely diagnosis?
(A) Transient osteoporosis of the hip
(B) Sacroiliac joint pain
(C) Osteonecrosis of the hip
(D) Sciatica
(E) None of the above

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01:06

Problem 819

Which of the following is not a main cause of low back pain during pregnancy?
(A) Increased incidence of herniated nucleus pulposus during pregnancy
(B) The lumbar lordosis becomes markedly accentuated during pregnancy
(C) Endocrine changes during pregnancy soften the ligaments around the pelvic joints and cervix
(D) Direct pressure of the fetus on the lumbosacral nerves may cause radicular symptoms
(E) Sacroiliac joint dysfunction is common during pregnancy

Narayan Hari
Narayan Hari
Numerade Educator
01:35

Problem 820

Which of the following is a true statement regarding headaches during pregnancy?
(A) In pregnant women with a history of migraines prior to pregnancy, more than $50 \%$ will report worsening of migraine headaches during this period
(B) In women of childbearing age, their first migraine headache will usually occur during pregnancy
(C) Pregnant patients presenting with "the worst headache of my live " should have an immediate rule out of subarachnoid hemorrhage
(D) Preeclampsia usually does not presents with headaches
(E) Initial presentation of headaches during pregnancy should not precipitate thorough search for potential pathology unless the headaches continue after labor and delivery

Amy Adkisson
Amy Adkisson
Numerade Educator

Problem 821

A 22-year-old female patient presents to the office with sudden onset of abdominal pain. She has a 10-week pregnancy history and no other symptoms upon questioning. Pain is localized to the lower portion of the abdomen. The differential diagnosis should not include
(A) miscarriage
(B) ovarian torsion
(C) ectopic pregnancy
(D) myofascial pain
(E) sacroiliac joint pain

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Problem 822

Which of the following opioids is considered to be compatible with breast-feeding by the American Academy of Pediatrics?
(A) Codeine
(B) Methadone
(C) Fentanyl
(D) Propoxyphene
(E) All of the

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Problem 823

In the critically ill patient, true statements regarding pain assessment include all of the following, EXCEPT
(A) pain assessment tools such as the visual analogue scale or numeric rating scale (NRS) are most useful
(B) in noncommunicative patients, assessment of behavioral and physiologic indicators is necessary
(C) the NRS may be preferable because it is applicable to many age groups and does not require verbal responses
(D) patient self-reporting is not useful for the assessment of pain and the adequacy of analgesia
(E) the patient and family should be advised of the potential for pain and strategies to communicate pain

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Problem 824

A 27-year-old male patient is at the ICU after sustaining multiple body traumas in a motor vehicle accident. The patient is on a mechanical ventilator with mild sedation. He has acute renal insufficiency and vital signs show mild to moderate hypotension. Upon evaluation it is determined that he has moderate to severe pain in both upper extremities and in the chest area as a result of multiple fractures. Which of the following would be the best medication to provide by an IV infusion for pain control?
(A) Fentanyl
(B) Morphine sulfate
(C) Ketorolac
(D) Demerol
(E) Hydromorphone

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01:31

Problem 825

In the critically ill patient, which of the following supports that epidural analgesia is a good alternative for pain control?
(A) It results in more stable hemodynamics
(B) There is reduced blood loss during surgery
(C) Better suppression of surgical stress
(D) Improved peripheral circulation
(E) All of the above

Asma Venkitta
Asma Venkitta
Numerade Educator

Problem 826

In certain populations of patients, epidural analgesia has been associated with
(A) prolonged intubation time
(B) fewer ICU stays
(C) respiratory failure after surgery
(D) poor pain relief if initiated prior to the surgery
(E) none of the above

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Problem 827

Which of the following is a reason for poor symptom management in critically ill patients with pain?
(A) The majority of pain scales do not require patient self-report
(B) For these patients it is easy to titrate sedatives and analgesics to their desired level of consciousness, but they are not encouraged to do so
(C) Physicians and other caregivers feel uncomfortable about giving high doses of sedatives, analgesics, and other mood-altering agents
(D) No need for pain medications as long as patient is sedated
(E) None of the above

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Problem 828

Which of the following is a nonpharmacologic intervention for pain relief in an ICU patient?
(A) Provoking encephalopathy that results from the hypercapnia and hypoxia in chronic obstructive pulmonary disease (COPD) patients if tolerated
(B) Ketosis in terminally ill patients that forgo nutrition and hydration
(C) Placing patients in a quiet environment where family and friends may visit
(D) Proper treatment of anxiety and depression
(E) All of the above

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Problem 829

Which of the following is a known fact about opioid infusions?
(A) Fentanyl is about 10 times more potent than morphine
(B) Hydromorphone is more sedating than morphine and produces more euphoria
(C) Release of histamine during morphine administration may cause vasodilation and hypotension
(D) Sedation, respiratory depression, constipation, urinary retention, and nausea are side effects that are only seen after administration of morphine, but not with the administration of fentanyl or hydromorphone
(E) All of the above

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Problem 830

A 37-year-old female is at the ICU recovering after major abdominal surgery. Patient is breathing spontaneously, has stable vital signs, and is not able to tolerate oral feedings at this time. Alternatives for administration of opioids for pain relief include
(A) IV morphine PCA
(B) oral controlled-release oxycodone
(C) transdermal hydromorphone
(D) oral immediate-release oxycodone
(E) all of the above

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Problem 831

A 33-year-old male underwent major abdominal surgery and is transferred to the ICU for postoperative management. Which of the following would be the best choice for postoperative pain management?
(A) IV hydromorphone PCA
(B) IV fentanyl infusion
(C) Controlled-release oxycodone via nasogastric tube
(D) Bupivacaine and fentanyl mix via epidural catheter
(E) None of the above

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Problem 832

In order to prevent atelectasis and pulmonary complications in patients at the ICU
(A) pain management is important in maintaining a balance between splinting and sedation with hypoventilation
(B) it is important to titrate opioids to the lowest possible since respiratory depression is detrimental in these patients
(C) hyperventilation from mild to moderate pain is beneficial for faster recovery;
opioids should not be administered during this period of time
(D) epidural analgesia has no role in preventing pulmonary complications and minimizing intubation time in these patients
(E) none of the above

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