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1. A 67-year-old man is scheduled for a Whipple procedure and is offered an
epidural for postoperative pain control. Which of the following is an absolute
contraindication to placement of an epidural?
A. Aortic stenosis with a valve area of 1.2 cm2
B. Recent upper respiratory tract infection
C. Patient refusal
D. Scoliosis
2. You are called to the postanesthesia care unit because a patient with an
epidural placed at T12-L1 is complaining of pain at the site of his lower
abdominal incision but cannot move his legs. He was initially very comfortable.
His motor examination has not changed since arrival in the postanesthesia care
unit. Which of the following local anesthetics is most likely to have been used?
A. Etidocaine 1.5%
B. Lidocaine 2%
C. Bupivacaine 0.5%
D. Chloroprocaine 3%
Order Parkinson Disease And Esophageal Cancer
3. A 67-year-old woman is on the first postoperative day following a Whipple
procedure. She has a thoracic epidural in place and is receiving a mix of
bupivacaine and dilaudid. She reports good pain relief but states that she is
incredibly itchy, especially in her face and on her nose. Which of the following is
LEAST likely to relieve her itching?
A. Naloxone
B. Propofol
C. Diphenhydramine
D. Elimination of opioids from epidural mix
4. A 100-kg, 71-year-old man with a history of asthma, snoring, and emphysema
undergoes thoracotomy and wedge resection for removal of a lung tumor.
Which of the following treatments would be most effective to control his pain
postoperatively while also maintaining adequate ventilation?
A. Thoracic epidural with a continuous infusion of bupivacaine and hydromorphone
B. As-needed doses of hydromorphone administered by the nurse
C. Patient-controlled analgesia (PCA) with hydromorphone
D. Lumbar epidural with a continuous infusion of bupivacaine and hydromorphone
5. 5. A 67-year-old woman who is 9 hours status post gastrectomy is noted to have
a respiratory rate of 6 and is also somewhat somnolent. Which of the following
neuraxial medications or combinations of medications would be predicted to
cause respiratory depression within 6-12 hours of exposure?
A. Morphine
B. Fentanyl
C. Bupivacaine
D. Bupivacaine plus sufentanil
6. Compared with a single epidural dose of morphine, a single epidural dose of
fentanyl has a longer half-time in the epidural space secondary to which of the
following properties?
A. Lipid solubility
B. Ionization state
C. Molecular size
D. Molecular weight
7. A 42-year-old woman undergoes total colectomy under general anesthesia with
a thoracic epidural (T10-T11) in place. At the conclusion of the procedure, she
receives an infusion of bupivacaine 0.1% and hydromorphone 20 μg/mL at
6 mL/h through her epidural catheter. You are called to see her 8 hours
postoperatively and find that she is complaining of pain at the site of her
incision. Her heart rate is 100 beats per minute and her blood pressure is
160/92 mm Hg. What is the most appropriate next step to manage this patient’s
A. Administer a bolus of 5 cc of 1.5% lidocaine with epinephrine 1:200 000
through her epidural catheter.
B. Add PCA with hydromorphone to her current regimen.
C. Add Toradol to her current regimen.
D. Check a serum bupivacaine level.
Order Parkinson Disease And Esophageal Cancer
8. You are caring for a 77-year-old man with no significant medical history who
underwent an L5-S1 fusion yesterday for spinal stenosis. He was taking
oxycodone at home for his chronic back pain, and you decide to write him for a
PCA. Which of the following medications should be avoided?
A. Hydromorphone
B. Morphine
C. Meperidine
D. Fentanyl
9. Which of the following settings is not recommended for a PCA pump using
hydromorphone for an opioid-naive patient in the postoperative period?
A. Continuous background infusion
B. Initial lockout interval of 10 minutes
C. Initial hourly dose limit of 1-2 mg
D. Addition of opioid-sparing medications to the analgesic regimen
10. A 65-year-old woman with Parkinson disease and esophageal cancer is
receiving an intravenous PCA with hydromorphone after undergoing Ivor
Lewis esophagectomy. She reports excellent pain control but is experiencing
nausea. Which of the following antiemetics is the most appropriate selection for
this patient?
A. Ondansetron
B. Haldol
C. Promethazine
D. Droperidol
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