A patient with lumbar disk disease requires lumbar epidural injection of a corticosteroid for control of low back pain. Which of the following statements concerning this treatment is true?
(A) Maximum effect occurs one hour after injection
(B) Maximum effect occurs when drug concentration peaks in cerebrospinal fluid
(C) Maximum effect occurs during the acute phase of the disease
(D) The beneficial effect results primarily from sympathetic neurolysis
(E) It is contraindicated if the patient has had prior surgical procedures on the lumbar disks
Arterial pressure in the radial artery is 155/70 mmHg measured by a correctly calibrated catheter-transducer system. At the same time, aortic pressure is 140/75 mmHg using a high-fidelity catheter tip transducer. The most likely cause of this discrepancy is
(A) a large amount of air in the dome of the radial artery transducer
(B) coarctation of the aorta
(c) peripheral vascular constriction produced by sympathetic stimulation
(D) physiologic amplification of the waveform from the aorta to the radial artery
(E) too high a frequency response in the catheter-transducer system
Which of the following findings on the left is most likely to be associated with an increased risk of complications with cannulation of the left internal jugular vein compared with cannulation of the right internal jugular vein?
(A) Longer recurrent laryngeal nerve
(B) Lower location of the cupola of the pleura
(C) More acute angle between the internal jugular and innominate veins
Pulmonary artery diastolic pressure increases acutely from 10 to 20 mmHg in a 28-year-old man undergoing cervical laminectomy in the sitting position. The most appropriate first step in the management of this patient is to
(A) administer furosemide
(B) aspirate from the proximal port of the pulmonary artery catheter
(C) inflate the balloon on the pulmonary artery catheter
(D) place the patient in the left lateral decubitus position
(E) start an infusion of nitroglycerin
B
With an interscalene brachial plexus block
(A) more local anesthetic drug is required than for axillary block
(B) the biceps and brachialis muscles are blocked last
(C) the intercostobrachial nerve is usually blocked
(D) the lateral antebrachial cutaneous nerve is usually spared
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