1. A 17-year-old adolescent girl presents to the emergency department with breathing trouble. She has no history of respiratory disease and no medical history of consequence. After leaving an uncomplicated laser hair removal appointment, she developed shortness of breath. On examination she is tachypneic and tachycardic with a pulse oximetry of 88% on 90% nonrebreather mask. What is the appropriate course of action?
a. epinephrine and intravenous diphenhydramine
b. intravenous methylene blue (1 mg/kg)
c. intravenous methylprednisolone sodium succinate (Solu-Medrol, Pharmacia & Upjohn Co)
d. oxygen and nebulizer treatments
e. spiral chest computed tomography
2. Which is the most likely order of symptoms in a patient with increasing lidocaine toxicity?
a. coma, anxiety, disorientation, focal seizures
b. nausea, bradypnea, metallic taste, dizziness
c. perioral numbness, diplopia, bradycardia, cardiac arrest
d. seizure, somnolence, vomiting, coma
e. slurred speech, dizziness, bradycardia, tinnitus, seizure
3. What is the maximum amount of 1% lidocaine (with epinephrine) that can be safely administered to a 50-kg healthy adult?
a. 150 mg
b. 175 mg
c. 200 mg
d. 250 mg
e. 350 mg
4. Which of the following will not decrease pain from local administration of lidocaine for most patients?
a. addition of sodium bicarbonate to the preparation
b. background music or conversation
c. quick administration
d. tapping the skin
e. warming the anesthetic
5. Which of the following can be safely used in a patient with a p-aminobenzoic acid allergy?
a. chloroprocaine
b. lidocaine (preservative free)
c. procaine
d. proparacaine
e. tetracaine