Answers

1. The answer is B. The application of heat reduces muscle spasms and cold reduces inflammation, both resulting in pain relief. In the case of the other modalities, endorphins are released providing pain relief.

2. The answer is B. Acetaminophen neither has anti-inflammatory properties nor peripheral action. It can produce hepatic necrosis if an overdose occurs.

3. The answer is A. When administered enterally, opioids undergo significant first-pass metabolism in liver and hence their bioavailability by this route is less in comparison with other routes. For the same reason, when given orally, the dose requirement is substantially higher than intravenous dose.

4. The answer is D. Slow onset of action secondary to slow rise in plasma concentration and dose-dependant potency make methadone an unsuitable agent for acute surgical pain. Prolonged duration of action and the need for close follow-up are yet another reasons.

5. The answer is C. Obese patients on PCA should be monitored for both oxygenation and ventilation. Pulse oximeter does not monitor ventilation and becomes even more unreliable when oxygen is supplemented.

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