Pain Management

Pain Management

Thomas Halaszynski

1. At what time frame following the postsurgical period does persistent postsurgical pain become defined as being “chronic pain”?

A. 1 to 2 weeks

B. 3 to 4 weeks

C. 1 to 2 months

D. 6 to 12 months

2. Both surgical trauma and anesthetic administration techniques can modulate which of the following human stress responses?

A. Neuroendocrine

B. Metabolic

C. Inflammatory

D. All of the above

3. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used as part of “multimodal” analgesic therapy; some of the potential advantages include all of the following, except

A. Decreases opioid requirements

B. Can decrease postoperative pain intensity

C. Indirect effect of decreasing opioid-related side effects

D. Can improve wound healing

4. Type(s) of symptomatic pain conditions that best describes “chronic” pain often includes

A. Neuropathic pain alone

B. Nociceptive pain alone

C. Neuropathic or nociceptive pain

D. Somatic or visceral pain

5. At what levels does the modulation of pain by electrical stimulation result in the activation of inhibitory fibers?

A. Nociceptor level alone

B. Spinal cord level alone

C. Only within the brain

D. All of the above

6. Activation of which of the following mechanisms and/or pathways best describes “central sensitization” at the level of the spinal cord?

A. Second-order wide dynamic range neurons

B. Dorsal horn neuron

C. Spinal cord reflexes

D. All of the above

7. A 26-year-old female undergoes a left stellate ganglion block for treatment of complex regional pain syndrome of the left hand. Twenty minutes after the block is placed, skin temperature in the left arm rises from 33 to 36.5°C. Venous engorgement of the left arm and hand, left eye papillary constriction, and drooping of the eyelid are observed. The pain is not relieved. Which of the following can best explain the block failure?

A. Pain-carrying fibers originated from right stellate ganglion

B. Pain-carrying fibers originated from middle cervical ganglion

C. Pain-carrying fibers originated from inferior cervical ganglion

D. Pain-carrying fibers originated from second thoracic ganglion

8. Chronic pain indications for insertion of a spinal cord stimulator include all of the following, except

A. Phantom pain

B. Complex regional pain syndrome

C. Chronic visceral pelvic pain

D. Compartment syndrome pain

9. The term used to best describe the PAIN condition “perception toward ordinary non-noxious stimulus as being painful” is

A. Hyperalgesia

B. Anesthesia dolorosa

C. Hypalgesia

D. Allodynia

10. Incorrect statement related to the definition of an abnormal sensation is

A. Dysesthesia is an abnormal sensation with or without a stimulus

B. Paresthesia is abnormal sensation without a stimulus

C. Neuralgia is due to abnormality in nerve roots

D. Hyperesthesia is an abnormal sensation of exaggerated response to mild stimulation

11. Which of the following clinical diagnoses best describes deafferentation pain?

A. Herniated disk

B. Amputation

C. Neuropathic pain

D. Diabetic neuropathy

12. Gasserian ganglion block is most commonly used for neuropathic pain located in which of the following nerve distributions?

A. Facial nerve

B. Trigeminal nerve

C. Glossopharyngeal nerve

D. Vagal nerve

13. Major excitatory neurotransmitters responsible for pain modulation include all the following, except

A. Substance P

B. Glutamate

C. Somatostatin

D. Aspartate

14. All the following are inhibitory neurotransmitters in the pain pathway, except

A. Norepinephrine

B. Adenosine

C. Serotonin

D. Calcitonin gene-related peptide

15. Incorrect statement regarding secondary hyperalgesia is

A. It is caused by neurogenic inflammation

B. It is associated with Lewis’ triple response

C. It is increased by injection of local anesthetics

D. It is increased by application of capsaicin

16. Types of pain disorders that are commonly treated using “sympathetic blockade” include all of the following, except

A. Complex regional pain syndrome

B. Phantom limb pain

C. Postherpetic neuralgia

D. Acute pain due to pelvic exenteration

17. Systemic responses of the human body that can develop secondary to symptoms of acute pain include all of the following, except

A. Hypertension and tachycardia

B. Increased work of breathing

C. Urinary retention

D. Increased peristalsis

18. A 56-year-old man presented to his primary care physician with a complaint of right buttock and right leg pain along with numbness and tingling sensations. He was subsequently diagnosed with a piriformis syndrome (trapped nerve). The nerve(s) responsible for this diagnosis is/are

A. Femoral and saphenous nerves

B. Ilioinguinal nerve

C. Sciatic nerve

D. Obturator and femoral nerves

19. A 56-year-old patient with a past medical history of hypertension, diabetes, and alcohol abuse presents to the operating room for a right-elbow open reduction internal fixation, secondary to a motor vehicle accident that occurred 24 hours ago. On postoperative day 1, the patient complains of right fourth and fifth digit numbness and minor pain. A diagnosis of cubital tunnel syndrome has been made. The nerve most likely to be involved is

A. Median nerve

B. Ulnar nerve

C. Radial nerve

D. Musculocutaneous nerve

20. Incorrect statement regarding myofascial pain is

A. Myofascial pain is associated with muscle discomfort (pain, stiffness, weakness, spasm)

B. Patient may have several trigger points producing pain upon stimulation

C. Systemic diseases such as connective tissue disease may cause myofascial pain

D. Myofascial pain is never associated with autonomic dysfunctions

21. The diagnosis of fibromyalgia includes all of the following, except

A. Minor pain

B. Pain lasts more than 3 months

C. No other pathologies can explain or contribute to the pain

D. Frequent association with psychiatric diagnosis

22. Common causes for lower back pain include all of the following, except

A. Lumbosacral strain

B. Degenerative disk disease

C. Myofascial syndromes

D. Fibromyalgia syndrome

23. A 68-year-old male presents to his primary care physician’s office with a major complain of back pain radiating into the gluteal region and pain in the distribution of the plantar surface of the foot on the same side. The patient’s physical examination reveals decreased plantar flexion of the foot. An MRI will most commonly show a herniated disk at

A. L2–L3

B. L3–L4

C. L4–L5

D. L5–S1

24. Disk herniation at L4–L5 of the vertebral column often presents with all of the following clinical symptoms, except

A. Diminished dorsiflexion of the foot

B. Quadriceps femoris muscle weakness

C. Posterior-lateral thigh pain

D. Dorsal foot pain between first and second toes

25. Facet syndrome is characterized by all the following, except

A. Pain relieved by local anesthetic injection of the medial branches of the posterior rami of spinal nerves

B. Pain relieved by an intra-articular injection of the zygapophyseal joints

C. Pain can be exacerbated by overextension and lateral rotation of back

D. Pain is sympathetically mediated

26. Incorrect statement regarding neuropathic pain is

A. It includes pain associated with stroke, spinal cord injury, and diabetic neuropathy

B. It is not associated with low back pain or multiple sclerosis

C. Neuropathic pain can be paroxysmal

D. Neuropathic pain can be associated with hyperpathia

27. Regarding the treatment of neuropathic pain, the correct statement is

A. Narcotics is the most effective and “first-line” treatment option

B. It is most optimally treated with multimodal therapies

C. Sympathetic blockade will eliminate all neuropathic pain

D. Spinal cord stimulator is not an effective therapy

28. Pathological features of complex regional pain syndrome include all the following, except

A. It is sympathetically mediated

B. It is often associated with documented nerve injury

C. It is only associated with major injuries (never from minor procedures)

D. It is not associated with evidence of skin color, hair, and temperature changes

29. Incorrect statement regarding treatment of complex regional pain syndrome (CRPS) is

A. Efficacious treatment with multimodal therapy early in the diagnosis (within 1 month of symptom) is most effective

B. It responds well to sympathetic blockade

C. If not treated properly and in a timely fashion, CRPS can result in functional disability

D. Patients need to refrain from physical therapy until the pain syndrome is resolved

30. Possible complications to disclose when obtaining an anesthesia consent from a patient prior to performance of a celiac plexus block include all of the following, except

A. Postural hypotension and lightheadedness

B. Constipation and urinary retention

C. Vena cava and aortic vascular injury

D. Retroperitoneal hemorrhage

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