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MCQs in Pain Medicine 1.

Regarding cholinergic receptors and Pain: a) Neurally-released acetylcholine acting on peripheral nociceptors has no modulatory effect on nociception. b) Nicotine has a weak excitatory effect on C nociceptors and induces mild sensitisation to heat. c) Muscarine desensitizes C nociceptors to mechanical and heat stimuli. d) M1 receptors on cutaneous nerve endings increase nociceptive response to nociceptive stimuli. e) Nicotinic and muscarinic have synergistic nociceptors. effect on cutaneous

2. The following opioids act on the Mu receptors when administered intrathecally: a) Methadone b) -endorphin c) Baclofen d) Ziconotide e) Butorphanol 3. Regarding the mechanism of action of opioids at the cellular level: a) Opioid receptors are coupled to Gq/Gi inhibitory proteins. b) Opioids inhibit voltage-dependent calcium channels or activate inward K+ channels. c) Opioids activate the cAMP pathway and inhibit mitogen-activated protein kinase (MAP) in cells. d) Mu receptor has interactions with the insulin receptor. e) Mu receptors are recycled after internalisation but delta receptors are degraded in the lysosome. 4. The following are the indications for spinal cord stimulation: a) Refractory angina pectoris b) Raynauds syndrome c) Phantom limb pain post-knee amputation 1

d) CRPS of the elbow following rugby injury e) Adenocarcinoma of the pancreas

5. limbs.

The following are the features of repetitive stress injury(RSI): a) The prevalence is the same across communities in upper and lower b) The pain is well-localised in a single-or 2 dermatomal distribution. c) Autonomic signs are rarely seen and if present, indicate development of

CRPS. d) Muscle wasting is common in chronic cases. e) RSI is associated with the development of fibromyalgia in later years. 6. The following are extra-abdominal causes for abdominal pain: a) Tabes dorsalis b) Pneumothorax c) Pulmonary infarction d) Henoch-Schonlein purpura e) Narcotic withdrawl 7. The following should be ruled out when red flags for headache (fever, neck stiffness, rash) are present: a) Sub-arachnoid haemorrhage b) Encephalitis c) Menigitis d) Lyme disease e) Collagen vascular disease 8. The following drugs have been found to be effective in trigeminal neuralgia: a) Tizanidine b) Lamotrigine c) Baclofen d) Tocainide e) Pimozide

i 9. Cognitive-behavioural approach to pain management: a) Is Treatment-orientated b) Is collaborative (patient and healthcare worker work together) c) Is the end-point of a patients treatment plan. d) Teaches patient to cope with feelings and expectations. e) Is set around a pain clinic environment. 10. Side-effects of SSRIs include: a) Constipation b) Akathisia ( inability to sit still) c) Sinus tachycardia d) Hyponatraemia e) Increased liver enzymes (ALT, AST) 11. Lamotrigine:

a) Is a phenylpiperidine derivate with a substitution of N for O2 at the Cterminal. b) It blocks K+ channel and inhibits glutamate release. c) It has shown to be effective in refractory trigeminal neuralgia. d) it is ineffective in central post-stroke pain. e) Can reduce pain after spinal cord injury. 12. The following are not seen in CRPS: a) Increased tone of the surrounding muscles b) Change of skin texture c) Recurrent infection d) Depression e) Insomnia

13. These substances facilitate the development and persistence of central pain: a) Glutamate b) Aspartate c) CGRP d) Cholecystokinin e) Nitric oxide 14. These substances are inhibitory towards the development of central pain: a) Enkephalin b) Norepinephrine c) Serotonin d) -endorphin e) GABA 15. Red flags in back pain include: a) Age > 50 years b) Progressive spinal deformity c) Thoracic pain d) History of long-term steroid administration e) Hip or knee weakness 16. The following are known to be yellow flags in back pain: a) The patient believes that walking would be impossible as years go by. b) The patient has had a recent bereavement. c) The patient has noticed transient weakness in the legs. d) On-going litigation since fall from a ladder at work causing the back pain. e) The patient has recently been proposed to by her ex-boyfriend.

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Regarding the cauda equina syndrome: 5

a) Involves the filum terminale part of the spinal cord. b) Sciatica is a rare symptom . c) Urinary incontinence is more common among men. d) Urinary retention is more common among women. e) Bowel symptoms precede the onset of bladder symptoms. 18. The following are true of fibromyalgia: a) Orthostatic hypotension. b) Autonomic dysfunction (Increased sympathetic activity and decreased parasympathetic activity). c) Coffee and chocolate excluded from the diet can help improve symptoms. d) It is a classic example of psychosomatic disorder like the hyperventilation syndrome. e) Differential diagnosis includes TMJ dysfunction and sarcoidosis. 19. Regarding phantom pain: a) The incidence is around 20%. b) It is more common among men older than 45. c) It is more common in children less than 5 yrs and in congenital amputees. d) It is well-localised to the proximal part of the amputated limb. e) Resolved phantom pain can recur in a previously amputated lower limb when the person is administered spinal anaesthesia. 20. Diabetic neuropathy: a) In the lower limb, starts at the knee and spreads to the toes. b) Loss of vibration sensation is the first sign of peripheral diabetic neuropathy. c) Is associated with significant motor loss over the years. d) Carpal tunnel syndrome is common, and could be the earliest symptom. e) Diabetic amyotrophy is common in the later years.

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