Which is the gold standard strong opioid of choice prescribed at step 3 of the analgesic ladder?

a.Morphine Sulphate T

b.Methadone

c.Oxycodone

Which of the following treatments are used to manage pain caused by bone metastases?

a.Bisphosphonates T

b.Radiotherapy

c.Amitriptyline

d.Naproxen

How many steps are there on the World Health Organisation Analgesia ladder?

a.2

B.3 T

c.5

Which of the following are common side effect of morphine?

a.Excess hair grwoth

b.Breathlessness

c.Constipation T

d.Nausea T

Acute pain

a.Is usually proportionate to the injury sustained T

b.Is usually self-limiting T

c.Can affect distant organ systems T

d.Is influenced by a patient's psychological state T

Central sensitisation
a.Is not seen in acute pain F

a.Can cause hyperalgesia T

b.Can cause allodynia T

c.Is not reversible F

Nociceptors

a. Are low threshold nerve endings F

b. Can be activated by electrical stimulus T

c. Have a fixed threshold for activation F

d. Contain phospholipase A2 T

Answer the questions true or false:

1. Poor recognition and management of acute pain occurs commonly T

2. Acute pain has no bearing on post-operative complications F

3. Pain increases anabolic hormone production F

4. The severity of acute post-operative pain may has been suggested as a risk factor for the
development of chronic pain T

5. In general, pain causes an increase in parasympathetic nervous activity F

6. Nociception, and a patient’s perception of pain are the same thing F

7. If possible, pain should be assessed with the patient active T

8. Pain should be assessed regularly during treatment T

9. Patient comfort only relates to analgesia F

10. Adverse effects of analgesic drugs need not be monitored during treatment F

11. Intramuscular injection provides reliable drug absorption F

12. Continuous IV opioid infusion carries the highest risk of serious adverse effects T
13. Patient-controlled analgesia devices are only used to deliver opioid medication F
14. Multi-modal analgesia aims to reduce opioid doses and adverse effects T
15. Acute pain service teams have clinical responsibilities only F
1. Which of the following statements is correct?

a. The prevalence of neuropathic pain in general population in Europe is approximately 7-

8%. T

b. Allodynia is an exaggerated pain response to a mildly painful stimulus F

c. N-methyl-D-aspartate (NMDA) receptors play an important role in central sensitization.

T

d. The Douleur Neuropathique en 4 questions (DN4) is a screening tool used for diagnosing
nociceptive pain. F

2. What is the mechanism of action of gabapentin?

a. Calcium channel blocker T

b. Sodium channel blocker

c. Inhibits the re-uptake of both serotonin and nor-adrenaline

d. NMDA antagonist

3. Which of the following drugs is not recommended as a first line treatment

a. Amitriptyline

b. Gabapentin

c. Duloxetine

d. Oxycodone T