Pain Management Quiz
Created by Connor Bohlken and Chris Galbraith
Edited by Dr. Paris Ingledew
Today is your first day in the pain clinic, and you are working alongside Dr. Payne, specialist extraordinaire. Among other things Dr. Payne is passionate about medical education, craft breweries, and cheese. Before you start Dr. Payne wants to make sure you have the classification of pain down. What type of pain is described as crampy?
Somatic Nociceptive Pain
Visceral Nociceptive Pain
Mr. Owch is a 73 year old male being treated with palliative chemotherapy for metastatic lung cancer that has spread to several skeletal sites including his hips and lower back. Unfortunately the cancer has proven somewhat resistant to treatment. He is presenting to the pain clinic run by your local cancer agency today. He describes a new onset sharp stabbing pain in his upper back. When you percuss along his spine it localizes to the T4 vertebrae and he noticeably recoils away from your hand. Mr. Owch’s last treatment was approximately 5 weeks ago. What cancer pain syndrome best describes Mr. Owch’s pain?
Pain associated with cancer therapy
Pain not related to cancer or cancer therapy
Direct tumor involvement
Pain that is psychosomatic
Dr. Payne has been impressed with your work so far. Today they want to see how well you understand analgesic choice, as per the WHO Pain Ladder. For instance, say you have Mr. Stub Matoe, who is experiencing some mild nociceptive pain localized to the hallux, which of the following would be an appropriate analgesic choice?
Dr. Payne wants to make sure that you understand the subtleties of how to conceptualize pain. He explains, I had this medical student once, all he talked about was craft beer, books, and how nice it was to buzz his head. This left me with a headache so severe that I could barely get out of bed for 2 days leaving me struggling to attend to my own hygiene. What degree of pain was I experiencing?
No Pain, Approx 0 on a 0 - 10 scale.
Mild Pain, Approx 1 - 3 on a 1 - 10 scale.
Moderate Pain, Approx 4 - 6 on a 1 - 10 scale.
Severe Pain, Approx 7 - 10 on a 1 - 10 scale.
Dr. Payne has been really impressed with you so far. So much so that he opens up about this one time he had to go on morphine. It turns out he had this one student that talked so much about video games and his bowel movements that Dr. Payne accidentally forgot to look both ways when crossing the street and got hit by a car. He asks you which of the following is correct about the pharmacology and metabolism of opioid analgesics?
Zero order kinetics
Converted into active metabolite morphine 3 glucuronide
Peak effect and plasma concentration at 30 minutes post oral
90-95% excreted by the kidney
Peak effect and plasma concentration at 30 minutes post IV
Dr. Payne goes on to explain that sadly his time on morphine was fraught with unfortunate side effects. They would like to know which of the following is NOT a known side effect of opioid use.
Nausea and Vomiting
Which of the following INCORRECTLY pairs an Analgesic with a known potential adverse effect of that Analgesic.
NSAIDS and Gastropathy
Acetaminophen and Hepatotoxicity
NSAIDS and Renal Failure
Opioids and Constipation
Opioids and Blindness
It is your final day in the pain clinic, and you will be sad to say goodbye to Dr. Payne. Before you go they would like to make sure that you have a grasp on adjuvant therapy. Of the following, which is a properly paired medication and adjuvant treatment?
Dexamethasone and Somatic Pain
Methamphetamine and Terminally Ill Lethargic Patient
Venlafaxine and Intracranial Pressure
Capsaicin and Somatic Pain
Gabapentin and Visceral Pain
You are a R2 family practice resident working in a pain clinic. You are fortunate to have an on-site pharmacist working with you today. You are discussing a patient’s current analgesic medications. This patient has known cirrhosis in addition to metastatic GI cancer. The patient’s pain has been difficult to control as they consistently report having “6 - 7 / 10 pain constantly” and you have been considering increasing his Tylenol 3 dosage to assist with pain relief. Thankfully the pharmacist was there because she gently reminded you that switching to another opioid may be a reasonable approach in this patient because:
Acetaminophen can induce hepatotoxicity and opioids combined with other drugs are limited by the non-opoid components.
Tylenol 3 does not contain any opioid and you had chosen the wrong analgesic from the start.
Codeine, the opioid component of Tylenol 3, is a very strong opioid and this patient has likely developed tolerance.
Codeine is hepatically cleared and this conflicts with the patient’s known cirrhosis.
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