Samobathi Pain Clinic



MULTIPLE CHOICE QUESTIONSDownloaded from Dr Debjyoti Dutta MD. FIPP. Kolkata India1.The femoral nerve originates from which of the following roots?A.T12, L1, L2B.L1, L2, L3C.L2, L3, L4D.L3, L4, L52.If symptoms persist after appropriate conservative management of acute cervical disc herniation, the next step is to perform a: A.cervical laminectomy and fusionB.cervical epidural injectionC.chemonucleolysisD.cervical facet injection3.A 45-year-old patient with a history of chronic low back, left hip and left thigh pain who’s status is post multiple lumbar laminectomy received a differential epidural block of 3% 2-chloroprocaine. Some pain resumed with return of full sensation and motor function in the lower extremities; all pain returned with return of sympathetic function. The pain was transmitted via which fibers?A.A alpha B.A delta C.C D.A delta and C 4. Examination of a patient with neck and shoulder pain reveals referred pain in the lateral aspect of the forearm, with weakness and dysfunction of the biceps and brachioradialis, and hypoesthesia in the lateral aspect of the forearm and thumb. The patient most likely has a lesion of which nerve root?A.C4B.C5C.C6D.C75. The most appropriate diagnostic nerve block for pain in upper abdominal viscera is a/an: A.intercostal blockB.lumbar sympathetic blockC.celiac plexus blockD.hypogastric plexus block6. Sympathetic innervation to the upper extremity is carried by which fibers of the brachial plexus?A.T1-T2 preganglionic fibersB.T3-T5 preganglionic fibersC.T1-T2 postganglionic fibersD.T3-T5 postganglionic fibers7.Intense whiteness of fingers with subsequent blue coloration with coldness and red coloration on rewarming is most likely due to:A.frostbiteB.Raynaud’s diseaseC.reflex sympathetic dystrophyacute venous thrombosis8.Indications for lumbar epidural steroid injections include all of the following EXCEPT:A.radicular pain with corresponding sensory changeB.radiculopathy due to herniated disc with failed conservative treatmentC.acute herpes zoster in the lumbar dermatomesD.postlaminectomy (failed back) syndrome without radiculopathy9.Which of the following nerve blocks is LEAST helpful in diagnosing sympathetically mediated pelvic pain?A.Differential spinalB.Pudendal nerveC.Superior hypogastric plexusD.Differential epidural10.Which of the following statements regarding the anatomy of the superior hypogastric plexus is NOT true?A.It lies anterior to L5 vertebra.B.It lies just inferior to the aortic bifurcation.C.It lies right of midline.D.It branches left and right and descends to form the inferior hypogastric plexus.11.All of the following are indications for a stellate ganglion block EXCEPT?A.reflex sympathetic dystrophy B.acute herpes zoster (ophthalmic division)C.hyperhidrosisD.pancreatitis12.Which of the following regional anesthesia techniques is NOT commonly used with children due to its side effects?A.Epidural blockSubarachnoid blockC.Caudal blockD.Brachial plexus block13.A brachial plexus block is indicated for all of the following conditions EXCEPTA.sympathetic independent pain due to reflex sympathetic dystrophy B.brachial plexalgiaC.anginaD.Raynaud's disease14.A celiac plexus block is effective in reducing pain originating from all of the following organs EXCEPT the:A.pancreasB.transverse portion of the large colonC.gall bladderD.descending portion of the pelvic colon15.A patient is positioned prone on the fluoroscopic table, the T1-T4 spinous processes are identified on the ipsilateral side, and a skin weal is raised 4-5 cm lateral to the spinous process. A spinal needle is directed to the lamina and "walked" laterally until there is loss of resistance. These procedures are consistent with which type of block?A.Stellate ganglionB.Thoracic sympatheticC.InterpleuralD.Thoracic epidural16. The brachial plexus is formed by which rami?A.C5-T1 anterior primary B.C3-T2 anterior primary C.C5-T1 anterior and posterior D.C3-T2 anterior and posterior 17.Cell bodies of preganglionic fibers of the lumbar sympathetic chain arise at which of the following sites?A.T5-T9B.T11-L2C.L3-L5D.S1-S418. A lateral femoral cutaneous block is indicated for which of the following conditions?A.Meralgia parestheticaB.Femoral neuralgiaC.Saphenous neuralgiaD.Groin pain19.Which of the following statements is true regarding neurolytic concentrations of less than 2% phenol?A.They have no effect.B.They selectively destroy A-delta and C fibers.C.They have a reversible local anesthetic action when applied to nerve bundles.D.They destroy nerves but have no effect on blood vessels.20.Mydriasis, tachypnea, tachycardia, delirium and a modest decrease in pain can be produced by agonists of which receptor type?A.MuB.KappaC.DeltaD.Sigma21. A diminished triceps jerk indicates a lesion of which nerve root?A.C4B.C5C.C6D.C722.To achieve sympathetic denervation of the head and neck, the best site of blocking is the:A.middle cervical ganglionB.superior cervical ganglionC.stellate ganglionD.sphenopalatine ganglion23. The lesser splanchnic nerve is formed by which of the following sympathetic nerves?A.T5-T7B.T8-T9C.T10-T11D.T12 24. Continuous radiofrequency (CRF) procedures for pain: Use alternating current with a frequency of 500 Hz.Produce an effect by coagulating target nerves.Produce heat energy in tissue distal to the active tip of the electrode.Produce differential lesioning of target nerves.25. Pulsed radiofrequency (PRF) procedures for pain: Use a 50 kHz alternating current delivered in 20 ms pulses at a frequency of 2 Hz for 120 s.Cause significant heating of target tissue.Lead to heat dissipation by convection, conduction and radiation.Have a mechanism of effect that is not clear.26. In chronic pain management: Percutaneous radiofrequency trigeminal rhizotomy is a first line treatment for trigeminal neuralgia.Potential side-effects of trigeminal rhizotomy include diplopia.Selection criteria for radiofrequency neurotomy in somatic spinal pain include placebo-controlled diagnostic blocks.Radiofrequency neurotomy of the dorsal ramus of C3 is used in management of cervicogenic headache.27. A fifty year old senior administrator who presents with Right sided earache of one month’s duration. The pain radiates into the temple area and down the side of her face. The pain is worst when she wakes in the morning and after eating.On examination the ear is clear, there is lateral deviation of the jaw on opening and all other observations are normal.The MOST likely diagnosis is:Temporal arteritisTrigeminal neuralgiaTemporo mandibular joint dysfunctionEustachian Tube Dysfunction28. "Allodynia" is:A. Pain caused by stimuli that are usually not painfulB. The 'burning' sensation of causalgiaC. Red flare with nerve damageD. Due to reflex sympathetic dystrophy29. The pain of chronic herpetic neuralgia is usually controlled byA. ipsilateral stellate ganglionectomyB. intrathecal alcohol injectionC. Anti-convulsants D. dorsal rhizotomy30. Neurolytic lumbar sympathetic block: Confirm needle placement by:A. Injection local anaesthetic to check effect just prior to alcohol injectionB. Nerve stimulatorC. Injection gives sensation of warmth in affected areaD. Use an image intensifier31. Coeliac plexus blockA . Is used to treat visceral pain of malignant origin.B. Requires 22g Radiofrquency needle.C. Causes hypertension.D. Cannot be used in pain of non malignant cause.32. A coeliac plexus block with alcohol may cause:A. Abdominal painB. DiarrhoeaC. Pleuritic chest painD. Groin pain33. A 60-year-old diabetic has had a below knee amputation for an ischaemic leg. He has neuropathic pain being managed with oxycodone 40 mg bd and paracetamol 1 gqid. He is also on omeprazole 20 mg daily for reflux. You decide to commence gabapentin. Before deciding on a dosage regimen and commencing therapy it is most important that youA. cease his omeprazoleB. check his hepatic transaminase levelC. check his renal functionD. check his QT interval on a resting EGG34. Complex Regional Pain SyndromeCharacterized by disabling pain, swelling, vasomotor instability, sudomotor abnormality, and impairment of motor functionType II CRPS was formally known as reflex sympathetic dystrophyTo be managed with sympathetic blocks only.Physiotherapy has no role.35. A strategy shown to reduce the incidence of severe phantom limb pain is the use ofA. continuous regional blockade using nerve sheath cathetersB. patient controlled analgesia with opioids post-opC. perioperative ketamineD. perioperative NSAIDs36. Regarding Epidural Abcess - which is WRONGA. Diagnosis is DEPENDENT on triad of back pain, fever, and paralysisB. Occurs at a rate of 1:1000-3000 (OR 1:2000 - 1:5000)C. Worse outcomes if advanced ageD. Usually gram positive cocci37. Sympathetic blocks are used in the following conditions:except Reynaud’s syndrome.Herpes zoster.Chronic pancreatitis.Migraine.38. Clinical features of fibromyalgia include all exceptLocalized pain.Fatigue.Sleep disturbance.Diarrhoea.39. Regarding management of fibromyalgia:Educating the patient regarding the condition plays an important role.Tri-cyclic agents are not beneficial in treating pain.There is evidence that strong opioids are beneficial.There is evidence that steroids are beneficial.40. Indications for spinal cord stimulation include: all exceptComplex regional pain syndrome.Failed back surgery syndrome.Post-amputation pain.Postoperative pain.41. Which of the following statements regarding management of neck pain in WAD injuries isTRUE?Evidence supports benefit of using cervical collar.Early RF neurotomy of cervical facet neurotomy gives better outcome. There is enough evidence to support passive mobilization of C/S as a single treatmentInterventions of benefit include home exercise, analgesics , combined with specific exercises.42. A 42-year-old Caucasian male presented with a 10-week history of left leg and back pain. He described his pain as sharp and shooting down to posterior left thigh and calf, and posterior ankle. Straight leg raise test is positive on left side, and trigger points are present over L QL muscle. Weight-bearing lumbar radiographs demonstrate mild loss of disc height at L5-S1, and MR images demonstrate a large left paracentral disc herniation at L5-S1 with moderate degenerative changes at L4-L5. Sharp and shooting pain in posterior left thigh/calf and posterior ankle is: Due to degenerative changes of L L4-L5 facet joint Referred pain due to irritation of Right S1 nerve root Due to irritation of the Left S1 nerve root caused by L5-S1disc herniation Radicular pain originating from L QL trigger points 43. Which of the following statements about electrical potentials detected in trigger points isFALSE?They are not restricted to trigger pointsThey represent miniature endplate potentialsThey represent activity in intramuscular nerves or from sympathetic nerves in the muscleThey are evidence of pathology by trigger points44. Which of the following statements about low back pain is incorrect?A. Nearly 80% of acute low back pain cases are self-limiting.B. Yellow flags predict poor recovery and a high risk of progression from acute to chronic LBP.C. Straight leg raising test has a high sensitivity for sciatica.D. Routine MRI is advised for patients who can afford it.45. A 63-year-old woman presents with low back pain and cramping in both posterior thighs and numbness radiating into the feet with ambulation. It worsens with standing and walking and improves with sitting and bending forward. She has no bowel or bladder complaints. On examination, she has full strength, normal sensation, reflexes are symmetric and she has 2+ peripheral pulses. Straight leg raise is negative. What is this patient’s most likely diagnosis?Cauda equina syndromeInternal disc disruptionSpinal stenosisVascular claudication46. A 33-year-old man presents with a sudden onset of back and left leg pain and weakness after performing heavy squats at the gym. Radiographs are normal, but a MRI reveals a posterolateral left L5-S1herniated disc. What would a careful neurologic examination likely reveal?Foot plantar flexion weakness with absent Achilles reflexFoot plantar flexion weakness with absent patella reflexGreat toe extension weakness with absent Achilles reflexGreat toe extension weakness with absent patella reflex47. Botox is indicated in Episodic migraineChronic migraineHemiplegic migraine Basilar type migraine 48. The secetomotor fibre to the parotid gland passes through Otic ganglion Sphenopalatine ganglion Geniculate ganglion Lesser ganglion49. The vertebral artery traverses all of the following except?A. Foramen magnumB. Subarachnoid spaceC. Intervertebral foramenD. Foramen transversarium50. Red flag markers for serious spinal pathology include:History of previous spinal trauma.Pain persisting for >1 yr.History of steroid use.History of depression.51.DRG is widest atL1L3S1S352.Most commonly missed nerve with interscalene approach to brachial plexus:UlnarMedianMusculocutaneousRadial53.Artery of Adamkiewicz arises at following spinal levelT1-t6T5-t8T9-l-2T11-l354.Approach to celiac plexus are all exceptIntercruralLateralTranscruralRetrocrural55.Potential complications of stellate ganglion block all exceptPneumothoraxLesion of recurrent laryngeal nerveNeuritisHorners syndrome56.Gasserian ganglionMandibular br is located medial to ophthalmicLies outside cranium in meckel caveForamen rotundum is used for blockadeMedial br are sensory and lat br is partial motor57.Blood supply to spinal cord2 post spinal and 2 ant spinal art1 post and 1 ant2 post and one antBranches of lumbar arteries58.Nutrition to lumbar intervertebral disc is fromPosterior spinal arteryAnterior spinal arteryInternal iliac arteryLumbar artery59.Trigeminal ganglion: which is correctLocated in anterior cranial fossaOphthalmic branch is located ventrally Maxillary branch is a mixed nerve with sensory and motor componentTG links with automatic nerves system through ciliary, sphenophalatine, otic and sub maxillary ganglia 60.50 year old man with no comorbid illness is given (left) maxillary nerve block by extra oral approach. All can occur as except:Blindness of (left) eye Air can be aspirated if needle is not in proper place Paraesthesia while the needle hits lateral pterygoid lamina Corneal anesthesia61.Mandibular nerve supplies motor nerve to all except:Tensor tympani BuccinatorMylohyoid muscle and anterior belly of digastric muscle Muscle of mastication 62.All of the following are true about glossopharyngeal nerve block except:Styloid process in as important landmark Used to differentiate geniculate ganglion neuralgia Used in awake intubationUseful in significant behavioral abnormalities and atypical facial pain.63.Identify the structure Uncovertebral jointFacet jointAtlanto-Axial JointAtlanto- occipital joint64.Needle is passed through Greater palatine foramen Maxilary SinusForamen ovaleInfra temporal fossa65.The procedure shown in the picture is indicated in all of the following conditions exceptChronic Pelvic pain CRPSHerpes Zoster involving the lower extremitiesPulmonary Thromboembolism 66. A 59 year-old female complaining of moderately severe low back pain and right buttock pain which is exacerbated with prolonged sitting. On physical examination there is sciatic notch tenderness and the pain is exacerbated with flexion, adduction, and internal rotation of the right hip. Which of the following is the most likely diagnosis?(A) L5-S1 facet syndrome(B) Piriformis syndrome(C) Sacroiliac (SI) joint syndrome(D) L3 radiculopathy67. Following are the complications of percutaneous RF procedure in trigeminal neuralgia except –Keratitis Paralysis of the buccinator muscleTemporary paralysis of the third and fourth cranial nervesAnaesthesia dolorosa68. Stellate ganglion is located between theC6-C7C7-T1C5-C7C5-C669. In relation to the stellate ganglion the subclavian artery is locatedanteriorlyposteriorlylaterallymedially70. Despite satisfactory stellate ganglion block for sympathetic-mediated pain, the pain relief in upper extremity is inadequate. The technical explanation for this may lie in inadequatespread of local anesthetics toC5 nerve rootinferior cervical ganglionfirst thoracic ganglionT2 and T3 gray communicating rami71. When performing lumbar discography, the “opening pressure” is the recorded pressureSignifyingfirst appearance of the contrast in nucleus pulposusopening of the annular tear to the contrastreproduction of concordant painresting pressure transduced from thenucleus72. Intradiscal electrothermal coagulation (IDET) outcomes were adversely affected byappearance of the disc on T2-weighted MRI imagesobesityagecoexisting radicular pain73. When performing lumbar discography, in relation to the laterality of pain, which of the following should be the needle entry site?IpsilateralContralateralLaterality does not make a differenceGuided by MRI images74. Apatient with painful sacroiliac joint syndrome had only short-term relief with two sacroiliac (SI) injections using local anesthetics and steroids. Which of the following is the next treatment option?SI joint fusionS1, S2, S3, S4 radiofrequency DenervationL5, S1, S2, S3 radiofrequency denervationL4, L5, S1, S2, S3 radiofrequency denervation75. Radiation dose to the patients and medical personnel can be reduced bydecreasing the distance between the image intensifier and the patientincreasing the distance between the image intensifier and the patientusing continuous fluoroscopyoblique views76. Personnel radiation protection can be achieved bylead apronslead glassesincreased distance from the x-rayall of the above77. T2 and T3 sympathetic blockis used for treatment of upper extremity complex regional pain syndrome (CRPS)will help by denervating the Kuntz nervescan lead to pneumothoraxshould avoid radiofrequency of T2 and T3 sympathetic ganglia78. Vertebroplasty may be indicated formultiple myelomachronic compression fractures of vertebral bodyosteolytic metastatic tumorsfacet arthropathy79. Complications from vertebroplasty include all exceptPulmonary embolusIntradiscal leak of polymethyl methacrylateHemiplegiaPsoas muscle leak of polymethyl methacrylate and femoral neuropathy80. Which of the following is incorrect with regards to piriformis muscle injection?Should be done at lateral part of a muscleBotox can be usedNerve stimulation may aid in muscle locationIdentification of the muscle can be done through rectal examination81. SI joint painIs transmitted by the S1-S4 levels of spinal nervesHas been treated by the SI joint fusionCan be relieved by blind steroid injectionsIs transmitted by L4 medial branch, L5 dorsal ramus, and S1-3 lateral branches82. Ganglion impar blockIs indicated for testicular pain.Trans-sacrococcygeal approach is a safer way.Is best performed by anococcygeal approach.Can be complicated by perforation of appendix.83. Visual analogue scale (VAS) all are true exceptCorrelate highly with pain measured on verbal and numerical rating scalesIs minimally intrusiveAssumes that pain is a multidemnsional experienceMeasures the intensity of pain84. McGill Pain QuestionnaireConsists of three major measuresWas developed by mcgillIs not widely usedIs a single-dimensional pain scale85. Which of the following conditions is more likely to be associated with neuropathic pain?Traumatic nerve injuryStrokeSyringomyeliaMultiple sclerosis86. The least common adverse effects associated with TCA are (is)Dry mouthSeizureUrinary retentionBlurred vision87. Compared to TCAs, SSRIsAre more effective in the treatment of painHave more side effectsHave less side effectsHave more serious consequence of overdosage88. Which of the following is false regarding tramadol?It has opioid characteristicsThere is a dose limit of 400 mg/dIt is a centrally acting analgesicNo effect on norepinepherine or serotonin89. The benzodiazepine which is used to treat various neuropathic pain syndromes isDiazepamClonazepamFlunazepamLorazepam90. Which of the following are not the risk associated with SCS?Epidural hematomaSpinal cord injuryCatheter Breakage Electromechanical failure of lead or extension cable91. Which of the following is (are) true regarding SCS for visceral pain?SCS suppresses visceral response to colon distention in animal modelsSCS is a first-line treatment for visceral painCase studies have indicated SCS may be helpful for visceral pain but at this time there is a lack of supporting randomized controlled trialsA good lead placement for stimulation of chronic pancreatitis would logically be around T12 or L192. Which of the following should be considered when selecting patients for SCS?Disease statesUntreated drug addictionPatient comorbiditiesPhysician’s monthly case quota93. Which of the following is (are) true regarding the history of electrical stimulation for the treatment of pain?Electrical stimulation for the treatment of pain dates back to the first century AD when electrical fish were documented to be used in the treatment of goutImplantable SCS were used for treatment of pain for a decade prior to the published gate control theory of painEarly stimulation case reports were of peripheral nerve stimulation; later emphasis turned toward SCSPsychiatric and/or psychologic screening evaluation prior to implants was a new idea imposed upon physicians by health maintenance organizations in the 1990s94. Needle shown in the picture is positioned forSpinal Cord StimulationVertebroplasty Cervical Facet Median Branch BlockHypogastric plexus block.95. Identify the nerve rootL4L5S1S296. Identify the procedure Lumbar Interlaminar epiduralLumbar transforaminal epiduralCaudal epiduralLumbar sympathetic block97. Identify the complicationIntravenous uptakeIntraarterial uptakeIntrathecal uptakeEpidural spread98. Positive lumbar Discogram for Mechanical disc sensitization is<30 psi>30 psi<50 psi<90psi99.Ramsay Hunt syndrome is caused by infection of varicella-zoster virus ofSphenopalatine ganglionGasserian ganglionGeniculate ganglionGlossopharyngeal ganglion100. In all chronic pain there are problems in the nervous system exceptCRPSFibromyalgiaMigraineRheumatoid arthritisANSWERS Correct answer is CCorrect answer is BCorrect answer is DCorrect answer is CCorrect answer is CCorrect answer is ACorrect answer is ACorrect answer is DCorrect answer is BCorrect answer is CCorrect answer is DCorrect answer is BCorrect answer is CCorrect answer is DCorrect answer is BCorrect answer is ACorrect answer is BCorrect answer is ACorrect answer is CCorrect answer is DCorrect answer is DCorrect answer is CCorrect answer is CCorrect answer is BCorrect answer is DCorrect answer is DCorrect answer is CCorrect answer is ACorrect answer is CCorrect answer is DCorrect answer is ACorrect answer is BCorrect answer is CCorrect answer is ACorrect answer is CCorrect answer is ACorrect answer is DCorrect answer is DCorrect answer is ACorrect answer is DCorrect answer is DCorrect answer is CCorrect answer is DCorrect answer is DCorrect answer is CCorrect answer is ACorrect answer is BCorrect answer is BCorrect answer is CCorrect answer is ACorrect answer is CCorrect answer is ACorrect answer is CCorrect answer is BCorrect answer is DCorrect answer is DCorrect answer is BCorrect answer is DCorrect answer is DCorrect answer is DCorrect answer is BCorrect answer is DCorrect answer is ACorrect answer is DCorrect answer is DCorrect answer is BCorrect answer is BCorrect answer is BCorrect answer is ACorrect answer is DCorrect answer is ACorrect answer is BCorrect answer is CCorrect answer is DCorrect answer is ACorrect answer is DCorrect answer is ACorrect answer is ACorrect answer is CCorrect answer is ACorrect answer is DCorrect answer is B Correct answer is CCorrect answer is ACorrect answer is CCorrect answer is B Correct answer is CCorrect answer is DCorrect answer is B Correct answer is CCorrect answer is B Correct answer is ACorrect answer is B Correct answer is B Correct answer is B Correct answer is ACorrect answer is ACorrect answer is CCorrect answer is CCorrect answer is D ................
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