Pain & Palliative

Question 1

Which neurotransmitter is implicated in Migraine?

Answer 1

Calcitonin gene related peptide

Question 2

Baclofen Activate?

Answer 2

GABA(b)

Question 3

In normal resting condition Glutamate an excitatory neurotransmitter is inhibited by?

Answer 3

Magnesium

Question 4

M/A of paracetamol includes?

Answer 4

1.central Cox inhibitor
2.Activate inhibitory Descending spinal pathway via serotonergic mechanism
3.Endocannaboid Reuptake inhibitor
4.Inhibits NO & TNF-alpha

Question 5

M/A of TCA?

Answer 5

1.serotonin & NE reuptake inhibition at synapse in spinal cord
2.potential effect in Limbic system
3.reduce Na channel

Question 6

M/A NSAID?

Answer 6

Inhibit Prostaglandin synthesis

Question 7

M/A of opioids?

Answer 7

Opioid receptor agonist
& block ascending pain pathway

Question 8

M/A ketamine?

Answer 8

1.NMDA antagonist
2.Reduction in central Pain sensitisation

Question 9

M/A Capsaicin?

Answer 9

Activates TRPV-1 on subset of C fibre

Question 10

M/A lidocaine?

Answer 10

Na channel blocker

Question 11

Which opiod is safe at Renal impairment?

Answer 11

Buprenorphine

Question 12

Fastest nerve fibre?

Answer 12

A alpha

Question 13

Unmyelinated nerve fibre?

Answer 13

c fibre

Question 14

What do you mean by allodynia?

Answer 14

Pain due to non painful stimuli like light touch

Question 15

Negative sensory disturbances include?

Answer 15

Numbness
Tingiling(parasthesia)
Loss of temperature & sensitivity

Question 16

What is formication?

Answer 16

Feeling of insect crawling over skin

Question 17

1st line drugs for Neuropathic pain?

Answer 17

1.SNRI(Duloxetine)
2.TCA
3.Gabapentin and pregabalin

Question 18

If 1st line drugs for neuropathic pain fails?

Answer 18

2nd line-

capsaicin patch,lidocaine patch,Tramadol…

Question 19

Third line drugs for neuropathic pain?

Answer 19

Botulinum toxin,strong opioid

Question 20

Strong recommended drugs for Neuropathy?

Answer 20

1st line

Question 21

CRPS (complex regional pain syndrome) is diagnosed by?

Answer 21

BUDAPEST CRITERIA

Sensory,Motor,sudomotor,vasomotor

Question 22

Palliative Care

The commonest barrier to assessment of palliative pain is?

Answer 22

Idiosyncratic shortcuts

Question 23

Palliative Care

How you clinically assess pain in cancer patient?

Answer 23

EPAT(Edinburg Pain assessment and management Tool)

Simple screening question..In a scale of 0-10

Question 24

Palliative Care

What is the mainstay treatment in cancer associated pain?

Answer 24

Pharmacological treatment

Question 25

#Palliative Care Who analgesic ladder?

Answer 25

Step1- paracetamol/Nsaid Step2-1+weak opioid Step3-strong opioid

Question 26

#Palliative Care Most commonly prescribe strong opoid?

Answer 26

Morphine

Question 27

#Palliative Care Most effective and appropriate route for morphine?

Answer 27

Oral

Question 28

#Palliative Care Effective morphine equivalent dose for cancer pain?

Answer 28

200mg/day

Question 29

#Palliative Care Treatment of choice for pain due to bone metastasis?

Answer 29

Radiotherapy

Question 30

#Palliative Care Drug of choice for pain arising from liver capsule?

Answer 30

Glucocorticoid

Question 31

#Palliative Care Pain for raise ICP?

Answer 31

Glucocorticoid Radiotherapy Opioid

Question 32

#Palliative Care Ishchemic pain?

Answer 32

Nsaid & ketamine

Question 33

#Palliative Care Opioid related resistant constipation..Rx?

Answer 33

Opioid+Naloxone combinations

Question 34

#Palliative Care To break opioid related nausea cycle?

Answer 34

IV haloperidol/levomepromazine

Question 35

#Palliative Care In Opioid,which symptoms are beyond tolerance?

Answer 35

Dry mouth & constipation

Question 36

#Palliative Care Indications of glucocorticoids in palliative care?

Answer 36

1. Raised ICP 2.Liver capsule pain 3.Nerve compression 4.Soft tussue infiltration

Question 37

#Palliative Care Treatment of choice for severe resistant neuropathic pain

Answer 37

Ketamine(NMDA antagonist) under specialist supervision.

Question 38

#Palliative Care Following radiotherapy to releive pain in bone metastasis, pt develops transient flare of pain..Mx?

Answer 38

24-48 Hrs Dexamethasone

Question 39

#Palliative Care Management of palliatiave Breathlessness?

Answer 39

Opioid both oral and parental are effective...If anxious,lorazepum may be given.. O2 has no role

Question 40

#Palliative Care Persistent nonproductive cough in palliative care..treatment?

Answer 40

Opioid

Question 41

#Palliative Care Productive/troublesome secretion..Rx?

Answer 41

Hyosine hydrobromide..Commonest A/E dry mouth

Question 42

#Palliative Care In cancer patient which drug temporarily boost appetite?

Answer 42

Glucocorticoids

Question 43

#Antiemetic Drugs act on CTZ

Answer 43

D2 antagonists Haloperidol and Metoclopromide CTZ is stimulated by drugs and toxins or metabolites..So this drugs are indicated

Question 44

#Antiemetic Drugs act on vomiting center?

Answer 44

Anti H1,Ach Cyclizine Hyoscine Levomepromazine Motion sickness এ ভালো কাজ করে

Question 45

#Antiemetic Gut distension stimulate which receptor?

Answer 45

Via vagus Histamin receptor H1

Question 46

#Antiemetic Histamine receptor located in?

Answer 46

Vomiting centre and Gut

Question 47

#Antiemetic Gut chemoreceptor?

Answer 47

5-HT As chemorceptor it stimulates CTZ