CME/JAAPA Flashcards
- A patient you have been treating for over a year with an opioid for chronic pain has been asking for increased doses of the medication, has missed a recent urine drug screen, and has called earlier than usual for a refill. Which term best describes this series of actions?
a. compulsive opioid use
b. pseudoaddictive behavio
c. dependent behavior
d. aberrant drug-related behavior
D
Which statement is correct about patients’ risks for opioid use disorder?
a. Patients who have abused stimulants are not at risk for opioid use disorder because stimulants and opioids have different mechanisms of action in humans.
b. Patients who have a positive family history of substance
abuse but a negative personal history of substance abuse require no special considerations for opioids.
c. Patients with chronic pain and comorbid depression or post-
traumatic stress disorder should be referred for mental health treatment.
d. A patient with a personal history of alcohol abuse should never be prescribed opioids for chronic pain because the abuse of one substance always signals the abuse of other substances.
C
Which of the following should be included in treatment
agreements between providers and patients?
a. Pill counts and urine drug screening every 2 weeks.
b. Random urine toxicology screening and a signed agreement
to fill prescriptions at the same pharmacy each time.
c. Strict rules about what will happen if the patient loses a writ-
ten prescription.
d. Expected goals of treatment and expectations for pill counts
at visits.
D
Which description most likely identifies a patient who is addicted?
a. The patient’s urine toxicology screens are positive for illicit
substances.
b. The patient doubled his opioid medication for the past 3 days
when his pain flared.
c. The patient lost her written prescription for the opioid that
was prescribed yesterday.
d. A patient was a no-show for his scheduled follow-up appoint-
ment today
A
Which of the following statements should guide providers
who treat patients for chronic nonmalignant pain?
a. Headache is the most common presenting complaint in all
patients who have had pain for more than 3 months.
b. Extended-release or tamper-resistant formulations of opioids
do not ensure against illicit use and diversion.
c. Buprenorphine and methadone have no potential for abuse and diversion and should be the drugs of choice for chronic pain.
d. NSAIDs should always be the first class of drugs prescribed
for patients with chronic pain.
B
Which statement is correct about the cause of pain?
a. Nociceptive and neuropathic pain can coexist when patients have tissue damage.
b. Disorders that cause spasticity and rigidity are not likely to cause concomitant pain.
c. Nociceptive pain occurs only when a patient has a peripheral lesion of the nervous system.
d. Neuropathic pain is a direct result of actual tissue damage beyond the somatosensory nervous system.
A
Which statement is correct about the mechanism of neuropathic pain?
a. Spinal cord injury results in peripheral neuropathic pain.
b. Carpal tunnel syndrome is a polyneuropathy.
c. Pain with varicella zoster or Guillain-Barré syndrome is due to central neuropathy.
d. Multiple sclerosis and phantom limb pain are associated with central neuropathic pain.
D
Which is an accurate characterization of signs and symptoms of neuropathic pain?
a. Hypoalgesia is considered a positive sign.
b. Paresthesia such as skin crawling is considered a spontaneous positive symptom.
c. Temporal summation is a negative sign.
d. Evoked signs include that of hypoesthesia.
B
Which statement is correct about diagnosing neuropathic pain?
a. Imaging studies are proven to be superior to history and physical examination.
b. Screening tools such as PainDETECT and the Leeds Assessment uncover nearly 100% of patients with neuropathic pain.
c. Electromyography and somatosensory evoked potentials are unhelpful in determining if a patient has neuropathic pain.
d. A combination of positive and negative signs and symptoms on history and physical examination is highly suggestive for neuropathic pain.
D
Which statement is correct about treatment for neuropathic pain?
a. Gabapentin and pregabalin commonly cause dry mouth.
b. Daily doses of amitriptyline or nortriptyline should not exceed 100 mg.
c. A trial of 4 weeks is needed to determine if gabapentin therapy is adequate.
d. Duloxetine is contraindicated in patients with diabetes
C
