Pain Flashcards
A 35-year-old young woman presents with left-sided facial pain without any numbness. She had several episodes in the last few months, and her pain triggers after eating, talking, and touching her cheek. MRI shows a vessel compressing cranial nerve V. Which vessel is most commonly involved?
● A. Superior cerebral artery
● B. AICA
● C. PICA
● D. PCA
A. Superior cerebral artery
A 25-year-old young male presented with painful vesicular eruption. It was in dermatomal distribution on one side of thorax. What is the effective treatment for the pain of acute attack?
● A. Epidural
● B. Intercostal block
● C. Antiviral
● D. Both A and B
D. Both A and B
A 60-year-old female with history of breast cancer, with metastasis to bone and pain in right arm, reports 3 weeks of worsening of pain (burning in right hand—brachial plexus neuropathy). She was prescribed tricyclic antidepressant, use of which is limited by which of the following?
● A. Anticholinergic effect
● B. Central effects
● C. Limited pain relief
● D. All of the above
D. All of the above
Ramsay Hunt syndrome is characterized by which of the following triads?
● A. Contralateral facial paralysis, ear pain, and vesicle on face,
ear, or in the ear
● B. Recurrent oral ulcers, genital ulcers, and iridocyclitis
● C. Sixth cranial n. palsy, persistent ear discharge, deep-seated retro-orbital pain
● D. Ipsilateral facial paralysis, ear pain, and vesicle on face, ear, or in the ear
D. Ipsilateral facial paralysis, ear pain, and vesicle on face, ear, or in the ear
Which of the following is correct regarding primary otalgia?
● A. More common in children
● B. Mostly unilateral
● C. Cold, air, and water most common triggers
● D. 75% associated with aural symptoms (hearing loss, tinnitus, and vertigo)
● E. All of the above
E. All of the above
A European solider presented to the emergency department after 24 hours of being shot, with classical triad of burning pain, autonomic dysfunction, and trophic change (complex re-
gional pain syndrome) on his upper extremity. Which of the following statements is true?
● A. Medical therapy is sufficient
● B. Sympathetic block may not help
● C. Guanethidine commonly used intravenous injection
● D. No role of tricyclic antidepressants
● E. All of the above
C. Guanethidine commonly used intravenous injection
There are three major types of pain, namely, nociceptive pain (somatic and visceral), deafferentation pain, and sympathetically maintained pain. Pain which is caused by lesion or
compression of peripheral or central nervous system manifesting as sensory signs and symptoms is called as neuropathic pain. Following are peripheral neuropathic pain syndromes except?
● A. Acute and chronic inflammatory demyelinating polyneuropathy
● B. Entrapment neuropathies
● C. Cervical spondylotic myelopathy
● D. Post herpetic neuralgia
● E. Painful diabetic neuropathy
C. Cervical spondylotic myelopathy
Which of the following statements regarding medical treatment of neuropathic pain is true?
● A. Traditional treatment includes narcotic analgesic and tricyclic antidepressants (amitriptyline 75 mg daily)
● B. Gabapentin is effective for post herpetic neuralgia, painful diabetic neuropathy, trigeminal neuralgia, postoperative state, spinal cord injury, cancer, MS, and migraine
● C. Lidocaine patch is applied for 12 hours/d over the most painful area
● D. Tramadol is a centrally acting analgesic which is effective for these patients
● E. All of the above
E. All of the above
Possible pathways for facial pain include trigeminal nerve, facial nerve, and cranial nerve eight. Which of the following is a cause of cephalic neuralgia?
● A. Tic convulsif: otalgia and deep prosopalgia
● B. Diabetic neuritis of oculomotor nerve
● C. Nerve injury to superior or inferior alveolar nerves
● D. Sinusitis of frontal, maxillary, sphenoidal, or ethmoidal sinus
● E. All of the above
A. Tic convulsif: otalgia and deep prosopalgia
Primary otalgia is unilateral in most cases, and it is mostly triggered by cold air or water. It is associated with aural symptoms like hearing loss, vertigo, and tinnitus. Following is true regarding the management of primary otalgia except?
● A. An initial trial with medications used in trigeminal neuralgias like carbamazepine, phenytoin, and baclofen is the first
line of defense
● B. Suboccipital exploration of the 7th cranial nerve or lower cranial nerve with MVD has no role in these cases
● C. Ultimate treatment is sectioning of nervus intermedius, the 9th and upper two fibers of 10th nerve, and a geniculate ganglionectomy
● D. Pain relief with nerve block of pharyngeal tonsils suggests glossopharyngeal neuralgia
● E. CT or MRI should be done in any case where no cause is found
B. Suboccipital exploration of the 7th cranial nerve or lower cranial nerve with MVD has no role in these cases
A woman 50 years of age presented with unilateral pain in forehead with tenderness on one side of forehead. The pain is temporarily relieved with nerve block in the region of orbital roof. This condition responds to gabapentin, pregabalin, or topical capsaicin. What is the most likely diagnosis in this case?
● A. Trigeminal neuralgia
● B. Migraine
● C. Supraorbital neuralgia
● D. Hemi crania continua
● E. Trochleitis
C. Supraorbital neuralgia
Herpes varicella zoster virus is responsible for painful vesicular cutaneous eruptions mostly in the area of thorax or in distribution of trigeminal neuralgia. If pain from this condition persists for more than 1 month, then this condition is called
post herpetic neuralgia. The recommended medical treatment for this condition includes which of the following?
● A. Acyclovir 800 mg every 4 hours for 7 days
● B. Tricyclic antidepressants
● C. Gabapentin
● D. Lidocaine patch
● E. All of the above
E. All of the above
For post herpetic neuralgia, gabapentin is started at a dose of 300 mg once a day for first day, 300 mg twice a day on second day, and 300 mg thrice a day on third day. Which side effect of gabapentin makes a surgeon to start it at night with slow increments of doses?
● A. Ataxia and fatigue
● B. Drowsiness
● C. Peripheral edema and confusion
● D. Depression
● E. All of the above
B. Drowsiness
Capsaicin patches or lidocaine patches are helpful in post herpetic neuralgia patients. Intrathecal steroid with methylprednisolone plus 3% lidocaine once every week for 4 weeks has shown good to excellent pain relief for up to 2 years. What is the surgical treatment that is uniformly successful in treating post herpetic neuralgias?
● A. Nerve block
● B. Neurectomies
● C. Cordotomy
● D. Rhizotomy
● E. None of the above
E. None of the above
Complex regional pain syndrome also known as causalgia is a disproportionate pain syndrome which can cause burning pain, autonomic dysfunction, or trophic changes. Which of the following is true regarding the cause of this syndrome?
● A. These are high velocity missile injuries (also known as CRPS type 2)
● B. Sympathetic dystrophy or causalgia minor is caused by nonpenetrating injury and is called as CRPS type 1
● C. It can occur in postoperative patients following carpal tunnel surgery or surgery on lumbar or cervical spine
● D. It can occur because of direct injury to nerve or because of injury to surrounding soft tissue
● E. All of the above
E. All of the above
