Neurology/Psychiatry Exam #3 (Pain/Addiction)

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| By Kmccor2008
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Kmccor2008
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Quizzes Created: 7 | Total Attempts: 3,418
Questions: 36 | Attempts: 152

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Questions and Answers
  • 1. 

    The dorsal horn is responsible for the transmission of signals, due to noxious stimuli,  from peripheral nerve to the thalamus via the descending pain pathway.  

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Pain from nerves to thalamus via the dorsal horn follows the ascending pain pathway, while the descending (from brain to dorsal horn) signals modulate activity to control pain transmission.

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  • 2. 

    Which of the following statements about types of chronic pain is FALSE?  

    • A.

      Chronic back pain is observe only in the case of morphologic changes

    • B.

      Diabetic neuropathy is the result of vasoconstriction of microvasculature

    • C.

      Postherpetic neuralgia may last for years

    • D.

      “Tingling” sensation is the result of neurons that are hypersensitized due to change in sodium receptor concentrations and demyelinated axons.

    • E.

      All of the above are correct

    Correct Answer
    A. Chronic back pain is observe only in the case of morphologic changes
    Explanation
    Chronic back pain may be present without morphologic changes

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  • 3. 

    Tricyclic Antidepressants have not shown significant efficacy in controlling chronic back pain.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    While pain control may not be supported by evidence, it may be trialed in (appropriate) patients and may be used to treat Depression

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  • 4. 

    Which of the following statements about gabapentin (Neurontin) are FALSE?

    • A.

      Common ADE- Dizziness, somnolence

    • B.

      Onset of action = 2-3 weeks, Trial requires = 3-8 weeks

    • C.

      Requires renal adjustment

    • D.

      Titration- Day 1- 300mg at bedtime; Day 2- 300mg BiD; Day 3- 300mg TiD

    • E.

      All of the above are True

    Correct Answer
    E. All of the above are True
    Explanation
    The given answer states that all of the statements about gabapentin (Neurontin) are true. This means that all of the following statements are true: common adverse effects of gabapentin are dizziness and somnolence, the onset of action for gabapentin is 2-3 weeks, a trial of gabapentin requires 3-8 weeks, gabapentin requires renal adjustment, and the titration schedule for gabapentin is 300mg at bedtime on day 1, 300mg twice a day on day 2, and 300mg three times a day on day 3.

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  • 5. 

    Which of the following statements about pregabalin (Lyrica) are FALSE?  

    • A.

      Maximum doses dependent on indication

    • B.

      Requires renal adjustment

    • C.

      Should be used in caution in patients at risk of cardiovascular disease due to potential peripheral edema

    • D.

      Starting dose - 500mg/day; Titration-Within 1 week

    • E.

      All of the above are True

    Correct Answer
    D. Starting dose - 500mg/day; Titration-Within 1 week
    Explanation
    Starting dose = - 75 mg BiD (I try to avoid dosing questions, but should have an idea within 10X the appropriate doses)

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  • 6. 

    Proper administration of the lidocaine patch include applying a 5% patch daily, which can be cut to fit the site of administration  

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Proper administration (or the notes say) q12 hours. Patch can be cut to fit the site

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  • 7. 

    It may take up to 1 month to see a noticeable effect of treatment with capsaicin  

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Capsaicin is a compound found in chili peppers that is commonly used in topical creams for pain relief. When applied to the skin, capsaicin can help alleviate pain by reducing the levels of substance P, a chemical that transmits pain signals to the brain. However, it can take some time for the effects of capsaicin to become noticeable. This is because capsaicin needs to build up in the body over time in order to have a significant impact on pain perception. Therefore, it is true that it may take up to 1 month to see a noticeable effect of treatment with capsaicin.

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  • 8. 

    Of the opioid receptors (mu, kappa, delta), the pharmacologic side effect of constipation based on action on the delta receptor.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Pharmacology side effects of constipation is a result of action on the mu (like your mother said, Trebek! http://i.imgur.com/31vllYu.png) receptor.

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  • 9. 

    Which of the following statements regarding morphine is FALSE?  

    • A.

      Cannot be used in patients with hepatic dysfunction

    • B.

      Initiation doses: IR - 5mg q4hr, SR/CR - 15 mg q8-12hr, ER - 30 mg qd

    • C.

      Metabolized to an active metabolite; avoid in renal dysfunction

    • D.

      Risk of allergic reaction

    • E.

      Titrated every 2 days until no longer tolerated

    • F.

      All of the above are True

    Correct Answer
    A. Cannot be used in patients with hepatic dysfunction
    Explanation
    In hepatic dysfunction, dose can be reduced/extended

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  • 10. 

    Which of the following statements regarding oxycodone is TRUE?  

    • A.

      Controlled release formulation can be mixed into small (

    • B.

      Less histamine release than morphine at initiation

    • C.

      Requires no change in initial dose in renal dysfunction

    • D.

      Titration - dose is increased every 1-2 weeks as tolerated

    • E.

      All of the above are False

    Correct Answer
    B. Less histamine release than morphine at initiation
    Explanation
    Don’t crush, break, or chew CR formulation
    Renal dysfunction = 33-50% reduction in initial dose
    Dose can be increased every 1-2 days, max = as tolerated

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  • 11. 

    Oxymorphone should be taken within 30 mins. after a meal (>500cal)  

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    take on an empty stomach

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  • 12. 

    Which of the following statements regarding tramadol is FALSE?

    • A.

      Epileptogenic risk

    • B.

      Non-controlled substance

    • C.

      Reduced risk of respiratory depression

    • D.

      Titrate up as tolerated

    • E.

      All of the above are True

    Correct Answer
    D. Titrate up as tolerated
    Explanation
    Max dose = 400 mg/day

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  • 13. 

    Tapentadol is a Schedule II medication because it has a higher abuse potential than tramadol

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Tapentadol is classified as a Schedule II medication because it has a higher abuse potential than tramadol. Schedule II drugs have a high potential for abuse, which may lead to severe psychological or physical dependence. Tapentadol is a centrally acting opioid analgesic that works by binding to the mu-opioid receptors in the brain, providing pain relief. However, it also has a higher risk of misuse, addiction, and overdose compared to tramadol, which is classified as a Schedule IV medication. Therefore, the statement is true.

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  • 14. 

    Choice of opioid for control of pain is dependent on patient preference, compliance, and superior opioid efficacy

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    No single agent is superior in efficacy. Patient preference and compliance are very important.

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  • 15. 

    Which of the following statements about opioid treatment principles is FALSE?  

    • A.

      Titration: Daily dose should be increased by 25% at time

    • B.

      Short acting doses should be 10% of the daily dose given

    • C.

      Administration of short-acting doses should be PO q4-6 hrs

    • D.

      Discontinuation: Daily dose taper 10% each week as tolerated (withdrawal)

    • E.

      All of the above are True

    Correct Answer
    D. Discontinuation: Daily dose taper 10% each week as tolerated (withdrawal)
    Explanation
    Taper can be 25-50% reduction of daily dose per week

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  • 16. 

    Opioid Withdrawal should be treated immediately due to increased risk of severe problems such as seizure, mortality, or death.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Opiate withdrawal is not associated with mortality, seizures, coma, or death

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  • 17. 

    While Mu opioid receptors are responsible for the common side effects of opiates, Kappa receptors are responsible for the euphoric effects of opioid abuse.  

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Mu = ADE and euphoric effects

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  • 18. 

    Which of the following statements about clonidine is FALSE?  

    • A.

      FDA approved for treatment of opioid withdrawal

    • B.

      As an alpha-2 adrenergic receptor agonist, it suppresses the sympathetic CNS system

    • C.

      Dosing based on COWS assessment

    • D.

      Given in combination with other medication

    • E.

      All of the above are True

    Correct Answer
    A. FDA approved for treatment of opioid withdrawal
    Explanation
    Is not FDA approved for opioid withdrawal

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  • 19. 

    Which of the following statements about buprenorphine/naloxone (Suboxone) is FALSE?  

    • A.

      Buprenorphine is a partial mu receptor agonist and weak kappa receptor agonist

    • B.

      Buprenorphine is highly protein bound

    • C.

      Buprenorphine yields an active metabolite via CYP3A4 metabolism

    • D.

      Dosing of Suboxone is based on most recent opioid dose

    • E.

      Time to peak effect of Suboxone is 30-60mins.

    • F.

      All of the above statements are True

    Correct Answer
    D. Dosing of Suboxone is based on most recent opioid dose
    Explanation
    Dosed as needed based on COWS assessment

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  • 20. 

    Subutex (buprenorphine) is not prefered over Suboxone for opiate maintenance expect in pregnant patients

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Subutex (buprenorphine) is not preferred over Suboxone for opiate maintenance, except in pregnant patients. This is because Suboxone contains buprenorphine along with naloxone, whereas Subutex only contains buprenorphine. Naloxone is added to Suboxone to deter misuse and reduce the risk of overdose. Therefore, Suboxone is generally the preferred option for opiate maintenance treatment, except in cases where the patient is pregnant, as the use of naloxone during pregnancy may not be recommended.

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  • 21. 

    Patient must be in withdrawal before administration of first dose of Suboxone.  

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The combination of buprenorphine (partial) and naloxone (full) mu antagonist would cause withdrawal in patient that was not in withdrawal. Suboxone is meant to give relief from withdrawal, not cause it

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  • 22. 

    Which of the follow statements about methadone is FALSE?  

    • A.

      Dose tapering depends on opiate of abuse from which patient is withdrawing

    • B.

      Indicated for both treatment of opiate withdrawal and opiate maintenance treatment

    • C.

      Mechanism of action - Full mu receptor agonist weak NMDA antagonist

    • D.

      Monitor for QT prolongation via EKG

    • E.

      All of the above are True

    Correct Answer
    E. All of the above are True
    Explanation
    Methadone is a medication that is used for both the treatment of opiate withdrawal and opiate maintenance treatment. It acts as a full mu receptor agonist and weak NMDA antagonist. It is important to monitor patients taking methadone for QT prolongation via EKG. Dose tapering of methadone depends on the opiate of abuse from which the patient is withdrawing. Therefore, all of the above statements about methadone are true.

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  • 23. 

    Detoxification with methadone may only be performed in a licensed, designated facility except in the case of: Inpatient setting - Can administer methadone for withdrawal if patient scores “severe” on COWS.  

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Methadone can be administered in an inpatient setting only if patient was admitted for something other than opiate addiction/withdrawal

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  • 24. 

    Detoxification with methadone may only be performed in a licensed, designated facility except in the case of: Outpatient setting - Physician can prescribe 72 hour of methadone to treat a patient’s opioid withdrawal  

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Detoxification with methadone is typically only allowed in licensed facilities, but there is an exception for outpatient settings. In these cases, a physician can prescribe up to 72 hours of methadone to treat a patient's opioid withdrawal. Therefore, the statement is true.

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  • 25. 

    The standard for opiate withdrawal in pregnant patients is maintenance treatment with methadone, though buprenorphine shows potential benefit with further studies

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The statement is true because methadone is the standard treatment for opiate withdrawal in pregnant patients. However, further studies have shown that buprenorphine also has potential benefits in this population.

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  • 26. 

    Which of the following tools is used to assess the severity of alcohol withdrawal symptoms  

    • A.

      CIWA-Ar

    • B.

      COWS

    • C.

      McGill

    • D.

      NIH Consensus Scale

    • E.

      None of the above

    Correct Answer
    A. CIWA-Ar
    Explanation
    The CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised) is a tool used to assess the severity of alcohol withdrawal symptoms. It is a standardized assessment tool that helps healthcare professionals evaluate and monitor the symptoms experienced by individuals going through alcohol withdrawal. The CIWA-Ar includes a list of 10 common withdrawal symptoms, such as nausea, tremors, and anxiety, and assigns a score to each symptom based on its severity. This tool helps healthcare providers determine the appropriate treatment and level of care needed for individuals experiencing alcohol withdrawal.

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  • 27. 

    Which of the following statements about the PK and PD of alcohol is FALSE?  

    • A.

      Acute toxicity stems from down regulation of alcohol dehydrogenase

    • B.

      Alcohol binds to the benzodiazepine site on the GABA receptor

    • C.

      Chronic consumption of alcohol leads to hypersensitivity to glutamate

    • D.

      Eventual effect is extended periods of open chloride ion channels

    • E.

      All of the above are True

    Correct Answer
    A. Acute toxicity stems from down regulation of alcohol dehydrogenase
    Explanation
    Acute toxicity of alcohol does not stem from down regulation of alcohol dehydrogenase. Acute toxicity is primarily caused by the depressant effects of alcohol on the central nervous system, leading to impaired coordination, respiratory depression, and potentially fatal alcohol poisoning. Alcohol dehydrogenase is an enzyme responsible for metabolizing alcohol in the liver, and down regulation of this enzyme can occur with chronic alcohol consumption, leading to increased alcohol tolerance.

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  • 28. 

    Alcohol withdrawal can cause death, therefore monitoring/treatment of most severe mortality is greatest within 24 hours of last drink

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The onset of alcohol withdrawal delirium (including delirium tremens) comes 48 to 72 hours after the last drink (Note- This is a differentiating factor from benzo withdrawal)

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  • 29. 

    Which of the following statements regarding alcohol withdrawal treatment is TRUE?

    • A.

      Short-acting benzodiazepines create a smoother withdrawal course as they can be doses for symptoms on an as needed basis

    • B.

      Because benzodiazepine are metabolized via CYP3A4, liver impairment is a contraindication

    • C.

      Symptom-triggered treatment with benzodiazepines shows less time on BZD and shorter length of stay (than fixed dose treatment), but requires more monitoring

    • D.

      Lorazepam and Diazepam can be given PO, IM, or IV but Chlordiazepoxide and Oxazepam are limited to PO and IM use

    • E.

      All of the above are False

    Correct Answer
    C. Symptom-triggered treatment with benzodiazepines shows less time on BZD and shorter length of stay (than fixed dose treatment), but requires more monitoring
    Explanation
    Longer acting BZD create smoother withdrawal course
    Liver impairment is not an absolute contraindication in all BZD
    Chlordiazepoxide and Diazepam are limited to PO use

    Rate this question:

  • 30. 

    Alcohol Withdrawal Delirium is treated with phenobarbital in addition to BZD  

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Alcohol Withdrawal Delirium is a severe and potentially life-threatening condition that occurs when a person abruptly stops drinking alcohol after a prolonged period of heavy consumption. The symptoms of delirium tremens include confusion, hallucinations, seizures, and severe agitation. Treatment typically involves the use of benzodiazepines (BZD) to manage symptoms and prevent complications. However, in some cases, the addition of phenobarbital, a long-acting sedative, may be necessary to effectively control symptoms and ensure the safety and comfort of the patient. Therefore, the statement that Alcohol Withdrawal Delirium is treated with phenobarbital in addition to BZD is true.

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  • 31. 

    Which of the following statements about Wernicke’s Encephalopathy (WE) is False?  

    • A.

      WE stems from thiamine deficiency due to alcohol abuse

    • B.

      Characterized by neurologic complications such as confusion, opthalmoplegia (affected eye movement), and gait ataxia

    • C.

      Treatment should begin immediately with suspected WE (even before possible test results)

    • D.

      While there are no specific guidelines, IV therapy as a 2000mg continuous infusion (over 60mins) is preferred

    • E.

      Complications of WE include deterioration to Korsakoff’s Syndrome

    • F.

      All of the above are True

    Correct Answer
    D. While there are no specific guidelines, IV therapy as a 2000mg continuous infusion (over 60mins) is preferred
    Explanation
    IV is preferred, short course = 500 mg IV/IM tid x 3 days; then 500 mg IV/IM daily x 5 days; then oral therapy if symptoms have improved

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  • 32. 

    Treatment of withdrawal from sedatives/hypnotics differs from alcohol withdrawal in that it based on CIWA-Ar score.  

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Treatment of sedatives/hypnotics is based on agent of abuse (also, alcohol has delayed delirium 48-72 hours, sed/hyp may be more immediate)

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  • 33. 

    Which of the following statements about duloxetine (Cymbalta) are FALSE?

    • A.

      Dosed at 30-60 mg, requiring no titration

    • B.

      Requires renally adjusted dose if CrCl < 30mL/min

    • C.

      Has a relatively short trial time at 2-3 weeks

    • D.

      Specific precaution for use in hypertensive patients

    • E.

      All of the above are True

    Correct Answer
    B. Requires renally adjusted dose if CrCl < 30mL/min
    Explanation
    Not recommended for use in patient with CrCl

    Rate this question:

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  • Current Version
  • Mar 21, 2023
    Quiz Edited by
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  • Apr 06, 2013
    Quiz Created by
    Kmccor2008
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