PAIN MANAGEMENT 2013

24years old, accident with diagnosis fracture femur sinistra. doctor has been done open fracture
operation. one hour after operation feel pain

1. what is the type of pain in this case?

a. physiologic pain
b.nociceptive pain
c. mix nociceptive pain n neuropathic pain
d. chronic pain
e. neuropathic pain

2. Which one is not involve in the pain perception?
A. trasnduction
B. conduction
C. modulation
D. transmission
E. ectopic activation

3. Stimulus change to electrical signal at
A. Transmission
B. Modulation
C. Transduction
D. Perception
E. Ectopoc activation

4. Man with prostate cancer.. come with complaint abdominal pain. Treat with step ladder.Step
ladder, except
A. Specific drug
B. Specific type of pain
C. Based on quality pain
D. Combine with adjuvant

6. step 1 ladder, except
A. mild pain : VAS, nrs 3
B. non-opiod : codeine, tramadol
C. adjuvant : analgesic effect in certain pain condition
D. due to side effect

7)5 phases of 3 step ladder WHO, xcept: A.by the mouth
B.by the clock
C.by the ladder
D.individualized for the patient
E.adjuvant

8. Extensive use of opioid is associated with a variety of perioperative side effect, except
A. drowsiness and sedation
B. pruritus
C. diarhea
D. can delay hospital discharge
E. PONV

9. When weak opioid combine with non-opioid drug fortreatment:
A. preventive analgesia
B. premordial analgesia
C. preemptive analgesia
D. multimodal (balanced analgesia)
E. adjuvant analgesia

10. nociceptor process except:
a) transmission
b) transduction
c) perception
d) modulation
e) transition


12.Pharmacokinetic of NSAIDs
A.Strong acid and lipid soluble (90%)
B.Cross the blood brain barrier
C.Hepatic metabolism
D.Rapid absorption
E.Renal and hepatic excretion

13. side effect of NSAID towards renal?
a) fluid inbalance and electrolyte imbalance until it cause renal insufficiency
b) hypokalemia
c) increase sodium and water absorption
d) interstitial nephritis and nephritic syndrome

14.Pharmacokinetics of NSAIDs except:
A. Strong acid and lipid soluble(90%)
B. Cross the blood brain barrier
C. Hepatic Metabolism
D. Rapid absorbtion
E. Renal and Hepatic excretion

15. The side effect of ketamine, except:
A. Hypotensio
B. Nausea & vomitting
C. Dizziness & confusion
D. Diplopia
E. Cardiac arrythmia

17.related about transdermal patches

A. peak effect after application 24 hours
B. HIGH AFFINITY FOR OPIATE RECEPTOR
c.withdrawal symptoms
D.
e. strong kappa antagonist

19. Effect opioid of nausea and vomitting:
A. Initial side effect and usually resolve over a few days
B. take oral morphine
C. Metoclopramide 10mg
D. Haloperidol 1,5 mg
E. dietary fiber intake

18.common side effect of opiod
a.delirium
b.myoclonus
c.pruritus
d.sedation
e.headache

21. related about COX-2
A. Rofecoxib
B. Parecoxib
C. Celecoxib
D. Meloxicam
E. Piracetam

23. Why access pain, except?
E. to know side effect

26.)opioid that can cause less addiction effect
A)morphine
B)fentanyl
C)tramadol
D)codeine
E)pethidine

31. Related about morhine except
A. Metabolize accumulate in renal
B. Severe sedation
C. Respiratory depression
D. Morphine by intravena is a strong opioid of the choice in cancer

33. according to the side effect of opioid, delirium:
a. hypercalcemia
b. opioid induced toxicity
c. haloperidol 0,5-2 mg
d. confusio, bad dreams
e. all above true

34. the classes of propionic acid
I. ibuprofen
II. diclofenac
III. ketoprofen
IV. indomethacine

35. yg termasuk fenamic acid
1 fenyl butazole
2 mefenamic acid
3 peroxicam
4 mechlofenamate

36. Pain is complex, it involve
- stimulus
- behavioral
- perception
-
ans: E (all true)

37. Endogenous opioids:
1. dynorphine
2. GABA
3. enkphaline
4. norepinephrine

38. if pain has occurred treating central sensitization NMDA antagonist except:
1. ketamine low dose
2. DMP
3. MK 801
4. 5HT agonist

40. Related about opiod
1.analgesia
2.dysphoria
3.reduced GI motility
4.myosis

41. A delta mechanothermal nociceptor:
1. respond to mechanical and thermal stimuli
2. first pain and well localized
3. rapid conduction
4. diffuse

42. Characteristic of C-fibers polimodal..
1. second pain
3. mechanical, touch, thermal receptor

44.two types of receptors at the DHN
1.WIDE GREY
2. NMDA
3.HIGH COGNITIVE NEURON
AMPA

43. Large myelinated fibre:
1. AB fibre
2. Fast conduction fibre
3. Touch & pressure
4. Ad & C-fibre

45. 2 types of 2nd order nociceptive neurons in dhn:
1.1. nociceptive-spesific neurons
2. NMDA
3. WDR neuron
4. AMPA

47. Pain has multidimensional experience
1. Sensory descriptive
2. Identifying intensity
3. Assess injury and meaning of injury
4. Mood and behavorial

49. 5 characteristics about visceral pain
1. is not linked to visceral injury
2. Refers to other location
3. lupa
4. Evoked from all visceral

answers from jurnal:
(i) is not evoked from all viscera,
(ii) is not linked to visceral injury,
(iii) is referred to other locations,
(iv) is diffuse and poorly localised, and
(v) is accompanied by motor and autonomic reflexes.

Delta mechanothermal receptor?
1 Mechanical n thermal pain
2 First n localised
3 Rapid conduction
4 Diffuse

Central sensitivation Nmda agonist except?
1 Ketamin
2 Dmp Antagonist
3 Ht5
4 Mk 801

Pain complex interaction?
1 Perception
2 Cognitif
3 Behavior
4 Stimulus

Tract accending pathway
a. spinothalamic pathway
b. spinoreticular pathway
c.
d.
e. spinal cord