10 exam-style questions with answers and explanations, straight from our 1,053-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
These 10 free PM questions are organized by exam domain, so you can see how each part of the Pain Medicine blueprint is tested. Reveal the answer and explanation under each question.
A 54-year-old woman has taken extended-release morphine for 3 years for chronic low back pain. Over the past 4 months her pain has become diffuse, now involving her thighs and shoulders, and feels different from her original back pain. Each dose increase has been followed by worsening pain. Examination is unremarkable and imaging is unchanged. Which of the following BEST explains her presentation?
Correct answer: C - Opioid-induced hyperalgesia
A 68-year-old man with a creatinine clearance of 14 mL/min requires opioid therapy for painful bony metastases. Which agent is MOST appropriate?
Correct answer: D - Fentanyl
A 58-year-old woman of Han Chinese ancestry is diagnosed with classical trigeminal neuralgia, and carbamazepine is planned. Which action must be taken before initiating therapy?
Correct answer: D - Test for the HLA-B*1502 allele
A 61-year-old man is scheduled for a right C6-C7 transforaminal epidural steroid injection for cervical radicular pain. Which corticosteroid preparation should be selected, and for what reason?
Correct answer: B - Dexamethasone, because it does not aggregate into particles capable of occluding arterioles
A patient on apixaban is scheduled for a procedure. According to the ASRA guideline on interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications, which procedure is categorized as HIGH bleeding risk?
Correct answer: A - Spinal cord stimulator trial lead placement
A 44-year-old office worker has had nonspecific low back pain for 8 days after moving furniture. He has no red flag features and a normal neurologic examination. He asks for an MRI. Which response reflects current guideline-concordant care?
Correct answer: A - Defer imaging, advise remaining active, and reassess if symptoms persist or red flags emerge
A 39-year-old woman has had chronic abdominal pain for 2 years. Her oral morphine equivalent dose has been escalated from 30 mg to 180 mg daily, and she reports her pain has become steadily worse with each increase. Repeat endoscopy, CT, and laboratory studies are unrevealing. Which management approach is MOST appropriate?
Correct answer: D - Structured opioid taper with multimodal and behavioral support
A 41-year-old man describes strictly unilateral, excruciating retro-orbital pain lasting about 45 minutes, recurring nightly for the past 3 weeks. Attacks are accompanied by ipsilateral tearing and nasal congestion, and he paces the room during them. Which acute treatment is MOST appropriate?
Correct answer: A - High-flow oxygen by non-rebreather mask
A 34-year-old woman is evaluated 5 months after a wrist fracture. She reports burning pain disproportionate to the injury, along with color changes, sweating changes, and stiffness. On examination today you document only allodynia and reduced range of motion. No other diagnosis explains her findings. Using the Budapest clinical criteria, what is the correct conclusion?
Correct answer: D - Criteria are met, because she reports symptoms in three categories and demonstrates signs in two
A 5-year-old is discharged following tonsillectomy for obstructive sleep apnea. Which analgesic order should be questioned?
Correct answer: C - Codeine
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