15. About the intrathecal drug delivery system, which of the following statements is NOT correct?
(A) It places medication directly into the cerebrospinal fluid that surrounds the spinal cord.
(B) Morphine delivered directly to the intrathecal space is particularly effective because it does not have to circulate systemically to reach the CSF and the dorsal horn of the spinal cord.
(C) As a result, much smaller doses are needed (e.g., approximately 1/30 of an oral morphine dose), and the frequency of side effects is reduced.
(D) Advantages of intrathecal therapy in pain includes effective pain relief, reduced side effects for patients, reduced consumption of systemic medication, improved ability to perform ADLs, and enhanced quality of life.

11. Which of the following statements regarding morphine is true? (A) Morphine is absolutely contraindicated in non-cancer pain management. (B) The constipation induced by morphine treatment can be reversed by naloxone. (C) In patients with renal failure, morphine-3-glucuronide may be accumulated and induce stronger analgesic effect. (D) Its metabolite, morphine-3-glucuronide, is a potent analgesic.

12. Indications for lumbar epidural steroid injections include all of the following, EXCEPT? (A) Post-laminectomy (failed back) syndrome without radiculopathy (B) Radicular pain with corresponding sensory change (C) Radiculopathy due to herniated disc with failed conservative treatment (D) Acute herpes zoster in the lumbar dermatomes

13. Which of the following is the acceptable statement about neurodestructive RF lesions? (A) These temperatures are a result of friction heat. (B) The size of RF lesion with 22 gauge RF needle is around with a radius of 5 mm (C) The heat is generated on the tip of RF needle, the RF needle then heat up the tissues. (D) The RF permanent neurodestructive lesion is formed when neural temperatures exceed 42℃ (E) All of the above

14. Which of the following statement concerning hypnotic analgesia is least likely: (A) Hypnosis has been highly associated with theta activity (4~8 Hz) using EEG methods. (B) Hypnotic analgesia can be understood as the result of a placebo manipulation, and it is not more than just relaxation. (C) Increases in hypnotic relaxation are associated with increases in regional cerebral blood flow in the occipital cortex. (D) Deep relaxation, dissociated imagery and focused analgesia produced significant reductions on all pain-related measures. (E) Descending projections from amygdale, PAG and locus coeruleus contribute to modulate nociceptive processes in the brain stem and the spinal cord.

16. Which drug below is less likely an option for inhibiting central sensitization following acute postoperative pain: (A) NMDA antagonist (B) Opioid (C) COX2-inhibitor (D) Pre-emptive analgesia (E) Gabapentin

17. Which postoperative factor may not delay recovery: (A) Pain (B) Nausea and vomiting (C) Ileus (D) Hypothermia (E) Optimal mobilization 

18. A 61-year-old woman presents to the pain clinic with a chief complaint of left shoulder and arm pain 3 years after undergoing radiation therapy for breast cancer. Physical examination reveals lymphedema of the left axilla with noticeable skin changes. Examination of the left supraclavicular area precipitates a sharp pain that radiates down her left arm. Which of the following is her likely diagnosis? (A) Tumor metastasis (B) Cervical radiculopathy (C) Reflex sympathetic dystrophy (D) Thrombangitis obliterans (E) Radiation-induced plexopathy

19. Correct comparisons between osteoarthritis (OA) and rheumatoid arthritis (RA) dose not include: (A) Steroids and the newer drugs that focus on controlling cytokines, such as tumor necrosis factor (TNF), may reduce pain in OA and RA (B) OA mainly involve the joints and RA may present extra-articular features (C) OA appears to be a mechanically driven, and RA presents an immunologically driven disorder (D) Pain management is similar in RA and OA, but the main focus is on controlling the disease process through the use of disease-modifying antirheumatic drugs (DMARDs) (E) Female sex is a common factor in either OA or RA

20. Which medication below is not suggested in fibromyalgia syndrome (FMS): (A) Non-steroidal anti-inflammatory drugs (ibuprofen, naproxen) (B) Pregabalin (C) Tricyclics (amitriptyline, nortriptyline, doxepin, cyclobenzaprine) (D) Opioids (E) All of the above treatments are suggested for pain management of OA

21. A 27-year-old woman with a history of malignant melanoma and multiple subcutaneous metastases has been successfully managed with slowly increasing doses of MS-Contin (Morphine SR), in conjunction with doxepin and ibuprofen. She calls the pain center to complain of a new onset of increasing nausea, vomiting, and headaches, as well as poor pain control. The most appropriate immediate action would be to (A) speak with the patient by telephone and tell her to increase the MS-Contin (B) see the patient as soon as possible to determine if there is a new, treatable source of pain (C) schedule the patient for an evaluation in your office within the week (D) switch to a fentanyl patch since the patient is nauseated and may be unable to take oral analgesics (E) add ondansetron for nausea and vomiting so she is able to continue to take oral analgesics