22. Which of the following practice in the management of cancer pain and associated events for the dying patients in the last hours and days of life is not advisable?
(A) Non-essential drugs should be discontinued
(B)If the insight of the patient, family, and carers into the patient’s condition is identified, high dose of opioids should be discontinued to avoid respiratory depression
(C)”As-required” subcutaneous medication is prescribed according to an agreed protocol to manage pain
(D) Decisions are made to discontinue inappropriate interventions.
(E) all of the above are acceptable practices.

18. Which of the following site of lesion with its referral site of pain is not common? (A) Diaphragmatic irritation with Shoulder (B) Urothelial tract with Inguinal region and genitalia (C) L1–2 with Sacroiliac joint and hip (D) Pharynx with Ipsilateral ear (E) all of the above are common patterns of pain referral

19. Which of the following patterns of pain is not attributed to a typical breakthrough pain syndrome? (A) pain is exacerbated by volitional actions of the patient (B) pain is exacerbated by non-volitional events (C) exacerbations of pain associated with failure of anlagesia (D) Neuropathic non–movement-related pain (E) Visceral pain—volitional or non-volitional

20. Which of the followings is not suggested for the use of opioids for cancre pain in children? (A) Treat opioid side effects promptly. (B) Use the transdermal route first in most circumstances. (C) If side effects are bothersome with one opioid, consider switching to another one. (D) Treat constipation pre-emptively. (E) all of the above should be suggested for prescription of opioids in cancre pain in children

21. Which of the following adjuvant analgesic is not suggested for its following indication in the management of cancer pain? (A) Non steroidal anti-inflammatory/analgesic drugs (NSAIDs) for Musculoskeletal pain (B) Antidepressants for Neuropathic pain (C) benzodiazepines for Muscular spasm (D) Phenothiazines or Butyrophenones for Hallucinations (E) all of the above adjuvant analgesic are suggested for its following indication in the management of cancer pain.

23. Which of the following is not true about the properties of visceral pain? (A) It is diffuse in character and poorly localized. (B) It is typically referred rather than being felt at the source. (C) It is produced by stimuli different from those adequate for activation of somatic nociceptors. (D) Distention of hollow organs may induce adequate stimuli for production of visceral pain. (E) It is associated with emotional and autonomic responses but much less than those associated with somatic pain.

24. Which of the following is not true about chronic pelvic pain without pathology (CPP)? (A) CPP is defined as non-menstrual pelvic pain of 6 or more months’ duration that is severe enough to cause functional disability or to require medical or surgical treatment. (B) CPP is common and estimated to account for 40% of all gynecologic diagnostic laparoscopies. (C) A history of childhood physical and/or sexual abuse has been correlated with the development of CPP. (D) The best evidence-based management of patients with CPP is multidisciplinary care.. (E) All of the answers above are correct.

25. Which of the followings is probabaly a less predictive addition indicator? (A) Selling prescription drugs (B) Multiple episodes of loss of prescriptions (C) Repeated resistance to changes in therapy despite clear evidence of adverse physical or psychological effects from the drug (D) Resistance to a change in therapy associated with “tolerable” adverse effects with expressions of anxiety related to the return of severe symptoms (E) Concurrent abuse of alcohol or illicit drugs

26. Which of the following oral opioids is not recommended for padiatric patients with cancer pain? (A) morphine (B) hydromorphone (C) oxycodone (D) meperidine (pethidine) (E) all of the above can be prescribed for pediatric patients with cancre pain

27. Which of the following cell type sense the initial “endanger signal” and participates in the initial phase of pathogenesis of the nerve injury induced neuropathic pain? (A) Microglia (B) Spinal lamina I and II neuron (C) Astrocyte (D) oligodendrocyte

28. Pain is a frequent consequence of spinal cord injury (SCI). Which of the following statement is least likely: (A) Below-level neuropathic pain is most likely described as severe or excruciating months or years following initial injury. (B) Damage to the spinothalamic tracts is an important ingredient in the development of neuropathic pain following SCI. (C) Chronic musculoskeletal pain is common in tetraplegic patients after SCI. (D) Patients with cervical SCI are at risk of developing CRPS affecting upper limbs. (E) Below-level neuropathic pain is also referred to deafferentation pain.