MULTIPLE CHOICE QUESTIONS
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Dr Debjyoti Dutta MD. FIPP. Kolkata India
1. The femoral nerve originates from which of the following roots?
A. T12, L1, L2
B. L1, L2, L3
C. L2, L3, L4
D. L3, L4, L5
2. If symptoms persist after appropriate conservative management of acute cervical disc herniation, the next step is to perform a:
A. cervical laminectomy and fusion
B. cervical epidural injection
C. chemonucleolysis
D. cervical facet injection
3. A 45-year-old patient with a history of chronic low back, left hip and left thigh pain who’s status is post multiple lumbar laminectomy received a differential epidural block of 3% 2-chloroprocaine. Some pain resumed with return of full sensation and motor function in the lower extremities; all pain returned with return of sympathetic function. The pain was transmitted via which fibers?
A. A alpha
B. A delta
C. C
D. A delta and C
4. Examination of a patient with neck and shoulder pain reveals referred pain in the lateral aspect of the forearm, with weakness and dysfunction of the biceps and brachioradialis, and hypoesthesia in the lateral aspect of the forearm and thumb. The patient most likely has a lesion of which nerve root?
A. C4
B. C5
C. C6
D. C7
5. The most appropriate diagnostic nerve block for pain in upper abdominal viscera is a/an:
A. intercostal block
B. lumbar sympathetic block
C. celiac plexus block
D. hypogastric plexus block
6. Sympathetic innervation to the upper extremity is carried by which fibers of the brachial plexus?
A. T1-T2 preganglionic fibers
B. T3-T5 preganglionic fibers
C. T1-T2 postganglionic fibers
D. T3-T5 postganglionic fibers
7. Intense whiteness of fingers with subsequent blue coloration with coldness and red
coloration on rewarming is most likely due to:
A. frostbite
B. Raynaud’s disease
C. reflex sympathetic dystrophy
D. acute venous thrombosis
8. Indications for lumbar epidural steroid injections include all of the following EXCEPT:
A. radicular pain with corresponding sensory change
B. radiculopathy due to herniated disc with failed conservative treatment
C. acute herpes zoster in the lumbar dermatomes
D. postlaminectomy (failed back) syndrome without radiculopathy
9. Which of the following nerve blocks is LEAST helpful in diagnosing sympathetically mediated pelvic pain?
A. Differential spinal
B. Pudendal nerve
C. Superior hypogastric plexus
D. Differential epidural
10. Which of the following statements regarding the anatomy of the superior hypogastric plexus is NOT true?
A. It lies anterior to L5 vertebra.
B. It lies just inferior to the aortic bifurcation.
C. It lies right of midline.
D. It branches left and right and descends to form the inferior hypogastric plexus.
11. All of the following are indications for a stellate ganglion block EXCEPT?
A. reflex sympathetic dystrophy
B. acute herpes zoster (ophthalmic division)
C. hyperhidrosis
D. pancreatitis
12. Which of the following regional anesthesia techniques is NOT commonly used with
children due to its side effects?
A. Epidural block
B. Subarachnoid block
C. Caudal block
D. Brachial plexus block
13. A brachial plexus block is indicated for all of the following conditions EXCEPT
A. sympathetic independent pain due to reflex sympathetic dystrophy
B. brachial plexalgia
C. angina
D. Raynaud's disease
14. A celiac plexus block is effective in reducing pain originating from all of the following organs EXCEPT the:
A. pancreas
B. transverse portion of the large colon
C. gall bladder
D. descending portion of the pelvic colon
15. A patient is positioned prone on the fluoroscopic table, the T1-T4 spinous processes are identified on the ipsilateral side, and a skin weal is raised 4-5 cm lateral to the spinous process. A spinal needle is directed to the lamina and "walked" laterally until there is loss of resistance. These procedures are consistent with which type of block?
A. Stellate ganglion
B. Thoracic sympathetic
C. Interpleural
D. Thoracic epidural
16. The brachial plexus is formed by which rami?
A. C5-T1 anterior primary
B. C3-T2 anterior primary
C. C5-T1 anterior and posterior
D. C3-T2 anterior and posterior
17. Cell bodies of preganglionic fibers of the lumbar sympathetic chain arise at which of the following sites?
A. T5-T9
B. T11-L2
C. L3-L5
D. S1-S4
18. A lateral femoral cutaneous block is indicated for which of the following conditions?
A. Meralgia paresthetica
B. Femoral neuralgia
C. Saphenous neuralgia
D. Groin pain
19. Which of the following statements is true regarding neurolytic concentrations of less than 2% phenol?
A. They have no effect.
B. They selectively destroy A-delta and C fibers.
C. They have a reversible local anesthetic action when applied to nerve bundles.
D. They destroy nerves but have no effect on blood vessels.
20. Mydriasis, tachypnea, tachycardia, delirium and a modest decrease in pain can be produced by agonists of which receptor type?
A. Mu
B. Kappa
C. Delta
D. Sigma
21. A diminished triceps jerk indicates a lesion of which nerve root?
A. C4
B. C5
C. C6
D. C7
22. To achieve sympathetic denervation of the head and neck, the best site of blocking is the:
A. middle cervical ganglion
B. superior cervical ganglion
C. stellate ganglion
D. sphenopalatine ganglion
23. The lesser splanchnic nerve is formed by which of the following sympathetic nerves?
A. T5-T7
B. T8-T9
C. T10-T11
D. T12
24. Continuous radiofrequency (CRF) procedures for pain:
A. Use alternating current with a frequency of 500 Hz.
B. Produce an effect by coagulating target nerves.
C. Produce heat energy in tissue distal to the active tip of the electrode.
D. Produce differential lesioning of target nerves.
25. Pulsed radiofrequency (PRF) procedures for pain:
A. Use a 50 kHz alternating current delivered in 20 ms pulses at a frequency of 2 Hz for 120 s.
B. Cause significant heating of target tissue.
C. Lead to heat dissipation by convection, conduction and radiation.
D. Have a mechanism of effect that is not clear.
26. In chronic pain management:
- Percutaneous radiofrequency trigeminal rhizotomy is a first line treatment for trigeminal neuralgia.
- Potential side-effects of trigeminal rhizotomy include diplopia.
- Selection criteria for radiofrequency neurotomy in somatic spinal pain include placebo-controlled diagnostic blocks.
- Radiofrequency neurotomy of the dorsal ramus of C3 is used in management of cervicogenic headache.
27. A fifty year old senior administrator who presents with Right sided earache of one month’s duration. The pain radiates into the temple area and down the side of her face. The pain is worst when she wakes in the morning and after eating.On examination the ear is clear, there is lateral deviation of the jaw on opening and all other observations are normal.The MOST likely diagnosis is:
A. Temporal arteritis
B. Trigeminal neuralgia
C. Temporo mandibular joint dysfunction
D. Eustachian Tube Dysfunction
28. "Allodynia" is:
A. Pain caused by stimuli that are usually not painful
B. The 'burning' sensation of causalgia
C. Red flare with nerve damage
D. Due to reflex sympathetic dystrophy
29. The pain of chronic herpetic neuralgia is usually controlled by
A. ipsilateral stellate ganglionectomy
B. intrathecal alcohol injection
C. Anti-convulsants
D. dorsal rhizotomy
30. Neurolytic lumbar sympathetic block: Confirm needle placement by:
A. Injection local anaesthetic to check effect just prior to alcohol injection
B. Nerve stimulator
C. Injection gives sensation of warmth in affected area
D. Use an image intensifier
31. Coeliac plexus block
A . Is used to treat visceral pain of malignant origin.
B. Requires 22g Radiofrquency needle.
C. Causes hypertension.
D. Cannot be used in pain of non malignant cause.
32. A coeliac plexus block with alcohol may cause:
A. Abdominal pain
B. Diarrhoea
C. Pleuritic chest pain
D. Groin pain
33. A 60-year-old diabetic has had a below knee amputation for an ischaemic leg. He has neuropathic pain being managed with oxycodone 40 mg bd and paracetamol 1 g
qid. He is also on omeprazole 20 mg daily for reflux. You decide to commence gabapentin. Before deciding on a dosage regimen and commencing therapy it is most important that you
A. cease his omeprazole
B. check his hepatic transaminase level
C. check his renal function
D. check his QT interval on a resting EGG
34. Complex Regional Pain Syndrome
A. Characterized by disabling pain, swelling, vasomotor instability, sudomotor abnormality, and impairment of motor function
B. Type II CRPS was formally known as reflex sympathetic dystrophy
C. To be managed with sympathetic blocks only.
D. Physiotherapy has no role.
35. A strategy shown to reduce the incidence of severe phantom limb pain is the use of
A. continuous regional blockade using nerve sheath catheters
B. patient controlled analgesia with opioids post-op
C. perioperative ketamine
D. perioperative NSAIDs
36. Regarding Epidural Abcess - which is WRONG
A. Diagnosis is DEPENDENT on triad of back pain, fever, and paralysis
B. Occurs at a rate of 1:1000-3000 (OR 1:2000 - 1:5000)
C. Worse outcomes if advanced age
D. Usually gram positive cocci
37. Sympathetic blocks are used in the following conditions:except
A. Reynaud’s syndrome.
B. Herpes zoster.
C. Chronic pancreatitis.
D. Migraine.
38. Clinical features of fibromyalgia include all except
A. Localized pain.
B. Fatigue.
C. Sleep disturbance.
D. Diarrhoea.
39. Regarding management of fibromyalgia:
A. Educating the patient regarding the condition plays an important role.
B. Tri-cyclic agents are not beneficial in treating pain.
C. There is evidence that strong opioids are beneficial.
D. There is evidence that steroids are beneficial.
40. Indications for spinal cord stimulation include: all except
A. Complex regional pain syndrome.
B. Failed back surgery syndrome.
C. Post-amputation pain.
D. Postoperative pain.
41. Which of the following statements regarding management of neck pain in WAD injuries is
TRUE?
A. Evidence supports benefit of using cervical collar.
B. Early RF neurotomy of cervical facet neurotomy gives better outcome.
C. There is enough evidence to support passive mobilization of C/S as a single treatment
D. Interventions of benefit include home exercise, analgesics , combined with specific exercises.
42. A 42-year-old Caucasian male presented with a 10-week history of left leg and back pain.
He described his pain as sharp and shooting down to posterior left thigh and calf, and
posterior ankle. Straight leg raise test is positive on left side, and trigger points are present
over L QL muscle. Weight-bearing lumbar radiographs demonstrate mild loss of disc
height at L5-S1, and MR images demonstrate a large left paracentral disc herniation at L5-
S1 with moderate degenerative changes at L4-L5. Sharp and shooting pain in posterior left
thigh/calf and posterior ankle is:
A. Due to degenerative changes of L L4-L5 facet joint
B. Referred pain due to irritation of Right S1 nerve root
C. Due to irritation of the Left S1 nerve root caused by L5-S1disc herniation
D. Radicular pain originating from L QL trigger points
43. Which of the following statements about electrical potentials detected in trigger points is
FALSE?
A. They are not restricted to trigger points
B. They represent miniature endplate potentials
C. They represent activity in intramuscular nerves or from sympathetic nerves in the muscle
D. They are evidence of pathology by trigger points
44. Which of the following statements about low back pain is incorrect?
A. Nearly 80% of acute low back pain cases are self-limiting.
B. Yellow flags predict poor recovery and a high risk of progression from acute to chronic LBP.
C. Straight leg raising test has a high sensitivity for sciatica.
D. Routine MRI is advised for patients who can afford it.
45. A 63-year-old woman presents with low back pain and cramping in both posterior thighs and numbness radiating into the feet with ambulation. It worsens with standing and walking and improves with sitting and bending forward. She has no bowel or bladder complaints. On examination, she has full strength, normal sensation, reflexes are symmetric and she has 2+ peripheral pulses. Straight leg raise is negative. What is this patient’s most likely diagnosis?
A. Cauda equina syndrome
B. Internal disc disruption
C. Spinal stenosis
D. Vascular claudication
46. A 33-year-old man presents with a sudden onset of back and left leg pain and weakness after performing heavy squats at the gym. Radiographs are normal, but a MRI reveals a posterolateral left L5-S1herniated disc. What would a careful neurologic examination likely reveal?
A. Foot plantar flexion weakness with absent Achilles reflex
B. Foot plantar flexion weakness with absent patella reflex
C. Great toe extension weakness with absent Achilles reflex
D. Great toe extension weakness with absent patella reflex
47. Botox is indicated in
A. Episodic migraine
B. Chronic migraine
C. Hemiplegic migraine
D. Basilar type migraine
48. The secetomotor fibre to the parotid gland passes through
A. Otic ganglion
B. Sphenopalatine ganglion
C. Geniculate ganglion
D. Lesser ganglion
49. The vertebral artery traverses all of the following except?
A. Foramen magnum
B. Subarachnoid space
C. Intervertebral foramen
D. Foramen transversarium
50. Red flag markers for serious spinal pathology include:
- History of previous spinal trauma.
- Pain persisting for >1 yr.
- History of steroid use.
- History of depression.
51. DRG is widest at
A. L1
B. L3
C. S1
D. S3
52. Most commonly missed nerve with interscalene approach to brachial plexus:
A. Ulnar
B. Median
C. Musculocutaneous
D. Radial
53. Artery of Adamkiewicz arises at following spinal level
A. T1-t6
B. T5-t8
C. T9-l-2
D. T11-l3
54. Approach to celiac plexus are all except
A. Intercrural
B. Lateral
C. Transcrural
D. Retrocrural
55. Potential complications of stellate ganglion block all except
A. Pneumothorax
B. Lesion of recurrent laryngeal nerve
C. Neuritis
D. Horners syndrome
56. Gasserian ganglion
A. Mandibular br is located medial to ophthalmic
B. Lies outside cranium in meckel cave
C. Foramen rotundum is used for blockade