Opioid-Sparing Analgesia — MCQs

10 questions

What is the name of the nerve block technique shown in the image?

Match the following: A) Glossopharyngeal nerve B) Spinal accessory nerve C) Facial nerve D) Mandibular nerve 1) Shrugging of shoulder 2) Touch sensation from the posterior one-third of the tongue 3) Chewing 4) Taste from the anterior two-thirds of the tongue

Which of the following anaesthetic agent lacks analgesic effect? A) N2O B) Thiopentone C) Methohexitone D) Ketamine E) Fentanyl

Which of the following anesthetic agents have good analgesic property? a) Ketamine b) Nitrous oxide c) Thiopentone d) Propofol e) Midazolam

Which of the following is an example of placebo?

Which drug is commonly used for outpatient department (OPD) analgesia?

A 35-year-old woman presents with a history of recurrent migraines, unresponsive to prophylactic medications. What is the most appropriate next step in management?

Which Benzodiazepine decreases post-operative nausea & vomiting:-

Which opioid drug is effectively administered via the transbuccal route?

Q10

The image given below shows neuromuscular monitoring of the patient after anesthesia. What is the most commonly used nerve for monitoring?

Opioid-Sparing Analgesia Indian Medical PG Practice Questions and MCQs

Question 1: What is the name of the nerve block technique shown in the image?

A. Intra-arterial anesthesia (Correct Answer)
B. Bier's block
C. Regional anesthesia
D. Axillary block

Explanation: ***Intra-arterial anesthesia*** - The image shows a **cannula inserted directly into an artery**, indicated by the blood reflux and the context of anesthesia, suggesting direct drug delivery into the arterial system. - This method is used for specific types of regional pain management or diagnostic procedures where direct arterial access is required for **localized drug distribution**. *Bier's block* - A Bier's block, or **intravenous regional anesthesia**, involves injecting local anesthetic into a **vein** in an extremity after it has been exsanguinated and isolated by a tourniquet. - The image clearly shows a **bright red blood flash**, characteristic of arterial cannulation, not venous. *Regional anesthesia* - This is a broad term referring to the **anesthesia of a specific region** of the body and encompasses various techniques. - While intra-arterial anesthesia is a type of regional anesthesia, "regional anesthesia" itself is too general to specifically describe the technique shown. *Axillary block* - An **axillary block** is a type of peripheral nerve block targeting the brachial plexus in the axilla to anesthetize the arm. - The image does not depict the axillary region or the characteristic needle placement for an axillary block; instead, it shows direct vascular access.

Question 2: Match the following: A) Glossopharyngeal nerve B) Spinal accessory nerve C) Facial nerve D) Mandibular nerve 1) Shrugging of shoulder 2) Touch sensation from the posterior one-third of the tongue 3) Chewing 4) Taste from the anterior two-thirds of the tongue

A. A-3 , B-1 , C-4 , D-2
B. A-2 , B-3 , C-4 , D-1
C. A-4 , B-1 , C-2 , D-3
D. A-2 , B-1 , C-4 , D-3 (Correct Answer)

Explanation: ***A-2 , B-1 , C-4 , D-3*** - **A) Glossopharyngeal nerve (CN IX)** is responsible for **general sensation and taste from the posterior one-third of the tongue** [1]. (2). - **B) Spinal Accessory nerve (CN XI)** innervates the **sternocleidomastoid** and **trapezius muscles**, which are involved in shrugging the shoulders (1). - **C) Facial nerve (CN VII)** carries **taste sensation from the anterior two-thirds of the tongue** [1] (4) via the chorda tympani. - **D) Mandibular nerve (V3)**, a branch of the trigeminal nerve, innervates the muscles of mastication, enabling **chewing** (3). *A-3 , B-1 , C-4 , D-2* - This option incorrectly associates the **glossopharyngeal nerve** with chewing, which is a function of the mandibular nerve (V3). - It also incorrectly associates the **mandibular nerve** with touch sensation from the posterior one-third of the tongue, which is a function of the glossopharyngeal nerve [1]. *A-2 , B-3 , C-4 , D-1* - This option incorrectly links the **spinal accessory nerve** with chewing; this nerve primarily controls shoulder and neck movements. - It also incorrectly assigns shrugging of the shoulder to the **mandibular nerve** instead of the spinal accessory nerve. *A-4 , B-1 , C-2 , D-3* - This choice incorrectly attributes **taste from the anterior two-thirds of the tongue** to the glossopharyngeal nerve, which supplies the posterior one-third [1]. - It also incorrectly links **touch sensation from the posterior one-third of the tongue** to the facial nerve, which is involved in taste from the anterior two-thirds [1].

Question 3: Which of the following anaesthetic agent lacks analgesic effect? A) N2O B) Thiopentone C) Methohexitone D) Ketamine E) Fentanyl

A. N2O
B. Methohexitone
C. Ketamine
D. Fentanyl
E. Thiopentone (Correct Answer)

Explanation: ***Thiopentone*** - Thiopentone is a **barbiturate** anesthetic primarily used for inducing anesthesia. - It provides significant **hypnosis** and sedation but lacks intrinsic **analgesic properties**, meaning it does not relieve pain. *N2O* - **Nitrous oxide** (N2O) is an inhalation anesthetic that provides good **analgesia** at sub-anesthetic concentrations. - It is often used as an adjunct to other anesthetic agents to enhance pain relief during procedures. *Methohexitone* - Methohexitone is another **barbiturate** similar to thiopentone, used for induction of anesthesia. - While it provides rapid **hypnosis**, it also lacks significant **analgesic effects**. *Ketamine* - Ketamine is a **dissociative anesthetic** known for its potent **analgesic properties**. - It works by blocking **NMDA receptors**, providing pain relief even at sub-anesthetic doses. *Fentanyl* - Fentanyl is a powerful **opioid analgesic** that is commonly used in anesthesia for its strong pain-relieving effects. - It acts on **opioid receptors** in the central nervous system to reduce pain perception.

Question 4: Which of the following anesthetic agents have good analgesic property? a) Ketamine b) Nitrous oxide c) Thiopentone d) Propofol e) Midazolam

A. Ketamine and Nitrous oxide (Correct Answer)
B. Ketamine only
C. Nitrous oxide and Thiopentone
D. Ketamine and Propofol
E. Midazolam only

Explanation: ***Ketamine and Nitrous oxide*** - **Ketamine** is a dissociative anesthetic with potent **analgesic properties** secondary to its action as an **NMDA receptor antagonist**. - **Nitrous oxide** is an inhalational anesthetic known for its mild to moderate **analgesic effects**, making it useful for sedation and pain relief. *Ketamine only* - While **ketamine** has excellent analgesic properties, this option is incomplete as **nitrous oxide** also contributes significant analgesia among the choices. - Excluding other agents with analgesic properties makes this option less comprehensive than the correct answer. *Ketamine and Propofol* - **Ketamine** possesses strong analgesic effects, but **propofol** is a sedative-hypnotic agent with no significant intrinsic **analgesic properties**. - Propofol provides anesthesia and sedation but typically requires co-administration with opioids for pain control. *Nitrous oxide and Thiopentone* - **Nitrous oxide** provides analgesia, but **thiopentone** (a barbiturate) is primarily an anesthetic and sedative with **no significant analgesic properties**. - Thiopentone can induce unconsciousness rapidly but does not relieve pain. *Midazolam only* - **Midazolam** is a benzodiazepine primarily used for sedation, anxiolysis, and amnesia, with **no intrinsic analgesic properties**. - Its effects can reduce stress and perception of pain, but it does not directly act as an analgesic.

Question 5: Which of the following is an example of placebo?

A. Cognitive behavioral therapy
B. Sugar pill given as medication
C. Physiotherapy
D. Sham surgery (Correct Answer)

Explanation: ***Sham surgery*** - Sham surgery involves a **mock surgical procedure** performed on a patient without the actual therapeutic intervention, often used as a control in clinical trials. - Its purpose is to account for the **placebo effect** of the surgical experience itself, including anesthesia and incisions, independent of the direct physiological effects of the surgery. *Cognitive behavioral therapy* - **Cognitive behavioral therapy (CBT)** is a structured psychotherapy that helps individuals identify and change negative thought patterns and behaviors [1]. - It is a **specific, active treatment** with established mechanisms of action, not merely an inert substance or procedure [1]. *Sugar pill given as medication* - While a **sugar pill** is a classic example of a placebo, the question asks for *an* example of a placebo, and sham surgery is also a valid and often more complex form. - A sugar pill's effect primarily stems from the **expectation of relief** from a medication. *Physiotherapy* - **Physiotherapy** involves physical methods (e.g., exercise, massage, heat therapy) to treat disease, injury, or deformity. - It is an **active therapeutic intervention** with direct physiological and biomechanical effects, not an inert or non-specific treatment.

Question 6: Which drug is commonly used for outpatient department (OPD) analgesia?

A. Diclofenac
B. Ibuprofen
C. Paracetamol (Correct Answer)
D. Tramadol

Explanation: ***Paracetamol*** - It is a widely used and generally **safe analgesic** and antipyretic often prescribed for mild to moderate pain in an outpatient setting. - Its favorable side effect profile and availability as an **over-the-counter (OTC)** medication make it a first-choice drug for many common pain conditions. *Diclofenac* - While it is an effective NSAID used for pain and inflammation, its use can be associated with **gastrointestinal side effects** like ulcers and bleeding, as well as cardiovascular risks. - It is often reserved for more significant inflammatory pain or when other analgesics are insufficient, and may require more careful monitoring in an outpatient setting. *Ibuprofen* - Similar to diclofenac, Ibuprofen is an **NSAID** which is effective for pain and inflammation. However, it also carries risks of **gastrointestinal irritation** and renal side effects, especially with prolonged use or in certain patient populations. - While available OTC, its use for routine outpatient analgesia may be less preferred than paracetamol in some cases due to its GI and renal side effect profile. *Tramadol* - Tramadol is a **central acting opioid analgesic** with a higher potential for side effects such as nausea, dizziness, constipation, and the risk of dependence or abuse. - It is typically reserved for moderate to severe pain that is not adequately managed by non-opioid analgesics, and its prescription often involves more stringent monitoring than paracetamol.

Question 7: A 35-year-old woman presents with a history of recurrent migraines, unresponsive to prophylactic medications. What is the most appropriate next step in management?

A. Combination prophylactic therapy
B. Trial of alternative prophylactic medication from different class
C. Referral to headache specialist
D. Evaluation for medication overuse headaches (Correct Answer)

Explanation: ***Evaluation for medication overuse headaches*** - **Medication overuse headache (MOH)** is a common cause of chronic daily headache and can lead to unresponsiveness to prophylactic treatments in patients with pre-existing primary headache disorders. - Identifying and addressing MOH involves gradually withdrawing the overused acute medication, which can lead to significant improvement in headache frequency and severity. *Trial of alternative prophylactic medication from different class* - While switching prophylactic medications is a standard approach when a drug is ineffective, it's crucial to rule out MOH first, as continued use of acute medications can worsen the underlying migraine condition and perpetuate refractoriness [1]. - Introducing new prophylactic treatments without addressing MOH may not be effective and can delay appropriate management [1]. *Combination prophylactic therapy* - Combination therapy can be considered for refractory migraines, but it's generally reserved for cases where single-agent prophylactic regimens have failed and MOH has been excluded. - Adding more medications before assessing for MOH might further complicate treatment and obscure the root cause of treatment unresponsiveness. *Referral to headache specialist* - Referral to a headache specialist is often appropriate for refractory migraines, but the specialist will likely also prioritize ruling out secondary causes like MOH. - A structured evaluation for MOH can often be initiated by the primary care provider before or in conjunction with a specialist referral.

Question 8: Which Benzodiazepine decreases post-operative nausea & vomiting:-

A. Midazolam (Correct Answer)
B. Diazepam
C. Lorazepam
D. All of the options

Explanation: ***Midazolam*** - **Midazolam** is a commonly used benzodiazepine in anesthesia that has been shown to have **antiemetic properties** and can decrease the incidence of **postoperative nausea and vomiting (PONV)**. - Its mechanism may involve its sedative and anxiolytic effects, indirectly reducing the triggers for nausea. *Diazepam* - While **diazepam** is a benzodiazepine with sedative and anxiolytic effects, it is not primarily known for reducing PONV. - Its longer duration of action compared to midazolam can also contribute to unwanted **postoperative sedation**. *Lorazepam* - **Lorazepam** is another benzodiazepine used for anxiolysis and sedation but is not a primary agent for the prevention of PONV. - Like diazepam, its prolonged effects can lead to **delayed recovery** and drowsiness, which may not be desirable in the postoperative period. *All of the options* - While all listed drugs are benzodiazepines, only **midazolam** is consistently recognized and utilized for its ability to reduce PONV in the perioperative setting. - The other benzodiazepines do not demonstrate the same consistent benefit in PONV reduction and may have other side effects that limit their utility for this specific purpose.

Question 9: Which opioid drug is effectively administered via the transbuccal route?

A. Sulfentanil
B. Remifentanil
C. Fentanyl (Correct Answer)
D. Alfentanil

Explanation: ***Fentanyl*** - **Fentanyl** is a potent, **lipophilic opioid** that is well-absorbed through mucous membranes, making it suitable for **transbuccal administration**. - Its high potency and rapid onset of action when administered transbuccally make it useful for breakthrough pain or rapid analgesia. *Sulfentanil* - While also a potent opioid, **sulfentanil** is primarily used intravenously for anesthesia and is not commonly formulated or administered via the transbuccal route. - Its chemical properties and pharmacokinetic profile do not lend themselves as readily to transbuccal absorption compared to fentanyl for practical clinical use. *Remifentanil* - **Remifentanil** is an **ultra-short-acting opioid** metabolized by plasma esterases, making it ideal for continuous intravenous infusions where rapid offset is desired. - Its rapid metabolism and specific pharmacokinetic properties make it unsuitable for transbuccal extended release or sustained absorption. *Alfentanil* - **Alfentanil** is a short-acting opioid predominantly used intravenously for induction and maintenance of anesthesia. - Although it has a rapid onset, it is not optimized or commonly utilized for transbuccal administration due to its lower lipophilicity and different absorption characteristics compared to fentanyl.

Question 10: The image given below shows neuromuscular monitoring of the patient after anesthesia. What is the most commonly used nerve for monitoring?

A. Ulnar nerve (Correct Answer)
B. Median nerve
C. Radial nerve
D. Metacarpal nerve

Explanation: ***Ulnar nerve*** - The **ulnar nerve** is the most commonly chosen site for neuromuscular monitoring due to its ease of accessibility and predictable response of the **adductor pollicis muscle**. - Stimulation of the ulnar nerve at the wrist causes **adduction of the thumb**, which is easily quantifiable and provides reliable information about neuromuscular blockade. *Median nerve* - While the median nerve can be monitored, it is **less commonly used** than the ulnar nerve due to potential for confusing responses or less clear twitch measurements. - Stimulation of the median nerve primarily leads to **flexion of the thumb and fingers**, but the adductor pollicis response from ulnar nerve stimulation is often preferred for its clear isolation. *Radial nerve* - The radial nerve innervates muscles involved in **wrist and finger extension**, which are not typically targeted for standard neuromuscular monitoring. - Its stimulation can be more complex to interpret and may not provide the precise information needed for monitoring paralytic depth in the same way as the ulnar nerve. *Metacarpal nerve* - The term "metacarpal nerve" is broad and refers to nerves near the metacarpals, which are **not primary sites** for direct neuromuscular blocking agent monitoring. - Specific named peripheral nerves like the ulnar, median, or radial nerves are targeted for their predictable muscle responses, not generalized metacarpal innervation.

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free