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Self-Assessment Answers for Section 1: Opioid Analgesics in the Management of Acute and Chronic Pain

1 . Which type of pain is characterized by aberrant signal processing in the peripheral or central nervous system?

A.Nociceptive pain

B.Acute pain

C.Neuropathic pain

D.Chronic non-cancer pain

2 . What term describes the phenomenon of pain being caused by a normally innocuous stimulus such as light touch?

A.Allodynia

B.Hyperalgesia

C.Hypoalgesia

D.Referred pain

3 . What is the likely physiological basis for opioid-induced hyperalgesia?

A.Upregulation of nociceptive pathways in peripheral and central nervous systems

B.Downregulation of nociceptive pathways in dorsal horn neurons

C.Increased release of substance-P in neuronal synapses of peripheral and central nervous system neurons

D.Disinhibition of neuropathic pain pathways in central nervous system

4 . Which statement best summarizes the CDC finding about opioids for chronic pain?

A.Opioid analgesics should be confined to use in patients with neuropathic, as opposed to nociceptive, pain syndromes

B.Chronic non-cancer pain can be effectively treated with immediate-release opioid agents, but should not be treated with long-acting or extended-release formulations

C.No evidence shows a long-term benefit of opioids in pain and function versus no opioids although extensive evidence shows the potential harms of opioids

D.Evidence supports the use of opioid analgesics for long-term non-cancer chronic pain except in patients with pre-existing substance use disorders

5 . Opioid pain medications should not be combined with _______________?

A.Benzodiazepines

B.Stimulant medications

C.SSRI antidepressants

D.Anti-hypertensive medications

6 . Which of the following topics should be routinely covered as part of patient education about opioid analgesics?

A.Background information about acute vs. chronic pain

B.Criteria for Opioid Use Disorder

C.Safe medication disposal

D.Difference between nociceptive and neuropathic pain

7 . Although the absolute risk for inducing opioid misuse or addiction due to prescriptions of opioids for acute pain is low, the large number of such prescriptions means that approximately how many people are at risk each year?

A.260,000

B.160,000

C.60,000

D.6,000

8 . Non-pharmacologic methods for treating acute pain are appropriate for which phase of healing?

A.Immediately after tissue trauma

B.> 48 hours after tissue trauma

C.Late healing phase for recovery of function

D.Immediately after tissue trauma as well as in late healing phase

9 . Long-acting (LA) and extended-release (ER) formulations of opioids should not be used for __________________?

A.Treating acute pain

B.Treating cancer pain

C.Treating end-of-life pain

D.Treating chronic non-cancer pain

10 . What is one suggestion for a way to augment opioid treatment in order to help improve a patient’s pain and function?

A.Use an every-other-day dosing pattern for the opioid, alternating with an NSAID analgesic

B.Rotate the route of administration every 6 weeks

C.Add a long-acting opioid to a prescription for an immediate-release opioid

D.Try concurrent non-pharmacologic approaches such as exercise or cognitive behavioral therapy

11 . Which of the following is an example of a functional goal?

A.Reduced anxiety about pain

B.Reduced need for rescue analgesia

C.Reduced daily dose of opioid analgesic

D.Walking around the block

12 . According to the Centers for Disease Control and Prevention, what amount of opioid analgesic is appropriate for most painful conditions?

A.2-day supply

B.3-day supply

C.5-day supply

D.7 day supply

13 . Which class of patients might require more frequent or intense monitoring when prescribed an opioid analgesic?

A.Young adults

B.Older adults

C.Female patients

D.Patients with hypertension

14 . Which of the following characteristics is typical of patients who are addicted to a pain medication?

A.Medication use improves quality of life

B.Follows practitioner-patient agreement for opioid use

C.Medication use continues or increases despite adverse effects

D.Has left-over medication at each visit

15 . Most experts agree that opioid dosages should not be increased to _______ without careful justification based on diagnosis and on an individualized assessment of benefits and risks.

A.Greater than or equal to 50 MMED

B.Greater than or equal to 60 MMED

C.Greater than or equal to 80 MMED

D.Greater than or equal to 90 MMED

16 . The availability of naloxone was increased in 2019 by an FDA decision that ____________.

A.Allowed naloxone to be sold over the counter

B.Approved a generic formulation of nasal-spray naloxone

C.Allowed registered nurses to prescribe naloxone

D.Provided government subsidy to increase production of naloxone

17 . Which of the following medications is a full mu-receptor agonist used to treat Opioid Use Disorder?

A.Methadone

B.Buprenorphine

C.Extended-release naltrexone

D.Naloxone

18 . Which of the following medications can be self-administered by patients with a medication obtained from a regular pharmacy?

A.Methadone

B.Buprenorphine

C.Extended-release naltrexone

D.Naloxone

19 . For which of the following must clinicians obtain a special waiver from the DEA prior to being able to prescribe the medication?

A.Methadone

B.Buprenorphine

C.Extended-release naltrexone

D.Naloxone

20 . Which of the following is a possible reason for prescribing naloxone to a patient who has been prescribed an opioid analgesic?

A.The patient is taking a dose of an opioid < 50 MMED

B.The patient has recently been released from prison

C.The patient has history of hypertension

D.The patient has a concurrent prescription for an SSRI antidepressant

Self-Assessment Answers for Section 2: Enhancing Physician Mental Health and Resilence

21 . What was the prevalence of psychological distress (mostly anxiety and depression) burnout among medical students in the United States?

A.6%

B.12%

C.35%

D.42%

22 . The prevalence of suicide is significantly higher among what subpopulation of physicians, compared to the general population?

A.Attendings

B.Men

C.Residents

D.Women

23 . Roughly what percentage of those exposed to a traumatic event will develop Post Traumatic Stress Disorder?

A.1-4%

B.6-12%

C.10-20%

D.15-25%

24 . Which component of physician workload has been shown to be particularly taxing and associated with higher levels of burnout?

A.Dealing with terminal patients

B.Working night shifts

C.Taking calls at night

D.Dealing with difficult patients

25 . According to one study, for every hour physicians spend in face-to-face time with patients, how many hours do they spend using electronic health records or doing desk work?

A.1.5 hours

B.2 hours

C.2.5 hours

D.3 hours

26 . What individual-based practice has been shown to be an independent predictor of lower risk of burnout and higher quality of life among medical students?

A.Regular exercise

B.Avoidance of alcohol

C.Good sleep hygiene

D.Mediterranean diet

27 . _______________ is an example of a discussion-group intervention aimed at reducing symptoms of mental illness among internal medicine physicians.

A.MD-Listen

B.COMPASS groups

C.Talk About It

D.HI-QOL sessions

28 . Which of the following is an example of systems-level intervention to help reduce physician burnout?

A.Balint sessions

B.Mindfulness meditation

C.Interpersonal therapy

D.Schedule changes

29 . What was the goal of the AMA’s Joy in Medicine Recognition Program?

A.To identify physicians who have successfully implemented changes in their work/life balance that reduced stress and burnout

B.To bring attention to organizations trying to improve physician satisfaction and reduce burnout

C.To acknowledge hospitals that have reduced documented rates of burnout by 10% or more

D.To recognize medical school programs that enhance wellness and emotional health among students

30 . Which of the following is a component of the Patient-Centered Medical Home model that could help reduce burnout?

A.Collaborative clinical decision making

B.Streamlined billing procedures

C.Electronic medical record integration

D.Care-team huddles

2021 New Hampshire Medical Licensure Program

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