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Pain Management and WHO Analgesic Ladder:: MSRA MCQs

Updated: Aug 9

  1. Which step of the WHO analgesic ladder would you start for mild pain?

Choose the correct answer

  • A) Strong opioids

  • B) Weak opioids ± non-opioids

  • C) Non-opioid analgesics

  • D) Fentanyl patches

  • Answer: C) Non-opioid analgesics

Explanation: Step 1 is for mild pain and includes paracetamol, NSAIDs, and aspirin.



  1. Which of the following is a contraindication for morphine use?

Choose the correct answer

  • A) Bone pain due to mets

  • B) Severe acute bronchial asthma

  • C) Neuropathic pain

  • D) Muscle spasm

  • Answer: B) Severe acute bronchial asthma

Explanation: Morphine induces histamine release causing bronchoconstriction, making it unsafe in severe asthma.



  1. Which medication is first-line for neuropathic pain management?

Choose the correct answer

  • A) Baclofen

  • B) Amitriptyline

  • C) Carbamazepine

  • D) Ibuprofen

  • Answer: B) Amitriptyline Explanation: Amitriptyline is first-line for neuropathic pain (shooting, burning, tingling pain).



  1. Which statement is TRUE regarding fentanyl patches?

Choose the correct answer

  • A) They have rapid onset and are suitable for acute pain

  • B) They should be avoided in patients who are still in pain

  • C) They are first-line in neuropathic pain

  • D) They can be used in neonates

  • Answer: B) They should be avoided in patients who are still in pain Explanation: Fentanyl patches have a slow onset and are not for uncontrolled acute pain.



  1. Which of the following is an alternative to morphine in post-operative pain if morphine causes excessive sedation?

Choose the correct answer

  • A) Baclofen

  • B) Gabapentin

  • C) Oxycodone

  • D) Diazepam

  • Answer: C) Oxycodone


Explanation: Oxycodone can be used if morphine is not tolerated or causes excessive sedation.


  1. What is the first-line treatment for trigeminal neuralgia?

Choose the correct answer

  • A) Amitriptyline

  • B) Gabapentin

  • C) Carbamazepine

  • D) Baclofen

  • Answer: C) Carbamazepine Explanation: Carbamazepine is the gold-standard first-line for trigeminal neuralgia.



  1.  A 64-year-old man with metastatic prostate cancer presents with severe lower back pain due to bony metastases. He has been taking regular paracetamol and ibuprofen, but his pain persists despite this. Which of the following is the most appropriate next step in his pain management according to the WHO analgesic ladder?

Choose the correct answer

  • A) Increase the dose of NSAIDs

  • B) Add codeine to his current medications

  • C) Start oral morphine

  • D) Switch NSAID to aspirin

  • Answer: C) Start oral morphine

Explanation: According to the WHO analgesic ladder, management of severe pain (such as bone metastases) requires escalation directly to Step 3 (strong opioids such as morphine). Step 2 (weak opioids) can be skipped in cases like bone metastasis where pain is severe.

  1. Which joint is most commonly affected in gout?

Choose the correct answer

  • A) Knee

  • B) First metatarsophalangeal joint

  • C) Wrist

  • D) Elbow

  •  Answer: B) First metatarsophalangeal joint


Explanation: Gout classically starts at the big toe (first MTP joint).




  1. Which is the most appropriate first-line pharmacological treatment for acute gout in a patient with history of peptic ulcer disease?

Choose the correct answer

  • A) NSAIDs + PPI

  • B) Oral colchicine

  • C) Corticosteroids

  • D) Allopurinol

  • Answer: B) Oral colchicine Explanation: NSAIDs are avoided in peptic ulcer history; colchicine is preferred.



  1. Which medication should NOT be stopped during an acute gout attack if already established on it?

Choose the correct answer

  • A) Colchicine

  • B) Allopurinol

  • C) Ibuprofen

  • D) NSAIDs

  •  Answer: B) Allopurinol


Explanation: Allopurinol or febuxostat should be continued during an acute attack if already prescribed.




  1. Which of the following medications increases the risk of gout?

Choose the correct answer

  • A) Metformin

  • B) Diuretics

  • C) Statins

  • D) Omeprazole

  •  Answer: B) Diuretics


Explanation: Diuretics (especially thiazides) reduce uric acid excretion, increasing gout risk.




  1. Which lifestyle modification is recommended for gout management?

Choose the correct answer

  • A) Increase purine intake

  • B) Reduce alcohol intake

  • C) Increase sugary drinks

  • D) Decrease fluid intake

  •  Answer: B) Reduce alcohol intake Explanation: Alcohol raises uric acid levels, worsening gout attacks.



  1. Which is first-line for bone pain due to metastasis?

Choose the correct answer

  • A) Bisphosphonates

  • B) Radiotherapy

  • C) Morphine

  • D) Amitriptyline

  •  Answer: C) Morphine


Explanation: Morphine is first-line for bone pain; radiotherapy and bisphosphonates are adjuncts.




  1. Which medication is used for muscle spasm pain relief?

Choose the correct answer

  • A) Gabapentin

  • B) Baclofen

  • C) Oxycodone

  • D) Amitriptyline

  • Answer: B) Baclofen


Explanation: Baclofen or diazepam are used to treat muscle spasm pain.

  1. In sciatica, which medication should be avoided?

Choose the correct answer

  • A) Gabapentin

  • B) Ibuprofen

  • C) Naproxen

  • D) Paracetamol

  • Answer: A) Gabapentin Explanation: Gabapentinoids are not effective for sciatica; NSAIDs are first-line.

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