Manajemen Nyeri

1. Stimulus change to chemical signal at

a. Transmition
b. Modulation
c. Transduction
d. Perception
e.
2. Which one is not involve in the pain perception ?
a. Transduction
b. Conduction
c. Modulation
d. Transmission
e. Ectopic activation
3. WHO analgesia ladder except :
a. Step 1 : non opioid, +/- adjuvant
b. Step 2 : opioid for mild to moderate pain
c. Step 3 : opioid for moderate to severe pain
d. Step 2 : freedom for cancer pain
4. 5 phrases of 3 step ladder WHO except :
a. By the mouth
b. By the clock
c. By the ladder
d. Individualized for the patient
e. Adjuvant
5. Extensive use of opioid is associated with a variety of perioperative side
effect, except
a. Drowsiness and sedation
b. Pruritus
c. Diarrhea
d. Can delay hospital discharge
e. PONV
6. When opioid combined with non-opioid for treatment :
a. Preventive analgesia
b. Primordial analgesia
c. Preemptive analgesia
d. Multimodal (balanced analgesia)
e. Adjuvant analgesia
7. Nociceptive pathway of pain, except :
a. Transduction
b. Transmission
c. Modulation
d. Perception
e. Transition
8. Protection for GI mucosa :
a. PGI2
b. PGE2
c. Bradykinin
d. Substansi P
e. Platelet

9. Pharmakokinetik of NSAIDs except :

a. Strong acid and lipid soluble (90%)
b. Cross the blood brain barrier
c. Hepatic metabolism
d. Rapid absorption
e. Renal and hepatic excretion
10.Alpha 2 agonist, except :
11.The side effect of ketamin except :
a. Hypotension
b. Nausea and vomiting
c. Dizziness and confussion
d. Diarrhea
e. Cardiac arythmia
12.Below is tramadol, except :
a. Inhibit serotonin
b. Inhibit norepinephrine
c. Strong micro receptor
d. Poor metabolism CYP2D6
e. Accumulation M1
13.What is tue about codein, except :
a. Respiratory depression
b. Severe sedation
c. Dose 30-90 mg between 4-6 hours
d. Total daily dose 240 mg
e. ?
14.Opioids that cause less addiction effect
a. Morphine
b. Fentanyl
c. Tramadol
d. Codein
e. Pethidine
15.Reaction of NSAIDs and other drug
a. Digoxin-hepatotoxicity
b. Lithium-increase clearance
c. Aminoglycosides toxicity
d. Sulfonylureas-nephrotoxicity
e. Acetaminophen-bleeding
16.Side effect of NSAIDs towards renal
a. Hypokalemia
b. Increase sodium and water absorption
c. Intestinal nephritis and nephritic syndrome
d. Fluid imbalance and electrolyte imbalance until it causes renal
insufficiency
e. ?
17.Related about transdermal patches
a. peak effect after application 24 hours
b. High affinity for opiate receptor
c. Withdrawal syndrome
d. ?
e. Strong kappa antagonist

18.Related about COX2, except :

a. Rofecoxib
b. Parecoxib
c. Meloxicam
d. Piracetam
e. Celecoxib
19.Why acsess pain, except :
a. To determine mechanism of pain
b. To determine diagnosis
c. To monitor progression
d. To determine type of pain
e. To know side effect
20.Medicine that can cause less addiction in
a. Morphine
b. Codeine
c. Tramadol
d. Fentanyl
e. Pethidine
21.Opioid to be avoid for cancer pain except :
a. Meperidine
b. Nalbuphine
c. Pentazodine
d. Phentany patch
e. Buprenarphine
22.The classes of propionic acid :
1. Ibuprofen
2. Diclofenac
3. Ketoprofen
4. Indomethacin
23.Related about opioid receptor :
1. Anorexia
2. Dysphoria
3. Decrease GI motility
4. Miosis
24.Two type s of receptors at the DHN :
a. Wide grey
b. NMDA
c. High cognitive neuron
d. AMPA
25.This is all about dorsal horn neuron
1. The place where afferent output is process
2. The place to terminal ending pathway and primary afferent neuron
3. ?
4. Interaction between excitatory and inhibitory system
26.What is neuropathic pain, except :
a. Sensitization ectopic
b. Peripheral sensitization
c. Central sensitization
d. Loss inhibitory control
e. Inhibitory control

27.Endogenous opioid
1. Enkaphalin
2.
3. Dynorphin
4.
28.Why opioid is not given to children except
a. Neonates have delayed maturation of liver enzyme systems
b. Children have a higher percentage of body weight as a water and less as
fat
c. Children have reduced plasma albumin
d. Neonates have diminished ventilator responses to decreased oxygen
contents in the blood
e. Neonates have high cross blood brain barrier
29.What is the function of dorsal horn neuron (DHN)
1. Interaction between excitatory and inhibitory mechanism
2. End of afferent nerve endings
3. All peripheral nerve
4. Processing transmission of afferent nerve endings
30.What are true ? having big myelinated
1. A fiber
2. Large myelinated and fast conduction fibre
3. Touch, pressure
4. A and C-fibre
31.Pain is :
1. Associated with tissue damage and nociception
2. Describe in term of damage
3. Unpleasant sensational and emotional experience
4. Has biological meaning
32.Acute pain is :
1. Due to surgery, trauma, and acute illness
2. Affects behavior, emotion and cognitive behavior
3. Prolonged pain can cause delay in surgery
4. Due to noxius stimuli
33.Efek samping yang umum terjadi pada pemberian opioid :
a. Delirium
b. Mioklonus
c. Pruritus
d. Sedasi
e. Sakit kepala
34.Yang benar mengenai fentanyl
1. 75-125 kali lebih poten daripada morfin
2. Bersifat larut dalam air
3. Transdermal patch untuk nyeri kontak
4. Kappa receptor kuat
35.Efek samping tramadol :
1. Mual dan muntah
2. Mulut kering
3. Kejang
4. Konstipasi

Seorang pasien 60 tahun dating denga keluhan nyeri terbakar kesetrum

lancinating. Dari anamnesis diketahui pernah operasi dan dokter menemukan
putus saraf medianus
36.Berdasarkan anamnesis yeri yang dialami pasien tersebut memiliki
patofisiologi
a. Nosiseptif pain
b. Neuropatik pain
c. Kombinasi nosiseptif dan neuropatik
d. Somatic pain
e. Fisiologi pain
37.Karakteristik neuropatik perifer kecuali
a. Terbakar
b. Spontan
c. Hyperalgesia
d.
e.
38.Berikut ini yang bukan merupakan efek samping ketamin
a. Hipotensi
b. Mual
c. Sakit kepala
d. Diplopia
e. Aritmia
39.Benar mengenai alfa-2-adrenergik agonis kecuali
a. Klonidin
b. Sedasi post operative dan bradikardi
c. Hasilkan nyeri dan anlgesik opioid
d. Analgesic sparing efek
e.
40.COX inhibitor kecuali
a. As. Mafenamat
b. Ketorolac
c. Metimazole
d.
e. 41.Tanda vital kecuali
a. Nadi
b. Nyeri
c. Saturasi
d. Tekanan darah
e. Suhu
42.Penyebab nyeri visceral
a. Iskemik
b. Inflamasi
c. Relaksasi otot polos
d.
e.
43.Dibawah ini benar mengenai nyeri kanker :
a. Nyeri yang timbul merupakan kombinasi nyeri akut dan nyeri kronis
b. Pengobatan nyeri WHO step 1 adalah NSAID

c. Penambahan obat anti depressan disamping obat anti nyeri

d. Obat yang diberikan diawal sebaiknya opioid agar pasien tidak menderita
e.
44.Pemakainan opioid akan memberikan efek samping perioperatif kecuali :
45.Yang benr mengenai morfin ?
46.Codein
47.Yang benar tentang tramadol kecuali
48.Morfin
49.Pengobatan kanker kecuali