ABFM KSA Pain Management Actual
Exam Questions and Answers with
Rationales 2026/2027 | Family Medicine
Board Exam | Pass Guarantee
Question 1
A 55-year-old patient with osteoarthritis reports moderate knee pain not
relieved by acetaminophen. What is the next recommended step in
management?
A. Immediate referral for surgery
B. NSAIDs
C. Opioid therapy
D. Corticosteroid injection
,,,,answer,,: B. NSAIDs
Rationale: NSAIDs are the next step when acetaminophen is insufficient
for osteoarthritis pain, after considering the patient's cardiovascular and
gastrointestinal risk profile. NSAIDs provide effective anti-inflammatory
and analgesic effects for osteoarthritis. Surgery is reserved for advanced
disease; opioids are not first-line; and corticosteroid injections are
typically considered after oral pharmacotherapy fails.
,Question 2
Which of the following is considered first-line pharmacologic therapy for
chronic neuropathic pain?
A. Acetaminophen
B. Duloxetine
C. Morphine
D. Ibuprofen
,,,,answer,,: B. Duloxetine
Rationale: Duloxetine, a serotonin-norepinephrine reuptake inhibitor
(SNRI), is effective for chronic neuropathic pain and is preferred due to
its efficacy and safety profile. SNRIs and gabapentinoids are first-line
agents for neuropathic pain, while opioids are generally second- or third-
line. Acetaminophen and ibuprofen are not effective for neuropathic
pain.
Question 3
Which opioid receptor is primarily responsible for analgesia?
A. Delta
B. Kappa
C. Sigma
D. Mu
,,,,answer,,: D. Mu
,Rationale: The mu-opioid receptor mediates most of the analgesic
effects of opioids. Mu receptor activation also produces respiratory
depression, euphoria, and constipation. Delta and kappa receptors
contribute to analgesia to a lesser extent, while sigma receptors are not
primarily involved in opioid analgesia.
Question 4
Which of the following adjuvant medications is effective for neuropathic
pain?
A. Gabapentin
B. Acetaminophen
C. Prednisone
D. Naproxen
,,,,answer,,: A. Gabapentin
Rationale: Gabapentin binds to calcium channels in the central nervous
system, reducing neurotransmitter release and neuropathic pain. It is a
first-line agent for various neuropathic pain conditions. Acetaminophen
and naproxen are not effective for neuropathic pain, and prednisone is
not a standard treatment.
Question 5
A patient develops constipation while on chronic opioid therapy. The
most appropriate management is:
, A. Reduce opioid dose
B. Prescribe a stimulant laxative
C. Add another opioid
D. Discontinue opioids
,,,,answer,,: B. Prescribe a stimulant laxative
Rationale: Opioid-induced constipation is best managed with a
stimulant laxative or stool softener without reducing necessary
analgesia. Preventive laxative therapy should be considered when
initiating chronic opioid therapy. Reducing or discontinuing opioids may
compromise pain control.
Question 6
Which non-opioid analgesic is associated with hepatotoxicity in
overdose?
A. Ibuprofen
B. Naproxen
C. Acetaminophen
D. Aspirin
,,,,answer,,: C. Acetaminophen
Rationale: Acetaminophen overdose can cause severe liver injury due to
accumulation of the toxic metabolite NAPQI. The maximum daily dose is
3-4 grams for adults. Ibuprofen, naproxen, and aspirin are associated
with gastrointestinal and renal toxicity rather than hepatotoxicity.
Exam Questions and Answers with
Rationales 2026/2027 | Family Medicine
Board Exam | Pass Guarantee
Question 1
A 55-year-old patient with osteoarthritis reports moderate knee pain not
relieved by acetaminophen. What is the next recommended step in
management?
A. Immediate referral for surgery
B. NSAIDs
C. Opioid therapy
D. Corticosteroid injection
,,,,answer,,: B. NSAIDs
Rationale: NSAIDs are the next step when acetaminophen is insufficient
for osteoarthritis pain, after considering the patient's cardiovascular and
gastrointestinal risk profile. NSAIDs provide effective anti-inflammatory
and analgesic effects for osteoarthritis. Surgery is reserved for advanced
disease; opioids are not first-line; and corticosteroid injections are
typically considered after oral pharmacotherapy fails.
,Question 2
Which of the following is considered first-line pharmacologic therapy for
chronic neuropathic pain?
A. Acetaminophen
B. Duloxetine
C. Morphine
D. Ibuprofen
,,,,answer,,: B. Duloxetine
Rationale: Duloxetine, a serotonin-norepinephrine reuptake inhibitor
(SNRI), is effective for chronic neuropathic pain and is preferred due to
its efficacy and safety profile. SNRIs and gabapentinoids are first-line
agents for neuropathic pain, while opioids are generally second- or third-
line. Acetaminophen and ibuprofen are not effective for neuropathic
pain.
Question 3
Which opioid receptor is primarily responsible for analgesia?
A. Delta
B. Kappa
C. Sigma
D. Mu
,,,,answer,,: D. Mu
,Rationale: The mu-opioid receptor mediates most of the analgesic
effects of opioids. Mu receptor activation also produces respiratory
depression, euphoria, and constipation. Delta and kappa receptors
contribute to analgesia to a lesser extent, while sigma receptors are not
primarily involved in opioid analgesia.
Question 4
Which of the following adjuvant medications is effective for neuropathic
pain?
A. Gabapentin
B. Acetaminophen
C. Prednisone
D. Naproxen
,,,,answer,,: A. Gabapentin
Rationale: Gabapentin binds to calcium channels in the central nervous
system, reducing neurotransmitter release and neuropathic pain. It is a
first-line agent for various neuropathic pain conditions. Acetaminophen
and naproxen are not effective for neuropathic pain, and prednisone is
not a standard treatment.
Question 5
A patient develops constipation while on chronic opioid therapy. The
most appropriate management is:
, A. Reduce opioid dose
B. Prescribe a stimulant laxative
C. Add another opioid
D. Discontinue opioids
,,,,answer,,: B. Prescribe a stimulant laxative
Rationale: Opioid-induced constipation is best managed with a
stimulant laxative or stool softener without reducing necessary
analgesia. Preventive laxative therapy should be considered when
initiating chronic opioid therapy. Reducing or discontinuing opioids may
compromise pain control.
Question 6
Which non-opioid analgesic is associated with hepatotoxicity in
overdose?
A. Ibuprofen
B. Naproxen
C. Acetaminophen
D. Aspirin
,,,,answer,,: C. Acetaminophen
Rationale: Acetaminophen overdose can cause severe liver injury due to
accumulation of the toxic metabolite NAPQI. The maximum daily dose is
3-4 grams for adults. Ibuprofen, naproxen, and aspirin are associated
with gastrointestinal and renal toxicity rather than hepatotoxicity.
