NCS Pain Management in Neurology 3

Question 1

A patient with trigeminal neuralgia fails carbamazepine. Which second-line medication is most appropriate?

Accepted Answer

Oxcarbazepine

Answer

Oxcarbazepine has similar sodium channel blocking efficacy to carbamazepine with a more favorable side-effect profile, making it the preferred second-line agent.

Question 2

Which quantitative sensory testing (QST) finding is most characteristic of small-fiber neuropathy causing neuropathic pain?

Accepted Answer

Elevated cold detection threshold and impaired heat pain threshold

Answer

Small-fiber neuropathy impairs Aδ and C fibers, elevating cold detection thresholds and altering heat pain thresholds on QST.

Question 3

A 55-year-old develops post-herpetic neuralgia. Which topical agent is FDA-approved as first-line for localized neuropathic pain?

Accepted Answer

Lidocaine 5% patch

Answer

The lidocaine 5% patch is FDA-approved for post-herpetic neuralgia and provides targeted sodium channel blockade with minimal systemic absorption.

Question 4

The pain of central post-stroke syndrome (CPSP) most commonly follows infarction involving which brain region?

Accepted Answer

Thalamus (especially VPL nucleus)

Answer

Thalamic infarction, particularly of the ventroposterolateral nucleus, is the most common lesion site in CPSP due to disruption of spinothalamic input processing.

Question 5

Which intervention is considered when spinal cord stimulation (SCS) is indicated for failed back surgery syndrome?

Accepted Answer

Electrode placement covering the thoracic cord at T8-T10

Answer

For failed back surgery syndrome with leg pain, SCS electrodes are typically placed at T8-T10 to cover the lower extremity dermatomes.

(NCS) Neurologic Clinical Specialist Practice Test

(NCS) Neurologic Clinical Specialist Practice Test

NCS Pain Management in Neurology 3