2020 CO*RE LEARNER ASSESSMENT (v.J) Post-test Please mark the single best answer to each question. The questions with an asterisk are mandatory. Please answer: OK Question Title * 1. Name of Host Institution/Organization? American Osteopathic Society of Rheumatic Diseases Pacific Northwest University American College of Family Physician Oklahoma Osteopathic Association American Osteopathic Academy of Sports Medicine Oklahoma State University - COM American College of Family Physicians California Arkansas Osteopathic Medical Association New York State Osteopathic Medical Society American College of Osteopathic Internists Michigan Osteopathic Association Georgia Osteopathic Medical Association OK Question Title * 2. Location of CO*RE Course? Virtual Reno, NV Yakima, WA New Orleans, LA Oklahoma City, OK Anaheim, CA Tulsa, OK Branson, MO New York, NY Marco Island, FL Norman, OK Grand Rapids, MI Suwanee, GA OK Question Title * 3. AOA ID Number? (If you do not have or know your AOA ID, please enter None or Unknown) OK Question Title * 4. Contact Information for Attendee Name Email Address OK Question Title * 5. Primary State or Foreign Country of Practice: OK Question Title * 6. Please select your profession: Physician Advanced Practice Nurse Pharmacist Dentist Optometrist Physician Assistant Podiatrist Other (please specify) OK Question Title * 7. I have a Registration with the DEA to prescribe controlled substances (CS) Individual Institutional None OK Question Title * 8. Do you perform surgical procedures? Yes No OK Question Title * 9. Please indicate the primary area of your clinical practice: Emergency Medicine Family Medicine Geriatric Medicine Hospice/Palliative Care Internal Medicine Neurology Obstetrics/Gynecology Pain Medicine Pediatrics Physical Med/Rehab Psychiatry Substance Use Disorder General Surgery Orthopedic Surgery Surgery Other Other OK Question Title * 10. How long have you been in clinical practice? Trainee <5 years post training 6-10 years 11-15 years 16-20 years Over 20 years OK Question Title * 11. Have you prescribed ER/LA opioids within the past year? Yes No OK Question Title * 12. Which comorbid condition may predict the development of chronic pain following acute pain? A. Asthma B. Depression C. Diabetes Mellitus D. Hypertension OK Question Title * 13. Pain secondary to post-herpetic neuralgia is what type of pain? A. Mixed type B. Neuropathic C. Nocieptive D. Nociplastic OK Question Title * 14. Which of the following is an anticipated outcome of a patient taking a prescribed opioid medication as recommended? A. Diversion B. Misuse C. Tolerance D. Withdrawal OK Question Title * 15. What is the first step in assessment of a patient’s pain who complains of burning and tingling in his lower extremities? A. Complete history and physical exam to determine the cause of his pain B. Perform social history to establish cultural background C. Send patient for an EMG to determine possible neuropathic pain D. Validate the patient’s provided treatment history with your state’s PDMP OK Question Title * 16. Which of the following is the most important thing to consider in creating a pain treatment plan? A. Quality of life is not a significant factor in pain management B. Reduction of the pain score by 25% will be the primary endpoint C. The goal is to completely resolve pain D. The goal is to improve functional outcomes OK Question Title * 17. According to expert guidelines, which of the following is the best sequence for establishing a pain treatment plan of care? A. Establish the cause and type of the pain, initiate non-pharmacological and/or non-opioid therapies, regularly reassess B. Identify the pain generator through a complete history and physical examination, initiate opioid therapy, regularly reassess C. Obtain imaging, initiate non-pharmacological and/or non-opioid therapies, refer to pain management D. Validate the patient’s pain complaint, obtain imaging, initiate opioid therapy, follow-up regularly OK Question Title * 18. Which side effect of opioid therapy should always prompt proactive treatment? A. Constipation B. Dizziness C. Itching D. Nausea OK Question Title * 19. In which of the following circumstances is the patient at greatest risk of life-threatening respiratory depression from opioid treatment? A. During dosage taper B. Upon treatment initiation C. When converting dosage from one opioid to another D. When co-prescribed with a benzodiazepine OK Question Title * 20. Select the correct statement regarding counseling a woman, currently on chronic opioid therapy, who is contemplating a possible pregnancy. A. Chronic opioid therapy causes congenital skeletal abnormalities as well as bone demineralization in women B. For pregnant women with opioid dependence, switching to methadone is safer and more successful than detoxification C. Neonatal abstinence syndrome (NAS) is a rare adverse outcome in babies born to mothers using opioids D. Since chronic opioid use impairs fertility, women taking opioids cannot become pregnant OK Question Title * 21. After determining that non-opioid therapies are inadequate for a patient’s pain, which of the following are the three most important things to have in place at the beginning of a trial of opioids? A. Baseline urine drug test (UDT), psychological testing, and patient’s medication preference identified B. Informed consent, family history, current medication reconciliation C. Patient provider agreement (PPA), baseline urine drug test (UDT), informed consent D. Patient provider agreement (PPA), lab work-up, social worker referral OK Question Title * 22. While all of the following behaviors might merit investigation in a patient receiving long term opioid therapy, which would most strongly prompt your concern for a possible opioid use disorder? A. Negative urine drug test (UDT) results for the medication prescribed B. Patient reports recent family problems and being fired from job C. Request for a dosage increase due to lack of pain control D. Request for an early refill OK Question Title * 23. In transitioning an 80 y/o patient from morphine 180 mg/day to oxycodone, and accounting for incomplete cross-tolerance, which one of the following would be an appropriate initial dose? Recall that thirty (30) mg of PO morphine is approximately equianalgesic to 20 mg long-acting oxycodone; that is, the equianalgesic ratio for morphine: oxycodone is 3:2 (although some tables indicate, oxycodone is roughly twice as potent as morphine). A. Oxycodone ER 30 mg PO Q 12 hours B. Oxycodone ER 80 mg Q 8 hours C. Oxycodone IR 5 mg PO Q 4 hours D. Oxycodone IR 10 mg PO Q 6 hours OK Question Title * 24. Of the following, which is an appropriate reason for tapering and discontinuing opioid medication and not a situation that calls for further investigation and increased monitoring? A. Negative urine drug screen B. Ongoing pain with aberrant use C. Pain is resolving D. Scheduled for a future surgical procedure OK Question Title * 25. What is the most important piece of information when educating patients and their families about naloxone use? A. Be prepared to give the patient an IR dose for pain upon awakening B. Discourage naloxone access because it promotes drug misuse C. Secure naloxone in a home drug safe D. Seek medical attention as soon as possible when naloxone is used OK NEXT