10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
These 10 free NSPM questions are organized by exam domain, so you can see how each part of the Nonsurgical Pain Management blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Anatomy, Physiology and Pathophysiology of Pain 20% of exam
Question 1
Fourteen months after a minor lifting injury, a patient's pain involves the neck, low back, and both thighs. Light pressure is painful across several regions, and fatigue and unrefreshing sleep are prominent. Strength, reflexes, and dermatomal sensation are preserved. Evaluation identifies no inflammatory disorder or somatosensory lesion that adequately explains the distribution. What pain classification best fits this presentation?
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Correct answer: C - Nociplastic pain involving altered nociceptive processing
Question 2
Ten weeks after a healed distal-radius fracture, a patient has persistent regional hand pain disproportionate to the injury. The patient reports touch sensitivity, episodes of redness, asymmetric sweating, and stiffness. Today's examination shows allodynia, visible edema, and reduced wrist motion, but temperature and color are symmetric. No peripheral nerve injury or better explanation is identified. How do the Budapest clinical criteria apply?
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Correct answer: A - The presentation supports CRPS despite the absence of current vasomotor signs.
Domain 2: Imaging Equipment and Radiation Safety 15% of exam
Question 3
Before a lumbar injection, the fluoroscope's X-ray tube is beneath the table, the image receptor is 25 cm above the patient, and the field includes more spinal levels than necessary. Image quality is already adequate. Which adjustment reduces unnecessary exposure while preserving useful guidance?
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Correct answer: D - Bring the receptor closer and collimate to the required anatomy.
Question 4
During a shoulder ultrasound examination, a focal area of the supraspinatus tendon appears hypoechoic when the beam crosses it obliquely. A small heel-toe adjustment makes the dark area disappear and reveals intact, continuous fibrils. What explains the apparent abnormality?
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Correct answer: C - Angle-dependent anisotropy
Domain 3: Assessment, Diagnosis and Plan of Care 20% of exam
Question 5
A flooring installer develops right foot drop after several days of prolonged kneeling. Dorsiflexion, toe extension, and eversion are weak; inversion and hip abduction remain strong. Sensation is reduced over the dorsum of the foot, and tapping at the fibular neck reproduces paresthesia. Lumbar MRI shows a small right L4-L5 disc protrusion touching, but not displacing, the traversing L5 root. Which localization best reconciles the motor pattern with the imaging?
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Correct answer: C - Common fibular nerve at the fibular neck
Question 6
At the start of a multimodal pain program, a patient's past-week PEG ratings were pain intensity 6, interference with enjoyment of life 7, and interference with general activity 8. Six weeks later, the corresponding ratings are 6, 3, and 3. The patient has resumed preparing meals and attending family activities without new adverse effects. Which follow-up entry accurately captures the result?
Codeine provides little analgesia despite verified adherence. Pharmacogenetic testing reports a CYP2D6 activity score of 0; renal and hepatic function are normal. After reassessment, an opioid remains appropriate. Which change addresses the pharmacogenetic reason for the poor response?
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Correct answer: B - Switch to morphine, bypassing the deficient CYP2D6 activation step.
Question 8
A patient taking apixaban 5 mg twice daily for atrial fibrillation presents for an elective lumbar interlaminar epidural steroid injection. The last dose was 24 hours ago, creatinine clearance is 85 mL/min, platelet count is normal, and INR is 1.0. The prescribing clinician agrees that a temporary interruption is acceptable. Under the ASRA/multisociety interventional spine and pain guidance, which plan is appropriate?
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Correct answer: D - Reschedule the injection after a total 3-day interruption of apixaban.
Domain 5: Interventional Pain Strategies 25% of exam
Question 9
A patient receives lumbar medial-branch blocks with 0.3 mL of lidocaine per target after intravenous midazolam and fentanyl. The patient reports 90% relief but rests throughout the anesthetic window instead of performing the standing tasks that usually provoke pain. Before using this response to select radiofrequency treatment, what would most improve the validity of a repeat prognostic block?
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Correct answer: A - Avoid routine sedation and have the patient test the usual painful activities.
Question 10
During an intercostal block for persistent post-thoracotomy pain, a 64-kg adult develops tinnitus, a generalized seizure, and wide-complex tachycardia with hypotension. Injection has stopped, emergency help has been called, ventilation is supported, and a benzodiazepine has terminated the seizure. Which rescue treatment should now be added?
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Correct answer: A - 20% lipid emulsion: 96 mL IV over 2-3 minutes, then 16 mL/min.
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