skip to main content

Fibromyalgia — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardRheumatologyFibromyalgiaRACP Adult Medicine

A patient with metastatic cancer and eGFR 16 mL/min develops new myoclonus, vivid hallucinations and allodynia after rapid escalation of oral morphine. Pain remains severe. What is the best response?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Correct precipitants and rotate away from renally cleared morphine

Explanation lettering: D = shown as B · E = shown as D · B = shown as E

D is correct. Renal impairment, rapid escalation, myoclonus and hallucinations indicate accumulation of neurotoxic morphine metabolites; correct precipitants and rotate/reduce under specialist guidance. E worsens accumulation. A may increase sedation without treating the cause. B causes avoidable pain and withdrawal. C is reserved for dangerous opioid ventilatory toxicity and would reverse analgesia.

Reference: Palliative Care Australia, Pain and pain management: https://palliativecare.org.au/resource/learn-more-about-pain-and-pain-management/; ANZCA PS01(PM), Opioid analgesics in chronic non-cancer pain: https://www.anzca.edu.au/getattachment/7d7d2619-6736-4d8e-876e-6f9b2b45c435/PS01%28PM%29-Statement-regarding-the-use-of-opioid-analgesics-in-patients-with-chronic-non-cancer-pain