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MCQ 1: Analgesic LadderA 65-year-old woman with metastatic breast cancer is experiencing severe pain despite being on the maximum dose of codeine. What is the most appropriate next step in pain management?A. Increase the dose of codeineB. Add tramadolC. Start oral morphineD. Add gabapentinE. Switch to transdermal fentanylAnswer: Start oral morphineExplanation: Following the WHO analgesic ladder, when pain is not controlled with weak opioids (like codeine), the next step is to switch to strong opioids. Oral morphine is typically the first-line strong opioid in palliative care. Increasing codeine or adding tramadol would not be appropriate as they are both weak opioids. Gabapentin is an adjuvant, not a primary analgesic. Fentanyl patches are usually reserved for patients with stable opioid requirements.
