Activity 13: Pain and Approach to Care | Hospice & Palliative Board Review

Pain and Approach to Care

1.

Patient is 84-year-old with multiple myeloma and is admitted to the hospital with cord compression and is made N.P.O. awaiting corpectomy by neurosurgeon. Pain is previously well controlled on LA morphine 30 mg P.O. Q8H, he now develops renal failure (preferred agents are Hydromorphone, fentanyl, and methadone). Convert patient to equianalgesic IV Hydromorphone regimen.

A. Hydromorphone 2 mg IV Q4H ATC

B. Hydromorphone 1 mg IV Q4H ATC

C. Hydromorphone 0.5 mg IV Q4H ATC

D. Hydromorphone 1.5 mg IV Q4H ATC

2.

Which of the following is not an available gabapentin preparation?

A. Oral capsule

B. Oral liquid

C. Oral sustained release preparation

D. Parenteral

3.

For which of the following does acupuncture have the most evidence of benefit?

A. Diabetic peripheral neuropathy

B. Migraine headaches

C. Low back pain

D. Complex regional pain syndrome

4.

Which of the following may be beneficial in the treatment of nausea and vomiting?

A. Acupuncture

B. Acupressure

C. Hypnosis

D. A and B only

E. All of the above

5.

Which of the following is likely the best intervention for a 45 year-old-female with breast cancer, prior hyperemesis gravidarum, and a long history of motion sickness?

A. Metoclopramide

B. Diphenhydramine

C. Scopolamine

D. Haloperidol

6.

Given the patient functionalities as indicated below, which ones are the best candidates for nivolumab?

A. ECOG 1

B. ECOG 2

C. ECOG 3

D. Choice A and B only

E. All of the above are good candidates

7.

Which of the following are true regarding United States healthcare?

A. It is qualitatively driven

B. It is quantitatively driven

C. It has been consistently ranked 37th in the world by the WHO

D. Choice B and C only

E. Choice A and C only

8.

All of the following are part of the Triple Aim except:

A. Improving the patient experience of care

B. Improving the health of populations

C. Reducing the amount of health care delivered

D. Reducing the per capita cost of health care

9.

Which of the following regarding PEG tubes are true?

A. They eliminate patient risk for aspiration

B. They eliminate patient risk for infection

C. They can be helpful for patients with newly diagnosed head and neck cancer

D. They improve quality of life for patients with end-stage dementia

10.

In addition to constipation, which side effect of opiates do patients not develop tolerance to?

A. Sedation

B. Miosis

C. Nausea

D. Pruritus

11.

For a patient to be admitted to hospice under an Alzheimer’s dementia diagnosis, the patient must have a FAST score of at least:

A. 6a

B. 6c

C. 6e

D. 7a

12.

Which of the following are appropriate for a primary hospice diagnosis?

A. Cerebrovascular disease

B. Adult failure to thrive

C. Abnormal weight loss

D. A and C

E. None of the above

13.

Which of the following is not a prominent symptom in superior vena cava (SVC) syndrome?

A. Headache

B. Facial swelling

C. Bradycardia

D. Dyspnea

14.

Which of the following conditions is the most common cause of SVC syndrome?

A. Diffuse large B-cell lymphoma

B. Small-cell lung cancer

C. AML

D. CML

15.

Treatment for SVC syndrome typically includes all of the following except:

A. Surgery

B. Diuretics

C. Corticosteroids

D. Radiation therapy

16.

Which of the following cancers is least likely to cause spinal cord compression?

A. Breast

B. Colon

C. Prostate

D. Lung

17.

Which of the following is not a commonly used treatment for cord compression?

A. High-dose IV corticosteroids

B. Radiation

C. Surgery

D. High-dose IV NSAIDs (i.e. ketorolac)

18.

Which of the following patients has the best performance status?

A. ECOG 0

B. ECOG 1

C. ECOG 2

D. ECOG 3

E. ECOG 4

19.

Which of the following is not typically used to treat hypercalcemia of malignancy?

A. Hydration and loop diuretics

B. Hydration and thiazide diuretics

C. Bisphosphonates

D. Corticosteroids

20.

Symptoms of hypercalcemia include all of the following except:

A. Lethargy

B. Depression

C. Polyuria

D. Polydipsia

E. Polyphagia