Peds, Epidural, Spirituality, and Grief

1. Incidence of childhood cancers in the United States over the last several decades has:
2. Five-year survival for childhood cancers in the United States over the last several decades has:
3. All of the following are common childhood cancers except:
4. Your patient is a 7-year-old hospice patient with recurrent, refractory medulloblastoma (initially diagnosed in infancy with localized disease). The patient is s/p trach and peg with refractory seizures and ongoing mechanical ventilation and tube feeds at home. The parents of your patient feel the patient has poor quality of life and wish to discontinue tube feeds, you respond by:
5. The hospice patient in question #4 has now developed refractory seizures and agitation despite ongoing therapy with lorazepam and levetiracetam, which of the following antiepileptic drugs should be added?
6. A 13-year-old with prior osteosarcoma and status post left upper extremity amputation is complaining of phantom limb pain, which of the following is the best answer?
7. A patient with severe pain due to stage 4 non-small cell lung cancer is taking 900 mg of oral morphine per day. The patient is being considered for an intrathecal pain pump, how many milligrams of intrathecal morphine daily would be equivalent to this dose?
8. Epidural analgesia (PCEA) can be highly effective after surgery.
9. Epidural analgesia (PCEA) can have many side effects.
10. Informed consent should be obtained prior to initiating epidural analgesia (PCEA).
11. Spiritual assessment tools include HOPE and FICA.
12. Buddhists may avoid certain medications that contain animal byproducts.
13. Spirituality and religion are the same.
14. Jehovah’s Witnesses generally refuse whole blood products, but may accept derivatives of primary blood components such as albumin and immunoglobulins.
15. Apneic episodes, Cheyne-Stokes breathing, and loss of radial pulse are all signs of imminent death (hours to days).
16. Risk factors for complicated grief include, but are not limited to, unexpected or violent death, death of a child, social isolation, and PTSD.
17. Anxiety, spiritual distress, and lack of social supports are all risk factors for anticipatory grief amongst family members of terminally ill patients.
18. Some cultures and religions view pain and suffering as a normal part of their disease process.
19. Patients from some cultures may defer decision making to his/her family. This is appropriate if they have capacity for decision making.
20. In the United States, all states are consistent regarding surrogacy in the absence of advanced directives.