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Based on Real Life Scenarios to Prepare You for Exams and Enhance Your Knowledge
Activity 3: Symptom Management and Psychosocial Considerations
Symptom Management and Psychosocial Considerations
58-year-old male with glioblastoma multiforme is admitted to the inpatient hospice unit because of status epilepticus. Per his family, patient has had seizure-like activity for the past 12 hours. Patient was on levitracetam 750 mg TID and was compliant. Patient is DNR/DNI. The patient’s family and POA desire a focus on comfort only. Choose the best treatment choice:
A. Levitracetam IV load
B. Phenytoin IV load
C. Lorazepam IV drip and titrate until seizure free
D. Phenobarbital load
Patient in question #40 remains with some refractory seizure activity and appears to be grimacing and does not appear comfortable. Family relates long history of neuropathic pain secondary to chemotherapy. Choose the best next step:
A. Levitracetam IV load
B. Phenytoin IV load
C. Increase IV lorazepam drip
D. Ketorolac IV
68-year-old white female with a history of breast cancer diagnosed 8 years ago with last checkup showing no evidence of disease. Patient presents to ED with severe dyspnea on exertion, weakness, and extreme thirst. Patient has an 80-pack-a-year smoking history and continues to smoke. CXR shows large right sided pleural effusion. What is next best step in management?
A. CT chest with and without IV contrast
B. Spiral CT chest with and without IV contrast
C. Diagnostic and therapeutic thoracentesis
D. Chest tube placement for drainage of pleural effusion
Above patient‘s thoracentesis shows malignant cells. Chemistry of sodium 124, K 3.4, Cl 90, HCO3 32, BUN, creatinine. Which is most likely diagnosis?
A. Breast cancer recurrence
B. Non-small cell lung cancer
C. Small cell lung cancer
D. Multiple myeloma
Still patient above states “I would like to know what is going on.” Which is NOT part of breaking bad news?
A. Fire warning shot
B. Assess what patient knows about diagnosis
C. Find a public place to talk
D. Ask if patient would like support system there
Which of the following may potentiate seizures?
Which of the following does not have benefits for neuropathic pain?
64-year-old female had breast cancer diagnosed 8 years ago and has completed numerous courses of chemotherapy, radiation therapy, and surgeries. She presented to her PMD with recurrent and persistent nausea and vomiting, workup revealed brain metastases with path consistent with breast cancer. Patient’s PPS is 60%. Patient states “I am tired of fighting” and inquiries about hospice. Your response:
A. Right now your functional status precludes you from hospice.
B. I think you should fight this and everything you have.
C. Let me speak with your PMD and oncologist. I know you have fought this for a long time, hospice may be appropriate for you.
D. You should go to the hospital right away.
37-year-old white female with breast cancer presents to your outpatient clinic because of persistent neuropathy of both hands and feet s/p chemotherapy. During history it is found that patient’s mother had breast cancer at age 54. Maternal uncle with CRC at age 49, and maternal aunt with breast cancer at age 58. You refer patient to genetic counseling and discuss with patient possible test for:
A. BRCA 1
B. BRCA 2
C. A and B
D. MEN I
E. MEN II
Above patient becomes tearful and states “I just want to end it all. My husband is having an affair, and who will then take care of our 8-year-old daughter when I’m gone?” What is the next step?
A. Reassure patient things will get better
B. Be empathetic and sensitive while exploring patient suicidal and/or homicidal ideation
C. Ask patient CAGE questions
D. Encourage patient to be “strong” for their daughter
Appropriate step is taken for patient above. Patient admits to being depressed and is anhedonic. Which treatment choice would be best suited to this patient?
Patient returns in one week with decreased pain, but remains depressed. Which is the best option?
A. Increase medication treatment picked above
B. Change to a different medication
C. Offer reassurance
D. Add additional medication
Patient returns again three weeks after initial visit and feels “things are better,” pain and depression wise. You notice several bruises and ask patient what happened. She begins to cry. Next step is:
A. Ask CAGE questions
B. Encourage wife to press legal charges against husband
C. Explain bruising may be a side effect related to patient medication
D. Ask SAFE questions
Which of the following is not a common cause of constipation?
Which of the following is a potentially life-threatening side effect of immunotherapy?
Which of the following medications can cause paradoxical agitation?
C. Valproic acid
34-year-old African American male with sickle cell disease has history of numerous vaso-occlusive episodes with severe chronic pain on methadone 60 mg P.O. TID with Hydromorphone 8 to 12 mg P.O. every 4 hours as needed for pain with 7/10 pain at baseline and 9/10 on exertion. Patient would like to know what maximum dose of methadone is. Your reply:
A. You are already on maximum dose
B. You have exceeded maximum dose
C. There is no “maximum dose”
D. Let me look it up for you
Which of the following is the average necessary dose of gabapentin for patients to achieve adequate neuropathic analgesia?
A. 900 mg/day in divided doses
B. 1500 mg/day in divided doses
C. 1900 mg/day in divided doses
D. 2400 mg/day in divided doses
56 year-old-male with ES CHF and COPD receiving 5 mg po/sL morphine Q4H ATC for dyspnea (controlled). Now for discharge from general inpatient hospice to home with major adherence concerns, what dose TD fentanyl?
A. Fentanyl 25 mcg TD Q48HR
B. Fentanyl 25 mcg TD Q72HR
C. Fentanyl 12 mcg TD Q72HR
D. Fentanyl 50 mcg TD Q72HR
A palliative care patient who has well-controlled pain on methadone develops community-acquired pneumonia, which of the following interventions is least likely to have a drug interaction with methadone?
Patient is 74-year-old female with stage 4 breast cancer, now admitted to hospice, pain stable on Oxycodone Extended Release (non-formulary) 20 mg P.O. Q8H ATC and Oxy-IR 10 mg P.O. Q3H PRN BTP (not utilizing). Change patient to long-acting morphine.
A. Morphine 15 mg P.O. Q12H
B. Morphine 15 mg P.O. Q8H
C. Morphine 30 mg P.O. Q12H
D. Morphine 30 mg P.O. Q8H
E. Morphine 60 mg P.O. Q12H
Time is Up!