Copy of Palliative Care Module 1

Which of the following is not considered a general indicator of decline and increasing needs in patients requiring palliative care?

Which group of decedents is most likely to be ADL dependent in their final year before death?

Which of the following opioid is NOT safe for use in patients with renal impairment?

The parents of a child in the Intensive Care unit with a terminal illness make a choice not to pursue further treatment for their child’s condition. Medical advice has been that there is little hope that any intervention would prolong the child’s life. In this situation, which of the following should not be withheld?

A patient has severe pain from locally advanced pancreatic cancer. The pain is eventually well controlled by 80 mg per 24 hours of subcutaneous morphine infusion in hospital. It is intended to discharge the patient on oral sustained-release morphine.

Which one of the following is likely to be the most appropriate dose?

Which of the following opiod has increased risk of QT prolongation?

Which of the following opioid increases the risk of convulsions?

Which of the following is least consistent with a drug seeking behaviour?

With regards to the management of opioid induced constipation in a patient with advanced metastatic disease currently in hospice care, which of the following is least likely to be useful?

A 78-year-old woman with metastatic breast cancer who has received palliative doses of morphine for 2 months is hospitalized with a 2-week history of abdominal pain and distention. Passage of a bowel movement alleviates her pain, although she reports that the stools are quite hard. Abdominal examination reveals distention and slight tenderness. Rectal examination reveals hard stool in the rectal vault.

Which of the following treatment will most likely relieve this patient’s abdominal symptoms and constipation?

You are reviewing a 66-year-old man with metastatic prostate cancer in the ward. He is known to have spinal metastases but until now has not had any significant problems with pain control. Unfortunately he is now getting regular back pain despite taking regular paracetamol 1g QID and Ibuprofen 400mg TDS. Neurological examination is unremarkable.

What is the most appropriate next step?

A 70-year-old man with chronic kidney disease stage 4 and metastatic prostate cancer presents to hospital as his pain is not controlled with ParaCode (paracetamol and codeine phosphate).

Which one of the following opioid is the most appropriate to use given his impaired renal function?

A 57-year-old man with lung cancer is currently taking Sevredol 10mg Q4hrly for pain relief.

What dose of oral morphine solution should he be prescribed for breakthrough pain?

If a patient takes 60mg of oral codeine phosphate every 6 hours, what is the equivalent dose to oral morphine in 24 hours?

A 65 year old man with a diagnosis of metastatic lung cancer is opiate naive and has been prescribed short acting morphine (elixir) at a dose of 5mg every four hours. He required an additional 10mg as breakthrough over the last 24 hours. His pain appears to be well controlled with this medication. So after 3 days, you decide to switch him over to a long acting preparation.

Which of the following dose would be the most appropriate long acting preparation?

Which of the following is the most common side effect of opioid?

Which of the following is the correct single dose equivalent?

Which of the following best describes the primary purpose of the Supportive and Palliative Care Indicators Tool (SPICT™)?

Which of the following tools is NOT used to describe patient function?

When conducting advanced care planning conversations with patients, which of the following is NOT recommended to encourage and support the process?

A 68-year-old male patient with terminal cancer, has expressed his wishes regarding end-of-life care. He has a strong desire for a dignified passing that aligns with his personal beliefs and comfort.

Which of the following aspects of his care plan would NOT directly contribute to fulfilling his wish for a good death?

In the context of identifying biomarkers indicative of the final days to weeks of life in cancer patients, which of the following is NOT considered an evidence-based biomarker of dying?

Which of the following medications is NOT commonly used for end-of-life (EOL) care to manage symptoms such as pain, agitation, nausea/vomiting, and respiratory secretions?

A 54-year-old patient with metastatic breast cancer is started on an anti-emetic regimen by the hospice team for severe nausea and vomiting. Three days into treatment, the patient complains of sudden onset of difficulty in speaking and stiffness around her mouth and neck.

Her medical history is notable for hypothyroidism, and she is currently on levothyroxine.

Which anti-emetic medication is most likely responsible for these side effects?

A palliative patient with advanced Parkinson’s disease presents with symptoms of nausea and vomiting.

Which of the following anti-emetic medications is most appropriate for managing this patient’s symptoms?

A 63 year old male patient with end-stage liver disease (ESLD) presents with significant bleeding manifested as haematemesis and melena. The patient’s history reveals advanced malignancy and known coagulopathies associated with their liver condition. The patient expressed a wish to pursue active treatment.

In managing this acute bleeding episode, which of the following interventions is most appropriate?

A 68-year-old patient with advanced myeloma presents with symptoms of severe hypercalcemia, including confusion, nausea, vomiting, and polyuria.

Laboratory tests confirm an adjusted calcium level of 3.2 mmol/L.

Which of the following interventions is least appropriate in the initial management of hypercalcemia of malignancy in this patient?

A 72-year-old patient with advanced lung cancer presents to the palliative care clinic with symptoms of major airway obstruction, manifesting as difficulty breathing, wheezing, and frequent coughing. The patient’s goals of care have been discussed, focusing on comfort and quality of life.

Which of the following is the most appropriate palliative management strategy for this patient’s airway obstruction?

A second year House Officer is assessing a patient and observing signs that may indicate the patient is entering the terminal phase of life.

Which of the following observations is least indicative of the patient entering the last hours of life?

When managing a dying person, which of the following actions is essential regarding medication management?