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Model Question on Palliative Medicine
1. Which is the most common ECG abnormality produced by amitriptyline toxicity?
(1) Sinus tachycardia
(2) QT prolongation
(3) Nonspecific ST segment and T wave changes
(4) Torsade de pointes
2. All are used in treatment of hypercalcemia, EXCEPT —
(4) Gallium nitrate
3. In the context of treating pain in children (2-5 year old), which of the following statement is true?
(1) Children cannot explain their pain reliably
(2) Opioids are not safe
(3) If the child can be distracted, the child is not in pain
(4) Paracetamol and ibuprofen and recommended in mild pain
4. Bone pain is –
(1) Opioid pseudo resistant
(2) Opioid responsive
(3) Opioid resistant
(4) Opioid semi resistant
5. All of the following are adverse effect of cyclophosphamide, EXCEPT –
(1) Hemorrhagic cystitis
6. A patient of end stage lung cancer is receiving very high dose opioid for pain relief. He complains of constipation. Stool has to be manually disimpacted as multiple daily oral laxatives and enema are not effective. Considering this ongoing constipation, what can be considered as a next step?
(1) Decrease opioid
(2) Injection naloxone
(3) Injection methylnaltrexone
7. According to the World Health. Organization (WHO) ladder
(A) Adjuvants are used only in Steps 1 and 2.
(B) Medications should be prescribed in a stepwise progression from Step 1 to Step 3.
(C) Medications should be prescribed according to the intensity of the pain.
(D) Non — steroidal anti – inflammatory drugs are recommended for pain score of 1 —3 on a 10 point scale.
(1) (C) and (D)
(2) (B) and (D)
8. Tissue repairing activity of platelet rich attributed to (PRP) is mainly –
(2) Growth factors
(3) Coagulation factors
(4) Complement factors
9. Which of the following is not the term associated with caring for people with advanced illness?
(1) Hospice care
(2) Advanced care
(3) Continuing care
(4) Supportive care
10. Four elements of pain processing does not include –
11. Opioid induced hyperalgesia is a condition in which?
(1) Subjects describe diminished reaction to a drug over time
(2) Subject describes a paradoxical response in which the patient experiences worsening pain with increased opioid
(3) Subject experiences physical and psychological dependence on opioids
(4) Subject experiences severe pain after abrupt drug discontinuation or dose reduction
12. Catastrophic haemorrhages can be a terminal event. The palliative care team needs to be prepared for a Terminal Haemorrhage. Preparedness includes all the options given below, EXCEPT —
(1) Sedatives, analgesics
(2) Large dark towels
(3) Central venous access
(4) Debrief for traumatized staff
13. Which of the following finding of EMG / NCV is most helpful to differentiate between direct tumor infiltration and radiation fibrosis?
(1) Segmental nerve conduction slowing
(3) Fibrillar potential
(4) Positive sharp waves
14. All of the following are used in cancer related fatigue, EXCEPT —
(2) Megestrol acetate
15. Palliative Sedation is the intentional lowering of awareness towards, and including, unconsciousness for patients with severe and refractory symptoms. It is ethically defensible in specific situations. Which of the following statements regarding palliative sedation is incorrect?
(1) only used after careful interdisciplinary evaluation and treatment of the patient.
(2) indicated when palliative treatments that are not intended to affect consciousness have failed or, in the judgment of the clinician, are very likely to fail.
(3) is the same as active shortening of life process.
(4) used only for the actual or expected duration of symptoms.
16. Commonest cause of diarrhea in palliative care setting —
(2) Bowel fistula
(3) Defective dietary habit
(4) Imbalance of laxative therapy
17. Drug of choice in panic with hyperventilation is —
18. In a terminally ill patient which of the following is an example of the principle of non — maleficence?
(1) Discussing patient details with your neighbour
(2) Administering heavy sedation at the request of the patients husband
(3) Avoiding prescription of high doses of opioids
(4) Withdrawing artificial nutrition when death rattle develops
19. Burgdof’s syndrome is caused by all, EXCEPT —
(3) Liposomal doxorubicin
(4) Liposomal cytarabine
20. A 30-year-old bus driver married and having two young children is diagnosed with locally advanced buccal mucosa cancer. He is experiencing severe pain. The pain is preventing his from sleeping, easting and he has no joy in his life. How would you best describe his pain?
(1) Nociceptive Pain
(2) Neuropathic Pain
(3) Mixed Nociceptive and Neuropathic Pain
(4) Total Pain
21. Somesh is taking oral instant release morphine 5 mg four hourly, for nociceptive pain in his leg, due to osteosarcoma. The morphine is effective, but the relief is inadequate. Which the single best option from the listed treatments?
(1) Increase morphine to 7.5 mg four hourly
(2) Switch him to regular intramuscular injection Fortwin as the morphine is not adequate
(3) Add amitriptyline 10 mg at night
(4) The correct rescue dose is 2.5 mg morphine (1/2 of the four hourly dose )
22. Stephen has reported to the emergency room with moderate to severe pain. His records reveal renal impairment. Which of the following analgesics is the safest to use?
23. Generalist spiritual care competencies includes all, Except —
(1) Recognize spirituality as an integral component of the human experience of illness, healing and health
(2) Practice compassionate presence and active listening as part of clinical caregiving
(3) Perform spiritual histories in a patient — centred, confidential and respectful manner
(4) None of the above
24. To achieve sympathetic denervation of the head and neck, the best site of blocking in the –
(1) Middle cervical ganglion
(2) Cervico-thoracic ganglion
(3) Superior cervical ganglion
(4) Sphenopalatine ganglion
25. History of use of which drug has been correlated with the occurrence of Parkinson’s disease (PD)?
26. A 75-year-old woman is a known case of chronic heart failure. She presents to the emergency department with severe breathlessness and acute decompensation. The cardiologist. Has recommended home / hospice based palliative care. What is the best pharmacological treatment option to relieve her acute breathlessness?
(1) Frusemide and low dose Morphine
(2) Hydrochlorothiazide and low dose Morphine
(3) Spironolactone and low dose Morphine
(4) Metolazone and low dose Morphine
27. Which of the following statements is TRUE regarding prognostication?
(1) Accurate prognostication is easier in Dementia
(2) Doctor’s predictions for prognoses are usually optimistic
(3) There are no guidelines to help determine prognoses
(4) Cardiologists can determine the prognosis for heart disease confidently
28. A patient present with a huge ulcerating malignant wound on the left side of the cheek and reports malodour and inability to eat food. What of the following is the best pharmacological treatment to reduce malodour?
(1) Topical Povidone Iodine
(2) Topical Hydrogen Peroxide
(3) Topical Metronidazole
(4) Topical Soframycin
29. Ketamine is used in the management of –
(1) Visceral pain
(2) Pain due to raised intracranial pressure
(3) Neuropathic pain
(4) All of the above
30. An 83-year-old type 2 insulin dependent diabetic patient with metastatic non-small cell lung cancer is nearing end stage of life. What is the best approach to manage blood sugar levels during the last days of life?
(1) Convert SC Insulin to oral hypoglycaemic agents
(2) Convert to sliding scale insulin
(3) Convert insulin to long acting dose, reduce slightly to minimise hypoglycaemia
(4) Stop all insulin
31. Severe hypercalcaemia is defined as a serum calcium concentration of greater than —
(1) 2.0m mol/L
(2) 2.5m mol/L
(3) 3.0m mol/L
(4) 3.5m mol/L
32. Indications for Palliative Care in COPD are all, EXCEPT —
(1) Able to attend pulmonary rehabilitation
(2) Complex troublesome symptoms
(3) Hospitalization or transition in place of residence
(4) Referral for transplantation
33. A 75-year-old gentleman with a history of hypertension, type 2 diabetes mellitus, coronary artery disease, diabetic nephropathy and osteoarthritis presents to your clinic with complaints of bilateral knee pain which is severe in intensity and impacting his activities of daily living. Acetaminophen 650 mg four hourly for pain has not provided any relief. The best approach for managing this patient’s pain is –
(1) Add NSAIDs
(2) Start with high dose opioids.
(3) Start with low dose opioids
34. The doctrine of double effect distinguishes the effects that are intended, from those that are foreseeable though unintended. In the context of control of pain at the end of life, which statement is incorrect?
(1) The doctor’s duty to relieve pain takes precedence over preserving life.
(2) The intention is to relieve severe pain and not to shorten life.
(3) The relief of severe pain is achieved through causing the patient’s death.
(4) Proportionally, the need to relieve sever pain is such that it warrants accepting a remote possibility of hastening death.
35. A patient presents with a permanent colostomy performed one year ago and reports a need for emptying the colostomy bag frequently such that he finds it difficult to go for his work. He is advised colostomy irrigation. What type of colostomy is an indication for irrigation?
(1) Transverse colostomy
(2) Loop colostomy
(3) Sigmoid colostomy
(4) All of the above
36. The life span of platelets —
(1) 5 days
(2) 10 days
(3) 15 days
(4) 20 days
37. Validity of clinical studies is described as internal validity and external validity. Which of the following questions are crucial to determine the external validity of a study?
(A) Can the results be combined with other studies?
(B) What are the study settings?
(C) What is the study population?
(D) Which instruments were used?
(1) (D) and (B)
(2) (D) and (C)
(3) (A) and (C)
(4) (A), (B), (C) and (D)
38. Which has proved to be best approach for the assessment of physical symptoms?
(1) Asking open — ended questions
(2) Asking which symptom is least troublesome
(3) Traditional systems approach
(4) Systematic assessment of symptoms and open — ended questions
39. Which statement is true?
(1) Artificial nutrition and hydration do not delay death from terminal cancer
(2) Loss of appetite and progressive weakness are uncommon towards the end of life
(3) Intravenous fluids relieve dry mouth
(4) Patients with malignant bowel obstruction must receive Total Parenteral Nutrition
40. Which of these is a multi — dimensional pain assessment tool?
(1) Visual analogue scale
(2) Wong Baker scales
(3) Brief pain inventory
(4) Numerical rating scales
41. When initiating a new medication in a patient taking antiretroviral therapy, it is always best to check for the presence of interactions. The use of many medications is associated with potential Cytochrome 450 related drug interactions with anti — retroviral drugs. The following drugs, used in palliative care are all cytochrome P450 inhibitors, EXCEPT –
42. The top four leading causes o death, according to the WHO Global health estimates data, 2016 –
(1) Cancer, Stroke, IHD, Road accidents
(2) IHD, Stroke, COPD, Lower respiratory tract infections
(3) IHD, Stroke, Cancer, Diarrhoea
(4) Stroke, IHD, COPD, Tuberculosis
43. Mr. Ghanshyam has just been told he has an advanced stage of a serious illness. Which of the following statements reflects “good” communication?
(1) Our multidisciplinary team will decide which treatment options are best for you considering your comorbidities and age.
(2) What is you understanding of your disease and what are your hopes are for your treatment?
(3) The course of this treatment is difficult; you must be strong and get through it.
(4) This disease is advanced and there is no further treatment that we can offer you.
44. Patient on Epidural morphine and bupivacaine develops an intense itch. What is the drug you will choose?
45. A 33-year-old female with metastatic melanoma presents with anhedonia, low mood and decreased appetite. She is prescribed duloxetine for her deemed depression. What best describes the mechanism of action of duloxetine?
(1) Serotonin re-uptake inhibitor
(2) Serotonin and noradrenaline re-uptake inhibitor
(3) GABA agonist
(4) Selective noradrenaline re-uptake inhibitor