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Questions and Answers on Palliative Medicine
1. NDPS (Narcotic Drugs and Psychotropic Substance) amendment bill was passed in which year?
2. Health care workers in Oncology and palliative care settings may be vulnerable to stress and burnout. Maslach captured the burnout syndrome in three dimensions –
(1) Emotional exhaustion, depersonalization and sense of personal accomplishment
(2) Compassion fatigue, anxiety and depression
(3) Emotional exhaustion, anhedonia, moral distress
(4) Depersonalization, frequent physical illness, demoralization
3. In the levels of evidence for therapy, prevention research aetiology and harm research. The Centre for Evidence Based Medicine Research classes which of the following as 2a —
(1) Individual Randomised Controlled Trial (RCT)
(2) Individual cohort study
(3) Systematic review of cohort studies
(4) Case series
4. Most common cause of hyponatremia in oncology patients —
(1) Syndrome of inappropriate antidiuresis (SIAD)
(2) Secondary adrenal insufficiency
(3) Secondary hypothyroidism
(4) None of the above
5. Which among the following is not an input ostomy?
6. According to the ISSCM Consensus Statement 2012, when the fully informed capable patient / family desires to consider the overall treatment goal of “comfort care only”, the physician should clearly communicate the modalities of limiting life — prolonging interventions. If the patient or family do not desire the continuation of life — supporting interventions, the available options for limiting the supports include all the following statements, EXCEPT —
(1) Do—Not—Resuscitate status (DNR)
(2) Withdrawal of life support
(3) Withholding of life support
(4) Discontinue morphine
7. Oropharyngeal dysphagia is a common problem in older people. Common conditions leading to this symptom include all the below, EXCEPT –
(1) Acute unilateral stroke
(2) Alzheimer’s disease
(3) Parkinson’s disease
(4) Cancer oesophagus
8. A patient of advanced motor neuron disease is referred to palliative care. The family is very worried and fears that palliative care referral means it is all over for the patient. Which principle of palliative care can be best used to allay this fear?
(1) Palliative care improves survival and facilitates it by providing all active treatment
(2) Palliative care strongly believes in continuing all life sustaining treatment until end of life
(3) Palliative care affirms life, it believes in neither hastening nor inappropriately prolonging
(4) Palliative care promises newer and advanced therapies that may reverse the present condition
9. Which of the following is not a feature of oral candidiasis?
(1) Intense inflammation
(2) Reddish appearance of mucosa
(3) White patches in the mucous membrane
10. Kanhaiya, 71-year-old, gentleman gradually developed weakness in his legs and arms over the past five months. Clinical examination: lower upper motor neuron dysfunction with hyperreflexia, increased tone, atrophy and fasciculation. Electromyography (EMG): fibrillation and positive sharp waves. Which of these complications is Kanhaiya most likely to face?
(1) Respiratory failure
(2) Cardiac arrest
(4) Electrolyte imbalance
11. The Keel Start Back Tool (SBT) is used for –
(1) Prognostication purpose
(2) Assessment of quality of life
(3) Assess the proportion of neuropathy pain
(4) Assess the role of psychological factors
12. Shankar is 68-yrs-old, with end-stage heart failure (alcohol-related cardiomyopathy) He is admitted for end-of-life care. He is very confused and is hallucinating. The confusion and hallucinations are a new problem over the past few days. He is distressed and agitated by the symptoms. What is your plan of action?
(1) Start oral Haloperidol 10mg
(2) He is dying; we should explain to the family that the confusion is frequently seen at this stage and further investigations or management should not be planned
(3) Pharmacological management of delirium should be initiated if it is causing distress to the patient or if he is a danger to himself or others
(4) ACT head is the first line investigation. This should be followed —up with a lumbar puncture
13. History of use of which drug has been correlated with the occurrence of Parkinson’s Disease (PD)?
14. While managing the arm with lymph edema, identify the wrong statement —
(1) Do not exercise the lymph edema affected arm
(2) Do not give injection in the lymph edema affected arm
(3) Do not check blood pressure in the lymph edema affected arm
(4) Do not wear any metal / glass ornament in the lymph edema affected arm
15. Good “Dying” is influenced by cultural and societal norms. Important components of a “good death” from the patient’s perspective are –
(1) No plan, death at home, resolution of unfinished business
(2) Symptom control, hospice admission, resolution of unfinished business
(3) Symptom control, patient’s preferred place of care, resolution of unfinished business
(4) Symptom control, death at home, resolution of existential issues
16. Which of the following drugs are not used for opioid rotation?
17. Physiological basis of the counter irritation phenomenon or ‘pain inhibits pain’ may be explained by –
(1) Diffuse noxious inhibitory control (DNIC)
(2) Gate control theory of pain
(4) Specificity theory of pain
18. The neurons responsible for the sensation of itching are —
(1) A fibers
(2) B fibers
(3) C fibers
(4) All of the above
19. A 65-year-old male presents with fatigue and abdominal pain. He was asymptomatic until three months ago, when he started experiencing frequent fatigue. There has been significant weight loss in the last three months, he has severe abdominal pain radiating to the back. This is relieved in foetal position. His CA19-19 is elevated. CT confirms advanced cancer of the pancreas. A nerve block is planned for this patient to relieve his pain. What is a common complication of this nerve block?
(1) Orthostatic hypotension
20. Pharmacological basis of respiratory depression following opioid administration is –
(1) Inhibition of baroreceptors
(2) Inhibition of vagus nerve input
(3) Agonism of mu-opioid receptor at the ventral medulla
(4) Paralysis of phrenic nerve
21. The SPIKES mnemonic for delivering bad news was described by –
(1) Robert Buckman
(2) Bailes Walter F
(3) Anthony Back
(4) Randall W Curtis
22. The following statements describe elements in an informed consent form (A, B, C, D, E, F). Two statements are NOT essential elements of informed consent document according to the ICMR guidelines of 2017. Which of the following element are not essential. Choose from options 1, 2, 3, and 4.
A. Expected duration of the participation and frequency of contact types of data collection
B. Benefits to the participant that might reasonably be expected as an outcome of research
C. Any foreseeable risks, discomfort or inconvenience to the participant
D. Access to the trial drug after completion of the clinical trail
E. Identity and contact details of the principal investigator
F. Insurance coverage
(1) D and F
(2) E and F
(3) A and D
(4) D and E
23. What type of intermittent pain is not classified as Breakthrough pain?
(1) Movement related pain
(2) Non volitional incident pain
(3) End of does failure
(4) Volitional incident pain
24. Fora patient on 30 mg sustained release morphine twice daily, the rescue does of immediate release morphine for break through pain is —
25. Which antiemetic is recommended for uremia — induced nausea in patients with end — stage chronic kidney disease?
(4) Hyoscine hydrobromide
26. SOCRATES Acronyms is used for assessment of —
27. High dose fluoxetine and tramadol administered together can give rise to –
(1) Serotonin syndrome
(2) Loss of analgesia
(3) Opioid toxicity
(4) Liver failure
28. All are endocrine adverse effects of immune checkpoint inhibitors, EXCEPT —
29. Routes of administration and absorption will determine if a drug will undergo first pass effect. All these routes of administration avoid “first — pass” hepatic effects, EXCEPT —
(1) Sublingual administration
(2) Proximal rectal absorption
(3) Lower rectal suppositories
30. Opioid endocrinopathy refers to decrease in the blood level of the following hormones, EXCEPT –
(1) Thyroid stimulating hormone
31. In nausea and vomiting due to gastric distension associated with bowel obstruction which drug would your prescribe?
(3) Aluminium hydroxide and magnesium hydroxide
32. The following cancer chemotherapy is associated with peripheral neuropathy –
33. All are techniques for fertility preservation in women, EXCEPT —
(1) Odocyte cryopreservation
(2) Embryo cryopreservation
(3) Ovarian tissue cryopreservation
(4) GnRH agonist
34. You are considering intrathecal analgesia in a patient with intractable pain in the setting of metastatic cancer. Which of the following is an absolute contraindication?
(1) Chemotherapy 3 weeks back
(2) Raised intracranial pressure
(3) Age of the patient
35. SVC obstruction is most commonly associated with –
(2) Esophageal cancer
(3) Lung cancer
36. Epidural compression of the spinal cord is a common complication of cancer. Most epidural compression is caused by –
(1) posterior extension of vertebral body metastasis to the epidural space.
(2) tumour extension from the posterior arch of the vertebra
(3) infiltration of a paravertebral tumour through the intervertebral foramen
(4) leptomeningeal tumor
37. All are associated with progressive multifocal leukoencephalopathy, EXCEPT —
38. The term ‘Palliative care’ is attributed to –
(1) Dr. Balfour Mount
(2) Dame Cicely Saunders
(3) Dr. Robert Twycross
(4) Dr. Vittorio Ventafridda
39. Opioid induced constipation is related to which receptors in the small intestines?
(1) Opioid 111 receptor
(2) Opioid 112 receptor
(3) Opioid 13 receptor
(4) Opioid delta receptor
40. During a discussion with the patient and his wife, the patient gets emotional, he starts crying. What is the incorrect response?
(1) Allow him to express his emotion
(2) Tell him “Be positive”
(3) Remain silent
(4) Name the emotion
41. All are true about cerebral edema, EXCEPT —
(1) Tumour induced brain oedema is sustained by vasogenic mechanisms.
(2) Goals of conservative management of cerebral oedema are maintenance of Cerebral Perfusion Pressure (CPP) and reduction of vasogenic oedema.
(3) Intracranial processes can impair cerebral perfusion pressure by increasing ICP.
(4) CPP is defined as ICP minus mean arterial pressure.
42. Which of following are NOT TRUE about hypoactive delirium in the palliative care setting?
(1) Slow responses
(2) Reduced mobility
(3) Visual hallucinations
(4) Social withdrawal
43. Chemical serositis is a common complication of intraperitoneal infusion of all of the following, EXCEPT —
44. To ensure proximity of the Radio Frequency (RF) electrode to the sensory fibers, stimulation is carried out at which frequency?
(1) 1 Hz
(2) 2 Hz
(3) 50 Hz
(4) 100 Hz
45. There is evidence to support the use of which FDA approved appetite enhancer in patients with HIV and cancer —
(3) Megestrol acetate