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Sample Question on Palliative Medicine
1. Which of the following drugs is not recommended for treatment of pain diabetic polyneuropathy?
2. Which of the following opioids is very easily dialyzed?
3. Dr. Lis your 34-year-old colleague in the department of palliative care. You notice that over the last 2 weeks she has become detached and disengaged when talking with patients and their families. She feels tired and drained most of the time, has difficulty falling asleep. She also confides in you a personal sense of failure and self — doubt. The most appropriate intervention at this time is —
(1) Recommend she see her psychiatrist to start SSRI
(2) Recommend she leaves Palliative care for a non – clinical branch
(3) Ask her to take a vacation
(4) Refer her to a psychologist
4. At all points along the disease trajectory, the members of the multi-disciplinary palliative care team identify goals of care. Setting of the goals of care is an essential part of decision-making and helps to deliver individualized care. The team implements the treatment approach that is appropriate for the patient (depending on the patient’s wishes, disease and where the patient is on the course of his illness). The care plan is determined by the relative priority of the goals. The three potential goals of medical care for patients being seen by the palliative care team are –
(1) Prolong survival, optimize function and improve comfort
(2) Care of the patient, care of the family, care of the community
(3) Pain management, free treatment, good death
(4) Control of pain, nausea and vomiting, breathlessness
5. Saleema lost her husband of 36-years after a protracted battle with cancer. She has participated in the customary 3 day, 40 day rituals typical to her socio religious milieu. Seven months after his death she is unable to get over her loss. Her preoccupation with him has cost her job. She avoids family functions and weddings. She has recently been diagnosed with hypertension. She now needs two antihypertensives medications. Saleema is suffering from –
(1) anticipatory grief
(2) inhibited grief
(3) complicated grief
(4) traumatic grief
6. A 75-year-old patient Babu has advanced metastatic squamous cell carcinoma of the lung. He is quiet, withdrawn and eating poorly for a few days. Clinically, he has poor eye contact and. Is withdrawn and dehydrated. He is mumbling unintelligibly, occasionally waving his arms in the air. Temperature, pulse, respiration, blood pressure and saturation are normal. Which of the following statement is NOT correct?
(1) He is actively dying and no intervention is necessary unless he is agitated.
(2) Physical examination should seek to exclude bladder distension.
(3) Test for hypercalcemia, if reversing the cause of delirium is consistent with his care goals.
(4) He may benefit from artificial hydration
7. Conflict resolution in palliative care teams, the following is true —
(A) Conflict is a sign of poor teamwork.
(B) Ability to resolve conflict is an important feature of successful teams.
(C) When conflict is personalized it can be destructive.
(D) Conflicts are a part of working in a stressful environment and gradually resolve with time.
(E) Avoiding conflict will ensure that the team performs better.
(1) (A) and (B)
(2) (B) and (C)
(3) (D) and (E)
(4) (A) and (C)
8. Which of the following statements is FALSE regarding spirituality at the end of life?
(1) Spiritual assessment is an essential component of evaluation.
(2) Spirituality is synonymous with religious faith.
(3) Spirituality has a strong protective effect against end — of — life distress.
(4) Spirituality is a protective factor against end — of — life distress.
9. A 68-year-old female reports to your clinic with significant chemotherapy induced peripheral neuropathy. The pain severely limits her functioning. She also has renal impairment and narrow angle glaucoma. Which analgesis would you prescribe for her neuropathic pain?
10. Which of the following opioid overdose can cause seizure?
11. Pulmonary rehabilitation program includes all, EXCEPT —
(1) Exercise training
(3) Oxygen therapy
(4) Patient education
12. Palliative care is best delivered through a team. Theory describing the phases of team development has been based on years of research related to group processes: forming, storming, norming and performing, adjourning. These stages of group development were described by —
(1) James Kouzes and Barry Posner
(2) Ken Blanchard
(3) Stephen Covey
(4) Bruce Tuckman and Mary Ann Jensen
13. A 40-year-old mechanic complains of back pain for the last 5 years. The pain is worse on getting up from bed in the morning but in an hour or two, it gets better. Pain sometimes spread to the buttocks. He always uses ibuprofen every now and then, and continues his work. What type of pain pattern is this?
(1) Chronic inflammatory back pain
(2) Discogenic pain
(3) Facet joint arthropathy
(4) Muscle spasm of back
14. Which of the following component is not a part of SF-36 (short from 36) questionnaire?
(2) Physical functioning
(3) Medical co-morbidity
(4) Bodily pain
15. Acute meningitis syndrome is caused by intrathecal administration of —
(2) Tetanus immunoglobulin
(3) Liposomal cytarabine
16. Midazolam is indicated in all of the following, EXCEPT —
17. All are mixed opioid agonist — antagonist, EXCEPT —
18. All of the following statements are TRUE about cardiac effects of Methadone, EXCEPT —
(1) Concurrent administration of drugs causing QT interval prolongation could lead to cardiac adverse effects
(2) QTc > 400 ms is contraindication for using Methadone
(3) Methadone should be used with extreme caution in patients with cardiac conduction abnormalities
(4) Monitor electrolytes regularly to avoid cardiac adverse effects of Methadone
19. Opioid headache is caused by release of —
(3) Substance P
20. Advance care planning towards the end — of — life will result in all the following, EXCEPT —
(1) Strengthened patient autonomy
(2) Decreased hope
(3) Decreased net costs of care
(4) Decreased bereavement related stress depression in family members
21. A patient with poorly controlled hypertension, diabetes and end stage renal disease is referred to you. After discussing his physical and psychological issues. He starts crying………. “Why did God do this to me? What is the appropriate response from your team?
(1) “This is because of the longstanding hypertension and diabetes that has damaged your kidneys”
(2) “We cannot go against our “Karma” ”
(3) Remain silent, listen
(4) “Do not cry, you must be brave, only then will you be able to cope with treatment”
22. Barriers to cancer pain management are all, EXCEPT –
(1) Inadequate pain assessment
(2) Patient reporting of pain
(3) Excessive state regulations
(4) Patient reluctance to use opioids
23. All are assessment tools for spirituality in palliative care, EXCEPT —
24. In India, the following practices are illegal at the end of life, EXCEPT —
(2) Medical assistance in dying
(3) Physician assisted suicide
(4) Withholding futile treatment
25. All are endoscopic techniques utilized for upper GI bleeding, EXCEPT —
(1) Injection of sclerosing agents
(2) Radiofrequency ablation
(3) Endoscopic clips
(4) Band ligation
26. A 72-year-old male presents to the emergency department with significant dyspnoea at rest. He has idiopathic pulmonary fibrosis and concomitant chronic obstructive pulmonary disease. He is on maximal inhaled bronchodilator therapy and oral corticosteroids. A chest X-ray confirms a small left sided pleural effusion. He has a mild anaemia (102 g/dL). What is the best management of his breathlessness in this scenario?
(1) Aspiration of effusion
(3) Adding theophylline
27. Doctors practicing in India are hampered by the misperceptions of legal liability linked to treatment limitation. The landmark judgement by the Supreme court that allowed the right to die when faced with intolerable suffering was —
(1) The case of P Rathinam
(2) Gian Kaur judgement
(3) The Aruna Shanbaug judgement
(4) The Tern Schiavo case
28. Which of the following is drug of choice for intractable hiccup?
29. Mechanism of action of SCS (Spinal Cord Stimulation) includes all, except –
(1) Inhibition of action of Wide Dynamic Range (WDR) neurones
(2) Activation of GABAergic inhibitory interneurons in the dorsal horn
(3) Activation of supraspinal mechanism: Descending Seratonergic neurones and locus coeruleus neurones
(4) Activation of efferent sympathetic fibres
30. Indication of erythropoietin — stimulating agents (ESAs) in patients undergoing myelosuppressive chemotherapy who have a haemoglobin level less than –
(2) 8 g/dL
(4) 10 g/dL
31. Pain management in children with palliative care needs is different because of all the reasons listed below, EXCEPT —
(1) Understanding and interpretating of pain in non — verbal children needs a different approach
(2) Medication is frequently prescribed outside the terms of product license in children
(3) Children cannot “assent”
(4) Many drugs have not been studied for longer term dosing in children
32. Which of the following disease is least likely to be associated with chronic neuropathic pain in patient’s?
(1) Alzheimer’s disease
(2) Multiple sclerosis
(3) Parkinson’s disease
33. Unmyelinated peptidergic CGRP — expressing neurons are found in —
34. Sunitha, a 22-year-old woman with metastatic osteosarcoma (and lung metastases) complains of breathlessness at rest. Choose the single best answer –
(1) She has lung metastases, therefore, breathlessness is expected.
(2) She should be discharged for a peaceful death at home.
(3) Morphine does not have a role in management as she does not have pain.
(4) She may be frightened, this should be explored and addressed.
35. In detrusor weakness or bladder outlet obstruction Postvoidal Residual (PVR) urine is —
(2) >100 ml
(3) > 150ml
(4) >200 ml
36. The lignocaine 5% patch is used in the treatment of neuropathic pain. Precautions are all the following, Except –
(1) Use for only 16 hours a day
(2) Avoid in patients on a class I antiarrhythmic drug
(3) Apply on intact skin
(4) Use only for peripheral neuropathic pain
37. The following are all stimulant laxatives, EXCEPT –
(1) Sodium picosulphate
38. Which of the following statement about Superior Vena Cava Syndrome (SVCS) is not true?
(1) The most common malignant cause of SVCS is Non — Small Cell Lung Cancer (NSCLC)
(2) Lymphoma is the most common cause in patients less than 50 years
(3) More florid and severe symptoms and signs develop if obstruction is above the entry of the azygos vein
(4) The severity of the syndrome depends on the rapidity of onset, the relevance of the obstruction, and its location
39. It will not be helpful for the health care practitioner to give false hope to patients even though family members might persuade him / her to give it. All the following are true, EXCEPT —
(1) The trust between the patient and the physician will be broken.
(2) The trust between the patient and the family will be broken.
(3) The trust between the family members and the physician will be broken.
(4) False reassurance can lead to more anxiety.
40. All are true about opioid receptors, EXCEPT —
(1) Mu-opioid receptor (MOR) family is responsible for inhibition of nociceptive pathways
(2) Morphine have the greatest affinity for the MOR
(3) Dynorphin is endogenous ligand for MOR
(4) Morphine can bind to a lesser degree to the other opioid receptors
41. Bio chemical mediator for vomiting includes the following, EXCEPT –
42. All of the following conditions lead to constipation except two —
B. Diabetes Mellitus
(1) D and E
(2) C and D
(3) B and E
(4) C and E
43. Oral Morphine to Methadone conversion ratio for a patient who is currently on 40 mg Morphine every 4 hourly is –
44. What is stemmer’s sign?
(1) Pitting edema
(2) Dry thick skin
(4) Inability to pinch the fold of skin at the base of 2nd toe
45. Which one of the following preparation has highest average intra-articular duration of action?
(1) Methylprednisalone acetate
(2) Tnamcinolone acetonide
(3) Dexamethasone sodium phosphate
(4) Betamethasone acetate