Fast Facts Quiz

Dypsnea

Mr. Jones is an 86-year-old man with severe COPD and lung cancer. He presents to your palliative medicine clinic today for follow-up. He has opted to cluster his appointments today before he goes out of town for the weekend. He is going to see his oncologist and pulmonologist later today. Of the following, which is the best diagnosis code (ICD-10) to use for the visit?

Anoxic Incephalopathy

Which of the following indicators is most strongly correlated with a poor neurological outcome in the setting of anoxic ischemic encephalopathy after a cardiac arrest?

Back Pain in the Cancer Patient

A breast cancer patient has dull-achy midline back pain that is progressively more intense over several weeks. The patient has a normal neurological examination. The first diagnosis that should be ruled out is?

Billing

You are seeing a patient as an outpatient consultant for support and cancer-related pain in the setting of non-small cell lung cancer. After spending 30 minutes with him, he leaves abruptly to get to his oncologist appointment. Which of the following is true?

Brain Injury Prognosis

Survival from a traumatic adult brain injury patient, with an initial Glasgow Coma Score of 3-5, can be expected in what percentage of patients?

CHF Prognosis

All of the following laboratory findings are independent predictors of shorter survival in advanced heart failure, except:

Dialysis Prognosis

A long-term kidney hemodialysis patient with no residual kidney function wants to know how long she would likely survive if she stops dialysis. The best response would be to say that the average patient survives approximately?

Informed Consent

Which one of the following statements is TRUE: a) Clinicians are allowed by law to provide any necessary emergency treatment without informed consent. b) Informed consent for treatment is not necessary if transported following a 911 call. c) Starting antibiotics in the Emergency Room does not require informed consent unless the patient is a minor. d) The legal standard of informed consent varies between states.

IV Hydration

Which one of the following statements about intravenous (IV) hydration in the last week of life is true?

LVAD Deactivation

Which of the following statements is TRUE for patients with a left ventricular assist device (LVAD) at the end of life?

Myoclonus

Ms. R. is a very pleasant 68 year old woman with metastatic ovarian cancer, who presents to the outpatient palliative care clinic with new onset jerking motions that have been occurring for about 4 days. She describes them as very brief, sudden movements that can occur at any time. She is not certain what triggers them, but notices that she jerks once and then they go away. After your examination you diagnose the jerks as myoclonus.

Nightmares

A 44 y/o man being seen today by his primary care provider in clinic for follow up of his hypertension and recent diagnosis of basal cell skin carcinoma on the side of his nose. He underwent Mohs Surgery 6 weeks ago with clean surgical margins. Today, he shares that he is having nightmares, with recurrent […]

Non-Disclosures

You are caring for a 64-year-old man who presented with painless jaundice and fatigue, but is otherwise in his normal state of health. With the family in the room, you tell the patient that you are concerned about possible causes including cancer, and are recommending a CT of the abdomen and pelvis. The patient’s son […]

Opioid-Induced Constipation #3

Which of the following agents has an FDA-approved indication for use to treat patients with opioid-induced constipation in the setting of advanced cancer? a. Naloxegolb. Alvimopanc. Linaclotided. Methylnaltrexone bromide The correct answer: D. Methylnaltrexone is indicated for treatment of opioid-induced constipation (OIC) in adult patients with chronic, non-malignant pain, as well as in those patients […]

Opioid-Induced Constipation #2

Which of the following statements about the treatment of opioid-induced constipation (OIC) is true? a. A high-fiber diets is the cornerstone for treating OIC.b. Senna is an effective osmotic laxative commonly used in treating OIC.c. The use of stimulant laxatives like bisacodyl may be limited by abdominal cramping and pain in the setting of OIC.d. […]

Opioid-Induced Constipation #1

Which of the following treatments is ineffective in treating opioid-induced constipation? a. Sennab. Docusate sodiumc. Manual evacuationd. Polyethylene glycol The correct answer: B. In randomized controlled studies for opioid-induced constipation, the use of docusate sodium did not result in improved laxation when compared to placebo. Senna (stimulant laxative) and polyethylene glycol (osmotic laxative) are both […]

Opioid Dose Escalation

A patient reports increasing cancer pain on her current opioid regimen along with recent cancer progression. Up to 3 weeks ago she had good pain control but since then, the pain has gradually worsened. She reports a pain level of 8/10 most of the day and difficultly falling and staying asleep due to pain. The […]

Onset of Opioid Analgesia

When would you expect that a patient would experience the onset of analgesic effect after taking a dose of Morphine Sulphate Immediate Release tablets (MSIR)? a.      5 – 10 minutes b.   20 – 30 minutes c.    45 – 60 minutes d.   75 – 90 minutes Answer: b.   The onset […]

Opioid Poorly Responsive Pain

Mr. Jones is a 66 y/o man with colon cancer with metastases to his bones and liver. His bone pain was well controlled on morphine ER and oxycodone IR. Over the next two weeks he noted increasing pain. Upward titration of the opioids had no effect. What is the first step in responding to pain […]

Pain in the Cognitively Impaired

You are seeing an elderly man with prostate cancer and cognitive dysfunction. His daughter is concerned that he may be experiencing pain. Which of the following statements is true regarding pain management in a cognitively impaired patient. a. Family members tend to under estimate the degree of pain in cognately impaired loved ones.b. Opioids tend […]

Palliative Care Consultation

When a referring clinician wants to broach the subject of a palliative care specialty consultation with a patient and family, which one is the best suggested phrases to use: a) Palliative care clinicians have special expertise in managing dying patients. b) Palliative care clinicians work together as an interdisciplinary team. c) Palliative care clinicians can […]

Senna Laxatives

The laxative senna has all of the following features, except: a) It frequently causes abdominal gas. b) It is available at health food stores as a “natural” product. c) It requires transformation to active drug in the gut. d) It stimulates the dorsal root ganglion to increase gut motility. Answer d Senna-based products are inexpensive, […]

The DNR Discussion

Which of the following is the best first step in leading a DNR discussion? a) Ask the patient if they have completed an advance directive b) Decide if you believe CPR to be medically indicated c) Inform the patient that you will respect their decision d) Tell the patient your CPR/DNR recommendation Answer b. Before […]

Tube Feeding

Which of the following statements about feeding tubes is true? A. Tube feeding can help reduce incidence of aspiration pneumonia events in patients who are bedridden after a stroke. B. Feeding tubes may enhance the quality of life in patients with proximal small bowel obstruction. C. Increasing caloric intake via feeding tube prolong life in […]