MCQs review 13-24

A 75-year-old man diagnosed 6 months ago with stage D cancer of the prostate comes to your office. He has been asymptomatic for the past 6 months, but last week he began to develop severe pain in the lower lumbar spine. He also appears quite pale. On examination, his prostate is hard. He has tender lumbar vertebrae L2- 5. Your suspicions of metastatic bone disease are confirmed when a technetium-99 m bone scan shows increased uptake of radionuclide in L2-5 and in both femurs, both tibias, and both humeri.

1. What is the treatment of first choice at this time?

You institute appropriate therapy for this patient. He quickly becomes pain free and remains that way for 6 months. He then returns with cervical, thoracic, and lumbar back pain; bilateral thigh pain; bilateral knee and leg pain; and pain in both shoulders and both arms (diffuse). Therapeutic options at this time include which of the following?

Which of the following pharmacologic agents is the drug of first choice for the treatment of mild metastatic bone pain?

A 52-Year-Old Man with Metastatic Renal Cell Carcinoma A 52-year-old man with metastatic renal cell carcinoma presents for assessment of a pain beginning in the buttocks and traveling down the left leg. It has a sharp, stabbing, burning, or “zinger-like” quality, according to the patient. The patient indicates that the baseline pain is 5 on a 10-point scale, with a range from 3 to 7. 5. What is (are) the drug(s) of first choice for the management of this patient’s cancer pain?

A 66-Year-Old Woman with Metastatic Renal Cell Carcinoma A 66-year-old woman with metastatic renal cell carcinoma presents for assessment of a pain also beginning in the buttocks and traveling down the left leg. The only difference between this patient’s pain and that of the patient in Clinical Case Problem 2 is that this patient describes the pain as dull and throbbing. 6. What is (are) the drug(s) of first choice for the management of this patient’s cancer pain?

The location of the lesions described in the two patients presented in Clinical Case Problems 2 and 3 is best portrayed as which of the following?

Which of the following agents would be classified as second-line analgesic therapy for the management of cancer pain?

Which of the following agents is not classified as a third-line pharmacologic agent in the management of cancer pain?

A patient comes to your office with moderately severe cancer pain. You prescribe the third-line agent (because of the description of the pain as moderately severe). Which of the following best describes the preferred approach to management of this patient’s cancer pain?

begin with a twice-daily oral dose of long-acting morphine

begin with a twice-daily oral dose of long-acting morphine plus short-acting oral morphine for breakthrough pain

begin with a dose of short-acting oral morphine every 4 hours

begin with a transdermal fentanyl analgesic patch

begin with a dose of 200 mg morphine/day in any form

A patient who is maintained with long-acting morphine and short-acting morphine for breakthrough pain presents with a 1-week history of an increasing need for short-acting morphine. He is now taking three times the number of short- acting tablets as previously. What should you do at this time?

prescribe more short-acting morphine; keep the amount of long-acting morphine the same

transfer the increased requirement into long-acting morphine and maintain a supply of short-acting morphine

c. transfer the increased requirement into both increased amounts of long-acting morphine and increased amounts of short-acting morphine

switch to another third-line oral agent

switch to a transdermal delivery system