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After regaining consciousness, the patient informs you that she is 20 weeks pregnant. 5 Regarding pregnancy and usage of opioids, which of the following would most likely have the best outcome?

Continuing the patient on methadone.

Withdrawing the patient from all opioids in the first trimester (too late or this one).

Withdrawing the patient from all opioids in the second trimester.

Withdrawing the patient from all opioids in the third trimester.

You followed up today 60 years old lady with multiple myeloma, She’s been on hydromorphone 6mg PO Q4h and 4mg PO Q1h PRN for 2 weeks. She reported controlled pain on current regimen with 2-3 BTs per day. She asked to decrease the frequency as she does not like to take medications frequently. You offered hydromorphone SR and fentanyl patch and she preferred fentanyl patch. What is her dose?

12.5 mic/h Q72h.

25 mic/h Q72h.

50 mic/h Q72h.

100 mic/h Q72h.

Which of the following measures can improve the quality of dying:

Achieving good symptom control.

Avoiding inappropriate prolongation of dying.

Achieving sense of control.

Relieving burden for family members.

All of the above

Which of the following statement is false about palliative care?

It improve patient’s Quality of life and Quality of Dying.

Patient’s assessment is comprehensive which include physical, psychological, social and spiritual aspects.

Candidate patients are the one with life-long chronic illness.

It start early in the disease and continue after death by offering the family bereavement counselling.

Palliative care is an active approach and not a soft or hopeless option.

Which of the following is NOT a clue to spiritual pain?

Usually the patient get improved after optimizing his pain medications.

Profound feeling of emptiness, disconnection and hopelessness.

Feeling of separation from the God.

All symptoms in ESAS rated high.

No source for the symptom e.g pain

Which statement about palliative care is correct?

Palliative care doesn’t hasten death instead it attempt to prolong patient’s life as much as possible.

Palliative care is better to be started during the end of life as the family in need of support during this time.

Primary palliative care offered by palliative care physician at the Primary Care Center.

Multidimensional assessment and management is one of the principles of palliative care.

Clinical dietitian is one of the members of the palliative team

Which statement is false about respite of care?

Respite care is short-term inpatient care provided to the individual only when necessary to relieve the family members or other persons caring for the individual at home.

It is provided when the care giver has a strong reason like to attend a family event, such as a wedding, graduation, or other event.

It can be offered to patients residing in nursing homes.

If a caregiver is requesting frequent respite care, then a change in patient care environment may be warranted.

All of the above are true

Which of the following is NOT true regarding the role of the Family physician in palliative care.

Leader and coordinator of the team.

Referral to the specialists when needed.

Providing home visits that can keep the terminally ill patients at home as much as possible.

Prescribing methadone when the patient doesn’t respond to first line opioids.

Death pronouncement at home

Which of the following statement is true about opioids?

Opioids hasten death and better to be started at the end of life.

The Immediate Release oral morphine’s onset of action is 2-10 minutes and peak in 2 hours.

The Sustained release Oral morphine’s onset of action is 1 hour and peak in 2-3 hours.

After removal of fentanyl patch, the level decrease in blood by 50% in 6 hours.

The SC route equal the oral route when use morphine

You are following a 56 years old patient with metastatic pancreatic cancer. His main symptom is abdominal pain for which he is using hydromorphone SR 9mg PO BID and hydromorphone IR 2mg PO Q1h PRN. He use 7 doses per day. You tried many treatment for the pruritus he has but it seems refractory to treatment and affected the patient’s Quality of life. You decided to switch him to oxycodone. What is his new regimen?

Oxycodone SR 80mg PO BID and oxycodone IR 15mg PO Q1h PRN.

Oxycodone IR 15mg PO Q4h and 10mg PO Q1h PRN.

Oxycodone SR 50mg PO Q12h and Oxycodone IR10mg PO Q1h PRN.

Oxycodone SR 35mg PO Q8h and oxycodone IR 10mg Po Q1h PRN.

Non of the above regimen is right