Q133- 144

A 68 year old female has significant peripheral neuropathy which is severely limiting function. She has renal impairment and narrow angle glaucoma.
Which of the following is the preferred neuropathic pain option
duloxetine
amitryptiline
gabapentin
pregabalin
pregabalin
A 60-year-old woman with locally advanced cancer of the left breast presented with recent-onset lymphoedema of her left arm. She is not a candidate for radical resection, and due to her pulmonary co-morbidities, she is unable to tolerate radiotherapy. Her examination shows a very swollen left arm, elbow and wrist associated with ischaemic changes in the fingers of her left hand. There is no radial pulse and doppler ultrasound scan shows no thrombus in any of the veins however reduced flow within her brachial arteries.
What is the most appropriate initial management of her lymphedema?
Multilayer lymphedema bandaging
Manual lymphatic drainage
Frusemide and spironolactone
Compression sleeve
A 78 year old male with metastatic prostate cancer with multiple bony lesions complains of sudden onset right hip pain. A CT scan shows a large lytic lesion with cortical thinning within the upper third of the femur.
What is the most appropriate management for this patient?
Densoumab
Radiotherapy
Surgical Fixation
Non-weight bearing status
Bisphosphonates and analgesia
The dose conversion ratio of oral (PO) morphine (M) to oral hydromorphone (HM) in the management of chronic pain is?
M 10 mg PO = HM 5 mg PO
M 10 mg PO = HM 20 mg PO
M 10 mg PO = HM 2 mg PO
M 10 mg PO = HM 10 mg PO
M 10mg PO = HM 50 mg PO
Which one of the following would not be an appropriate treatment for a patient with advanced cancer requiring morphine treatment for pain who presents with myoclonus, hallucinations, sedation?
Nalaxone (opioid antagonist)
Switch the opioid (opioid rotation)
Reduce the opioid dose while trying other measures to control pain
Hydrate the patient
Give haloperidol
An 88-year-old man enrolled in hospice four months earlier for the diagnosis of advanced dementia. He has been slowly deteriorating. This morning on examination the patient was lethargic with cool extremities. This afternoon the patient’s daughter calls you with concerns that the patient is making “a weird gurgling noise.”
Which of the following is true?
Glycopyrrolate may help treat this symptom without crossing into the central nervous system.
The “terminal secretions” described is often very distressing to patients.
The average survival time after the onset of “terminal secretions” is 2 days.
Multiple studies support the use of anticholinergic medications to treat "terminal secretions"
Scopolamine is the best drug to use for such symptoms occurring acutely
79-year-old man in a nursing home becomes apneic and unresponsive and has pinpoint pupils after being given his evening medications. His medications include lisinopril, aspirin, atorvastatin, and morphine sulfate ER. Which of the following may have caused his symptoms?
He is having withdrawal from not being given morphine
Lisinopril should not be taken with morphine and aspirin
His morphine tablet was crushed before administration.
He is having an anaphylactic reaction to aspirin.
This presentation is not related to his medications
You are visiting with the wife of a patient who is having difficulty making the transition to palliative care for her dying husband. What is the most desirable outcome for the couple?
They express hope for a cure.
They comply with treatment options.
They set additional goals for the future
They acknowledge the symptoms and prognosis.

A patient has been receiving palliative care for the past several weeks in light of her worsening condition after a series of strokes. The caregiver has rung the call bell,stating that the patient "stops breathing for a while, then breathes fast and hard, and then stops again." You recognize that the patient is experiencing

Apnea
Bradypnea
Death rattle
Cheyne-Stokes respirations
What is the primary purpose of hospice?
Allow patients to die at home.
Provide better quality of care than the family can.
Coordinate care for dying patients and their families.
Provide comfort and support for dying patients and their families
The hospice nurse identifies an abnormal grief reaction by the wife of a dying patient, who says
"I don't think that I can live without my husband to take care of me."
"I wonder if expressing my sadness makes my husband feel worse."
"We have shared so much that it is hard to realize that I will be alone."
"I don't feel guilty about leaving him to go to lunch with my friends."
A hospice nurse is visiting with a dying patient. During the interaction, the patient is silent for some time. What is the best response?
Recognize the patient's need for silence, and sit quietly at the bedside.
Try distraction with the patient.
Change the subject, and try to stimulate conversation.
Leave the patient alone for a period
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