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Palliative Exam > Disease Specific > Flashcards

Disease Specific Flashcards

1
Q

What kind of pain are commonly associated with HIV neuropathy?

A

Allodynia and hyperalgesia

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2
Q

True/false. Long term mortality is worse in NSTEMI compared to STEMI.

A

True

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3
Q

True or false? In glioblastoma multiform, females have a worse prognosis than men?

A

False, men have a worse prognosis.

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4
Q

What must be present to confirm brain death?

A

Core temp above >36 degrees Celsius. 97 F. No confounding med toxicities.

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5
Q

Most common type of incontinence in elderly pts? Tx?

A

Urge, abrupt, frequency. Tx is behavioral first then meds.

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6
Q

In actively dying pts who experience delirium, what other symptoms can be expected? Is delirium natural course of actively dying?

A

Will lead to myoclonic jerks and seizures. Not natural course for actively dying pt.

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7
Q

What is most common presentation and location of HIV neuropathy?

A

Affects lower extremities and starts distally then progresses proximally.

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8
Q

What can be considered for pneumothorax?

A

Heimlich Valve.

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9
Q

Time of brain death before cardiopulmonary arrest?

A

Couple of days prior

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10
Q

In STEMI pts, what is 30 day mortality?

A

2.5-10%

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11
Q

Octreotide can help with what kind of diarrhea?

A

Secretory diarrhea.

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12
Q

What is tx for tissue wasting in HIV/AIDS patient?

A

Starting antiretroviral therapy.

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13
Q

True/False. Scheduled replacement of urinary catheters reduce risk of infection?

A

False

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14
Q

In ALS pts, when is best time to place PEG if pt requests it?

A

Before vital capacity is less than 50%, if after it is associated with increased morbidity.

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15
Q

What pt population is drorabinol indicated for?

A

HIV pts with anorexia and weight loss. Also refractory chemotherapy induced nausea.

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16
Q

1st line tx for opioid induced constipation?

A

Senna. Docusate plus seen has not shown to be more efficacious. Naltrexone can be considered if no response to 1st line. Avoid Milk of magnesia in HD pts.

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17
Q

Which cancer is most associated with a chronic cough?

A

Head and neck cancer at 90%

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18
Q

Tx for severe xerostomia?

A

Pilocarpine.

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19
Q

What 2 effects can Menace improve in cancer pts?

A

Improve fatigue and poor appetite.

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20
Q

Nausea 2/2 to metabolic etiology affects which part of the brain?

A

Chemoreceptor trigger zone in 4th ventricle.

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21
Q

Best physical exam to evaluate for constipation?

A

DRE

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22
Q

Which part of the brain is responsible for anticipatory nausea?

A

Cerebral Cortex.

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23
Q

What is preferred laxatives in elderly due to lesser SE?

A

Miralax

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24
Q

What are tumor markers for breast CA?

A

CA 15-3 and CA 27.29

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25
Q

What electrolyte abnormalities are seen in Tumor Lysis syndrome?

A

Hypocalcemia and hyperphosphatemia

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26
Q

What 3 signs are strongly associated with worse prognosis in prostate cancer?

A

Anemia, poor PPS, spinal cord compression w/decreased ambulation.

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27
Q

Which type of dementia carries the worst prognosis?

A

Lewi-Body Dementia.

28
Q

What is the leading cause of death from blood transfusion?

A

TRALI

29
Q

Which SSRI needs to be tapered over long time (weeks) due to long half-life?

A

Fluoxetine

30
Q

What is 1st line tx for chronic cough?

A

Hydrocodone/tylenol

31
Q

What is 1st line treatment for HIV neuropathy?

A

1st is refer to HIV dietician or decrease antiretrovirals. Can consider gabapentin or lamotrigine if 1st line fails.

32
Q

Alzheimer pt with insomnia, what is med tx?

A

Trazodone 50 mg.

33
Q

What is pathophysiology of brain death?

A

Abnormal blood flow to brain leading to brain ischemia and sympathetic nervous system collapse.

34
Q

What is 1st line treatment for non-specific nausea? 2nd line?

A

Reglan then Zofran

35
Q

What components in Child-Pugh score? How long does it predict mortality?

A

Bilirubin, albumin, INR, Ascites, encephalopathy. Mortality at 1 year.

36
Q

What components are in MELD score? How long does it predict mortality for?

A

Cr, Bilirubin, INR, sodium. Predicts 3 month mortality

37
Q

How long with symptoms to be considered chronic prostatitis?

A

3 months

38
Q

What kind of nausea is haldol preferred for?

A

Metabolic or medication induced nausea

39
Q

Prognosis of untreated Stage 4 small cell lung CA?

A

2-3 months

40
Q

What MRSA antibiotic can potentiate Serotonin Syndrome with other agents?

A

Linezolid.

41
Q

True/False. In spinal cord compression, surgical intervention is associated with improved outcomes compared to radiation?

A

True.

42
Q

In spinal cord compression what is dose of Dexamethasone?

A

10 mg IV, Higher doses have not been shown to be more beneficial.

43
Q

What condition can present with nausea, weakness, anorexia, dehydration, orthostatic hypotension?

A

Adrenal insufficiency

44
Q

Pt with pelvic malignancy has burning pain in rectum/perineal area, achy dull in sacral, sphincter incontinence and sensory loss, what is this called?

A

Sacral plexopathy

45
Q

What are some signs/symptoms of impending death?

A

drooping of nasolabial folds, mandibular breathing, oliguria, decreased radial pulses, death rattle, cheyne stokes respirations, upper GI bleeding, neck hyperextension.

46
Q

Prognosis of untreated Stage 4 HCC?

A

4-6 months

47
Q

Tx for refractory vertebral cancer lesions?

A

Samariam 153 and strontium 89
Samarium 153 is tetraphosphonate.
Strontium 89 is radionucleotide.

48
Q

What drug is useful for tx of pruritus with unknown cause?

A

Gabapentin

49
Q

What is most reliable predictor of pt outcome after cardiac arrest?

A

Bilateral loss of cortical SSEPs, poor outcome.

50
Q

What is 5 year survival rate for metastatic melanoma?

A

15-20% survival at 5 years.

51
Q

True/false.

Stage 4 rectal and colon cancer have similar survival rates?

A

True. 5 year survival at 12 and 11%

52
Q

2nd most common cause of lung cancer after smoking is?

A

Radon at 7% annually.

53
Q

What ECOG stage if pt is capable of all self care, unable to carry work activities, up and about >50% of waking hours?

A

ECOG 2

54
Q

What ECOG stage if pt needs limited self care, confined to bed/chair >50% of waking hours? What tx is he excluded from?

A

ECOG 3

Excluded from clinical trial therapies.

55
Q

What is 2 year mortality of symptomatic AS?

A

50-70%

56
Q

What is prevalence of Alzheimers in US adults >85?

A

30-50%.

57
Q

Pt undergoes celiac plexus block however develops pain in legs, loss of motor and temp, but proprioception is intact. What happened?

A

Anterior cord syndrome.

58
Q

What is median survival for onset of symptoms of ALS?

At time of dx?

A

Symptom onset: 32 months

At time of dx: 19 months

59
Q

What are poor prognostic factors for ALS?

A

Single, female, bulbar symptoms, older, shorter time from symptom to dx.

60
Q

What is 3 step process to tx cholestatic pruritus?

A
  1. cholestyramine
  2. Rifampin
  3. Naltrexone, but only if pt is not in any pain and doesn’t need opioids.
61
Q

What disease is most associated with a chronic cough?

A

Head and neck cancer

62
Q

What malignancy is most common cause of pericardial effusion?

A

Lung Cancer

63
Q

What electrolyte abnormalities can be seen in Tumor Lysis Syndrome?

A

Hyperuricemia, Hyperphosphatemia, Hyperkalemia, HYPOcalemia, and renal impairment

64
Q

What conditions can Tumor Lysis Syndrome lead to?

A

cardiac arrhythmias, renal failure, seizures, death

65
Q

What is treatment to prevent TLS?

A

Rasburicase or allopurinol.

66
Q

What state is characterized by having sleep wake cycles but no purposeful movements to stimuli?

A

Persistent vegetative state.

Palliative Exam (4 decks)

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