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HPM Board Review > Early Tests and Prognostication > Flashcards

Early Tests and Prognostication Flashcards

1
Q

COPD relief before opioids:

A

oxygen, fans, pulmonary rehabc

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2
Q

Hiccup-genic meds:

A

benzos, dex

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3
Q

Drug of choice for hiccups:

A

baclofen

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4
Q

treats peripheral hiccups

A

reglan

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5
Q

30% of TIPS patients develope

A

encephalopathy

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6
Q

block for pelvic pain

A

hypogastric plexus

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7
Q

Did you review blocks?

A

Not yet

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8
Q

SSRIs and tamoxifen

A

Some (fluoxetine, paroxetine) inhibit cyto 2D6 and cannot be given with tamoxifen

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9
Q

Target of Aprepitant

A

Antiemetic, targets Neurokinin receptors in the the CRTZ

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10
Q

Treat cholestatic pruritis

A

cholestyramine, rifampin, naltrexone for opioid build up, methotrexate, sertraline, paroxetine, dronabinol

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11
Q

RLS at EOL

A

same as ever: pramipexole, ropinerole

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12
Q

drugs metabolized to morphine

A

codeine, heroin (codeine would be drug screen positive for codeine and morphine)

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13
Q

false positive for morphine

A

quinolones: ciprofloxacin, doxifloxacin, moxifloxacin

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14
Q

fentanyl class

A

phenylpiperdine (with pethidine, alfentanil, fentanyl, sufentanil and remifentanil) (synthetic)

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15
Q

methadone class

A

diphenylheptane derivatives (methadone, propoxyphene), (synthetic)

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16
Q

Natural opioids

A

Morphine, codeine, thebaine, papaverdine

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17
Q

semi-synthetic opioids

A

diamorphine (heroin), diahydromorphone, oxycodone, buprnorphine

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18
Q

synthetic opioids

A

fentanyl, methadone, tapentadol

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19
Q

MOP/mu agonism

A

How opioids provide analgesia

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20
Q

MOP/mu neuro pathway

A

indirectly INHIBITS periaqueductal grey (PAG) and nucleus reticularis paragigantocellularis (NRPG). INCREASES signal to the nucleus raphe magnus (NRM), increasing stimulation of 5-hydroxytryptamine and enkephalin-containing neurons which connect directly with the substantia gelatinosa of the dorsal horn.

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21
Q

4 A’s of pain treatment outcomes

A

analgesia, activities of daily living, adverse effects, aberrant behaviors

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22
Q

oxycodone or morphine–higher oral bioavailability?

A

oxycodone

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23
Q

Logistics of filling opioids q3m

A

2 post-dated prescriptions are allowed for scheduled II opioids. When this is done, prescribing clinicians should counsel patients to leave the post-dated prescriptions with their pharmacist for safe keeping

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24
Q

incidence of epidural mets is highest in these cancers, which frequently spread to the axial skeleton

A

breast, lung, prostate, myeloma, melanoma and hypernephroma

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25
Q

predicting mortality in dementia

A

7A qualifies for hospice, but dysphagia/feeding issues more strongly predicts death

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26
Q

when to increase basal morphine PCA

A

8 hours (accounts for 5 halflives)

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27
Q

time to peak effect of intranasal naloxone

A

20-30min, halflife is 2 hours. Always call 911 when giving naloxone

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28
Q

KPS

A

est 1949, 100-point scale for functional status in oncology settings. baseline activity levels, disease related disability, and dependence, 0 being dead, and 100 no functional limitation

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29
Q

KPS 40 or less predicts

A

median life expectancy of 3 months in cancer pt

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30
Q

ECOG

A

5-point global functional scale with 0 set as a normal and 4 being a moribund. Higher scores have been correlated with shorter survival. Not accurate in non-malignant illnesses.

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31
Q

Median survival 3 months (KPS, ECOG)

A

Karnofsky score <40 or ECOG > 3.

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32
Q

Prognosis for malignant hypercalcemia (except new dx breast)

A

8 weeks

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33
Q

Prognosis for malignant pericardial effusion

A

8 weeks

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34
Q

Prognosis for LMD

A

8-12 weeks

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35
Q

Prognosis for multiple brain mets

A

1-2 months without RT, 3-6 months with RT

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36
Q

Prognosis for malignant ascites, pleural effusion or bowel obstruction

A

<6 months

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37
Q

tx malignant hypercalcemia

A

treat cancer, bisphosphonates, hydration (and loop diuretics)

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38
Q

CPR survival

A

44% at 20 minutes; 17% leave the hospital. Arrhythmia 35%, asystole/PEA 10%

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39
Q

Worse prognosis CPR

A

Sepsis day prior, Cr > 1.5, metastatic cancer, dementia, dependent stats

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40
Q

Prognosis in compensated vs decompensated liver disease

A

12y vs 2y

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41
Q

prognosis for: metastatic solid cancer, acute leukemia or high-grade lymphoma, untreated (and 2 exceptions)

A

< 6 months, except breast or prostate with high KPS

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42
Q

In hospital mortality if feeding tube is placed:

A

15-25%; one year mortality is 60%

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43
Q

factors predicting high mortality from TF placement

A

advanced age, CNS pathology (stroke, dementia), cancer (except early stage head/neck cancer), disorientation, and low serum albumin.

44
Q

Modified Glasgow Prognostic Score mGPS

A

high mGPS means high CRP and low albumin; reduced survival in all cancer types

45
Q

PaP, palliative prognostic score

A

three risk groups of 30d survival: KPS, dyspnea, anorexia, white count and lymphs, clinical prediction of survival in weeks (D variant adds delirium)

46
Q

PPS, Palliative Prognostic Scale:

A

parallel to KPS (0-100), ambulation, activity level, self-care, intake, level of consciousness, determines estimated mean survival

47
Q

LMD by cancer type (solid)

A

common in breast cancer, small cell lung cancer, and melanoma while rare in gastrointestinal and gynecologic cancers.

48
Q

LMD in heme onc

A

found in 40-50% of patients, mostly commonly the acute leukemias, high-grade lymphomas (such as large cell and Burkitt lymphomas), and lymphomas in which the primary cancer site is the breast, testes, or vitreoretinal space.

49
Q

Best treatment response in LMD

A

hormone or HER2 receptor positive breast cancer, EGFR or ALK mutant lung cancers, BRAF or immunotherapy-responsive melanoma, some lymphomas, etc.

50
Q

Prognosis for patients with LMD who are treated with comfort care

A

weeks to months

51
Q

COPD prognosis factors:

A

age, degree of dyspnea, weight loss (BMI), functional status, and FEV1 are relevant prognostic factors for predicting 1-3 year survival.

52
Q

CHF hospice criteria

A

a) symptoms of recurrent HF at rest (NYHA class IV) and b) optimal treatment // EF < 20% is helpful but not required.

53
Q

CHF 1y mortality by class

A
  • Class II (mild symptoms): 5-10%.
  • Class III (moderate symptoms): 10-15%.
  • Class IV (severe symptoms): 30-40%.
54
Q

Negative prognostic indicators in CHF

A

hospitalization, treatment intolerance, hypotension, tachycardia, renal disease, low LVEF, arrhythmia, anemia, hyponatremia, cachexia, orthopnea, co-morbid diseases

55
Q

FAST stage 7A (impaired ADLs, incontinence, and can only speak 6 words) is appropriate for hospice enrollment if

A

also has aspiration, upper urinary tract infection, sepsis, multiple stage 3-4 ulcers, persistent fever, or weight loss >10% within six months

56
Q

MRI scale for dementia

A

morality risk index, uses variables and comorbidities, greater value at 6 months but only validated in new nursing home admits

57
Q

Dex dosing for bone pain:

A

2 to 8 mg of oral dexamethasone either given once in the AM or divided over BID dosing

58
Q

Maslach Burnout Inventory: three domains

A

a) Emotional Exhaustion: being emotionally overextended and exhausted by one’s work. B) Depersonalization C) Personal accomplishment: feeling competent and successful

59
Q

Survival from a traumatic adult brain injury, with an initial Glasgow Coma Score of 3-5 can be expected in:

A

15-20%

60
Q

neurologic damage related to a fracture is a relative contraindication for

A

vertebroplasty.

61
Q

antispasmodics in mechanical back pain

A

not effective beyond 2 weeks

62
Q

most sedating muscle relaxant

A

Tizanidine, avoid in elderly

63
Q

least sedating muscle relaxant

A

metaxolone

64
Q

atropine and scopalomine structure

A

tertiary amines, cross the BBB

65
Q

glycopyrolate structure

A

quaternary amine, does not cross BBB

66
Q

testosterone recovery after opioid cessation

A

days!

67
Q

known to cause skin irritation in SQ infusion

A

methadone

68
Q

Peak effect of IV tylenol

A

10 minutes (vs 1 hour for PO, likely due to increased CNS concentration)

69
Q

lido patch facts (4)

A

best for neuropathic pain, can be cut, contraindicated in liver disease, absorbed less than 5% so does not cause topical numbness

70
Q

an example of a small intestine secretogogue

A

liactolide

71
Q

an example of a selective chloride channel-2 activator

A

lubiprostone

72
Q

Answering “Yes” to the surprise question

A

93% while the positive predictive value of “no” answers may only be 37%. More accurate for cancer patients, has been studied and validated in almost every setting

73
Q

Tx acute urinary retention

A

alpha antagonists like doxazosin

74
Q

Only strong negative predictor of poor CPR outcome

A

myoclonic status epilepticus within 1 day of CPR or rewarming

75
Q

diffuse muscle loss associated with an increase in fat mass and abdominal circumference.

A

Sarcopenia

76
Q

how opioids cause myoclonus

A

3-glucuronide opioid metabolites

77
Q

opioid induced nausea

A

is not an allergic reaction, but rather a side effect to which tolerance develops within 3-7 days in most patients.

78
Q

increased risk of hospitalization from hypoglycemia

A

tramadol

79
Q

opioid metabolites are secrete by

A

kidneys

80
Q

proportion of active drug that enters systemic circulation

A

bioavailability

81
Q

legal standard of informed consent

A

varies by state

82
Q

does botox treat dry mouth

A

no, it treats hypersalivation (and depression!)

83
Q

skin wound that commonly occurs over the sacrum during dying process; usually irregularly shaped, pear-shaped, or butterfly-shaped; > 2 inches in diameter; and may include red, yellow, black, and/or purple discoloration.

A

Kennedy terminal ulcer

84
Q

Prognosis in HRS

A

6 months or less

85
Q

Liver disease, MELD score factors

A

serum creatinine, total bilirubin, and INR.

86
Q

One year mortality from onset of hepatic encephalopathy in end stage liver disease

A

60%

87
Q

Anuric renal failure, prognosis off HD

A

5-12 days

88
Q

Accuracy of prognosis in hospice discharges

A

20% of predictions were accurate, doctors overestimated by a factor of 5.3!

89
Q

ESRD on HD, 1 and 5 year mortality

A

25%, 60%

90
Q

ESRD on HD, KPS < 70

A

RR of dying within 3y is 1.44

91
Q

ESRD on HD, strong predictor of death

A

Albumin < 3.5

92
Q

Charleston Co-Morbidity Index

A

correlates to prognosis in ESRD

93
Q

Prognosis of HIV

A

same as general population, except for Black people, OIs, poor functional status, low CD4 count, hhigh viral load, active substance use

94
Q

Parkinsons complications, within 5 years of diagnosis

A

dyskinesias, psychosis, dystonia (treatment related)

95
Q

Parkinsons complications, within 12 years of diagnosis

A

falls, gait disturbance, balance issues

96
Q

Parkinsons complications, within 15-20 years of diagnosis

A

issues with dementia/hallucinations

97
Q

Poor prognosis in stroke (at 3 months)

A

NIHSS > 16, age > 75, women, embolic, hemorrhagic conversion, low income, poor social support, treatment after >2 hours, ED stay > 8h; not getting tPA, not being at a stroke center

98
Q

technical definition of cachexia

A

> 5% weight loss over 6 months in absence of starvation or BMI <20 and weight loss >2%; or appendicular skeletal muscle index consistent with sarcopenia and weight loss >2%

99
Q

refractory cachexia prognosis

A

<3 months

100
Q

ECOG 1

A

Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature (light housework/office work). (KPS 80-90)

101
Q

ECOG 2

A

Ambulatory and capable of self-care but unable to carry out work activities. Up and about more than 50% of waking hours. (KPS 60-70)

102
Q

ECOG 3

A

Capable of limited selfcare, confined to bed/chair more than 50% of waking hours. (KPS 40-50)

103
Q

ECOG 4

A

Disabled, unable to perform any self-care, and totally confined to bed or chair. (KPS 10-30)

104
Q

ECOG 5

A

Dead (KPS 0)

105
Q

ECOG limitations

A

meant to capture functional impairments from cancer or cancer treatments. It is difficult to interpret for functional limitations from unrelated processes (e.g., a preexisting spinal cord injury) and it is not validated in children nor for prognostication in people without cancer.

106
Q

ALS hospice criteria (3)

A

Impaired breathing, VC <30%; significant functional decline; life-threatening complications (sacral wound, sepsis, aspiration)

HPM Board Review (5 decks)

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