Ethics/Psych

Question 1

What is most common cause of death in bereaved pts?

Answer 1

Cancer and CV disease

Question 2

Jehovah’s Witness may accept what blood product?

Answer 2

Albumin

Question 3

True/False
75% of hospice pts are at least 85 y/o?
AA are more likely to enroll in hospice compared to whites?
1/3 of hospice pt dies at in-pt facility?
Majority of hospice pts die at home?

Answer 3

False. 40%
False
True
False, majority die in-pt or SNF.

Question 4

True/False.

Pts with continuous home hospice care were equally likely to die in home regardless of socioeconomic status.

Answer 4

True.

Question 5

What are preferences of lower socioeconomic pts?

Answer 5

Less likely to receive palliative care, more likely to have aggressive end of life care/admit to ICU, more likely to die in hospital, more likely to have physician directed care.

Question 6

What 2 cancers are most commonly associated with anxiety?

Answer 6

Lung and melanoma

Question 7

True/False.

Most families will agree to an autopsy if asked.

Answer 7

True.

Question 8

True/False.

Most pts want to know about their diagnosis but few want to know details of their diagnosis.

Answer 8

True.

Question 9

Can parents withhold life/limb saving interventions for their minor children?

Answer 9

No, physician does not consent from parents to treat. Minors are legally incompetent.

Question 10

What is 1st line treatment for complicated grief?

Answer 10

Targeted CBT. NO studies to support antidepressants as tx of complicated grief without underlying psychiatric disease.

Question 11

Name 5 risk factors for complicated grief?

Answer 11

1. Premature/unexpected death
2. Hx of psychiatric disorders
3. Nature of relationship to deceased
4. Dysfunctional families
5. Poor support system.

Question 12

What disorder involves grandiosity, need for admiration, superficial relationships, and lack of empathy?

Answer 12

Narcissistic disorder

Histrionic does not have the extreme grandiosity and wants approval/attention of others.

Question 13

What is treatment for complicated grief?

Answer 13

Cognitive Behavioral Therapy

Question 14

In cancer SURVIVOR pts, what % experience anxiety and what are the greatest risk factors?

Answer 14

20%, Younger age (<60), female.

Question 15

True/False. Artificial hydration can prolong dying process?

Answer 15

False, no evidence to support this. Controversial topic in hospice.

Question 16

True/False? Over half of grieving pts w/hx of mental illness will experience psychiatric illness, suicide, during first year of loss of loved one?

Answer 16

False, 1/3 not half.

Question 17

Muslim preference at end of life?

Answer 17

Needs to be cleaned of bodily fluids prior to praying

Question 18

What is true about Buddhist belief?

Answer 18

Buddhists may avoid meds with animal byproducts.

Question 19

What is % incidence of anxiety in cancer pts?

Answer 19

10%

Question 20

What is countertransference?

Answer 20

When a provider transfers their personal thoughts onto a patient.

Question 21

In Catholic pts, what is important at EOL?

Answer 21

Holy rites, viaticum before death.

Question 22

True/False.
Pacemaker will not prevent death?
Disabling pacemaker will lead to swift death?
It is possible to disable a defibrillator without disabling pacemaker?

Answer 22

True.
False.
True.

Question 23

True/False. About half of Medicare decedents are enrolled in hospice?

Answer 23

True

Question 24

How do preschool children view death?

How about elementary children (5-9 y/o)?

Answer 24

Preschool = death is reversible
Elementary = death is permanent

Question 25

What is 1st line tx for insomnia in bereaved pts?

Answer 25

Cognitive Behavioral therapy

Question 26

Difference between complicated grief and PTSD?

Answer 26

PTSD has fears, anxiety, and avoidance of trigger of event.

Question 27

What is determined quantitative futility?

Answer 27

Less than 1% chance of successful intervention.

Question 28

What is Judaism views in regards to end of life?

Answer 28

Life should be preserved however dying process should not be prolonged.

Question 29

True/False. Less than 1/4 of Americans are in enrolled in hospice at time of death.

Answer 29

False, About 45 % enrolled in hospice.

Question 30

Hospice requires bereavement counseling to families fora minimum of how long?

Answer 30

1 year.

Question 31

When informing family of a death, how long into a conversation should you bring up that pt has died?

Answer 31

Within 30 seconds to 2 mins.

Question 32

Sikhs preference at end of life?

Answer 32

Many like to say prayers immediately upon passing from family members, need to involve them at end of life. Prefer cremation over burial

Question 33

What % of pts with advanced cancer meet psychiatric disorder? What is most common disorder?

Answer 33

50%, Adjustment disorder

Question 34

What is distinctive feature of acute grief reactions? | Difference between complicated grief?

Answer 34

Intense thoughts and focus on memory of loss. Complicated grief has disabling effects. Acute grief is NOT a mental disorder

Question 35

What is most common type of delirium?

Answer 35

Mixed.

Question 36

Which group of pts have the highest risk of suicide, mental illness, and self-harm?

Answer 36

Pt's who have lost a child

Question 37

True/False? POLST form is part of AD?

Answer 37

False

Question 38

What is 1st line tx for borderline personality disorder?

Answer 38

Psychotherapy, dialectal behavioral therapy.

Question 39

What phobia is greater in cancer pts compared to general population?

Answer 39

Agoraphobia.

Question 40

What do advanced directives consist of?

Answer 40

POA and living will.

Question 41

Hindu preference at end of life?

Answer 41

Prefer male caregivers, involve many family members, gifs are common, value purity.

Question 42

In cancer survivor pts, what risk factors are associated with fear of recurrence?

Answer 42

Frequent doctor visits (5 per year), poor social support, young, female with children, hx of recurrence.

Question 43

What pt pop is higher risk of suicide in bereaved pts?

Answer 43

Risk of suicide is higher in non-caucasians, male, death of loved one by suicide, poor support, or hx of psychiatric disorder.

Question 44

What psychiatric condition is most common in HIV and substance abuse population?

Answer 44

Major Depression.

Question 45

True/False. | Majority of hospice pts transferred out of house before dying were transferred to ED.

Answer 45

False. Most transferred to in-pt hospice facility at death.

Question 46

Which race has the lowest utilization of hospice?

Answer 46

Asians/Pacific Islanders.

Question 47

What is one way to differentiate major depression from anticipatory grief?

Answer 47

Major depression has persistent thoughts of suicide. Cannot use anorexia, fatigue, insomnia, anger as depression in cancer its because overlap syndromes.

Question 48

What tool can be used to screen for cultural preferences? What does it stand for?

Answer 48

ABCD. | Attitude, beliefs, context, decision making

Question 49

According to USPSTF, what is % prevalence of elder abuse/neglect?

Answer 49

10%

Question 50

What tool can be used to screen for elder abuse?

Answer 50

EASI | elder abuse suspicion index

Question 51

In COPD/CHF pts, what % develop anxiety?

Answer 51

50%