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Palliative Exam > Ethics/Psych > Flashcards

Ethics/Psych Flashcards

1
Q

What is most common cause of death in bereaved pts?

A

Cancer and CV disease

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2
Q

Jehovah’s Witness may accept what blood product?

A

Albumin

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3
Q

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?

A

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

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4
Q

True/False.

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

A

True.

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5
Q

What are preferences of lower socioeconomic pts?

A

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.

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6
Q

What 2 cancers are most commonly associated with anxiety?

A

Lung and melanoma

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7
Q

True/False.

Most families will agree to an autopsy if asked.

A

True.

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8
Q

True/False.

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

A

True.

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9
Q

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

A

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

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10
Q

What is 1st line treatment for complicated grief?

A

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

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11
Q

Name 5 risk factors for complicated grief?

A
  1. Premature/unexpected death
  2. Hx of psychiatric disorders
  3. Nature of relationship to deceased
  4. Dysfunctional families
  5. Poor support system.
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12
Q

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

A

Narcissistic disorder

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

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13
Q

What is treatment for complicated grief?

A

Cognitive Behavioral Therapy

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14
Q

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

A

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

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15
Q

True/False. Artificial hydration can prolong dying process?

A

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

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16
Q

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?

A

False, 1/3 not half.

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17
Q

Muslim preference at end of life?

A

Needs to be cleaned of bodily fluids prior to praying

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18
Q

What is true about Buddhist belief?

A

Buddhists may avoid meds with animal byproducts.

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19
Q

What is % incidence of anxiety in cancer pts?

A

10%

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20
Q

What is countertransference?

A

When a provider transfers their personal thoughts onto a patient.

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21
Q

In Catholic pts, what is important at EOL?

A

Holy rites, viaticum before death.

22
Q

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

A

True.
False.
True.

23
Q

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

A

True

24
Q

How do preschool children view death?

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

A 
Preschool = death is reversible
Elementary = death is permanent
25
Q

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

A

Cognitive Behavioral therapy

26
Q

Difference between complicated grief and PTSD?

A

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

27
Q

What is determined quantitative futility?

A

Less than 1% chance of successful intervention.

28
Q

What is Judaism views in regards to end of life?

A

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

29
Q

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

A

False, About 45 % enrolled in hospice.

30
Q

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

A

1 year.

31
Q

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

A

Within 30 seconds to 2 mins.

32
Q

Sikhs preference at end of life?

A

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

33
Q

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

A

50%, Adjustment disorder

34
Q

What is distinctive feature of acute grief reactions?

Difference between complicated grief?

A

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

35
Q

What is most common type of delirium?

A

Mixed.

36
Q

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

A

Pt’s who have lost a child

37
Q

True/False? POLST form is part of AD?

A

False

38
Q

What is 1st line tx for borderline personality disorder?

A

Psychotherapy, dialectal behavioral therapy.

39
Q

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

A

Agoraphobia.

40
Q

What do advanced directives consist of?

A

POA and living will.

41
Q

Hindu preference at end of life?

A

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

42
Q

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

A

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

43
Q

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

A

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

44
Q

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

A

Major Depression.

45
Q

True/False.

Majority of hospice pts transferred out of house before dying were transferred to ED.

A

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

46
Q

Which race has the lowest utilization of hospice?

A

Asians/Pacific Islanders.

47
Q

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

A

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

48
Q

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

A

ABCD.

Attitude, beliefs, context, decision making

49
Q

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

A

10%

50
Q

What tool can be used to screen for elder abuse?

A

EASI

elder abuse suspicion index

51
Q

In COPD/CHF pts, what % develop anxiety?

A

50%

Palliative Exam (4 decks)

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