General

Question 1

What are the four domains of palliative medicine?

Answer 1

Physical, psychological, social, spiritual

Question 2

What are the four types of pain?

Answer 2

Physical, social, psychological, spiritual

Question 3

How can physical pain be categorised?

Answer 3

Nociceptive, somatic, visceral, neuropathic

Question 4

Name examples of non-opioid analgesics

Answer 4

ibuprofein, NSAIDs, paracetemol, aspirin

Question 5

Examples of weak opioids?

Answer 5

Codeine, tramadol, low-dose morphine

Question 6

Examples of strong opioids?

Answer 6

Morphine, fentanyl, oxycodone, hydromorphone

Question 7

Examples of adjuvants for analgesic therapy?

Answer 7

antidepressants, anticonvulsants, biphsophaonate, corticosteroid

Question 8

Can you combine opioid drugs within the same class?

Answer 8

no

Question 9

What is OME/MEDD?

Answer 9

oral morphine equivalent= morphine equivalent daily dose

Question 10

What are the four components of the 4AT test?

Answer 10

Alertness (0-4)
AMT4 (Abbreviated mental test= DoB, date, location- 1 mistake=1, >2 mistakes= 2),
Attention (months of the year backwards- max score of 2),
Acute change/fluctuating course (0 or 4)

Question 11

Name three factors that can precipitate opioid toxicity

Answer 11

Drug interactions, renal impairment, sepsis, rapid dose escalation

Question 12

Name three symptoms of opioid toxicity

Answer 12

Hyperalgesia, sedation, delerium, hallucinations, myoclonus, vivid dreams/nightmares

Question 13

Name four symptoms that anticipatory medicine aims to address?

Answer 13

Pain, nausea & vomiting, agitation, SoB, respiratory secretions

Question 14

How much more potent is injection morphine relative to oral morphine?

Answer 14

Twice as potent

Question 15

How would you calculate the PRN subcut dose of morphine relative to the daily dose?

Answer 15

PRN dose= 1/6th to 1/10th of total daily dose

Question 16

The total daily dose of injection morphine is 60 mg. What would be an appropriate PRN dosage?

Answer 16

Between 6mg and 10mg (1/6th-1/10th)

Question 17

Which tools/scores can be used to measure the physical decline of a patient? e.g.from cancer

Answer 17

Clinity frailty scale= Rockford frailty score (1-9), palliative care indicator scoring

Question 18

List three triggers for nausea and vomiting

Answer 18

1. Gut (chemical/stretch) 2. Vestibular-cochlear (motion) 3. Chemotactic trigger zone (chemical disturbances in blood) 4. Limbic system (emotion/stress/pain)

Question 19

What are the signs/symptoms of bowel obstruction?

Answer 19

vomiting, nausea, abdo pain

Question 20

How to distinguish between upper and lower GI obstruction?

Answer 20

upper- more vomiting and nausea

Lower- more significant pain

Question 21

How to estimate prognosis for unwell patient?

Answer 21

Rate of change and physical mobility. E.g. if one month ago they were mowing the lawn and are now bed ridden and don’t know where they are, this would be a matter of weeks at most

Question 22

Which antiemetic drug is used in chemotherapy but not in surgery/palliative care

Answer 22

ondansetron

Question 23

Should you mostly calculate 1/6 or 1/10 of morphine for breakthrough doses?

Answer 23

1/6, 1/10 might be too low of dose, best to apply this to patients who may be more frail/sensitive