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HPM boards > HPM > Flashcards

HPM Flashcards

1
Q

side effects of megestrol

A

adrenal insufficiency
venous thromboembolism
androgen insufficiency

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2
Q

what does MODS predict

A

predictor of mortality among ICU patients.

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3
Q

what variables does MODS use

A

physiological variables (PaO2/ FIO2, plt count, bilirubin, (heart rate*CVP)/SBP, GCS, serum creatinine)

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4
Q

what is most important parameter affecting mortality in MODS score

A

number of failing organs

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5
Q

what is the leading cause of death from blood transfusions

A

TRALI

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6
Q

prognosis of patients with HGb<3

A

median survival is 4-5 days

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7
Q

familial adenomatous polyposis- what cancers are associated with it

A

papillary thyroid cancer, adrenal carcinomas, central nervous system tumors

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8
Q

inherited pancreatic cancer= what also do they have increased risk of

A

2x likely to die of breast cancer

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9
Q

chances of developing breast cancer from Peutz-Jeughers

A

54%

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10
Q

hereditary conditions associated with increased risk of breast cancer

A

familial pancreatic cancer, cowden syndrome, peutx-jeghers syndrome, hereditary diffuse gastric cancer

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11
Q

how to notify patient’s family of death if they are not present

A

over phone if >1 hour away, otherwise wait for in person

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12
Q

how quickly should physicians tell family that a patient has died

A

important to get point out quickly- within 30 seconds to 2 mins of starting the conversation

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13
Q

how does having an additional child affect grief of parents

A

associated with recovering from grief of losing a child

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14
Q

what is best predictor of prognosis

A

functional status
pps 40%-> life expectancy <8 weeks

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15
Q

how to calculate intrathecal morphine dose from oral morphine dose

A

Morphine: 10mg IV = 1mg Epidural = 0.1mg Intrathecal (1/10 ratio; very hydrophilic)

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16
Q

which group has the lowest rates of hospice enrollment

A

asian and pacific islander

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17
Q

what receptors are in the GI tract that are affected by opioids

A

mu receptors

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18
Q

what type of opioid receptors are in the chemoreceptor trigger zone

A

mu opioids

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19
Q

what causes hypotension, rash, and pruritis with morphine use

A

histamine release

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20
Q

besides constipation, what is the other persisting effect of opioid use

A

miosis

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21
Q

what drugs can be used with buproprion

A

SSRIS/SNRIS as the bupropion counteracts sex side effects

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22
Q

what should you not take with bupropion

A

-MAOIS (wait 14 days or can cause htn)
-clozapine, theophylline, clomipramine because they lower seizure threshold

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23
Q

three risk factors most highly associated with decrease in global function in children after death of a parent

A
  1. lower socioeconomic status
    2.pre-exisiing psych factors
  2. presence of a depressed surviving patient
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24
Q

three mechanisms of methadone

A
  1. mu receptor agonist
  2. NMDA antagonist
  3. inhibitor of monoamine transmitter reuptake
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25
Q

TCA with best side effect profile

A

nortriptylline (also desipramine- secondary amines)

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26
Q

how do opioids affect respiratory depression

A

agonism of mu-opioid receptors in ventral medulla

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27
Q

when can children use number scale or visual analog scale for pain

A

> 8 years old when they can understand abstract concepts

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28
Q

when can the faces scale be used in kids

A

> 4 years old

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29
Q

how does buprenorphine work

A

mixed agonist-antagonist opioid receptor modulator with partial agonist at mu opioid receptors and opioid receptorlike receptors; antagonistic at kappa and delta opioid receptors

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30
Q

what medication interaction can dextromethorphan have

A

can cause serotonin syndrome

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31
Q

two central acting cough suppressants

A

opioids, gabapentin

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32
Q

what are the most common side effects of celiac plexus blocks

A
  1. diarrhea
  2. orthostatic hypotension (due to Inc parasympathatic tone, should volume resuscitate ahead of procedure)
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33
Q

can you have passive wishes for death in a normal grief reaction

A

yes, passive wishes are nomal, but more depression when it becomes SI and persistent

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34
Q

do all states have a next of kin rule

A

no

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35
Q

what is the most common cause of malignant cardiac effusion

A

lung cancer

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36
Q

where should intercostal nerve blocks be performed

A

under the rib to block nerve fibers associated with nociception

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37
Q

how to treat serotonin withdrawal

A

restart medication at prior dose and taper slowly

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38
Q

which herbal supplement has been shown to improve fatigue in patients with cancer

A

american ginseng

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39
Q

6-MAM is a unique metabolite of what substance

A

heroin

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40
Q

cisplatin- emetogenic risk

A

high

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41
Q

rituximab emetogenic risk

A

low

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42
Q

which anti-depressants don’t interact with tamoxifen

A

venlafaxine and desvenlafaxine

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43
Q

minimum age you can use the FACES scale

A

age 4

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44
Q

what is the prognosis of metastatic osteosarcoma

A

spread only to lungs- 40% survival rate
spread anywhere else- 5yr survival rate drops from 15-30%

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45
Q

what can be used for severe cases of xerostomia

A

pilocarpine

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46
Q

what is oral bioavailability of morphine

A

10-45%

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47
Q

is bereaving loss of loved one to suicide increased risk of causing suicide

A

yes

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48
Q

how does gabapentin work

A

a2-delta calcium channels and inhibits voltage-dependent sodium channels
-acts peripherally and centrally

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49
Q

peak plasma concentrations of gabapentin

A

2-3 hours

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50
Q

difference between opioid and opiate

A

opiate- from natural opium poppy plant

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51
Q

what does prognostic performance index predict

A

predicts 3 week survival estimates for terminally ill cancer patients receiving palliative care only (not cancer directed therapy)

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52
Q

what does the PPI incorporate

A

PPS + four symptoms (oral intake, dyspnea at rest/severity, edema, delirium)

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53
Q

what does HIV neuropathy most commonly involve

A

the bilateral lower extremities

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54
Q

most common cause of death in crest syndrome

A

pulmonary hypertension or acute renal failure

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55
Q

what opioid has no clinically active metabolites

A

methadone

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56
Q

what is hydrocodone’s active metabolite

A

hydromorphone

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57
Q

what percentage of people with chronic pain have MDD

A

15%, higher in pain clinicsw

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58
Q

what is the behavioral pain scale

A

pain scale for ventilated patients

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59
Q

what CBC findings are associated with poor prognosis is GBM

A

hgb<12
thrombocytosis

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60
Q

how do neonates metabolize morphine

A

protein binding is reduced and half life is increased

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61
Q

presentations of digoxin toxicity in elderly

A

nausea, anorexia, confusion

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62
Q

Most commonly used screen for complicated grief

A

inventory of complicated grief

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63
Q

cases in which dialysis should not be initiated

A

cirrhosis without possibility of tranpslant
metastatic cancer
severe CHF or endstage pulm disease

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64
Q

REMAP

A

REFRAME why status quo isn’t working
EXPECT emotion
MAP out what’s important
ALIGN with the patient’s values
PLAN to match values

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65
Q

what is the metabolite of cariprosodol

A

meprobomate

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66
Q

what are findings of complex regional pain syndrome

A

vasomotor (skin color changes)
sudomotor (swelling)
trophic (hair loss)
sensory (allodynia)

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67
Q

what type of pain is complex regional pain

A

sympathetically mediated pain

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68
Q

what pain scale can be used in neonates

A

CRIES

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69
Q

what pain scale can be used in2mos to 7yo

A

FLACC

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70
Q

what percentage of patients with chronic conditions have an affective disorder

A

20-25%

71
Q

what is the youngest age someone can get a PCA

A

6yo

72
Q

what medications induce metabolism of methadone (CYP450 inducers)

A

CRAP GPS
Carbemazepines
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas

73
Q

CYP540 inhibitors that increase levels of methadone

A

SICKFACES.COM
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol & Grapefruit juice
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole

74
Q

lab findings in tumor lysis

A

hypocalcemia
hyperphosphatemia

75
Q

do more asians or hispanics enroll in hospice

A

more hispanics than asians

76
Q

what causes overflow incontinence

A

impaired detrusor contractility or obstruction

77
Q

antidepressant that causes weight loss

A

bupropion

78
Q

scale used to track complicated grief

A

clinical global impression scale for complicated grief

79
Q

two mid acting BZDs

A

lorazepam and temazepam

80
Q

long acting BZDs

A

clonazepam, diazepam, amd flurazpeam

81
Q

short acting BZD

A

alprazolam

82
Q

what are phase one and two of metabolism of opioids

A
  1. CYP450
  2. glucoronidation
83
Q

what causes respiratory depression from opioids

A

agonism of mu opioid receptors in brainstem regions

84
Q

most common cause of infant mortality

A

congenital causes

85
Q

MCC death in babies 1mo to 1 year

A

SIDS

86
Q

is SIDS more common in boys or girls

A

boys

87
Q

mormon faith beliefs after death

A

soul released from physical body and then gets united with a perfect body

88
Q

step 2 WHO ladder

A

weak opioid like codeine or tramadol

89
Q

step 3 WHO ladder

A

strong opioid- morphine, methadone, fentanyl

90
Q

step 4 WHO

A

nerve block, epidural, PCA, spinal stimulator

91
Q

compare loperamide vs diphenoxylate

A

loperamide crosses BBB much less than diphenoxylate

92
Q

mortality of white vs black vs hispanic men

A

black men live 8 years less than white men and 6 years less than hispanic men

93
Q

can jehovah parents refuse blood transfusions for their children

A

not in life threatening situation

94
Q

non-selective NSAID that poses highest CV risk

A

diclofenac

95
Q

how many patients can be in GIP and respite for a hospice

A

total inpatient days of GIP and respite cannot exceed 20% of total medicare days

96
Q

when does most recovery after stroke take place

A

3-6 months after

97
Q

define potency

A

amount of medication required to produce effect of a given intensity

98
Q

where does superior hypogastric plexus block help with

A

helps with pain associated with cervical, rectal, bladder, and prostate cancer

99
Q

ecog 0

A

no performance restrictions

100
Q

ecog 1

A

moderate physical endurance but no strenous exercise

101
Q

ecog 3

A

limited self care but spend >50% sitting

102
Q

ecog 2

A

all self care and <50% sitting

103
Q

ecog 4

A

bed to chair bound

104
Q

most common psychiatric illness that cancer pateint develops

A

adjustment disorder

105
Q

chronic cough is most commonly seen in what condition

A

head and neck cancer
2. lung cancer

106
Q

most common type of incontinence elderly

A

urge incontinence

107
Q

safest pde5

A

sildenafil

108
Q

two most common cancers that result in anxiety

A

lung cancer, melanoma

109
Q

mortality rate for ARDS alone

A

25%

110
Q

mortality of aki alone +sepsis

A

35%

111
Q

mortality rate of multi organ failure caused by sepsis

A

40-75%

112
Q

what is the discriminant function

A

identifies patients who are likely todie from alcohol hepatitis

113
Q

maddrey discriminant >32 is associated with what

A

high short term mortality rate

114
Q

most common type of delirium

A

mixed

115
Q

what is the withdrawal syndrome of tramadol

A

restlessness, headache, insomnia, diarreha

116
Q

onset of action of tramadol

A

1 hour

117
Q

what percentage of patients are receiving hospice care at the time of their death

A

45% in gen populpation (47.5% in medicare)

118
Q

what percentage of patients will die one week into hospice admission

A

about 1/3

119
Q

what does the meld score predict

A

3 month mortality in patietns 12+ years old in patients with cirrhosis, acute alcohol hepatitis

120
Q

what does child pugh score predict

A

mortality in patients with cirrhosis

121
Q

at what age should you get screening ecg for tca

A

50

122
Q

what should be checked in citalopram doses >40mg/day

A

ECG

123
Q

requirements for continuous home care

A
  1. > 8 hours care (provided by nurse, homemaker, or hospice aide)
    2.>50% hours spent by RN, LPN
124
Q

most important prognostic indicator for colon cancer

A

stage at diagnosis

125
Q

dyspnea- first medication

A

opioid (unless test says there is wheezing on exam)

126
Q

when would clonazepam withdrawal occur

A

1-2 weeks after stopping due to half life

127
Q

what is fica screening tool

A

presence of FAITH
Importance of spirituality
Community
interventions to address spiritual needs

128
Q

drugs most commonly cause extrapyrimidal syndrome

A

haldol, fluphanezine

129
Q

what muscle relaxant has structure similar to TCA

A

flexeril

130
Q

how does tizanidine work

A

central alpha-2 adrenergic receptor agnoist

131
Q

baclofen MOA

A

GABA agonist

132
Q

mechanism of clonidine

A

alpha 2 adrenergic receptor agonist

133
Q

most significant risk factor for developing depression in a cancer patient

A

prior history of depression

134
Q

what is included in childs pugh

A

albumin, INR, bilirubin, degree of ascites, encephalopathy

135
Q

what is prognosis of stage IV gastric cancer, HCC, colon adenocarcinoma if left untreated

A

6 months

136
Q

what is prognosis of stage IV small cell lung cancer that is not treated

A

2 months

137
Q

wwhat has a better prognosis- small cell vs non small cell

A

non-small cell

138
Q

treatment of choice for pruritis of unknown cause

A

gabapentin or paroxetine

139
Q

prognosis of malignant hypercalcemia

A

8 weeks

140
Q

prognosis of malignant pericardial effusion

A

8 to 12 weeks

141
Q

prognosis of carcinomatous meningitis

A

8 to 12 weeks

142
Q

prognosis of brain cancer without XRT

A

4-8 weeks

143
Q

prognosis of brain cancer with XRT

A

12-24 weeks.

144
Q

how pain is transmitted

A

transmission
conduction
transduction
perception
modulation

145
Q

what are c fibers

A

small, unmyelinated, slow-conducting

146
Q

what are a-delta fibers

A

large, myelinated, fast-conducting

147
Q

where does transmission occur

A
  1. injury site-> spinal cord
  2. spinal cord-> brain stem & thalamus
  3. thalamus-> cortex
148
Q

age 2-6 understanding of death

A

death is reversible, death as punishment, wishful thinking

149
Q

age 7-12 understanding of death

A

death is irreversible

150
Q

normal ped BP

A

> 70/40+ (2xyear)

151
Q

how to dose opioids <6mo age

A

lower by 25% of usual weight-based childhood dose

152
Q

why is neonatal metabolism slower

A

-immature liver
-slow kidneys
-inc water to fat ratio
-high perfusion of tissues
-decr albumin
-decr ventilatory response

153
Q

one year mortality rate of pts who start dialysis

A

41% if greater than 75yo
20% for everyone else

154
Q

what is a clinically significant change on a 0-10 scale

A

2 points

155
Q

what does gangion impar block treat

A

pelvicpain

156
Q

most common cause of svc syndrome

A

nsclc-> small cell-> NHL

157
Q

Ca 19-9

A

Pancreatic cancer or colon cance

158
Q

Ca-125

A

Ovarian cancer

159
Q

Cea

A

GI, cervical, lung, ovarian

160
Q

Cd 117

A

GI stromal tumor and seminoma

161
Q

Anti depressants for pruritis from ckd

A

sertraline, amitriptyline, and doxepin

162
Q

What is the best antidepressant to use with tamoxifen

A

Venlafaxine

163
Q

Antidepressants that inhibit CYP2D6 and prevent tamoxifen from being converted into its active form

A

fluoxetine, paroxetine, bupropion

164
Q

FEV that can be used for hospice

A

FEV<30%

165
Q

What serum-ascites albumin <1.1 means

A

Likely malignant, won’t respond to diuretics

166
Q

Serum to ascites albumin ratio >1.1 suggestive of

A

Portal hypertension, responds well to diuretics

167
Q

how common are stillbirths

A

1% of deaths

168
Q

what causes decreased pain control after long-term opioid use

A
  1. increased neuronal activity in the dorsal horn
  2. sensitization of primary afferent neurons
  3. increased expression of substance P
169
Q

C fibers

A

Small, unmyelinated, slow

170
Q

What do C fibers conduct

A

Dull, pooorly localized pain

171
Q

What type of pain do a fibers conduct

A

Sharp and localized pain

172
Q

What role does lambic system play in pain

A

Emotional response

173
Q

Reticular system and pain

A

Manages autonomic responses

HPM boards (1 decks)

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