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HPM Questions 2 Flashcards

1
Q

What is the relationship between dyspnea and quality of life?

A

Strong and inversely proportional relationship

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2
Q

What is the treatment course to take for bronchospasm-related dyspnea?

A

Neublized albuterol and ipratropium
Inhaled beclomethasone
Systemic steroids (SVC syndrome)

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3
Q

What is the treatment course for dyspnea with rales?

A

Diuretics

Antibiotics

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4
Q

What is the treatment course for dyspnea with effusions?

A

Thoracentesis

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5
Q

What is the treatment course for dyspnea with airway obstruction?

A

Suctioning

Positioning

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6
Q

What is the treatment course for dyspnea with secretions?

A

Nebulized saline with guaifenesin

Thicken secretions

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7
Q

What benzodiazepine may be helpful as a second/third-line agent for chronic refractory dyspnea due to its long acting effects?

A

Clonazepam

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8
Q

What medication can help with radiation-induced dry mouth and should typically be started prior to radiation therapy?

A

Pilocarpine

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9
Q

What values are associated with GOLD 1 COPD?

A

FEV1 greater than 80%

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10
Q

What values are associated with GOLD 2 COPD?

A

FEV1 between 50% and 80%

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11
Q

What values are associated with GOLD3 COPD?

A

FEV1 between 30% and 50%

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12
Q

What values are associated with GOLD4 COPD?

A

FEV1 less than 30%

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13
Q

What factors portend a poor prognosis for individuals with end-stage renal disease?

A

Hypoalbuminemia, older age, poor functional status, BMI less than 18.5, peripheral vascular disease, end-stage heart failure, diabetes mellitus, active malignacy, and cerebrovascular disease

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14
Q

What are common symptoms related to spiritual suffering?

A

Joking, afterlife concerns, indescribable pain, and feelings of guild, anger, conflict, and punishment

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15
Q

What intervention may be helpful in patients with end-stage pulmonary disease who are refusing medication titrations?

A

High-flow oxygen therapy

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16
Q

What is the drug of choice to treat delirium in patients with Parkinson’s disease?

A

Quetiapine

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17
Q

What steroid regimen has been found to be as effective as very-high dose Dexamethasone for spinal compression?

A

Loading dose of 10mg followed by 16mg daily in divided doses

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18
Q

What is a closed family system?

A

A family that fears change, refuses to discuss feared topics, restricts contact with those outside of the family, and has privacy regarding family rules

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19
Q

What is an open family system?

A

One that views change as normal, inevitable, and desirable, and encourages supportive relationships with others

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20
Q

What is a disengaged family system?

A

One in which there is little mutual dependence or emotional support

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21
Q

What is the first line therapy to treat pruritis secondary to liver disease?

A

Cholestyramine

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22
Q

What is the standard of therapy for patients with COPD that is demonstrated to reduce mortality?

A

Oxygen

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23
Q

In what patients are ICDs not indicated?

A

Patients with NYHA class IV because their prognosis is less than 1 year

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24
Q

How often to stroke patients require long-term enteral feeding tubes?

A

Approximately 8% of the time, indicating that artificial nutrition may be effective acutely after a stroke

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25
Q

What are key features of breast cancer (i.e., adenocarcinoma) therapy in older patients?

A

Breast cancer in older women is generally hormone sensitive. This means that treatment may improve a patient’s prognosis and it is generally well-tolerated.

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26
Q

What are the key factors in determining prognosis in patients with advanced cancer?

A

Performance status
Tumor type
Extent of disease

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27
Q

What is the noted effect of a PEG tube in patients with ALS?

A

They typically stabilize body weight and BMI.

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28
Q

What is often seen in patients on checkpoint inhibitors in the early phase of treatment for metastatic malignant melanoma?

A

Transient worsening of disease before response is seen, also known as pseudoprogression

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29
Q

What is the mean life expectancy for patients with end-stage heart failure starting on inotrope infusions?

A

Approximately 9 months

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30
Q

What is the prognosis for survival to discharge for hospitalized patients who receive CPR?

A

25-29%

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31
Q

What is the time to death for patients with chronic kidney disease who discontinue dialysis?

A

8 to 12 days (median 10 days)

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32
Q

What is the purpose of the MELD score in liver patients?

A

To predict 3 month liver-related mortality

33
Q

What medication is often used to treat hypoactive delirium because it is less sedating?

A

Risperidone

34
Q

What medication most commonly causes insomnia in patients with dementia?

35
Q

What is the medication class of choice for terminal delirium?

A

Benzodiazepines

36
Q

Which is more effective: histamine blockers or proton pump inhibitors?

A

PPIs such as Omeprazole

37
Q

In what patient population is the CRIES pain scale effective?

38
Q

In what patient population is the FLACC pain scale effective?

A

Young children

39
Q

How are non-hospice-employed attending physicians reimbursed under Medicare?

A

Directly through Medicare Part B

40
Q

How is the 12 month post-death bereavement counseling reimbursed through Medicare?

A

It is not reimbursed separately and is included in the per diem payment.

41
Q

What happens when a hospice patient is admitted to the hospital for a diagnosis unrelated to the terminal diagnosis?

A

Both hospice and the hospitalization are covered under Medicare Part A.

42
Q

What is the median prognosis for a treated cancer patient who spends more than 50% of their waking hours in a chair or bed?

A

Around 3 months

43
Q

How often should face-to-face hospice visits be performed for the function of hospice recertification?

A

Before the third and subsequent benefit periods. This can be performed by the hospice physician or NP, but the narrative can only be done by the physician.

44
Q

What is an effective intervention for individuals with cholestatic pruritis who have good functional status?

A

Stenting of the bile duct

45
Q

What are the ECOG, PPS, and KPS values associated with a prognosis of 6 months or less?

A

ECOG - 2+
KPS - 70% or less
PPS - 70% or less

46
Q

When is surgical debulking an acceptable option for individuals with a malignant bowel obstruction?

A

Good functional status, single/few obstructions, and life expectancy is long

47
Q

What intervention is usually helpful in individuals with a malignant bowel obstruction, diffuse disease, and a desire to prevent rehospitalization?

A

Venting percutaneous gastrostomy

48
Q

What are the risk factors for prescription opioid misuse?

A 
Mood disorders
Young age
Family history of abuse
Personal history of abuse
History sexual abuse
49
Q

When is kyphoplasty indicated?

A

Fracture of a single vertebral body without severe destruction of the cortex and no cord compression

50
Q

Can kyphoplasty be combined with radiation therapy?

51
Q

What intervention has the best evidence-based risk/benefit ratio for treatment of chronic insomnia?

A

Cognitive behavioral therapy

52
Q

How long do people typically live after stopping fluid and food intake?

A

1 to 3 weeks

53
Q

What are the two most important questions to ask about pain in order to properly assess it?

A
  1. ) Pain intensity

2. ) Temporal pattern

54
Q

What is the most common complication of Tramadol therapy during initiation?

A

Hypoglycemia

55
Q

What are the characteristics of central sensitization of pain?

A

Increased distribution and intensity of pain sy mptoms in a patient with stable disease

56
Q

What is the mortality for patients who develop a hip fracture while also having cancer?

57
Q

How often do older adults with a hip fracture die?

A

One in five times

58
Q

What is the most important predictive measure of frailty?

A

Increased risk of death in 4 years

59
Q

When is topical metronidazole gel indicated for wound care?

A

Treatment of odor with anaerobic infections

60
Q

When are alginate dressings indicated for wound care?

A

To absorb exudates and provide hemostasis

61
Q

What non-medicated oils are effective in masking wound odors when the source cannot be treated?

A

Peppermint oil
Vinegar
Vanilla
Coffee grounds

62
Q

What is the function of the Karnofsky Performance Status?

A

Uses the ability to perform activities and correlates it with survival time

63
Q

What is the function of the Palliative Performance Index?

A

The likelihood of cancer survival at 6 weeks

64
Q

What is the side effects seen with high amounts of licorice?

A

Symptomatic hypertension, fluid retention, and hypokalemia

65
Q

What is the supplement Calendula used for?

A

Topical wound care and to help prevent radiation dermatitis

66
Q

What is the supplement ginger often used for?

67
Q

What is the first-line therapy for treating myoclonus related to uremia?

A

Benzodiazepines

68
Q

What drug has the best evidence for improving appetite and non-lean-mass weight in cancer-related cachexia for ambulatory patients?

A

Megestrol acetate

69
Q

When are opiates indicated for the treatment of post-herpetic neuralgia pain?

A

When pain is refractory to gabapentin and lidocaine patches

70
Q

What is the half-life of epoprostenol?

A

2 to 6 minutes

71
Q

How should epoprostenol be discontinued?

A

Taper by 20-25% every 30 minutes while monitoring for symptoms

72
Q

What physical examination findings indicate that patient death is imminent within the next 12 hours?

A 
Radial artery pulselessness
Less than 100mL urine in 12 hours
Cheyne-Stokes breathing
Respiration with mandibular movement
Death rattle
73
Q

Stimulation of what receptors is the underlying cause of opioid-induced central pain sensitization?

A

NMDA receptors

74
Q

What is a key indicator in advanced dementia patients of a prognosis of 6 months or less?

A

Loss of an ability to ambulate

75
Q

What is the most common reason people ask for physician aid in dying?

A

Loss of autonomy

76
Q

What symptoms typically occur alongside opioid-induced constipation?

A

Vomiting, dry mouth (xerostomia), and reflux (GERD)

77
Q

What antidepressants are activating?

A

Fluoxetine

Bupropion

78
Q

When is the optimal time to place a PEG tube in people with ALS?

A

Before the FVC falls below 50%

HPM Boards (2 decks)

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