Palliative Care

Question 1

A 57-year-old female patient with persistent glioblastoma has been transferred to hospice care. Her daughter called to state that recently all the mother desires to do is nap during the day as well as nights of sleep for 13-14 hours up to the following day. What should be the next step of management?
A. Provide frequent position changes to maintain good skin care
B. Continue anticonvulsants if the patient is able to swallow
C. Continue steroids if the patient is able to swallow
D. Position the head of the bed at 30 degrees
E. All of the above is correct

Answer 1

E. All of the above is correct

Question 2

A 45-year-old female presents with an ongoing onset of blurry vision and severe headache. The patient is currently undergoing chemotherapy for ovarian cancer. On examination, the patient appears to have bilateral papilloedema. Which of the following might help in improving the patient’s condition?
A. Diuretics
B. Carbonic anhydrase inhibitor
C. Corticosteroids
D. Tetracycline
E. None of the above

Answer 2

C. Corticosteroids

Question 3

A 66-year-old female with a history of glioma is currently undergoing chemotherapy. The patient was discharged from the hospital to hospice 5 days later after a strange having mild cognitive change, suicidal thoughts, and altered mental status. Which of the following options can explain this patient’s strange behavior?
A. Hypocalcemia
B. Steroid psychosis
C. Hypernatremia
D. Hyperglycemia
E. Vincristine encephalitis

Answer 3

B. Sterid psychosis

Question 4

A corticosteroid such as a dexamethasone (Decadron) is a commonly prescribed medication for patients who are diagnosed with a brain tumor. What is the mechanism of this analgesic agent?
A. Decreases vascular permeability
B. Offers low potency
C. Inhibits the synthesis of prostaglandin
D. Has a short half-life
E. Option A and C

Answer 4

E. Option A and C

Question 5

A 43-year-old female patient having grade 4 glioblastoma presented to the clinic due to worsening symptoms. The prognosis of this patient is poor. What should be the role of a multidisciplinary brain tumor program in palliative care?
A. To deliver a tailored understanding of the diagnosis
B. To provide needed knowledge in relation to the prognosis
C. To offer information regarding the treatment options
D. To deliver tailored education with reference to the recurrence as well as end-of-life care
E. All of the above is correct

Answer 5

E. All of the above is correct

Question 6

A 63-year-old male patient, diagnosed case of low-grade glioma, presented to the emergency department with complaints of cognitive issues. The patient is taking multiple medications for his tumor for the past 1-year. Which of the following might be the reason behind the intellectual impairment in this patient?

A 63-year-old male patient, diagnosed case of low-grade glioma, presented to the emergency department with complaints of cognitive issues. The patient is taking multiple medications for his tumor for the past 1-year. Which of the following might be the reason behind the intellectual impairment in this patient?
A. Anti-epileptic drugs
B. Corticosteroids
C. NSAIDs
D. Chemotherapy
E. Radiotherapy

Answer 6

A. Anti-epileptic drugs

Question 7

Which of the following is the main reason behind the disability in the patients with end-stage brain tumors that also increases the risks of thromboembolic complications?
A. Epilepsy
B. Fatigue
C. Headache
D. Focal deficits
E. Stiffness syndrome

Answer 7

D. Focal deficits

Question 8

A 39-year-old female patient was diagnosed with a primary brain cancer tumor (glioma). Although the patient’s prognosis remains generally poor, a variety of treatment options can be used as standard care such as cytotoxic chemotherapy. Which of the following is a common side effect of chemotherapy combined with Temozolomide?
A. Reversible posterior leukoencephalopathy syndrome
B. Hypertension
C. Pneumocystis Jiroveci Pneumonia
D. Skin Rash
E. Delayed wound healing

Answer 8

C. Pneumocystis Jiroveci Pneumonia

Question 9

A 43-year-old female patient, diagnosed case of glioblastoma has presented to the emergency department with complaints of body aches, gradual muscular weakness, and dry skin. The patient’s blood pressure (BP) is 179/100 and respiratory rate (RR) is 24. On inquiring, the ER physician gets to know that the patient has been taking corticosteroids for the past 2 years. To avoid any further complications, the physician plans to switch this patient from corticosteroid to another alternative drug. Which drug is most likely to be recommended?
A. Dexamethasone
B. Valproic Acid
C. Bevacizumab
D. Option a and b
E. All of the above

Answer 9

C. Bevacizumab

Question 10

A 67-year-old male patient diagnosed with grade II astrocytoma presented to emergency with a single episode of seizure. The patient is in fear of getting hospitalized and is restless. What should be the acute treatment of seizures used for brain tumor patients?
A. Benzodiazepine
B. Succinylcholine
C. Phenytoin
D. Benzodiazepine and Phenytoin
E. Succinylcholine and Phenytoin

Answer 10

D. Benzodiazepine and Phenytoin

Question 11

A 55-year-old female patient was diagnosed with a primary brain tumor. While the prognosis of primary brain tumor patients continues to remain poor, a variety of treatment options are used. Cytotoxic chemotherapy is considered to be part of the care provided for the majority of glioma patients. Which of the following is a common side effect of chemotherapy with vincristine?
A. Delayed wound healing
B. Pulmonary fibrosis
C. Neuropathy
D. Skin Rash
E. Hypertension

Answer 11

C. Neuropathy

Question 12

A 63-year-old male patient is seen for grade 2 meningioma, which is using high-dose corticosteroids (Dexamethasone) for the past 6 months. Recently, the patient has been experiencing significant side effects which lead to a worsening in his quality of life. Thus, the patient’s physician decided to initiate a tapering plan. Which of the following option is an indicator that the physician can start tapering the dose of corticosteroids?
A. The tumor is a response to the patient’s systemic treatment
B. Post-radiation edema is being resolved with time
C. Surgical removal of the tumor previously
D. The tumor has been surgically debulked
E. All of the above

Answer 12

E. All of the above

Question 13

Palliative care is an important aspect of dealing with patients suffering from incurable brain tumors with poor prognoses. Which of the following best describes the “patient and care giver needs” aspect of palliative care?
A. Multidisciplinary support programs that address the patient’s problem, which help to reduce the burden on the patient and caregivers
B. Care strategies must be changed after every evaluation
C. Palliative care only deals with the medical needs of the patient
D. Psychological support is not a part of palliative care
E. Our main concern in palliative care is to prolong the life of the patient at any cost

Answer 13

A. Multidisciplinary support programs that address the patient’s problem, which help to reduce the burden on the patient and caregivers

Question 14

A Neuro-oncologist physician is seeing multiple brain cancer patients in an oncology ward and the majority of them have seizure complaints. The physician is directed to choose a drug depending upon each patient’s comorbidities and other medications. After research, the physician finds out that Levetiracetam is the most commonly used drug to treat seizures. Which of the following options makes this drug a favorable choice?
A. Less interaction with mood disorders
B. Less interaction with anxiety disorders
C. Metabolism through the liver
D. Ease of titration
E. Option c and d

Answer 14

D. Ease of titration

Question 15

A 54-year-old patient presented to emergency with complaints of episodes of seizures and motor weakness. The patient is drowsy and has difficulty speaking. The patient’s caregiver reports personality changes in the patient for the past few months. You suspect a malignant brain tumor. Which of the following tumors is the largely common malignant central nervous system (CNS) tumor?
A. Grade 4; Low-grade gliomas
B. Grade 4; High-grade gliomas
C. Grade 4; Ependymoma
D. Grade 4; Meningioma
E. Option b and c

Answer 15

B. Grade 4; High-grade gliomas

Question 16

A 38-year-old male patient is being treated for a grade 4-brain tumor that has a very poor prognosis. Based on current evidence regarding the patient’s condition, which of the following symptoms is most common at the end of life in such patients?
A. Swallowing disorders
B. Headaches
C. Insomnia
D. Epilepsy
E. Delirium

Answer 16

A. Swallowing disorders

Question 17

A 72-year-old female patient presented to you with complaints of headache. Based on your research, you prescribe dexamethasone to this patient. Which of the following can be the associated symptom of dexamethasone that becomes worse with the increase in the dosage or duration of the treatment in patients of glioma?
A. Cushing’s effect
B. Diabetes mellitus
C. Muscles weakness
D. Malignant hyperthermia
E. All except option d

Answer 17

E. All except option d

Question 18

Glioma patients are at a greater risk of acquiring Deep Venous Thrombosis (DVT). Tumor surgery could also lead to a hypercoagulable state, in which a release of thrombotic microparticles could occur. Neurosurgical data recommends a ‘‘triple’’ prophylaxis to DVT in glioma patients, which consists of?
A. Limb setting, pneumatic compression, and Low Molecular Weight Heparin (LMWH)
B. Preventive aspirin and Low Molecular Weight Heparin (LMWH)
C. Pneumatic compression and limb setting
D. Low Molecular Weight Heparin (LMWH)
E. Limb setting and preventive aspirin

Answer 18

A. Limb setting, pneumatic compression, and Low Molecular Weight Heparin (LMWH)

Question 19

70-year-old male patient with complaints of headache, nausea, vomiting, vision disorders (double vision), and deteriorating consciousness. The patient is a known case of glioma and is currently on chemotherapy and radiotherapy. Dexamethasone is considered the standard choice for dealing with vasogenic brain edema. Which of the following is the main reason behind choosing this corticosteroid to treat vasogenic brain edema?
A. Longer half life
B. The absence of mineralocorticoid effect
C. Low inhibition of leucocyte migration
D. Option b and c
E. All of the above

Answer 19

E. All of the above

Question 20

A 63-year-old male patient presents with subacute onset of apraxia and new headaches. The headaches are present when the patient first awakens and, at times, they wake him from sleep. More recently, they have been associated with nausea and vomiting. An MRI scan is showed a single nature of the lesion and the heterogeneous nonspherical enhancement pattern, which suggests a diagnosis of a high-grade primary brain tumor such as glioblastoma, the most common glioma in adults. In glioblastoma, which of the following is associated with better survival?
A. Bevacizumab added to up-front treatment with radiation therapy and temozolomide
B. Age greater than 65 years at diagnosis
C. MGMT promoter methylation presence
D. Neoadjuvant chemotherapy before radiation therapy
E. All except option c

Answer 20

C. MGMT promoter methylation presence

Question 21

A 54-year-old male patient, a diagnosed case of glioma presented to you with complaints of frequent headaches. You suspect it to be due to the vasogenic edema. What would be the first choice to treat this type of headache?
A. Dexamethasone
B. Opioids
C. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
D. Anticonvulsants
E. Opioids along combined with anticonvulsants

Answer 21

A. Dexamethasone

Question 22

A 63-year-old male patient who is a diagnosed case of high-grade glioma presents with gradual shortness of breath and chest tightness. The patient’s body temperature is also increased and there’s audible wheezing. The patient is taking steroids for the past 6 months for his brain tumor. What could be the most probable diagnosis?
A. Pneumocystis jiroveci pneumonitis (PJP)
B. Acute respiratory distress syndrome (ARDS)
C. Lymphocytic interstitial pneumonia (LIP)
D. Chronic obstructive pulmonary disease (COPD)
E. None of the above

Answer 22

A. Pneumocystis jiroveci pneumonitis (PJP)

Question 23

A 60-year-old female patient who is diagnosed with a malignant glioma. It has been shown in previous studies that malignant glioma patients are usually at a high risk of developing venous thromboembolism (VTE). Certain drugs are used to help in both the treatment of symptomatic VTE as well as the prevention of recurrent VTE among cancer patients but not in malignant glioma patients?
A. Bevacizumab
B. Low molecular weight heparin (LMWH)
C. Erythropoietin
D. Darbopoietin-alpha
E. Bevacizumab and LMWH

Answer 23

E. Bevacizumab and LMWH

Question 24

A 73-year-old female patient, a known case of glioma presented to the clinic with complaints of headache and dizziness. The patient also suffered from frequent episodes of vomiting and neck stiffness. On MRI, peritumoral brain edema has been confirmed. The physician is planning to prescribe either dexamethasone or methylprednisolone for chronic treatment of peritumoral brain edema. What is the recommended dosage of dexamethasone and methylprednisolone respectively?
A. 96 mg and 8 mg given once or twice daily
B. 8 mg and 96 mg are given once or twice daily
C. 96 and 8 mg given thrice daily
D. 8 mg and 96 mg given thrice daily
E. 8 mg and 96 mg are given only once daily

Answer 24

B. 8 mg and 96 mg are given once or twice daily

Question 25

A 56-year-old male patient is diagnosed with glioblastoma multiforme. Even after aggressive and multidisciplinary treatment with chemotherapy, radiotherapy, and surgery, the prognosis for both primary as well as metastatic brain tumors continues to be poor. What is the median survival rate for glioblastoma multiforme?
A. 7 to 8 years
B. 12 to 15 months
C. 2 to 5 years
D. 3 to 4 years
E. None of the above

Answer 25

B. 12 to 15 months

Question 26

A 34-year-old female patient diagnosed with high-grade glioma presented to the emergency department with frequent episodes of seizures. The prognosis of this patient is poor and he is currently being treated at home. What should be the preferred mode of AEDs administration for this patient?
A. Oral
B. Intravenous
C. Intramuscular
D. Oral and Intravenous
E. None of the above

Answer 26

C. Intramuscular

Question 27

A 61-year-old male patient is undergoing treatment for low-grade glioma. The patient has presented to the clinic with complaints of changes in appetite and weight loss. Which of the following treatments can help in increasing the appetite of this patient?
A. Steroids
B. Valproic acid
C. Topiramate
D. Options a and b
E. None of the above

Answer 27

D. Options a and b

Question 28

A 32-year-old male is diagnosed with end-stage brain cancer. He has been experiencing fatigue on a daily basis. What is the best course of action that will help brain cancer patients with their fatigue?
A. Light excercise on a daily basis
B. Methylphenidate
C. Ginseng
D. Erythropoietin and darbepoetin-alpha
E. Option a and d

Answer 28

E. Option a and d

Question 29

A 64-year-old male patient being treated for an end-stage glioma is complaining of myalgias and arthralgias. He has been taking steroids for the past 12 months, which could result in causing myopathy and osteoporosis. Which would be the best course of action in dealing with patients if steroids are a necessary part of treatment in advanced stages?
A. Provide adequate nutritional support to the patient (calcium, protein, vitamin D)
B. Suggest an adequate daily physical activity
C. Recommend physiotherapy sessions
D. If needed, a slow tapering of steroids is recommended
E. All of the above

Answer 29

E. All of the above

Question 30

A 83-year-old female patient undergoing whole brain radiotherapy for the past 6 months for a high-grade brain tumor presented with complaints of memory disturbances, and deterioration of complex intellectual functions with mood and personality changes. The patient also complains of slowed thinking and processing of information. Complaints of aphasias, apraxias, and agnosias are absent. Frontal sub-cortical dementia is suspected. What would be the drug of choice for this patient?
A. Methylprednisolone
B. Methylphenidate
C. Valproic acid
D. Rivastigmine
E. None of the above

Answer 30

B. Methylphenidate

Question 31

A 64-year-old male patient presented to the clinic with complaints of frequent episodes of epilepsy. He has been recently diagnosed with high-grade glioma and is currently undergoing chemotherapy sessions. As interactions of AEDs, steroids, and chemotherapy are common, which is the preferred drug choice that will help in the management of this patient?
A. Gabapentin
B. Levetiracetam
C. Valproic acid
D. Option a and b
E. Bevacizumab

Answer 31

D. Option a and b

Question 32

A 62-year-old female is diagnosed with an incurable brain tumor. End-of-life (EoL) treatment decisions are provided for alleviation of the symptoms in incurable brain tumor patients. They include withholding, withdrawing, and terminal sedation. Which of the following option best describes withdrawing?
A. Not to accept symptomatic therapies in which were otherwise warranted in a planned decision
B. Symptomatic treatments withdrawal of that have been ongoing
C. Complete loss of consciousness by the pharmacologically induced reduction of vigilance up to abolish or reduce the perception of symptoms that could be intolerable
D. Option a and b are correct
E. None of the Above

Answer 32

B. Symptomatic treatments withdrawal of that have been ongoing

Question 33

A 61-year-old male patient presents to the clinic with a history of headaches and current personality change. An MRI of the brain taken has confirmed a diagnosis of Grade IV Astrocytoma. What is the approximate survival rate for a patient with glioblastoma?
A. 3-5 years
B. 1-1.5 years
C. 12-15 years
D. 1-2 months
E. None of the above

Answer 33

B. 1-1.5 years