Palliative Medicine Previous Question

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Previous Question on Palliative Medicine

1. Anandamide is an –
(1) Opioid
(2) Endocannabinoid
(3) Exocannabinoid (synthetic cannabinoid)
(4) NSAID

2. WHO Grade 2 of oral mucositis refers to –
(1) Oral soreness, erythema
(2) Mucositis to extent that alimentation is not possible
(3) Erythema, ulcers, patient can swallow solid food
(4) Ulcers with extensive erythema, patient cannot swallow food

3. When a health care practitioner delivers bad news by the SPIKES protocol — these are the six components?
(1) Setting, Perception, Invitation, Knowledge, Empathy, Strategy
(2) Setting, Permission, Investigation, Knowledge, Empathy, Summary
(3) Safety, Privacy, Invitation, Knowledge, Empathy, Strategy
(4) Situation, Patience, Invitation, Knowledge, Emotion, Spiritual Support

4. What is “Scrambler therapy”?
(1) It is a type of cognitive behavior therapy
(2) It is an innovative neuromodulation approach
(3) Itis a pharmacotheraphy by a combination of multiple drugs
(4) It is alternative treatment for pain

5. Outcome of good communication includes all, EXCEPT —
(1) Good communication is associated with significantly decreased anxiety in patients with cancer.
(2) Honest disclosure, along with the inclusion of sensitive yet pessimistic statements, is also associated with improved prognostic concordance between physicians and their patients.
(3) Outside the setting of serious illness, patient perceptions of physician empathy are not correlated with improved patient satisfaction.
(4) Good communication leads to a better matching of treatments with patients’ preferences and goals.

6. The Palliative Prognostic (PaP) Score includes all, EXCEPT —
(1) Karnofsky Performance Status
(2) Dyspnoea
(3) Lymphocyte percentage
(4) Neutrophil percentage

7. On the basis of the current level of evidence the stepwise pharmacological approach for the symptomatic treatment of cough in advanced lung cancer is –
(1) Step 1 Cough demulcent, Step 2 Morphine, Step 3 Levodropropizine
(2) Step 1 Levodropropizine, Step 2 Gabapentin, Step 3 Codeine
(3) Step 1 Cough demulcent, Step 2 Ambroxol, Step 3 Azithromycin
(4) Step 1 Cough demulcent, Step 2 Local anaesthetics, Step 3 Thalidomide

8. Sabiha is being treated for major depression after the diagnosis of osteosarcoma. She has been on Amitriptyline for depression for some month. After the amputation surgery, she is prescribed Tramadol, Ondansetron and Linezolid. Sabiha develops a high — grade fever and is shifted to the intensive care unit. She is diagnosed with a life — threatening condition. Hunter criteria are used as a diagnostic aid by clinicians to clinch the diagnosis. All the symptoms given below are seen in this condition, EXCEPT –
(1) Spontaneous clonus
(2) Agitation
(3) Diaphoresis
(4) Miuiosis

9. Which of the following is an example of nociceptive pain?
(1) Chronic post mastectomy pain
(2) Phantom limb pain
(3) Herpes related neuralgia
(4) Colic from subacute intestinal obstruction

10. Imran’s clinical picture and imaging are suggestive of lung carcinoma. Bronchoscopic biopsy confirms squamous cell lung cancer. He is found to have stage 4 (advance, metastatic) disease –
(1) He should not be given any indication that the diagnosis may be cancer until the biopsy results are back.
(2) Information should be shared with full detail to all patients even if the patient does not want to know.
(3) It is helpful to check Imran’s current understanding before explaining further information according to his pace and wishes.
(4) We should not share the information with Imran as it is not culturally appropriate to discuss death and dying.

11. Approach to celiac plexus neurolysis are all, EXCEPT –
(1) Intercrural
(2) Transcrural
(3) Lateral
(4) Retrocrural

12. All these drugs are used for the treatment of pruritus in palliative care, EXCEPT –
(1) Paroxetine
(2) Fluoxetine
(3) Promethazine
(4) Rifampicin

13. Which of the following is TRUE regarding anxiety at the end of life?
(A) Anxiety can be a side effect of albuterol, metoclopramide.
(B) Pharmacologic approaches are essential for managing anxiety.
(C) Anxiety can also develop on withdrawal of some drugs.
(D) Anxiety manifests itself through only physical and cognitive signs and symptoms.
(1) (A) and (C)
(2) (A), B), (C)
(3) (B)
(4) (D)

14. Active listening involves —
(1) Validating patient’s feeling
(2) Watching patient’s body language
(3) Asking patients to prioritize their problems
(4) All of the above

15. The four principles of ethics that govern and guide patient care in palliative care are all, EXCEPT —
(1) Serve the patients well being
(2) Avoid harm
(3) Fairness and justice
(4) Sound financial choices

16. Tranexamic acid is used to treat haemorrhage from several cancer sites. In palliative care, Administration of Tranexamic acid is recommended by all the following routes, EXCEPT —
(1) Intravenous
(2) Oral
(3) Topical
(4) Transdermal

17. Measures to prevent bleeding from fungating wounds include the following, EXCEPT –
(1) Topical adrenaline
(2) Ice pack
(3) Topical sucralfate
(4) Charcoal dressing

18. Which of the following is an USFDA approved indication for 8% capsaicin patch use?
(1) Post herpetic neuralgia
(2) Diabetic polyneuropathy
(3) HIV related neuropathy
(4) Post surgical neuropathy

19. Documentation of the informed consent is clearly described by the ICMR guidelines. If a participant is illiterate, a witness is essential. The witness should be a literate person who can read the participant information sheet and consent form and understand the language of the participant. This witness could be any of the below options, EXCEPT —
(1) Another patient in the ward who is not part of the study
(2) Staff from the social service department
(3) Patient’s literate family member
(4) Hospital counsellor

20. Opioid-induced bladder dysfunction (i.e. difficulty voiding or frank urinary retention) is a significant especially in postoperative patients after epidural opioid administration. All the following effects are expected, EXCEPT –
(1) Decrease detrusor tone
(2) Increase detrusor force of contraction
(3) Decrease the sensation of fullness and urge to void
(4) Opioid-induced bladder dysfunction is naloxone reversible

21. Most common cause of pain among patients with active cancer is —
(1) Neuropathic pain
(2) Bone pain
(3) Visceral pain
(4) All of the above

22. In dealing with difficult questions and reactions of patients, choose the wrong step –
(1) Acknowledge the reaction
(2) Explore the concerns
(3) Remain silent if you don’t have an answer
(4) Find solutions for the patient

23. The ICMR published the Consensus Guidelines for Do Not Attempt Resuscitation (DNAR) guidelines (JMR, 2020 on). These guidelines clarify the procedure for —
(A) Cardiopulmonary resuscitation
(B) Withdrawal of support
(C) Artificial nutrition and hydration
(D) Withholding of support
(1) (A), B), (C), (D)
(2) (A)
(3) (A), (B), D)
(4) (B) and (D)

24. 68-year-old Sumeeta has advanced cancer of the right breast. She has pain that involves the right elbow, medial forearm and fourth and fifth fingers. You are treating her for the moderate aching and lancinating dysaesthesias along the ulnar aspect of the forearm on follow up Sumeeta, the pain has worsened. She also is, now complaining of pain in the lateral aspect of the right arm. When you examine her, you notice partial ptosis of the right eye and mioisis. What is the appropriate next step?
(1) MRI of the cervico-dorsal spine
(2) Hospitalise her for parenteral analgesics
(3) CT scan of the thorax
(4) Tarsorrhaphy of the right eye, artificial tears and antibiotic eye drops

25. When teaching communication skills through role play. After each role play — you ask the participant first to reflect on what went well. Then the remaining students add comments. You then invite the participant to reflect on what went less well / or what they would do differently next time. This is followed by similar reflections from the remaining students. What does this framework for giving feedback follow?
(1) Pendleton’s rules
(2) Performer – reflection
(3) Peer — mentorship
(4) Shaw’s framework

26. In March, 2018 this landmark decision was taken by the Indian legal system on this topic –
(1) Amendment of Narcotics Drugs and Psychotropic Substances Act (NDPS)
(2) Passive Euthanasia law
(3) Living will
(4) Universal access to palliative care

27. Glucocorticoids have proven clinical benefit in the treatment of hypercalcemia in all the following conditions, EXCEPT —
(1) Myeloma
(2) Leukaemia
(3) Lymphoma
(4) Renal cancer

28. In clinical trials for a drug in palliative care settings, Two of the following statements (A, B, C, D) are TRUE. Select the answer (from 1, 2, 3, 4) with the two correct options —
A. Placebo group is not ethical
B. Active control is one that has shown effectiveness for that condition
C. Historical controls are not acceptable
D. The placebo pill can provide relief
(1) A and C
(2) B and C
(3) D and A
(4) B and D

29. Metastatic spinal cord compression occurs most frequently in –
(1) the cervical spine
(2) the thoracic spine
(3) the Jumbar spine
(4) the cauda equina

30. A 45-year-old man with HIV — AIDS comes to your clinic for follow — up for HIV — related neuropathy pain. He has long declined any antiretroviral therapy and has consistently stated he wants supportive — only care focused on maintaining his quality of life. He has a CD4 count of 90 cells/mm3. 1 year ago it was 100. He reports worsening pain control which he relates to inability to swallow his morphine Sustained Release tabs (60 mg tid) much of the time. He reports mid — throat pain and frequently chokes on the pills, ‘gags’ them back up. Examination reveals a thin man. Scattered white plaques on the palate which reveal a red base next when scraped away. Best next step is to —
(1) Prescribe Nystatin ‘Swish & Swallow’; change morphine to 30 mg solution q4h
(2) Prescribe fluconazole, change Morphine sustained release pills to 30 mg morphine solution q4h.
(3) Prescribe fluconazole change his morphine to methadone symp.
(4) Prescribe Nystatin “Swish & Swallow, change his morphine SR to a fentanyl] patch.

31. Clinical trials can have a crossover design. This design has inherent advantages and disadvantages in a Palliative care population, with respect to cross over clinical trials two of the following statements are true. (A, B, C, D). Select the option (1, 2, 3, 4) with two correct statements —
A. Each patient receives both interventions, so acts as his own control, less inter individual variability
B. Disease status is relatively stable over time and patient can participate in two phases
C. Blinding is not possible
D. Smaller sample sizes are acceptable
(1) A and D
(2) A and C
(3) B and C
(4) None of the above

32. Assertion (A)— Morphine — induced analgesia may be limited by competition at the receptor level if buprenorphine is added.
Reason (R) — Buprenorphine is a partial agonist and morphine is a full agonist.
(1) Both (A) and (R) are individually true and (R) is the correct explanation of A
(2) Both (A) and (R) are individually true and (R) is not the correct explanation of A
(3) (A) is true but (R) is false
(4) (A) is false but (R) is true

33. Formula to calculate total parental dose of iron in anaemia —
(1) Dose of iron (mg) = whole — blood haemoglobin deficit (g / dL) x body weight (1b)
(2) Dose of iron (mg) = whole — blood haemoglobin deficit (g / dL) x body weight (kg)
(3) Dose of iron (mg) = whole — blood haemoglobin deficit (g / dL) x body weight (Ib) x 0.4
(4) Dose of iron (mg) = whole ~ blood haemoglobin deficit (g / dL) x body weight (kg) x 0.4

34. All are anticancer drugs associated with severe hypospermatogenesis, EXCEPT —
(1) Vincristine
(2) Cyclophosphamide
(3) Chlorambucil
(4) Busulfan

35. All are true about Transcutaneous electrical nerve stimulation (TENS), EXCEPT —
(1) TENS is non — invasive peripheral neurostimulation delivered via two electrodes placed on the skin.
(2) The analgesic mechanisms implicates spinal and suprapinal pathways.
(3) High — frequency TENS affects GABA in the dorsal horn.
(4) Low frequency TENS activates delta opioid receptors.

36. Pneumonitis can be caused by all, EXCEPT –
(1) Everolimus
(2) Temsirolimus
(3) Trastuzumab
(4) Rituximab

37. Which of the following is TRUE regarding opioid analgesics in the context of palliative care?
(1) Opioids have a ceiling effect
(2) Pethidine is a recommended as a Step 3 WHO stepladder analgesic
(3) Methadone is an option for first — line treatment of severe pain
(4) Intravenous administration of opioids is preferred over oral delivery

38. Collusion between the family and doctors in terminal illness like Cancer in common i.e. the patient is not aware of the disease status and / or prognosis. All the following statements are true regarding this form of collusion, EXCEPT –
(1) patients are likely to receive futile intensive care
(2) patients are likely to undergo chemotherapy in the last weeks of life
(3) more patients receive “goal concordant care”
(4) the utilisation of emergency services and readmissions in higher in these patients

39. Which is not a cause of Post Mastectomy Pain Syndrome (PMPS)?
(1) Intercostobrachial neuralgia
(2) Neuroma pain
(3) Phantom pain
(4) Radiation plexopathy

40. The doctrine of “double effect” addresses the situation when treatment may have the unintended side effect of shortening the dying process. In the context of end — of — life care, which of the following statements is incorrect?
(1) The obligation to provide freedom from pain and distress is above the principle to do no harm provided the harm is unintended.
(2) All medications should be carefully titrated according to protocols to achieve relief.
(3) Meticulous documentation should be in place.
(4) Avoid morphine and benzodiazepines in a patient with respiratory distress at the end of life.

41. Which of the following sentences is TRUE regarding the management of fatigue in palliative care?
(A) Aerobic exercise has been shown to relieve fatigue
(B) Additional rest / sleep is an effective strategy for alleviating fatigue
(C) Fatigue may provide a protective effect in the last hours or days
(D) Causal treatment should be provided rather than symptomatic treatment
(1) (A) and (D)
(2) (B) and (C)
(3) (A) and (C)
(4) (B)

42. Which is wrong as regards advanced directive?
(1) Also called death will
(2) States your wishes about health care you want or don’t want
(3) You can appoint a person to take decision on your behalf
(4) Useful in preventing futile treatment

43. In the context of haemoptysis palliative care – a functional definition of “massive” haemoptysis can be defined as – Choose the best option.
(1) 800-1000ml blood coughed out in 24 hours
(2) 400ml volume coughed out in one single bout
(3) 200ml blood coughed out in the sputum if the patients haemoglobin is 8
(4) An amount that is enough to cause a life — threatening condition

44. Ramesh, 68-year-old with stage IV prostate cancer is a registered patient at your clinic. He has a history of one major depressive episode during his college years. He was on an antidepressant at the time but cannot recall its name. He screens positive with a Patient Health Questionnaire (PHQ)-9. He does not have a history of suicide attempt and denies suicidal ideation at present, plan or intent. He takes morphine for neuropathic pain due to his prostate cancer with minimal benefit. What is the most appropriate antidepressant drug for Ramesh?
(1) Sertraline
(2) Amitriptyline
(3) Bupropion
(4) Venlafaxine

45. Which of the following is not a criteria for good clinical communication?
(1) Eliciting and understanding the patient’s perspective
(2) Understanding the patient’s psychosocial context
(3) Achieving a shared understanding of the problem and its appropriate treatment in the context of the patient’s preferences and values
(4) Empowerment, by involving patient’s relative in decision-making