Adam's Weak Spots > Questions I got wrong :( > Flashcards

Questions I got wrong :( Flashcards

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1
Q

List 6 measurable markers of an effective interprofessional team

A
  1. Patient-centred care (ease of referral, EBM, outcomes)
  2. Interprofessional communication (how, how often)
  3. Participatory leaders/Collaborative leadersip
  4. Conflict resolution mechanisms (e.g. complaints, M&Ms, suggestions)
  5. Clearly defined roles/responsibilities
  6. Team function/teamwork (how is this measured?)

Can be thought of as
- structure
- process
- outcomes

I’m still not sure what the exact answer to this is.

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2
Q

8 nonpharma prevention/treatments for delirium

A
  1. Reorientation
  2. Visual/hearing aids
  3. Early/regular mobilisation
  4. Monitor bowel/bladder function
  5. Sleep hygiene/routines
  6. Monitor nutrition/hydration
  7. Deprescribe
  8. Familiar people/objects
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3
Q

2 rx + 4 non-rx treatments for neuropathic pain

A
  1. Anticonvulsants
  2. Antidepressants
  3. Massage
  4. Mindfulness based therapies
  5. Acupuncture
  6. CBT
  7. Neuroablation surgeries/interventions
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4
Q

Which CYP metabolises methadone?
Name 2 inhibitors
Name 2 inducers

A

CYP 3A4

  1. Grapefruit juice inhibits
  2. Erythromycin inhibits
  3. Haloperidol inhibits
  4. Carbamazepine induces
  5. Dexamethasone induces
  6. Phenytoin induces
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5
Q

When do fentanyl pharmacokinetics change?

A
  1. TD form + hyper or hypothermia
  2. TD form + severe cachexia (anything that lowers Vd)
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6
Q

6 symptoms to expect after d/c hemodialysis

A
  1. Confusion
  2. Nausea/vomiting
  3. Itch
  4. Myoclonus
  5. Fatigue
  6. Dyspnea
  7. Pain
  8. Anxiety
  9. Depression
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7
Q

What are the 3 core components of the burnout syndrome?

A
  1. Depersonalisation/loss of empathy
  2. Emotional exhaustion
  3. Loss of sense of personal accomplishment
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8
Q

You have a new consult and you’re not feeling up to it (i.e. burned out). List 3 things you would check with yourself before doing that consult.

A
  1. Am I emotionally exhausted?
  2. Am I capable of empathy?
  3. Have I lost my sense of personal accomplishment?

No idea if this is the right answer.

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9
Q

8 non-symptom topics to discuss with a family toward EOL

A
  1. DNR
  2. SDM
  3. Family can be present, talk, touch, etc.
  4. Cultural norms they would like respected
  5. Funeral home contact
  6. Crisis preparation (what might happen, what the plans are)
  7. Nutrition education
  8. Prognosis/what to expect
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10
Q

6 non-rx pain management techniques for infants

A
  1. Distraction with toys/bubbles, etc.
  2. Music
  3. Swaddling
  4. Cuddling parent
  5. Sugar
  6. Calm environment
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11
Q

4 aspects of decisionmaking capacity

A

Understanding of illness/situation
Appreciation of risks/benefits of options
Reasoning ability to make a decision
Communication ability to express decision

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12
Q

8 vulnerable populations

A
  1. Indigenous
  2. Immigrant
  3. Children/dependent adults
  4. Unhomed
  5. Minority sexuality
  6. Minority race
  7. Low SES
  8. Rural/remote community
  9. Cognitive or physical disabilities
  10. Mental health/addictions
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13
Q

4 strategies to have culturally sensitive GOC discussions

A
  1. Interpreters
  2. Ask patient/family how they want to receive information
  3. Solicit agenda/questions
  4. Establish decisionmakers based on pt/family presence
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14
Q

4 causes of respiratory congestion at EOL

A
  1. Terminal upper airway secretions
  2. Pulmonary edema/fluid overload
  3. Lymphangitis
  4. TE fistula
  5. Pulmonary hemorrhage
  6. Pneumonia
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15
Q

What behavioural changes may indicate a child is in pain? (6)

A
  1. Loss of interest in surroundings
  2. Inconsolability
  3. Appetite changes
  4. Sleeplessness
  5. Grimacing/vocalising
  6. Irritability
  7. Poor performance in school
  8. Resistance to being moved
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16
Q

6 risk factors for bleeding in the cancer setting.

A
  1. Thrombocytopenia, any cause
  2. Anticoagulant medications
  3. Large central lung tumour
  4. ENT malignancy
  5. High-dose radiation
  6. Severe liver disease
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17
Q

3 rx + 3 non-rx treatments for ALS sialorrhea

A
  1. TCAs
  2. Anticholinergics
  3. Botox
  4. Suction
  5. Salivary gland XRT
  6. Parasympathetic nn ablation
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18
Q

6 risk factors for depression, not disease related

A
  1. Female sex
  2. Younger age
  3. FHx of MDD
  4. Personal hx of MDD
  5. Poor social supports
  6. Poor physical symptom management
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19
Q

3 tx for nonmalignant pleural effusion at EOL

A
  1. Tunnelled pleural catheter (allows drainage as outpatient)
  2. Diuresis (e.g. if CHF)
  3. Symptom management (e.g. opioids, O2 for dyspnea)
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20
Q

List 4 categories of interventions for dysphagia

A
  1. Dietary/texture modifications
  2. Enteral feeding
  3. Structural interventions (stenting, dilation)
  4. Oral care
  5. Positioning when eating
  6. Parenteral feeding
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21
Q

6 reasons a patient with SUD might overuse opioids

A
  1. Pseudoaddiction
  2. Poor absorption/rapid metabolism
  3. Diversion
  4. Euphoria/side effects
  5. High opioid tolerance
  6. Misunderstanding of dosing (e.g. thinking q1h prn dose is to be taken regularly)
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22
Q

4 causes + 1 invx of acute dyspnea/hypoxemia

A
  1. PE
  2. Pneumonia
  3. Pneumothorax
  4. Pulmonary edema/AECHF
  5. SCVO

CT

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23
Q

4 steps of confusion assessment before invx

A

CAM
1. Acute change, fluctuating
2. Attention assessment
3. Cognitive assessment (esp. orientation, psychosis)
4. Altered LOC
5. Review potential organic causes (i.e. H&P, chart review, med review)

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24
Q

4 considerations when family want feeding in dementia

A
  1. Explore family fears/needs/understanding
  2. Limited benefits of enteral feeding
  3. Harms of enteral feeding (bleeding, pain, infection, medicalisation, aspiration risk)
  4. Explore feeding at risk
  5. Explore reasons they may not be eating
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25
6 components of a new palliative care program
1. Existing resources (i.e. who is currently caring for this population) 2. Who will the population be? 3. Who will staff the service (which allied teams) 4. Funding 5. Where will care be provided (inpatient, outpatient, community, LTC) 6. Referral / triage criteria and processes 7. EBM options
26
4 relative contraindications to THC
1. Cardiac risk factors 2. Severe hepatic or renal failure 3. Preexissting mood disorder 4. Preexisting SUD
27
4 indications for an intrathecal pump
1. Pain refractory to systemic analgesia 2. Patient intolerant of systemic analgesia 3. Good response to trial epidural/spinal 4. Intractable tenesmus 5. Locoregional pain
28
6 symptoms of complicated grief
Symptoms >1 year: 1. Rumination 2. Persistent intense longing for decedent 3. Social function impaired 4. Work function impaired 5. Denial 6. Anger 7. Intrusive thoughts about decedent or death 8. Suicidal ideation
29
4 mx for decubitus ulcers
DIME 1. Downloading 2. Infection prevention/treatment 3. Moisture mangement (dressings, continence products) 4. Edge effects (debriding, surgery, hyperbaric O2)
30
DSM-V criteria for delirium
1. Acute onset / Fluctuating course 3. Inattention + altered awareness 4. At least 1 other cognitive deficit (e.g. disorganisation, disorientation, language alterations) 5. Not explained by a baseline cognitive issue 6. Organic cause identified
31
4 psychosocial issues to consider in a child with Duchenne
1. Body image issues 2. Processing his shortened life 3. Sexuality/puberty 4. Maintaining normalcy (school, peer relations) 5. Distress at functional changes
32
Son requests you don't tell his mother about her cancer diagnosis. List 5 considerations as you approach this.
1. Explore son's fears/goals/needs 2. Explain to him your legal responsibility 3. Speak to her directly, but plan discussions with son to allow him to feel he has a say 4. Professional interpreters if there is a language barrier 5. Establish patient wishes and autonomy
33
6 specific questions in dignity-conserving care
1. What are some of the most important moments in your life? When did you feel most alive? 2. What were some of your biggest accomplishments? 3. What roles are you most proud of filling? What do you think you achieved in those roles? 4. Do you have any life advice for family or friends? 5. Do you have any instructions going forward? 6. Do you have anything left unsaid? 7. What would you most want to be remembered for? 8. What are your hopes and dreams for your lived ones?
33
4 ways to increase access to PC in unhomed
1. Partner with existing healthcare outreach 2. Partner with existing resource services (e.g. housing) 3. Mobile- or shelter-based teams 4. Educating staff about needs more common in this population, including a resource limited setting
34
5 systemic barriers to home discharges
1. Lack of equipment 2. Lack of formal caregivers 3. Lack of medication access/ease of administration 4. Need for adequate informal caregivers as ADLs decline 5. Medical needs (subq sites, tubes, CSCIs, lifts) requiring skills
35
4 aspects of PC that improve with reflection
1. Reduced burnout/unplanned time off 2. Improved patient satisfaction 3. Improved practitioner satisfaction 4. Improved empathy
36
5 causes of hiccups in cancer
1. Central structural causes 2. Iatrogenic (esp. dex) 3. Diaphragmatic/phrenic irritation 4. Airway irritation 5. Ascites 6. Gastroparesis/gastric obstruction 7. GERD
37
Why not to suddenly d/c Parkinson's meds
Parkinsonian crisis/NMS mimic "DAWS" - abrupt functional decline - rigidity - ANS dysfunction - confusion - anxiety/depression - craving dopamine agonists - death
38
4 non-pharm treatments for SBO nausea/vomiting
1. Bowel rest 2. Venting (NGT/PEG) 3. Stenting if able 4. Excellent oral care 5. IVF (isn't this pharmacological?)
39
5 dyspnea strategies in ALS (not treating the cause)
1. Positioning (upright when able) 2. Breathing techniques / exercises 3. NIPPV if hypoxemic 4. Opioids for dyspnea 5. Calm environment
40
4 types of terminal diseases that lead to depression
1. ENT cancers 2. CHF 3. Dementia 4. Progressive neurodegenerative conditions
41
6 strategies to manage opioids in substance abuse setting
1. Long-acting formulations preferrable 2. Adjuvant therapy to spare doses 3. Taper if able (e.g. after XRT) 4. Do not ignore/undertreat pain just because of SUD 5. Shorter prescriptions, single-prescriber, single pharmacy 6. Engage support network in managing pain 7. Monitor for interactions with recreational drugs
42
Codeine enzyme; codeine in kids?
CYP 2D6 No codeine in kids--metabolism unpredictable and hypermetabolisers can overdose, while immature CYP enzymes may mean limited benefit.
43
SICG Components
1. Set up conversation 2. Assess illness understanding 3. Assess information preferences 4. Share prognosis 5. Explore goals, fears, strengths, trade-offs etc. 6. Close conversation 7. Document
44
6 complicated grief risk factors
1. Age >60 2. Female 3. Poorer 4. Marginalised population 5. Any psychiatric history 6. Loss of child 7. Loss of spouse 8. Young decedent 9. Death by trauma 10. Multiple losses
45
4 treatments for DM gastroparesis
1. Glycemic control 2. Dietary modifications 3. D2 antagonists 4. Erythromycin
46
4 complications of celiac axis entrapment
1. Gastroparesis 2. Gastric outlet obstruction 3. Obstructive hepatic failure 4. Mesenteric ischemia 5. Bleeding/clotting in celiac vessels 6. Abdominal pain
47
4 indications for methadone
1. Neuropathic pain 2. Chronic nonmalignant pain 3. Pain in renal failure 4. Poor oral absorption 5. OUD
48
List the 5 phases of reflection on a difficult encounter, error, etc.
1. Describe the facts 2. Describe your feelings 3. Describe where things went wrong 4. Review what could have been done differently 5. Review what will be done differently next time
49
3 things to ask yourself when you don't feel like a consult
I still don't have an answer.
50
4 reasons you need to adjust dosing in peds
1. Wee organs 2. Immature enzymes 3. Reduced glycoproteins 4. Altered surface-area-to-volume ratio 5. Altered fat-to-lean ratio
51
SCC--how to decide on XRT alone vs surgery + XRT
1. Multilevel vs. single-level disease 2. Performance status 3. Radioresistant/sensitive tumour 4. Radiosaturation 5. +/- Metastatic disease 6. Unstable fracture 7. Goals of care
52
3 solid tumours associated with hyperCa
1. Lung ca 2. Breast ca 3. Prostate ca 4. Renal ca
53
3 CNS causes of fatigue
1. Structural disease 3. Post-WBR 4. Dementia 5. Lack of sleep
54
3 paraneoplastic sydromes that cause fatigue
1. Lambert-Eaton Syndrome 2. Hypercalcemia 3. SIADH 4. Limbic encephalitis
55
4 red flags in dyspnea that indicate urgent assessment
1. Hypoxemia 2. Stridor 3. Fatiguing 4. Marked tachypnea 5. Marked new tachycardia 6. Altered LOC
56
4 treatments of urinary fistulae
1. Symptom palliation 2. Surgical diversion 3. Surgical repair 3. Obstructive stenting (e.g. in ureter)
57
4 mechanisms of opioid-induced vomiting
1. CTZ 2. Gastroparesis 3. Constipation 4. Vestibular activation
58
5 areas where pharmacokinetics are different in kids (which is increased?)
1. Absorption 2. Distribution 3. Metabolism I a. faster prepuberty 4. Metabolism II 5. Elimination | Absorption of dermal medications increased 2* area/volume ratio
59
6 steps in planning a family meeting
1. Patient (or SDM) permission to arrange a meeting 2. Identify reasons/agenda per care team + patient 3. Chart review 4. Review of previously-stated wishes, ACP, etc. 5. Review social context of patient (e.g. home setup) 6. Identify who should be present (from care team and from patient team) 7. Identify a quiet, private space for the meeting with adequate chairs + time that works
60
5 serious risks of IVR interventions
1. Bleeding 2. Perforation of hollow viscus 3. Infection 4. Iatrogenic / thrombotic embolus 5. Nerve damage
61
4 drugs that interact with cannabis
1. Additive sedation with sedatives 2. Induces olanzapine clearance 3. Induces theophylline clearance (only when smoked) 4. Increases INR on warfarin
62
4 factors that increase the perception of pain
1. Opioid neurotoxicity 2. Fear of what the pain signifies 3. Anxiety, depression, negative houghts 4. Lack of control, or feeling thereof 5. Hypervigilance around pain
63
6 functions of PC associations that lets them advocate for palliative pts
1. Public awareness campaigns 2. Professional education 3. Advocacy for policy change/resources 4. Advocacy for medication access 5. Social supports for palliative patients/families 6. Networking between professionals
64
2 nonopioid receptors methadone acts on
1. NMDA antagonism (S-methadone) 2. SNRI (S-methadone) 3. ACh antagonism
64
Distinguish NMS from serotonin syndrome.
Both: - hypertension - tachypnea/cardia - hyperthermia - sweating NMS: - hyporeflexia - severe rigidity--"lead pipe" - no GI symptoms - high WBCs - low iron SS: - hyperrflexia + clonus - pupils dilated - GI symptoms
65
4 components of existential distress
1. Fear of death 2. Meaninglessness 3. Regret about opportunities/unfinished business 4. Isolation 5. Loss of control
66
List 5 considerations/foci when assessing confusion in a patient on opioids who does not want investigations.
1. Full medication review 2. S/sx evidence of infection 3. S/sx of neurotoxicity 4. Is it delirium? 4. Assess GOC for empiric treatment 5. Chart review for pre-existing contributors (e.g. structural disease, known cognitive impairment, known organ failure)
67
Pediatric mg/kg/dose morphine for: - pain - dyspnea
Pain: 0.3mg/kg/dose, q4h Dyspnea: 0.15mg/kg/dose, q4h
68
What is the calcium correction formula?
[40 - (patient albumin)]*0.02 + measured Ca e.g. 2.83, albumin 26 = [40-26]*0.02 + 2.83 = 0.28 + 2.83 = 3.11 | This formula is outdated.
69
3 treatments for bladder-ca-induced hematuria. No XRT.
1. Systemic or local TXA 2. CBI 3. Cystoscopic cautery 4. Local styptic (e.g. silver nitrate, alum)
70
In a 17yo with Ewing sarcoma met. ++ to lung, list 5 non-pain emergencies at EOL - 1 drug + route to treat any
1. Delirium 2. Hemoptysis/bleeding 3. Dyspnea crisis 4. SVCO 5. Symptomatic hypercalcemia 6. Spinal cord compression Midazolam subq
71
Match the drug with the symptom: **Symptoms**: Restless leg syndrome Sleep disturbance Alterations in taste and smell Hiccups Neuropathy **Medications**: Baclofen Cannabis Methadone Pramipexole Zinc
1. Restless leg syndrome + pramipexole 2. Sleep disturbance + cannabis 3. Dysgeusia/anosmia + zinc 4. Hiccups + baclofen 5. Neuropathic pain + methadone
72
6 drug classes for tenesmus
1. Topical anesthetics 2. CCBs (e.g. nifedipine) 3. Anticholinergics 4. Opioids 5. Stool softeners/osmotic laxatives 6. Steroids
73
4 skin changes in chronic/late lymphedema
1. Thickening/pitting 2. Exaggerrated skin folds 3. Chronic inflammation/erythema 4. Papillomata 5. Hyperkeratosis
74
3 differences between moisture dermatitis and pressure ulcer
1. Location (skin folds/gluteal cleft vs. bony prominences) 2. Necrosis (not present in dermatitis) 3. Shape ("kissing" spots, diffuse spots in moisture vs. round/well defined in pressure) 4. Edges (less distinct in MD) 5. Depth (rarely any depth to MD) 6. Colour (more variegated, blanchable in MD)
75
4 topical treatments for bleeding in malignant wounds
1. TXA 2. Styptics (silver nitrate, alum) 3. Pressure dressings 4. Calcium alginate dressings 5. Cautery 6. Epinephrine
76
4 treatment for malodorous wounds
1. Topical antibiotics 2. Debridement of necrotic tissue 3. Environmental techniques (essential oils, kitty litter, ventilation) 4. Charcoal dressings
77
4 indications for paracentesis in PC
1. Abdominal discomfort 2. Squashed stomach syndrome (NV, early satiety, reflux) 3. Dyspnea 2* elevated diaphragm 4. Diagnosis (e.g. suspicion of infection) 5. Unresponsive to diuresis
78
4 side effects of cannabis
1. Drowsiness 2. Dry mouth 3. Anxiety 4. Confusion
79
4 validated pain scales in a nonverbal child.
FLACC - face, legs, activity, cry, consolability CHEOPS - Children’s Hospital of Eastern Ontario Scale FACES Visual analog scale
80
5 reasons non-medical interpreters are a bad idea in palliative care
1. They have the role of delivering bad news 2. Limited medical knowledge/vocabulary 3. Cannot confirm information being conveyed is correct 4. They may not want to know everything they are required to translate 5. Emotional stress added to having an ill parent 6. They are caught between the doctor and family
81
Describe the 4 stages of pressure wounds
0. At risk, blanchable redness. 1. Nonblanchable redness, no breakdown 2. Epidermal breakdown, dermis visible 3. Skin breakdown, subcut fat visible +/- slough 4. Full-thickness breakdown to connective tissue +/- slough X. Excessive slough or eschar make staging impossible
82
4 chemical ligands involved in pain transduction
1. Histamine 2. Bradykinin 3. Serotonin 4. Heat/cold 5. Prostaglandins 6. Substance P 7. Nerve Growth Factor
82
4 pathophysiological characterstics of neuropathic pain
1. Related to direct nerve damage 2. Experienced in distribution of nn. 3. Associated with peripheral and central sensitisation (e.g. allodynia) 4. Associated with nonpainful neuropathy such as numbness, tingling, dysesthesias 5. Typical pain features (e.g. burning, electric)
83
4 steps in neurophysiology of pain
1. Transduction (peripheral nn) 2. Transmission (peripheral nn, spinal cord) 3. Modulation (spinal cord, brainstem, thalamus) 4. Perception (cortex)
84
4 factors that affect opioid pharmacokinetics
1. Hepatic function 2. Renal function 3. Fat:lean ratio (esp. fentanyls, methadone) 4. Age 5. Perfusion/hypotension
85
What is lidocaine traditionally used for? (2)
1. Local anesthesia 2. Antiarrhythmic
86
What is the half-life of lidocaine?
1.5-2h
87
Name 6 blood tests in a breast cancer patient with nausea
1. Na+ 2. Ca++ 3. Cr/BUN 4. Bilirubin + ammonia 5. CBC (esp. WBCs) 6. Cultures 7. Glucose 8. TSH
88
Name 4 contraindications to ketamine
1. Pregnant/breastfeeding 2. Psychotic disorder 3. Elevated ICP 4. CHF or recent ACS 5. Hypertension
89
Onset of po ketamine
30 min.
90
4 medication classes that can cause constipation
1. Opioids 2. Anticholinergics 3. TCAs 4. 5-HT3 antagonists 5. Iron 6. CCBs 7. L-dopa 8. Antihistamines 9. Antidiarrheals
91
4 classes of oral laxative
1. Stimulant 2. Stool softener (e.g. docusate) 3. Osmotic 4. Lubricant 5. Oral opioid antagonists (e.g. naloxegol) 6. Bulk-forming
92
4 classes of medication to manage complete SBO
1. Somatostatin analogues 2. Non-prokinetic antinauseants (e.g. ondansetron, Haldol) 3. Steroids 4. Antispasmotics 5. Other antisecretory agents (PPI, H2RA)
93
4 complications of PEG insertion
1. Bleeding 2. Infection 3. Gastric perforation 4. Pain
94
4 poor surgical prognostic factors in SBO
1. Poor functional status 2. Ascites 3. Peritoneal/omental disease 4. Extensive extraabdominal disease 5. Low albumin/cachexia 6. Multifocal obstruction
95
4 elements of CAM
1. Acute onset/fluctuating course 2. Inattention 3. Disorganised thinking 4. Altered LOC | 1 + 2 + either 3 or 4
96
Lewy body dementia + delirium--first line drug
Quetiapine
97
3 most common symptom indications for palliative sedation
1. Refractory delirium 2. Refractory dyspnea 3. Refractory seizures
98
2 parameters measured in palliative sedation
1. Responsiveness/LOC 2. Signs of discomfort (e.g. grimacing, tachypnea) 3. Family coping
99
4 s/e from bisphosphonates
1. Uveitis 2. Mandibular necrosis 3. Influenza-like symptoms 4. GI upset/esophagitis 5. Bone pain
100
4 nonpharmacological management of secretions in a waking cystic fibrosis pt
1. Positioning 2. Good hydration 3. Oral care 4. Shallow suctioning 5. Cough assist devices 6. Chest physiotherapy
101
5 signs + their etiologies that can help determine cause of dyspnea
1. Tachycardia = tachyarrhythmia 2. Wheeze = obstructive lung disease 3. Paradoxical breathing = respiratory muscle weakness 4. Unilateral leg swelling/heat/tenderness = VTE 5. Reduced a/e + dullness on percussion = pleural effusion 6. Localised crackles/egophony = pneumonia 7. Pallor = anemia
102
4 symptom mx for dyspnea crisis in lung mets; GOC M1
1. Oxygen (humidified) 2. Opioids 3. Upright positioning 4. Anxiolytics/sedatives 5. Emotional support/presence
103
4 physical exam findings in SCVO
1. Facial / arm swelling 2. Distended neck vv. 3. Distended hand vv. that do not collapse w. elevation 3. Dysphonia/hoarse voice 4. Altered LOC 5. Conjunctival edema
104
6 s/sx of severe anxiety
1. Sweating 2. Tremor 4. Palpitations/tachycardia 5. Chest tightness/pain 6. Nausea 7. Muscle tension 8. Insomnia 9. Trouble concentrating
105
3 medication classes that can cause/worsen anxiety
1. Stimulants 2. Corticosteroids 3. Decongestants 4. Theophylline 5. High-dose serotonin agents (SSRI, SNRI) 6. Thyroxine
106
4 substances from which withdrawal can trigger anxiety
1. Alcohol 2. Opioids 3. Nicotine 4. SNRIs/SSRIs 5. Benzodiazepines
107
4 risk factors for depression + malignancy
1. Pain 2. Metastases 3. ENT tumour 4. Female sex 5. Vinca alkaloids 6. Personal/FHx depression
108
Endicott Scale--2 cognitive components
1. Depressed affect 2. Social withdrawal 3. Pessimism/brooding 4. Reduced responsiveness
109
4 characteristics of complementary/alternative medicine users
1. Women 2. Gyne cancers 3. From cultures with strong traditions 4. Distress of allopathic system 5. Richer 6. More educated
110
3 mind-body therapies for pain
1. Hypnosis 2. Mindfulness meditation 3. Therapeutic imagery 4. Music therapy 5. Yoga
111
3 ways inflammatory breast ca differs from noninflammatory
Inflammatory is: 1. More aggressive 2. Associated with peau d'orange, erythema, edema 3. Less responsive to treatment
112
4 modalities to treat bone mets
1. XRT 2. Surgical fixation for specific lesions 3. Bisphosphonates 4. Isotope therapy (esp. radium 223 as well as iridium) 5. Chemotherapy
113
2 criteria for tumour debulking in met breast ca
1. Symptoms to justify surgery (e.g. malignant wound) 2. Spinal cord compression 3. Good baseline functional status 4. Limited metastatic disease
114
4 s/e of hormone treatment for breast ca
1. Depression 2. Hot flashes 3. Reduced libido 4. Osteoporosis 5. Fatigue 6. Bone/joint pain
115
2 treatments for high-risk prostate cancer
1. Prostatectomy + LN dissection 2. Radical XRT
116
Lung cancer pathology most common in nonsmokers
Adenoca
117
2 paraneoplastic syndromes associated with SCLC
1. SIADH 2. Lambert-Eaton Syndrome 3. Cushing syndrome 4. Myaesthenia gravis
118
4 natural changes in sexual function as women age
1. Reduced lubrication 2. Reduced vaginal length 3. Labial atrophy --> clitoral prominence 4. Fragile vaginal tissue
119
4 causes of reduced libido in colon ca post-op
1. Body image issues 2. Post-operative pain 3. Anxiety/depression 4. Side effects of chemotherapy 5. Side effects of opioids 6. Fatigue
120
2 treatments for vaginal dryness
1. Nonmedicated lubricants 2. Prolonged foreplay 3. Regular vaginal moisturisers
121
4 natural changes in sexual function as men age
1. Reduced erectile tumescence 2. Prolonged time to orgasm 3. Reduced seminal fluid 4. Prolonged refractory period 5. Prolonged time to erection
122
4 causes of ED in prostate ca
1. Post-operative changes 2. Post-radiation changes 3. ADT 4. Depression 5. Opioid therapy
123
4 ways to re-establish intimacy post-cancer
1. Emphasise nonsexual intimacy (cuddling, kissing) 2. Schedule intimacy around energy levels 3. Consider aids (lubricants, toys, porn) 4. Consider alternative positions that take less energy 5. Masturbation to relearn what it feels like to be sexual
124
Advice for safe sex on chemotherapy
1. Condoms/dental dams while receiving chemotherapy 2. Typically 2-3 days post infusions 3. Condoms on sex toys, which should also be washed
125
6 risk factors for colorectal ca
1. Family history of colon ca 2. Genetic conditions (e.g. FAP) 3. Smoking 4. Alcohol use 5. Previous pelvic radiation 6. Age >50 7. High-fat diet 8. IBD
126
6 presenting s/sx of colorectal ca
1. LBO 2. Incidental on screening 3. Hematochezia 4. Abdominal pain 5. Stool changes 6. Unintentional weight loss 7. Abdominal mass
127
4 poor prognostic features of colorectal ca
1. Obstructive at diagnosis 2. Metastatic at diagnosis 3. Advanced age at diagnosis 4. High CEA
128
3 PE signs of advanced pancreatic ca
1. Jaundice 2. Cachexia 3. Ascites 4. Palpable liver 5. Virchow's node (L supraclavicular) 6. Sister Mary Joseph nodule (umbilical)
129
4 features of pain associated with pancreatic ca
1. Epigastric 2. Radiates to mid-back 3. Burning, gnawing 4. Worse with po intake 5. Nocturnal 6. Improved when curled up
130
2 nonmedication ways to treat pancreatic cancer pain
1. Celiac plexus block or ablation 2. XRT
131
2 symptoms of pancreatic exocrine insufficiency
1. Diarrhea/steatorrhea 2. Cachexia 3. Abdominal pain 4. Excessive flatulence
132
6 clinical manifestations of pheo
1. Episodic tachycardia/hypotension 2. Episodic diarrhea 3. Headache 4. Episodic flushing 5. Pallor 6. Refractory hypertension | 6 Ps--palpitations, poo, pain, perspiration, pallor, (blood) pressure
133
What pain medications should be avoided in pheochromocytoma?
1. Morphine (histamine release) 2. Tramadol (SNRI effect) 3. Ketamine (sympathetic effect) 4. Steroids (cortisol release) 5. TCAs (SNRI effect) 6. SNRIs/SSRIs
134
What nausea medications must be avoided in pheochromocytoma?
All D2 antagonists
135
What is the FICA mnemonic in assessing spirituality?
1. Faith (any faith or spirituality?) 2. Importance to their life/decisions 3. Community (are they part of one? is this important?) 4. Address spiritual issues
136
What perception is at the root of suffering?
A threat to our personal, psychological, spiritual integrity.
137
List 3 risk factors for existential suffering
1. Poor symptom management 2. Social isolation 3. Immobility 4. Self-blame for illness, decline, etc. 5. Loss of sense of control
138
ABCD of dignity-conserving care
1. Attitude 2. Behaviour 3. Compassion 4. Dialogue
139
Duration of symptoms to diagnose complicated grief?
12+ mo
140
4 bedside interventions for terminal bleed
1. Be calm, even if no one else is 2. Dark towels 3. Opioids subq/IV 4. Sedatives subq/IV 5. Pressure on the bleeding area 6. Wound packing if from a wound
141
4 pharmaceutical treatments for UGIB
1. PPI 2. H2RA 3. Somatostatin analogue 4. TXA 5. Vasopressin 6. Stop anticoagulants/antiplatelet agents 7. Vitamin K
142
3 contraindications to hyperbaric oxygen therapy
1. Bleomycin treatment 2. Untreated pneumothorax 3. Recent ENT surgery 4. URTi 5. Pulmonary blebs 6. Severe obstructive pulmonary disease 7. Claustrophobia
143
4 contraindications to anticoagulation in DVT/PE
1. Bleeding diathesis 2. Thrombocytopenia <50 3. Active bleeding 4. GOC do not indicate 5. Recent surgery 6. Intracranial tumour 7. Previous intracranial hemorrhage 8. IT or epidural pump in place
144
145
Seizures despite phenytoin in a patient on dex for brain mets--medication options?
1. Stop/reduce dex or increase phenytoin a. dex reduces phenytoin blood levels 2. Levetiracetam 2. Valproic acid 3. Phenobarbital 4. Benzodiazepines
145
Medication options for benzo-refractory status epilepticus
1. Levetiracetam 2. Phenytoin 3. Phenobarbital 4. Valproic acid 4. Propofol
146
3 symptoms of progressive end stage CHF
1. Syncopal episodes 2. Refractory edema 3. Refractory dyspnea 4. Angina 5. Severe fatigue
147
6 symptomatic indications for radiotherapy
1. Pain 2. Bleeding 3. Seizure/brain disease 4. Spinal cord compression 5. Obstruction (e.g. esophagus, GOO, colonic) 6. SCVO
148
4 acute abdominopelvic XRT s/e
1. Diarrhea (enteritis/colitis) 2. Dysuria/hematuria (cystitis) 3. Vaginal mucositis 4. Nausea/vomiting (gastritis/enteritis) 5. Dermatitis
149
4 late s/e from oropharyngeal XRT
1. Xerostomia 2. Dental caries/disease 3. Osteonecrosis 5. Dysphagia 6. Skin fibrosis 7. Skin telangiectasia
150
3 contraindications to XRT
1. Prognosis
151
4 cardiac causes of syncope
1. Valve failure 2. Arrhythmia (tachy/brady) 3. Ventricular failure (i.e. reduced EF 2* myopathy) 4. MI 5. Tamponade
152
4 s/e of stopping HF medications
1. Increased edema 2. Increased dyspnea/fluid overload 3. Syncope 4. Sudden death
153
List the components of the CHADS-2 score.
1. CHF 2. Hypertension 3. Age >75 4. T2DM 5. Previous stroke (2) | CHADS-2-Vasc uses age >65
154
List the components of the CHA2-DS-S2-Vasc
1. CHF 2. Hypertension 3. Age (65+ = 1; 75+ = 2) 4. DM 5. Sex (female = 1) 5. Stroke (2) 6. Vascular disease
155
List the components of the HAS-BLED score
1. Hypertension 2. Age >65 (1) + anticoagulants (1) 3. Stroke 4. Bleeding history 5. Labile INR (1) 6. Ethanol (1) 7. Diseased liver (1) or kidney (1)
156
4 cancers with high risk for spinal cord compression
1. Breast 2. Lung 3. Prostate 4. Renal 5. Lymphoma
157
What are the 4 stages of spinal cord compression pathology?
1. Venous engorgement 2. White matter edema 3. Grey matter edema 4. Nerve infarction
158
What is the main advantage of tunnelled over nontunnelled abdo catheters?
Reduced infection risk
159
160
4 triggers for worsening hepatic encephalopathy
1. UGIB 2. Benzodiazepines 3. Constipation 4. Increased protein intake 5. Biliary obstruction 6. Infection 7. Dehydration
160
3 ways to improve hepatic encephalopathy
1. Lactulose 2. Rifamixin 3. Late night snacks of complex carbs 4. Reduce mitigating factors (e.g. stop alcohol, reduce protein, maintain kidney function) 5. Reduce protein intake and divide through day
160
5 measures of Child-Pugh score
1. INR 2. Bilirubin 3. Albumin 4. Ascites 5. Encephalopathy
160
2 preferred opioids in liver failure
1. Fentanyl 2. Morphine 3. Hydromorphone | Sources disagree about morphine.
161
5 complications of dialysis
1. Line infection 2. Dialyser reaction 3. Hypotension OR hypertension 4. Chest pain/dyspnea 5. Muscle cramping 6. Lifestyle inconvenience 7. Seizure 8. Nausea/vomiting
162
4 treatments of CKD-associated itch
1. Emolient creams 2. Antihistamines 3. Gabapentin 4. Sertraline 5. UVB 4. Thalidomide
163
5 non-pharmacological treatments for dry skin
1. Fatty creams 2. Cotton gloves at night 3. Clip nails 4. Avoid dessicants (e.g. alcohol hand sanitiser) 5. Avoid hot baths/showers 6. Hypoallergenic soaps 7. Humidifiers in dry environments
164
3 medications that can worsen restless leg syndrome
1. Antihistamines (esp. 1st-gen) 2. D2 antagonists 3. Antidepressants (all classes)
165
2 drugs for muscle cramps in dialysis
1. Vitamin C + E 2. Gabapentinoids 3. TCAs
166
1 way to prevent respiratory failure in ALS
Adequate vaccinations - pneumococcal - flu - COVID Treat sialorrhea
167
NIPPV indications in ALS
1. Dyspnea 2. Hypoxemia Initiate BEFORE FVC <50%
168
2 rx for muscle cramping in ALS
1. Baclofen 2. Tizanadine 3. Botox
169
Etiology of pseudobulbar affect in ALS?
Reduced descending inhibition 2* corticobulbar degeneration
170
3 neurological / 3 psychiatric / 3 cognitive symptoms of Huntington
Neurological - chorea - hyperreflexia - gait disturbance - dystonia Psychiatric - depression - apathy - paranoia - disinhibition Cognitive - memory loss - concentration loss - loss of insight
171
3 causes of chorea
1. Huntington disease 2. Dopamine agonists 3. CNS infections 4. Alcohol intoxication 5. Stroke
172
2 medications for HD + 2 main s/e
1. Deu/tetrabenazine (VMAT inhib) 2. Dopamine antagonists - depression - sedation
173
2 signs in multiple sclerosis
1. Spasticity 2. Hyperreflexia 3. Intranuclear ophthalmoplegia 4. Babinski + 5. Ataxia
174
2 investigations to diagnose MS
1. MRI 2. Lumbar puncture for IgG bands 3. Visual-evoked potentials
175
4 dysautonomic sx in PD
1. Orthostatic hypotension 2. Hyperhidrosis 3. Thermoregulatory failure 4. Sialorrhea 5. Gastroparesis 6. Constipation 7. ED
176
How does carbidopa combine with levodopa?
It prevents peripheral conversion of L-dopa to dopamine before it crosses the BBB
177
List 4 systemic medications for movement in Parkinson disease
1. L-dopa/carbidopa 2. Rotigotine 3. Pramipexole 4. Amantadine 5. Apomorphine
178
4 palliative care challenges unique to children
1. Decisionmaking, especially in late-school age and adolescence 2. Parental needs/wants vs. children's 3. Different medical situations 4. Weight-based medication dosing 5. Many orphaned/rare diseases 6. Practitioner emotional overinvolvement
179
For each statement, state developmental stage it's ass'd with - understand death is final - experience the world through senses - see death as reversible - understand death is caused by illness - believe death is only caused by external factors - understand universality of death, but not for them - death as a "monster" - death as punishment - attribute life to inanimate objects - invincibility
- understand death is final (6-8) - experience the world through senses (0-2) - see death as reversible (3-5) - understand death is caused by illness (9-11) - believe death is only caused by external factors (6-8) - understand universality of death, but not for them (12+) - death as a "monster" (6-8) - death as punishment (6-8) - attribute life to inanimate objects (3-5) - invincibility (12+)
180
For each statement, state developmental stage it's ass'd with: a. Guilt about things said or not said, done or not done b. Concern about personal future and security c. Confusion about circumstances of death and a need to review it frequently: d. Regression in behaviors, such as bed-wetting e. Asks a lot of questions, focus on gory details f. Blame others for the death and how it affects their life g. Fears of changes in their world, of more family deaths h. Covering up emotions and trying to appear normal
a. Guilt about things said or not said, done or not done (12+) b. Concern about personal future and security (9-11) c. Confusion about circumstances of death and a need to review it frequently: (3-5) d. Regression in behaviors, such as bed-wetting (3-11) e. Asks a lot of questions, focus on gory details (6-8) f. Blame others for the death and how it affects their life (12+) g. Fears of changes in their world, of more family deaths (6-8) h. Covering up emotions and trying to appear normal (9-11)
181
For each statement, state developmental stage it's ass'd with: * Spirituality is imaginative, and participation in ritual becomes important * Concern over right and wrong and connecting ritual with personal identity * Needs include trust, a sense of hope and equanimity among others, and feelings of self worth and love * Search for meaning, purpose, hope, and value of life, and an evolving relationship with a higher power
* Spirituality is imaginative, and participation in ritual becomes important (3-5) * Concern over right and wrong and connecting ritual with personal identity (7-11) * Needs include trust, a sense of hope and equanimity among others, and feelings of self worth and love (0-2) * Search for meaning, purpose, hope, and value of life, and an evolving relationship with a higher power (12+)
182
4 cancers in 15-29-year-old patients
1. Testicular 2. Germ cell 3. Lymphoma 4. Melanoma 5. MSK sarcoma 6. Thyroid
183
5 issues specific to young adults when faced with cancer dx/tx
1. School/career future 2. Normalcy in life 3. Puberty/sexuality/body image 4. Independence 5. Shortened prognosis 6. Fertility impact 7. Social isolation
184
4 allied health disciplines in young adult cancer patients
1. Social work 2. Occupational therapy 3. Physiotherapy 4. Spiritual care
185
2 resources to refer young adult patients to in Canada
1. Young Adult Cancer Canada 2. School counsellors 3. Peer support groups
186
BODE Index
1. BMI 2. Obstruction (FEV1/FVC) 3. Dyspnea 4. Exercise capacity (6 minute walk)
187
2 nonpharmacological sx mx tips in COPD
1. Quit smoking 2. Keep exercising 3. Inhaler technique 4. Pulmonary rehab
188
1 indication for O2 in COPD / ILD Why are the O2 targets different in COPD/ILD?
PaO2 <55mmHg COPD = CO2 retention
189
4 stages of HIV/AIDS
1. Virus but asymptomatic 2. Virus + symptoms of HIV infection 3. CD4 count <200 and/or AIDS-defining illness (AIDS) 4. CD4 counts <50 (advanced/late AIDS)
190
4 accelerated nonninfectious conditions in HIV
1. Atherosclerosis 2. Dementia 3. Neuropathy 4. CHF 5. COPD 6. Renal failure 7. Osteoporosis 8. Depression/anxiety 9. Frailty
191
1 reason to continue HAART in late-stage HIV
Infection or viremia can be symptomatic
192
2 reasons to stop HAART/antibiotics in late stage AIDS
1. Actively dying 2. Patient request 3. Pill burden 4. Drug side effects 5. Drug interactions w. symptom drugs
193
3 palliative medications that can interact with HAART
1. Dexamethasone (inducer) 2. Haloperidol (inhibitor) 3. Phenytoin 4. All opioids 5. Methadone especially 6. TCAs
194
4 categories of rehabilitation
1. Preventative 2. Restorative 3. Maintenance/Supportive 4. Palliative
195
4 non-motor skills assessed by OT
1. Sensory skills 2. Cognitive skills 3. Interpersonal skills 4. Self-maintenance skills 5. Work skills 6. Leisure skills
196
4 ways to preserve energy with hygiene
1. Chair in shower/bath 2. Reach tools (e.g. sponge on a stick) 3. Soap on a rope 4. "Focal" bathing of axilla, face, perineum 5. Bathtub/shower organisers 6. Dry off using a thick robe
197
5 components of PPS
1. Ambulation 2. Activity 3. Self-care 4. Oral intake 5. LOC
198
What is a 3-6 week survival tool? 5 components?
PPI 1. PPS 2. Dyspnea 3. Delirium 4. Edema 5. Oral intake
199
What is a 30-day survival tool? 5 components?
1. KPS 2. Clinician estimate of survival 3. Dyspnea 4. Oral intake 4. WBCs 5. Lymphocyte %
200
NURSE model
Used to explore emotions with patients/families. 1. Name the emotion 2. Understand the emotion/express (partial) understanding 3. Respect the person's ability to cope with it 4. Support them/offer support 5. Explore
201
Legal documents for preferences of EOL or health care proxy? Process of reflecting and communicating about future care?
Advanced directives ACP
202
Brain death vs. PVS?
Brain Death - complete loss cortical and brainstem functions - no brainstem reflexes PVS - intact brainstem
203
4 strategies to improve communication with patients/families
1. Be polite, punctual, mannerly 2. Allow them to set the agenda 3. Solicit questions 4. Be direct and concrete 5. Acknowledge your own limitations when giving answers 6. Consistency in messaging from all staff 7. Maintain continuity of communication on patient and provider side 8. Give explicit examples of problematic behaviour
204
3 strategies to reduce intra-team conflict
1. Allowing different opinions to exist 2. Consistent channels for suggestions/complaints 3. High standards for communication 4. Deal with conflict as it arises--no ruminating 5. Focusing on problems and solutions, not people 6. Keep issues internal
205
3-stage process to conflict management
1. Listen to understand the problems (all stakeholders) 2. Explore and agree on a plan 3. Enact the plan/follow up on everyone's feelings i.e. communicate, collaborate, check-in
206
List 4 of CSPCP's goals
1. Support CFPC (PC) certification 2. Support RCSPM certification 3. Support YAC programs 4. Monitor/support adequate palliative practitioners 5. Physician networking spaces 6. Policy/advocacy for accessible PC 7. Support ongoing CME for palliative care
207
CSPCP 5 strategic priorities
1. Education 2. Member engagement 3. Infrastructure 4. Research 5. Advocacy/Partnerships | PRIME
208
Vision statement for CHPCA?
That all Canadians have access to quality hospice/palliative care.
209
8 questions to identify patient vulnerabilities?
1. Do you have a stable place to live? 2. Do you feel safe in your home/relationship? 3. Can you read? 4. Do you ever worry about where you will get your next meal? 5. Who can you turn to in life for support? 6. Do you ever have trouble paying utility bills? 7. Do you read to your child at night? 8. Have you ever neede to take out a restraining order? 9. Do you have questions about your immigration status? 10. Do you ever have trouble getting places? For instance, paying for public transit?
210
4 factors that influence "good death"
1. Control 2. Closure 3. Comfort 4. Companionship 5. Circumstances of death 6. Cultural norms respected
211
Characteristics of a study to benefit future (not current) patients? How do you enhance these characteristics?
Validity Value Larger studies Improve generalisability
212
4 risk factors for frailty
1. Advanced age 2. Multimorbidity 3. Polypharmacy 4. Sedentary lifestyle 5. Weight loss 6. Poverty
213
Name one clinical frailty tool and its components
Clinical Frailty Scale - not actuarial - 1-9 score, 9 being terminally ill - 3 = not regularly active - 6 = need help inside and outside home, incl. bathing - 7 = total dependence but not dying - 8 = total dependence and declining ("maximum frailty") - 9 = EOL <6mo regardless of frailty
214
3 negative outcomes associated w frailty
1. Hospitalisation 2. Early death 3. Increased dependence 4. Reduced QOL
215
2 possible pathogeneses of frailty
1. Pro-inflammatory cytokines 2. Cachexia-promoting gene activation 3. Testosterone deficiency 4. Vitamin D deficiency
216
3 markers of poor short-term survival in dementia
1. Dysphagia/aspiration 2. Pressure sores 3. Weight loss 4. Recurrent infections
217
4 factors that influence stroke outcomes
1. Ischemic vs. hemorrhage 2. Embolic vs. thrombotic 3. Location 4. Extent of damage 5. Age 6. Baseline health (function, comorbidities)
218
2 tools to measure neurological severity of a stroke
1. Canadian Neurological Scale 2. NIH Stroke Scale
219
2 causes of pain in stroke
1. Central sensitisation 2. Contractures 3. Immobility/sores 4. Shoulder-hand syndrome
220
PAINAD Scale--5 items + how long before using
Observe for 5+ minutes. 1. Non-verbal vocalisations 2. Grimace 3. Consolability 4. Body language 5. Breathing
221
4 s/e of antipsychotic medication in BPSD
1. Dystonia 2. ANS instability (orthostasis) 3. Sedation 4. Premature death 5. Hypercholesterolemia/T2DM
222
List the 3 qualities of dyspnea
1. Air hunger 2. Breathlessness/increased WOB 3. Chest tightness
223
List 4 physical complications of cough
1. Incontinence 2. Rib #/chest wall pain 3. Insomnia 4. Muscle strain
224
What 2 features are necessary for a bony met to be seen on XR?
<1cm <50% mineral loss
225
What feature is required for a met to show up on bone scan? Which cancers will they not show up on as easily?
Mineral deposition (i.e. element of sclerosis) Aggressive sclerotic lesions - thyroid - aggressive lung - myeloma
226
What % of malignant pathological # heal?
1/3 (35%)
227
List 3 cancers associated with osteoBLASTIC lesions
SCLC Prostate Medullablastoma Hodkgin lymphoma Carcinoid
228
List 3 cancers associated with osteoLYTIC lesions
NSCLC Thyroid Renal cell ca NHL
229
List 3 cancers that metastasise to the hands/feet.
1. Renal 2. Esophagus 3. NSCLC
230
List 3 cancers responsive to embolisation
1. Thyroid 2. RCC 3. HCC
231
List 3 indications for nephrostomy placement in palliative care
1. Malignant ureteric obstruction 2. Hemorrhagic cystitis 3. Radiation cystitis 4. Urinary diversion from fistula
232
2 indications for IVC filter
1. Anticoagulation contraindicated in lower limb DVT 2. Free-floating IVC thrombus
233
What syndrome can follow arterial chemoembolisation of HCC?
"Postablation syndrome" d/t released necrotic tumour 1. Fever 2. Abdominal pain 3. WBCs 4. Malaise | Sustained fevers suggest abscess.
234
List 4 benefits of medical multidisciplinary teams
1. Patient accessibility 2. Reduced unplanned admissions 3. Reduced length of stay 4. Reduce spending
235
What are 3 core elements of evaluating an inpatient palliative care team
Organisation/Structure - specific goals - healthy work culture - distinct roles within team - distinct role of team - adequate participatory leadership - necessary services Individual contributions Team processes
236
List 4 roles the leader of a PC team must assume
1. Management 2. Conflict management 3. Motivation 4. Policy-setting 5. Maintaining focus on vision 6. PR 7. Ongoing practice of palliative care
Adam's Weak Spots
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