HPM Questions 2

Question 1

What is the relationship between dyspnea and quality of life?

Answer 1

Strong and inversely proportional relationship

Question 2

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

Answer 2

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

Question 3

What is the treatment course for dyspnea with rales?

Answer 3

Diuretics

Antibiotics

Question 4

What is the treatment course for dyspnea with effusions?

Answer 4

Thoracentesis

Question 5

What is the treatment course for dyspnea with airway obstruction?

Answer 5

Suctioning

Positioning

Question 6

What is the treatment course for dyspnea with secretions?

Answer 6

Nebulized saline with guaifenesin

Thicken secretions

Question 7

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

Answer 7

Clonazepam

Question 8

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

Answer 8

Pilocarpine

Question 9

What values are associated with GOLD 1 COPD?

Answer 9

FEV1 greater than 80%

Question 10

What values are associated with GOLD 2 COPD?

Answer 10

FEV1 between 50% and 80%

Question 11

What values are associated with GOLD3 COPD?

Answer 11

FEV1 between 30% and 50%

Question 12

What values are associated with GOLD4 COPD?

Answer 12

FEV1 less than 30%

Question 13

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

Answer 13

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

Question 14

What are common symptoms related to spiritual suffering?

Answer 14

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

Question 15

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

Answer 15

High-flow oxygen therapy

Question 16

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

Answer 16

Quetiapine

Question 17

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

Answer 17

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

Question 18

What is a closed family system?

Answer 18

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

Question 19

What is an open family system?

Answer 19

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

Question 20

What is a disengaged family system?

Answer 20

One in which there is little mutual dependence or emotional support

Question 21

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

Answer 21

Cholestyramine

Question 22

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

Answer 22

Oxygen

Question 23

In what patients are ICDs not indicated?

Answer 23

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

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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.

Question 26

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

Answer 26

Performance status Tumor type Extent of disease

Question 27

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

Answer 27

They typically stabilize body weight and BMI.

Question 28

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

Answer 28

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

Question 29

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

Answer 29

Approximately 9 months

Question 30

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

Answer 30

25-29%

Question 31

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

Answer 31

8 to 12 days (median 10 days)

Question 32

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

Answer 32

To predict 3 month liver-related mortality

Question 33

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

Answer 33

Risperidone

Question 34

What medication most commonly causes insomnia in patients with dementia?

Answer 34

Donepezil

Question 35

What is the medication class of choice for terminal delirium?

Answer 35

Benzodiazepines

Question 36

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

Answer 36

PPIs such as Omeprazole

Question 37

In what patient population is the CRIES pain scale effective?

Answer 37

Neonates

Question 38

In what patient population is the FLACC pain scale effective?

Answer 38

Young children

Question 39

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

Answer 39

Directly through Medicare Part B

Question 40

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

Answer 40

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

Question 41

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

Answer 41

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

Question 42

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

Answer 42

Around 3 months

Question 43

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

Answer 43

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.

Question 44

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

Answer 44

Stenting of the bile duct

Question 45

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

Answer 45

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

Question 46

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

Answer 46

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

Question 47

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

Answer 47

Venting percutaneous gastrostomy

Question 48

What are the risk factors for prescription opioid misuse?

Answer 48

``` Mood disorders Young age Family history of abuse Personal history of abuse History sexual abuse ```

Question 49

When is kyphoplasty indicated?

Answer 49

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

Question 50

Can kyphoplasty be combined with radiation therapy?

Answer 50

Yes

Question 51

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

Answer 51

Cognitive behavioral therapy

Question 52

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

Answer 52

1 to 3 weeks

Question 53

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

Answer 53

1. ) Pain intensity | 2. ) Temporal pattern

Question 54

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

Answer 54

Hypoglycemia

Question 55

What are the characteristics of central sensitization of pain?

Answer 55

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

Question 56

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

Answer 56

Doubles

Question 57

How often do older adults with a hip fracture die?

Answer 57

One in five times

Question 58

What is the most important predictive measure of frailty?

Answer 58

Increased risk of death in 4 years

Question 59

When is topical metronidazole gel indicated for wound care?

Answer 59

Treatment of odor with anaerobic infections

Question 60

When are alginate dressings indicated for wound care?

Answer 60

To absorb exudates and provide hemostasis

Question 61

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

Answer 61

Peppermint oil Vinegar Vanilla Coffee grounds

Question 62

What is the function of the Karnofsky Performance Status?

Answer 62

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

Question 63

What is the function of the Palliative Performance Index?

Answer 63

The likelihood of cancer survival at 6 weeks

Question 64

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

Answer 64

Symptomatic hypertension, fluid retention, and hypokalemia

Question 65

What is the supplement Calendula used for?

Answer 65

Topical wound care and to help prevent radiation dermatitis

Question 66

What is the supplement ginger often used for?

Answer 66

Nausea

Question 67

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

Answer 67

Benzodiazepines

Question 68

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

Answer 68

Megestrol acetate

Question 69

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

Answer 69

When pain is refractory to gabapentin and lidocaine patches

Question 70

What is the half-life of epoprostenol?

Answer 70

2 to 6 minutes

Question 71

How should epoprostenol be discontinued?

Answer 71

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

Question 72

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

Answer 72

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

Question 73

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

Answer 73

NMDA receptors

Question 74

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

Answer 74

Loss of an ability to ambulate

Question 75

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

Answer 75

Loss of autonomy

Question 76

What symptoms typically occur alongside opioid-induced constipation?

Answer 76

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

Question 77

What antidepressants are activating?

Answer 77

Fluoxetine | Bupropion

Question 78

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

Answer 78

Before the FVC falls below 50%