July 2011 – Palliative care

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ADVANCES IN PAIN CONTROL IN PALLIATIVE CARE

1. Pain in the palliative care setting can be caused by (choose one):

A. The disease itself

B. The treatment

C. General debility

D. Concurrent disorders

E. All of the above.

2. True (A) or false (B):

Opioid drugs provide adequate pain relief for more than three-quarters of cancer patients.

3. True (A) or false (B):

The main reason for not prescribing opioid analgesia is opioid phobia.

ETHICS AND PALLIATIVE CARE

4. Which one of the following demonstrates the principle of respect for autonomy?

A. Balancing benefits and risks of a patient’s treatment

B. Discussing the patient’s prognosis with the family

C. Withholding or withdrawing futile treatment from a patient

D. Providing information about treatment options to a patient

E. Ensuring education for health care professionals in palliative care.

5. Which one of the following statements about artificial hydration at the end of life is correct?

A. Artificial hydration is a futile treatment for patients with advanced cancer

B. Artificial hydration adequately replaces oral intake of fluids

C. Artificial hydration improves the patient’s quality of life

D. Artificial hydration stimulates the hypothalamus to improve appetite

E. Artificial hydration results in better nursing care with attention being given to the IV equipment and site.

6. True(A) or false (B):

Relief of severely distressing and refractory symptoms can be achieved through palliative sedation without rendering the patient unconscious.

CAN WE EFFECTIVELY MANAGE SUDDEN BEHAVIOUR CHANGES IN THE DYING PATIENT?

7. Which key features of delirium help to differentiate it from dementia, depression and psychosis (choose one):

A. Low mood, suicidal thoughts and insomnia

B. Recent onset, fluctuating course and inattention

C. Gradual onset, progressive deterioration and poor short-term memory

D. Hallucinations, delusions and blunted affect

E. All of the above.

8. Which one of the following statements about delirium is correct:

A. Delirium is uncommon in patients with advanced cancer

B. Most delirious patients have a single underlying contributing factor

C. The ‘M’ in the mnemonic DIMTOP stands for metastases

D. Haloperidol is the initial drug of choice in managing delirium

E. All patients with advanced cancer and delirium should have an extensive battery of special investigations.

9. True (A) or false (B)?

Delirium in patients with advanced cancer can be corrected in more than 80% of cases.

USING COMMUNICATION SKILLS FOR DIFFICULT CONVERSATIONS IN PALLIATIVE CARE

10. True (A) or false (B):

Palliative care is practised only in hospices.

11. True (A) or false (B):

Social workers are important in palliative care because their only role is to apply for financial assistance.

12. True (A) or false (B):

The GP has a key role in palliative care provision.

CARING FOR CHILDREN WITH LIFE-LIMITING AND LIFE-THREATENING ILLNESSES: WHAT THE GP SHOULD KNOW

13. The order in which Elisabeth Kubler-Ross described the ‘stages of grief’ was (choose one):

A. Anger, denial and isolation, depression, bargaining and acceptance

B. Depression, anger, denial and isolation, bargaining and acceptance

C. Denial and isolation, anger, depression, bargaining and acceptance

D. Bargaining, anger, acceptance, depression, denial and isolation

E. None of the above.

14. True (A) or false (B):

Palliative care is only provided once all curative options have been exhausted.

SPIRITUAL ASPECTS OF PALLIATIVE CARE

15. Recognising and addressing spiritual needs (choose one):

A. Is only to be addressed by chaplains

B. May reduce the utilisation of health care services

C. Is not an effective measure in the control of total pain

D. Is only done in a religious context

E. Is not the responsibility of the doctor.

16. True (A) or false (B):

Spiritual support has been shown to positively affect the quality of life of a patient with cancer as they near death.

WHEN SHOULD ONE START PALLIATIVE CARE?

17. The following health facilities are sites where palliative care may be given (choose one):

A. An emergency unit

B. A frail care centre

C. A hospice

D. An intensive care unit

E. All of the above.

18. True (A) or false (B):

Patients should only be referred for palliative care when they are in the terminal stage of their illness.

SOME THOUGHTS ON OPIOID-INDUCED NEUROTOXICITY

19. True (A) or false (B):

Myoclonus, delirium, hallucinations, hyperalgesia and allodynia are features of opioid-induced neurotoxicity.

20. True (A) or false (B):

Dehydration is a common reason for opioid-induced neurotoxicity.