Yale Palliative care Education - Post-participation Quiz
This quiz is designed to assess the knowledge of medical students, who HAVE completed Med I & II, who DID participate in the Interdisciplinary Palliative Care Educational Project, a new initiative beginning in October 2008. If you took the Internal Medicine Clerkship as your FIRST clerkship in fall 2008 you did not have this course- Please DO NOT take this quiz, please attend the session on Palliative Caree Pain Management with Dr. Ellman during ICM, you may attend the session again if you like, to prepare for internship.
Please do not look up questions, just answer the best you can. Read more
This is an anonymous quiz, no names will be used in evaluating the results. Entering your name below is optional, you can leave it blank. Please enter the access code you received in your e-mail.
Thank you again for your help with this project! We really appreciate it.
Dr. Matthew Ellman, MD
Susan Larkin, Project Coordinator
- 1.
Pain described as burning and limited to the distal extremities is most likely:
- A.
Neuropathic pain
- B.
Somatic pain
- C.
Vascular pain
- D.
Visceral pain
Correct Answer
A. Neuropathic painExplanation
Neuropathic pain is often described as burning, numb, radiating, shooting, stabbing, tingling, touch sensitive (hyperalgesia). Distribution of neuropathic pain depends on nerves affected:
Radicular—single or multiple nerve roots: Herpes zoster; Sciatica
Stocking-Glove (fingers/toes): Diabetic or chemotherapy neuropathyRate this question:
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- 2.
The most reliable indicator of pain severity is:
- A.
Fluctuations in pulse
- B.
Patient behaviors: grimacing and crying
- C.
Skilled nursing assessment
- D.
The patient's self report
Correct Answer
D. The patient's self reportExplanation
Although patient's appearance, changes in vital signs, reports of nurses and others are useful data in the assessment of pain, pain is a subjective experience and the most reliable indicator of pain severity is the patient's self report.Rate this question:
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- 3.
The peak analgesic effect from a dose of short-acting oral morphine can be expected in?
- A.
15-30 minutes
- B.
20-40 minutes
- C.
60-90 minutes
- D.
120-180 minutes
Correct Answer
C. 60-90 minutesExplanation
The peak analgesic effect of short-acting oral opioids occurs in 60-90 minutes with an expected total duration of analgesia of 2-4 hours.Rate this question:
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- 4.
300 mg/day of a long-acting morphine preparation is equivalent to what dose-rate of IV morphine as a continuous infusion?
- A.
1 mg/hr
- B.
4 mg.hr
- C.
7 mg/hr
- D.
10 mg/hr
Correct Answer
B. 4 mg.hrExplanation
The equianalgesic ration of IV:PO morphine = 1:3, so 300 mg of oral morphine = 100 mg of IV morphine (IV morphine is 3 times stronger than oral). A continuous infusion would therefore be 100mg/24 hours which is approximately 4 mg/hour.Rate this question:
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- 5.
The dose of breakthrough morphine, for a patient taking 300 mg of long acting morphine/day should be approximately:
- A.
10 mg
- B.
30 mg
- C.
60 mg
- D.
120 mg
Correct Answer
B. 30 mgExplanation
A reasonable starting breakthrough or rescue dose is typically 10 of the total 24 hour dose. So, 10% of 300 mg is 30 mg. For morphine, frequency of dosing should be available: every 2-4 hours PO, every 30-60 minutes IM or SC, and every 10-20 minutes IV as needed.Rate this question:
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- 6.
Which one of the following statements about pain management is False?
- A.
Addiction is very rare when opioids are used in patients with pain.
- B.
Emotional or spiritual distress may affect a patient's experience of pain and its severity.
- C.
Respiratory depression from opioids is very rate and occurs only after a patient has a decreased level or arousal.
- D.
Opiate-associated constipation often resolves over time so laxatives can be used sparingly.
Correct Answer
D. Opiate-associated constipation often resolves over time so laxatives can be used sparingly.Explanation
Nearly 100% of patients taking opioids will experience constipation which will not improve over time. Prevention with stool softener or wetting agent alone is usually not sufficient without the use of a stimulant laxative (e.g., senna or bisocodyl) or a hyperosmotic agent (e.g., laculose, polyethelene glycol ("Miralax")).Rate this question:
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- 7.
Common metabolic causes of delirium include all the following, except:
- A.
Hypocalcemia
- B.
Hypercalcemia
- C.
Hypernatremia
- D.
Uremia
Correct Answer
A. HypocalcemiaExplanation
Hypocalcemia does not typically cause delirium. Common effects of hypocalcemia include: skeletal muscle cramps and tetany, abdominal pain, prolongation of the QT interval, parasthesias, convulsions.
Many metabolic derangements and organ can cause delirium, including hypercalcermia, hypo/hypernatremia, hypo/hyperglycemia, and renal (uremia), liver, and cardiac dysfunction.Rate this question:
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- 8.
Benzodiasepines are not the first drug choice for treating delirium because of the:
- A.
Risk of aspiration due to sedation
- B.
Risk of dependence
- C.
Risk of paradoxical worsening of delirium
- D.
Risk of respiratory depression when used with opioids
Correct Answer
C. Risk of paradoxical worsening of deliriumExplanation
Benzodiazepenes can cause paradoxical worsening of some symptoms of delirium and therefore are not first line agents to treat the agitation or anxiety associated with delirium. Neuroleptics (anti-psychotics) such as haloperidol are first line agents for this purpose. If needed, low dose benzodiazepines (e.g. lorazepam 0.5-1.0 mg) can be used cautiously as co-therapy.Rate this question:
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- 9.
Opioid-induced constipation is caused by all the following except:
- A.
Decreased bowel fluid secretion and/or increased absorption
- B.
Decreased tone of bowel musculature
- C.
Opioid binding to gut and central nervous system opioid receptors
- D.
Increase in non-propulsive activity
Correct Answer
B. Decreased tone of bowel musculatureExplanation
Opioid-induced constipation is multi-factorial, and through * binding to gut and central nervous system receptors:
*Increase bowel musculature tone and non-propulsive activity--the gut is moving, just not in the normal coordinated mannerRate this question:
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- 10.
All of the following metabolic conditions may cause constipation, except:
- A.
Hypothyroidism
- B.
Hypercalcemia
- C.
Hypnotremia
- D.
Uremia
Correct Answer
C. HypnotremiaExplanation
Hypercalcemia and uremia are common causes of constipation in patients with advanced cancer. Hypothyroidism also causes constipation. Hyponatremia does not.Rate this question:
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Mar 21, 2023Quiz Edited by
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Sep 30, 2008Quiz Created by
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