Yale Palliative care Education - Post-participation Quiz | Attempts: 1344

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| By Susanla

Susanla

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Quizzes Created: 1 | Total Attempts: 1,344

Questions: 10 | Attempts: 1,344 | Updated: Mar 21, 2023

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Yale Palliative care Education - Post-participation Quiz - 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

Questions and Answers

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 pain

Explanation
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 neuropathy

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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 report

Explanation
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.

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1
0
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 minutes

Explanation
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.

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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.hr

Explanation
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.

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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 mg

Explanation
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.

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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")).

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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. Hypocalcemia

Explanation
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.

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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 delirium

Explanation
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.

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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 musculature

Explanation
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 manner

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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. Hypnotremia

Explanation
Hypercalcemia and uremia are common causes of constipation in patients with advanced cancer. Hypothyroidism also causes constipation. Hyponatremia does not.

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Current Version
Mar 21, 2023

Quiz Edited by
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Sep 30, 2008

Quiz Created by
Susanla

Yale Palliative care Education - Post-participation Quiz

Pain described as burning and limited to the distal extremities is most likely:

The most reliable indicator of pain severity is:

The peak analgesic effect from a dose of short-acting oral morphine can be expected in?

300 mg/day of a long-acting morphine preparation is equivalent to what dose-rate of IV morphine as a continuous infusion?

The dose of breakthrough morphine, for a patient taking 300 mg of long acting morphine/day should be approximately:

Which one of the following statements about pain management is False?

Common metabolic causes of delirium include all the following, except:

Benzodiasepines are not the first drug choice for treating delirium because of the:

Opioid-induced constipation is caused by all the following except:

All of the following metabolic conditions may cause constipation, except: