Palliative Care

Chapter 17 Palliative Care




Clinical Case Problem 1: Depression Complicating Dementia


You are called to the home of a 75-year-old patient with progressive dementia. He has become increasingly depressed and agitated and now is unable to sleep at night. His family is concerned that he will wander away or perhaps set the house on fire. As you talk to the patient and review in your head the criteria for depression, you realize that this patient has an agitated depression.



Select the best answer to the following questions




1. Which of the following may be indicated in the treatment of this patient’s condition?


a. a sedating tricyclic antidepressant in the evening

b. an anxiolytic agent given on an as-needed basis

c. fluoxetine

d. a and b

e. all of the above

2. Which of the following statements is (are) true regarding use of palliative care and dementia patients?


a. more than 32% of dementia patients are referred for palliative care

b. because dementia patients have flawed memory, they do not suffer psychological distress and palliative care is unnecessary

c. estimating survival of end-stage dementia patients complicates referral to palliative care/hospice care

d. dementia patients rarely have pain, so they rarely need palliative care

e. all of the above

3. Referral for palliative care of patients who have life-threatening, nonmalignant care is compromised by which of the following?


a. disagreements between physicians regarding appropriateness and timing of referral

b. difficulty predicting actual anticipated time of death

c. concern that expansion of palliative care to this group might lead to a shortage of expertise available for patients with malignant disease

d. overly optimistic estimates of survival leading to failure to refer patients in a timely manner

e. all of the above

4. Barriers to timely referral to hospice/palliative care include which of the following?


a. association of hospice with death

b. physician reluctance to make referrals

c. physician lack of awareness of available resources

d. misperception of hospice as a place rather than a service

e. all of the above

5. Palliative care and hospice care are synonymous.


a. True

b. False


Clinical Case Problem 2: A 51-Year-Old Woman with Severe Nausea, Vomiting, and Anorexia in Severe, Advanced Ovarian Cancer


A 51-year-old woman with advanced ovarian cancer has terminal disease. She is constantly nauseated, vomiting, and anorexic. You are called to see her at home. In addition to the symptoms mentioned, the patient complains of a “sore abdomen,” and she is having significant difficulty breathing. She also has a “sore mouth.”


The patient has gone through chemotherapy with cisplatinum. This therapy ended 8   months ago. Her ovarian cancer was first discovered 12   months ago. Since that time, her condition has deteriorated to the point at which she has lost 40 pounds and is feeling “weaker and weaker” every day.


On examination, the patient’s breathing is labored. Her respiratory rate is 28 beats/minute. The breath sounds heard in both lungs are normal. Her mouth is dry, and there are whitish lesions that rub off with a tongue depressor. She looks significantly cachectic. Her abdomen is significantly enlarged. There is a level of shifting dullness, and there is a large abdominal mass that is approximately 8 × 35   cm.



6. What is (are) the drug(s) of choice for the management of cancer-associated cachexia and anorexia?


a. prednisone

b. prochlorperazine

c. megestrol acetate

d. cyproheptadine

e. a or c

7. The nausea and vomiting that this patient has developed may be treated with various measures or drugs. Which of the following could be recommended as a first-line agent(s) for this patient’s nausea and vomiting?


a. prochlorperazine

b. dimenhydrinate

c. metoclopramide

d. all of the above

e. none of the above

8. The drug that you selected for the treatment of the nausea and vomiting unfortunately was not effective. What would you do at this time?


a. forget drugs and use a nasogastric (NG) tube

b. combine two or three of the previously mentioned drugs

c. forget treatment and attempt hydration with intravenous (IV) fluids

d. select ondansetron as an antiemetic

e. b or d

9. Based on the history of her “sore mouth” and white lesions that scrape off with a tongue depressor, which of the following agents would you recommend?


a. ketoconazole

b. penicillin

c. amphotericin B

d. chloramphenicol

e. methotrexate

10. The patient undergoes palliative radiotherapy for severe bone pain that develops 1   month after the problems described. After this, significant diarrhea develops. Which of the following agents may be helpful in the treatment of this problem?


a. diphenoxylate hydrochloride

b. loperamide

c. codeine

d. all of the above

e. none of the above

11. What is the most prevalent symptom in patients with cancer?


a. anorexia

b. asthenia

c. pain

d. nausea

e. constipation

12. What is the most frequent cause of chronic nausea and vomiting in advanced cancer?


a. bowel obstruction

b. raised intracranial pressure

c. narcotic bowel syndrome

d. hypercalcemia

e. autonomic failure

13. The patient becomes increasingly short of breath. You suspect a pleural effusion. A chest radiograph confirms the diagnosis of a left pleural effusion. Which of the following is the treatment of first choice for this complication?


a. thoracocentesis

b. home oxygen

c. hospital bed that is elevated at the head

d. decreased fluid intake

e. prochlorperazine

14. Which of the following treatments may also be useful for this symptom?


a. palliative radiotherapy

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Palliative Care

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