ABFM Palliative Care case studies
ABFM Palliative Care · Put your knowledge to work in context.
The Certificate of Added Qualification (CAQ) in Hospice and Palliative Medicine is a subspecialty credential for family physicians who want formal recognition of their training and knowledge in caring for patients with serious, life-limiting illness and their families. ABFM offers the CAQ in conjunction with the American Board of Internal Medicine and eight other ABMS member boards. The ABFM Palliative Care case studies are 5 cases and about 3,231 words.
1Escalating Myoclonus and Delirium on Morphine in Advanced Kidney Disease
R is a 72-year-old retired teacher with metastatic pancreatic cancer and a solitary kidney (eGFR 22 mL/min/1.73 m²). For three weeks she has taken morphine extended-release 30 mg orally every 12 hours plus immediate-release morphine 10 mg every 4 hours as needed, averaging five rescue doses daily.
678 words, about 3 min2Malignant Bowel Obstruction When Surgery Is Not an Option
L is a 61-year-old woman with recurrent ovarian cancer, peritoneal carcinomatosis, prior debulking, and two lines of chemotherapy. Over three days she has vomited 8–10 times daily, has colicky periumbilical pain every few minutes, and has passed no flatus or stool.
642 words, about 3 min3Withdrawing Noninvasive Ventilation Over a Proxy's Objection
K is a 64-year-old former school principal with bulbar-onset ALS, 16 hours of noninvasive ventilation daily, and a forced vital capacity of 28%. His advance directive, signed 18 months ago when he had capacity, declines intubation and tracheostomy but accepts noninvasive ventilation for comfort.
626 words, about 3 min4Grief, Insomnia, and a Request for a Benzodiazepine
D is a 70-year-old retired postal worker whose wife died five months ago after six years of COPD, during which he was her sole caregiver. He now has insomnia, has lost 6 kg, cries daily, and feels guilty about signing her do-not-resuscitate order.
648 words, about 3 min5Steroid Toxicity, Opioid Fears, and a Child's Own Voice
Toby is a 9-year-old boy with diffuse intrinsic pontine glioma, 11 months from diagnosis, after radiation. He now has progressive dysphagia, choking on liquids, morning headaches, and a left-sided weakness.
637 words, about 3 min