ABIM Palliative Care case studies
ABIM Palliative Care · Put your knowledge to work in context.
Hospice and palliative medicine is the subspecialty that asks a physician to hold two ideas at once: meticulous symptom control, and a clear-eyed understanding of what a seriously ill person actually wants from the time that remains. The ABIM subspecialty certification exam assesses whether a physician can do both across the full range of settings, from an inpatient consult service to a home hospice visit. The ABIM Palliative Care case studies are 5 cases and about 4,156 words.
1Burning Legs, a Broken Hip, and a Bad Kidney: Opioid Choice in Dialysis
A is a 78-year-old retired seamstress with type 2 diabetes and end-stage kidney disease on in-center hemodialysis three times weekly. She has a pathologic left femoral neck fracture from metastatic breast cancer; orthopedic fixation is scheduled in a week but she is not yet a surgical candidate.
840 words, about 4 min2Malignant Bowel Obstruction and a Son Who Wants Surgery
B is a 62-year-old woman with recurrent high-grade serous ovarian cancer, peritoneal carcinomatosis, and chemotherapy stopped six weeks ago for progression. For three days she has vomited eight to ten times daily, has colicky periumbilical pain, and has passed no flatus or stool.
805 words, about 4 min3An ICD, an Endotracheal Tube, and Two Women Who Disagree
C is a 71-year-old Spanish-speaking man with nonischemic cardiomyopathy (ejection fraction 20%), an implantable cardioverter-defibrillator placed four years ago for primary prevention, and three admissions in six months for decompensation. He is in the intensive care unit on milrinone, intubated on day three, awake and following simple commands but unable to speak.
807 words, about 4 min4A Hip Fracture, a Full Medicine Cabinet, and a Daughter Who Wants Her Mother Sedated
D is an 84-year-old widow with mild dementia (baseline Mini-Mental State Examination 24) who lives with her daughter. She fell and sustained a right intertrochanteric femur fracture and underwent hemiarthroplasty two days ago.
842 words, about 4 min5The Death Rattle, the Feeding Tube Request, and the Cousin Who Asks for 'Something to Keep Him Asleep'
E is a 58-year-old former construction worker with metastatic pancreatic cancer admitted to an inpatient hospice unit after three weeks of decline and a 20% weight loss. He is now in the last days: unresponsive to voice, Cheyne-Stokes respirations, mottled knees, urine output about 100 mL/day, and loud gurgling respirations audible across the room.
862 words, about 4 min