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CFPC CAC Palliative Care study materials
CFPC CAC Palliative Care study resources

CFPC CAC Palliative Care practice questions

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Question 1Palliative Care (content domains not enumerated in source)

Which opioid is generally preferred for a patient with severe chronic kidney disease who requires strong analgesia for cancer pain?

  1. Hydromorphone
  2. Morphine
  3. Codeine
  4. Fentanyl Correct answer.

Explanation

Fentanyl is hepatically metabolized and has inactive metabolites, so it accumulates less in renal failure. Morphine and codeine both produce active metabolites cleared by the kidney and can cause toxicity. Hydromorphone also has renally excreted metabolites and requires caution.

Question 2Palliative Care (content domains not enumerated in source)

What is the typical starting dose of oral morphine for a palliative patient with moderate cancer pain who is opioid-naive?

  1. 200 mg once daily
  2. 30-60 mg every 4 hours as needed
  3. 100 mg every 12 hours
  4. 5-10 mg every 4 hours as needed Correct answer.

Explanation

Opioid-naive adults typically begin with 5-10 mg of immediate-release oral morphine every 4 hours as needed, with reassessment and titration. Higher doses risk respiratory depression and oversedation. Long-acting high-dose regimens are inappropriate for initial titration.

Question 3Palliative Care (content domains not enumerated in source)

Which medication is first-line for treating opioid-induced constipation in a patient receiving palliative care?

  1. A stimulant laxative such as senna with or without a stool softener Correct answer.
  2. Loperamide
  3. Atropine
  4. Ondansetron

Explanation

Stimulant laxatives, often combined with a stool softener, are the standard first-line prophylaxis and treatment for opioid-induced constipation. Loperamide and anticholinergics worsen constipation. Antiemetics do not address the underlying motility problem.

Question 4Palliative Care (content domains not enumerated in source)

A dying patient has noisy respiratory secretions. Which intervention is most appropriate?

  1. Antibiotics to treat presumed aspiration
  2. Increasing intravenous fluid rate
  3. Repositioning and anticholinergic medication such as glycopyrrolate Correct answer.
  4. Suctioning every 15 minutes

Explanation

Terminal secretions are managed by repositioning and anticholinergic agents that reduce secretion production. Frequent suctioning is distressing and usually ineffective. Antibiotics and increased fluids do not address the mechanism and may prolong suffering.

Question 5Palliative Care (content domains not enumerated in source)

Which symptom is most characteristic of a malignant bowel obstruction in advanced cancer?

  1. Watery diarrhea
  2. Colicky abdominal pain with vomiting and absence of flatus Correct answer.
  3. Painless jaundice
  4. Isolated lower back pain

Explanation

Malignant bowel obstruction classically presents with colicky abdominal pain, vomiting, abdominal distension, and failure to pass flatus or stool. Diarrhea may occur in partial obstruction but is not the hallmark. Jaundice and back pain suggest other processes.

Question 6Palliative Care (content domains not enumerated in source)

What is the primary purpose of palliative sedation for a terminally ill patient?

  1. To hasten death
  2. To substitute for adequate analgesia
  3. To treat depression
  4. To relieve refractory symptoms by reducing consciousness Correct answer.

Explanation

Palliative sedation is used to relieve intolerable, refractory symptoms by reducing consciousness when other measures fail. It is not intended to hasten death, and intent distinguishes it from euthanasia. It is not a treatment for depression or a substitute for analgesia.

Question 7Palliative Care (content domains not enumerated in source)

Which finding most strongly suggests that a patient is in the last days of life?

  1. Mottled extremities and reduced level of consciousness Correct answer.
  2. Stable weight
  3. Improved appetite
  4. Increased urine output

Explanation

Mottling, cool extremities, and declining consciousness are recognized signs of imminent death. Improved appetite and stable weight suggest stability rather than decline. Increased urine output is not typical of the dying phase.

Question 8Palliative Care (content domains not enumerated in source)

A patient with advanced cancer reports severe pain that is not relieved by regular morphine. What is the most appropriate initial step?

  1. Assess pain characteristics and current analgesic regimen, then adjust dosing Correct answer.
  2. Add a benzodiazepine
  3. Discontinue opioids
  4. Switch to a different opioid immediately

Explanation

Before changing therapy, one should reassess the pain mechanism, severity, and current dosing to determine whether the regimen needs titration or a change. Immediate opioid switching without assessment may be premature. Adding sedatives or stopping opioids does not address uncontrolled pain.

Question 9Palliative Care (content domains not enumerated in source)

Which adjuvant analgesic is most appropriate for neuropathic pain in a palliative care patient?

  1. Loperamide
  2. Acetaminophen
  3. Gabapentin Correct answer.
  4. Ibuprofen

Explanation

Gabapentin is an anticonvulsant with established benefit for neuropathic pain and is commonly used as an adjuvant in palliative care. Acetaminophen and ibuprofen are primarily for nociceptive pain. Loperamide treats diarrhea and has no analgesic role.

Question 10Palliative Care (content domains not enumerated in source)

Which route of opioid administration is generally preferred for a patient with severe pain who cannot swallow and has no intravenous access?

  1. Oral
  2. Transdermal
  3. Rectal
  4. Subcutaneous Correct answer.

Explanation

Subcutaneous administration provides rapid, reliable absorption when oral intake is impossible and intravenous access is unavailable. Oral and rectal routes are unsuitable in this scenario, and transdermal delivery is too slow for acute severe pain.

Question 11Palliative Care (content domains not enumerated in source)

What is the most appropriate management of dyspnea in a patient with advanced chronic obstructive pulmonary disease receiving palliative care?

  1. Bronchodilators alone
  2. Low-dose opioids plus nonpharmacologic measures such as fan therapy Correct answer.
  3. High-flow oxygen for all patients regardless of saturation
  4. Sedation as first-line therapy

Explanation

Low-dose opioids reduce dyspnea, and nonpharmacologic measures such as a cool fan and positioning add benefit. Oxygen is indicated only for hypoxemic patients. Sedation is reserved for refractory symptoms after other measures.

Question 12Palliative Care (content domains not enumerated in source)

Which statement about advance care planning is most accurate?

  1. It is a one-time document that cannot be revised
  2. It requires legal representation
  3. It excludes family members from the process
  4. It involves ongoing discussion of goals and values with substitute decision-makers Correct answer.

Explanation

Advance care planning is an ongoing process of discussing values, goals, and preferences with substitute decision-makers and clinicians. Documents can be revised as circumstances change. It does not require legal representation and typically involves family.

Question 13Palliative Care (content domains not enumerated in source)

A patient's family asks about withdrawing non-beneficial treatments. Which principle best guides this decision?

  1. Withdrawal is equivalent to euthanasia
  2. Withdrawal always requires court approval
  3. Withdrawal should never occur once started
  4. Withdrawing treatment is ethically equivalent to withholding it when burdens outweigh benefits Correct answer.

Explanation

Ethically and legally, withdrawing a treatment that is no longer beneficial is treated the same as withholding it when burdens outweigh benefits. Court approval is not routinely required. Withdrawal is distinct from euthanasia because the intent is to stop burdensome treatment, not to cause death.

Question 14Palliative Care (content domains not enumerated in source)

Which medication is appropriate for managing nausea in a palliative patient with a bowel obstruction?

  1. Haloperidol Correct answer.
  2. Docusate
  3. Metoclopramide
  4. Senna

Explanation

Haloperidol is useful for nausea related to obstruction and is less likely to worsen colic than prokinetics. Metoclopramide is a prokinetic and may aggravate colicky pain in complete obstruction. Laxatives are inappropriate in obstruction.

Question 15Palliative Care (content domains not enumerated in source)

Which of the following is a recognized sign of opioid toxicity requiring urgent attention?

  1. Pinpoint pupils with hyperventilation
  2. Myoclonus with drowsiness and reduced respiratory rate Correct answer.
  3. Hypertension with tachycardia
  4. Increased bowel sounds

Explanation

Opioid toxicity manifests as sedation, respiratory depression, myoclonus, and pinpoint pupils. Hyperventilation is not typical and respiratory rate falls. Hypertension and increased bowel sounds are not features of opioid toxicity.

Question 16Palliative Care (content domains not enumerated in source)

Which nonpharmacologic intervention is most helpful for a patient with cancer-related fatigue in palliative care?

  1. Strict bed rest
  2. Graded physical activity and energy conservation Correct answer.
  3. Prolonged daytime napping
  4. High-dose caffeine

Explanation

Graded activity and energy conservation are evidence-based strategies for cancer-related fatigue. Strict bed rest and prolonged napping may worsen deconditioning and disrupt sleep. High-dose caffeine can impair sleep quality.

Question 17Palliative Care (content domains not enumerated in source)

A patient with advanced illness develops confusion and myoclonus after starting morphine. What is the most likely cause?

  1. New-onset dementia
  2. Hypoglycemia
  3. Opioid-induced neurotoxicity from metabolite accumulation Correct answer.
  4. Serotonin syndrome

Explanation

Confusion and myoclonus in a patient on morphine suggest opioid-induced neurotoxicity from accumulation of active metabolites, especially in renal impairment. Opioid rotation or dose reduction often resolves symptoms. Hypoglycemia, dementia, and serotonin syndrome have different clinical features.

Question 18Palliative Care (content domains not enumerated in source)

Which statement about hydration in the dying patient is most appropriate?

  1. Artificial hydration always prolongs life meaningfully
  2. Artificial hydration may worsen secretions and edema without clear benefit Correct answer.
  3. Fluids should be increased for terminal secretions
  4. Withholding fluids is always unethical

Explanation

In the dying phase, artificial hydration may contribute to secretions, edema, and discomfort without clear survival benefit. Decisions should be individualized based on goals of care. Withholding fluids when they add burden is ethically acceptable, and increasing fluids can worsen secretions.

Question 19Palliative Care (content domains not enumerated in source)

Which agent is appropriate for managing anxiety in a palliative patient near the end of life?

  1. Metformin
  2. Senna
  3. Ondansetron
  4. Lorazepam Correct answer.

Explanation

Benzodiazepines such as lorazepam are used for anxiety and dyspnea in palliative care. Metformin is for diabetes, ondansetron is an antiemetic, and senna is a laxative. None of these treat anxiety.

Question 20Palliative Care (content domains not enumerated in source)

A patient with terminal illness reports pain that is worse with movement and relieved by rest. Which pain mechanism is most likely?

  1. Somatic nociceptive Correct answer.
  2. Visceral nociceptive
  3. Psychogenic
  4. Neuropathic

Explanation

Somatic nociceptive pain arises from bone, muscle, or soft tissue and is typically worsened by movement and relieved by rest. Neuropathic pain is burning or shooting, and visceral pain is poorly localized and colicky. Psychogenic pain is not a primary mechanism.

Question 21Palliative Care (content domains not enumerated in source)

Which medication is preferred for managing excessive respiratory secretions in a dying patient?

  1. Furosemide
  2. Metoclopramide
  3. Glycopyrrolate Correct answer.
  4. Prednisone

Explanation

Anticholinergic agents such as glycopyrrolate reduce secretion production and are used for terminal secretions. Furosemide is a diuretic, metoclopramide is a prokinetic antiemetic, and prednisone is a corticosteroid; none specifically reduces secretions.

Question 22Palliative Care (content domains not enumerated in source)

Which factor is most important when deciding whether to start palliative chemotherapy in advanced cancer?

  1. Clinician's convenience
  2. Tumor size alone
  3. Patient's performance status and goals of care Correct answer.
  4. Family's preference alone

Explanation

Performance status and patient goals of care are central to determining whether palliative chemotherapy offers meaningful benefit. Family preference alone, tumor size alone, or clinician convenience are insufficient. Decisions should be individualized and aligned with the patient's values.

Question 23Palliative Care (content domains not enumerated in source)

Which of the following best describes the role of a substitute decision-maker in palliative care?

  1. To override the patient's expressed wishes
  2. To decide solely on financial grounds
  3. To replace the need for advance care planning
  4. To make decisions based on the patient's known values and prior wishes Correct answer.

Explanation

A substitute decision-maker applies the patient's known values, wishes, and prior capable expressions to guide decisions. They should not override valid prior wishes or decide on financial grounds. Advance care planning remains important alongside substitute decision-making.

Question 24Palliative Care (content domains not enumerated in source)

A patient with severe cancer pain is started on transdermal fentanyl. What is an important consideration?

  1. It provides rapid onset for acute pain
  2. It is preferred for opioid-naive patients
  3. It is unsuitable for acute pain because absorption is slow Correct answer.
  4. It requires no titration

Explanation

Transdermal fentanyl has slow onset and is unsuitable for acute or uncontrolled pain; it is generally used in opioid-tolerant patients with stable requirements. It is not appropriate for opioid-naive patients and still requires titration.

Question 25Palliative Care (content domains not enumerated in source)

Which of the following is a core component of a comprehensive palliative care assessment?

  1. Physical, psychological, social, and spiritual domains Correct answer.
  2. Only laboratory values
  3. Only pain scores
  4. Only functional status

Explanation

Comprehensive palliative care assessment addresses physical, psychological, social, and spiritual dimensions. Focusing only on laboratory values, pain scores, or functional status misses important domains that shape care planning.

Question 26Palliative Care (content domains not enumerated in source)

Which total daily oral morphine dose is commonly used as the threshold for considering an opioid switch in a palliative patient whose pain remains poorly controlled?

  1. 200 mg Correct answer.
  2. 120 mg
  3. 400 mg
  4. 60 mg

Explanation

A common clinical benchmark is that when pain is not controlled at roughly 200 mg of oral morphine equivalent per day, clinicians should reconsider the analgesic strategy, including opioid rotation or adding adjuvant approaches. Below this level, dose titration of the current opioid is usually the first step. The exact threshold is a guide rather than an absolute rule.

Question 27Palliative Care (content domains not enumerated in source)

Which bowel regimen should be started prophylactically when a palliative patient begins regular oral morphine?

  1. A bulk-forming fibre supplement alone
  2. An osmotic laxative alone
  3. No laxative until constipation develops
  4. A stimulant laxative with or without a stool softener Correct answer.

Explanation

Opioids slow intestinal transit and reduce secretion, so a stimulant laxative, often combined with a stool softener, is recommended prophylactically rather than waiting for constipation. Osmotic agents alone do not counter opioid-induced hypomotility. Bulk-forming agents are generally avoided because they require adequate fluid intake and can worsen obstruction.

Question 28Palliative Care (content domains not enumerated in source)

A dying patient has loud gurgling respirations from pooled secretions. Which nonpharmacologic measure is most appropriate as an initial step?

  1. Applying a tight abdominal binder
  2. Starting intravenous fluids
  3. Repositioning the patient onto the side Correct answer.
  4. Suctioning the airway repeatedly

Explanation

Repositioning, particularly lateral positioning, allows pooled secretions to drain and often reduces noise without distress. Deep suctioning is discouraged because it is uncomfortable and rarely removes secretions below the larynx. Intravenous fluids do not reduce existing pooled secretions and may worsen them.

Question 29Palliative Care (content domains not enumerated in source)

Which statement best describes the concept of double effect when increasing an opioid for a dying patient with severe pain?

  1. A foreseeable but unintended hastening of death may be acceptable if the intent is symptom relief Correct answer.
  2. The opioid dose must be capped once sedation occurs
  3. The clinician must document that death is the intended outcome
  4. Double effect only applies to withdrawal of mechanical ventilation

Explanation

The principle of double effect holds that an action with a good intended effect, such as relieving pain, may be permissible even if a foreseeable but unintended harmful effect, such as respiratory depression, could occur. The intent must be symptom relief, the harm must not be the means of achieving relief, and the benefit must be proportionate. It is not a justification for intentionally ending life.

Question 30Palliative Care (content domains not enumerated in source)

Which finding in a family caregiver most strongly raises concern about complicated grief requiring additional support?

  1. Talking about the deceased with friends
  2. Attending a bereavement support group
  3. Persistent functional impairment and yearning more than a year after the death Correct answer.
  4. Crying during the funeral

Explanation

Complicated or prolonged grief is distinguished by persistent yearning and clinically significant functional impairment lasting beyond the expected period, commonly around twelve months in adults. Normal grief can include crying, reminiscing and seeking support. The key discriminator is duration plus impairment in daily functioning.

Question 31Palliative Care (content domains not enumerated in source)

Which symptom cluster is most characteristic of the final hours of life?

  1. Acute severe pain requiring new opioid initiation
  2. Increasing urine output and clear consciousness
  3. Sudden return of appetite and thirst
  4. Cool extremities, mottled skin and irregular breathing Correct answer.

Explanation

In the final hours, peripheral circulation declines, producing cool and mottled extremities, while breathing becomes irregular with pauses. Consciousness typically diminishes and urine output falls. A return of appetite or alertness would be atypical and would prompt reassessment of the prognosis.

Question 32Palliative Care (content domains not enumerated in source)

A patient with advanced heart failure has dyspnea despite optimal diuretics. Which medication class is most appropriate to add for symptomatic relief?

  1. Inhaled anticholinergics
  2. Nonsteroidal anti-inflammatory drugs
  3. Oral opioids Correct answer.
  4. Beta-blockers at high dose

Explanation

Low-dose opioids reduce the sensation of breathlessness and are recommended for refractory dyspnea in advanced heart failure and other terminal illnesses. High-dose beta-blockade is not a symptomatic dyspnea therapy and may worsen fatigue. NSAIDs risk fluid retention and renal injury, and anticholinergics do not relieve the sensation of breathlessness.

Question 33Palliative Care (content domains not enumerated in source)

Which oral medication is most appropriate for a palliative patient with nausea caused by raised intracranial pressure?

  1. Metoclopramide
  2. Domperidone
  3. Ondansetron
  4. Dexamethasone Correct answer.

Explanation

Raised intracranial pressure causes nausea through cerebral edema and stretch of the meninges, so a corticosteroid such as dexamethasone is the targeted treatment. Prokinetics and serotonin antagonists do not reduce intracranial pressure. Dexamethasone is typically given in the morning to limit insomnia.

Question 34Palliative Care (content domains not enumerated in source)

Which statement about the use of corticosteroids in advanced cancer is most accurate?

  1. They reliably reverse malignant bowel obstruction in all patients
  2. They are useful for anorexia, fatigue and bone pain from metastases Correct answer.
  3. They are contraindicated in patients with brain metastases
  4. They should be continued indefinitely at high dose

Explanation

Corticosteroids can improve appetite, energy and pain from bony metastases, and they reduce edema around brain and spinal lesions. Because of cumulative toxicity such as hyperglycemia, myopathy and infection risk, they are generally used at the lowest effective dose with planned review. They are not a universal treatment for bowel obstruction.

Question 35Palliative Care (content domains not enumerated in source)

A palliative patient with severe pain and renal impairment is being started on an opioid. Which opioid is preferred?

  1. Codeine
  2. Fentanyl Correct answer.
  3. Morphine
  4. Hydromorphone

Explanation

Fentanyl has no active renally cleared metabolites and is therefore the safest choice in significant renal impairment. Morphine and codeine accumulate active metabolites that can cause sedation, myoclonus and respiratory depression. Hydromorphone is less problematic than morphine but its metabolites can still accumulate.

Question 36Palliative Care (content domains not enumerated in source)

Which approach best describes culturally safe palliative care for an Indigenous patient?

  1. Asking the patient and family about preferred decision-making roles and spiritual practices Correct answer.
  2. Avoiding discussion of prognosis to prevent distress
  3. Limiting family involvement to reduce ward disruption
  4. Applying a standard care plan regardless of the patient's preferences

Explanation

Culturally safe care requires eliciting the patient's and family's values, decision-making structures and spiritual needs rather than imposing a standard approach. In many communities, extended family and Elders play central roles in decisions, and assuming otherwise can cause harm. Prognosis discussions should be tailored to the patient's stated wishes rather than avoided by default.

Question 37Palliative Care (content domains not enumerated in source)

Which symptom is most likely to be relieved by palliative radiotherapy in a patient with painful bone metastases?

  1. Hypercalcemia of malignancy
  2. Superior vena cava obstruction from a small cell lung cancer
  3. Malignant ascites
  4. Pain from a lytic spinal metastasis Correct answer.

Explanation

Palliative radiotherapy is effective for painful bone metastases, including lytic lesions, and can also prevent pathological fracture and cord compression. Ascites and hypercalcemia are managed medically. SVC obstruction may respond to radiotherapy but is often treated urgently with stenting and steroids.

Question 38Palliative Care (content domains not enumerated in source)

Which statement about artificial nutrition in a patient with advanced dementia and dysphagia is most accurate?

  1. Careful hand feeding is generally preferred over tube feeding Correct answer.
  2. Percutaneous feeding reliably prevents aspiration pneumonia
  3. Feeding tubes improve survival and functional status in advanced dementia
  4. Tube feeding is mandatory once the patient stops eating

Explanation

Evidence does not show that tube feeding improves survival, function or comfort in advanced dementia, and it may increase aspiration and restraint use. Careful hand feeding with attention to positioning and food preferences is generally preferred. Decisions should reflect the patient's previously expressed wishes.

Question 39Palliative Care (content domains not enumerated in source)

Which statement about the assessment of delirium in a palliative patient is most accurate?

  1. Delirium is often missed when the patient is quiet and withdrawn Correct answer.
  2. Hyperactive delirium is the most common subtype
  3. Benzodiazepines are first-line treatment for all delirious patients
  4. Delirium is a normal and expected part of dying and needs no workup

Explanation

Hypoactive delirium, characterized by withdrawal and reduced responsiveness, is common and frequently mistaken for depression or fatigue. Systematic screening with a validated tool improves detection. Delirium is not an inevitable part of dying and reversible causes should be sought, with antipsychotics used cautiously for distressing symptoms.

Question 40Palliative Care (content domains not enumerated in source)

Which finding is most consistent with malignant spinal cord compression requiring urgent action?

  1. Gradual onset of constipation over weeks
  2. Bilateral leg weakness with a sensory level and urinary retention Correct answer.
  3. Unilateral sciatica relieved by lying flat
  4. Night sweats with normal neurological examination

Explanation

Cord compression typically produces bilateral weakness, a sensory level, and sphincter dysfunction, and it is an oncologic emergency requiring immediate corticosteroids and imaging. Sciatica relieved by recumbency is more typical of benign disc disease. Constipation and night sweats alone do not suggest cord compression.

Question 41Palliative Care (content domains not enumerated in source)

A patient with advanced cancer has severe pain that is well controlled on oral hydromorphone. The patient now has an acute bowel obstruction and cannot take oral medication. What is the most appropriate next step?

  1. Convert to a parenteral opioid with appropriate dose reduction Correct answer.
  2. Stop all analgesia until the obstruction resolves
  3. Double the oral dose and give it crushed
  4. Start a transdermal fentanyl patch for immediate relief

Explanation

When the oral route is unavailable, the opioid should be converted to a parenteral route, accounting for incomplete cross-tolerance by reducing the calculated equianalgesic dose. Crushing and giving oral medication is inappropriate in obstruction. Transdermal fentanyl is unsuitable for acute uncontrolled pain because absorption is slow.

Question 42Palliative Care (content domains not enumerated in source)

Which approach is most appropriate when a patient asks about stopping chemotherapy to focus on comfort?

  1. Explain that stopping treatment means giving up hope
  2. Explore the patient's goals and values and discuss what comfort-focused care would include Correct answer.
  3. Defer the discussion until the next scheduled oncology visit
  4. Recommend continuing chemotherapy until it is no longer tolerated

Explanation

Decisions about stopping disease-directed therapy should be grounded in the patient's goals, values and preferences, with clear information about what comfort-focused care entails. Framing this as giving up hope is harmful and inaccurate. Deferring the conversation leaves the patient without needed support.

Question 43Palliative Care (content domains not enumerated in source)

Which statement best describes the role of a palliative care physician in shared decision-making with a patient and family?

  1. Providing information and recommendations while supporting the patient's values Correct answer.
  2. Presenting only the option the clinician prefers
  3. Avoiding discussion of prognosis to reduce anxiety
  4. Making the final decision to relieve the family of burden

Explanation

Shared decision-making involves the clinician offering expert information and recommendations while the patient's values and preferences guide the choice. The clinician does not unilaterally decide, nor should options be filtered to a preferred one. Prognosis is shared in a way that respects the patient's readiness to hear it.

Question 44Palliative Care (content domains not enumerated in source)

Which finding most strongly suggests that an opioid is causing neurotoxicity rather than disease progression?

  1. New myoclonus and hyperalgesia after a dose increase Correct answer.
  2. Increasing jaundice
  3. New cough with fever
  4. Gradual weight loss over months

Explanation

Opioid-induced neurotoxicity presents with myoclonus, hyperalgesia, delirium and sometimes seizures, typically after dose escalation or accumulation of metabolites. These features temporally follow the dose change and may improve with dose reduction or opioid rotation. Weight loss, jaundice and infection are not specific to opioid toxicity.

Question 45Palliative Care (content domains not enumerated in source)

Which intervention is most appropriate for a patient with advanced cancer and a malignant wound that is malodorous and exuding heavily?

  1. Daily surgical debridement in all cases
  2. Withholding wound care because the patient is dying
  3. Applying an occlusive film dressing alone
  4. Metronidazole and an absorbent dressing Correct answer.

Explanation

Malignant wounds are often colonized by anaerobic bacteria, and topical or oral metronidazole reduces odour, while absorbent dressings manage exudate and protect surrounding skin. Aggressive debridement is not always appropriate in advanced illness. Occlusive films trap moisture and can worsen maceration.

Question 46Palliative Care (content domains not enumerated in source)

Which statement about the use of benzodiazepines for terminal agitation is most accurate?

  1. They reliably reverse opioid-induced myoclonus
  2. They are first-line for all agitated patients regardless of cause
  3. They should be given only by the intramuscular route
  4. They are useful when agitation is due to anxiety or a reversible cause has been excluded Correct answer.

Explanation

Benzodiazepines are appropriate for agitation driven by anxiety or fear, and in the terminal phase when reversible causes have been addressed. They can paradoxically worsen delirium and are not first-line for all agitation. They do not reverse opioid-induced myoclonus, which responds to dose reduction or rotation.

Question 47Palliative Care (content domains not enumerated in source)

Which is the most appropriate approach to managing pain in a patient with advanced illness who has a history of substance use disorder?

  1. Withhold opioids entirely to prevent relapse
  2. Prescribe only as-needed opioids without a plan
  3. Use a structured plan with clear goals, regular review and monitoring Correct answer.
  4. Refer the patient elsewhere for all pain management

Explanation

Patients with substance use disorder are entitled to adequate analgesia, and a structured plan with explicit goals, regular reassessment and monitoring reduces harm and improves outcomes. Withholding opioids causes unnecessary suffering. As-needed dosing without a plan risks both undertreatment and misuse.

Question 48Palliative Care (content domains not enumerated in source)

Which measure best supports a family through the dying process in the final days?

  1. Avoiding discussion of death until it occurs
  2. Restricting visiting hours to reduce stimulation
  3. Encouraging the family to leave the bedside overnight
  4. Providing clear information about what to expect and offering practical support Correct answer.

Explanation

Families cope better when they understand the expected changes and feel supported in practical ways, such as help with meals and rest. Restricting visiting or excluding family can increase distress. Open, gentle discussion of what is happening allows families to prepare and participate in care.

Question 49Palliative Care (content domains not enumerated in source)

Which statement about the subcutaneous route in palliative care is most accurate?

  1. It is suitable for continuous infusion of opioids and other medications Correct answer.
  2. It requires a central venous catheter
  3. It is contraindicated in the community setting
  4. It cannot be used in patients with peripheral edema

Explanation

The subcutaneous route allows continuous infusion of opioids and other drugs through a small cannula, and it is widely used in hospital, hospice and home settings. It can be used in many patients, including those with peripheral edema when sites are chosen carefully. A central line is not required.

Question 50Palliative Care (content domains not enumerated in source)

Which statement about the use of antipsychotics for delirium in palliative care is most accurate?

  1. They reliably improve cognition in hypoactive delirium
  2. They should be used routinely in all patients with delirium
  3. They can reduce distressing symptoms but do not treat the underlying cause Correct answer.
  4. They are preferred over nonpharmacologic measures

Explanation

Antipsychotics such as haloperidol can reduce agitation and perceptual disturbance but do not address the underlying cause of delirium, so reversible contributors must be sought. Nonpharmacologic measures, such as orientation and sleep hygiene, are first-line. Antipsychotics are not used routinely in all patients and do not reliably improve cognition.