Palliative care principles, hospice criteria, and end-of-life decision making as tested on USMLE Step 3.
35 cards · basic cards · AI-written, checked twice. Edit anything.
- A patient is eligible for the Medicare hospice benefit if their life expectancy is ____, assuming the disease runs its normal course.
- 6 months or less
- How many benefit periods make up the initial structure of the Medicare hospice benefit before ongoing recertification?
- Two initial 90-day periods, followed by an unlimited number of 60-day periods (each requiring recertification of terminal prognosis).
- How does palliative care differ from hospice care in terms of required prognosis?
- Palliative care can be offered at any stage of a serious illness regardless of prognosis, while hospice requires a prognosis of 6 months or less.
- On the WHO analgesic ladder, what type of medication is used first for mild pain?
- A nonopioid analgesic, such as acetaminophen or an NSAID.
- On the WHO analgesic ladder, what is added for moderate pain not controlled by a nonopioid alone?
- A mild (weak) opioid, such as codeine or tramadol, often combined with the nonopioid.
- On the WHO analgesic ladder, what class of drug is used for severe pain?
- A strong opioid, such as morphine.
- What is the approximate oral-to-intravenous morphine conversion ratio?
- About 3:1 (3 mg oral morphine is roughly equivalent to 1 mg IV morphine).
- Fentanyl patches should not be used to start opioid therapy in ____ patients because of the risk of fatal respiratory depression.
- opioid-naive
- Which opioid, used for both pain control and addiction treatment, carries a notable risk of QT interval prolongation?
- Methadone.
- Does tolerance develop to the constipating effect of chronic opioid use?
- No, tolerance to opioid-induced constipation does not develop, so prophylaxis should continue for as long as the opioid is used.
- What type of laxative is first-line for preventing opioid-induced constipation?
- A stimulant laxative, such as senna, often paired with a stool softener.
- In a patient on chronic opioids who develops mild respiratory depression, why is full-dose naloxone avoided?
- It can precipitate severe pain and acute opioid withdrawal; small, titrated doses are used instead if reversal is needed.
- What is the first-line pharmacologic agent for treating terminal delirium?
- Haloperidol, a low-dose antipsychotic.
- Why are benzodiazepines generally avoided as first-line therapy for delirium in most palliative patients?
- They can worsen confusion and paradoxically increase agitation.
- What class of medication is used to reduce noisy respiratory secretions ('death rattle') near the end of life?
- Anticholinergic agents, such as scopolamine or glycopyrrolate.