#august2020mccqe1
An 87-year-old man with prostate cancer, Gleason grade 9, is now receiving palliative care following failure of hormonal therapy and chemotherapy. He has severe bone pain from multiple metastases, despite receiving both bisphosphonate and radiation therapy. His oxygenation is borderline on room air, and he has required supplemental oxygen by face mask. The patient and his family are distraught that he is in so much pain, and they ask the physician to “make the pain stop.” The physician explains that raising the dose of opiates will suppress the patient’s breathing, but the family repeats their request. Which of the following is the best course of action?
(A) Give strong nonsteroidal anti-inflammatory drugs to avoid respiratory depression, even if the pain is not well controlled
(B) Increase the dose of bisphosphonate
(C) Intubate the patient
(D) Medicate the patient with sufficient opioids to control his pain, regardless of respiratory response
(E) Obtain an ethics consultation
An 87-year-old man with prostate cancer, Gleason grade 9, is now receiving palliative care following failure of hormonal therapy and chemotherapy. He has severe bone pain from multiple metastases, despite receiving both bisphosphonate and radiation therapy. His oxygenation is borderline on room air, and he has required supplemental oxygen by face mask. The patient and his family are distraught that he is in so much pain, and they ask the physician to “make the pain stop.” The physician explains that raising the dose of opiates will suppress the patient’s breathing, but the family repeats their request. Which of the following is the best course of action?
(A) Give strong nonsteroidal anti-inflammatory drugs to avoid respiratory depression, even if the pain is not well controlled
(B) Increase the dose of bisphosphonate
(C) Intubate the patient
(D) Medicate the patient with sufficient opioids to control his pain, regardless of respiratory response
(E) Obtain an ethics consultation
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