pearljam59
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9. A 48 year-old man with advanced metastatic gastric cancer is admitted to the hospital because of severe abdominal pain High doses of oral analgesics, including numerous opioids, nonsteroidal anti-inflammatory drugs, and tricyclic agents, have not been successful in managing the pain Morphine administered by intravenous infusion successfully controls his pain, but the doses needed cause respiratory depression. He has repeatedly stated that he does not want cardiopulmonary resuscitation and that he wishes "to die with dignity without unnecessary pain." Which of the following is the most appropriate course of action?
A) Administer the lowest dose of morphine that relieves pain, even if it depresses respiration
B) Decrease the dose of morphine and administer an anxiolytic
C) Decrease the dose of morphine, explaining that he will have to tolerate some pain
D) Discontinue morphine and try different analgesics
E) Increase the dose of morphine progressively until the patient stops breathing
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| druas
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C?
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| yasmeen
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A
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| penshoppe
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A?
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| tolito
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A
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| guest007
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A.......though C is pretty close......here the point is patient wants to die......without pain and he is termially ill...no treatment for adv.gastric ca.....
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| robin082006
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C
A is considered malpractice. we can prescribe drugs that may decrease patients's life expectancy in the long run but we cannot do if drugs have acute dangerous effects.
Edited by robin082006 on 05/29/06 - 10:29 PM
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| mjl1717
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i go with answer a. [ if pt states he wants to die with dignity- the doc cant directly kill him but can officially offer meds that EASE the pain but may shorten his life--just part of being a doc.
answer c -even by todays standards would seem cruel. and id think twice before telling a patient or his family this especially in a city hospital.
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| netlover
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It's A
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| nadiabarati
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A for sure
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| Diego Casali
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A
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| Diego Casali
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It's A.
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| DrVirgo
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I agree with A... Make the patient comfortable. If he is DNR, with gastric cancer and other pain meds didin't work there is not much more you can do.
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| leen
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I too go with A
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| klimt
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definitely A....FA says so
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| jamdoc
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A, cant let pt.suffer
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| kashdoc21
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ANS : A
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| Addicudo
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D) Discontinue morphine and try different analgesics
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| lq2006
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A
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| Addicudo
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A) Administer the lowest dose of morphine that relieves pain, even if it depresses respiration ... CANNOT do this ... CANNOT KILL a Pt ... ACTIVELY ... !!! Can kill him by NOT giving anything ... BUT NOT BY GIVING HIM !!! ... thats the rule I applied here .... !!!!!
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| Addicudo
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D) Discontinue morphine and try different analgesics
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| tolito
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i am older and 'wiser' since my last entry. i would go for B. in real life, the answer is A but this may result in pt's death. so for mle, we cannot offer any treatment that may result in death. adding an anxiolytic to the lower dose of morphine will calm him, make him sleepy and improve the efficacy of the morphine.
usmle answers are not always 'practical' but we need to be wary and remember to always answer 'ideal' situations.
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| paresh1225
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A
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| test123
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D) Discontinue morphine and try different analgesics
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| i_m_legend
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answer is either B or C.
A can`t be answer as we are almost actively killing the patient...same is happening in E
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