1. Providing ED care for older patients, especially palliative patients, is more about goal-oriented care than problem oriented care. Which of the following statements is FALSE with relation to goal-oriented care?

• A) Goal-oriented care is often an increase in the amount of and intensity of care.
• B) Goal-oriented care is based on a patient’s wishes about hopeful outcomes from their visit to the ED.
• C) Goal-oriented care is based on the patient’s pathophysiology, i.e. what disease they are suffering from.
• D) It is important to use the right language when discussing goal-oriented care with a patient. Language that suggests “withdrawing” care may not be appropriate.

2. Which of the following statements about opioid conversions are TRUE? Select all that apply

• A) Oral Morphine is twice as potent as intravenous Morphine.
• B) Hydromorphone is five times as potent as Morphine.
• C) Oxycodone is twice as potent as Morphine.
• D) A 25mcg Fentanyl patch is considered roughly equivalent to 60mg of oral Morphine.

3. Which of the following are known and common side effects of opioid therapy that it would be wise to tell your patients about? Select all that apply

• A) Nausea
• B) Constipation
• C) Urticaria
• D) Dizziness

4. What ‘trajectory of dying’ is represented by the graph below?

• A) Frailty
• B) Terminal Illness
• C) Sudden Death
• D) Organ Failure

5. Mr. Taft is a 75 year old male who presents to your ED with 9/10 back pain, which he says is an acute worsening of his chronic pain secondary to bony prostate cancer metastases. He takes Hydromorphone Contin 40mg PO BID for his pain at home, and has been on this dose for months. You are keen to properly control his pain before you continue with his assessment, but are quite worried about respiratory depression at the levels of opioid you would be forced to give him to control his pain. What is the best approach to controlling his pain in the ED?

• A) Give him small amounts of opioids and slowly titrate the dose until he receives pain control.
• B) Try Acetaminophen first to see if another modality of pain control will help without respiratory depression.
• C) Calculate his Morphine Equivalent Daily Dose and provide an appropriate breakthrough dose intravenously in a monitored environment where sedation and respiratory depression can be observed within the first 10 minutes when it is likely to occur.
• D) Call Palliative Care for advice before administering any analgesia.