Internal-Medicine

128 6: Oncology
Questions 60 through 63
(A)
(B)
(C)
(D)
(E)
(F)
(G)
nonsteroidal anti-inflammatory drugs
(NSAIDs)
opioids
amphetamines
anticonvulsants
phenothiazines
butyrophenones
steroids
For each patient with metastatic cancer pain, select
the most likely treatment choice.
60. A 52-year-old woman has metastatic breast
cancer with boney metastases. She is taking
hydromorphone for the pain but is still experiencing
back pain. She is reluctant to take more
of the hydromorphone since she become very
drowsy with higher doses. This group of medications
is particularly useful for pain from
bony metastases. (SELECT ONE)
61. A 74-year-old man with metastatic prostate
cancer develops shooting pains in his left leg
and constant back pain. Further evaluation
reveals a pathologic compression fracture of the
lumbar spine and involvement of the nerve
roots in his lower spine causing the pain. He is
started on a medication to help reduce the symptoms,
but a limitation of the drug is leukopenia
and thrombocytopenia. (SELECT ONE)
62. A 68-year-old woman was treated for
melanoma 3 years ago. She now presents with
constant headaches, nausea, vomiting, and leftsided
weakness. A CT scan reveals two masses
in the right parietal lobe consistent with
metastatic melanoma. She is started on medication
to help reduce her symptoms of
headaches and nausea. (SELECT ONE)
63. A 65-year-old man has metastatic lung cancer
and severe bone and chest pain. He is started on
morphine and ibuprofen to control the pain but
is still not comfortable. Further gradual increases
in the morphine dose achieve good pain control
but he becomes drowsy on the appropriate dose
and is unable to do much. He is started on a
medication that can be useful in controlling
opioid-induced sedation. (SELECT ONE)