Free Specialty Certificate Examination in Palliative Medicine Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Specialty Certificate Examination in Palliative Medicine practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A hospice patient thought to be dying becomes more alert, starts drinking and walks to the bathroom over the following day. How should the physician interpret this change when reviewing the prognosis?

   1. A.It may indicate stabilisation or recovery and warrants reassessment.Correct answer: A
   2. B.It indicates a terminal rally that confirms continued irreversible decline.
   3. C.It indicates opioid withdrawal and warrants replacement of the opioid dose.
   4. D.It indicates hyperactive delirium and warrants antipsychotic treatment.

   Explanation: The guideline states: "Be aware that improvement in signs and symptoms or functional observations could indicate that the person may be stabilising or recovering." Improving function should prompt reconsideration of the trajectory; these observations alone do not establish a terminal rally, withdrawal or delirium.

   Reference: NICE NG31 — Care of dying adults in the last days of life (HSCNI official copy) — Recommendation 1.1.3

2. 2An adult receiving stable palliative care for heart failure also has insulin-treated diabetes. He is alert and has swallowed oral glucose for a symptomatic capillary glucose of 3.1 mmol/L. When should his glucose first be rechecked to assess the response?

   1. A.2–5 minutes
   2. B.10–15 minutesCorrect answer: B
   3. C.30–45 minutes
   4. D.60–90 minutes

   Explanation: The source states: "Check your blood sugar after 10 to 15 minutes." The initial response is checked after 10–15 minutes. This is an episode of concurrent diabetic hypoglycaemia, not evidence of worsening heart failure.

   Reference: NHS — Low blood sugar — How to treat low blood sugar yourself

3. 3In England, a patient refuses admission after discussing the risks and understanding the alternatives. The team considers the choice unwise. What effect does that disagreement alone have on the Mental Capacity Act assessment?

   1. A.It establishes incapacity because preventable harm is foreseeable.
   2. B.It establishes incapacity because professional advice was declined.
   3. C.It does not establish an inability to make the decision.Correct answer: C
   4. D.It transfers the decision to a relative with health-care experience.

   Explanation: The source states: "A person is not to be treated as unable to make a decision merely because he makes an unwise decision." An unwise choice is not itself evidence of incapacity. Foreseeable risk and disagreement do not replace assessment of the decision-making abilities.

   Reference: Mental Capacity Act 2005 — Section 1(4)

4. 4A patient with metastatic cancer develops rapidly worsening back pain and urinary difficulty. The initial neurological examination is normal. What is the significance of the normal examination for suspected malignant spinal cord compression?

   1. A.It excludes compression until objective limb weakness develops.
   2. B.It excludes compression if the plantar responses are flexor.
   3. C.It permits exclusion of compression without urgent imaging.
   4. D.It does not exclude compression and urgent assessment remains necessary.Correct answer: D

   Explanation: The source states: "A full neurological examination should be performed; normal examination does not exclude MSCC." New progressive back pain and urinary symptoms remain concerning despite a normal examination; waiting for deficits may permit irreversible harm.

   Reference: Scottish Palliative Care Guidelines — Malignant spinal cord compression — Introduction — Overview

5. 5A patient with newly diagnosed amyotrophic lateral sclerosis asks which listed medicine can slow the progression of that condition. Which is the appropriate medicine to discuss with the neurology team?

   1. A.Levodopa
   2. B.RiluzoleCorrect answer: B
   3. C.Rivastigmine
   4. D.Memantine

   Explanation: The source states: "a medicine called riluzole if you have amyotrophic lateral sclerosis (ALS), which can help slow down its progression" Riluzole is the disease-modifying medicine identified for ALS. The alternatives are neurological medicines used for different conditions.

   Reference: NHS — Motor neurone disease — Medicines for MND

6. 6A patient with advanced cancer has opioid-induced constipation despite adequate trials of conventional laxatives. A peripherally acting mu-opioid receptor antagonist is considered. Which condition is a contraindication to that treatment?

   1. A.Stable background opioid analgesia
   2. B.Previous treatment with a stimulant laxative
   3. C.Gastrointestinal obstructionCorrect answer: C
   4. D.Persistent constipation without colic

   Explanation: The source states: "Contraindications to PAMORAs include gastrointestinal (GI) obstruction or patients at risk of GI perforation." Obstruction is a direct contraindication; opioid treatment and previous laxative failure instead form the context in which a PAMORA may be considered.

   Reference: Scottish Palliative Care Guidelines — Constipation — Opioid-induced constipation

7. 7A patient has well-controlled background cancer pain but brief severe pain whenever transferring from bed to chair. What term most specifically describes these triggered exacerbations?

   1. A.Incident painCorrect answer: A
   2. B.End-of-dose failure
   3. C.Continuous background pain
   4. D.Opioid-induced hyperalgesia

   Explanation: The source states: "Breakthrough and incident pain: a transient exacerbation of pain which occurs either spontaneously (breakthrough) or in relation to a trigger (incident pain) in someone who has mainly stable or adequately relieved background pain." Movement is a predictable trigger against controlled background pain, making incident pain the most specific term.

   Reference: Scottish Palliative Care Guidelines — Pain assessment — Assessment — breakthrough and incident pain

8. 8A patient taking oral morphine 20 mg every four hours regularly can no longer swallow. The clinician selects the Scottish approximate oral-to-subcutaneous morphine conversion of 2:1. Before any further individual adjustment, what total subcutaneous morphine dose corresponds to the regular oral dose over 24 hours?

   1. A.30 mg
   2. B.60 mgCorrect answer: B
   3. C.120 mg
   4. D.240 mg

   Explanation: The source states: "Morphine 10mg ≈ SC morphine 5mg Divide by 2" There are six four-hourly doses: 20 × 6 = 120 mg oral morphine/day. Divide by two for approximately 60 mg SC/day. 30 mg halves the converted dose again, 120 mg omits conversion, and 240 mg reverses the conversion direction. Clinical judgement and monitoring remain necessary.

   Reference: Scottish Palliative Care Guidelines — Opioid conversion tables — Conversions from oral strong opioids — morphine to SC morphine

9. 9An adult palliative patient with adequate subcutaneous tissue needs a breakthrough bolus through a separate subcutaneous site. Under the Scottish syringe-pump practice points, what is the maximum bolus volume normally specified?

   1. A.0.5 mL
   2. B.1 mL
   3. C.2 mLCorrect answer: C
   4. D.5 mL

   Explanation: The source states: "a maximum volume of 2ml can be used for subcutaneous bolus but consider your patient and avoid a volume over 1ml for cachexic patients with little subcutaneous tissue" The general maximum is 2 mL, with a lower-volume consideration for cachectic patients. The scenario expressly supplies adequate subcutaneous tissue.

   Reference: Scottish Palliative Care Guidelines — Syringe pump/driver practice points — Subcutaneous breakthrough doses

10. 10A patient with advanced but stable COPD is offered a structured group programme combining exercise and education to improve exertional tolerance, confidence and emotional wellbeing. Which rehabilitation programme is this?

    1. A.Cardiac rehabilitation
    2. B.Vestibular rehabilitation
    3. C.Neurological rehabilitation
    4. D.Pulmonary rehabilitationCorrect answer: D

    Explanation: The source states: "Pulmonary rehabilitation is a specialised programme of exercise and education designed to help people with lung problems such as COPD." The programme is pulmonary rehabilitation, which supports function and wellbeing in COPD alongside other treatments.

    Reference: NHS — COPD treatment — Pulmonary rehabilitation