NR572 SCRIPT 2026 FULL SOLVED
CONTENT
◉Conversations regarding end-of-life care, it may be helpful to
reframe the transition to hospice as the "standard of care" at that
point along the disease trajectory when further disease modification
is no longer possible and symptom burden becomes more
prominent. Answer: Coomunictoin with family about hospice
◉-patients who are incompetent and terminally ill and who have not
completed an advance care directive, next of kin can exercise that
right, although this may be restricted in some states, depending on
how clear and convincing the evidence is of the patient's preferences
For incompetent patients
three criteria have been suggested to guide the decision to terminate
medical interventions
1. ordinary care should be administered but extraordinary care
could be terminated
2. substituted-judgment criterion, which holds that the proxy
decision-makers should try to imagine what the incompetent patient
would do if they were competent
,3. best-interests criterion holds that proxies should evaluate
treatments by balancing their benefits and risks and select those
treatments where the benefits maximally outweigh the burdens of
treatment. Answer: WITHDRAWING AND WITHHOLDING LIFE-
SUSTAINING TREATMENT
◉terminal extubation, which is the removal of the endotracheal
tube, and terminal weaning, which is the gradual reduction of the
fraction of inspired oxygen (FIO2) or ventilator rate
-To ensure comfort for conscious or semiconscious patients before
withdrawal of the ventilator, neuromuscular blocking agents should
be terminated and sedatives and analgesics administered
withholding CPR
Quantitative futility occurs "when physicians conclude (through
personal experience, experiences shared with colleagues, or
consideration of reported empiric data) that in the last 100 cases, a
medical treatment has been useless."
Physiologic futility means that an intervention will have no
physiologic effect. Answer: Withholding and withdrawing acutely
life-sustaining medical interventions
,◉Not recommended for patients with seizure disorders, eating
disorders, or those on MAOIs.. Answer: Bupropion Contraindications
◉Include suicidal ideation, severe psychosis, mania, and
uncontrolled depression.. Answer: Indications for Psychiatry
Consult:
◉episodic symptoms due to catecholamine surges, including
headache, sweating, and tachycardia (palpitations).
Patients may experience severe pounding headaches, profuse
diaphoresis, and a racing heartbeat during episodes.
Symptoms can be triggered by stress, exercise, or certain
foods/medications
hypertension may be present between episodes, and patients may
exhibit weight loss and hyperglycemia due to a hypermetabolic
state.
During an attack, one might observe very high blood pressure,
tachyarrhythmia, sweating, and pallor.
If the tumor is adrenal, it usually does not cause pain; extra-adrenal
tumors may present with location-specific symptoms.. Answer:
Presentation of Pheochromocytoma
, ◉Stroke, swallowing difficulty; Communication disorders. Answer:
Speech Therapy: Indications
◉Amputation
Spinal cord injury
Stroke, in conjunction with speech therapists, recreational
therapists, physical therapists, and occupational therapists
Traumatic brain injury
Medical patients requiring complex rehabilitation
Musculoskeletal syndromes: low back pain, fibromyalgia
Chronic pain management, in conjunction with psychologists,
physical therapists, occupational therapists, chiropractors, and
anesthesiologists with expertise in pain management and
interventional procedures. Answer: Common Indications for
Physiatry Consultation
◉LTACH
-Facilities providing complex medical care (eg, post-ICU and
Ventilator Support)
-Respiratory Failure, Pulmonary Edema, Sepsis
Independent rehab facility
-Facilities providing active rehab to patients who are able to perform
at least 3h/d of PT and/or OT
CONTENT
◉Conversations regarding end-of-life care, it may be helpful to
reframe the transition to hospice as the "standard of care" at that
point along the disease trajectory when further disease modification
is no longer possible and symptom burden becomes more
prominent. Answer: Coomunictoin with family about hospice
◉-patients who are incompetent and terminally ill and who have not
completed an advance care directive, next of kin can exercise that
right, although this may be restricted in some states, depending on
how clear and convincing the evidence is of the patient's preferences
For incompetent patients
three criteria have been suggested to guide the decision to terminate
medical interventions
1. ordinary care should be administered but extraordinary care
could be terminated
2. substituted-judgment criterion, which holds that the proxy
decision-makers should try to imagine what the incompetent patient
would do if they were competent
,3. best-interests criterion holds that proxies should evaluate
treatments by balancing their benefits and risks and select those
treatments where the benefits maximally outweigh the burdens of
treatment. Answer: WITHDRAWING AND WITHHOLDING LIFE-
SUSTAINING TREATMENT
◉terminal extubation, which is the removal of the endotracheal
tube, and terminal weaning, which is the gradual reduction of the
fraction of inspired oxygen (FIO2) or ventilator rate
-To ensure comfort for conscious or semiconscious patients before
withdrawal of the ventilator, neuromuscular blocking agents should
be terminated and sedatives and analgesics administered
withholding CPR
Quantitative futility occurs "when physicians conclude (through
personal experience, experiences shared with colleagues, or
consideration of reported empiric data) that in the last 100 cases, a
medical treatment has been useless."
Physiologic futility means that an intervention will have no
physiologic effect. Answer: Withholding and withdrawing acutely
life-sustaining medical interventions
,◉Not recommended for patients with seizure disorders, eating
disorders, or those on MAOIs.. Answer: Bupropion Contraindications
◉Include suicidal ideation, severe psychosis, mania, and
uncontrolled depression.. Answer: Indications for Psychiatry
Consult:
◉episodic symptoms due to catecholamine surges, including
headache, sweating, and tachycardia (palpitations).
Patients may experience severe pounding headaches, profuse
diaphoresis, and a racing heartbeat during episodes.
Symptoms can be triggered by stress, exercise, or certain
foods/medications
hypertension may be present between episodes, and patients may
exhibit weight loss and hyperglycemia due to a hypermetabolic
state.
During an attack, one might observe very high blood pressure,
tachyarrhythmia, sweating, and pallor.
If the tumor is adrenal, it usually does not cause pain; extra-adrenal
tumors may present with location-specific symptoms.. Answer:
Presentation of Pheochromocytoma
, ◉Stroke, swallowing difficulty; Communication disorders. Answer:
Speech Therapy: Indications
◉Amputation
Spinal cord injury
Stroke, in conjunction with speech therapists, recreational
therapists, physical therapists, and occupational therapists
Traumatic brain injury
Medical patients requiring complex rehabilitation
Musculoskeletal syndromes: low back pain, fibromyalgia
Chronic pain management, in conjunction with psychologists,
physical therapists, occupational therapists, chiropractors, and
anesthesiologists with expertise in pain management and
interventional procedures. Answer: Common Indications for
Physiatry Consultation
◉LTACH
-Facilities providing complex medical care (eg, post-ICU and
Ventilator Support)
-Respiratory Failure, Pulmonary Edema, Sepsis
Independent rehab facility
-Facilities providing active rehab to patients who are able to perform
at least 3h/d of PT and/or OT
