100+ Free ABA Palliative Care Practice Questions

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A 68-year-old woman with metastatic breast cancer is taking morphine sustained-release 30 mg PO every 12 hours (60 mg/day). Her pain is controlled but she has severe, refractory nausea attributed to morphine. You decide to rotate to oral hydromorphone. Using standard equianalgesic dosing and accounting for incomplete cross-tolerance, what is the most appropriate starting daily dose of oral hydromorphone?

Hydromorphone 15 mg/day (divided Q4H)

Hydromorphone 7.5-11 mg/day (divided Q4H)

Hydromorphone 30 mg/day (divided Q4H)

Hydromorphone 3 mg/day (divided Q4H)

to track

2026 Statistics

Key Facts: ABA Palliative Care Exam

240

Max MCQ Questions

Up to 240 single-best-answer items

1 Day

Exam Length

Comprehensive computer-based

$2,500

Initial Exam Fee

$2,125 retake

12 mo

Required Fellowship

ACGME-accredited HPM fellowship

10 yr

Certification Validity

MOC via exam or LKA

Cosponsoring Boards

Shared exam via ABIM

The ABA HPM exam is a 1-day computer-based test of up to 240 single-best-answer MCQs administered by ABIM at Pearson VUE. Candidates must hold primary ABA certification and have completed a 12-month ACGME HPM fellowship. Content covers pain management, non-pain symptoms (dyspnea, nausea, delirium, constipation), communication and advance care planning, ethics (capacity, palliative sedation, MAID), psychosocial and spiritual care, and prognostication (PPS, Karnofsky, FAST, hospice eligibility). Initial exam fee $2,500; certification is valid 10 years with MOC via recertification or LKA.

Sample ABA Palliative Care Practice Questions

Try these sample questions to test your ABA Palliative Care exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 68-year-old woman with metastatic breast cancer is taking morphine sustained-release 30 mg PO every 12 hours (60 mg/day). Her pain is controlled but she has severe, refractory nausea attributed to morphine. You decide to rotate to oral hydromorphone. Using standard equianalgesic dosing and accounting for incomplete cross-tolerance, what is the most appropriate starting daily dose of oral hydromorphone?

A.Hydromorphone 15 mg/day (divided Q4H)

B.Hydromorphone 7.5-11 mg/day (divided Q4H)

C.Hydromorphone 30 mg/day (divided Q4H)

D.Hydromorphone 3 mg/day (divided Q4H)

Explanation: Oral morphine 30 mg = oral hydromorphone 7.5 mg (equianalgesic). So 60 mg/day morphine PO converts to 15 mg/day hydromorphone PO. Because of incomplete cross-tolerance, reduce the calculated equianalgesic dose by 25-50% when switching opioids, giving a target starting dose of roughly 7.5-11 mg/day. Exam Tip: Always reduce by 25-50% for incomplete cross-tolerance, except when rotating because of toxicity at high doses (use the larger reduction) or when rotating to methadone (non-linear, much larger reduction).

2A 4-year-old child with neuroblastoma and an intact cognitive status reports pain. Which pain assessment tool is most appropriate?

A.Numeric Rating Scale (0-10)

B.PAINAD (Pain Assessment in Advanced Dementia)

C.Wong-Baker FACES Pain Rating Scale

D.Brief Pain Inventory

Explanation: The Wong-Baker FACES scale (ages 3+ with intact cognition) uses 6 cartoon faces from smiling to crying and is validated for self-report in young children. The Numeric Rating Scale requires abstract numerical thinking usually not developed until ~7-8 years old. PAINAD is for nonverbal adults with dementia. FLACC (Face, Legs, Activity, Cry, Consolability) is observational and used when self-report is not possible (infants, preverbal, or unresponsive patients). Exam Tip: Match the tool to the patient — self-report whenever possible; observational scales only when communication is impaired.

3According to the World Health Organization (WHO) analgesic ladder, which medication class is appropriate for Step 1 (mild pain)?

A.Strong opioids such as morphine or hydromorphone

B.Weak opioids such as codeine or tramadol

C.Non-opioid analgesics such as acetaminophen or NSAIDs

D.Adjuvants such as gabapentin or TCAs alone

Explanation: The WHO analgesic ladder begins with Step 1: non-opioids (acetaminophen, NSAIDs) +/- adjuvants for mild pain. Step 2 adds weak opioids (codeine, tramadol, low-dose hydrocodone). Step 3 uses strong opioids (morphine, oxycodone, hydromorphone, fentanyl). Adjuvants (gabapentinoids, antidepressants, corticosteroids) may be added at any step. Exam Tip: The WHO ladder was designed for cancer pain but is broadly applied; current practice often skips Step 2 in severe cancer pain, going directly to low-dose strong opioids.

4A patient with advanced lung cancer is on morphine ER 60 mg PO every 12 hours (total daily dose 120 mg). What is the appropriate morphine immediate-release dose for breakthrough pain?

A.Morphine IR 5 mg PO Q4H PRN

B.Morphine IR 60 mg PO Q4H PRN

C.Morphine IR 12-24 mg PO Q1H PRN

D.Morphine IR 1-2 mg PO Q1H PRN

Explanation: Breakthrough dose = 10-20% of the total 24-hour opioid dose, offered every 1 hour PO as needed (or every 15-30 min for parenteral). 120 mg × 10-20% = 12-24 mg. Oral morphine immediate-release peaks at ~60 minutes, so Q1H dosing is appropriate. Exam Tip: Never limit breakthrough doses to Q4H for uncontrolled pain — that does not match the pharmacokinetic peak of IR opioids.

5A 79-year-old woman with advanced Alzheimer dementia is nonverbal. She appears restless and grimaces with repositioning. Which tool is most appropriate to assess her pain?

A.PAINAD (Pain Assessment in Advanced Dementia)

B.Numeric Rating Scale (NRS)

C.Brief Pain Inventory

D.McGill Pain Questionnaire

Explanation: PAINAD is a 5-item observational scale (breathing, vocalization, facial expression, body language, consolability) validated for nonverbal patients with advanced dementia. Scores range 0-10. The NRS, BPI, and McGill questionnaires all require reliable self-report. Exam Tip: FLACC is used for infants/children and unresponsive adults; PAINAD is the dementia-specific tool; CPOT and BPS are used in ICU patients.

6A 55-year-old woman with metastatic pancreatic cancer develops burning, lancinating leg pain consistent with neuropathic pain. She is already on controlled-release opioids. Which adjuvant has the strongest evidence for first-line use?

A.Ibuprofen

B.Gabapentin

C.Acetaminophen

D.Methocarbamol

Explanation: Gabapentinoids (gabapentin, pregabalin), serotonin-norepinephrine reuptake inhibitors (duloxetine), and tricyclic antidepressants (nortriptyline, amitriptyline) are first-line adjuvants for neuropathic pain. NSAIDs and acetaminophen are ineffective for neuropathic pain alone. Exam Tip: For diabetic neuropathy specifically, duloxetine and pregabalin have FDA approval; for postherpetic neuralgia, gabapentin, pregabalin, and topical lidocaine/capsaicin are first-line.

7A hospice patient on long-term oral opioids has severe constipation despite senna and docusate. Work-up shows no obstruction. Which agent specifically targets the peripheral mu-opioid receptor to reverse opioid-induced constipation without reversing analgesia?

A.Magnesium citrate

B.Methylnaltrexone

C.Lactulose

D.Bisacodyl

Explanation: Methylnaltrexone (and oral naldemedine, naloxegol) are peripherally-acting mu-opioid receptor antagonists (PAMORAs) that do not cross the blood-brain barrier, so they reverse opioid-induced constipation without blocking central analgesia or precipitating withdrawal. Exam Tip: Constipation is universal with opioids — there is NO tolerance. Always prescribe a stimulant laxative (senna) prophylactically; reserve PAMORAs for refractory OIC after traditional laxatives fail.

8A 72-year-old man with end-stage COPD and FEV1 of 20% predicted reports severe dyspnea at rest despite maximal bronchodilators, oxygen, and steroids. Which pharmacologic intervention has the strongest evidence for relieving refractory dyspnea?

A.High-dose IV furosemide

B.Low-dose systemic opioids

C.Sublingual nitroglycerin

D.Nebulized albuterol around-the-clock

Explanation: Low-dose systemic opioids (oral or parenteral morphine at 2.5-5 mg or equivalent) are first-line for refractory dyspnea in advanced disease, with Level 1 evidence. They reduce the perception of breathlessness without significantly reducing respiratory drive at palliative doses. Benzodiazepines may be added if anxiety is prominent. Nebulized opioids are NOT recommended — evidence shows no benefit over nebulized saline. Exam Tip: Expect a question on refractory dyspnea — low-dose systemic opioids, not nebulized opioids.

9A patient with advanced cancer develops hyperactive delirium with agitation, hallucinations, and combativeness. After addressing reversible causes, which first-line pharmacologic agent is most appropriate?

A.Lorazepam

B.Haloperidol

C.Diphenhydramine

D.Morphine

Explanation: Haloperidol is first-line for hyperactive delirium in palliative care (typical starting dose 0.5-2 mg PO/IV/SC Q4-6H). Atypicals (risperidone, olanzapine, quetiapine) are alternatives. Benzodiazepines (lorazepam) can worsen delirium and should be avoided except for alcohol/benzodiazepine withdrawal or refractory terminal delirium after antipsychotics have failed. Diphenhydramine is strongly anticholinergic and worsens delirium. Exam Tip: Always search for reversible causes (UTI, constipation, hypoxia, dehydration, medications, pain) before labeling delirium as terminal.

10A patient with advanced cancer reports chronic nausea thought to be chemoreceptor trigger zone (CTZ) mediated (opioid-induced, metabolic). Which antiemetic has the best evidence as a first-line agent for this mechanism?

A.Haloperidol

B.Lorazepam

C.Dexamethasone

D.Promethazine

Explanation: Haloperidol is a potent D2 antagonist at the chemoreceptor trigger zone and is highly effective for opioid-induced and metabolic (uremia, hypercalcemia) nausea at low doses (0.5-2 mg). Match the antiemetic to the mechanism: CTZ (dopamine) = haloperidol; vestibular/motion = meclizine/scopolamine; gastric stasis = metoclopramide; chemotherapy/radiation = 5-HT3 antagonists (ondansetron); cerebral edema/raised ICP = dexamethasone. Exam Tip: Rational antiemetic selection by mechanism is a high-yield topic.

About the ABA Palliative Care Exam

The ABA Hospice and Palliative Medicine (HPM) subspecialty certification recognizes anesthesiologists with specialized expertise in symptom control, serious-illness communication, and end-of-life care. After 2014, eligibility requires completion of a 12-month ACGME-accredited HPM fellowship. The exam is the same comprehensive examination used by all 10 cosponsoring ABMS boards and is administered by ABIM on behalf of the ABA.

Questions

240 scored questions

Time Limit

1-day computer-based exam (approximately 9 hours on-site)

Passing Score

Absolute standard (criterion-referenced)

Exam Fee

$2,500 initial / $2,125 retake (American Board of Anesthesiology (ABA) — exam administered by ABIM)

ABA Palliative Care Exam Content Outline

25%

Pain Assessment and Management

WHO analgesic ladder, opioid pharmacology and rotation, equianalgesic dosing, breakthrough pain, neuropathic pain adjuvants, assessment tools (numeric, FACES, FLACC, PAINAD)

25%

Non-Pain Symptom Management

Dyspnea, nausea/vomiting, delirium, constipation, anorexia-cachexia, pruritus, terminal secretions, and integrative therapies

15%

Psychosocial, Spiritual, Cultural

Total pain (Cicely Saunders), depression vs demoralization, anticipatory grief, FICA spiritual assessment, bereavement, pediatric/adolescent care

15%

Communication and Advance Care Planning

SPIKES protocol, goals-of-care conversations, POLST/MOLST, DNR orders, surrogate decision-making, family meetings

10%

Ethical and Legal Issues

Capacity assessment, withholding/withdrawing LST, artificial nutrition/hydration, palliative sedation vs euthanasia, double effect, MAID (state-law dependent)

10%

Prognostication and Hospice Eligibility

PPS, Karnofsky, FAST dementia staging, ePrognosis, Medicare Hospice Benefit (≤6 months), disease-specific trajectories

How to Pass the ABA Palliative Care Exam

What You Need to Know

Passing score: Absolute standard (criterion-referenced)
Exam length: 240 questions
Time limit: 1-day computer-based exam (approximately 9 hours on-site)
Exam fee: $2,500 initial / $2,125 retake

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABA Palliative Care Study Tips from Top Performers

1Memorize equianalgesic conversions cold: morphine 30 mg PO = oxycodone 20 mg PO = hydromorphone 7.5 mg PO = morphine 10 mg IV. Always reduce by 25-50% for incomplete cross-tolerance when rotating opioids, and remember methadone conversion is non-linear

2Breakthrough pain dose = 10-20% of the total 24-hour opioid dose; know how to calculate this quickly from any baseline regimen

3For opioid-induced constipation, prescribe a stimulant laxative (senna) prophylactically with every opioid; escalate to methylnaltrexone or naldemedine for refractory OIC

4Delirium — first-line is haloperidol or risperidone; avoid benzodiazepines except for alcohol/benzo withdrawal or terminal delirium where haloperidol has failed

5Master SPIKES (Setting, Perception, Invitation, Knowledge, Emotion, Summary) for breaking bad news — expect at least one communication vignette on the exam

6Know Medicare Hospice Benefit eligibility: terminal illness with prognosis of ≤6 months if disease runs its usual course, certified by two physicians initially, and patient foregoes curative treatment for the terminal condition

Frequently Asked Questions

What is the ABA Hospice and Palliative Medicine certification?

The ABA HPM subspecialty certification is offered by the American Board of Anesthesiology as one of 10 cosponsoring ABMS boards (along with ABIM, ABFM, ABEM, ABPMR, ABPN, ABOG, ABP, ABR, and ABS). The same comprehensive examination is administered by ABIM on behalf of all 10 boards and tests expert-level knowledge in pain management, non-pain symptom control, communication, ethics, and end-of-life care.

Who is eligible to take the ABA HPM exam?

Candidates must be primary-certified by the American Board of Anesthesiology and in good standing, hold a valid unrestricted US medical license, and since 2014 have completed a 12-month ACGME-accredited Hospice and Palliative Medicine fellowship. The fellowship program director must attest to clinical competence. Candidates register through ABA GO; ABIM then schedules and administers the exam.

What is the format of the ABA HPM exam?

The initial HPM certification exam is a comprehensive 1-day computer-based examination delivered at Pearson VUE test centers. It consists of up to 240 single-best-answer multiple-choice questions organized into timed blocks with scheduled breaks. An absolute (criterion-referenced) passing standard is applied — your performance does not depend on other candidates.

How much does the ABA HPM exam cost?

The initial certification examination fee is $2,500. A retake is $2,125. These fees are payable to ABA during registration through ABA GO. Once certified, physicians pay an ongoing MOC fee (approximately $175/year) and either take a 10-year recertification exam or participate in the Longitudinal Knowledge Assessment (LKA).

What topics are on the ABA HPM exam?

Content follows the ABIM HPM blueprint: pain assessment and management (~25%), non-pain symptom management (~25%), psychosocial/spiritual/cultural care (~15%), communication and advance care planning (~15%), ethical and legal issues (~10%), and disease-specific palliative care and prognostication (~10%). Pain and non-pain symptom management together make up about half the exam.

How should I prepare for the ABA HPM exam?

Start with a structured board-review course or textbook (Oxford Textbook of Palliative Medicine, Fast Facts, AAHPM's UNIPAC or HPM PASS). Master equianalgesic conversions and opioid rotation — these are heavily tested. Practice communication frameworks (SPIKES, REMAP). Memorize hospice eligibility criteria, PPS, FAST, and the Medicare Hospice Benefit. Finish with a high-volume practice-question bank covering all 6 content domains.

How long is ABA HPM certification valid?

Initial HPM certification is valid for 10 years. Diplomates must maintain certification through ABA's MOC program, which includes continuing medical education, a professional standing review, and assessment of knowledge either via a traditional 10-year recertification examination or the Longitudinal Knowledge Assessment (LKA), which delivers questions quarterly over 5-year cycles.

Is the ABA HPM exam the same as the ABIM HPM exam?

Yes — the initial HPM certification examination is a single, shared comprehensive exam administered by ABIM on behalf of all 10 cosponsoring ABMS boards, including the ABA. Candidates register with their primary board (ABA for anesthesiologists) but sit for the same examination content regardless of primary specialty. This is why ABA candidates study from ABIM-published blueprints and broad HPM review resources.