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DNB Palliative Medicine Previous Year Questions

These are the DNB Palliative Medicine theory questions asked by NBEMS in the December 2025 and June 2025 exams, listed paper by paper as they appeared. The Prep DNB app has all 3 DNB sessions from October 2024 to December 2025 — 110 questions in total — with repeat-question tracking, examiner keywords and MCQs.

Jump to: December 2025 · June 2025 · Important topics · Older papers

DNB Palliative Medicine December 2025 Question Paper

Paper 1

  1. a) Describe the anatomical structure of the spinal cord. [5] b) With a neat diagram, describe the neurological control of urinary bladder. [5]
  2. a) Briefly describe the WHO pain ladder. [5] b) Describe pain assessment tools for children. [5]
  3. a) Discuss opioid tolerance vs opioid dependence. [5] b) Buprenorphine. [5]
  4. a) Discuss various models of palliative care delivery. [5] b) Discuss the role of the community in developing palliative care in India. [5]
  5. a) What is burnout syndrome? [2] b) How will you identify care givers burnout in chronic illness? [8]
  6. a) Explain the principle of double effect with examples in palliative care setting. [5] b) Discuss the ethical consideration associated with the same. [5]
  7. a) Define spiritual pain with example. [3] b) Distress spiritual scale. [7]
  8. a) Define frailty. [2] b) Define cachexia. [2] c) Discuss the physiological changes of ageing and its clinical significance. [6]
  9. Hypercalcemia in malignancy: a) Write clinical features of hypercalcemia. [3] b) Give grading of hypercalcemia. [3] c) Discuss management of hypercalcemia. [4]
  10. Fungating wound & oral care in cancer patient: a) Triple therapy in wound management having maggots. [3] b) Management of fungating wound. [3] c) Magic mouth gargle. [2] d) Oral care in patient with mucositis. [2]

Paper 2

  1. a) Define breakthrough pain with its etiology. [5] b) Management of breakthrough pain. [5]
  2. a) List the common palliative emergency in oncology patient. [2] b) Discuss in detail pathophysiology, etiology and management of superior vena cava syndrome in palliative care settings. [8]
  3. a) Enumerate causes of bone pain in cancer patient. [2] b) Role of bisphosphonate and denosumab in bone pain. [8]
  4. Malignant bowel obstruction (MBO): a) Signs and symptoms in patients with MBO. [3] b) How will you evaluate this patient? [3] c) Management of patient with MBO. [4]
  5. Neuropathic pain: a) Define hyperalgesia with examples. [2] b) Evaluation and management of opioid induced hyperalgesia. [8]
  6. a) Role of disease modifying chemotherapy in head and neck cancer patient. [5] b) Role of palliative radiotherapy in head and neck cancer. [5]
  7. a) Define constipation and describe the probable causes of constipation in patients presenting to palliative medicine OPD. [5] b) Describe the laxatives available for the management of constipation. [5]
  8. a) Palliative issues in care of patients with cancer of head and neck. [5] b) Care givers issues in patients with head and neck cancer. [5]
  9. Discuss role of following drugs in palliative care: a) Fentanyl patch. [5] b) Dexamethasone. [5]
  10. A 57-year-old female patient with carcinoma breast is having lymphedema: a) What is lymphedema? [1] b) Clinical features and evaluation of lymphedema. [3] c) Current concept of lymphedema management in breast cancer patients. [6]

Paper 3

  1. a) What is prognostication triad in cirrhosis of liver? [2] b) Prognostic tool & hospice referral criteria for end stage liver disease. [5] c) Psychological issues in patients with chronic liver disease. [3]
  2. a) Classify various insulin preparations. [4] b) Discuss management of glycemic control in patients with Diabetes Mellitus at End-of-Life. [6]
  3. a) Role of counselling in a patient with CKD. [6] b) Challenges in implementation of palliative care in patients with CKD. [4]
  4. a) Geriatric giant. [5] b) Importance of deprescribing in geriatric population. [5]
  5. a) List the neurological conditions needing palliative care in paediatric group of patients. [3] b) Role of palliative care physician in paediatric patients with chronic neurological disease. [7]
  6. a) Discuss mandatory documentation & counselling for palliative sedation in cardiac ICU. [5] b) List the drugs used for palliative sedation and discuss any one in detail. [5]
  7. a) How to recognize people who are in the last days of life? [5] b) Care of actively dying patient. [5]
  8. a) List the causes of delirium. [2] b) Mention the types of delirium. [3] c) Management of delirium in palliative care settings. [5]
  9. a) Write a note on GOLD criteria for classification of chronic obstructive pulmonary disease (COPD) and define end stage COPD. [5] b) Discuss the triggers and need for palliative care referral in a patient with COPD. [5]
  10. Write a note on polypharmacy and evidence for deprescribing in palliative care. [10]

Paper 4

  1. a) Discuss challenges and palliative care needs of a bed-bound person. [5] b) Discuss recent evidence-based consensus guidelines on prevention and management of pressure sores. [5]
  2. a) What is palliative sedation? [3] b) Recent NCCN guidelines for palliative sedation. [7]
  3. Discuss the role of Point of Care Ultrasound (POCUS) in a palliative care setting. [10]
  4. a) Article 21: Right to die with dignity. [3] b) Recent supreme court guidelines for withholding/ withdrawing of life support system. [3] c) Discuss four cardinal principles of medical ethics with examples. [4]
  5. Uses for intravenous albumin in critically ill patient: recent guidelines. [10]
  6. a) List the landmark trials in palliative medicine. [4] b) Discuss one landmark trial (Palliative care) in detail. [6]
  7. a) What is CAR-T Therapy? [2] b) Role of palliative care in patients who are on CAR-T therapy. [8]
  8. Discuss MORE care statement on best methods to research in end-of-life care. [10]
  9. Leeds palliative care oxygen therapy guidelines. [10]
  10. Discuss the role of following in the management of terminal delirium: a) Dexmedetomidine. [3] b) Midazolam. [3] c) Haloperidol. [4]

DNB Palliative Medicine June 2025 Question Paper

Paper 1

  1. a) Role of cytochrome P450 enzymes in the metabolism of opioids. [4] b) Pharmacogenomics of codeine. [4] c) Give one example of cytochrome P450 enzyme associated drug interaction. [2]
  2. a) Physiological role of somatostatin. [7] b) Somatostatin analogues in management of the following in a palliative care setting: i) Nausea and vomiting. ii) Diarrhoea. iii) Malignant bowel obstruction. [8]
  3. a) Neurological control of urinary bladder. [4] b) Sensory neurogenic bladder. [2] c) Reflex neurogenic bladder. [2] d) Motor paralytic neurogenic bladder. [2]
  4. a) Mechanisms of action of corticosteroids. [4] b) Role of corticosteroids in bone pain. [2] c) Role of corticosteroids in malignant spinal cord compression. [2] d) Role of corticosteroids in nausea and vomiting. [2]
  5. a) Pathophysiology of oral mucositis. [4] b) WHO grading of oral mucositis. [3] c) Oral measures in the management of mucositis. [3]
  6. a) Pathophysiological mechanisms underlying cancer cachexia. [4] b) Clinical assessment of cancer cachexia. [3] c) Drugs used in the management of cancer cachexia. [3]
  7. a) Neural pathways for pain sensation. [4] b) Gate control theory of pain. [3] c) Peripheral and central sensitisation. [3]
  8. a) Classification of prognostic tools in palliative care. [4] b) Palliative Prognostic Scale. [4] c) Two examples of disease-specific prognostic tools/scales. [2]
  9. a) Physiological mechanisms contributing to breathlessness. [3] b) Mechanisms through which morphine relieves breathlessness. [3] c) Palliative oxygen therapy. [4]
  10. a) Virchows triad and its role in pathogenesis of venous thromboembolism. [3] b) Risk factors for venous thromboembolism in patients with advanced cancers. [3] c) Management of venous thromboembolism in the palliative care setting. [4]

Paper 2

  1. a) Chemotherapeutic agents causing peripheral neuropathy. [3] b) Pathophysiology of chemotherapy-induced peripheral neuropathy. [3] c) Prevention and management of chemotherapy-induced peripheral neuropathy. [4]
  2. a) Actiopathogenesis of tumour lysis syndrome (TLS)'. [3] b) Specific investigations that aid the diagnosis of TLS. [3] c) Management of TLS. [4]
  3. a) Sociology of pain in children with cancer. [3] b) Disease 4 tools used in the assessment of pain in children. [4] c) Principles of cancer pain management in paediatric setting. [3]
  4. a) Diseases role of tyrosine kinase inhibitors (TKIs) in a palliative care setting. [4] b) Common side effects of TKIs. [3] c) Evidence-based decision-making regarding stopping TKIs. [3]
  5. a) Describe Mirels score system. [3] b) Role of Mirels score in a patient with bone pain. [3] c) Discuss xerothorplasty and kyphoplasty. [4]
  6. a) Time toxicity of cancer treatment. [3] b) Ethical issues in time toxicity of cancer treatment. [3] c) Optimisation of cancer-directed therapy at the end of life. [4]
  7. a) Causes of xerostomia in a patient with head and neck cancer. [4] b) Clinical assessment of xerostomia. [3] c) Management of xerostomia. [3]
  8. a) Radiopharmaceuticals used in cancer bone pain. [4] b) Indications for using radiopharmaceuticals in cancer bone pain. [3] c) Adverse effects of radiopharmaceuticals. [3]
  9. a) Principles of palliative radiotherapy. [4] b) Palliative radiotherapy in malignant spinal cord compression. [3] c) Stereotactic body radiation therapy for palliative management. [3]
  10. a) Causes of bleeding in a patient with cancer receiving palliative care. [3] b) Local therapies for the management of bleeding malignant wounds. [4] c) Managing terminal haemorrhage in a carotid blow out. [3]

Paper 3

  1. a) Classification of chronic obstructive pulmonary disease as per GOLD criteria. [3] b) Triggers for palliative care referral in a patient with COPD. [3] c) Pointers to limit treatment in a patient with end-stage COPD. [4]
  2. a) Pathophysiology of chronic phantom limb pain. [3] b) Pharmacological management of chronic phantom limb pain. [3] c) Rehabilitation and non-pharmacological measures for chronic phantom limb pain. [4]
  3. a) Triggers to initiate advance care planning. [3] b) Process of advance care planning. [4] c) Excerpts of 2023 Supreme Court judgement on advance care planning. [3]
  4. a) FAST staging in dementia. [3] b) Triggers for palliative care referral in dementia. [3] c) Palliative care needs in a patient with dementia. [4]
  5. a) Factors contributing to burnout in a palliative care setting. [3] b) Maslach burnout inventory. [3] c) Interventions to mitigate burnout for health care providers in palliative care. [4]
  6. a) Definition of palliative sedation. [2] b) Indications for palliative sedation. [3] c) Prerequisites before initiating palliative sedation. [2] d) Pharmacological agents used in palliative sedation. [3]
  7. a) Differences between disease versus palliative prognostication. [4] b) Prognostication in stage D heart failure. [3] c) Prognostication in end-stage liver disease. [3]
  8. a) Palliative care in humanitarian crisis. [4] b) Palliative care in pandemics like COVID-19. [3] c) Essential package of palliative care for humanitarian emergencies. [3]
  9. a) Therapeutic value of hope in patients with serious illness. [3] b) Hope assessment framework in patients with terminal illness. [3] c) Hope-enhancing strategies using the framework for hope intervention. [4]
  10. a) Suicide in people with advanced and terminal illness. [3] b) Risk factors associated with suicidal ideation. [3] c) Assessment and management of a patient with a suicidal tendency. [4]

Paper 4

  1. a) Causes of malignant hypercalcemia. [3] b) Approach to a patient with malignant hypercalcemia. [3] c) Current clinical practice guidelines for treating hypercalcemia of malignancy. [4]
  2. a) Forest plot in metanalysis. [3] b) Interpretation of a forest plot. [3] c) Four practice-changing metanalysis published in palliative medicine. [4]
  3. a) Four landmark trials on early integration of palliative care in cancer. [4] b) Outcomes of early integration of palliative care in cancer. [3] c) Facilitative barriers for early integration of palliative care in cancer. [3]
  4. a) Electrical storm. [3] b) Integration with cardiology team in patients with cardiac devices at end of life. [3] c) Discontinuing left ventricular assist devices in a palliative care setting. [4]
  5. a) Current NCCN guidelines for the management of emotional distress. [4] b) Communication strategies to address spiritual distress. [3] c) Controversy surrounding palliative sedation in existential distress. [3]
  6. a) Evidence for Ketamine in management of depression. [3] b) Evidence for Dexmedetomidine for hyperactive delirium. [3] c) Evidence for Mirtazapine use in palliative care. [4]
  7. a) Role of point of care ultrasound (POCUS) in a palliative care setting. [4] b) Discuss two procedures performed using POCUS. [4] c) Significance of POCUS training during palliative medicine residency. [2]
  8. a) Discuss any 4 updated terminologies on the care of the dying by the ICMR. [4] b) ICMR guidance document on DNAR. [3] c) Ethical issues surrounding inappropriate CPR. [3]
  9. a) Evidence on the role of metronomic chemotherapy in a palliative care setting. [3] b) Four commonly used OMCT drugs in a palliative care setting. [4] c) Evidence from India on using OMCT in palliative setting. [3]
  10. a) The opioid epidemic in the USA and its relevance in India. [3] b) Opioid risk assessment tool. [3] c) Principles of opioid therapy in a chronic pain setting. [4]

High-Yield DNB Palliative Medicine Topics

A selection of 24 of the 35 important topics curated in the app from repeated DNB Palliative Medicine questions.

Pain management — highest yield

  • Total pain concept and WHO analgesic ladder (including Step 3 nuances)
  • Opioid pharmacology: equianalgesic dosing, rotation, breakthrough pain, side effects
  • Neuropathic pain: pathophysiology, assessment tools, adjuvants (gabapentin, amitriptyline, duloxetine)

Common symptoms in palliative care

  • Breathle's ness: pathophysiology, opioids for dyspnoea, palliative oxygen, non-pharmacological measures
  • Malignant bowel obstruction: conservative vs surgical approach, octreotide
  • Malignant pleural/pericardial effusion: drainage and pleurodesis

Neurological and emergency palliative issues

  • Malignant spinal cord compression: diagnosis, dexamethasone, RT vs surgery
  • Seizures and delirium in palliative care: causes, management, palliative sedation indications
  • Hyperactive delirium: dexmedetomidine, antipsychotics; communication with family

Prognostication and communication

  • Prognostication tools: PaP score, PPI, disease-specific (FAST for dementia, NYHA/AHA for HF)
  • Trajectories of illness: cancer, organ failure, frailty, sudden death
  • Breaking bad news: SPIKES protocol; NURSE for emotional responses

Disease-specific palliative care

  • End-stage COPD, heart failure, liver disease, CKD: when to shift to palliative approach
  • Renal palliative prescribing: analgesic ladder in CKD, opioid dose adjustment
  • Paediatric palliative care: pain assessment tools, ACT categories, communicating with children

Models and integration of care

  • WHO definition and models of palliative care delivery (home-based, integrated, embedded)
  • Early integration trials (Temel, Bakitas): benefits of concurrent palliative-oncology care
  • Palliative radiotherapy: bone metastases, cord compression, SBRT; palliative chemotherapy (metronomic)

Psychosocial and spiritual care

  • Psychological distress (NCCN guidelines), hope, anxiety/depression management
  • Spiritual pain and spiritual care assessment; caregiver support and burnout
  • Financial and time toxicity in advanced cancer; survivorship issues

Special situations

  • Last days of life care: hydration, mouth care, symptom control, verification of death
  • COVID-19 and humanitarian crisis palliative care; telemedicine in palliative care
  • POCUS in palliative care (ascites, pleural effusion drainage)

Older DNB Palliative Medicine Question Papers

The remaining 1 papers are available in the Prep DNB app, organized paper-wise with repeat-question tracking.

Get all 3 papers in the app

Previous Year Questions for Other DNB Subjects