General - Palliative care and oncology

Question 1

What antiemetic is best used for intracranial disease?

Answer 1

Cyclizine

Question 2

What drug can be used for nausea due to raised ICP?

Answer 2

Dexamethasone

Question 3

What drug can be used for nausea caused by chemically mediated symptoms i.e. opioids

Answer 3

Ondansetron

Question 4

What drugs can be used for nausea caused by drugs and toxins (2)?

Answer 4

Metoclopramide and domperidone

Question 5

What drugs can be used for nausea caused by gastric stasis (2)?

Answer 5

Metoclopramide and haloperidol

Question 6

1) What is the conversion factor of oral tramadol to oral morphine?
2) What is the conversion factor of oral codeine to oral morphine?

Answer 6

1) 10
2) 10

Question 7

Name 2 management/medications that can be used to manage pain from metastatic bone disease?

Answer 7

• Bisphosphonates
• Denosumab
• Radiotherapy

Question 8

When increasing the dose of opioids the next dose should be increased by what percentage?

Answer 8

10-50%

Question 9

What is the conversion factor of morphine to oxycodone?

Answer 9

1.5-2 times

Question 10

A transdermal fentanyl 12 microgram patch equates to approximately how many mg oral morphine daily?

Answer 10

30 mg

Question 11

A transdermal buprenorphine 10 microgram patch equates to approximately how many mg oral morphine daily?

Answer 11

24

Question 12

1) What is the conversion factor for oral morphine to subcutaneous morphine?
2) What is the conversion factor for oral morphine to subcutaneous diamorphine?
3) What is the conversion factor for oral oxycodone to subcutaneous diamorphine?

Answer 12

1) Divide by 2
2) Divide by 3
3) Divide by 1.5

Question 13

1) Name a management options for hiccups in palliative setting?
2) What drug may be used for hiccups if there’s associated hepatic lesions?

Answer 13

1) Chlorpromazine, haloperidol, gabapentin
2) Dexamethasone

Question 14

What drug is initially given for suspected neoplastic spinal cord compression

Answer 14

High dose dexamethasone

Question 15

1) What opioid is prefered in renal impairment?
2) Name an opioid that’s used in severe renal impairment

Answer 15

1) Oxycodone
2) Fentanyl, buprenorphine, alfentanil

Question 16

1) What is the earliest and commonest symptom of neoplastic spinal cord compression?
2) Name another feature
3) How is it investigated?
4) How is it managed?
5) Name a way you could differentiate between the lesion level

Answer 16

1) Back pain
2) Lower limb weakness, sensory changes, neurological signs based on lesion level
3) Spine MRI
4) High dose dexamethasone. Radiotherapy if this doesn’t work
5) If below L1 - perianal numbness. Above L1 - UMN signs in legs, below L1 - LMN signs in legs. Tendon reflexes typically exaggerated below level of lesion and absent above