Palliative Care

Question 1

What is Tumour Lysis syndrome?

Answer 1

Metabolic and electrolyte abnormalities caused by tumour cells release contents into the bloodstream.

Spontaneous/Response to therapy.
Oncology Emergency

Question 2

TLS Signs and Symptoms?

Answer 2

Vomiting
Muscle spasms
Electrolyte derrangement = +K, +Phos, HypoCa, +Urea, Lactic acidosis

Question 3

What is the criteria for TLS?

Extra - All patients are assessed for their risk before chemo

Answer 3

Cairo and Bishop

Uric acid - 25% Increase from baseline (476 umol)
Potassium - 25% Increase from baseline (>6mmol)
Phosphate - 25% Increase from baseline (>1.45mmol)
Calcium - Decrease of 25% from basline (<1.75mmol)

Question 4

6 Main areas that causes vominting?

Answer 4

Chemical - Drugs/Toxins/Metabolic
GI Stretch/Irritation - Constipation, intestinal obstruction, liver mets, retroperitoneal cancer, Drugs
Gastric Stasis - Drugs, Peptic ulcer, gastritis, autonomic failure, ascites
Increased ICP -Tumour/bleeding
Anxiety-related -Cerebral cortex stimulation
Movement associated - Gastroparesis

Question 5

Injury/Stimulation of which nerve can cause vomiting?

Answer 5

Vagus Nerve - Controls the gag reflex

Injury - Can cause gastroparesis (Non contraction of stomach + motility)

Question 6

Choices of anti-emetics?
A - Metoclopramide
B -  Ondansetron
C - Cyclizine
D - Haloperidol
E- Benzo(Lorazepam)

Answer 6

A - Gastric stasis
B - Chemotherapy/Radiotherapy
C - Motion-sickness, Vestibular disease, Intracranial disease, Brain mets
D- Drug Induced / Chemical cause of nausea
E- Anxiety-related

Question 7

What are the six main symptoms seen in palliative care?

Answer 7

Constipation 
Nausea
Pain 
Breathlessness 
Restlessness
Confusion

Question 8

When is metoclopramide contraindicated?

Answer 8

Bowel obstruction

Question 9

When should cyclizine not be used?

Answer 9

Heart related conditions - Heart failure

Question 10

When should you consider levomepromazine instead of Midazolam?

Answer 10

If you suspect delirium in patient

Question 11

Benefits of oxycodone vs. oral morphine?

Answer 11

Less side effect profile - Vomiting, pruritus, sedation

Question 12

7 Common differentials for shortness of breath in oncology?

Answer 12

Pneumonia
Anxiety 
Lung collapse due to tumour of narrowing of airway 
Pleural effusions 
Radiation Pneumonitis 
Anaemia 
Oncological emergencies (SVCO)