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Finals > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

When should a patient be treated as neutropenic sepsis?

A

Temperature above 38 and neutrophils below 1

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2
Q

How long after chemotherapy is neutropenic sepsis likely?

A

Within 6 weeks

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3
Q

What is the time limit for when a patient with suspected neutropenic sepsis should receive antibiotics?

A

Less than 1 hour since arrival

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4
Q

What is an appropriate antibiotic for neutropenic sepsis?

A

IV tazocin (can switch to oral after 24-48 hours)

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5
Q

What are the symptoms of metastatic spinal cord compression (MSCC)?

A

Worsening back pain, limb weakness, sensory loss, bowel and bladder dysfunction

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6
Q

What are the causes of MSCC?

A

Vertebral metastases, soft tissue mass or retropulsed bony fragment due to fracture

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7
Q

What is the investigation of choice in MSCC?

A

MRI whole spine with gadolinium enhancement

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8
Q

What is the initial management of MSCC?

A

Dexamethasone 8mg BD (monitor BM and give PPI)

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9
Q

What is the definitive management of MSCC?

A

Surgical decompression (if single site)

Radiotherapy (if multiple sites)

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10
Q

Why do cancer patients develop hypercalcaemia?

A

Bone metastases, dehydration or production of ectopic PTH

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11
Q

What are the symptoms of hypercalcaemia?

A

Abdominal pain, vomiting, constipation, polyuria, polydipsia, fatigue, weakness, confusion, depression

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12
Q

What investigations need to be done in metastatic hypercalcaemia?

A

Imaging for bone mets, ECG to look for shortened QT interval

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13
Q

What is the management of hypercalcaemia?

A

Rehydrate 4-6L of 0.9% saline

Bisphosphonates IV (e.g. zolendronic acid)

Manage cause if possible

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14
Q

What are the signs of SVC obstruction?

A

Dilated veins, oedema, severe respiratory distress, cyanosis, neck and face swelling, cough

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15
Q

What is the definitive investigation in SVC obstruction?

A

CT thorax

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16
Q

What is the management of SVC obstruction?

A

High dose steroids, endovascular stenting

17
Q

When is ondansetron a good antiemetic?

A

Chemotherapy and radiotherapy related N+V, post op N+V

18
Q

What are the contraindications for ondansetron?

A

Prolonged QT

19
Q

When is metoclopramide a good antiemetic?

A

Useful in decreased gut motility such as opioids

20
Q

What are the contraindications for metoclompramide?

A

Parkinson’s (use domperidone instead), GI obstruction

21
Q

What is the antiemetic choice for hypercalcaemia?

A

Haloperidol

22
Q

When is cyclizine a good antiemetic to use?

A

Motion sickness, vertigo, bowel obstruction

23
Q

When should cyclizine be avoided?

A

In elderly patients due to anticholinergic side effects

24
Q

How is capillary bleeding managed?

A

Tranexamic acid

25
Q

How is dry mouth managed?

A

Artificial saliva and good mouth care

26
Q

How is oral thrush managed?

A

Nystatin and fluconazole

27
Q

How is breathlessness managed?

A

Oral morphine or diazepam

28
Q

How is dysphagia cause by obstruction managed?

A

Dexamethasone

29
Q

How is bowel colic treated?

A

Loperamide or hyoscine butyl bromide

30
Q

How is abdominal distention/hiccups managed?

A

Antacids, antiflatulent and domperidone

31
Q

How are fungating tumours managed?

A

Metronidazole and regular dressings

32
Q

How are excessive respiratory secretions managed?

A

Hyoscine buytl bromide

33
Q

How is raised ICP managed?

A

Dexamethasone

34
Q

How is restlessness/confusion managed?

A

Haloperidol or levomepromazine

35
Q

How is intractable cough managed?

A

Moist inhalations and regular oral morphine

36
Q

How is bone met pain managed?

A

Radiotherapy and bisphosphonates

37
Q

How is neuropathic pain managed?

A

TCA, anti-epileptics, ketamine

38
Q

What 4 medications are commonly found in anticipatory prescriptions?

A

Morphine or some form of opioid pain relief

Levomepromazine (or other antiemetic)

Midazolam (for agitation/restlessness)

Hyoscine butylbromide (for respiratory secretions)

Finals (21 decks)

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