Palliative care

Question 1

Illness trajectory of cancer

Answer 1

Maintenance of function until treatment stops working, then fairly rapid decline. Occurs over weeks/months/years

Question 2

Illness trajectory of chronic diseases such as heart failure/COPD

Answer 2

Gradually declining function over months/years. Regular exacerbation events which they usually recover from- hard to predict which exacerbation will be terminal

Question 3

Reason why the Liverpool care pathway was criticised

Answer 3

Terminal patients weren’t being hydrated/fed properly

Question 4

Cheyne-Stokes respiration

Answer 4

abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in temporary apnea

Question 5

Hypercalcaemia

Answer 5

Reversible factor which may mimic the dying process

Question 6

Sensitive sign to diagnose dying

Answer 6

Struggling to take oral medicine, and loss of interest in food and fluid

Question 7

Best way of delivering control of symptoms in dying patients

Answer 7

Syringe driver with up to three medicines

Question 8

Mechanism of a syringe driver

Answer 8

Continuous subcutaneous infusion

Question 9

Morphine

Answer 9

Pain/SOB

Question 10

Distress

Answer 10

Midazolam

Question 11

Nausea

Answer 11

Levopromazine (also helps terminal delirium)

Question 12

Pooling of respiratory secretions

Answer 12

Buscopan