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Medical Finals 2020 > Palliative Care > Flashcards

Palliative Care Flashcards

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USMLE® Step 1 flashcards
1
Q

How to certify death - how do you confirm a patient’s death?

A

CHECK RESUS STATUS - if uncertain CPR

  • ask ward staff about circumstance, read notes
  • to family introduce yourself, offer condolences, explain you need to confirm and ask the family if they want to be present or not
  1. confirm identify - wrist label
  2. general inspection
  3. respiratory effort
  4. verbal stimuli
  5. pain response
  6. pupils
  7. central carotid pulse
  8. heart sounds 2 minutes
  9. respiratory sounds 3 minutes

DOCUMENT CLEARLY

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2
Q

What is cyclizine used for?

A

Motion sickness, anti-emetic

It is an antihistamine

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3
Q

What is prochlorperazine?

A

An antipsychotic, used in treatment of schizophrenia, first gen

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4
Q

What is promethazine?

A

A sedating antihistamine along with chlorphenamine

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5
Q

What does off-licence mean?

A

This is the use of a medication for a different purpose than intended. For example, using morphine to reduce coughing and breathlessness instead of for pain.

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6
Q

What is an unlicenced medication?

A

A medicine without marketing authorisation that cannot be sold in the UK.

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7
Q

What can be given to suppress a cough in a palliative patient?

A

Opiates - codeine, morphine, methadone

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8
Q

What can be given to patients to encourage a cough?

A

Physiotherapy

NaCl 0.9% nebuliser

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9
Q

Give 5 symptoms that are commonly treated in palliative care.

A 
Cough
Dyspnoea
Pain
Nausea and Vomiting
Bleeding
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10
Q

What can be given to reduce bleeding risk in palliative cancer patients?

A

Discontinue anticoagulation
Transexamic acid for minor or moderate bleeds
Major bleeds are usually predicted, often little can be done, midazolam to reduce anxiety and fear

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11
Q

Give some physiological causes of nausea.

A

GI: dopamine, seratonin, can be caused by constipation, obstruction, infections
Brain: dopamine, seratonin, raised ICP
Vomiting Centre - ACh, H2, 5HT3
Medication (chemo, morphine), hypercalcaemia, hypomagnesia, uraemia

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12
Q

Give five anti-emetics and the situation they are best used in.

A

Domperidone - nausea caused by gastric problems
Hyoscine butylbromide - antimuscarinic, used for GI spasms
Cyclizine - antihistamine, used for vestibular vauses
Ondansetron - 5HT3 antagonist, used for medication induced nausea
Haloperidol - works in metabolic induced nausea

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13
Q

What are the steps of the analgesic pain ladder?

A 
Paracetamol
NSAIDs
Alternatives: Gabapentin, Amitryptylline, Pregabalin
Weak Opioids
Strong Opioids
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14
Q

What are some contraindications and side effects of NSAIDs?

A

Not to be used in history of GI bleeding or ulcers, asthma, heart disease or renal disease.
Can cause renal impairment, GORD, ulcers (give PPI if long-term use)

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15
Q

What strength is codeine relative to morphine?

A

1/10th, as is tramadol

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16
Q

A patient’s PO morphine is adjusted to be SC. What needs to be done to the dose when this happens?

A

PO morphine is half as potent as IV morphine, so changing to PO means the dose needs to be halved.

17
Q

What are some common side effects of opioids?

A

Nausea
Drowsiness
Constipation

18
Q

A gentleman with a syringe driver is suffering from bowel colic. What drug helps?

A

Hyoscine butylbromide

Hyosceine hydrobromide is used in respiratory secretions

19
Q

What can be used for metastatic bone pain?

A

Analgesia, bisphosphonates and radiotherapy

20
Q

Which opioids are preferred in patients with renal disease?

A

Alfentanil
Buprenorphine
Fentanyl

21
Q

How much breakthrough pain relief should be prescribed?

A

Usually 1/6th of their daily morphine dose

22
Q

What are the advantages and disadvantages of a syringe driver?

A

Advantages: increased comfort, control of multiple symptoms, increased independence and mobility
Disadvantage: can only be used by trained staff, lack of flexibility with prescriptions, inflamed injection sites

23
Q

What clinical features are seen in spinal cord compression?

A

Back pain
Weakness/Parasthesia/Numbness
Inability to control bladder o bowel

24
Q

What is SVCO?

A

Superior Vena Cava Obstruction - occurs due to a tumour involving mediastinum or lung

25
Q

Give 5 features of SVCO

A 
Facial swelling
Redness
Vein/Artery swelling, distension or pulsation
Breathlessness
Periorbital oedema
26
Q

How do you manage someone with SVCO?

A

Steroids - Dexamethason 16mg

27
Q

What neutrophil count is worrying and why?

A

<1.0 and a temperature of >38

Febrile neutropenia/Neutropenic sepsis

28
Q

What is your immediate treatment of hypercalcaemia?

A

IV fluids

Later IV bisphosphonates

29
Q

A patient presents with pin-prick pupils, reduced SpO2, confusion and low GCS, what is the most likely drug causing this?

A

Opiates

30
Q

What do you give in an opiate overdose?

A

Naloxone 400 microgram STAT

31
Q

What are the 5 priorities in the care of the dying?

A 
Recognition
Communication
Involvement - of family and dying person in decisions
People important to the dying person
Compassionate care + dignity

Medical Finals 2020 (25 decks)

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