Palliative Care Flashcards
Management of nausea
Cyclizine
Metoclopramide
Reduction of respiratory secretions medication
Hyoscine hydronromide
Features of carcinoid syndrome
Diarrhoea
Recurrent episodes of flushing and sweats aswell as heart racing
What is the difference between carcinoid tumour and carcinoid syndrome
Carcinoid tumours secrete their serotonin into the bowel but it gets metabolised in the liver so their are no systemic symptoms
In carcinoid syndrome the tumour metastasises to the liver so you get symptoms
Features of tumour lysis syndrome
Abdominal pain and cramps
Occurs a couple of days after chemo
RENAL FAILURE
Features of immunotherapy toxicity
Generalised rash on torso
Feeling lethargic
Diarrhoea (because of immune colitis)
Delayed reaction. Basically the immune system is in overdrive and starts to recognise healthy cells aswell
Side effects of chemotherapy
Anthracyclines (doxorubicin, daunorubicin) and anti-HER-2 monoclonal antibodies (e.g. Herceptin) cause cardiomyopathy
Platinum agents (cisplatin, carboplatin) cause peripheral neuropathy and sensorineural hearing loss
Cyclophosphamides lead to haemmorhagic cystitis and transitional cell carcinoma of the bladder
Tamoxifen increases the risk of endometrial cancer
Bleomycin can cause lung fibrosis
Cisplatin has a risk of ototoxicity and nephrotoxicity
Cytarabine can cause ataxia
What might you prescribe with morphine?
Regular senna and as required cyclizine
Where are small cell lung cancers usually located?
In the bronchi
What are some features of squamous cell lung cancers?
Cavitating on x-ray
More haemoptysis
Is it possible to tell between abscess and cancer on x-ray?
On X-ray it is not possible to tell whether it is an abscess or a cancer (the border’s definition cannot be easily seen) but on the CT there is obviously a jagged border – indicating cancer.
What are the Duke’s stages of colorectal cancer?
A: limited to the bowel wall (i.e. not beyond the muscularis).
B: extending through the bowel wall (i.e. beyond the muscularis).
C: regional lymph node involvement.
D: distant metastases.
Summary of management of diabetes in palliative care. Which drugs do you stop and which do you continue?
Keep metformin going unless renal failure
Stop anything that can induce hypoglycaemia because they probably won’t be eating and it will give them distressing and unnecessary symptoms
First-line management of metastatic cord compression
Dexamethasone PO BD
Management of metastatic cord compression
Dexamethasone PO BD
Stenting
Radiotherapy
4 main symptoms in the last days of life
Increased respiratory secretions
Nausea and vomiting
Pain
Terminal agitation
Medications for reducing respiratory secretions
Hyoscine
Glycopyrronium
Features of mesothelioma
Increasing SOB
Stony dull percussion
Weight loss
Pleural effusion on xray aswell as pleural thickening! (This gives it away as asbestos exposure). Always check for apical thickening on chest x-ray
A 59 year old female with a background of small cell carcinoma of the lung and type 2 diabetes presents to the emergency department complaining of poorly controlled blood glucose levels and muscle weakness. She also complains of unintended weight gain, particularly around her abdomen. Her only regular medication is metformin. On examination blood pressure is 162/102mmHg. There are violaceous striae on her lower abdomen and proximal muscle weakness on neurological examination.
What is being ectopically produced?
ACTH
What is affected in Horner’s syndrome
The cervical sympathetic plexus
Results in drooping eyelid
Dry eye
Miosis (BECAUSE THE SYMPATHETIC CHAIN IS DISRUPTED!!!! So NOT DILATING IN FIGHT AND FLIGHT!!!!)
28-year-old man presents to A&E with a six week history of progressive dyspnoea and headaches. He reports that the headaches are worse in the morning and when bending over. Over the last 3 months, he reports infrequently awaking at night sweating profusely. He also thinks that his clothes feel looser than before. On examination, he has marked facial oedema and prominent contiguous cervical lymphadenopathy. His respiratory rate is 22 and his oxygen saturations are 96% on air
What is the likely unifying diagnosis?
Hodgkin’s lymphoma causing superior vena cava obstruction
Ix for Hodgkin’s
CT scan to stage
Complex medical management involving chemotherapy
Mx morphine you should initially start on
20-30mg per day
Typically 5mg IR QDS
