Palliative Care

Question 1

Management of nausea

Answer 1

Cyclizine

Metoclopramide

Question 2

Reduction of respiratory secretions medication

Answer 2

Hyoscine hydronromide

Question 3

Features of carcinoid syndrome

Answer 3

Diarrhoea

Recurrent episodes of flushing and sweats aswell as heart racing

Question 4

What is the difference between carcinoid tumour and carcinoid syndrome

Answer 4

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

Question 5

Features of tumour lysis syndrome

Answer 5

Abdominal pain and cramps
Occurs a couple of days after chemo
RENAL FAILURE

Question 6

Features of immunotherapy toxicity

Answer 6

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

Question 7

Side effects of chemotherapy

Answer 7

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

Question 8

What might you prescribe with morphine?

Answer 8

Regular senna and as required cyclizine

Question 9

Where are small cell lung cancers usually located?

Answer 9

In the bronchi

Question 10

What are some features of squamous cell lung cancers?

Answer 10

Cavitating on x-ray

More haemoptysis

Question 11

Is it possible to tell between abscess and cancer on x-ray?

Answer 11

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.

Question 12

What are the Duke’s stages of colorectal cancer?

Answer 12

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.

Question 13

Summary of management of diabetes in palliative care. Which drugs do you stop and which do you continue?

Answer 13

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

Question 14

First-line management of metastatic cord compression

Answer 14

Dexamethasone PO BD

Question 15

Management of metastatic cord compression

Answer 15

Dexamethasone PO BD
Stenting
Radiotherapy

Question 16

4 main symptoms in the last days of life

Answer 16

Increased respiratory secretions
Nausea and vomiting
Pain
Terminal agitation

Question 17

Medications for reducing respiratory secretions

Answer 17

Hyoscine

Glycopyrronium

Question 18

Features of mesothelioma

Answer 18

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

Question 19

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?

Answer 19

ACTH

Question 20

What is affected in Horner’s syndrome

Answer 20

The cervical sympathetic plexus
Results in drooping eyelid
Dry eye
Miosis (BECAUSE THE SYMPATHETIC CHAIN IS DISRUPTED!!!! So NOT DILATING IN FIGHT AND FLIGHT!!!!)

Question 21

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?

Answer 21

Hodgkin’s lymphoma causing superior vena cava obstruction

Question 22

Ix for Hodgkin’s

Answer 22

CT scan to stage

Complex medical management involving chemotherapy

Question 23

Mx morphine you should initially start on

Answer 23

20-30mg per day

Typically 5mg IR QDS