Palliative Care and ENT

Question 1

red flag symptoms for head and neck cancer?

Answer 1

any of the following for >3 weeks

• sore throat
• hoarseness
• stridor
• difficulty swallowing
• lump in the neck
• unilateral ear pain

Question 2

the majority of head and neck cancers are which type?

Answer 2

squamous cell

Question 3

how do HPV associate cancers present?

Answer 3

younger
small tumour, big nodes
HPV sexual transmission
better prognosis

Question 4

describe the WHO analgesic ladder

Answer 4

non-opiod +/- adjuvant > mild-moderate opioid +/- non-opioid +/- adjuvant > moderate-severe opioid +/- non-opioid +/- adjuvant
manages 70-80% of patients

Question 5

name 2 painkillers which are not primarily used for pain

Answer 5

anticonvulsants - gabapentin, pregabalin

antidepressants - amitriptyline

Question 6

possible side effects of tricyclics (amitriptyline)?

Answer 6

dry mouth

dizzy spells - postural BP drop

Question 7

when are fentanyl patches used?

Answer 7

e.g after patient goes home, transfer from syringe driver in hospital
only give for stable, long term pain as it forms a depot under the skin and enters into systemic circulation over long period of time

Question 8

what usually is the mode of death in head and neck cancer?

Answer 8

infection - pneumonia, sepsis
hydration and nutrition issues
frailty and medical comorbidities
airway issues
bleeding

Question 9

how is stridor managed?

Answer 9

oxygen
steroids
heliox
tracheostomy
stenting/laser
radiotherapy
active sedation if no reversibility of airways obstruction and patient is going to die

Question 10

how is a major haemorrhage managed?

Answer 10

large dose of midazolam IM or IV if patient is going to die