Palliative Care ILOs

Question 1

Give 3 key questions to ask during a confusion history

Answer 1

1. Duration
2. Recent trauma
3. Recent medication changes

Question 2

Give 3 general features to assess in the examination of a confused pt.

Answer 2

Sign of trauma
Hydration Status
Frailty Score

Question 3

Give 6 systems which should be considered during the examination of a confused pt.

Answer 3

CVS
Respiratory 
GI 
Neuro
Psychiatric 
MSK

Question 4

Define dementia

Answer 4

Decline in cognition involving one or more cognitive domains

Question 5

Describe the pathology of Alzheimer’s dementia

Answer 5

• Accumulation of beta-amyloid peptide

- Neurofibrillary tangles/amyloid plaque and loss of acetylcholine

Question 6

Give 2 management options for Alzheimer’s

Answer 6

Acetylcholinesterase inhibitor e.g. Donepezil

Correct vascular risk factors

Question 7

State the two types of vascular dementia

Answer 7

Post-stroke dementia

Vascular dementia without recent stroke

Question 8

Give 3 additional symptoms in Lewy Body dementia alongside the general symptoms of dementia

Answer 8

Visual hallucination
Parkinsonism
Sleep disorder

Question 9

Give 3 symptoms of fronto-temporal dementia

Answer 9

1. Change in personality
2. Disinhibition
3. Compulsive behaviour

Question 10

Give 4 causes of delirium

Answer 10

Infection
Polypharmacy
Electrolyte imbalance
New environment

Question 11

Give 3 non-pharmacological management options for delirium

Answer 11

Treat underlying cause

Talk to pt. calmly

Ensure pt. has hearing aid/glasses

Question 12

Give 2 pharmacological management options for delirium

Answer 12

Antipsychotics e.g.
Haloperidol

Benzodiazepines e.g. Lorazepam

Question 13

What are the 4 domains of palliative care?

Answer 13

• Physical
• Psychological
• Social
• Spiritual

Question 14

Where is the vomiting centre located?

Answer 14

Medulla Oblongata

Question 15

Name 3 areas of input to the vomiting centre

Answer 15

Chemoreceptor trigger zone
Vestibular
CNS

Question 16

Name the location of the chemoreceptor trigger zone and give 2 triggers

Answer 16

Outside BBB in 4th ventricle

Opioids
Chemotherapy

Question 17

Give 3 non pharmacological methods used in palliative care

Answer 17

Mouth care
Avoid constipation
Regular small meals

Question 18

What is metoclopramide and what is it used for?

Answer 18

Dopamine antagonist anti-emetic which stimulated bowel and chemoreceptor trigger zone

Used in impaired gastric emptying

Question 19

What is cyclizine and what is it used for?

Answer 19

Histamine receptor antagonist targeting vomiting centre

1st line in raised ICP, motion sickness and complete bowel obstruction

Question 20

What is Ondansetron and what is it used for?

Answer 20

Serotonin receptor antagonist anti-emetic

1st line chemo nausea, post-op

Question 21

What is Haloperidol and what is it used for?

Answer 21

Dopamine antagonist working on chemoreceptor trigger zone

Used in delirium

Question 22

What is Levomepromazine and what is it used for?

Answer 22

Systemic anti-emetic which works everywhere

1st line in indeterminate cause or when other 1st lines don’t work

Question 23

Give 3 indicators of the dying phase

Answer 23

Poor appetite
Profound weakness
Difficulty swallowing

Question 24

Give 2 barriers to diagnosing dying

Answer 24

Futile interventions

Disagreement on resuscitation

Question 25

What is the ECOG score?

Answer 25

Determines if a patient is fit enough for chemo/radiotherapy

0-2 = fit 
3 = limited self-care
4 = completely disabled 
5 = dead

Question 26

What does the SPICT tool help identify?

Answer 26

Who would benefit from palliative care services