Palliative medicine

Question 1

Most common cause of nausea/comiting?

Answer 1

Chemotherapy

Question 2

Classification of N/V?

Answer 2

Acute: less than 24 hours after chemotherapy. (serotonin)
Delayed: more than 24 hours

Question 3

RFs for N/V?

Answer 3

Female
young age
motion sickness
COMBINATION chemotherapy

Question 4

What decreases risk for N/V?

Answer 4

Alcohol consumption

Question 5

Which antineoplastic agents have HIGH risk of N/V?

Answer 5

Cisplatin
Cyclophosphamide
Dacarbazine

Question 6

How to treat high risk N/V?

Answer 6

Use several anti-emetic agents at the same time

Question 7

Management of N/V?

Answer 7

PREVENTION with antiemetics:

• Ondansetron
• metoclopramdie
• dexamethasone

Question 8

Criteria for febrile neutropenia?

Answer 8

Temp above 38,5

Neutrophils

Question 9

What is most concerning complication of chemotx?

Answer 9

Febrile neutropenia

Question 10

When does febrile neutropenia show an even worse prognosis?

Answer 10

When proven bacteremia

Question 11

What is name of risk score in febrile neutropenia?

Answer 11

MASCC

Question 12

Which MASCC score shows low risk of complication?

Answer 12

score over 21

Question 13

Treatment if low risk of febrile neutropenia?

Answer 13

give oral ABs (ciprofloxacin, amoxicillin)

Question 14

Treatment if high risk of febrile neutropenia?

Answer 14

give broad-spectrum ABs (carbopenems)

Question 15

How high is mortality if MASCC score is beklow 15?

Answer 15

36 %

Question 16

Which therapeutic treatment used in febrile neutropenia?

Answer 16

G-SCF (Filgrastim!)

Question 17

What is filgrastim?

Answer 17

G-CSF, used in febrile neutropenia

Question 18

how is pain classified?

Answer 18

Nociceptive: somatic and visceral
Neuropathic: central and peripheral

Question 19

In which cancer is VISCERAL pain commonly seen?

Answer 19

Pancreatic ca!!!!

Question 20

Tx of allodynia?

Answer 20

Amytryptiline (TCA)
Gabapentin (Neurontin)

+ non-opioids and strong-opioids

Question 21

Which ca give bone mets?

Answer 21

Lung
Prostate
Breast

Question 22

Examples of weak opioids?

Answer 22

Tramadol

Codeine

Question 23

Examples of strong opioids?

Answer 23

Fentanyl

Morphine

Question 24

What anti-neoplastic tx may cause dyspnea?

Answer 24

Lung resection
Bleomycin
Radiotx

Question 25

Tx of dyspnea?

Answer 25

``` Opiods positioning fresh air Benzo/SSRIs Bronchodilator, steroids, ABs ```

Question 26

Whish respiratory symptoms is a POOR prognostic factor?

Answer 26

Recurrent pleural effusion!!!

Question 27

Criteria used in pleural effusion?

Answer 27

Light's criteria

Question 28

Tx for cough?

Answer 28

Morphine Codeine Dihydrocodeine

Question 29

What is the cause of death rattle?

Answer 29

Accumulation of airway secretions --> movement of secretions in hypopharynx

Question 30

What does death rattle predict?

Answer 30

DEATH (STRONG predictor!)

Question 31

Management of death rattle?

Answer 31

Positioning ANticholinergics Fluid restriction