Palliative, Oncology, Geris, Immunology

Question 1

Confusion in palliative care first line Rx (3)

Answer 1

Haloperidol
Chlorpromazine
Levomepromazine

Question 2

Agitations or restlessness in palliative care (1)

Answer 2

Midazolam

Question 3

Hiccups in palliative care (4)

Answer 3

Chlorpromazine - intractable hiccups
Haloperidol, gabapentin
Dexamethasone

Question 4

Opiates in palliative care prescribing:
Initialy prescribing
Breakthrough pain
Increasing

Answer 4

20-30mg MR (15mg MR BD) with 5mg IR breakthrough pain
With laxatives
Increase by 30-50%

Question 5

What should the breakthrough dose of morphine be?

Answer 5

One sixth the daily dose of morphine

Question 6

What to give instead of morphine if there is mild to moderate renal impairment? (1)
Severe renal impairment? (3)

Answer 6

Oxycodone
Alfentanil, buprenorphine, fentanyl

Question 7

Morphine to oxycodone =
PO morphine to SC morphine

Answer 7

Divide by 1.5
Divide by 2

Question 8

Medications in palliative care:
Nausea and vomiting (4)
Secretions (3)
Agitation (3)
Pain (1)

Answer 8

Cyclizine, levomepromazine, haloperidol, metoclopramide
Secretions: hyoscine hydrobromide, butylbromide, glycopuronium bromide
Agitations: midaz, haloperidol, levomepromazine
Pain diamorphine

Question 8

PO morphine to SC diamorphine

Answer 8

Divide by 3

Question 9

N&V in palliative care mx
Reduced gastric motility (opioid related) (2)

Answer 9

Metoclopramide
Domperidone

Question 10

N&V in palliative care mx
Raised ICP (cerebral mets) (2)

Answer 10

Cyclizine
Dexamethasone

Question 11

N&V in palliative care mx
Chemically mediated (hypercalcaemia, chemo) (3)

Answer 11

Ondansetron
Haloperidol
Levomepromazine

Question 12

N&V in palliative care mx
Visceral (due to constipation) (2)

Answer 12

Cyclizine + levomepromazine

Question 13

N&V in palliative care mx
Vestibular (1)

Answer 13

Cyclizine

Question 14

N&V in palliative care mx
Corticol (anxiety, pain, fear)

Answer 14

Loraz

Question 15

Mild - moderate Alzheimer’s disease mx (3) MOA
Second line treatment (1) MOA

Answer 15

Donepezil
Galantamine
Rivastigmine
Acetylcholinesterase inhibitors

Memantine
NMDA receptor antagonist

Question 16

Donepezil CI (1) and adverse effect (1)

Answer 16

Bradycardia
Insomnia

Question 17

Assessment tools for dementia recommended by NICE

Answer 17

10 point cognitive screener
6 item cognitive impairment test

Question 17

What is Pick’s disease?
Age of onset

Answer 17

Frontotemperal dementia
Progressive non fluent aphasia
<65yo

Question 18

personality change and impaired social conduct. Other common features include hyperorality, disinhibition, increased appetite, and perseveration behaviours =

Answer 18

Pick’s disease/ frontotemperal dementia

Question 19

Focal gyral atrophy with a knife-blade appearance = which type of dementia?

Answer 19

= Picks

Question 19

Alzheimer’s vs Lew body dementia vs Pick’s

Answer 19

AD - early impairments in attention and executive function
LBD - cognitive impairment
Picks - personality changes, progressive aphasia

Question 20

Patient who has deteriorated following the introduction of an antipsychotic agent =

Answer 20

Lewy body dementia

Question 21

Lewy body dementia features (3)

Answer 21

Visual hallucination
Progressive cognitive impairment
Parkinsonism

Question 22

Waterlow score is used to screen patient who are at risk of developing…
Classification

Answer 22

Pressure areas
1 erythema of intact skin
2 partial thickness skin loss
3 full thickness skin loss
4 extensive destruction

Question 23

Types of allergy tests (3)
What are they useful for?

Answer 23

Skin prick - most common, food and pollen
RAST - food and pollen, used instead of skin tests e.g in severe eczema
Skin patch - contact dermatitis

Question 24

Adrenaline doses in anaphylaxis
<6 month
6months-6 years
6-12 years
>12 years

How often can adrenaline be repeated?
Location

Answer 24

<6 month - 100-150mcg
6months-6 years 150mcg
6-12 years 300 mcg
>13 years 500 mcg

1 in 1000
Every 5 mins
Location anterolateral aspect of the middle third of the thigh

Question 25

Mx following stabilisation of allergy: - 4

Answer 25

Non sedating oral antihistamines
Serum tryptase levels
Specialist allergy clinic referral
Adrenaline injector as interim measure (x2 injections)

Question 26

Discharge following anaphylaxis (3)

Answer 26

Fast track discharge (<2 hours) single dose adrenaline
Minimum 6 hours 2 doses of adrenaline
Minimum 12 hours - >2 doses of adrenaline

Question 26

What is oral allergy syndrome?

Answer 26

pollen-food allergy, is an IgE-mediated hypersensitivity reaction to specific raw, plant-based foods including fruits, vegetables, nuts and certain spices

Question 26

Most common tumour causing bone metastases (3)
Most common cancers in the UK (3)
Most common causes of death from cancer in the UK (3)

Answer 26

Prostate, breast, lung

Breast, lung, bowel

Lung, bowel, breast

Question 27

Chemo N&V 1st line mx
Low risk
High risk (2)

Answer 27

Low risk metoclopramide
High risk ondansetron +/- dexamethasone

Question 28

RF for development of N&V with chemo (4)

Answer 28

Anxiety
<50yo
Concurrent opioid use
Type of chemo

Question 29

Adverse effects of cyclophosphamide (3)

Answer 29

Haemorrhagic cystitis
Myelosuppression
Transitional cell carincoma

Question 30

Mx neoplastic spinal cord compression

Answer 30

High dose oral dexamethasone
Oncology assessment

Question 31

Superior vena cava obstruction is most commonly associated with which cancer?

Answer 31

Lung

Question 31

dyspnoea
swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
headache: often worse in the mornings
visual disturbance
pulseless jugular venous distension =

Answer 31

Superior vena cava obstruction

Question 32

Ca 15-3

Answer 32

Breast ca

Question 33

S-100 tumour antigen =

Answer 33

Melanoma