MRCGP AKT Category: End Of Life

AKT-1850

Mrs Rogers is an 83-year-old lady with a history of mild cognitive impairment, hypertension and type 2 diabetes mellitus. She requires carers twice daily to assist with activities of daily living.

Recently, her daughter noticed that Mrs Rogers had become jaundiced and took her to see her GP for investigation. Unfortunately, radiological imaging revealed a probable cholangiocarcinoma with multiple liver metastases. The upper gastrointestinal MDT determined that Mrs Rogers should receive best supportive care and she was referred to her local community palliative care team.

According to the Gold Standards Framework Proactive Identification Guidance, the ‘Surprise Question’ can be used to identify patients who may be approaching the end of life. Therefore, the question would be: Would you be surprised if Mrs Rogers were to pass away in the next few months?

AKT-1851

You are assessing a palliative care cancer patient with advanced metastatic disease who is in their 70s.

You have been requested by the palliative care community nurse to attend for a joint home visit as the patient has been experiencing headaches. The patient had a CT head scan four weeks ago that revealed extensive brain metastases.

No further active treatment has been planned, and the patient has chosen to receive home care with community support. You suspect that the headaches are due to increased intracranial pressure.

What is the most appropriate medication to prescribe for symptom relief?

AKT-1852

You are requested to make a home visit for a palliative care patient who is experiencing difficulties with a cutaneous metastatic lesion. She is an elderly woman with advanced metastatic breast cancer and has developed a fungating deposit in her left groin that has been treated with regular dressings by the district nurses. In recent days, she has been experiencing issues with localized capillary bleeding from the wound that has not responded to local pressure and simple dressings.

What treatments would be suitable in this situation?

AKT-1853

You are seeing an elderly patient with advanced gastric cancer at home who has called you due to persistent vomiting. The patient is receiving palliative care.

The patient reports persistent large volume vomiting with little preceding nausea, frequent hiccups, early satiety, and acid reflux. The patient also reports that vomiting provides relief.

Which antiemetic medication would be the most appropriate to prescribe?

AKT-1854

You are evaluating an elderly gentleman with metastatic prostate cancer. He has bony metastases affecting his pelvis and has been experiencing a persistent pain in his groin that he describes as a combination of burning and shooting. Despite taking paracetamol 1 g QDS and codeine 60mg QDS regularly, he has found that his current medication doesn’t effectively alleviate this new pain. He has been struggling with this pain for the past few weeks and has sought advice due to its persistent nature and the failure of his current medication. What is the most appropriate medication to add to his treatment regimen for this symptom?

AKT-1839

A 70-year-old man with advanced colon cancer presents with generalized pruritus. Upon examination, there are no visible skin lesions or jaundice. Despite frequent use of emollients, the patient’s symptoms persist. Upon reviewing his medication history for symptom management, which of the following drugs is most commonly associated with itching?

AKT-1840

A 72-year-old woman with metastatic breast cancer presents with chest wall pain and pain in her left hip. She is under the oncologists and recent imaging revealed diffuse metastatic deposits throughout her pelvis, spine and ribs, some of which appear to account for her present pain.

The patient has come to see you to discuss pain relief as she currently takes only regular paracetamol. You discuss the options and she agrees that the next step is to use a non-steroidal anti-inflammatory drug (NSAID). Her past medical history includes angina which gives her relatively frequent symptoms and for which she continues to receive medication to treat.

Which is the most appropriate NSAID to prescribe for this patient?

AKT-1841

Which medication is not suitable for subcutaneous administration and should not be used in a syringe driver?

AKT-1842

Which prescription contains the highest opioid dosage?

AKT-1843

How should strong opioids be used for cancer pain management in primary care?