MRCGP AKT Category: End Of Life

AKT-1826

A 65-year-old man with oesophageal cancer is having difficulties with taking regular oral morphine medications. After consulting with the oncology team, it is decided to switch him to transdermal fentanyl patches. He is currently taking 50 mg twice daily of modified-release oral morphine which has been effectively managing his pain. You prescribe a fentanyl ’25’ patch which provides the same level of pain relief. What instructions do you give the patient when starting to use the patches?

AKT-1811

A 75-year-old woman is diagnosed with locally invasive pancreatic cancer. She has decided she doesn’t want any oncological input. She lives with her husband of 50 years. She is clear she would like to be cared for at home as much possible. She comes alone to the appointment. She wants to discuss her care plans; in particular, she would like more information about a Lasting Power of Attorney (LPA) for Health and Welfare.
What is the most appropriate advice you can provide this patient?

AKT-1827

You are requested by district nurses to visit a patient at home to assess his medication. He is an 80-year-old man with terminal prostate cancer and widespread metastases. His pain is currently well managed by taking Morphine Sulphate SR tablets, 60mg twice a day. However, his overall condition has deteriorated, and he is experiencing difficulty swallowing the tablets, as well as increased agitation. Your recommendation is to initiate a syringe driver containing Diamorphine and a small dose of Midazolam subcutaneously to replace the oral Morphine tablets. What would be the appropriate dosage of sc Diamorphine to prescribe over a 24-hour period?

AKT-1812

A 68-year-old woman with a history of hypothyroidism currently treated with thyroxine replacement presents with gradually progressive weakness over the past few months. She now finds it difficult to get out of a chair and to climb the stairs at home. Medication includes thyroxine and ramipril.
On examination, her BP is 138/88 mmHg, heart rate is 75 bpm and regular. She has fatigable ptosis and proximal myopathy affecting both the upper and lower limbs. There is no muscle wasting or fasciculation.
Which of the following is the most likely diagnosis?

AKT-1828

A geriatric patient with terminal illness is currently receiving 60mg of modified release morphine every 12 hours. Due to difficulty in swallowing, you plan to switch to a 24 hour subcutaneous infusion of morphine. The morphine ampoules available are of 10 mg/ml strength. What would be the required volume of morphine (in ml) to be added to the syringe driver for a 24 hour period?

AKT-1813

A 68-year-old man has metastatic disease following a carcinoma of the lung. He has been discharged to be cared for at home as per his wishes and has a home visit from his general practitioner. He is not eating or drinking and has a syringe driver of morphine and cyclizine to manage symptoms. His conscious level is variable.
Which of the following signs would indicate that he is entering the last days of life?

AKT-1814

The importance of comprehending the function of grief in palliative care lies in aiding patients and their caregivers in managing it. What is the typically acknowledged sequence of the phases of bereavement?

AKT-1815

A 70-year-old man presents to his General Practitioner (GP) for a review. He has a diagnosis of advanced liver cancer. The patient undergoes a physical examination. He has lost 12 kg since his last GP review (three months ago) and reports loss of appetite, along with frequent vomiting. He has widespread muscle wasting.
Which of the following is the most important diagnostic factor for cachexia in this patient?

AKT-1816

An 80-year-old gentleman with a history of lung cancer is brought to your clinic by his family with complaints of ‘depression’. He has been receiving treatment for his lung cancer for several months now and was doing well both physically and emotionally. However, his family noticed a sudden change in his behavior yesterday. He became withdrawn, quiet, and tearful, which is not typical of his usual self. There was no apparent trigger for this change, and he had plans to visit his family in the coming days.

Upon examination, he appears withdrawn and quiet, and he reports not knowing why he feels the way he does. He is apyrexial, and there are no physical findings to explain his symptoms.

What would be the most appropriate management plan for this patient?

AKT-1817

You are asked to assess an elderly 83-year-old man who has advanced prostate cancer and is experiencing poor appetite and anorexia. Upon further inquiry, he reports that his nausea is well-managed with cyclizine as needed, and he doesn’t have any difficulty swallowing. His pain is adequately controlled, and he has regular bowel movements. What would be the most beneficial approach in this situation?