A 60-year-old woman with advanced breast cancer is found to have a corrected serum calcium level of 3.2 mmol/L (normal reference range 2.62-2.8 mmol/L). Her presenting symptoms were worsening fatigue and mild confusion.
Which of the following is the most appropriate measure to recommend?
A 65-year-old woman with advanced breast cancer has noticed an increase in nausea and vomiting as her opioid dose has been raised. She is currently experiencing persistent and severe vomiting with minimal relief of her nausea.
Which medication is most likely to provide relief for this patient?
In palliative care, what is the most appropriate initial management strategy for treating opioid-induced constipation?
A 72-year-old woman comes to her General Practitioner complaining of intense pain radiating through her left sciatic nerve, which is not being managed by her current pain medication. The pain is so severe that it is disrupting her sleep. She has recently been diagnosed with spinal metastases from a primary breast cancer. She has been prescribed 20 mg oral morphine sulphate twice daily for her back pain. What is the best course of action for managing this patient’s condition?
A 68-year-old man has terminal metastatic prostate cancer. His General Practitioner visits him in the care home because he is no longer taking medication by mouth. He is bed-bound and in and out of consciousness. He appears comfortable, but his carers report that he has been intermittently in pain, particularly around personal care. He has a ‘just-in-case box’ of medications available but has not required anything for symptom control yet.
Which of the following medication regimens is the most appropriate management plan?
A 50-year-old woman presents to the General Practitioner with generalised pruritus. She has metastatic disease from endometrial carcinoma and is not jaundiced. What is the most suitable initial treatment?
A 52-year-old man being treated for prostate cancer comes to the general practice surgery to discuss his treatment. He feels that he is not coping emotionally and has not returned to his work as a construction worker; he is feeling very low in mood. He is anxious and is not sleeping well. He doesn’t want to discuss his feelings with his family; he asks for some information about services available for psychological support.
What is the most appropriate initial advice you can provide this patient about access to psychological support?
A 57-year-old woman comes to see her GP after a year. Her husband is currently receiving treatment for bladder cancer. She expresses feeling very distressed about his condition and treatment. They live together in a house which they own. Since her husband’s illness, they have not had a regular income and she is unable to seek employment as she needs to care for her husband and take him to appointments. They have no children. She is distressed and confides in you that she ‘did not know where else to turn’.
What is the most appropriate initial course of action for this patient? Choose ONE option only.
A 68-year-old man has inoperable small-cell lung cancer but has been reasonably well. He has a forthcoming hospital appointment. He reports no significant symptoms other than his long-standing persistent cough. His General Practitioner (GP) requests some blood tests as per his consultant’s last letter.
Which of the following results would raise the most concern in this patient?
A 70-year-old woman has liver metastases from a colorectal cancer. She complains of nausea, which comes in waves, and experiences vomiting before going for chemotherapy but finds this less troublesome after chemotherapy. She also finds the nausea less troublesome when she is distracted.
Which of the following is the most likely cause of her symptoms?