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?
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?
Which medication is not suitable for subcutaneous administration and should not be used in a syringe driver?
Which prescription contains the highest opioid dosage?
How should strong opioids be used for cancer pain management in primary care?
A 75-year-old patient of yours has terminal lung cancer and is taking morphine. One day you visit him at home to review his medication and check on symptoms. He and his wife are both confused with dosing and think he may have taken too much.
Which of the following symptoms and signs suggests opioid toxicity?
A 16-year-old girl presents with chronic leg pain and is diagnosed with an osteosarcoma.
Which of the following is true of osteosarcoma?
A patient in their late 60s with end stage chronic obstructive pulmonary disease on home oxygen is presenting with intractable cough and breathlessness.
They use regular nebulised salbutamol and ipratropium as well as saline nebulised PRN. They also have a regular inhaled corticosteroid and long acting beta agonist combination inhaler and once daily tiotropium inhaled. They take regular oral theophylline. They keep an emergency pack of prednisolone and amoxicillin at home in case they develop any infective symptoms.
On examination, they are apyrexial and chest auscultation reveals globally reduced air entry, with no focal acute signs. There is no evidence of cardiac failure or peripheral oedema.
What is the most appropriate additional treatment for their cough and breathlessness?
A 68-year-old man with known Hodgkin’s lymphoma presents with concerns of facial swelling. Upon examination, his face appears red and puffy, with engorged neck veins and a non-rising jugular venous pulse upon liver palpation. What is the likely diagnosis?
A 58-year-old gentleman with known lung cancer is seen as an emergency. He has developed a significant deterioration in his breathlessness over the last few days. He also complains of headache and dizziness.
On examination he has a soft stridor and you notice some dilated veins on his chest wall.
What is the most appropriate management plan?