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?
When administering diamorphine, which drug should be given using a separate syringe driver?
A 55-year-old woman has terminal breast cancer. She has liver metastases but her pain is well controlled.
Her main symptom, however, is anxiety. She feels nervous all the time and has a tremor. She says she feels tense about almost anything. She has read that beta blockers can help people like her and asks whether they would be worthwhile.
What symptoms are beta blockers most likely to alleviate in a 55-year-old woman with terminal breast cancer and anxiety?
You are seeing a 65-year-old man with locally advanced prostate cancer which has been considered by his oncologist to be at a high risk of progression.
He is taking bicalutamide 150 mg daily.
What is the most common side effect of this medication?
You are asked to prescribe a syringe driver for a palliative care patient with pain who is now struggling to swallow tablets.
Her pain has been well controlled on morphine sulphate tablets, 60 mg twice a day, and severadol (quick release morphine) 20 mg three times a day.
You decide to prescribe morphine, subcutaneously, via the syringe driver.
Which of the following dosing regime would be appropriate?
A 76-year-old patient comes to you complaining of intense pain in their right shoulder. After an X-ray examination, it is discovered that they have a pathological fracture in their proximal humerus. Which primary solid tumor cancer groups are most prone to metastasizing to bone?
You are asked to see a 64-year-old woman known to have breast cancer.
Her family has become worried as yesterday she seemed to be behaving ‘oddly’. They tell you that her behaviour has become inappropriate and that she has been walking around the house naked and been swearing a lot in conversation. Prior to yesterday she was her ‘usual self’.
The family also report that she seems to be passing urine and opening her bowels as per usual and that she has been eating and drinking fine.
Examination reveals that the patient is alert and uncomplaining. Temperature is 37.1°C, blood pressure is 118/78 mmHg and pulse rate is 86 regular. Systems examination doesn’t reveal anything acute aside from the patient swearing frequently and talking about inappropriate topics of conversation. Urine dipstick testing reveals ‘trace’ of blood and protein.
Which if the following investigations will confirm the underlying diagnosis?
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?
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?