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?
An 87-year-old woman with metastatic breast cancer who is in the last days of life is having difficulty drinking due to swallowing problems. Her main symptoms of pain and nausea are being managed with a syringe driver. She complains of thirst despite frequent mouth care.
Which is the most appropriate treatment option?
A 64-year-old man is seen by the District Nurse at home, where he is being looked after by his family as he has advanced prostate cancer with bone metastases. His pain has been well controlled; he has a catheter in situ and can take oral medication. In the last week, he has not been eating and drinking much. His urine output is reduced; hence, his urine looks concentrated.
Over the last two days, he has become very confused, especially in the evening. He has been trying to get out of his bed and he has been pulling his catheter. He has been shouting at the family. His wife is very distressed. She asks for some sedation.
On examination by the District Nurse, his temperature is 37 oC. His pulse is 90 bpm and regular, while his blood pressure is 112/78 mmHg. His oxygen saturation is 96% on air. A urine dipstick is positive for protein.
What is the most appropriate initial management option for this patient’s symptoms?
A 27-year-old man was diagnosed with a melanoma six weeks after being referred to the Dermatology Department by his General Practitioner (GP). His friends call his GP, concerned that he has withdrawn to his room over the last four weeks, has stopped playing basketball, has appeared to lose weight, and has missed his hospital appointments. There is a letter in his medical records informing the practice that he has missed two surgery appointments.
He later attends the surgery with a friend. He is dressed scruffily and doesn’t make eye contact during your conversation. His Patient Health Questionnaire-9 score is 15.
What is the most likely diagnosis?
An elderly patient has a terminal illness and it is likely that the end stage of this is approaching. The General Medical Council (GMC) has produced guidance concerning treatment and care of patients coming towards the end of life.
Which of the following options conforms to the principles described by the GMC regarding end-of-life care?
In a 78-year-old man with dementia, which feature is the LEAST suggestive of approaching end of life (within the next 12 months)?