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)?
A 66-year-old man presents to the General Practitioner with spinal pain. He has a history of bronchial carcinoma. Which of the following signs is LEAST indicative of spinal metastases?
Select ONE answer only.
An 80-year-old man complains to the palliative care team of increasing fatigue and breathlessness over the past four weeks. He is under their care and has ceased any active treatment; his preferred care plan is for symptom-related treatment only. He is living independently at home and has been reasonably well over the last six months.
On examination, he is pale, with a pulse of 96 bpm at rest. He becomes breathless after undressing for the examination. There is a palpable spleen.
Investigations:
Investigation Result Normal values
Haemoglobin (Hb) 66 g/l 130–175 g/l
White cell count (WCC) 1.2 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 34 × 109/l 150–400 × 109/l
Neutrophils 0.5 × 109/l 2.0–7.5 × 109/l
Lymphocytes 0.6 × 109/l 1.0–4.5 × 109/l
What is the most likely underlying diagnosis?
The guidance produced by the General Medical Council (GMC) pertains to the treatment and care provided during the end of life. Which of the following options aligns best with this guidance?
A 65-year-old woman presents to the General Practitioner with worsening symptoms over a brief period. She reports experiencing anorexia, thirst, nausea, constipation, and polyuria. The patient has a history of breast cancer and bone metastases. What is the most suitable investigation to determine the cause of her current condition? Choose ONE answer.
A 68-year-old man is brought to the doctor by his wife because of a 2-week history of increasing confusion. He has advanced prostate cancer. He reports constipation, passing urine more frequently and feeling nauseous. He has no signs of infection, and urine testing is negative. He is taking ibuprofen and paracetamol for backache and receives gonadorelin analogue injections for his cancer, but takes no other medications. The clinical examination is unremarkable.
Which of the following is the most likely cause of this patient’s clinical presentation?
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 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 68-year-old man has metastatic prostate cancer. Because he is now experiencing excessive fatigue, some routine blood tests are performed.
Which of the following findings would raise the most concern?