A 83-year-old woman is terminally ill with metastatic breast cancer. Her General Practitioner (GP) reviews her at her home, with her family present. There is a discussion around treatment escalation, and a ‘just-in-case box’ is prescribed. The GP explains that in the last days of life, a syringe driver may be helpful to control symptoms such as pain, agitation, breathlessness or nausea.
Which of the following drugs is suitable for continuous subcutaneous infusion?
Which option represents good practice in end-of-life care for a Primary Healthcare Team from the following list?
A 68-year-old man is evaluated after being bedridden due to severe heart failure and chronic obstructive pulmonary disease. He has been immobile in bed and his wife is struggling to care for him. During the examination, his blood pressure is 110/80 mmHg, heart rate is 85 bpm and regular. Bilateral crackles and wheezing are heard on chest auscultation, and he has pitting edema on both knees and over the sacrum. Which scoring system is utilized to assess his risk of developing pressure ulcers?
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?