A 68-year-old man with metastatic lung cancer is admitted with upper back pain. It radiates around his chest ‘like a band’. He is having difficulty moving due to the pain. Neurological examination is normal and he has no bladder and bowel disturbance. An MRI spine is pending to determine if this is thoracic spinal cord compression. Currently, he is taking paracetamol 1 g qid and senna 2 tabs od. What medication should be initiated while waiting for the MRI results?
A 68-year-old man with prostate cancer and widespread bony metastases presents with chest pain. He describes it as a ‘shooting’ pain which originates in his back but radiates forward in a band around his chest. This pain is associated with altered sensation affecting the skin at the level of his nipples.
He is currently taking paracetamol 1 g QDS, modified release morphine sulphate (MST) 30 mg BD, and oral morphine liquid 10 mg PRN. He is taking four doses of oral morphine liquid each day which he does not feel is helping his pain.
What would be the most appropriate next step in managing this patient’s pain?
A 38-year-old man with a history of glioblastoma multiforma was admitted to a hospice on a Friday evening for symptom control.
He had undergone debulking surgery six months ago, but a recent scan showed significant tumour re-growth, and he was referred for palliative care support.
Two months before admission, he experienced abnormal shaking of his right arm and lost consciousness with urinary incontinence. He saw a neurologist and started taking antiepileptic medication. He was also taking a stable dose of steroids.
The patient’s mother was concerned about his abnormally aggressive behaviour and episodes of forgetting the way to the bathroom at home. The GP tried increasing the steroid dose for seven days, but the symptoms persisted. In between these episodes, the patient was his usual self.
What is the best approach to address this patient’s issue?
A 75-year-old woman presents with dyspnea. She was diagnosed with malignant mesothelioma eight months ago and was referred to palliative care services as no treatment was suitable. Her functional status has declined significantly in the last fortnight, requiring substantial assistance at home and limiting her walking to a few yards. She has recently experienced increased breathlessness, particularly when lying flat, and has noticed facial swelling and flushing. Her oxygen saturation is 97% on room air. What is the most appropriate initial management for this patient?
An 81-year-old man presents with metastatic bowel cancer. He is brought in by ambulance after experiencing symptoms at home. Upon arrival, he displays confusion, widespread muscle rigidity, and tremors. The patient has recently started taking medication for constipation and nausea. His current medication list includes Paracetamol 1 g qds, Ibuprofen 400 mg tds, Oramorph 2.5 mg PRN, Levomepromazine 6.25 mg nocte, and Sodium docusate 100 mg bd. During examination, his heart rate is 119, blood pressure is 180/105 mmHg, and temperature is 38.5°C. Blood results show Hb 92 g/L (130-180), WCC 15.0 ×109/L (4-11), and CK 2123. What is the most likely diagnosis?
A 38-year-old man has completed treatment for a glioblastoma and is now feeling well. He wants to know when he can start driving again. What is the current guidance from the Driver and Vehicle Licensing Agency (DVLA) regarding the waiting period for a patient with treated glioblastoma before their driving licence can be reinstated?
A 38-year-old man has completed treatment for a glioblastoma and is now feeling well. He visited your clinic for a follow-up and inquired about when he can resume driving. As per the current DVLA guidelines, what is the waiting period for a patient with treated glioblastoma after completing therapy before their driving license can be reinstated?
A 53-year old man with metastatic lung cancer is brought to the hospital after experiencing a seizure while at work. He works in telesales and is the primary breadwinner for his family. Upon undergoing a CT scan of his brain, it is discovered that he has multiple metastases. What is the recommendation of the DVLA regarding his ability to drive in this circumstance?
A 59-year-old man with a history of metastatic renal cell carcinoma presented with recent onset of back pain. A bone scan revealed increased uptake in the left hip, suggestive of a metastatic deposit. He was scheduled for one fraction of palliative radiotherapy. Upon admission, his U&Es showed a creatinine level of 235, which had increased from 87 one month prior. Despite taking regular paracetamol and codeine phosphate 60 mg every six hours, he experiences severe pain in his hip when moving from the bed. While waiting for radiotherapy, what is the most appropriate PRN analgesic for him?
A 70-year-old man has been diagnosed with metastatic ovarian cancer. He has a history of heart failure and diabetes. He is currently taking aspirin, bisoprolol, and ramipril. His GP prescribed tramadol (100 mg six hourly) for his abdominal pain, but it has significantly worsened. The GP referred him to you for assessment.
Upon assessment and investigation, no acute cause for the pain exacerbation was found. The pain team initiated oral morphine (immediate release) 5 mg four hourly, which has helped with the pain but caused nausea in the patient. What is the most appropriate antiemetic to start?