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?
You are urgently called to the oncology ward to assess a 70-year-old man with a history of metastatic buccal cancer that has spread and is now causing a fungating lesion. The MDT had previously deemed the cancer inoperable due to involvement of the carotid artery. The patient was admitted with hypercalcaemia but has since deteriorated and is now on the end-of-life pathway.
Upon arrival, you observe a significant amount of blood around the patient, and staff are using towels to apply pressure to the neck. The nursing team reports that there was a sudden pop and a large volume of bleeding began at the site of the fungating cancer. They mention that bleeding has occurred before, but not to this extent.
What would be the most appropriate course of action in managing this situation?
A 50-year-old woman with metastatic bowel cancer is currently receiving hospice care for severe abdominal pain. While being treated for a chest infection with co-amoxiclav, she suddenly experiences acute shortness of breath and significant swelling of the lips and tongue. What is the best course of action for managing her condition?
A 75-year-old man with metastatic small cell lung cancer was sent home on regular oral morphine sulphate for pain relief. He had initially experienced good relief from the medication, but after a few weeks required readmission due to poorly controlled pain. He had taken his medication as directed. While in the hospital, he contracted pneumonia and his condition worsened, resulting in respiratory failure and a decreased Glasgow Coma Scale (GCS). He continued to experience significant discomfort. What is the appropriate resuscitation status for this patient?
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?
A 65-year-old man presents with confusion, constipation, and nausea. He has a history of malignancy and his serum calcium levels are elevated. Treatment with intravenous fluids and bisphosphonate improves his symptoms. What is the probable location of his primary cancer?
Sarah is an 80-year-old woman with locally advanced bowel carcinoma who presents in complete bowel obstruction. Her main symptoms are nausea, vomiting, constipation and colicky abdominal pain.
The medical team is considering setting up a syringe driver to control her symptoms but is unsure of the best drug to use.
What would be the most appropriate drug to use in this situation?
A 72-year-old man with brain metastases has been admitted to a hospice for end-of-life care. He experiences regular seizures and has previously been successfully treated with lamotrigine. However, he is now unable to swallow and will be started on a syringe driver. His current medications include MST 20 mg twice daily, Movicol 1 sachet twice daily, cyclizine 50 mg as needed, and lamotrigine 100 mg once daily. What combination of medications should be included in his initial 24-hour syringe driver?