4th April [26th-2nd]

Question 1

What does the ADRT contain?

Answer 1

1. Personal details
2. Who you’ve discussed Advanced Decision with
3. Refusals of Tx
4. To avoid doubt
5. Advance statement
6. People involved in the are
7. Lasting Power of Attorney
8. Signature
9. Witness signature

Question 2

What is the ‘to avoid doubt’ section in the ADRT?

Answer 2

• Yes/no to all pain relief
• pregnancy and having the baby when palliative
• organ donation

Question 3

Baile’s model for breaking bad news

Answer 3

S - setting
P - perception
I - invitation
K - knowledge [check/chunk]
E - empathic
S - summary/strategy

Question 4

Success rates on general population in hospital CRP?

Answer 4

Around 18% recover sufficiently in hospital

- though number very variable based on health of person

Question 5

What could be given for an end of life patient with heat failure to help with his breathing?

Answer 5

Opiates

• via syringe drivers [titrating up]
• via buprenorphine patches

Benzos
- in small doses for acute episodes would help [Mirdazalam/Lorazepam]

Question 6

Advantages/disadvantages of different types of opiates administration

Answer 6

Syringe drivers

• quick action
• can titrate up easily
• easier to OD with
• need to be attached to a machine

Patches [buprenorphine]

• can cause sore skin area
• take longer to work
• not as easy to titrate up

Question 7

Chance of people with advanced metastatic disease [particularly the upper thorax] recovering from CPR

Answer 7

Rare -> around 2% chance, with near 0% chance fully recover and get discharged.

Question 8

Patient factors hyper/hypovolaemia and hydration

Answer 8

Trauma, febrile illness/sepsis, age, burns. polyuria etc.

Question 9

Sx of dehydration

Answer 9

Cyanososi, SOB, pallor, malar flush, oedema, leukonychia [end-stage liver disease, protein-losing enteropathy], colour hands, temperature, CRT, skin turgor, radial pulse, brachial pulse, BP, JVP, eyes [sunken/pallor], mucous membranes mouth, chest for heart/lungs sounds, abdomen for shifting dullness/distnesion, sacral oedema/pitting pedal oedema

Question 10

Red flags bowel Ca

Answer 10

• persistent change bowel habits [pooing more often, looser stools, tummy pain]
• blood in the poo w/o Sx of piles
• abdominal pain or discomfort or bloating always brought on by eating

Question 11

Common Ca to spread to bone

Answer 11

Prostate, breast, lung, kidney, thyroid, myeloma

Question 12

Sx of secondary bone Ca

Answer 12

Pain - continuous, gnawing often described
Backache - gets worse despite resting
Breaks - bone getting weaker
Hypercalcaemia - dehydration, confusion, being sick, tummy pain, constipation
increased risk infection, SOB, looking pale, bruising and bleeding due to low level blood cells.
Pain/weakness/numbness in the legs/blowel/bladder control due to spinal cord compression

Question 13

What can CPR involve?

Answer 13

• chest compression
• defibrillator
• artificial ventilation
• giving medicine by injection

Question 14

Success CPR factors

Answer 14

1. Lungs/heart/other organs working before heart/breathing stops
2. Near person trained in CPR
3. Any equipment needs like defibrillates is ready

Question 15

Where does pain begin?

Answer 15

Nociceptors [branching ends of peripheral nuerones] -> primary afferent neurones -> spinal thalamic tract -> thalamus -> somatosensory cortex

Question 16

NT released in pre-synpatic neurones

Answer 16

1. GLUTAMATE [-> NMDA, AMPA]
2. Substance P [NK-1]
3. CGRP [CGRP-R]

Question 17

Main types of opioid receptors?

Answer 17

M, delta and K