palliative/oncology

Question 1

first line in pain management

Answer 1

oral modified or immediate release morphine with breakthrough
if no comorbidities 20-30mg of MR a day with 5mg breakthrough

Question 2

what is the calculation for the breakthrough dose of morphine

Answer 2

1/6 of daily dose

Question 3

what should patients receiving opioids also be prescribed

Answer 3

laxative

Question 4

what pain management to prescribe if the patient also has mild-moderate renal impairment

Answer 4

oxycodone
if renal impairment more severe: alfentanil, buprenorphine, fentanyl

Question 5

how much to increase the dose of opioids to when it is not controlling pain

Answer 5

30-50%

Question 6

management of secretions

Answer 6

hyoscine hydrobromide (muscarinic receptor antagonist)

Question 7

first line management for raised intra-cranial pressure causing nausea

Answer 7

cyclizineis
dexamethasone can be used

Question 8

palliative care management of hiccups

Answer 8

chlorpromazine first line
also: haloperidol, gabapentin, dexamethasone

Question 9

palliative care management of agitation and confusion

Answer 9

first line: haloperidol
other options: chlorpromazine, levomepromazine

Question 10

management of metastatic bone pain

Answer 10

analgesia, bisphosphonates or radiotherapy

Question 11

shortness of breath, swelling of the face, neck and arms
visual disturbance and cancer

Answer 11

superior vena cava obstruction

Question 12

management of superior vena cava obstruction

Answer 12

IMMEDIATE: dexamethasone
endovascular stenting

Question 13

management of palliative patient with severe dyspnoea already on oxygen

Answer 13

IV morphine

Question 14

what is AFP a tumour marker for

Answer 14

hepatocellular carcinoma, teratoma

Question 15

how to convert oral morphine to subcut

Answer 15

divide by two

Question 16

tumour marker to monitor pancreatic cancer

Answer 16

CA 19-9

Question 17

investigation for spinal metastases

Answer 17

whole body MRI