Palliative quiz

A 67-year-old man with metastatic prostate cancer developed hot flushes. His only medication was monthly luteinising hormone-releasing hormone antagonist. According to NICE guidance ‘Prostate cancer: diagnosis and management’ (2014), what is the first-line treatment for his hot flushes?

A 25-year-old man with relapsed Hodgkin disease presented with an 8-week history of widespread itch, which was worse at night. On examination, there were excoriations on his legs and trunk. The consultant suggested treating him with cimetidine. What level of evidence supports the use of cimetidine in this situation?

Which of the following medications is NOT used in the management of pruritus in the palliative care setting?

A 78 year old male with metastatic renal cell carcinoma who has trialled surafanib, evorolimus and nivolumab and is refractory to all medical therapy presents to the emergency department with intractable fevers and night sweats. What is an appropriate medication to give this man?

A 68 year old female has significant peripheral neuropathy which is severely limiting function. She has renal impairment and narrow angle glaucoma. Which of the following is the preferred neuropathic pain option?

A 60-year-old woman with locally advanced cancer of the left breast presented with recent-onset lymphoedema of her left arm. She is not a candidate for radical resection, and due to her pulmonary co-morbidities, she is unable to tolerate radiotherapy. Her examination shows a very swollen left arm, elbow and wrist associated with ischaemic changes in the fingers of her left hand. There is no radial TK pulse and doppler ultrasound scan shows no thrombus in any of the veins however reduced flow within her brachial arteries. What is the most appropriate initial management of her lymphedema?

A 78 year old male with metastatic prostate cancer with multiple bony lesions complains of sudden onset right hip pain. A CT scan shows a large lytic lesion with cortical thinning within the upper third of the femur. What is the most appropriate management for this patient?

The dose conversion ratio of oral (PO) morphine (M) to oral hydromorphone (HM) in the management of chronic pain is?

Which one of the following would NOT be an appropriate treatment for a patient with advanced cancer requiring morphine treatment for pain who presents with myoclonus, hallucinations, sedation?

An 88-year-old man enrolled in hospice four months earlier for the diagnosis of advanced dementia. He has been slowly deteriorating. This morning on examination the patient was lethargic with cool extremities. This afternoon the patient’s daughter calls you with concerns that the patient is making “a weird gurgling noise.” Which of the following is true?

A 76-year-old man in a nursing home becomes apneic and unresponsive and has pinpoint pupils after being given his evening medications. His medications include lisinopril, aspirin, atorvastatin, and morphine sulfate ER. Which of the following may have caused his symptoms?

You are visiting with the wife of a patient who is having difficulty making the transition to palliative care for her dying husband. What is the most desirable outcome for the couple?