Palliative Care Module 2

A 60-year-old patient presents with abdominal distension and discomfort secondary to malignant ascites related to advanced ovarian cancer. Symptoms began to intensify as the volume of ascitic fluid increased beyond 1 liter.

The patient’s overall prognosis is estimated to be less than 6 months, but the discomfort has significantly impaired her quality of life.

The ascites is not loculated, and there’s no evidence of bowel distension. After an initial discussion, the patient expresses a desire for symptomatic relief.

Which of the following management strategies is most appropriate in this clinical scenario?

Which of the following mechanisms is primarily involved in the pathogenesis of cancer anorexia-cachexia syndrome?

In the management of palliative patients with hepatic failure, when adjusting drug dosages due to impaired liver function, which of the following statements is most accurate?

In the context of palliative care, which of the following best describes the role of the Beers Criteria, STOPP (Screening Tool of Older Person’s Prescriptions), and START (Screening Tool to Alert doctors to Right Treatment)?

Which of the following best describes a fundamental principle of the deprescribing process in palliative care patients?

The remote effects of cancer can be classified as paraneoplastic syndromes. They are thought to be rare, affecting perhaps only 1% of people with cancer.

Interestingly, some syndromes may be identified before the diagnosis of cancer is made.

Which of the following neurological syndromes is correctly matched with its commonly associated underlying cancer?

A 60-year-old male patient presents with a persistent cough that has significantly impacted his quality of life, affecting sleep and the ability to communicate. The patient has a history of chronic obstructive pulmonary disease (COPD) and was recently diagnosed with metastatic lung cancer. Additionally, he is on Perindopril for hypertension.

Which of the following is the most important differential diagnosis to consider for this patient’s cough?

Which of the following statement accurately explains why hyoscine hydrobromide may cause delirium, while glycopyrrolate and hyoscine butylbromide do not?

A patient with carcinoid is experiencing severe sweating, which has been affecting their quality of life.

Which of the following intervention is NOT a specific treatment option for severe sweating?

A 55-year-old patient with advanced breast cancer presents to palliative care with a large, malodorous fungating wound on her chest. The wound is producing a significant amount of exudate and the patient reports considerable discomfort and embarrassment due to the odor.

The palliative care team is assessing various management strategies to improve the patient’s quality of life.

Which of the following interventions is NOT recommended for managing this patient’s wound?

In the context of end-of-life care, distinguishing between clinical depression and profound sadness is important.

Which of the following statements most accurately differentiates clinical depression from profound sadness in terminally ill patients?

Which of the following statement most accurately describes the management of Behavioural and Psychological Symptoms of Dementia (BPSD)?

An 82-year-old patient with advanced dementia is brought to your clinic by their family, who report changes in behavior over the last two months. The patient, who used to participate in daily activities with some enthusiasm, now shows little interest in their surroundings, has reduced interaction with family members, and has been observed to have episodes of agitation and aggression.

The patient’s speech has become minimal, and appears to be in a state of constant fatigue. The family is concerned these changes might indicate depression, but they are also aware of the patient’s dementia progressing.

Which of the following is the most likely differential diagnosis to consider first?

In the management of delirium in palliative care patients, which of the following treatment options would be recommended for managing severe symptoms?

A 76-year-old patient with advanced dementia in a residential care facility has recently exhibited increased verbal outbursts, restlessness, and refusal to eat, alongside a documented weight loss of 5% over the past month. The patient also has a newly developed chest infection and has been noted to have a low-grade fever.

Given these findings, which of the following is the most likely explanation for the patient’s current condition?

A 67 year old male with metastatic lung cancer presents with persistent hiccups that have been unresponsive to initial non-pharmacological interventions.

Which of the following steps would be the most appropriate next action?

Which anatomical location in the the central nervous system (CNS) is predominantly involved in the mechanism of nausea and vomiting?

Select the appropriate anti-emetic medication matched with its indication:

A palliative care patient receiving opioid therapy for chronic pain management presents with constipation. Despite the preventive measures, the constipation persists, and the patient prefers not to undergo rectal interventions.

Considering the patient’s condition and preferences, which of the following management strategies is most appropriate?

A 55 year old male with metastatic bowel cancer was recently admitted to hospice 3 days ago. He now presents with symptoms indicative of an intestinal obstruction, characterized by intermittent abdominal pain, vomiting, and the inability to pass stools or gas.

The obstruction is suspected to be mechanical, due to peritoneal metastasis.

After an initial assessment, which of the following management strategies is most appropriate for this patient, considering the palliative care principles of minimizing discomfort and maintaining quality of life?