PALLIATIVE CARE REVISION PAST EXAM 2025/2026 ALL
QUESTIONS AND SOLUTIONS GRADED A+ TIP
✔✔A 31-year-old male is reviewed by gastroenterology following an episode of rectal
bleeding. He does not report any other symptoms pre-admission. No abnormalities were
noted on abdominal examination. Colonoscopy reveals evidence of over a 200
adenomatous polyps throughout the large bowel, some of which are actively bleeding.
He reports his father passed away from complications related to colorectal cancer at the
age of 39.
Given the diagnosis of familial adenomatous polyposis (FAP), what would be the most
appropriate treatment to reduce his risk of developing colorectal carcinoma? - ✔✔Total
proctocolectomy
Prophylactic removal of the large bowel is the best treatment available for familial
adenomatous polyposis, which carries nearly a 100% risk of colorectal cancer by the
age of 40 in untreated patients.
58%
✔✔A 65-year-old woman presents to A&E with a two week history of progressive
dyspnoea and chest pain. She describes being initially short of breath on exertion, but
now she currently struggles to catch her breath even at rest. She has been in remission
for seven years from Stage II oesophageal cancer. This was treated with neoadjuvant
chemoradiotherapy, followed by an oesophagectomy, and adjuvant chemotherapy with
Carboplatin and Paclitaxel. On examination, her jugular venous pressure is raised at 7
cm above the sternal notch, and does not rise on inspiration.
Which of the following clinical features is most likely to be associated with this patient's
presentation? - ✔✔Pericardial rub
This is the correct answer. This woman has presented with constrictive pericarditis,
secondary to neoadjuvant radiotherapy directed at the mediastinum to shrink her
oesophageal tumour prior to surgery. Delayed constrictive pericarditis after radiotherapy
for thoracic malignancies is well described, secondary to radiation-induced fibrosis of
the pericardium. Constrictive pericarditis initially presents with features of right heart
failure (such as a raised jugular venous pressure) as the right ventricle is less muscular
and is first affected. A pericardial rub may be present as a result of the myocardium
coming up against the edges of a tightened pericardium
21%
✔✔A 75-year-old man is reaching the last few days of his life due to end-stage heart
failure. Despite nonpharmacological measures, he is feeling breathless and is becoming
distressed.
Which medication may be initially prescribed to relieve his breathlessness? -
✔✔Morphine sulphate 2.5-5 mg by subcutaneous injection as required
Subcutaneous morphine sulphate is the first-line pharmacological treatment for
breathlessness in the last few days of life. It relieves the sensation of dyspnoea and so
relieves distress. Doses can be repeated every 30 minutes as required.
, midazolam is second line for breathlessness
✔✔immediate release or modified release morphine for prn prescription - ✔✔immediate
release morphine sulphate
because it acts more rapidly than modified release
✔✔what is given alongside opioid in anticipatory meds - ✔✔senna
NOT NALOXONE
✔✔oral morphine to subcutaneous morphine - ✔✔divide by 2
✔✔A 55-year-old woman with terminal pancreatic cancer is at the hospice for palliative
care. The woman usually has a low level of consciousness and her responsiveness
fluctuates throughout the day. She does not appear agitated. Recently her daughter,
who visits daily, has noticed a rattling sound coming from her mother's throat when she
breathes in and out. The daughter is worried about this and informs the staff at the
hospice.What is the mechanism of action of the drug that can be used to alleviate these
palliative symptoms? - ✔✔This woman is experiencing excessive bronchial and
hypopharyngeal secretions which can occur in the terminal phase of life. These
turbulent secretions are responsible for the rattling noise. Hyoscine hydrobromide is an
antimuscarinic medication that acts to reduce the volume of bronchial secretions and
therefore would be helpful in this scenario. Hyoscine butylbromide and glycopyrronium
bromide may also be considered.
remember muscarinic is associated with the PNS --> rest and digest --> you need
secretions to digest - so antimuscarinics are used to reduce seceetions
✔✔opioid used in mild- moderate renal impairment - ✔✔oxycodone
✔✔why may glycopyrronium be preferred to hyocine hydrobromide for resp secretions -
✔✔hyoscine crosses BBB so causes sedation
✔✔what is buscopan - ✔✔hyoscine butylbromide
✔✔opioids used in severe renal impairment - ✔✔alfentanil, buprenorphine and fentanyl
are preferred
✔✔mx of metastatic bone pain - ✔✔metastatic bone pain may respond to strong
opioids, bisphosphonates or radiotherapy. The assertion that NSAIDs are particularly
effective for metastatic bone pain is not supported by studies. Strong opioids have the
lowest number needed to treat for relieving the pain and can provide quick relief, in
contrast to radiotherapy and bisphosphonates*. All patients, however, should be
considered for referral to a clinical oncologist for consideration of further treatments
such as radiotherapy
QUESTIONS AND SOLUTIONS GRADED A+ TIP
✔✔A 31-year-old male is reviewed by gastroenterology following an episode of rectal
bleeding. He does not report any other symptoms pre-admission. No abnormalities were
noted on abdominal examination. Colonoscopy reveals evidence of over a 200
adenomatous polyps throughout the large bowel, some of which are actively bleeding.
He reports his father passed away from complications related to colorectal cancer at the
age of 39.
Given the diagnosis of familial adenomatous polyposis (FAP), what would be the most
appropriate treatment to reduce his risk of developing colorectal carcinoma? - ✔✔Total
proctocolectomy
Prophylactic removal of the large bowel is the best treatment available for familial
adenomatous polyposis, which carries nearly a 100% risk of colorectal cancer by the
age of 40 in untreated patients.
58%
✔✔A 65-year-old woman presents to A&E with a two week history of progressive
dyspnoea and chest pain. She describes being initially short of breath on exertion, but
now she currently struggles to catch her breath even at rest. She has been in remission
for seven years from Stage II oesophageal cancer. This was treated with neoadjuvant
chemoradiotherapy, followed by an oesophagectomy, and adjuvant chemotherapy with
Carboplatin and Paclitaxel. On examination, her jugular venous pressure is raised at 7
cm above the sternal notch, and does not rise on inspiration.
Which of the following clinical features is most likely to be associated with this patient's
presentation? - ✔✔Pericardial rub
This is the correct answer. This woman has presented with constrictive pericarditis,
secondary to neoadjuvant radiotherapy directed at the mediastinum to shrink her
oesophageal tumour prior to surgery. Delayed constrictive pericarditis after radiotherapy
for thoracic malignancies is well described, secondary to radiation-induced fibrosis of
the pericardium. Constrictive pericarditis initially presents with features of right heart
failure (such as a raised jugular venous pressure) as the right ventricle is less muscular
and is first affected. A pericardial rub may be present as a result of the myocardium
coming up against the edges of a tightened pericardium
21%
✔✔A 75-year-old man is reaching the last few days of his life due to end-stage heart
failure. Despite nonpharmacological measures, he is feeling breathless and is becoming
distressed.
Which medication may be initially prescribed to relieve his breathlessness? -
✔✔Morphine sulphate 2.5-5 mg by subcutaneous injection as required
Subcutaneous morphine sulphate is the first-line pharmacological treatment for
breathlessness in the last few days of life. It relieves the sensation of dyspnoea and so
relieves distress. Doses can be repeated every 30 minutes as required.
, midazolam is second line for breathlessness
✔✔immediate release or modified release morphine for prn prescription - ✔✔immediate
release morphine sulphate
because it acts more rapidly than modified release
✔✔what is given alongside opioid in anticipatory meds - ✔✔senna
NOT NALOXONE
✔✔oral morphine to subcutaneous morphine - ✔✔divide by 2
✔✔A 55-year-old woman with terminal pancreatic cancer is at the hospice for palliative
care. The woman usually has a low level of consciousness and her responsiveness
fluctuates throughout the day. She does not appear agitated. Recently her daughter,
who visits daily, has noticed a rattling sound coming from her mother's throat when she
breathes in and out. The daughter is worried about this and informs the staff at the
hospice.What is the mechanism of action of the drug that can be used to alleviate these
palliative symptoms? - ✔✔This woman is experiencing excessive bronchial and
hypopharyngeal secretions which can occur in the terminal phase of life. These
turbulent secretions are responsible for the rattling noise. Hyoscine hydrobromide is an
antimuscarinic medication that acts to reduce the volume of bronchial secretions and
therefore would be helpful in this scenario. Hyoscine butylbromide and glycopyrronium
bromide may also be considered.
remember muscarinic is associated with the PNS --> rest and digest --> you need
secretions to digest - so antimuscarinics are used to reduce seceetions
✔✔opioid used in mild- moderate renal impairment - ✔✔oxycodone
✔✔why may glycopyrronium be preferred to hyocine hydrobromide for resp secretions -
✔✔hyoscine crosses BBB so causes sedation
✔✔what is buscopan - ✔✔hyoscine butylbromide
✔✔opioids used in severe renal impairment - ✔✔alfentanil, buprenorphine and fentanyl
are preferred
✔✔mx of metastatic bone pain - ✔✔metastatic bone pain may respond to strong
opioids, bisphosphonates or radiotherapy. The assertion that NSAIDs are particularly
effective for metastatic bone pain is not supported by studies. Strong opioids have the
lowest number needed to treat for relieving the pain and can provide quick relief, in
contrast to radiotherapy and bisphosphonates*. All patients, however, should be
considered for referral to a clinical oncologist for consideration of further treatments
such as radiotherapy
