Think about how you should deal with the following problems. You may find it helpful 

to visit the palliative care page on this web site. Click Here to do so.

1) A mother of two young children with back pain. You have X-rayed her and found a

   3rd dorsal vertebra metastasis. She had a mastectomy last year.

2) A patient with abdominal carcinomatosis secondary to Ca colon. He is developing

   progressive symptoms of intestinal obstruction.

3) A 70 year old man with Ca prostate who arrives on your list. His PSA is >1,000 and

   he has multiple bony metastases. He is on MST-30 b.d. but has pain+++ and nausea.

4) A 75 year old man with inoperable Ca bronchus. His wife is adamant that he must not

   be told the diagnosis.

5) Whether to go into a hospice or to stay at home.

6) The following problems:

        Intractible pain in a dying patient

        Uncontrollable vomiting

        Fungating Ca breast

        Hiccup

        Dyspnoea in carcinomatosis

        Lassitude  "    "     "      

       "Please doctor, put me out of this misery"

       "I don't want to know, if it's really serious"

       "How much longer have I got?"


Feel free to add any other problem cases you think you may encounter.



                                  Tutorial submitted by Andrew Crawshaw - Mevagissey - 2001