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Palliative medicine
17 notes, 51 questions and 149 flashcards.
Tier 1 is core knowledge expected of every trainee. Tier 2 is deeper or less common.
Presentations
- Constipation in palliative careFree sampleWhy almost every palliative patient on an opioid gets constipated, how to separate it from bowel obstruction and cord compression, the regular stimulant-plus-softener regimen, rectal measures, and when to use methylnaltrexone or another PAMORA.Tier 1, approach to a presentation, 3 questions, 9 flashcards
- Dyspnoea in palliative careReversible causes of breathlessness in advanced cancer and organ failure, non-drug measures that work, when oxygen helps, where opioids now stand after BEAMS and MABEL, and managing a breathlessness crisis in the last days of life.Tier 1, approach to a presentation, 3 questions, 9 flashcards
- Nausea and vomiting in palliative careFinding the cause of nausea in advanced illness, matching the antiemetic to the likely mechanism, the doses and routes used in palliative care, malignant bowel obstruction, and the drug interactions that undo each other.Tier 1, approach to a presentation, 3 questions, 9 flashcards
- Pain in palliative careAssessing cancer and palliative pain by type and cause, starting and titrating oral morphine, breakthrough doses, opioid choice in renal and hepatic impairment, bone and neuropathic pain, opioid toxicity, and the trials that changed practice.Tier 1, approach to a presentation, 3 questions, 9 flashcards
- Tracheobronchial secretions in the dying patientNoisy respiratory secretions ("death rattle") in the last hours to days of life, what they predict, how to explain them to families, repositioning and fluid review, and where antimuscarinics such as hyoscine butylbromide and glycopyrronium fit given weak evidence.Tier 1, approach to a presentation, 3 questions, 9 flashcards
Key conditions
- Recognising the dying phase and illness trajectoriesFree sampleThe three illness trajectories and what they mean for planning, tools for identifying patients in their last year (surprise question, SPICT, AKPS, PCOC phases), the signs that someone is entering the last days, and what to do once dying is recognised under the 2023 National Consensus Statement.Tier 1, medical sciences concept, 3 questions, 9 flashcards
- Terminal delirium and terminal restlessnessDelirium and agitation in the last days of life, the reversible causes worth finding, the bladder and drug causes not to miss, non-drug care, haloperidol and midazolam doses, what the Hui trials (2017, 2020, 2025) showed, and proportionate palliative sedation.Tier 1, approach to a presentation, 3 questions, 10 flashcards
Less common or complex conditions
- Depression near the end of lifeTelling depression from sadness, demoralisation and the physical effects of dying, screening questions that work, which antidepressant suits a short prognosis, psychostimulants, drug interactions in cancer, and when to bring in psychiatry.Tier 2, condition, 3 questions, 9 flashcards
- Malignant bowel obstructionRecognising malignant bowel obstruction, the CT and the surgical question, who benefits from surgery or a stent, the medical regimen without a nasogastric tube, venting gastrostomy, parenteral nutrition and the drugs to stop.Tier 2, condition, 3 questions, 9 flashcards
- Seizures in palliative careWho seizes near the end of life, the causes worth correcting, midazolam doses by non-IV routes, keeping antiseizure cover going when the patient can no longer swallow, and how a seizure plan for home works.Tier 2, condition, 3 questions, 8 flashcards
Investigations and procedures
- Pain assessment in reduced consciousnessFree sampleHow to assess pain when a patient can't self-report (dying, sedated, delirious or with advanced dementia), the ASPMN hierarchy, Abbey, PAINAD, CPOT and BPS scores with cut-offs and worked examples, the analgesic trial, and the things that mimic pain.Tier 1, medical sciences concept, 3 questions, 9 flashcards
- Subcutaneous infusion pumps and syringe driversWhen to start a continuous subcutaneous infusion (CSCI), converting oral opioids to a 24-hour SC dose with a worked example, mixing and diluents, sites, what to check on a syringe driver chart, drugs that don't go in the driver, and common faults.Tier 1, medical sciences concept, 3 questions, 9 flashcards
Specific issues
- Cultural and religious aspects of death and dyingAsking rather than assuming, interpreters, Aboriginal and Torres Strait Islander and Māori practices around dying (Country, sorry business, whānau, tūpāpaku, tangihanga), what major faiths ask of the dying and after death, rapid burial, coronial objections to autopsy, and organ donation.Tier 1, topic overview, 3 questions, 8 flashcards
- Ethics, advance care planning and respecting patient wishesThe four principles applied at the end of life, beneficence versus non-maleficence, advance care planning and advance care directives in Australian law, substituted judgement, advocacy, cultural safety for Aboriginal and Torres Strait Islander and Māori families, organ donation, and how voluntary assisted dying fits alongside palliative care in 2026.Tier 1, topic overview, 3 questions, 9 flashcards
- Medicolegal aspects of end-of-life careConsent and refusal at the end of life, the cases that define Australian law, futility and non-beneficial treatment, proxy decision-makers and the statutory hierarchies, legal protection for palliative care, and voluntary assisted dying law in 2026 including the NT Act, Victoria's 2027 amendments and the Commonwealth telehealth problem.Tier 1, topic overview, 3 questions, 8 flashcards
- Psychological and spiritual needs, dignity and compassionTotal pain and the psychosocial and spiritual domains of palliative care, screening with the Distress Thermometer and a spiritual history (FICA, HOPE), Chochinov's dignity model, the Patient Dignity Question and dignity therapy, compassion and compassion fatigue, carers, the desire to hasten death, and prolonged grief disorder.Tier 1, topic overview, 3 questions, 9 flashcards
- Resuscitation orders and withdrawal of life-prolonging treatmentWhat a not-for-CPR order and a goals-of-care plan do and don't mean, CPR outcomes that inform the decision, who decides under Australian law and ANZCOR guidance, and the practical steps for withdrawing ventilation, NIV, dialysis, nutrition and ICDs.Tier 1, topic overview, 3 questions, 7 flashcards