Symptom Management and Palliative Care
What the exam tests
Assessment and management of pain, nausea and vomiting, mucositis, fatigue, dyspnea, anorexia, constipation, and delirium, plus core palliative and hospice principles.
Pain
Use a validated scale and treat the cause. Continuous cancer pain calls for a scheduled long-acting opioid plus a short-acting breakthrough dose, conventionally 10–20% of the total daily dose, every 1–2 hours as needed. Add a bowel regimen (stimulant plus osmotic) whenever opioids start. Distinguish tolerance (needing more for the same effect), physical dependence (withdrawal on abrupt cessation), and addiction (compulsive use despite harm). Withholding analgesia out of fear of addiction is a common and dangerous error.
Nausea and vomiting
Identify the pattern: acute (within 24 hours), delayed (24–120 hours), or anticipatory. Match the class to the pathway - 5-HT3 antagonists, NK-1 antagonists, dexamethasone, dopamine antagonists; lorazepam is often used for anticipatory nausea.
Other symptoms
Mucositis: saline or sodium bicarbonate rinses, avoid alcohol-based mouthwash, inspect the mouth regularly. Fatigue: first rule out anemia, pain, depression, and sleep disruption, then use activity and energy conservation. Dyspnea: treat the cause, use positioning, fans, and opioids for refractory air hunger.
Traps
Confusing addiction with pseudoaddiction (drug-seeking behavior driven by undertreated pain). Also assuming hospice means stopping all treatment - it stops curative treatment of the terminal illness while aggressively treating symptoms.
Rule of thumb
Any new or suddenly worsening symptom gets assessed for progression or an emergency before medicating.