How to use this deck

Palliative care questions often test whether you can connect a symptom to a safe next step, not just name a drug. Use this deck to practise retrieving one decision or fact at a time. The cards are deliberately focused on common adult-care principles; drug choices, dose conversions and prescribing routes vary between countries and services. Check your local palliative-care guideline or formulary before using a dose in clinical practice.

For each prompt, say or think through the answer before turning the card. Then grade your recall honestly: choose Again if you could not retrieve it, Hard if you needed substantial effort or missed a detail, Good if you recalled it correctly, and Easy only if it came quickly and precisely. A card graded Again or Hard needs another retrieval soon; do not upgrade it just because the answer looks familiar once revealed.

In MySummaries, a palliative-care revision board can generate a deck from your own notes. This one covers 18 high-yield facts to practise today:

Cards — Palliative Care — symptom control and safety18 due

What four dimensions are included in the concept of total pain?

Physical, psychological, social and spiritual.

All 18 cards
What four dimensions are included in the concept of total pain?Physical, psychological, social and spiritual.
A common adult breakthrough-opioid starting rule is what fraction of the total regular opioid dose over 24 hours?About one-sixth, adjusted to the patient and local prescribing guidance.
What is the approximate oral-to-subcutaneous conversion for morphine?Oral morphine 2 mg is approximately equivalent to subcutaneous morphine 1 mg; confirm the local conversion table.
When rotating from one strong opioid to another, what adjustment is commonly considered for incomplete cross-tolerance?Reduce the calculated equianalgesic dose by about 25–50%, then individualise and monitor. Methadone needs specialist conversion advice.
Why can morphine become problematic in severe renal impairment?Its active metabolites can accumulate and contribute to prolonged sedation and neurotoxicity.
What is a practical first step when an opioid-naive patient with severe renal impairment needs an opioid?Seek an individualised plan using the local renal and palliative-care guidance; fentanyl has no active metabolites, but its route and suitability still matter.
What should usually accompany regular opioid treatment to prevent constipation?A prescribed laxative regimen, commonly combining a stimulant and an osmotic laxative, unless contraindicated.
Name three medicines commonly used as adjuvants for neuropathic pain, depending on the patient and local guidance.Amitriptyline, gabapentin and pregabalin.
Name two simple non-drug measures that may ease breathlessness.A handheld fan directed towards the face and a position that supports comfortable breathing.
Should oxygen be prescribed routinely for breathlessness in a patient who is not hypoxaemic?No. Assess for hypoxaemia and other indications; oxygen is not a routine treatment for breathlessness without hypoxaemia.
What should a clinician look for when assessing new or worsening delirium?Potentially reversible causes, including infection, medication effects, dehydration, constipation, urinary retention and metabolic disturbance.
What is a useful first non-drug approach to distressing terminal respiratory secretions?Explain the sound to those present, consider repositioning, and assess whether secretions are distressing the patient; use medicines according to local guidance.
In suspected metastatic spinal cord compression with neurological symptoms, what is the immediate priority?Treat it as an emergency: arrange urgent assessment and follow the local spinal cord compression pathway, including urgent imaging and specialist discussion.
What dexamethasone dose is used in some adult spinal cord compression pathways while urgent treatment is arranged?Some guidelines use 16 mg orally (or an equivalent parenteral dose) promptly, then continue according to the pathway; check local guidance.
What corrected calcium level is commonly used to define hypercalcaemia?Above 2.6 mmol/L is a commonly used threshold, but interpret it using the laboratory reference range and clinical context.
Why is metoclopramide generally avoided in complete mechanical bowel obstruction?Its prokinetic action may worsen colicky pain; assess the obstruction and select antiemetic treatment using the local pathway.
What features can indicate opioid toxicity?Increasing sedation, delirium or hallucinations, myoclonus and, in severe toxicity, respiratory depression; assess the whole clinical picture.
What is the defining principle of palliative sedation?For refractory suffering, sedation is proportionate to the clinical need, carefully monitored and managed under specialist and local protocols.

That is a MySummaries deck, filled with palliative care material. Yours is written from your own notes. Start free

What to retain after the first pass

Do not aim to memorise every card with equal priority. The important habit is to separate a remembered headline from a safe clinical answer. For a dose or conversion, name the assumption, state that local guidance applies, and consider the patient’s renal function, current opioid exposure, route and goals of care. In an examination answer, that qualification shows you understand why a number is not a prescription by itself.

The opioid cards are connected. First establish the regular 24-hour opioid dose and the prescribed breakthrough plan. If conversion is needed, use a recognised local table rather than calculating from memory alone. If rotating opioids, account for incomplete cross-tolerance and monitor for both uncontrolled pain and toxicity. A dose reduction is a safety adjustment, not a fixed rule that replaces individual assessment. Methadone conversion is particularly variable and should not be treated as a simple morphine-equivalence calculation.

The symptom cards also reward a sequence of reasoning. For breathlessness, assess reversible causes and the patient’s level of distress, then consider positioning and airflow; do not assume oxygen is indicated. For delirium, look for contributing or reversible causes before treating the behaviour alone. With noisy secretions near the end of life, explain what is happening and consider whether the sound is distressing the patient, rather than automatically treating what is upsetting observers.

The must-not-miss core

Once you have graded the deck, use a short checklist to test whether the safety-critical ideas stayed available. This core is not a substitute for a local formulary: it is a prompt to retrieve the key caveats as well as the headline facts.

The board’s must-not-miss core for this deck is:

Must not miss corePalliative Care — symptom control and safety
A commonly used adult breakthrough-opioid guide is about one-sixth of the total regular opioid dose over 24 hours; individualise and check local guidance.
Approximate morphine conversion: oral 2 mg to subcutaneous 1 mg. For opioid rotation, a 25–50% reduction for incomplete cross-tolerance is commonly considered; methadone needs specialist advice.
With severe renal impairment, morphine metabolites can accumulate. Choose and dose an opioid using local renal and palliative-care guidance.
Suspected metastatic spinal cord compression with neurological symptoms is an emergency. Follow the local urgent pathway; some adult guidance uses dexamethasone 16 mg promptly.

Say each item in your own words, including its qualification. If you can recall the one-sixth rule but cannot say that it is a common guide rather than a universal prescription, mark it Hard. If you remember the spinal cord compression dose but forget that urgent assessment and the local pathway come first, mark it Again. That is the difference between reciting a figure and using it safely.

Turn repeated errors into a repair card

A repeated miss usually points to a missing link, not a need to reread the whole subject. For example, a learner may remember that morphine is used for pain but fail to connect renal impairment with metabolite accumulation. Make the repair card test that decision directly. After reviewing the explanation, answer the question again without looking, then return to it in a later session.

A remediation card from this deck could read:

Remediation tray

You lost this mark twice: why can morphine cause prolonged sedation or neurotoxicity in severe renal impairment, and where would you check before choosing an alternative opioid?

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How MySummaries helps

Build a revision board from your own palliative-care notes, then use it to create and review cards like these. Keep local dose guidance alongside your source material, and use repeated misses to decide what to revisit next. Open MySummaries to start with your own material.