Phys Vivas · oncological
Breakthrough Cancer Pain AND Opioid Titration — Viva Defence
DCE viva defence for Breakthrough Cancer Pain AND Opioid Titration.
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Target exams
Breakthrough Cancer Pain AND Opioid Titration Viva
Long Case Viva Defence
Opening statement
"This patient presents with a problem best framed as Breakthrough Cancer Pain AND Opioid Titration. My priorities are to identify red flags, confirm the mechanism with purposeful investigations, start a sequenced management plan, and integrate multimorbidity and follow-up." [1] [2]
Examiner questions
Q1: "What makes this urgent?" [1]
"I look for threats to airway, perfusion, neurology, metabolism, infection or bleeding, and I escalate those before elective work-up." [1] [2]
Q2: "What is your first investigation package?" [2]
"I order tests that change management now, not a scattergun panel." [1] [2]
Q3: "Walk me through treatment." [1]
"Stabilise, treat the mechanism, prevent complications, and plan monitoring." [1] [2] [3]
Q4: "What is the classic trap?" [2]
"Treating a label without confirming the discriminating mechanism, or delaying escalation." [1] [2]
Short case
Counsel the patient on the plan, risks and warning symptoms in plain language. [1] [2]
References
- [1]Mercadante S, Candido K, Staats P, Davis M Spinal analgesia in cancer pain management-MASCC general practice recommendations Support Care Cancer, 2025.PMID 40634640
- [2]Mercadante S Once again... breakthrough cancer pain: an updated overview J Anesth Analg Crit Care, 2023.PMID 37480136
- [3]Mercadante S An overview of the current drug treatment strategies for moderate to severe, chronic malignant tumor-related pain Expert Opin Pharmacother, 2024.PMID 37016731
- [4]Kiani CS, Hunt RW Lidocaine Continuous Subcutaneous Infusion for Neuropathic Pain in Hospice Patients: Safety and Efficacy J Pain Palliat Care Pharmacother, 2021.PMID 33793373
- [5]Michenot N, Rostaing S, Baron L, Faure S, et al. [Opioid switch and change of route of administration in cancer patients treated by morphine] Bull Cancer, 2018.PMID 30274680
- [6]Xi Y, Yao T, Zhang C, Zhuang T Effectiveness of safety care and clinical nursing pathway in patients undergoing cardiovascular intervention: a randomized controlled trial Perioper Med (Lond), 2026.PMID 42469924
- [7]Marks FJ, Walters SJ, Sutton L, Jacques RM What statistical methods are more appropriate for predicting recruitment at the design stage of a randomised controlled trial? Trials, 2026.PMID 42469922
- [8]Hajiaqaei M, Mohammadi A Transcranial random noise stimulation (tRNS) over the left dorsolateral prefrontal cortex ameliorates emotion dysregulation and executive function: a single-blind, randomized, sham-controlled clinical trial BMC Psychol, 2026.PMID 42469906