Peripheral Mottling as Sign of Imminent Death — SCE Palliative Medicine MCQ

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EasyEnd of Life CarePeripheral Mottling as Sign of Imminent DeathSCE Palliative Medicine

A 72‑year‑old woman with advanced bowel cancer is dying at home. Her family notice a blue‑grey discolouration of her fingers, toes and knees with a lace‑like (reticular) pattern on her legs. What does this indicate?

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Correct answer: E — Peripheral cyanosis with livedo reticularis—a sign of circulatory failure and imminent death

The description—blue‑grey, lace‑like (reticular) discoloration of extremities—is classic mottled skin (livedo reticularis) due to diminished perfusion, recognised as a physical sign of circulatory failure and imminently approaching death in end‑of‑life care. NICE NG31 explicitly lists mottled skin as a sign of someone entering the last days of life. Raynaud’s phenomenon is episodic, painful and reversible, not progressive in terminal decline. DVT causes unilateral swelling, pain and warmth. Meningococcal sepsis has petechial or purpuric rash and acute systemic symptoms and would not align with an expected dying process. Allergic reactions typically present acutely with urticaria, erythema or swelling, not lacy cyanosis in a dying patient.

Reference: NICE NG31: Care of dying adults in the last days of life – Recommendations (2015), QS144: Assessing signs and symptoms in dying adults (2017), https://www.nice.org.uk/guidance/ng31/chapter/Recommendations

Peripheral Mottling as Sign of Imminent Death — SCE Palliative Medicine MCQ

A 72‑year‑old woman with advanced bowel cancer is dying at home. Her family notice a blue‑grey discolouration of her fingers, toes and knees with a lace‑like (reticular) pattern on her legs. What does this indicate?

A 72‑year‑old woman with advanced bowel cancer is dying at home. Her family notice a blue‑grey discolouration of her fingers, toes and knees with a lace‑like (reticular) pattern on her legs. What does this indicate?