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Last days of life recognition — DGM MCQ

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EasyEnd-of-life careLast days of life recognitionDGM

A 92-year-old woman with advanced heart failure becomes bedbound, drowsy and unable to swallow tablets. She has cool peripheries and Cheyne-Stokes breathing. Her family report rapid decline over two days. Current medicines include furosemide and ramipril. What is the most likely diagnosis?

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Correct answer: A — Entering the last days of life

Rapid decline with reduced consciousness, inability to swallow, cool peripheries and altered breathing suggests the last days of life. Psychosis, vertigo, insomnia and mild cognitive impairment do not explain the global physiological decline. Recognition should trigger communication, review of medicines and anticipatory care.

Reference: NICE NG31