1 - History and Examination Flashcards
What are the top 6 cancers in the UK?
- breast
- prostate
- lung
- bowel
- melanoma
- bladder
What are the top 10 cancer deaths in the UK?
What are the different performance statuses on the WHO performance status system?
**0- ** fully active, no restriction
**1- ** restricted in strenuous activity. carries out ambulatory work and office work
**2- ** only ambulatory and self care work
3- limited self care. bed/chair bound >50%
**4- ** disabled and bedbound
**5- ** dead
What age is the clinical frailty scale validated in?
>65s
What questions can you ask in the history of presenting complaint if you are suspecting a hameotological malignancy?
Don’t forget to think about onset of symptoms etc
- Fatigue, breathlessness and dizziness (anaemia)
- Easy bruising and bleeding (thrombocytopenia)
- Recurrent or atypical infections (impaired immune response)
- Weight loss, night sweats and pyrexia (known as “B-symptoms”)
After taking a history of presenting complaint for a suspected haematological malignancy, what other questions should you ask in the history?
PMHx: Lymphoma/Leukaemia/Myelodysplasia, Bleeding disorders, Anaemias, Thrombotic disorders
Transfusion Hx: What was transfused, any reactions, Any stem cell transplant
DHx + Allergies: Steroids, NSAIDs, anticoagulants
SHx: included recent prolonged immobility like travel
FHx: of haemtological cancers or bleeding disorders e.g haemophilia or Von Willebrand’s
How do you examine a patient if you are suspected a hameotological malignancy?
https://geekymedics.com/wp-content/uploads/2020/09/OSCE-Checklist-Lymphoreticular-Examination.pdf
- Introduce, Consent, Chaperone
- 45 degrees on bed
- General Inspection: pallor, petichiae, bruising
- Cervical lymph nodes
- Axillary lymph nodes
- Epitrochlear lymph nodes
- Inguinal lymph nodes
- Abdominal: lie flat, palpate abdomen, check for hepatic and splenomegaly
- Further Ix: FBC, blood film, further imaging, lymph node biopsy
What is important to know about a patient when referring them to the MDT to make a management plan for their newly diagnosed cancer?
- Performance status
- Psychological and spiritual needs
- Social history
When performing an examination for any suspected solid cancer what do you need to make sure you check for?
LYMPHADENOPATHY!!!!
What is the purpose of screening?
Identify people in an apparently healthy population (asymptomatic) who are at higher risk of a health problem or a condition, so that an early treatment or intervention can be offered
Lung cancer often presents late. Why do we not screen for lung cancer?
-often asymptomatic until late stage
- high degree of false negatives in screening test
- better to increase early diagnosis in symptomatic patients rather than screening in healthy population as more cost effective
What are the aims of screening?
- Reduce mortality by early detection and early treatment
- Reduce incidence of a condition by identifying and treating its precursors
- Reduce severity of a condition by identifying people with the condition
- To increase choice by identifying conditions or risk factors at an early stage in a life-course when more options are available
What are Wilson’s and Jugner’s principles of screening?
- condition should be important health problem
- accepted treatment in place post screening
- facilities for diagnosis and treatment should be available
- recognisable latent/early symtpomatic phase
- suitable screening test or examination
- cost of case finding should be balanced in relation to money spent on medical care
- case finding should be continuous not j once and for all.
How do you calculate the following?
How does prevalence affect positive predictive value?
↑prevalence = ↑ PPV and ↓false positive
What are the benefits and harm of screening programmes?
What cancers can these infections cause?
**h.pylori- gastric
HPV- cervix, vulva, vaginal, anus,penis
EBV- nasopharynx
HIV- kaposci sarcoma, lymphoma
hep b- liver
hep c- liver and non hodgkin lymphoma
What are some ways to reduce your risk of cancer?
