1 - History and Examination Flashcards
What are the top 10 cancers in the UK?
What are the top 10 cancer deaths in the UK?
What are the different performance statuses on the WHO performance status system?
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?
-Penia symptoms and B symptoms
Anaemia
Fatigue
Breathlessness
Dizziness
Palpitations
Reduced physical exercise tolerance
Thrombocytopenia
Easy bruising
Easy bleeding e.g. epistaxis
Heavy periods
Leukopenia
Recurrent infection
Persistent infections
Atypical infections
B-symptoms
Weight loss,
Night sweats
Fever
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?
If late diagnosis of cancer is a feature of a health system, screening won’t be effective as the initial stategy because coverage and capacity not good enough to reduce mortality
Early diagnosis is better
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?
How do you calculate the following?
How does prevalence affect positive predictive value?
An increase in prevalnce causes a higher positive predictive value
Because more cases detected are true positives making the testing more accurate
What are the benefits and harm of screening programmes?
What cancers can these infections cause?
