Blue book Flashcards
1
Q
aromatic amines are associated with which cancer
A
bladder
2
Q
benzene is associated with which cancer
A
leukaemia
3
Q
wood dust si associated with which cancer
A
nasal adenocarcinoma
4
Q
vinyl chloride is associated with which cancer
A
angiosarcomas
5
Q
HPV assocated with which cancer
A
cervical and anal
6
Q
EBV associated with which cancer
A
non-hodgkins lymphoma
7
Q
Hep B associated with which Ca
A
hepatocellular
8
Q
HTLV1 infection associated with which Ca
A
t-cell lympohma
9
Q
h pylori associated with which Ca
A
MALT
10
Q
T
N
M
what do they stand for?
A
tumour
node
mets
11
Q
high grade is
A
poorly differentiated
12
Q
which cancers do you use CT in?
which do you use MRI in?
A
CT - chest, abdo
MRI - post fossa of brain, pelvis. gold standard in neurospinal, rectal, prostate, MSK
13
Q
what does the RECIST system assess?
A
response to treatment
14
Q
sensitivity definition
A
ability to detect people with certain disease
15
Q
specificity definition
A
accurately define who is disease-free
16
Q
CEA
A
colorectal but also other cancers
17
Q
ca125
A
ovarian
18
Q
ca19.9
A
pancreatic
19
Q
ca15.3
A
breast
20
Q
aFP
A
hepatocellular carcimoma and some germ cell
21
Q
beta HCG tumour marker
A
germ cell tumours incl Gestational trophoblastic disease (choriocarinoma and hydatiform mole) and testicular cancer and semionoma
22
Q
other things that raise PSA
A
BPH, prostatitis, DRE, UTI
23
Q
what type of cancer is waldenstroms macroglobulinaemia
A
non-hodgkin
24
Q
bence jones protein in which cancers (2)
A
multiple myeloma
waldenstoms macroglobulinaemia
25
other things that can cause raised CEA (not cancer)
smoking
| IBD, pancreatitis, gastritis, hepatitis
26
other things that can caused raised CA125
pregnancy, endometriosis, PID
| Also other cancers
27
high levels of aFP and progosis in malignancy
poor
28
CSF appearance on T2 and T1 MRI
T1 - dark
| T2 - bright
29
what is cytoreductive suregry
reduce bulk of tumour (then will do another treatment eg with chemo)
30
what marker is used in PET-CT
18F-FDG
31
how long after remission do you keep giving maintenance therapy in childhood leukaemia?
18 months
32
example of chemo given intravesically
superficial bladder cancer
33
example of chemo given intraperitoneally
ovarian
34
example of chemo given intra-arterially
tumour with well-defined blood supply eg hepatic artery infusion for liver mets
35
how is chemotherapy dose usually calculated and what formula is used?
body surface area
| DeBois and DeBois
36
Which chemotherapy drug has a dose calculated from renal function
carboplatin
37
which chemotherapy drugs are more likely to cause peripheral neuopathy
platinum drugs esp cis platin
taxanes
vinca alkaloids
38
which chemotherapy drug is associated with pulmonary fibrosis
bleomycin and busulphan
39
which chemotherapy drugs is associated with conduction defects
doxorubicin
40
which solid cancers are associated with bone marrow replacement and subsequent pancytopenia
breast, lung, prostate
41
which type of anaemia is seen in blood loss from a tumour
iron deficiency
42
which type of anaemia is due to repeated chemotherapy
macrocytic
43
clinical features of thrombocytopenia
unprovoked nose bleeds, petichiae, haematuria, corneal haemorrhage
44
management of thrombocytopenia
platelts urgently if <10
platelets non-urgent if 10-20
nothing if >20
45
prophylactic antibiotics for patients with COPD + lymphoma (at risk of PCP pneumonia)
co-trimoxazole
46
what makes up maximum androgen blockade
non-steroidal anti-androgen + LHRH analogue
47
positive side effect of progestogens in anti-cancer hormonal therapy
stimilate apetite
48
what is the aim of phase 1 clinical trial
to determine toxicity and maximum tolderated dose
49
who are phase 1 trials tested on
patients with any tumour
normal renal and heptaic function
fit
no conventional treatments appropriate
50
phase 1 trial method (dose escalation)
10% of lethal dose/kg in mice starting
3 patients at each dose level until side effects
then 6 patients until side effects are intolerable
51
aim of phase 2 of clinical trial
assess anti-tumour activity on a range of cancers
52
primary outcome measure and how is assessed of phase 2
response rate - radiological shrinkage
53
primary outcome measures in phase 3 (2 of them)
overall survival
| progression -free survival
54
secondary outcome measure in phase 3
response rate
55
aim of phase 3
is it better than the exisiting drugs
56
what is RECIST
define tumour responses radiologically
57
what criteria is used to classify toxicity in clinical trials
WHO
58
how many patients are required to test a 20% response rate to a new cancer treatment?
14
59
how is survival data presented graphically . and what is plotted on each axis
kaplan meier curves
| probability of survival plotted against time
60
what is acturaral data in terms of clinical trials
estimated data for the patients lost to follow-up
61
what are basket trials
all tumours with a particular mutation are tested with a drug that targets that mutation
62
what are umbrella trials
all tumours of the same type are tested and then genetic profile and treated with different experimental treatments depending on the results
63
what are platform trials
one control arm + lots of experimental arms
64
5 things to measure for QoL
```
Physcial functionung
psychological functioning
social functioning
disease and treatment-realted symptoms
other
```
65
who gets breast scrennig? and how often
50-70yrs
| every 3 yrs
66
who gets bowel screening and how often
60-74
| every 2yrs
67
who gets cervical cancer screnening and how often
25-49 every 3 yrs
| 50-64 every 5 yrs
68
prevention in women at high risk of breast Ca as determined by IBIS breast Ca risk evaluation tool
offer tamoxifen or raloxifene for 5 yrs
69
What do you give to people with lynch syndrome to reduce risk of colorectal ca
aspirin
70
3 ways to treat bone pain
nsaids eg diclofenac
radiotherapy
bisphosphonates eg pamidronate infusion
71
dull ache over large area, worse on movement
bone pain
72
dull, deep seated, poorly localised pain
visceral pain
73
management of liver capsule pain
dexamethasone 8mg or nsaid
74
management of bowel colic
SC hyoscine butylbromide
75
managment of bladder spasm
PO oxybutynin
76
dull, oppressive headache. worse on waking, coughing. associated with N&V
raised ICP
77
management of raised ICP headache
16mg dexamethasone then reduce
NSAIDs
paracetamol
cyclizine for N&V
78
side effects of nsaids
gi, renal impairment, fluid retention
79
cautions for amitryptilline
CVD
80
which laxative to prescribe for opiates
co-dranthamer
81
management of anorexia in palliative
famliy education
advise small meals
give dexamethasone (but only works for a 2-3 weeks)
give megestrol acetate but may cause fluid retention
82
which antiemetic for gastric stasis
metoclopramide
83
causes of gastric statis N&V
ascites, hepatomegaly, dismoltility
84
features of gastric stasis N&V
early satiety, epigastric fullness, hiccups, heartburn, minimal nausea, lots of vomiting
85
management of toxic causes of N&V
haloperidol
86
features of toxic causes of N&V
lots of nausea, retching, not much vomiting
87
causes of toxic causes of N&V
drugs, hypercalcaemia, uraemia, infections
88
management of anticipatory N&V
loraz, CBT, complementary therapies
89
examples of softener laxiatives
lactulose, sodium docusate
90
examples of stimulant laxatives
senna, dantron
91
contraindications of stimulant laxatives
bowel obstruction, colic
92
examples of combined laxatives
movicol, co-danthrusate (dantron + docusate), co-dranthramer
93
normal/immediate release morphine - how quickly does it work and how long effective for?
20-30mins. effective for 4 hours
94
which opiate should be prescribed to patients with renal failure
fentanyl or buprenorphine
95
pain intervention for pain from femoral metastses
intramedullary nail
96
what is allodynia
when non-painful stimulus is painful
97
what is hyperalgesia
when things that are painful are more painful
98
antiemetic of choice in last days of life
levomapromazine
99
antiemetic for toxic causes
haloperidol
100
antiemetic for chemo
ondansetron
101
signs of MSCC (4)
weakness, parapepesis, paraplegia
clonus and painless bladder distention
hyperreflexia below level of lesion
changes in sensation below level of lesion
102
definition of neutropenic sepsis
neutrophils <1 x 10^9
| + fever on >1 occasion or for >1hr (may have no fever though) or any other signs of infection
103
pathogens in neutropenic sepsis ususally
70% are gram +ve - staph aureus, alpha and beta haemolytic strep
30% gram -ve eg e coli, klebsiella pneumoniae, pseudomonas aeriginosa
104
where to take blood cultures from in neutropenic sepsis
line and peripheral
105
antibiotics in neutropenic sepsis
tazocin (maybe + gent to cover pseudomonas)
106
what score do you use to risk statify people with neutropenic sepsis?
MASCC score
107
most common cancers associated with hypercalcaemia
squamous cell, breast, lymphoma
108
managment of hypercalcaemia
```
Normal saline (1 L every 4 hours for 24 hrs then 1L every 6 hrs for 48-72hrs + K+)
Give bisphosphonates after starting NaCl
```
109
4 examinations to do in MSCC
Full neuro exam
PR - to assess anal tone
Abdo - palpate for urinary retention
Spine for tenderness
110
what is pembertons sign
in SVCO
| heand above head and JVP elevated, distended head and neck veins, insp stridor
111
management of SVCO (immediate and definitive)
16mg dexamethasone + PPI
| Stent + ?chemo/radio
112
what is the most common type of breast cancer?
infiltrating/invasive ductal carcinoma
113
screening questions for amber care bundle
is pt deterioriating, clinically unstable and with limited reversibility?
AND
is pt risk of dying in next 1-2 months, has life-limiting illness that will limit escalation of care, short prognosis
