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Year 6 > Cancer incorrects > Flashcards

Cancer incorrects Flashcards

1
Q

in people aged 60 and over with hypercalcaemia or leukopenia and a presentation that is consistent with possible myeloma eg back pain, what is the first line investigation?

A

serum electrophoresis

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2
Q

A 44 year old woman has shooting pain in her left leg. She has an advanced rectal cancer compressing the sciatic nerve. She is taking morphine sulfate modified release 20 mg twice daily. This is providing some benefit but not fully controlling her pain.
Which is the most appropriate additional medication?

UKMLA ppq

A

Amytriptiline! Not NSAIDs

Amitriptyline first line for nerve compression pain / neuropathic pain. Pregabalin, gabapentin and duloxetine are also first line options for treating neuropathic pain.

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3
Q

An 66 year old woman with advanced bowel cancer is taking morphine sulfate modified release, 30 mg twice daily for abdominal pain. She is in the last days of life and is now unable to swallow oral medications. She has not needed any doses for breakthrough pain.Investigations:
eGFR 51 mL/min/1.73 m2 (>60)A continuous subcutaneous infusion of morphine sulfate is required, as a direct conversion from oral morphine sulfate.
Which is the correct dose of morphine sulfate to prescribe over 24 hours?

UKMLA past question

A

30mg. Subcut is twice as strong!!,

Learn all the conversions

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4
Q

27 year old with 2 cm mobile breast lump. no other findings. management?

A

routine!!! breast clinic referral

NICE CKS recommends a 2-week-wait referral for those AGED 30!!! or over with an unexplained breast lump,

OR over 50 years old with unilateral nipple changes.

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5
Q

which type of hodgkins lymphoma carry the best and worst prognosis?

most common type?

A

best = lymphocyte rich
worst = lymphocyte predominant

most common = nodular sclerosing

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6
Q

which type of lung cancer can cause cushings syndrome?

A

Small cell!!

can also secrete adh and can cause lambert eaton syndrome

small cell but make you SADh

small cell cancer but it makes you

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7
Q

describe paraneoplastic syndromes associates with squamous cell lung cancer

what about associated with adenocarcinomas?

A

hypercalcaemia
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH

gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)

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8
Q

side effect of anastrazole use for breast cancer?

A

osteoporosis -> dexa scan recommended when initiating treatment

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9
Q

how to differentiate AML and CML

A

CML
=an increase in granulocytes at different stages of maturation +/- thrombocytosis

AML - neutropenia and thrombocytopenia

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10
Q

Rain drop skull is seen on skull x ray in which condition?

A

Multiple myeloma

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11
Q

Risk factors for non Hodgkin’s lymphoma?

A

Caucasians - notttt Afro Caribbean!
History of viral infection (specifically Epstein-Barr virus)
Immune deficiency eg HIV!!,

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12
Q

Testicular cancer is typically seen in which age range

A

15 and 35 years.

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13
Q

First line investigation for suspected bladder cancer?

Bladder cancer symptoms?

A

Flexible cystoscopy!

In bladder cancer most present with painless gross hematuria. Small percentage present with microscopic hematuria and infection should be excluded

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14
Q

Tb may present with cough weight loss night sweats

Lung cancer may have history of smoking, CXR could show a central mass

How could lung abscess present?

A

Lung abscess - fever, foul smelling sputum.!! Risk factors -dysphagia or altered consciousness levels. Typically follows aspiration pneumonia

Tb

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15
Q

Voice hoarseness. 2 months. Ent found no cause. History of smoking. Cxr clear.
What investigation is likely to be diagnostic

A

CT chest - pancoast tumour

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16
Q

Prior to surgery, how is axillary lymphadebopathy assessed? And what is the management if lymphadenopathy is or is not noted?

A

women with no palpable axillary lymphadenopathy at presentation should have a pre-operative axillary ultrasound before their primary surgery
if negative then they should have a sentinel node biopsy to assess the nodal burden

in patients with breast cancer who present with clinically palpable lymphadenopathy, axillary node clearance is indicated at primary surgery.
this may lead to arm lymphedema and functional arm impairment
(if impossible then axillary radiotherapy)

Essentially you’d always do a lymph node biopsy or node clearance

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17
Q

Indications for mastectomy vs wide local excision?

A

,Mastectomy = multi focal, = al, central, large lesion in small breast, DCIS > 4 cm
Wide local excision = solitary lesion, peripheral tumour, small lesion in large breast. DCIS less than 4

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18
Q

What hormonal therapy is added on in ER positive breast cancers in pre and post menopausal women?

A

Pre or peri = tamoxifen
Post = anastrozole

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19
Q

What biological therapy is used in HER 2 positive breast cancers?

A

Trastuzumab

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20
Q

When is chemotherapy used to treat breast cancer?

A

neo-adjuvant to downgrade primary tumours before surgery or when there is axillary node disease found.

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21
Q

A 56-year-old woman is diagnosed with left breast cancer and undergoes wide local excision with sentinel node biopsy. The sentinel node is negative for cancerous cells.

What would be the next step in management?

A

Whole breast radiotherapy!!

It is recommending after wide local excision

No chemo needed as no lymph node involvement

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22
Q

bladder cancer treatment?

A

in situ = transurethral resection of superficial lesions

invasive = radical cystectomy or radical radiotherapy

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23
Q

hypercalcemia effect on QT interval?

A

shortens

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24
Q

what is the first line *imaging in multiple myeloma?

A

whole body MRI

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25
Q

A 73-year-old male with a background history of prostate cancer treated by external beam radiation therapy 5 years ago presents with a 3-month history of urgency, diarrhoea, and crampy abdominal pain.

On examination, the patient appears thin with conjunctival pallor. The abdomen is soft and non-tender, with no blood or mucus on digital rectal examination. most likely diagnosis?

A

colorectal cancer

patients may develop proctitis ( inflammation of the rectum bloody diarrhoea, tenesmus, and painful diarrhoea) and are also at increased risk of bladder, colon, and rectal cancer following radiotherapy for prostate cancer

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26
Q

diagnostic investigation for pancreatic cancer?

name the sign that may be seen

A

CT pancreas

double duct sign
palpable gallbladder

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27
Q

66 yo man presenting with dysphagia to solids and liquids. most important 1st line test?

A

Upper GI endoscopy within 2 weeks! to rule out oesophageal cancer

(if cancer then you then do endoscopic ultrasound for staging)

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28
Q

*check out your oncology flashcards from last year + do remaining 6 qs on passmed

A
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29
Q

in lung ccancer what finding may be seen on blood tests

A

raised platelets

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30
Q

what may interfere with PSA level in a test?

A

ejaculation or vigorous exercise in last 48 hours
urinary retention NOT constipation
prostatitis and urinary tract infection

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31
Q

small cell lung cancer manaegement?

A

chemo + radiotherapy

surgery only considered for up to T2N0M0

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32
Q

HNPCC is associated with increased risk of what cancer in a man? , aside from colorectal cancer

A

pancreatic cancer

33
Q

role of the anti-androgen, cyproterone acetate in treatment of prostate cancer?

A

Prevent paradoxical increase in symptoms with GnRH agonists
67%

34
Q

A 56-year-old man presents with a 6-week history of progressively worsening hoarse voice, difficult and painful swallowing and weight loss. He has a past medical history of gastro-oesophageal reflux disease (GORD) and his BMI is 31kg/m². He takes no regular medication and reports having never drunk alcohol, but he is a current smoker with a 30 pack-year history.

most likely diagnosis?

A

Adenocarcinoma of oesophagus !! = associated with GORD!!!! obesity and smoking(although smoking more associated with squamous)

reffered otalgia, difficulty breathing and stridor are not mentioned so squamous cell carcinoma of larynx less likely

35
Q

anastrazole mechanism of action

A

inhibits peripheral eostrogen synthesis

36
Q

normal psa but examination findings consistent with prostate cancer, what is next step in investigation?

A

multiparametric MRI

37
Q

A 73-year-old man presents to his general practice with episodes of fever over the last 5 days. He has also noticed he has lost weight over the last month. On further questioning, he mentions a cough productive of white sputum which he has had for about 2 years. He also remembers having a sore throat about 2 weeks ago, which has now improved.

Past medical history consists of of chronic obstructive pulmonary disease, chronic lymphocytic leukaemia, hypertension, and type 2 diabetes.

On examination, his chest has mild wheeze without crackles. His throat appears clear and he has some lymph nodes palpable in his neck which are non-tender.

What investigation is most likely to reveal the diagnosis?

A

Lymph node biopsy!!

new b symptoms in CLL => richter transformation

38
Q

what is the key reason why neo-adjuvant chemotherapy is used in breast cancer?

A

to downsize the tumour before surgery and allow breast conserving surgery rather than mastectomy

effects on overall survival has been mixed.

39
Q

non hodgkins lymphoma diagnostic investigation?

A

EXCISIONAL lymph node biopsy

rituximab treatment

40
Q

what hormone is eleveated in testicular seminomas?

in testicular non seminomas?

A

seminomas: seminomas: hCG may be elevated in around 20%
non-seminomas: AFP and/or beta-hCG are elevated in 80-85%

41
Q

with gleason score, what is the best prognosis? worst?

A

2 is best prognosis and 10 the worst.

42
Q

achalasia increases risk of what oesophageal cancer?

A

squamous cell carcinoma

plummer vinson syndrome also increases risk

43
Q

do seminomas have better prognosis to teratomas?

A

yes

44
Q

management of a patient who is >= 40 years old presenting with unexplained haemoptysis?

A

2WW

45
Q

what are the complications of a radical prostatectomy?

A

erectile dysfunction
incontinence

46
Q

NSAIDs may precipitate renal failure in patients with multiple myeloma

A
47
Q

key side effects of immunotherapy?

how to treat?

A

Hepatitis - bloods/liver screen, treat with steroids

48
Q

treatment of radiotherapy induced mucositis?

A

mouthwash, fluids etc

49
Q

key side effect of platinums eg cisplatin?

A

vomiting
- give fluids and electrolytes and anti-emetics

50
Q

chemo induced diarrhea management?

A

investigations - stool culture, endoscopy
treatment - LOPERAMIDE, fluid and electrolyte replacement

consider dose reduction of chemo

51
Q

tumour lysis syndrome management?

A

high phosphate - give phosphate binder
high potassium - give insulin and desxtrose + Ca gluconate
high uric acid - give allopurinol or rasburicase

52
Q

Side effects of chemotherapy?

A
  1. febrile neutropenia -> prophylactic GCSF, dose reduction of chemotherapy to prevent.
53
Q

Signs of morphine overdose?

A

reduced conscious level, slow respiratory rate, myoclonic jerks, and pinpoint pupils.

54
Q

Options for metastatic bone pain?

A

Analgesia, bisphosphonates, radiotherapy

Dex only considered for metastatic spinal cord compression

55
Q

which lung cancer is most common in non smokers

A

adenocarcinoma

56
Q

ovarian cancer investigation

A

ca125

57
Q

most common tumour causing bone mets?

A
  1. prostate
  2. breast
  3. lung
58
Q

SVC obstruction management?

A

give dex, followed by stent. give chemo for tumour

dex often prescribed with PPI

59
Q

what do you monitor in breast cancer?

A

CA 15-3

60
Q

Key side effect of cisplatin?
methotrexate?
doxorubicin?
cyclophosphamide?
Bleomycin?
Vincristine?
tyrosin kinase inhibitors eg imatinib?

A

cisplatin = hypomagnesemia
methotrexate = myelosupression, liver fibrosis, oral mucositis
doxorubicin (and other anthracyclines eg idarubicin) = cardiomyopathy
cyclophosphamide = hemorrhagic cystitis
bleomycin = lung fibrosis, pneumonitis (treat with steroids)
vincristine = peripheral neuropathy
tyrosine kinase inhibitors = rash

61
Q

Cervical cancer management?/positive pap smear?

A

If positive for HPV 16, 18, or 33 specifically = refer for colposcopy

62
Q

spinal cord compression management

A

high dose oral dex + mri whole spine

63
Q

as PSA levels may be increased, testing should not be done within at least:
6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation

A
64
Q

contraindications to lung cancer surgery?

A

SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis

65
Q

lower number of immunoglobulins in multiple myeloma increaes risk of infections eg lung infections

A
66
Q

pain on alcohol consumption and lymphadenopathy is a feature of ?

A

hodgkins lymphoma

67
Q

after CXR for suspected lung cancer,
what is the gold standard investigation?

A

contrast enhanced! ct scan

68
Q

prostate cancer typically asymptomatic, when symptomatic, what signs typically seen?

A

bladder outlet obstruction: hesitancy, urinary retention
haematuria, haematospermia
pain: back, perineal or testicular

69
Q

when starting a gnrh analogue for prostate cancer, what must you co prescribe in 1st 3 weeks?

A

Anti-androgen treatment such as cyproterone acetate, flutamide

70
Q

greatest risk factor for urothelial (transitional cell) carcinoma of the bladder?

for squamous cell carcinoma?

A

smoking

shistomiasis

71
Q

A 78-year-old gentleman has been unable to pass urine for the last 5 hours. He is extremely uncomfortable. You insert a catheter, which drains 1 litre of urine. The patient feels much better after this. You perform a PR examination and find an enlarged, hard nodular feeling prostate. The Urology Registrar recommends to admit the patient and observe for 24 hours; he warns that following an episode of acute urinary retention a complication may occur. Which test is most important to (re)check in the next 12 hours to help identify such a complication?

A

serum creatinine!!!

AKI may develop after acute urinary retention

72
Q

tamoxifen mechanism of action?

A

oestrogen receptor selective antagonsim

73
Q

patient with hemoptysis, weigh loss, history of smoking, CXR show cavitating lesions. most likely diagnosis?

A

squamous cell carcinoma!!

  • strongly associated with cavitating lesions
74
Q

management option for patients with low-grade prostate cancer, and significant co-morbidities?

A

watchful waiting

75
Q

75 YO man. lung cancer. cord compression. too weak for surgical decompression and has lesion to multiple vertebral bodies.
what is the best treatment option to preserve neurological function?

A

external beam radiotherapy!!!

76
Q

A 45 year old man with pain caused by cancer has been using opioids to
control his pain very successfully. He is taking a regular dose of MST
Continus® 60 mg 12-hourly orally. He has been using three breakthrough
doses (oral morphine 20 mg) per day for the past week

what is the most appropriate opiate prescription?

A

first step = calculate total daily morphine

The breakthrough dose should be one-sixth of
the total daily dose. The current daily morphine dose is 180 mg, hence MST
continous at 90 mg 12 hourly and the breakthrough at morphine 30 mg.

77
Q

first step in treatment for spinal cord compression?

A

IV dex!!!

spinal decompression comes later

78
Q

glycoporrunium bromide, butylbromide, Hyoscine bromide = secretions

Midazolam = agitation

Haloperidol = nausea

End of life stop all oral medication and then prophylactic meds eg statin, LMWH( subcut as well which is painful) keep subcut insulin as is treating critical medical condition
Breathlessness = midazolam or morphine

Pain with renal impairment = oxycodone. Learn coversion from morphine to oxycodone

A

Year 6 (20 decks)

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