Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 OSCE > Case 21- Colorectal Cancer > Flashcards

Case 21- Colorectal Cancer Flashcards

1
Q

Sx CRC

A

Change in bowel habit, weight loss, PR bleeding, tenesmus, signs of anaemia, bowel obstruction, rectal mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Differentials for CRC

A

IBS, UC, Crohn’s disease, haemorrhoids, anal fissure, diverticula disease, gastroenteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Investigations for CRC

A

DRE
2 weeks wait pathway
FBC, UE (malnutrition, CT contrast), Ca (metastasis)LFT (hepatic metastasis), FIT (if not presented with blood in faeces)
Colonoscopy with biopsy (and OGD as it may be an upper GI bleed- melaena)
Staging CT scan (abdomen thorax pelvis)
Carcinoembryonic antigen (CEA)- useful for predicting relapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Diverticulitis Sx

A

Let iliac fossa/ lower abdominal pain, tenderness and guarding, fever, diarrhoea, PR blood and mucus, nausea and vomiting, constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diverticula disease investigations

A

DRE and stool test (rule out infection)
FBC, CRP, UE (contrast and malnutrition)
Abdominal CT with contrast
Colonoscopy- not during an acute episode. Wait 6 weeks for Sx to die down and then do it to rule out a malignancy/ assess extent of diverticulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hiatus hernia Sx

A

GORD Sx, epigastric or substernal pain, early satiety, retching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Investigations for a hiatus hernia

A

FBC UE
CXR
OGD- ensure no malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Acute abdomen

A

Ask about passing wind- bowel obstruction

Distension- bowel obstruction or fluid. Also pregnancy (may have noticed distension for a few weeks prior)

Bowel sounds- absent in peritonitis and ileus and increased in small bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Acute abdomen investigations

A

FBC, UE, LFT, CRP, serum amylase and lipase, BM, VBG (lactate), urinary pregnancy test, urine dipstick (UTI or pyelonephritis)
Erect CXR and supine AXR
CT scan of abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Elderly patients and the acute abdomen

A

Always do a PR exam and look for hernias (strangulated)

AF- may have mesenteric ischaemia due to an embolus (signs of obstruction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Iron deficiency anaemia in over 50’s

A

2 week wait cancer referral for OGD and colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Investigations for diverticulitis

A

DRE and stool test
FBC UE LFT CRP
Colonoscopy (not during acute flare up- 6 weeks after)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of diverticulitis

A

Dietary changes and mild analgesia

Severe- consider admission, antibiotics, analgesia, fluid resuscitation, may require surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Classic signs of acute abdomen

A

Fever, tenderness, rigidity and guarding, rebound tenderness, absent bowel sounds in peritonitis, increased in SBO, abdominal distension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the most common form of inherited colon cancer?

A

HNPCC- autosomal dominant. Also at risk of endometrial cancer
Amsterdam criteria can aid diagnosis
MSH2/MLH1 gene mutations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is FAP?

A

Autosomal dominant condition which leads to early onset polyp formation and carcinoma development- total colectomy with ileo anal pouch formed in 20’s
Also at risk of duodenal tumours
APC gene mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Location of CRC’s

A 
Rectal-40%
Sigmoid-30%
Ascending colon and caecum-15%
Transverse colon-10%
Descending colon-5%
18
Q

Type of resection for caecal, ascending or proximal transverse colon cancers

A

Right hemicolectomy

19
Q

Type of resection for distal transverse or descending colon cancers

A

Left hemicolectomy

20
Q

Type of resection for sigmoid colon cancers

A

High anterior resection

21
Q

Type of resection for upper rectal cancer

A

Anterior resection (TME)

22
Q

Type of resection for low rectal cancer

A

Anterior resection (low TME)

23
Q

Type of resection for anal verge cancer

A

Abdomino perineal reaction of the rectum

24
Q

Hartman’s procedure

A

Resection if sigmoid colon and end colostomy fashioned

25
Q

Bowel perforation and stoma

A

In an emergency setting, if colonic tumour is associated with perforation, perform an end colostomy which can be reversed later

26
Q

CRC referral guidelines

A

Urgent 2 ww

40+ with unexplained weight loss and abdominal pain
50+ with unexplained rectal bleeding
60+ with iron deficiency anaemia or change in bowel habit
Tests show occult blood in faeces

Consider 2 ww in

Rectal, anal, or abdominal mass
Patients less than 50 with rectal bleeding who have any of the following- abdominal pain, change in bowel habit, weight loss, iron deficiency anaemia

27
Q

CRC screening

A

Every 2 years for all 60-74 year olds in England

Faecal immunochemical test (FIT) which measures faecal occult blood (FOB)- abnormal result, offered colonoscopy

NB- FIT recommended for people with new symptoms who don’t meet 2 week wait referral

28
Q

Dukes classification

A

Extent of spread of colorectal cancer

A- confined to mucosa
B- invading bowel wall
C- lymph node metastases
D- distant metastases

29
Q

Clinical features of haemorrhoids

A

Painless rectal bleeding
Pruritis
Pain- not significant unless piles or thrombosed
Soiling

Location: 3, 7, 11 o’clock position

30
Q

External haemorrhoids

A

Below dentate line

Prone to thrombosis, can be painful

31
Q

Internal haemorrhoids

A

Originate above dentate line

Don’t generally cause pain

32
Q

Grading of internal haemorrhoids

A

1- do not prolapse out of the anal canal
2- prolapse on defecation but reduce spontaneously
3- manually reduced
4- can’t be reduced

33
Q

Management of haemorrhoids

A

Stool softeners (increase dietary fibre and fluid intake)
Topical local anaesthetics and steroids
Rubber band ligation
Surgery is reserved for large symptomatic haemorrhoids that don’t respond to outpatient treatments

34
Q

Investigations for acute abdomen

A

Bedside- observations, AE, abdominal examination, urine dip, pregnancy test

Bloods- FBC UE LFT CRP amylase lipase BM ABG

Imaging- erect CXR and AXR

35
Q

Bowel cancer tumour marker

A

Carcinoembryonic antigen (CEA)- not useful in screening, but can be used for monitoring purposes post-surgery

36
Q

Bowel cancer tumour marker

A

Carcinoembryonic antigen (CEA)- not useful in screening, but can be used for monitoring purposes post-surgery

37
Q

Haemorrhoids vs anal fissure

A

Haemorrhoids cause painless bleeding, anal fissures cause painful bleeding

38
Q

Anal fissure

A

Typically presents with painful rectal bleeding

Location: midline 6 (posterior midline 90%) & 12 o’clock position. Distal to the dentate line

39
Q

Anal fistula

A

Usually form after previous ano-rectal abscess

40
Q

Solitary rectal ulcer

A

Associated with chronic straining and constipation. Histology shows mucosal thickening, lamina propria replaced with collagen and smooth muscle (fibromuscular obliteration)

Year 3 OSCE (61 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions