CCC 1 Flashcards
When would Cyclazine be used over other anti-emetics?
Cyclizine is a good first line anti-emetic for intracranial causes of nausea and vomiting
When would Domperidone and metoclopramide be used over other anti-emetics?
Domperidone and metoclopramide are useful for nausea and vomiting when caused by gastric stasis.
When would Haloperidol be used over other anti-emetics?
Haloperidol is useful for nausea induced by drugs (such as chemotherapy) and toxins.
A 74-year-old woman with a breast cancer attends a clinic with palliative care due to a recent diagnosis of brain metastases. She reports feeling nauseous and vomited several times in the past week. She asks for some medication to ease these symptoms.
Which is the best anti-emetic to prescribe in the first instance?
Raised ICP from her metastases can stimulate H1 receptors in the cerebral cortex, causing the symptoms of nausea and vomiting. H1 receptor antagonists, such as cyclizine, are a good choice to combat these symptoms.
You review a 65-year-old woman in oncology clinic. She has known metastatic breast cancer, and has received a mastectomy, chemotherapy and radiotherapy.
She has complained of headaches and nausea for the last 7 days, which are worse in the mornings. A CT head showed multiple brain metastases, with compression of the ventricles and sulci.
Your patient declines further chemotherapy or radiotherapy. She is currently taking opioid painkillers.
Which of the following medications can be used as an adjunct to further relieve her symptoms?
Headache caused by raised intracranial pressure due to brain cancer (or metastases) can be palliated with dexamethasone
You review a 47-year-old woman who was diagnosed with breast cancer two years ago. She has been ‘off her legs’ since yesterday and cannot walk more than a few steps. What is the most common and early feature of spinal cord compression?
Spinal cord compression - back pain is the earliest and most common symptom
Which of the cytotoxic agents is most associated with lung fibrosis?
Bleomycin may cause pulmonary fibrosis
Bleomycin is a cytotoxic antibiotic used to treat metastatic germ cell cancer, squamous cell carcinoma and in some regimes non-Hodgkin’s lymphoma. Lung fibrosis is the major adverse effect and is dose-related
Which of the cytotoxic agents is most associated with Cardiomyopathy?
Anthracyclines
Which of the cytotoxic agents is most associated with Haemorrhagic cystitis, myelosuppression, transitional cell carcinoma?
CyclophosphamideAlkylating agent - causes cross-linking in DNA
A 48-year-old female who has just completed a course of chemotherapy complains of difficulty using her hands associated with ‘pins and needles’. She has also experienced urinary hesitancy. Which cytotoxic drug is most likely to be responsible?
Vincristine - peripheral neuropathy
Vincristine is associated with peripheral neuropathy. Urinary hesitancy may develop secondary to bladder atony.
A 33-year-old woman is seen by her GP complaining of weight loss and other non-specific symptoms. On examination there is a suspicious lump on the woman’s neck, so she is sent for a red flag referral to ENT. The GP performs a series of investigations in order to speed up the process, and notices that the calcitonin is markedly raised. Which of the following cancers is calcitonin a tumour marker for?
Calcitonin is a tumour marker in medullary thyroid cancer
A 67-year-old with chronic kidney disease stage 4 and metastatic prostate cancer presents as his pain is not controlled with co-codamol. Which one of the following opioids is it most appropriate to use given his impaired renal function?
Alfentanil, buprenorphine and fentanyl are the preferred opioids in patients with chronic kidney disease.
A 67-year-old man is being treated in the ENT ward for cancer of the oral cavity. He has undergone multiple cycles of radiotherapy that have been ineffective and now he is being treated palliatively. This morning, he complains about sore ulcers in his mouth that prevent him from eating and drinking normally.
On examination of the inside of his mouth, three white lesions with central ulceration can be seen, each one around 1mm wide. He is otherwise pain-free due to regular maximal doses of morphine.
Which one of the following options would help him with his pain?
Benzydamine hydrochloride mouthwash or spray may be useful in reducing the discomfort associated with a painful mouth that may occur at the end of life
A 34-year-old man is reviewed four years after having an orchidectomy for a testicular teratoma. What are the most useful follow-up investigation(s) to detect disease recurrence?
Alpha-fetoprotein + beta-HCG
A 68-year-old woman has presented with painless jaundice. On examination there is a palpable gallbladder. A cancer blocking the common bile duct is suspected. Blood is taken in order to screen for serum tumour markers.
Which of the following tumour markers is the most relevant to the most likely diagnosis?
Pancreatic cancer - CA 19-9
A 54-year-old man is investigated for a chronic cough. A chest x-ray arranged by his GP shows a suspicious lesion in the right lung. He has no past history of note and is a life-long non-smoker. An urgent bronchoscopy is arranged which is normal. What is the most likely diagnosis?
Lung adenocarcinoma
most common type in non-smokers
peripheral lesion
What is Pemberton sign
Pemberton’s sign is used to evaluate venous obstruction in patients with goiters. The sign is positive when bilateral arm elevation causes facial plethora.
A 68-year-old woman has been investigated as an inpatient for a six month history of cough and weight loss. Following a CT scan of her chest she is diagnosed with lung cancer. Biopsy and further imaging confirm this to be metastatic small cell lung cancer. After discussion at the multi-disciplinary team meeting and subsequently with the patient it is agreed that her treatment be palliative.
On the ward she has been taking codeine sulphate 60mg four times a day for pain however this is still poorly controlled. The decision is made to convert this to oral morphine.
What is the equivalent dose of oral morphine daily?
Codeine to morphine - divide by 10
Which chemotherapy is most likely to cause hypomagnesia?
Hypomagnesemia is a well known side-effect in patients receiving cisplatin-containing chemotherapy.
Which chemotherapy is most likely to cause cardiomyopathy?
Doxorubicin
A 65-year-old man is seen in the lung cancer clinic for investigation of a lung nodule in close proximity to his left main bronchus. He has also had some weight loss over the past 3 months. He has no past medical history or family history. He is on no regular medications and has no allergies. He has 65 pack year smoking history. He has no occupational exposure to asbestos.
Which of the following is the most likely histological diagnosis of this mass?
Squamous cell lung cancer has the strongest association with smoking
A 54-year-old female is receiving a course of chemotherapy for breast cancer. She is experiencing troublesome vomiting which has not been helped by domperidone. What is the most appropriate next management step?
For patients at low-risk of symptoms then drugs such as metoclopramide may be used first-line. For high-risk patients then 5HT3 receptor antagonists such as ondansetron are often effective, especially if combined with dexamethasone
A 72-year-old man with metastatic small cell lung cancer is admitted to the local hospice for symptom control. His main problem at the moment is intractable hiccups. What is the most appropriate management?
Hiccups in palliative care - chlorpromazine or haloperidol
A 22-year-old man presents with carcinoma of the caecum. His brother died from colorectal cancer aged 25 and his father died from the disease aged 30.
Lynch Syndrome
A 5-year-old boy presents with recurrent episodes of sinusitis. The casualty staff are surprised to find his liver lying in the left upper quadrant of the abdomen
Kartagener’s syndrome
