CCC Flashcards
What is CA 19-9 primarily a tumour marker for ?
Pancreatic cancer
Others = colorectal
Tumour marker CA 15-3 is useful in the prognosis for which cancer ?
Breast cancer
What is tumour marker CA 27.29 used for ?
Breast cancer - monitoring and prognosis, no role in screening or diagnosis
Name non malignant causes of raised PSA?
- BPH
- protastitis
- instrumentation
- urinary retention/UTI
- strenuous exercise
- ejaculation
- old age
Which malignant conditions is the tumour marker AFP raised in ?
Hepatocellular carcinoma
Teratomas (if hCG also raised)
Name three cancers in which bombesin may be raised?
- SCLC
- gastric cancer
- neuroblastoma
s-100 is a tumour marker for which malignancies ?
- melanoma
- schwannomas
Carcinoembryonic antigen (CEA) is a tumour marker used in the monitoring of which malignancy ?
Colorectal carcinoma esp adenocarcinoma
Dose of lorazepam for rapid relief of anxiety ? And alternative if nil by mouth
Lorazepam 0.5-1mg SL
Alternative = midazolam 2.5mg SC
Analgesics used for cancer bone pain (5)
- NSAIDS
- Bisphosphonates
- Corticosteroids
- opioids
- palliative radiotherapy
Which analgesics are used for painful muscle spasms in palliative patients ?
Diazepam 2-5mg nocte
Baclofen 5mg TDS
How might pain from liver capsule stretch be managed ?
NSAIDS (e.g. Ibuprofen 400mg QDS)
Dexamethosone 4-8mg OD
Symptomatic treatment of raised ICP?
Dexamethosone 4-8mg, or 16mg if severe
Symptomatic treatment of intestinal colic ?
Hyoscine butyl bromide 20mg SC
AKA buscopan
Treatment for symptomatic relief of nausea and vomiting caused by chemical e.g. Drugs or hypercalcaemia ? (Stat dose and 24hr range)
Haloperidol 500 micrograms PO or SC
24hr range = 1-5mg
treatment for symptomatic relief of nausea and vomiting caused by raised ICP?
Dexamethosone 8-16mg PO
+/- cyclizine 50mg PO or SC
reatment for symptomatic relief of nausea and vomiting caused by gastric irritation or stasis? (Stat dose and 24 Hr range)
Metoclopramide OR domperidone (+/- PPI) 10mg stat dose or 30-60mg in 24hrs
treatment for symptomatic relief of nausea and vomiting caused by bowel obstruction WITHOUT colic?
Metoclopramide 10mg SC
reatment for symptomatic relief of nausea and vomiting caused by bowel obstruction WITH colic?
Cyclizine 50mg SC
+/- haloperidol 1mg SC
+/- buscopan 20mg SC
If nausea and vomiting are treatment resistant or multi factorial which antiemetic should be used ?
Levomapromazine 6.25-12.5mg PO/SC
Name laxatives which are stool softeners (5)
Docusate (also mild stimulant) Poloxamer Lactulose Movicol My salts (for rapid evacuation)
Main adverse effect of lactulose ?
Significant bloating and flatulence
What type of laxative is Senna ?
Stimulant
What is codanthramer?
Combined laxative - dantron (stimulant) and poloxamer (softener)
Which opioid is used SC for advanced cancer pain?
Diamorphine
Which pains don’t tend to be opioid responsive? (7)
- tension headache
- tenesmoid pain
- bone pain
- muscle spasm
- visceral distension/spasm
- activity provoked pain
- treatment induced e.g. Post chemo nephropathy
Which opioids do have a rigid upper limit for dose ? (3)
- buprenorphine
- codeine
- tramadol
What are the effects on resp rate and oxygen sats if opioid overdose ?
Both reduced
Main tumour marker for ovarian cancer?
CA-125
EBV is associated with which malignancies ?
Non Hodgkin’s lymphoma and Burkitts lymphoma
- EBNA, 14:8 translocation in which Proto-oncogene c-MHC on chr8 becomes transcriptionally controlled by the control elements of immunoglobulin genes on chr14
Radiation is associated with which malignancy ?
Leukaemia
What is Li-Fraumeni syndrome ?
- inheritance pattern
- causes which conditions
- associated with which mutation
Rare autosomal dominant hereditary disorder
- predisposes carriers to cancer development
- SBLA syndrome
- sarcoma, breast, leukaemia, adrenal gland
- germline mutation of p53 tumour suppressor gene
Which mutation is associated with von Hippel-Lindau syndrome
VHL tumour suppressor gene on chromosome 3(p.25.3)
What is von Hippel-Lindau syndrome?
Inherited disorder causing benign and malignant tumours in CNS and viscera:
- retinal, CNS haemangioblastomas, RCC, renal cysts, phaeochromocytoma
Bladder cancer is associated with which chemical carcinogen ?
Aromatic amines
Benzene is associated with which malignancy?
Leukaemia
Nasal adenocarcinoma is associated with which chemical carcinogen ?
Wood dust
Vinyl chloride is associated with which malignancies ?
Angiosarcomas
How does cigarette smoke cause cancer ?
Carcinogens in the smoke cause specific mutations in p53 tumour suppressor genes
How much does HBV increase risk of hepatocellular cancer
100 fold
What infective organism is associated with mucosal associated lymphoid tissue (MALT) tumours ?.
H pylori
Expressive aphasia is associated with which area of the brain ?
Broca’s area - posterior inferior frontal lobe
How are patients affected by brocas aphasia ?
Know what want to say but can’t get it out
- can comprehend smile words and sentences but can’t generate speech
- problems with fluency, articulation, word finding, word repetition
- difficultly understanding complex grammatical sentences (both spoken and written)
Which type of aphasia tend to have good ability to self monitor language output ? (Whereas others seem unaware of mistakes)
Brocas aphasia aka expressive aphasia
A head injury resulting in head and eye paralysis, deviated to the left, suggests which part of the brain is affected ?
Left supplementary motor area
A change in personality would suggest a head injury to which part of the brain ?
Prefrontal cortex
Damage to the para central lobule causes what effects ?
- incontinence, urinary or bowel
- contralateral lower limb weakness
A brain injury causing loss of smell is likely to have affected which area of the Brain?
The orbital surface of the frontal lobe
In which area of the brain could an injury cause loss of 2 point discrimination ?
Post central gyrus sensory cortex of parietal lobe
What is Gerstmann syndrome ? (4 symptoms)
Syndrome resulting from injury to inferior parietal lobule of dominant hemisphere
- Dysgraphia
- Dyscalculi
- Agnosia
- Left-right disorientation
Injury to non dominant parietal lobe causes what symptoms ?
- neglect of contralateral limb
- ansognosia - denial of deficits
- constructional dyspraxia
- spatial neglect
- geographical agnosia (unable to find defined places)
Role of post-central gyrus?
Sense of touch, sensory homunculus for contralateral side
Functions of temporal lobe? (4)
Hearing ability
Memory acquisition
Some visual perceptions
Categorization of objects
When does Wernicke’s aphasia occur ?
Damage to dominant temporal lobe
- difficulty understanding spoken word
