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Holy Grail Docs > CLASP > Flashcards

CLASP Flashcards

1
Q

what is vertebraplasty?

A

used in palliative care
cement added to spine to hold it together again
E.G after high steroid dose has destroyed bone

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2
Q

when is O2 used in breathlessness?

A

only if they are hypoxic as well

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3
Q

what produces SiADH?

A

small cell lung cancer

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4
Q

what produces ACTH?

A

small cell (neuroendocrine)

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5
Q

what is lambert-eaton myasthenic syndrome?

A

muscles problems, antibody related in pre-synaptic membrane, not hormone-related

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6
Q

what indicates melanoma on histology?

A

brown pigments

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7
Q

what can be used to determine if mets are from lung, liver, stomach etc?

A

immunohistochemistry

If premalignant part of tumour is present

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8
Q

what is a carcinoid tumour?

A

neuroendocrine derived tumour usually in appendix/small bowel
yellow and assoc with serotonin

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9
Q

how is a carcinoid tumour diagnosed?

A

Urine 5-HIAA and plasma

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10
Q

what is required for carcinoid syndrome?

A

liver mets

chromogranin A

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11
Q

Lymphoma?

A

B cell MALT

assoc w/ coeliac disease

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12
Q

what cancer is kartageners syndrome associated with?

A

squamous cell carcinoma

cilia defect so affects lungs and fallopian tubes

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13
Q

what does BCL2 do?

A

evasion of apoptosis

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14
Q

what does P53 do?

A

spell checker

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15
Q

what tumour stage do you look for mets?

A

not T1, only T2-4

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16
Q

when is radio/chemotherapy used?

A 
radio = local sit of malignancy
chemo = systemic
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17
Q

what are the endpoints for cancer treatments?

A 
overall survival
progression free survival
disease free survival
local control
NOT TOXICITY FREE
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18
Q

what is atelectasis?

A

lung collapse

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19
Q

what is seen with asbestos exposure?

A 
pleural effusion
rounded atelectasis
pleural plaques
asbestosis
adenocarcinoma (esp. w/ smoking)
mesothelioma
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20
Q

what is the worst indication with mesothelioma?

A

blue fibres (eg. amphipole)

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21
Q

how does HPV cause cancer?

A

E6 targets P53 production
E7 targets pRB
(does not directly cause mutations however)

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22
Q

can HIV cause cancer?

A

not directly

immunosuppressed making susceptible to cancer causing viruses

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23
Q

what is plummer vinson?

A

increased risk of dysphagia, webs and then oesophageal cancer (squamous cell)

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24
Q

what does lynch syndrome cause?

A

endometrial and colon cancer

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25
Q

who gets screened for lynch syndrome?

A

everyone with MSI (microsatellite instability = spelling mistakes)

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26
Q

example of hyperplasia?

A

lining of uterus
liver regeneration
testes

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27
Q

example of hypertrophy?

A

muscle (skeletal and cardiac)

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28
Q

example of atrophy?

A

leg in plaster cast

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29
Q

example of metaplasia?

A

barrets

change from ciliated pseudostratified columnar epithelium in bronchi to squamous in response to smoking

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30
Q

squamous carcinoma in lung can only occur with smoking, true or false?

A

true

usually isn’t any squamous epithelium unless metaplastic change

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31
Q

anything shiny that’s exposed to air?

A

non-keratinised

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32
Q

anything hard that’s exposed to air?

A

keratinised

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33
Q

“heaped, rolled up edges”?

A

malignancy (means lesion is not well defined etc)

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34
Q

what is more common on greater/lesser curvature?

A 
lesser = malignancy
greater = ulcer
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35
Q

signet rings?

A

nucleus pushed to the side

= adenocarcinoma

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36
Q

does exrcise increase cancer risk?

A

yes

bowel, breast and endometrial

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37
Q

breastfeeding cancer link?

A

reduced risk with breastfeeding

- linked to oestrogen

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38
Q

vit A carotenoid?

A

reduced in smokers

increases cancer risk when low

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39
Q

beta carotene?

A

anti-oxidant at low levels

pro-oxidant at high levels

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40
Q

dairy guidelines?

A

2-3 milk portions

700mg calcium per day

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41
Q

acrylamide?

A

forms in starchy foods when burnt

likely human carcinogen

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42
Q

transitional epithelium?

A

in bladder

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43
Q

epithelial tumour (carcinomas) almost never occur in children, true or false?

A

true

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44
Q

what cancers do children get?

A

blood
brain
bone

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45
Q

most common type of cancer?

A

carcinoma

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46
Q

older person with brain lesion?

A

metastatic carcinoma until proven otherwise

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47
Q

how does epithelial malignancy spread?

A

local growth

spreads via haematogenous and lymphatic routes

48
Q

where will lung, breast, GI and prostate tumours spread haematogenously?

A 
lung = bone, brain, adrenal, liver
breast = similar to lung
GI = liver
Prostate = anywhere
49
Q

what is a mesenchymal tumour?

A

derived of connective tissue

sarcomas

50
Q

where do sarcomas occur?

A 
bone
cartilage
fat
fibrous tissue
muscle
blood vessels
nerves
51
Q

defining feature of sarcoma?

A

local growth but don’t often spread so can get very big

52
Q

what do sarcomas lesions look like?

A

spindle cell lesions (cigar shaped)

53
Q

diagnosis of sarcoma?

A 
FISH
karyotyping (eg. ewings sarcoma = t11;22)
54
Q

myeloid malignancy?

A

platelets
red cells
granulocytes

55
Q

lymphoma presentation?

A

big lymph nodes in more than one area that doesn’t fit with anatomical drainage of one location/area
large liver and spleen
less white cells

56
Q

how are lymphoma cells different than other cancer cells?

A

not pleomorphic

all look similar

57
Q

glioma?

A

brain tumour

58
Q

brain tumours don’t spread, true or false?

A

true

59
Q

most common causes of prostatism?

A

benign prostatic hyperplasia

prostate cancer

60
Q

what is PSA?

A

prostate specific antigen
type of tumour marker
can be high in prostate cancer of benign prostatic hyperplasia

61
Q

sensitivity?

A

% of people with disease that have +ve test result

62
Q

specificity?

A

where disease is absent, the % of people that will be diagnosed as healthy

63
Q

positive predictive value?

A

likelihood of +ve test result meaning person has the disease

64
Q

negative predictive value?

A

likelihood of a -ve test result meaning person is healthy

65
Q

how is recurrence of prostate cancer checked?

A

PSA monitoring

66
Q

ACG?

A

checks germ cells tumours and pregnancy

67
Q

when does ALP rise?

A

cholestatic disease
pregnancy
cancer bone mets (osteoblasts make new bone after osteoclasts break it down, increasing ALP)

68
Q

how are bone mets diagnosed?

A

isotope bone scan

69
Q

failed ERCP?

A

possible malignancy

70
Q

what causes more than1 area of pleural effusion (eg. bilateral)?

A

benign things

HF, nephrotic syndrome

71
Q

hypercalcaemia common in malignancy, true or false?

A

true (>2.55)

  • stones
  • bones
  • groans
  • moans (depression)
72
Q

result of high calcium?

A

dehydration

73
Q

how is calcium levels controlled?

A

parathyroid glands via PTH

74
Q

how does PTH control calcium?

A

causes bone absorption (calcium absorbed from skeleton)
more calcium reabsorbed from renal tubules
indirectly - activates Vit D causing gut absorption of calcium

75
Q

what is PTHrP?

A

parathyroid hormone related peptide

same action as PTH but not picked up on in PTH assay

76
Q

how is PTHrP detected?

A

really high calcium and very low PTH = presence of PTHrP

77
Q

symptoms of cushings syndrome?

A 
low K+
hypertension
nocturia
polydipsia
truncal obesity
plethora
ankle oedema
purpura of arms
78
Q

what can cause cushings?

A 
steroids
ectopic ACTH (small cell lung cancer)
79
Q

radical treatment?

A

curative intent - at expense of side effects

80
Q

palliative treatment?

A

non-curative - aims to improve QoL but not at expense of side effects

81
Q

adjuvant therapy?

A

after surgery

aimed at reducing recurrence

82
Q

neo-adjuvant therapy?

A

before surgery

usually shrinking a tumour before removal

83
Q

local control?

A

time without recurrence or progression at specific tumour site

84
Q

brachytherapy?

A

injecting tiny pellets of radioisotopes into tumour killing it from inside

85
Q

systemic anti-cancer therapy (SACT)?

A

cytotoxic chemo
targeted therapy
immunotherapy

86
Q

haematological effects of chemo?

A

neutropenia

thrombocytopenia

87
Q

GI chemo side effects?

A

diarrhoea
nausea
mucositis (mouth ulcers)
altered taste

88
Q

how does external beam radiotherapy work?

A

breaks double strand causing cell to die

89
Q

targeted cancer treatment?

A

monoclonal antibody

tractuzumab/Herceptin

90
Q

what cancer is radiotherapy good for?

A

squamous cancers

91
Q

length of time between decision to treat and first chemo/brachytherapy treatement?

A

31 days

92
Q

how can cancer cause facial swelling?

A

if tumour obstructs head and neck drainage (e.g SVC)

treated with a stent

93
Q

most common cancer inheritance?

A

multifactoral

94
Q

most common mutation causing oncogene activation?

A

missence amino acid change

95
Q

cancer is disease of somatic mosaicism?

A

yes

96
Q

BRCA gene?

A

DNA strand breaks

97
Q

hereditary colorectal cancer?

A

mismatched base

98
Q

what does UV or chemical crosslinking cause?

A

xeroderma pigmentosa

99
Q

what determines characteristic of cancer?

A

driver mutation

not origin site

100
Q

how does BRAF mutation cause melanoma?

A

activates KRAS pathway

specific BRAF inhibitor effective

101
Q

what is the Philadelphia chromosome?

A

genetic abnormality in chromosome 22 that causes leukaemia

102
Q

how can driver mutations and genomic profiles of tumours be found?

A

NGS

103
Q

what determines cancer behaviour?

A

somatic mutation

104
Q

in a family with suspected inherited cancer gene, who would you test?

A

surviving affected relative

105
Q

what is low cancer risk?

A

population risk

106
Q

what is medium cancer risk?

A

3% 10 year risk

107
Q

what is high cancer risk?

A

8% 10 year risk

108
Q

what is MLH1 assoc with?

A

hereditary, nonpolyposis colorectal cancer

109
Q

what does the MLH1 gene do?

A

DNA repair gene

110
Q

what type of cancer is mesothelioma?

A

not a lung cancer
primary pleural malignancy
epithelial malignancy as mesothelial cells rest on basement membrane

111
Q

how are asbestos fibres shown?

A

pearl stain (shows blue fibres)

112
Q

rounded atelectasis?

A

asbestos

113
Q

re-planning of stem cells?

A

metaplasia

114
Q

name some viral carcinogens?

A

HPV
EBV
polyomavirus
HHV-8

115
Q

how does plummer vinson syndrome present?

A

dysphagia
anaemia
oesophageal webs

116
Q

risk of plummer vinson?

A

increased risk of oesophageal SCC

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