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Clinical Flashcards

1
Q

What is leukaemia

What’s the result of it?

A 
Un regulated proliferation of immature WBC
Accumulation in BM
BM can’t function - anaemia 
- thrombocytopenia, bruises
- leukopenia, infections
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2
Q

People with leukaemia normally die ofwhat

A

Fetal infection or bleeding if untreated

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3
Q

What type of population makes bone transplant difficult

A

Life long smokers

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4
Q

What are the symptoms for leukaemia

A
  • anaemia
  • tired
  • bruises
  • bleeding
  • freq inf
  • SOB
  • petechiae sm red spot on skin caused by minor bleeding
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5
Q

Types of leukaemia

A

Acute (>30% blast in BM upon diagnosis
Chronic (manage symp not cure
Lymphoid leuk
Myeloid leuk

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6
Q

Which type of leukaemia is the most common in childhood 75% of childhood leuk

A

ALL

Acute lymphoblastic leuk

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7
Q

What are the diseases that can be treated by bone marrow transplant

A

Leukaemia,lymphoma, myeloma, bm failure, metabolic disorders

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8
Q

What are the indications for autologous bone marrow transplant

A

Lymphomas
Myeloma
Not leuk bc there will always be some leuk cells in pt bm

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9
Q

How does high-dose therapy (of chemo) work? Administered before the transplant

A

To eradicate any residue leukaemic or cancer cells in the bone marrow
Immunosuppresses patient
Ensure bm can’t be recovered wo stem cell infusion

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10
Q

What’s leukapheresis

A

Separation of leuk cells from blood

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11
Q

What are the two main sources of stem cells

A

Peripheral blood
Or
pelvic hipbones

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12
Q

What are the two methods of collecting stem cell

A

Peripheral blood stem cells from circulating blood
Bone marrow harvest from hipbone - Needle to hip bone where large amount of marrow exists
A way of collecting stem cells

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13
Q

What are the post transplant complications

A 
Infections
Anaemia SOB
bleeding (GIT, etc ) petechiae
UE imbalance
Graft vs host 
Mucosités (breakdown of tissue lining the mouth and throat caused by chemo on rapid dividing cells (eg methotrexate -symp dsyphasia - TPN
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14
Q

Trt for GvHD

A

High dose corticosteroid
Mabs- immunosuppress anti-tnf
Etanercept
Medenchymal stem cell- increase repair

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15
Q

Symptoms for lung cancer

A 
Often asymptomatic at early stage 
Haemoptysis (coughing blood)
Persistent cough >3w
Chest pain
Dyspnoea
Wt loss
Hoarseness
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16
Q

Staging TNM - T

A

T1 <3cm
T2 3-7cm, partial collapse
T3 >7cm collapsed lung, chest wall invasion
T4 invasion of mediastinum/ spine. Nodules in other lobes of same lung

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17
Q

Stage TNM -N

A

N0 none
N1 ipsilateral hilar
N2 ipsilateral hilar. Subcarinal
N3 contralateral (opposite side of same lung) supraclavicular

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18
Q

Late presentation of lung cancer

A

1/3 present as an emergency to hospital

19
Q

Surgery suitability

A

N0 or N1
Not T4
Lung function & co morbidities (smokers)

20
Q

Adjuvant chemo for lung cancer
Indication
Drug of choice

A

Tumour size > 4cm
And/or nodal involvement
4 cycles of cisplatin doublet (vinorelbine) 3weekly
Start w/i in 12 week of surgery

21
Q

What’s SABR

Indication

A

Steoreotactic ablative body radiotherapy - very high dose of radiotherapy in a few fractions

  • peripheral lung cancer < 5cm w/o nodal involvement
  • not fit for surgery
22
Q

Conventional radiotherapy indications

A

M0

Invasion or more extensive nodal (N2) involvement

23
Q

Conventional radiotherapy s/e

A

Dose to Sc
Volume of treated lung (acute pneumonitis)
Baseline lung function n development of fibrosis

24
Q

What are SACT?

A

Systemic anti cancer therapy

  • chemo
  • immunotherapy mabs
  • target therapy nibs
25
Chemotherapy SACT how is it given CT scan at baseline and ... Max cycles When to stop
``` 1 dose every 3 weeks (1 cycle) for 3 months (12 week’s) Total 4 cycles After 3 cycles (9 weeks) 4-6 cycles max If toxicity ```
26
1st gen EGFR inhibitors for lung cancer
Gefitinib 250mg od | Erlotinib 150mg od
27
1st gen EGFR inhibitor s/e
``` Diarrhoea Acne like skin rash Stomatitis -inflam of mouth or lips Paronychia - nail deformation Hepatitis ```
28
2nd gen EGFR inhibitor for lung cancer
Afatinib 40mg od | Increase to 50mg od after 1m
29
3rd gen EGFR inhibitor for lung cancer
Osimertinib 80mg od Target mutated Lung cancer T790M Reduced metastasis due to better brain penetration 1st line
30
List the three ALK inhibitors
Crizotinib 250 bd Ceritinib 750mg od Alectinib best evidence
31
S/e with crizotinib
``` Visual disturbance (overlapping tails of light — driving! NV diarrhoea Rash Oedema QT prolongation Bradycardia ```
32
Name the I-O (immunotherapy) used in lung cancer
Pembrolizumab
33
What is pembrolizumab
A PDL1. / PD1 inhibitor
34
What is PDL1 /PD1
Programmed cell death 1 PD1 Its ligand is PDL1 They are immune checkpoint proteins that inhibits T cell response
35
Why use immunotherapy? | But what’s the se
No chemo s/e such as diarrhoea rash NV stomatitis hairloss neutropenia Autoimmune response eg cytokines storm
36
What are the two main groups of Lung cancer
SCLC 15% - aggressive, metastatic, high response rate but replapse quickly, 100% are smokers NSCLC - 85%, three types - squamous cell/ adénocarcinoma / large cell carcinoma Cancer profiling important - EGFR ALK
37
What’s the name of cancer that is occurred on the pleura of lung
Mesothelioma
38
Can you do surgery in SCLC? what’s the trt options
``` No surgery If limited stage RT AND CHEMO Cisplatin / carbo + et opposed If extensive stage no RT ```
39
How to reduce the risk of brain metastasis in lung cancer
Prophylactic cranial irradiation PCI
40
What are the clinical features of the lung cancer
``` Palpable cervical Clubbing Obstruction of vena cava Stridor Pleural effusion Pancoast syndrome Metastasis Hypercalcium Hyponataemia ```
41
Referralnoathway for lung cancer
- refer by GP - CT in 2 weeks - biopsy for diagnosis - imaging for staging - magement plan - trt within 62 day
42
What are the main diagnostic tools for lung caner
Bronchoscopy (central) CT guided lung biopsy (peripheral) EBUS - ultrasound
43
What do we use for imaging of cancer
CXr CT PETCT - positron emission tomography - more sensitive to metastasis and N involvement - use flurodeoxyglycose

Oncology (7 decks)

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