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ΩΩ 3b Bateman - Community and Palliative Care > Community and Palliative Care > Flashcards

Community and Palliative Care Flashcards

1
Q

WHAT ARE THE DIFFERENT CLASSES OF ANTIEMETICS?

A
  1. Ondansetron - 5-HT3 - chemotherapty-related nausea
  2. Domperidone - prokinetic - used in parkinson’s as does not cross the blood brain barrier
  3. Cyclizine - anti-histamine - raised intracranial pressure
  4. Metocloprmaide - prokinetic - dopamine antagonist - extrapyramidal side effects
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2
Q

What antiemetic is best used in chemotherapy?

A
  1. Metoclopramide - dopamine antagonist
  2. 5HT3 receptor antagonist i.e ondansetron
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3
Q

What drug can you use to reduce intracranial pressure due to brain cancer?

A

Dexamethasone

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4
Q

What management would you do if a patient had back pain which was keeping them up at night?

A
  1. Refer for urgent MRI and prescribe dexamethasone
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5
Q

What cancer is CA 15-3 associated with?

A

Breast Cancer

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6
Q

What cancer is CA 19-9 associated with?

A

Pancreatic cancer

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7
Q

What cancer is CA 125 associated with?

A

Ovarian Cancer

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8
Q

What cancer is tumour marker CEA assocaited with?

A

Colorectal cancer

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9
Q

What cancer is tumour marker S-100 associated with?

A

Melanoma, schwannomas

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10
Q

WHAT IS NEOPLASTIC SPINAL CORD COMPRESSION?

A
  1. Spinal cord compression is an oncological emergency and affects up to 5% of cancer patients.
  2. Extradural compression accounts for the majority of cases, usually due to vertebral body metastases.
  3. It is more common in patients with lung, breast and prostate cancer
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11
Q

What are the features of neoplastic spinal cord compression?

A
  1. Back pain
    • the earliest and most common symptom
    • may be worse on lying down and coughing
  2. lower limb weakness
  3. sensory changes: sensory loss and numbness
  4. neurological signs depend on the level of the lesion. Lesions above L1 usually result in upper motor neuron signs in the legs and a sensory level. Lesions below L1 usually cause lower motor neuron signs in the legs and perianal numbness. Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion
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12
Q

What is the investigation for neoplastic spinal cord compression?

A

urgent MRI: the 2019 NICE guidelines recommend a whole MRI spine within 24 hours of presentation

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13
Q

What is the management of neoplastic spinal cord compression?

A
  1. High-dose oral dexamethasone
  2. Urgent oncological assessment for consideration of radiotherapy or surgery
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14
Q

WHAT DRUG IS COMMONLY USED FOR SECRETIONS IN PALLIATIVE CARE?

A

Hyoscine butylbromide

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15
Q

What class of drug is hyoscine butylbromide?

A

Muscarinic receptor antagonist

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16
Q

What is the conversion from oral codeine to oral morhpine?

A

Divide by 10

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17
Q

What is needed to prescribe along with some drugs for a syringe driver?

A

0.9% sodium cholride

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18
Q

What is the first line antiemetic for intracranial nausea and vomiting?

A

Cyclizine

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19
Q

What is a cancer with a weak inheritance?

A

Gastric cancer

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20
Q

What is a side effect of vincristine?

A

Peripheral neuropathy

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21
Q

What are the best opoids to use in renal failure?

A

Buprenorphine or fentanyl

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22
Q

How do you convert oral to subcut morphine?

A

Divide by 2

23
Q

What are the treatments for metastatic bone pain?

A
  1. Opoids
  2. Bisphosphonates
  3. Radiotherapy
24
Q

Who are lung adenocarcinomas most common in?

A
  1. Non-smokers
  2. Peripheral lesion
25
Q

What are the characteristics of sqamous cell cancer?

A
  1. typically central
  2. associated with parathyroid hormone-related protein (PTHrP) secretion → hypercalcaemia
  3. strongly associated with finger clubbing
  4. hypertrophic pulmonary osteoarthropathy (HPOA)
26
Q

What are the characteristics of large cell lung carcinoma?

A
  1. typically peripheral
  2. anaplastic, poorly differentiated tumours with a poor prognosis
  3. may secrete β-hCG
27
Q

WHAT IS SUPERIOR VENA CAVA OBSTRUCTION?

A

Superior vena cava (SVC) obstruction is an oncological emergency caused by compression of the SVC. It is most commonly associated with lung cancer.

28
Q

What are the features of superior vena cava obstruction?

A
  1. dyspnoea is the most common symptom
  2. swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
  3. headache: often worse in the mornings
  4. visual disturbance
  5. pulseless jugular venous distension
29
Q

What are the causes of superior vena cava obstruction?

A
  1. common malignancies: small cell lung cancer, lymphoma
  2. other malignancies: metastatic seminoma, Kaposi’s sarcoma, breast cancer
  3. aortic aneurysm
  4. mediastinal fibrosis
  5. goitre
  6. SVC thrombosis
30
Q

What is the management of superior vena cava obstruction?

A
  1. Endovascular stenting is often the treatment of choice to provide symptom relief
  2. Certain malignancies such as lymphoma, small cell lung cancer may benefit from radical chemotherapy or chemo-radiotherapy rather than stenting
  3. The evidence base supporting the use of glucocorticoids is weak but they are often given
31
Q

Which is the best antiemetic for gastric stasis patients?

A

Dopamine receptor antagonist e.g. Metoclopramide

32
Q

How does metastatic prostate cancer normally present?

A
  1. Pathological fractures
  2. Sclerotic lesions
33
Q

WHICH HPV’S INCREASE THE RISK OF CERVICAL CANCER?

A

16, 18, 33

34
Q

What are the investigations for investigating metastatic disease of unknown primary?

A
  1. FBC, U&E, LFT, calcium, urinalysis, LDH
  2. Chest X-ray
  3. CT of chest, abdomen and pelvis
  4. AFP and hCG
35
Q

What are the investigations for investigating metastatic disease of unknown primary for specific patinets?

A
  1. Myeloma screen (if lytic bone lesions)
  2. Endoscopy (directed towards symptoms)
  3. PSA (men)
  4. CA 125 (women with peritoneal malignancy or ascites)
  5. Testicular US (in men with germ cell tumours)
  6. Mammography (in women with clinical or pathological features compatible with breast cancer)
36
Q

What is an example of a immune checkpoint inhibitor?

A

Nivolumab

37
Q

Which cancer drug causes hypomagnesaemia?

A

Cisplatin

38
Q

What excludes a diagnosis of a seminoma testicular cancer?

A

Beta hCG AND alpha-feto protein

39
Q

What cancer does a raised alpha-feto protein indicate?

A

Liver

40
Q

How does a PET scan work?

A

Looks at glucose uptake

41
Q

What can hyoscine butylbromide also be useful for?

A

Biliary colic pain

42
Q

What is calcitonin a tumour marker for?

A

Medullary thyroid cancer

43
Q

What is the best antiemetic for gastric statis?

A

Metocloprmaide

44
Q

What is the side effect of cisplatin?

A

Hypomagnesaemia

45
Q

How much should you increase a palliative care patient’s opioid dose if they are still in pain?

A

30-50%

46
Q

What medications is useful for treating mouth ulcers in palliative care?

A

Benzydamine hydrochloride mouthwash

47
Q

WHAT ARE THE FEATURES OF LYNCH SYNDROME?

A
  1. Autosomal dominant
  2. Develop colonic cancer and endometrial cancer at young age
  3. 80% of affected individuals will get colonic and/ or endometrial cancer
  4. High risk individuals may be identified using the Amsterdam criteria
48
Q

WHAT IS THE DIFFERENCE BETWEEN MEN I AND MEN II?

A
  1. MEN I - 3 P’s
  2. MEN II - Thyroid
49
Q

WHAT ARE HPV 6 AND 11 ASSOCIATED WITH?

A

Genital warts

50
Q

What is the best opioid in renal impairment?

A

Oxycodone

51
Q

What is BRCA2 associated with?

A
  1. Breast Cancer
  2. Prostate Cancer
52
Q

Which lung cancer is most closely related to smoking?

A

Squamous cell carcinoma

53
Q

What medication is used for managing hiccups?

A

Chlorpromazine

ΩΩ 3b Bateman - Community and Palliative Care (2 decks)

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