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Yr 4 - CCC > Corrections - Oncology pt2 > Flashcards

Corrections - Oncology pt2 Flashcards

1
Q

What is the drug of choice in palliative care for reducing the discomfort of a painful mouth?

A

Benzydamine hydrochloride mouthwash or spray

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2
Q

Are prostatic bony mets sclerotic or lytic?

A

Sclerotic

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3
Q

What are the carcinogenic types of HPV (assocaiated with an increased risk of cervical cancer)?

A

16, 18 and 33

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4
Q

What is Ca15-3 a tumour marker for?

A

Breast cancer

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5
Q

Which lung cancer has the strongest association with smoking?

A

Squamous cell lung cancer

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6
Q

What is calcitonin a tumour marker in?

A

Medullary thyroid cancer

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7
Q

What breast condition is blood stained discharge most likely to be associated with?

A

Intraductal papilloma.

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8
Q

Which chemotherapy agent is most commonly associated with hypomagnesaemia?

A

Cisplatin

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9
Q

What does a PET scan demonstrate?

A

Glucose uptake

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10
Q

Where is the most common site of bony mets?

A

Spine

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11
Q

Which chemotherapy agent is most associated with haemorrhage cystitis?

A

Cyclophosphamide

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12
Q

Which 2 chemo agents can cause peripheral neuropathy??

A

1) vincristine

2) cisplatin

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13
Q

What cancer does a raised beta-HCG and raised AFP indicate?

A

Non-semiomatous testicular cancer (a raised AFP excludes a seminoma)

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14
Q

What investigation must be done on a daily basis in patients with post-op ileus?

A

Electrolyte panel

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15
Q

What is calcitonin a tumour marker for?

A

Medullary thyroid cancer

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16
Q

What are the 3 key side effects of cisplatin?

A

Nephrotoxicity, ototoxicity & peripheral neuropathy

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17
Q

Screening for patients at high risk of HCC (e.g. alcoholic liver disease, hep B, hep C, haemochromatosis and A1AT deficiency)?

A

6-12 monthly US + AFP

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18
Q

How can squamous cell lung cancer cause brachial neuropathy?

A

Pancoast tumour

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19
Q

Symptoms of brachial neuropathy?

A
  • Severe pain in the upper arm or shoulder.
  • Pain usually affecting just one side of the body.
  • After a few hours or days, the pain transitions to weakness, limpness, or paralysis in the muscles of the affected arm or shoulder.
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20
Q

Which type of testicular cancer does a raised AFP indicate?

A

Non-seminoma testicular tumour

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21
Q

WHO classification 0?

A

able to carry out all normal activity without restriction

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22
Q

WHO classification 1?

A

restricted in strenuous activity but ambulatory and able to carry out light work

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23
Q

WHO classification 2?

A

ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours

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24
Q

WHO classification 3?

A

symptomatic and in a chair or in bed for greater than 50% of the day but not bedridden

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25
Q

WHO classification 4?

A

completely disabled; cannot carry out any self-care; totally confined to bed or chair.

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26
Q

In what 2 cancers if transcoelomic spread seen?

A

ovarian carcinoma and mesothelioma

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27
Q

What is transcoelomic spread?

A

Refers to spread of a primary tumour through the peritoneal cavity and onto the surface of organs covered by the peritoneum.

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28
Q

What is the 1st line pharmacological treatment for nausea and vomiting in the last days of life for patients with obstructive bowel disorders?

A

Cyclizine

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29
Q

What cancer are Orphan-Annie cells on histology pathognomonic of?

A

Papillary thyroid cancers

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30
Q

What medication can be considered in metastatic bone pain?

A

Zolendronic acid (bisphosphonate)

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31
Q

What are the 3 most likely cancers to metastasise to the liver?

A

1) Colorectal (via the portal circulation which drains the gut)

2) Breast

3) Lung

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32
Q

What is the Hb threshold for blood transfusion in patients without features of ACS?

A

<70

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33
Q

What is the Hb threshold for blood transfusion in patients with features of ACS?

A

<80

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34
Q

What dose of morphine sulphate is typically given for opioid naive patients in end of life care?

A

1-2.5mg

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35
Q

What is the dose equivalent of 10mg oral morphine for oral oxycodone?

A

5mg

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36
Q

What is the dose equivalent of 10mg oral morphine for SC oxycodone?

A

1.5mg

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37
Q

What is the dose equivalent of 10mg oral morphine for diamorphine?

A

3mg

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38
Q

What are the 2 types of pain?

A

1) Nociceptive –> directs damage to body tissue (somatic e.g. muscle/skin/bones or visceral i.e. internal organs).

2) Neuropathic –> direct damage to nerve tissue (CNS or PNS)

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39
Q

What are the adjuvant analgesics? (4)

A

1) Neuropathic agents e.g. amitriptyline, pregabalin, gabapentin

2) NSAIDs

3) Corticosteroids

4) Non-pharmalogical –> TENS, radiotherapy, acupuncture, heat

40
Q

What is usual starting dose of a strong opioid?

A

5-10mg modified release morphine

5mg (or 2mg if patient is frail) immediate release opioid

41
Q

In patients with mild renal or hepatic impairment, how should an opioid dose be changed?

A

Doses should be reduced by 50%

Specialist advice should be sought before prescribing strong opioids for patients with moderate to severe renal or hepatic impairment.

42
Q

Contraindications of opioids?

A
  • Severe renal & hepatic impairment (specialist advice needed)
  • Pregnancy
  • Breastfeeding (presence in breast milk)

Other notes:
- Reduced doses in elderly
- Cessation of treatment should be tapered slowly

43
Q

NSAIDs contraindications

A

1) IHD
2) Active bleeding or history of active bleeding
3) Uncontrolled HTN
4) Peptic ulcer disease
5) Asthma (caution, contraindication in asthma with nasal polyps)

44
Q

What 3 classes of drugs can interact with NSAIDs and increase risk of bleeding?

A

1) SSRIs

2) Anticoagulants e.g. warfarin

3) Antiplatelets e.g. aspirin

45
Q

What 2 classes of drugs can interact with NSAIDs and increase risk of electrolyte imbalances?

A

1) ACEi e.g. ramipril (increased risk of hyperkalaemia)

2) Diuretics e.g. spironolactone (increased risk of hyponatraemia or hyperkalaemia)

46
Q

How do NSAIDs affect seizure activity?

A

Can worsen seizure activity

47
Q

What class of drugs can interact with NSAIDs and increase risk of seizures?

A

Fluoroquinolone antibiotics (e.g. ciprofloxacin)

48
Q

Before prescribing any strong opiate, consider ABC.

What is this?

A

A - prescribe Antiemetic

B - consider Breakthrough pain

C - prescribe laxative for Constipation

49
Q

What can be considered for people with localised neuropathic pain who wish to avoid oral treatments?

A

Capsaicin cream

50
Q

What is the role of capsaicin cream?

A

Relieve neuralgia

51
Q

What class of drug is cyclizine?

A

Antihistamine with some anticholinergic activity

52
Q

Major contraindication of metoclopramide?

A

Parkinson’s (use domperidone instead as doesn’t cross BBB)

53
Q

What medication should be considered 1st line for N&V in people in the last days of life with obstructive bowel disorders?

A

hyoscine butylbromide

54
Q

Contraindications of haloperidol and levomepromazine?

A

Parkinson’s

55
Q

Most common side effect of ondansetron?

A

Constipation

56
Q

What is a common cause of N&V in advanced intra-abdominal malignancy ie. ovarian, bowel, peritoneal?

A

Malignant bowel obstruction

57
Q

what type of laxative is docusate?

A

Stool softener

58
Q

Typical management of SVCO?

A

SVC stent

59
Q

What can be used in reducing the discomfort associated with a painful mouth that may occur at the end of life?

A

Benzydamine hydrochloride mouthwash or spray

60
Q

1st line anti-emetic for intracranial causes of nausea and vomiting?

A

Cyclizine

61
Q

3 options for metastatic bone pain?

A

1) analgesia

2) bisphosphonates

3) radiotherapy

62
Q

What is analgesic of choice in patients with:
a) mild-moderate renal impairment
b) severe renal impairment (eGFR <10)

A

a) oxycodone
b) buprenorphine or fentanyl

63
Q

Pharmacological management of hiccups in palliative care?

A

Chlorpromazine or haloperidol

64
Q

Why is diazepam not given as an end of life drug?

A

It is an irritant when given SC

65
Q

What is 1st line in cancer related breathlessness when no reversible element?

A

Low dose immediate release PO morphine (i.e. oramorph)

66
Q

Describe WHO performance status levels

A

0 = normal

1 = symptomatic and ambulatory

2 = ambulatory >50% of time

3 = ambulatory <50% of time

4 = bed ridden

5 = dead

67
Q

What drug is indicated for agitation and confusion in patients who are NOT in the terminal phase?

A

Haloperidol

68
Q

What drug is indicated for agitation and confusion in patients who are in the terminal phase?

A

SC midazolam

69
Q

What tends to be the presenting feature of MEN II?

A

medullary carcinoma of the thyroid

70
Q

1st line management of suspected spinal cord compression in the acute setting?

A

Oral dexamethasone

71
Q

Which chemotherapy agent used in the management of lymphoma can cause peripheral neuropathy?

A

Vincristine

72
Q

What 2 medications is it important to prescribe alongside strong opioids?

A

Regular laxative (senna)

As required antiemetic

73
Q

Which chemo agent can cause haemorrhagic cystitis?

A

Cyclophosphamide

74
Q

What side effect of radiation therapy can cause difficulty swallowing, hoarseness and coughing?

A

Radiation-induced laryngeal oedema.

75
Q

Patients with unexplained ulceration in the oral cavity lasting for how long should be referred under the suspected oral cancer pathway?

A

3 weeks

76
Q

What is 1st line for breathlessness in end of life?

A

Morphine –> relieves the sensation of dyspnoea, and so relieves distress.

77
Q

Is papillaty thyroid cancer ‘hot’ or ‘cold’?

A

‘Cold’ i.e. does not take up the iodine

78
Q

What is the initial management of MSCC?

A

Dexamethasone + radiation therapy

79
Q

What are some early side effects of radiotherapy?

A
  • Tiredness
  • Fatigue
  • Skin erythema
  • Alopecia
  • Mucositis (diarrhoea, dysuria)
80
Q

What are some late side effects of radiotherapy?

A
  • Skin pigmentation changes
  • Pulmonary fibrosis
  • Infertility
  • 2ary cancers
  • Constrictive pericarditis
  • Dysphagia, sore throat (note - coughing is a sign of the larynx being affected, less likely affected in oesophagitis)
81
Q

MST dose in opioid naive patients?

A

5mg immediate release to be given 4 hourly

82
Q

What chemical can cause angiosarcomas?

A

Vinyl chloride

83
Q

What cancer can long-term exposure to high levels of benzene in the air lead to?

A

Leukaemia

84
Q

What are aromatic amines?

A

Aromatic amines are chemicals found in industrial and manufacturing plants, tobacco smoke, commercial hair dyes, and diesel exhaust

85
Q

What type of cancer can exposure to aromatic amines lead to?

A

Bladder cancer

86
Q

What is the most common site of bone mets?

A

Spine

87
Q

Which chemo drug can cause hypomagnesaemia?

A

Cisplatin

88
Q

What is Gardners syndrome?

A

A variant of familial adenomatous polyposis coli (FAP) that is characterised by the development of numerous adenomatous polyps in the colon and rectum.

Although these polyps start out as benign, if left untreated they have a nearly 100% chance of becoming malignant, leading to colorectal cancer

89
Q

what are 3 sites of extra colonic disease in Gardners syndrome?

A

1) skull osteoma

2) thyroid cancer

3) epidermoid cysts

90
Q

What gene is implicated in Gardners syndrome?

A

APC gene located on chromosome 5

91
Q

What surgery will most patients with Gardners syndrome undergo?

A

Colectomy

92
Q

What appearance do prostate cancer mets typically have on an XR?

A

Sclerotic appearance

93
Q

What are the 2 main types of syringe driver?

A

1) Graseby MS16A (blue): the delivery rate is given in mm per hour

2) Graseby MS26 (green): the delivery rate is given in mm per 24 hours

94
Q

Conversion of morphine to diamorphine?

A

/3

95
Q
A

Yr 4 - CCC (54 decks)

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