Diagnostic Tools Flashcards
how many people are diagnosed with cancer in their lives
a) 1/5
b) 1/3
c) 1/2
d) 3/4
b) 1/3
which two cancers have the worst prognoses?
a) breast
b) colon
c) lung
d) skin
e) prostate
c) lung
e) prostate
which two cancers have the best prognosis
a) acute myeloid leukemia
b) breast
c) colon
d) hodgkin’s lymphoma
e) prostate
f) testicular
d) hodgkin’s
f) testicular
what does TNM staging stand for?
tumour
node
metastasis
what does it mean if a cancer is stage 4?
a) cancer is small and limited
b) patient has weeks to live
c) tumour is larger than 4cm
d) cancer is metastatic
d) cancer is metastatic
what does grade 4 cancer mean?
a) resemble normal cells, well differentiated, not growing rapidly
b) undifferentiated cells, anaplastic
b) undifferentiated cells, anaplastic
which cancer does NOT commonly metastasise to the liver?
a) prostate
b) colon
c) lung
d) breast
a) prostate
which cancer does NOT commonly metastasise to the lung?
a) breast
b) thyroid
c) lung
d) kidney
b) thyroid
which cancer does NOT commonly metastasise to the brain
a) lung
b) breast
c) ovary
d) melanoma
c) ovary
which cancer does NOT commonly metastasise to the bone?
a) breast
b) bronchus
c) kidney
d) squamous cell
e) prostate
f) thyroid
d) squamous cell
which cancer does NOT commonly metastasise to the peritoneum?
a) ovary
b) GI tract
c) pancreas
d) throat
d) throat
which metastasis site is most common for head and neck, thyroid and lung cancers?
a) high cervical nodes
b) low cervical/supra-clavicular nodes
c) axilliary nodes
a) high cervical nodes
which lymphatic metastatic site is NOT common for lung, breast, melanoma and GI cancers?
a) high cervical nodes
b) low cervical/supra-clavicular nodes
c) axilliary nodes
a) high cervical nodes
which of these cancers does NOT not commonly metastasise to the inguinal lymph nodes?
a) breast
b) ovary
c) prostate
d) ano-rectal
e) vulva
a) breast
what is the most common end of life symptom?
a) confusion
b) sweating
c) breathlessness
d) death rattle
d) death rattle (56%)
is urinary dysfunction frequent at the end of life?
a) yes
b) no
a) yes
is pain or nausea and vomiting more common at the end of life?
a) nausea & vomiting
b) pain
a) pain (51%)
nausea and vomiting only 14%
what is the name for the framework put in place by a doctor if they wouldn’t be surprised if a patient died within a year?
a) silver
b) gold
c) liverpool care pathway
d) newcastle care pathway
b) gold
how many palliative care patients have a single identifiable cause of nausea and vomiting?
a) 1/5
b) 1/3
d) 1/2
d) 3/4
b) 1/3
how many palliative care patients have multiple causes of nausea and vomiting?
a) 1/5
b) 1/3
d) 1/2
d) 3/4
b) 1/3
what are the four types of nausea mediated by the vomiting centre?
vestibular gastric toxic cerebral (it's Very Gross to Tactical Chunder)
what type of sickness is characterised by nausea and sudden vomiting on movement e.g. turning?
vestibular
what antiemetic is best to give in vestibular N&V?
a) haloperidol
b) metoclopramide
c) cyclizine
c) cyclizine
what type of sickness is characterised by early satiety, hiccoughs, heartburn, large vomits esp after eating and drinking, ‘sticking’?
gastric
what antiemetic is best to give in gastric N&V?
a) haloperidol
b) metoclopramide
c) cyclizine
b) metoclopramide
what type of sickness is characterised by persistent nausea, small vomits and retching?
toxic
what antiemetic is best to give in toxic N&V?
a) haloperidol
b) metoclopramide
c) cyclizine
a) haloperidol
what type of cerebral sickness is characterised by nausea and vomiting triggered in certain situations?
anxiety/anticipatory
what drug therapy is best in anxiety/anticipatory N&V?
BZDPs
what type of cerebral sickness is characterised by an early morning headache, vomiting, neurological stigmata?
raised ICP
what antiemetic should be given alongside dexamethasone in N&V caused by raised ICP?
a) haloperidol
b) metoclopramide
c) cyclizine
c) cyclizine
dolasetron and ondansetron are examples of what type of anti-emetic?
a) dopamine receptor antagonist
b) histamine antagonist
c) anti-cholinergic agents
d) 5-HT3 receptor antagonists
d) 5-HT3 receptor antagonists
what is the best use/most likely indication for use of ondansetron?
a) post-operative N/V
b) chemo-induced N/V
c) palliative care N/V
b) chemo-induced N/V
5-HT3 receptor antagonists can cause potassium channel blockage. this will result in what ECG abnormality? (a side effect of the drug)
qt prolongation
haloperidol, prochlorperazine and domperidone are examples of what type of anti-emetic?
a) dopamine receptor antagonist
b) histamine antagonist
c) anti-cholinergic agents
d) 5-HT3 receptor antagonists
a) dopamine receptor antagonist
how is domperidone administered?
a) orally
b) bucally
c) rectally
c) rectally
metoclopramide is a dopamine receptor antagonist but has what direct effect on the gut?
a) akinetic
b) prokinetic
c) spasmodic
d) anti-spasmodic
b) prokinetic
at high doses, metoclopramide can show effects of what other group of anti-emetics?
a) histamine antagonist
b) anti-cholinergic agents
c) 5-HT3 receptor antagonists
c) 5-HT3 receptor antagonists
what is the best use/most likely indication for use of haloperidol or prochlorperazine?
a) post-operative N/V
b) chemo-induced N/V
c) palliative care N/V
a) post-operative N/V
what type of anti-emetic is most likely to have these side effects?:
sedation, EPSEs, neurologic malignant syndrome
a) 5-HT3
b) dopamine
c) anti-cholinergic
d) histamine
b) dopamine
which neurological condition is contraindicated when considering prescribing dopamine receptor antagonists as anti-emetics?
parkinson’s disease
which anti-emetic works by blocking H1 receptors which induce sickness by triggering chemoreceptor zones?
histamine antagonists
which anti-emetic is best to use in pregnancy? why?
histamine antagonists - not teratogenic
what is the best use/most likely indication for use of cyclizine or promethiazine?
a) post-operative N/V
b) drug-induced N/V
c) palliative care N/V
b) drug-induced N/V
fill in the gaps for the following anticholinergic side effects:
___ as a hare, ___ as a bone, _____ as a bat, ___ as beet, ___ as a hatter
hot dry blind red mad
what group of anti-emetics do histamine antagonists share side effects with?
a) 5-HT3
b) dopamine
c) anticholinergic
c) anticholinergic AND DROWSINESS TOO
prostatic hypertrophy, urinary retention and closed-angle glaucoma are contraindications for the use of which antiemetic?
a) histamine
b) dopamine
c) anti-cholinergic
d) 5-HT3
a) histamine
hyoscine is an example of what type of anti-emetic?
a) a) histamine
b) dopamine
c) anti-cholinergic
d) 5-HT3
c) anti-cholinergic
aside from oral, how else can anticholinergic anti-emetics be administered?
transdermal patch
what type of anti-emetic is levomepromazine?
broad-spectrum (but it’s main action is dopamine receptor antagonist)
what is the best use/most likely indication for use of levomepromazine?
a) post-operative N/V
b) drug-induced N/V
c) palliative care N/V
c) palliative care N/V
what is the most dangerous side effect of levomepromazine?
agranulocytosis
drowsiness, dizziness, postural hypotension, photosensitivity and agranulocytosis are side effects of which anti-emetic?
a) hyoscine
b) levomepromazine
c) ondansetron
d) cyclizine
b) levomepromazine
alcohol, renal/hepatic failure, heart failure and high stroke risk are contraindications of which anti-emetic?
a) levomepromazine
b) hyoscine
c) domperidone
d) haloperidol
a) levomepromazine
which of these is NOT a reason why constipation is very common in palliative care?
a) immobility
b) overuse of laxatives
c) reduced food/drink intake
d) drugs e.g. opioids
e) bowel pathology
f) hypercalcaemia
b) overuse of laxatives
what counter-intuitive side effect can be caused by severe constipation?
overflow diarrhoea
how frequently should laxatives be reviewed in palliative care?
2 days
what therapies could be considered as step-ups in palliative care if the bowels haven’t opened after 3 days of laxative therapy?
PR, suppositories, enema
give an example of bulk forming laxatives
fybogel
are bulk forming laxatives used frequently in palliative care?
a) yes
b) no
b) no
give an example of a stool softener laxative
lactulose
sodium docusate
what is a side effect of lactulose?
bloating
flatulence
give an example of a stimulant laxative
senna
dantron
which laxative should be avoided if a patient has colic?
a) bulk forming
b) stool softener
c) stimulant
c) stimulant
movicol and co-danthrusate are combinations of which two types of laxative?
softener and stimulant
what laxatives are commonly used in treatment of opiod-induced constipation
a) stimulant e.g. senna
b) bulk-forming e.g. fybogel
c) combination e.g. movicol
c) combination e.g. movicol
in general, if a patient can swallow, should analgesia always be given orally?
a) yes
b) no
a) yes
in palliative analgesia, should you leave paracetamol on the prescription even if morphine is also prescribed?
a) yes
b) no
a) yes
give an example of a weak opiod
codeine
co-codamol
dihydrocodeine
fill in the gaps for the possible dosages for co-codamol tablets
_/500
__/500
__/500
8
15
30
how frequently can co-codamol be administered?
2 tablets QDS
what are the two formulations for morphine?
immediate release
modified release
after how long does immediate release morphine start to work?
30 mins
how long does immediate release morphine work for?
4 hours
how long does modified release morphine last for?
12 hours
what type of morphine is oramorph?
immediate release
what type of morphine is morphine sulphate?
modified release
what type of morphine is zomorph?
modified release
why are buprenorphine and fentanyl useful if a palliative care patient cannot swallow or tolerate a syringe driver?
can be given using a transdermal patch
name 3 other strong opiods except for morphine
fentanyl
oxycodone
methadone
name 2 drugs which can be used to treat neuropathic pain
amitriptyline
gabapentin
pregabalin
when calculating a PRN dose for morphine, what fraction of the total 24hr dose should it be?
1/6
when converting oral morphine to subcut morphine what do you divide the total 24hr dose by?
2
what other drug might you consider to reduce pain caused by swelling?
dexamethasone
what holistic treatment can often benefit patients with breathlessness at the end of their lives?
fan directed at face
how can opioid therapy help with breathlessness in palliative care?
decrease respiratory effort
how can BZDPs help with breathlessness in palliative care?
may calm anxiety or panic attacks causing hyperventilation
what is the commonly used name for hyoscine butylbromide?
buscopan
why is hyoscine butylbromide preferred over hyoscine hydrobromide?
doesn’t cross blood brain barrier (hydrobromide may cause sedation or agitation)
in calcium homeostasis, what does the thyroid release when there is high calcium in the blood?
a) calcitonin
b) PTH
a) calcitonin
in calcium homeostasis, how does calcitonin affect the kidneys?
reduced absorption of calcium
in calcium homeostasis, how does calcitonin affect the bone?
promotes osteoblast deposit of calcium in bones
in calcium homeostasis, what does the parathyroid release when there is low calcium in the blood?
a) calcitonin
b) PTH
b) PTH
in calcium homeostasis, how does PTH affect the kidneys?
stimulates to absorb calcium
kidneys also convert Vit D to stimulate the bowels to absorb calcium
in calcium homeostasis, how does PTH affect the bone?
promotes osteoclasts to release calcium from bone
fill in the blanks:
BRCA _ mutation is responsible for increased risk of early onset breast and male breast cancer. BRCA _ mutation is responsible for increased breast and ovarian cancer risk.
2
1
out of breast, colorectal and lung cancer, which two have stage 1 five year survival rates of around 80%?
breast and colorectal
out of breast, colorectal and lung cancer, which has a stage 4 five year survival rate of less than 6 months?
lung
what disease is QRisk2 a prediction algorithm for?
a) stroke in AF
b) CVD
c) blood clot
b) CVD
which GP prediction algorithm considers: age, BP, smoker, cholesterol ratio, BMI, ethnicity, deprivation, FHx, chronic kidney disease, rheumatoid arthritis, AF, diabetes, antihypertensives a) QRisk2 b) CHAD2DS2-VASc c) HASBLED
QRisk2
if a QRisk2 score is over 10, what action is indicated?
a) antihypertensive therapy
b) statin therapy
c) anti-coagulation
b) statin therapy
what disease is CHAD2DS2-VASc a prediction algorithm for?
a) stroke in AF
b) CVD
c) blood clot
a) stroke in AF
what do these values mean in a CHAD2DS2-VASc score? C H A D S V A Sc
congestive heart failure hypertension age (>=75) diabetes stroke, tia or clot previously vascular disease age 65-74 Sex (female more at risk)
what disease is HASBLED a prediction algorithm for?
a) major bleed in AF
b) CVD
c) blood clot
a) major bleed in AF
what do these values mean in a HASBLED score? H A S B L E D
hypertension abnormal liver/kidney stroke bleeding labile INR elderly >65 drugs/alcohol
what does a higher HASBLED score indicate?
prediction for how many patients with that score would have a bleed, out of 100
