General Flashcards
What are the clinical features of SVCO?
Dyspnoea, facial plethora, orthopnoea, dilated/engorged veins, pembertons sign
What is pembertons test?
When a patient is asked to raise their arms above their head for over 1 minute and this should cause facial plethora and cyanosis in someone with SVCO
Which type of lung cancer is most likely to cause pleural effusion?
Adenocarcinoma
Which type of lung cancer is most common in non-smokers?
Adenocarcinoma
Where in the lung are adenocarcinomas most often found?
Peripherally
Which carcinomas are most likely to spread to the bone?
Lung, thyroid, renal, prostate, breast
What are the indications for G-CSF in neutropenia sepsis?
If initial treatment with sepsis six fails and there is persistent neutropenia +/- haemodynamic instability
What are risk factors for neutropenia sepsis?
Clinically unstable, persistent and significant neutropenia, receiving chemotherapy, significant co-morbidities
In a 62 year old woman who has had radiotherapy for breast cancer and is now presenting with dysphagia, hoarseness and cough- what could be the cause?
Radiotherapy induced laryngeal oedema
How does hepatocellular carcinoma present?
Features of cirrhosis (jaundice, deranged LFTs, ascites and oedema) along with a raised serum AFP
What does a WHO performance score of 0 mean?
Able to carry out all normal activity without restriction
What does a WHO performance score of 1 mean?
Restricted in strenuous activity but ambulatory and able to carry out light work
What does a WHO performance score of 2 mean?
Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours
What does a WHO performance score of 3 mean?
Symptomatic and in a chair or in a bed for more than 50% of waking hours, but not bedridden
What does a WHO performance score of 4 mean?
Completely disabled; cannot carry out any self-care; totally confined to bed or chair
What can cause elevated AFP levels?
Hepatocellular carcinoma, germ cell tumours, GI cancers, metastatic lung cancer, pregnancy
What diagnosis is most likely in a patient with elevated AFP levels and persistent cough, breathlessness and unexplained weight loss?
Metastatic lung cancer
What diagnosis is most likely in a patient with elevated AFP levels and abdominal pain, weight loss and jaundice?
Hepatocellular carcinoma
What diagnosis is most likely in a patient with elevated AFP levels and abdominal pain, unexplained weight loss and change in bowel habit?
GI cancer
Orphan Annie cells are pathognomonic of what cancer?
Papillary thyroid cancer
Reed stern berg cells are a feature of what cancer?
Hodgkins lymphoma
What would be the prophylactic treatment for someone at high risk of tumour lysis syndrome?
Intravenous hydration- promotes urinary excretion of electrolytes and prevents AKI
Allopurinol- reduce production and accumulation of uric acid
How is neutropenic sepsis defined?
A neutrophil count of <0.5 in a patient with a temperature greater than 38 or other signs/symptoms of clinically significant sepsis
What are the most common causative organisms in neutropenic sepsis? Why is this?
Coagulase negative, gram positive bacteria- particularly staph epidermidis
Due to use of indwelling lines
What prophylactic treatment is offered to patients with neutropenia for neutropenic sepsis?
A fluoroquinolone
When would it be suggested to order investigations for fungal infections in a patient with neutropenic sepsis?
If patient not responding after 4-6 days
What is tumour lysis syndrome?
A serious metabolic disorder where rapid tumour cell death leads to massive release of intracellular contents into the blood
What is associated with tumour lysis syndrome?
Aggressive, rapidly proliferating tumours like acute leukaemia and high-grade lymphoma. Often occurs following chemotherapy but may be caused by other treatments
What electrolyte abnormalities are seen in tumour lysis syndrome?
Hypocalcaemia, hyperphosphataemia, hyperuricaemia, hyperkalaemia
Why does hypocalcaemia occur in tumour lysis syndrome?
Because of increased phosphate released from tumour cells acting as a calcium chelating agent
Why does hyperuricaemia occur in tumour lysis syndrome, what is the main complication of this?
The breakdown of DNA bases from tumour cells into uric acid
Uric acid then crystallises and gets deposited in kidney causing AKI
What are signs and symptoms seen in tumour lysis syndrome?
Hypocalcaemia: Arrhythmias, seizures, muscle cramps, tingling and numbness in hands and feet
Hyperuricaemia: gout/joint swelling, dysuria/oliguria
Hyperkalaemia: arrhythmias, muscle weakness, palpitations
Hyperphophataemia: itching, muscle cramps, peri oral tingling/numbness
What are key investigations to do for suspected tumour lysis syndrome?
U+Es (shows high K+ and phosphate and creatine), calcium, uric acid, ECG
What is involved in the management of tumour lysis syndrome?
Correction of electrolyte imbalances (may require temporary dialysis)
IV fluids
Prophylaxis in those at high risk with allopurinol or rasburicase
When is rasburicase given?
In individuals at high risk of tumour lysis syndrome, allopurinol given to lower risk or those with G6PD. Rasburicase also used in acute treatment whereas allopurinol only prophylaxis
What are indications for dialysis in tumour lysis syndrome?
Intractable fluid overload, hyperkalaemia, hyperphosphataemia, hyperuricaemia or hypocalcaemia
Why can gynaecomastia occur with germ cell and leydig cell testicular tumours?
Germ cell: HCG causes leydig dysfunction causing an increase in oestradiol production
Leydig cell: directly secrete more oestradiol
What tumour marker is raised in around 20% of seminomas?
HCG
What tumour markers can be raised in non-seminoma testicular tumours?
AFP and b-HCG
What is elevated in around 40% of germ cell tumours?
LDH
what is richter’s transformation?
when chronic lymphocytic leukaemia cells enter the lymph node and change into high grade non-hodgkins lymphoma
What investigation should women undergo before having breast cancer surgery if there is no palpable axillary lymphadenopathy?
USS of the axilla, if negative they should have sentinel lymph node biopsy rather than axillary node clearance
how do anastrazole medications work?
they inhibit the peripheral synthesis of oestrogen
what type of cancer does achalasia increase the risk of?
squamous cell carcinoma of the oesophagus
what is the first line imaging that should be conducted in a patient with suspected multiple myeloma?
whole body MRI scan
in which chronic leukaemia is lymphadenopathy more marked?
CLL
what is a characteristic finding of CLL on blood film?
smear/smudge cells
HNPCC increases the risk of which cancers?
Bowel, pancreatic and endometrial
what are the three components of the risk malignancy index in ovarian cancer?
Ca125, menopausal status and ultrasound findings
what are poor prognostic factors for ALL?
male sex, presenting age <2 years or >10years, having B or T cell surface markers and WCC >20 at diagnosis
what are riskfactors for developing cervical cancer?
HPV 16, 18, 33
smoking, HIV, many sexual partners, high parity, COCP, lower socioeconomic status
what are some complications of CLL?
anaemia, hypogammaglobulinaemia,warm autoimmune haemolytic anaemia, transformation to high-grade lymphoma
who is offered genetic testing for BRCA1 and BRCA2 mutations?
women under 50 with triple negative breast cancer
what is the staging of ovarian cancer?
1- tumour confined to ovary
2- tumour outside ovary but within pelvis
3- tumour outside pelvis but within abdomen
4- distant metastasis
what is the main ECG abnormality seen with hypercalcaemia?
short QT interval
which type of lung cancer is associated with hypertrophic pulmonary osteoarthropathy?
squamous cell carcinoma
radiotherapy for prostate cancer can increase the risk of which other cancers?
bladder, colon and rectal
which cancers does the COCP increase the risk of? which is it protective for?
risk of breast and cervical
protective for endometrial
what chemotherapy regime is used for breast cancer that is node +ve and which regime is used for node -ve?
node +ve = FEC-D chemotherapy
node -ve = FEC chemotherapy
what is first line investigation for suspected endometrial cancer?
transvaginal ultrasound to measure endometrial thickness
if lining is thickened then a hysteroscopy is carried out with biopsy
what is the treatment for endometrial cancer?
laproscopic hysterectomy with bilateral salpingo-oopherectomy, with or without radiotherapy
which type of lung cancer is associated with gynaecomastia?
adenocarcinoma
