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Y4 - Finals Edition > Lectures: Med D > Flashcards

Lectures: Med D Flashcards

1
Q

Define sensitivity

A

positivity in the presence of disease

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2
Q

Define specificity

A

negativity in the absence of disease

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3
Q

Give two prognostic indicators of testicular teratomas?

A
  • HCG
  • AFP
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4
Q

If a patient has HER2 positive breast cancer what can they be treated with?

A

Herceptin
- works to block receptors and stop signal responsible for cancer cell growth and division

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5
Q

What is Tumour Lysis Syndrome, and what are the biochemical features?

A
  • massive necrosis of tumour cells
  • during treatment with cytotoxic drugs

Features
1. Hyperkalaemia –> arrhythmias
2. Lactate
3. Hyperphosphatasaemia –> calcium, phosphate imbalance

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6
Q

What can be done to prevent tumour lysis syndrome?

A
  1. Maintain adequate hydration
  2. Allopurinol
    • (xanthine oxidase inhibitor) inhibits uric acid synthesis
  3. Monitor fluids and electrolytes
  4. Urinary alkalisation
  5. Renal dialysis
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7
Q

This is an immunological phenomenon:
- effectiveness of antibodies to form immune complexes can be impaired with concentrations of an antibody or antigen are too high

A

HOOK EFFECT

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8
Q

Key biochemical marker in ovarian cancer:

A

CA125

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9
Q

Key signs and symptoms of ovarian cancer

A
  • abdominal distention
  • early satiety
  • pelvic / abdominal pain
  • urinary urgency / frequency
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10
Q

What findings on examination would lead you to urgently refer a patient with suspected ovarian cancer

A

ascites or pelvic abdominal mass

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11
Q

A risk malignancy index of greater than what will lead to a patient being referred:

A

RMI = malignant features on US x menopausal status x Ca125 level

> 200 = high risk, staging ST and referral

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12
Q

What tumour marker is seen to be increased in patients with breast cancer with distant metastases?

A

CA15-3

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13
Q

Gene variations associated with increase risk of developing breast cancer:

A
  • BRCA1
  • BRCA2
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14
Q

Biochemical marker in pancreatic cancer

A

CA19-9
- low sensitivity
- main use is monitoring treatment
- may also be raised in gall bladder, bile duct and gastric cancers

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15
Q

Patients with what particular antigen will not produce the antigen for CA19-9 :

A

Patients who lack the LEWIS antigen will not express CA19.9

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16
Q

Marker for prostate cancer:

A

PSA

TOTAL VS FREE

  • malignant prostate cells produce more bound PSA
  • low level of free in relation to total PSA might indicate cancer
  • high level of free indicate normal prostate, BPH or other conditions
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17
Q

Prolactinoma: symptoms

A
  1. Female: amenorrhoea, infertility, lactation, loss of libido
  2. Males: erectile dysfunction, libido, infertility

Pressure of prolactinoma on surrounding tissues:

  • headaches
  • vision loss
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18
Q

Treatment of prolactinoma

A
  1. Cabergoline (dopamine agonist, to shrink tumour)
  2. Bromocriptine
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19
Q

If suspecting growth hormone excess, what important test should be done:

A

Glucose tolerance test.

Notes

  • glucose should suppress growth hormone levels.
  • will help decide if there is excess GH production
    • ACROMEGALY
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20
Q

Symptoms of primary aldosteronism:

A
  1. HTN resistance to medication
  2. Hypokalaemia
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21
Q

What test will be done to see where the excess aldosterone hormone is coming from:

A
  • adrenal vein sampling to lateralise
  • in unilateral disease
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22
Q

Pheochromocytoma

A

rare tumour, that forms in adrenal medulla

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23
Q

Paragangliomas

A

form outside the adrenal gland

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24
Q

Investigations for pheochromocytoma and paraganglioma

A
  • plasma free metadrenalines
  • total fractionated urine metadrenalines
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25
Q

PTHrP: What is this and where is it found?

A
  1. Found in pancreatic islet and ductal cells.
  2. PTHrP acts on PTH1P receptor
    - regulate cell proliferation
    - apoptosis
    - differentiation
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26
Q

Role of PTHrP

A
  • can stimulate calcium resorption from bone
  • and reabsorption in the kidneys
    • causing hypercalcaemia!
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27
Q

Tumours of pancreas summarised:

A

1. Insulinoma: Whipple’s triad

2. Glucagonoma –> 5Ds
- depression
- dermatitis
- diarrhoea
- diabetes
- deep vein thrombosis

3. Gastronioma –> Zollinger-Edison syndrome

4. VIPoma –> relaxes muscles in stomach and bowel

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28
Q

Zollinger-Ellison syndrome

A

multiple severe, recurrent peptic ulcers in part of small intestine

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29
Q

what occurs in carcinoid syndrome?

A
  • tumour produces excessive amounts of serotonin that the liver can’t break down
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30
Q

What gene is implicated in MEN 1 and what possible biochemical tests would you want to do?

A

MEN 1 tumour suppressor gene

Pituitary adenoma
Parathyroid hyperplasia
Pancreatic tumours

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31
Q

Men 2A

A

RET PROTONCOGENE

Parathyroid hyperplasia
Medullary thyroid carcinoma
Pheochromocytoma

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32
Q

Men 2B

A

RET PROTONCOGENE

  • mucosal neuroma
  • marfanoid body habitus
  • medullary thyroid carcinoma
  • pheochromocytoma
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33
Q

What might be seen on blood film in acute myeloid leukaemia?

A

AUER ROD

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34
Q

Commonest childhood cancer:

A

acute lymphoblastic leukaemia

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35
Q

What additional test would you do in a patient with suspected chronic myeloid leukaemia?

A

FISH to look for Philadelphia chromosome

  • translocation between chromosome 9 and chromosome 22.
  • present in 95% of CML patients.
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36
Q

Treatment of chronic lymphocytic leukaemia:

A

IMATINIB (tyrosine kinase inhibitors)

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37
Q

What is a blast crisis:

A

progression of CML to acute blast phase —> acute leukaemia

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38
Q

Myelodysplastic syndromes

A
  • group of cancers
  • immature blood cells in bone marrow do not mature or become healthy blood cells
    • bone marrow doesn’t make normal blood cells
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39
Q

Myeloma is associated with what abnormal proteins produced by the immune system:

A

Paraproteins

  • IgG
  • IgA
  • free light chain

Paraproteins in blood may lead to abnormal blood flow

  • hyper viscosity
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40
Q

Vertebral collapse in myeloma may lead to what condition:

A

Spinal cord compression

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41
Q

What type of cell is classically seen in Hodgkin Lymphoma

A
  • REED STERNBERG CELL
    • abnormal lymphocytes containing more than one nucleus
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42
Q

Name the most rapidly growing type of non-Hodgkin lymphoma:

A

BURKITT lymphoma

43
Q

Staging for lymphoma

A

Ann Arbor staging - done with CT

  1. Localised
  2. Two or more on same side of diaphragm
  3. two or more above and below diaphragm
  4. widespread disease, multiple organs and nodal involvement
44
Q

Microcytic anaemia causes:

A

TAILS

T- thalassemia
A- anaemia of chronic disease
I- iron deficiency
L- lead poisoning
S- sideroblastic anaemia

45
Q

Macrocytic anaemia causes:

A

Megaloblast
- b12 deficiency (e.g. pernicious anaemia)
- folate deficiency

Non-megaloblast
- alcohol
- reticulocytosis
- liver disease
- hypothyroid

46
Q

LDH is a marker of:

A

cell turnover so can show cell and tissue damage in the body

47
Q

What test might you do to help determine the potential cause of haemolysis

A

DAT (direct antiglobulin test)

Direct coombs test

48
Q

What genetic mutation has been shown to be associated with myeloproliferative neoplasm in a patient?

A

JAK 2 mutation

49
Q

When would a patient with thrombocythemia be referred to haematology?

A
  1. Platelet count > 1000 (unexplained)
  2. Platelets 600-1000 in association with thrombotic event
50
Q

What intervention may be used to help control the blood cell count without allowing blood cell count to do down:

A

cytoreductive therapy: hydroxycarbamide

51
Q

Important side effect of bisphosphonate use:

A

jaw necrosis

52
Q

DRAW OUT THE CHEMOTHERAPY TOXICITY BEAR

A

D- doxorubicin (cardiomyopathy)
A- asparagine (alopecia)
C- cisplatin (nephrotoxic)

53
Q

What is the ALARA principle:

A
  • avoiding exposure to radiation that does not have direct benefit to you
  • keep dose as low as reasonably possible
54
Q

What method may be used to help define quality of life:

A

EQD5 questionnaire

Looks at:
- mobility
- self-care
- usual activities
- pain / discomfort
- anxiety/ depression

55
Q

What sign is seen in superior vena cava obstruction:

A

Pemberton sign

56
Q

Management of superior vena cava obstruction:

A

EMERGENCY

  1. ABCDE
    a. nurse upright
    b. oxygen
    c. dexamethasone 8-16mg daily with PPI
    d. if thrombus then LMWH
57
Q

Definitive treatment of superior vena cava obstruction:

A

vascular stenting

58
Q

Case 1: 65 yo male, 4/52 hx of dyspnoea

  • Cough productive of thick yellow sputum with streaks of blood
  • Weight Loss ~ 1 stone
  • Noticed his face is puffy at the end of the day last 2/52
  • PMHx:
  • T2DM
  • SHx
  • Smoker, 30 pack year hx. Retired factory supervisor.

Indicative of:

A

Superior vena cava obstruction

59
Q

Case 2: 58 Female, generally unwell

  • known breast cancer
  • received her second cycle of adjuvant chemotherapy 10 days ago
  • 2/7 hx of dysuria and frequency of micturition
  • feeling hot and cold
  • uncontrollable shaking this afternoon

Observations:

  • HR 110bpm , BP 92/60mmHg
  • RR 18, oxygen sats 99% on RA
  • Temp 38.8

Indicative of:

A

Neutropenic sepsis

60
Q

Definition of febrile neutropenia

A
  • temperature > 38 degrees
  • neutrophils < 0.5
61
Q

What scoring system is used to identify low risk febrile neutropenic patients:

A

MASCC score - > 21 considered low risk

62
Q

Antibiotic protocol for low vs high risk patients of neutropenic sepsis

A

Low risk
No allergies: PO co-amoxiclav & Ciprofloxacin
Pen allergic: PO doxy & Cipro

High risk
No allergies: IV TAZ & IV Gent
Pen allergic: IV meropenem & IV gentamicin
Severe allergic: IV Teicoplanin & IV cipro & IV gent

63
Q

Case 3: 70 Male not his usual self

PC: attended for radical radiotherapy for known Lung Ca.

Complaining of feeling muddled over last 24 hours, disorientation. Tiredness, nauseated, increasingly thirsty, vague abdominal pain and constipation.

PMH: HTN and IHD

High creatinine, high calcium

Differential diagnosis

A

HYPERCALCAEMIA
- Painful bones
- renal stones
- abdominal groans
- psychiatric moans

64
Q

Management of hypercalcaemia

A
  1. Vigorous rehydration
    • 4L of IV fluid in 24 hours
  2. Monitor for fluid overload
    • repeat serum Ca before giving bisphosphonate
      • commence bisphosphonates 24hrs post rehydration
  3. RANK-ligand inhibitors such as denosumab
65
Q

Case 4:

PC: progressive lower thoracic back pain, radiates bilaterally around umbilicus, worse on coughing

PMH: metastatic prostate cancer

DH: 3 monthly zoladex (goserelin)

OE:

  • normal tone, power, reflexes
  • sensation normal
  • spinal bony tenderness palpable at T10

Differential diagnoses:

A

metastatic spinal cord compression

66
Q

Management of MSCC

A

URGENT MRI WHOLE SPINE (within 24hrs)

  • lie flat (log roll)

STEROIDS —> dexamethasone 8mg BD PO with PPI

  • WHO analgesia ladder
  • Consider: catheterisation, laxatives

Definitive treatment - surgery vs radiotherapy

  • MSCC pathway
67
Q

Case 6: 49 Male, diarrhoea and dizziness

PC: diarrhoea watery, non bloody, no vomiting and patient is afebrile.

Obs: T36.7, 114bpm, BP 98/56

PMH: advanced kidney Ca.

DH: new cancer drug about 7 weeks ago

OE: abdomen SNT, no masses

Likely diagnosis:

A

Immunotherapy mediated colitis

68
Q

Management of immunotherapy induced colitis

A

GRADE 1
—> fluids, loperamide
–> up to 3 extra stools, no blood or pain

Grade 2
–> admit under gastro
–> oral pred w/ PPI cover
–> omit next dose immunotherapy
–> regular obs/ NEWS/ Stool

Grade 3-4
–> more than 7 stools than baseline
–> severe abdo pain
–> methyl pred
–> stop immunotherapy

69
Q

What is brachytherapy?

A
  • Radioactive sources implanted into tumour or surrounding tissue
  • Like 125 I, 103Pd, 192Ir, 137Cs
  • Delivers high dose of radiation to desired target while minimizing the dose to surrounding normal tissues
70
Q

Chemotherapy: How to antimetabolites work ?

A

prevent DNA synthesis

Cell cycle specific (S-phase)
- folate antagonist (methotrexate)

71
Q

Chemotherapy: How do alkylating agents work?

A

prevent uncoiling of DNA for replication

  1. Topoisomerase inhibitors –> prevent uncoiling of DNA but breaking down enzymes used for uncoiling
  2. Non-classical alkylating agents –> lock cross links preventing them from uncoiling
72
Q

How do Vinca alkaloids work?

A

cell cycle arrest

by preventing microtubule formation

73
Q

How do antimitotic antibiotics work?

A

e.g. BLEOMYCIN

prevent mitosis from occuring

74
Q

How do Taxanes work?

A

spindle cell inhibition

examples: paclitaxel, docetaxel

75
Q

Give some examples of anti-metabolite drugs?

A
  • methotrexate
  • 5-FU
  • Capecitabine
76
Q

Give some examples of alkylating drugs (classical)?

A
  • etoposide
  • ifosphamide
77
Q

Give examples of alkylating drugs (non-classical)

A
  • cisplatin
  • carboplatin
  • oxaliplatin
78
Q

Give examples of Vinca Alkaloids:

A
  • Vincristine
  • Vinblastine
79
Q

Give examples of antimitotic antibodies

A

Anthracycline

  • doxorubicin
  • Epirubicin

Non-anthracycline

  • bleomycin
80
Q

Terminology used to determine response to chemotherapy

A

Complete response –> disappearance of all measurable disease

Partial response –> 30% decrease from baseline

Minimal response –> decrease in measurable lesions, no new lesions observed

Stable response –> neither partial response or progressive disease criteria have been met

Progressive disease –> 20% increase in one or more lesions

81
Q

One dose of an oncology therapy is known as:

A

cycle

Course = number of cycles given in one block

82
Q

What criteria may be used to determine response to treatment?

A

RECIST criteria

83
Q

Grading system used to determine severity of chemotherapy:

A

CTCAE - common terminology criteria for adverse events

84
Q

Intrathecal method of administration is:

A

given into CSF

85
Q

What is given alongside treatments which suppress bone growth?

A

growth factor

86
Q

What does it mean by maximum cumulative doses?

A
  • the max dose of drug a patient can be given in their lifetime
  • e.g. bleomycin can cause significant pneumonitis and interstitial lung disease! used in patients with testicular cancer
87
Q

Majority of chemotherapy is dosed based on what calculation

A

** body surface area (Duboi and Dubois) **

Obesity may affect the way drugs are handled / metabolised

  • increase blood volume (decreased steady state concentration)
  • increase in lean body mass
  • increase in organ size
  • increase phase 2 metabolism in liver
  • increase GFR
88
Q

Specific side effects of bleomycin

A

pulmonary fibrosis

89
Q

Specific side effects of gemcitabine

A

pneumonitis

90
Q

Specific side effects of anthracyclines

A

cardiac toxicity

91
Q

Specific side effects of cisplatin:

A

hearing loss

92
Q

Peripheral neuropathy quite common with what class of chemotherapy :

A

Taxanes

93
Q

What genetic deficiency in 5-FU toxicity can lead to significant mucositis, diarrhoea, extreme fatigue and dehydration

A

DPD deficiency

94
Q

What mutation results in loss of drug function of cetuximab in the treatment of colorectal cancer:

A

KRAS mutation
- people with colorectal cancer with a RAS mutation will not respond to treatment even if treated with it
- cetuximab cannot bind !

95
Q

Patients with BRCA mutation tend to respond well to what drug?

A

carboplatin

96
Q

How do PARP inhibitors work?

A
  • prevent cell DNA from repairing itself
    • e.g. Olaraparib
97
Q

What kind of receptors are quite active in melanoma and can be targeted with immunotherapy:

A

BRAF

98
Q

Name the type of cancer which develops in the glands that line your organs:

A

adenocarcinoma
- produce mucin
- mucin is a protein produced by epithelial cells

99
Q

Molecular tests in routine use for breast cancer

A
  • ER
  • PR
  • HER-2
100
Q
A
101
Q
A
102
Q
A
103
Q
A

Y4 - Finals Edition (40 decks)

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