Long term conditions including cancer

Question 1

5 most common UK cancers?

Answer 1

1-Breast
2-Prostate
3-Lung
4-Bowel
5-melanoma skin cancer

Question 2

5 most common UK cancers in males?

Answer 2

1-prostate
2-lung
3-bowel
4-head and neck
5-melanoma

Question 3

5 most common UK cancers in females?

Answer 3

1-breast
2-lung
3-bowel
4-uterus
5-melanoma

Question 4

1st line investigations in patients presenting with fatigue/tiredness?

Answer 4

FBC
U+Es
LFTs
inflammatory markers
HbA1c
TFTs
coeliac serology-IgA TTG

Question 5

Management options provided by a CFS service?

Answer 5

CBT +/- graded exercise therapy

Question 6

In managing tiredness in primary care how long should patients be recommended to limit rest periods to?

Answer 6

30 minutes at a time

Question 7

Proportion of cancers which are preventable through changes in behaviour?

Answer 7

40% (4 in 10)

Question 8

Risk of cancer if referred via 2ww pathway?

Answer 8

3% (PPV)

Question 9

When should a very urgent (within 48 hours) protein electrophoresis and Bence Jones protein urine test be offered?

Answer 9

in people aged 60 and over with hypercalcaemia or leukopenia and a presentation that is consistent with possible myeloma

Question 10

Definition of patients who are malnourished?

Answer 10

• BMI less than 18.5
• Unintentional weight loss of greater than 10% in last 3-6 months
• BMI less than 20 and unintentional weight loss greater than 5% in last 3-6 months

Question 11

Which patients are at risk of malnutrition and nutritional support should be considered?

Answer 11

• eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for 5 days or longer
• a poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs e.g. due to catabolism.

Question 12

Patients at high risk of refeeding?

Answer 12

1 or more of:
-BMI less than 16
-unintentional weight loss more than 15% in last 3-6 months
-little/no nutritional intake for more than 10 days
-low potassium/phosphate/magnesium prior to feeding
OR
2 or more of:
-BMI less than 18.5
-unintentional weight loss greater than 10% in last 3-6 months
-little/no nutritional intake for more than 5 days
-hx of alcohol abuse or drugs including insulin, chemotherapy, antacids or diuretics

Question 13

If starting nutritional support, what is the usual aim for total energy intake?

Answer 13

• 25-35 kcal/kg/day
• 30-35ml fluid/kg

if high risk of refeeding consider starting at 10kcal/kg/day, or even 5 if very high risk e.g. BMI less than 14.

Question 14

How long after insertion if no complications can PEG tubes be used for feeding?

Answer 14

after 4 hours

Question 15

5 most common causes of cancer death in UK?

Answer 15

1) lung
2) bowel
3) prostate
4) breast
5) cancer of unknown primary

Question 16

5 most common causes of cancer death in males?

Answer 16

1) lung
2) prostate
3) bowel
4) oesophagus
5) pancreas

Question 17

5 most common causes of cancer death in females?

Answer 17

1) lung
2) breast
3) bowel
4) cancer of unknown primary
5) pancreas

Question 18

Following an abnormal bowel cancer screening result how many patients will have bowel cancer at colonoscopy?

Answer 18

10%

8% of women and 12-15% of men

Question 19

Most prevalent morbidity?

Answer 19

HTN

followed by depression/anxiety, chronic pain, hearing loss and IBS.

Question 20

How should frailty be assessed?

Answer 20

1 of the following:

• informal assessment of gait speed e.g. time taken to answer the door
• formal assessment of gait speed-frailty indicated by taking more than 5s to walk 4 metres
• self reported health status-person asked to rate their health on scale of 0-10, score of 6 or less indicates frailty
• PRISMA-7 questionnaire-3 or more positive responses to the questions indicates need for further clinical review.