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Z CBL's > Medicine D > Flashcards

Medicine D Flashcards

1
Q

Positive Coomb’s test with IgG indicates what?

A

Extravascular haemolysis

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2
Q

Treatment for DIC

A

Platelets, fresh frozen plasma, cryoprecipitate

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3
Q

Genetic abnormality in CML?

A

The 9:22 translocation (the Philadelphia chromosome)

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4
Q

Haemorrhagic cystitis on what chemo drug?

A

Cyclophosphamide

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5
Q

Indications for a syringe driver:

A
  1. Poor swallow
  2. Nausea and vomiting
  3. Reduced consciousness
  4. Requiring more than two doses of an injectable medication in 12 hours
  5. Impaired absorption by oral route e.g bowel obstruction.

Reassure does not equate to EOL or active dying.

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6
Q

What are the side effects of glycopuronium / hyoscine butylbromide?

A

Anti-cholinergics therefore:
1. Dry mouth / eyes
2. Urinary retention
3. Constipation

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7
Q

Management of breathlessness in palliative patients:

A
  1. Sit up
  2. Box breathing
  3. Fan on trigeminal nerve
  4. Oxygen / CPAP / BIPAP
  5. Morphine breakthrough dose
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8
Q

What cancers most commonly metstasise to the spine?

A

Breast, prostate, lung

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9
Q

How to manage MSCC?

A
  1. Lie the patient flat and contact the MSCC co-ordinator, complete the proforma.
  2. MRI whole spine
  3. Dexamethasone 16mg + ppi cover.
  4. Stop any NSAID’s and aspirin
  5. LMWH
  6. WHO analgesic ladder
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10
Q

MSCC OSCE

A

Practice it!

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11
Q

How to manage analgesia in MSCC if the WHO ladder has failed?

A

Bisphosphonates
Radiotherapy
Surgery

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12
Q

Side effects of radiotherapy for MSCC

A

External beam - effective at treating pain for 12months, but does not reduce mechanical pain which can progress to instability and vertebral collapse.

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13
Q

What should be co-prescribed with morphine / any opioid?

A

A laxative and consider an anti-emetic and

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14
Q

Other than an MRI what investigations are needed for a patient with MSCC?

A

Glucose - steroids can cause hyperglycemia (DKA)
LDH - associated with a poor prognosis
Unknown primary? - do a myeloma screen
Bladder scan

Obvs baseline bloods and do a PR

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15
Q

Management of a paracetamol overdose:

A

Management
activated charcoal if ingested < 1 hour ago
N-acetylcysteine (NAC)
liver transplantation

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16
Q

Benzodiazepine overdose management?

A

Flumazenil
The majority of overdoses are managed with supportive care only due to the risk of seizures with flumazenil. It is generally only used with severe or iatrogenic overdoses.

17
Q

Lithium overdose management

A

Management
mild-moderate toxicity may respond to volume resuscitation with normal saline
haemodialysis may be needed in severe toxicity
sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretionvvvv

18
Q

Heparin overdose

A

Protamine sulphate

19
Q

Beta-blocker overdose

A

Atropine
Glucagon used in resistant cases

20
Q

Risks and complications of syringe drivers:

A

Local reaction
Pump failure
Interference

21
Q

Causes of nausea and vomiting:

A
  1. Physiological - constipation, hepatomegaly, cough, raised ICP.
  2. Iatrogenic - Chemo, radiotherapy, opioids, abx.
  3. Metabolic - hypercalcemia, hyponatraemia, uraemia, liver failure, hyperkalaemia.
  4. Psychological - Anxiety, fear, fatigue.
22
Q

Principles of treating nausea and vomiting:

A
  1. Assess underlying cause - reverse if possible.
  2. Dietary alterations
  3. Non-drug measures: Hypnosis, acupressure, relaxation.

Medication!

23
Q

Summary of laxative prescribing:

A

Rectal = quicker result
Oral = patient preference

Stimulant - if reduced frequency of stool
Softener - if hard stools
Mixed - if both

Enema

24
Q

What interventions can improve a patients appetite in palliative care?

A

Trial of steroids
Management of a sore mouth e.g. candida
Accept this is a part of the EOL process

25
Q

How to classify neck lumps:

A

Benign congenital: Thyroglossal cyst, branchial cyst, dermoid cyst, teratoma.

Benign acquired: Infection (reactive), inflammatory (sarcoidosis, autoimmune, hematomas, lipomas, haemangiomas.

Malignant: Metastatic head and neck, lymphoma, thyroid cancers, salivary gland tumours.

26
Q

Reed sternberg cells =

A

Hodgkins lymphoma

27
Q

Investigating HL:

A

Bloods - normal panel + LDH and an autoimmune screen, virology screen including HIV, EBV and CMV.

28
Q

Skim staging for HL:

A

Staging is performed using the Ann Arbor staging system which is as follows:

  • Stage I: involvement of a single lymph node region or lymphoid structure (e.g. spleen, thymus), designated by the suffix ‘E’ if there is involvement of a single extranodal site
  • Stage II: involvement of two or more lymph node regions on the same side of the diaphragm or involvement of a lymph node region and an adjacent extranodal organ or site
  • Stage III: involvement of lymph node regions on both sides of the diaphragm
  • Stage IV: diffuse or disseminated involvement of one or more extralymphatic organs or tissues with or without associated lymph node involvement\
29
Q

What is Pel-Ebstein fever?

A

Fever for 1-2 weeks with an alternating afebrile period around one week.
- almost diagnostic of Hodgkin lymphoma.

30
Q

Diagnosis of hodgkin’s lymphoma?

A

Histology:
Excision biopsy is ideal but core biopsy under radiological guidance may be quicker.

  • biopsy should be immediate.
31
Q

Markers on HRS cells:

A

CD30+ CD15+ and CD20- on HRS cells are diagnostic.

32
Q

Radiologic inv for HL:

A
  1. X-ray for sob
  2. USG - core biopsy and splenomegaly
  3. CT and PET CT used for staging
33
Q

Treatments for HL:

A

Radiotherapy: IFRT, treats localised disease or SVCO.
Chemotherapy: 1st - ABVD, 2nd - BEACOPP
Chemo-immunotherapy - used for chemo resistant HL.
Stem cell transplant

34
Q

ABVD
- what is it and what for?

A

Chemotherapy for HL:
Doxorubicin
Bleomycin
Vinblastine
Dacarbazine

35
Q

IFRT

A

Involved-field radiation therapy (IFRT) is a term used for delivering radiation to only those areas of the body involved by lymphoma.

Z CBL's (7 decks)

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