MEN syndromes

Question 1

MEN 1 Syndrome

Answer 1

Causes neoplastic mutations of the pituitary, parathyroid and the pancreas. It is caused by mutations in the MEN1 gene.

Question 2

MEN 2A Syndrome

Answer 2

Caused by mutations within the RET oncogene. Results in medullary thyroid cancer, phaechromocytoma and parathyroid adenoma.

Question 3

MEN 2B Syndrome

Answer 3

Caused by mutations within the RET oncogene. Results in medullary thyroid cancer, phaechromocytoma, mucosal neuroma, gastro-intestinal complaints, craniosynostosis

Question 4

what two combination of drugs cause serotonin syndrome

Answer 4

SSRI taken with MDMA as increase serotonin activity in the brain

Question 5

features of serotonin syndrome

Answer 5

Mental status changes

Autonomic hyperactivity - g., sweating, palpitations, dry mouth, lightheadedness, upset stomach).

Neuromuscular abnormalities.

Question 6

FIT tests are offered every 2 years to men and women aged 60–74. Patients who receive a positive FIT result should then be offered

Answer 6

a colonoscopy. This is the first-line investigation as it allows both for visualisation of the colon with identification of malignant or premalignant lesions and for biopsies to be taken.

Question 7

what patient type would require urgent referral via oral cancer pathway

Answer 7

Patients with unexplained ulceration in the oral cavity lasting for more than 3 weeks should be referred under the suspected oral cancer pathway.

Question 8

what breast cancer treatment can cause vaginal spotting and why

Answer 8

Tamoxifen is a oestrogen antagonist, commonly indicated for ER+ positive breast cancers. However, it also works as an agonist on endometrial tissue which can result in endometrial proliferation and cause abnormal vaginal bleeding.

Question 9

oral morphine to SC divide by

Answer 9

2

Question 10

transfusion threshold

Answer 10

below 80 hb

Question 11

Non-seminoma germ cell tumour what raised marker

Answer 11

AFP

Question 12

causes of raised AFP

Answer 12

Hepatocellular carcinoma
Gastro-intestinal cancers
Metastatic Lung Cancer
Pregnant patients (particularly elevated if there are fetal neural tube defects)
Germ cell tumours

Question 12

causes of raised AFP

Answer 12

Hepatocellular carcinoma
Gastro-intestinal cancers
Metastatic Lung Cancer
Pregnant patients (particularly elevated if there are fetal neural tube defects)
Germ cell tumours

Question 13

best definitive form of treatment for FAP

Answer 13

Total proctocolectomy

Prophylactic removal of the large bowel is the best treatment available for familial adenomatous polyposis, which carries nearly a 100% risk of colorectal cancer by the age of 40 in untreated patients.

Question 14

Li Fraumeni syndrome

Answer 14

A rare autosomal dominant disorder. It is the result of germ line mutation of the p53 tumour suppressor gene. It leads to an increased risk of sarcoma and cancer of the breast, brain and adrenal glands.

Question 15

neutropenic sepsis first line

Answer 15

IV tazocin

Question 16

Transcoelomic spread

Answer 16

Transcoelomic spread refers to spread of a primary tumour through the peritoneal cavity and onto the surface of organs covered by the peritoneum. It is a relatively rare type of metastasis and is most commonly seen in ovarian carcinoma and mesothelioma.

Question 16

Transcoelomic spread

Answer 16

Transcoelomic spread refers to spread of a primary tumour through the peritoneal cavity and onto the surface of organs covered by the peritoneum. It is a relatively rare type of metastasis and is most commonly seen in ovarian carcinoma and mesothelioma.

Question 17

Canalicular spread

Answer 17

Some tumours, especially carcinomas, may metastasise along the anatomical canicular spaces, such as the bile ducts, airways, urinary tract and subarachnoid space.

Question 18

differntials of nausea and vomiting in oncology

Answer 18

Treatment: chemotherapy and radiotherapy
Progression of the disease: blockage (e.g. bowel obstruction)
Inner ear problems
Metabolic disturbance (uraemia, hypercalceamia, hyperuricaemia)
Infection
Anxiety
Anticipatory vomiting.

Question 19

first line pain relief in CKD

Answer 19

Alfentanil

This drug is first line in those with stage 4 or 5 chronic kidney disease. This is due to limited renal excretion of parent drug or metabolites.

Question 20

A 35 year old with a red and white patch in oral cavity

This would be consistent with erythroplakia or erythroleukoplakia and what should happen

Answer 20

needs referral via the oral cancer pathway.

Question 21

Patients at high risk of hepatocellular carcinoma (including those with alcoholic liver disease, hepatitis B, hepatitis C, haemochromatosis and alpha-1 antitrypsin deficiency) are offered how often screening and what

Answer 21

6–12 monthly screening with AFP (a tumour marker) and an abdominal ultrasound.

Question 22

Buprenorphine is a weak opiod where does it metabolise

Answer 22

not in kidney
in liver me thnks

Hydrophobic drugs, to be excreted, must undergo metabolic modification making them more polar. Hydrophilic drugs, on the other hand, can undergo excretion directly, without the need for metabolic changes to their molecular structures.