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MRCP PART 1 > Onc / palliative > Flashcards

Onc / palliative Flashcards

1
Q

Side effect long term amiodarone

A

Hepato / pulm fibrosis
Hyper/Hypo thyroid
Corneal deposits
Pancreatitis
Long QT

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2
Q

supraclavicular fossa lymph node usually which tumour

A

Gastric
[Virchow’s node and

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3
Q

Infection assoc with 1/3 gastric tumours

A

H pylori

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4
Q

Metastatic gastic adenoma. What testing do you do? What is treatment if this is positive

A

HER2
[human epidermal growth factor receptor 2]

Trastuzumab

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5
Q

What is Zollinger-Ellison syndrome? Which syndrome are they linked to? Main symptoms ?

A

Gastrin secreting tumours -> gastric / duodenal ulceration
[Usually pancreatic in origin]

MEN1

Epigastric pain
Steatorrhoea (acid-related inactivation of digestive enzymes)
Diarrhoea - From acid secretion

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6
Q

Zollinger-Ellison syndrome - high serum gastrin levels and elevated basal gastric acid output.
Main Ix? 2 parts of medical RX?

A

Endoscopy + CT

High dose PPI
Surgical resection ( in most)
chemo
Somatostatin analogues - Eg Ocretide to reduce gastric secretion and diarrhoea

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7
Q

acrocyanosis

A

Blue discolouration of hands - especially when in cold

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8
Q

Poikilocytosis

A

Abnormal shape RBCs (making up >10%)

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9
Q

What is cryoglobulinemia? Conditions assoc? Ix?

A

abnormal blood proteins called cryoglobulins clump together at cold temperatures
Seen in myeloma / leukaemia / lymphoma
-Some infections too Eg HepC, HIV, toxoplasmosis, EBV, malaria

Incubate serum at 4°C

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10
Q

Some less common cancer markers…

Neurone specific enolase NSE

A

Small cell lung Ca
Neuroblastoma

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11
Q

Some less common cancer markers…

HCG

A

Testis

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12
Q

Some less common cancer markers…

Calcitonin

A

Medullary thyroid

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13
Q

Some less common cancer markers…

Parathormone

A

Parathyroid

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14
Q

Some less common cancer markers…

IgG, IgA, IgM, IgE

A

Multiple myeloma

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15
Q

Some less common cancer markers…

AFP - name 2

A

Liver
Testis
Yolk sac

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16
Q

Some less common cancer markers…
Ca 15-3

A

Breast
Bowel
Lung

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17
Q

how does late chemo toxicity usually present

A

Peripheral neuropathy
Ototoxicity

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18
Q

why do 5% of testis Ca have gynaecomastia

A

Tumour secretes HCG

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19
Q

Enzyme sometimes used for seminoma marker

A

PLAP
Placental alkaline phosphatase

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20
Q

2 main classes of testis Ca

A

-Seminoma

-Non-semonomas germ cell tumour (NSGCT)
Eg Yolk sac, teratoma, choriocarcinoma, embryonal

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21
Q

80% cure of testis Ca with orchidectomy.
What is offered to reduce the risk of relapse

A

Single dose carboplatin

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22
Q

Who gets resection of HCC? Transplant?

A

Need Childs-pugh class A for resection
[still 20% operative mortality]

Transplant
-Single tumour <5cm with no metastatic spread
-AFP <1000iu/ml

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23
Q

Which lung Ca usually has Mets at presentation

A

Small cell

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24
Q

Which lung Ca is usually more peripheral

A

Adenocarcinoma

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25
Q

General differentiation between lung mets and primary lung Ca on CT

A

Primary - soft tissue mass with irregular borders

Met - smooth and rounded

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26
Q

Paraneoplastic syndromes which lung Ca ?

Hypovolaemic hyponatraemia
Raised ACTH
Hyper Ca
Gynaecomastia
Hyperthyroid
Lambert-eaton
Hypertrophic pulmonary osteoarthropathy

A

Hypovolaemic hyponatraemia - SIADH = small cell

Raised ACTH - Small cell

Hyper Ca - Squamous - from bony mets [rarely produces PTH too)

Gynaecomastia - Large cell (large breasts) and adenocarcinoma

Hyperthyroid - Squamous (produces TSH)

Lambert-eaton - Small cell

Hypertrophic pulmonary osteoarthropathy - Adenocarcinoma

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27
Q

What is lambert eaton? How is it differentiated from myasthenia gravis

A

Paraneoplastic from small cell

-> proximal myopathy

Weakness improves with repetitive movements

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28
Q

What is Hypertrophic pulmonary osteoarthropathy

A

Paraneoplastic from lung adenocarcinoma (and rarely small cell)

Osteitis, Gross finger clubbing, and arthritis
Long bones usually affected

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29
Q

What is pancoast found? Where does it affect? Sx?
On CXR

A

Non small cell [in superior sulcus]

Affects C8 nerve root -> pain down arm
-may get hand muscle wasting
- Horners syndrome

CXR - shadow at apex + possible destruction of 1st/2nd ribs

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30
Q

Most common causes of fever (when neutropenic)

A

60% Gram positive - staph epi / strep viridans

30% gram neg - E coli, klebsiella, pseudomonas

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31
Q

Roll of MENSA in chemo

A

To prevent haemorrhagic cystis

[given with some chemo drugs (cyclophosphamide/ifosfamide) to protect bladder]

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32
Q

A and C fibres in pain

A

A - Acute
C - slower - chronic pain

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33
Q

Colorectal and endometrial cancer as a pair often in?

A

HNPCC

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34
Q

B symptoms hodgkins

A

Fevers
Night sweats
Weight loss

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35
Q

Main side effects of hyoscine

A

Anticolinergic

-> Tachycardia, dry mouth, urinary retention

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36
Q

When might you think colorectal ca is more likely HNPCC than sporadic

A

Young <45
Second cancer eg endometrial
Usually proximal colon
Strong family Hx

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37
Q

NHS bowel screening in who

A

60-74 every 2 years

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38
Q

Diagnosis of SIADH

A

Concentrated urine Na >20
HypoNatraemia <125
High osmolality

NO hypovolaemia, diuretics or oedema/ascities

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39
Q

What is demeclocycline used for

A

SIADH

->Blocks ADH and causes partial nephrogenic diabetes insipidus

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40
Q

Paraneoplastic cerebella degeneration is in tumours of breast, ovarian, fallopian tube… What is the antibody found

A

Anti-yo

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41
Q

Anti Hu found in

A

Small cell lung ca

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42
Q

Anti-ro

A

SLE

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43
Q

Anti-Tr

A

Hodgkins lymphoma

[The reed cells]

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44
Q

Anti zic4

A

small cell lung ca

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45
Q

Gabapentin mechanism

A

Blocks a2d receptor

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46
Q

Pt lacks capacity and has no NOK. Who is best to contact re DNACPR decision

A

Independent mental health advocate

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47
Q

Pt treated with doxorubicin (chemo) then develops cardiac failure several months later what has happened

A

Chemo induced cardiomyopathy
->biventricular failure

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48
Q

Genetic risk factor for breast Ca (not BRCA ?
Other risks

A

BRCA 1 and 2, TP53
COCP, HRT
Early menarche, late menopause, nulliparity

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49
Q

In order, what are the 2 most common met sites from breast Ca

A

Bones
Lungs

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50
Q

What should be given after resection of breast Ca

A

Tamoxifen

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51
Q

When would you get a mastectomy in breast Ca

A

> 4cm
multifocal
central

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52
Q

ER and HER2 status in Breast Ca prognosis?

A

ER +ve = better prognosis
HER2 = Poorer prognosis

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53
Q

Tachycardia, flushing, bronchoconstriction, diarrhoea, CV instability = ?
ix?

A

Carcinoid syndrome
5-HAI

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54
Q

Cancer with bone mets + anaemia. What would be seen on blood film

A

Leukoerythroblastic blood film

(nucleated erythrocytes and immature white cells of the neutrophilic myeloid series.)

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55
Q

Prostate Ca are adenocarciomas which area of prostate do they usually arise? BPH?

A

Peipheral zone
BPH is in transition zone
[Transition into old age]

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56
Q

What is the roll of LH agonists in prostate Ca ? Side effects? Eg?

A

Act on pit -> reduce LH secretion
-> Leydig cells in testes produce less testosterone

Loss of libido, flushing, malaise

Goserelin, buserelin, gonadorelin, leuprolide, nafarelin.
[-relin]

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57
Q

what is cyproterone acetate / flutamide / biclatumide

A

Anti androgen used in Protstate Ca

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58
Q

Main risks causing thyroid Ca

A

Radiation
MEN2
BRAF gene

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59
Q

What is most common type of thyroid cancer? Which gene is this linked to - not part of multi-ca syndromes?

A

Papilliary

BRAF

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60
Q

Which thyroid Ca in MEN2? produces what ? Diagnosis of MEN2 ?

A

Medullary
Calcitonin

RET- proto oncogene test

61
Q

Rash over lots of areas, muscle weakness + something in history about Ca Eg Weight loss and bloating =

A

Dermatomyositis
From ovarian/pancreas/breast and lung.

Dont get thrown by rash and go for SLE …

62
Q

Most common location for thyroid Ca mets to

A

lung
then bone

63
Q

Genetic condition very closely assoc with RCCs

A

Von hipple lindau

64
Q

How do RCCs present

A

Painless haematuria
May have varicocoele from obstructed veonous drainage

65
Q

Why dex in tumour pain Eg liver

A

Reduce oedema

66
Q

Bar 5HAII what is senstitive marker of carcinoid

A

Chromogranin A

67
Q

Differentiation on exam of serotonin syndrome vs NMS

A

Serotonin
-Develops over 24hrs
-Clonus clonus clonus
-Agitation and sweating

NMS
-Develops over days / weeks
- Rigidity and bradyreflexia

68
Q

2 main pharma options for seritonin syndrome

A

Cryptoheptadine
Propranolol

MAIN RX IS TO COOL THEM DOWN

69
Q

Clin trials stages are for what
1
2
3
4

A

1 - Pharmacokinetics + toxicity
2- measure effects of drug
3- Compare to conventional therapy
4- Long term toxicity

70
Q

Chemo drugs side effects TOXMAN

A

C (ears) - Cisplatin carboplatin -> Ototoxicity

T (eyes) - Tamoxifen
->Reduced acuity

B (lungs) - bleomycin, bulsupham
->Fibrosis

D with T (heart) - Doxorubicin
Tratasizumab
-> cardiac

M liver - methotrexate
Liver toxiticy

C - kidney. Cisplatin and carbocystine

O bladder (cycle) - cyclophosphamide - haemorrhage cystitis

V - Vincristine - peripheral neuropathy

5,6,MPH - Bone marrow suppression
5-fluorouracil
6-mercaptopurine
Methotrexate
Paclitaxel
Hydroxyurea

71
Q

How does SCC skin ca get about

A

Lymphatics

72
Q

Who can support a patient wishing to die at home? eg after big stroke

A

Mari curie nurses

73
Q

Who are the specialist dementia nurses for home visits

A

Admiral nurses

74
Q

Cancer nurses

A

Macmillan

75
Q

who arranges care in community for complex patients

A

Community matron

76
Q

Antiemetics receptors
Aprepitant
Domperidone
Metoclopramide
Ondansetron

A

Aprepitant - NK-1 receptor
[used for very emetogenic chemo regimes]

Domperidone/metoclopramide - Dopamine antagonist

Ondansetron - 5HT pathway

77
Q

Cisplatin mechanism

A

Causes cross linking of DNA to form adducts

78
Q

Fluorouracil mechanism

A

Inhibits protein synthesis

79
Q

Doxorubicin mechanism

A

topoisomerase inhibitor

dOxO - tOpO

80
Q

How long CPR if given fibrinolytic for known PE

A

60-90 mins

81
Q

Metastatic lung ca. Now tired, hypotensive and hyperK. What has happened

A

Adrenal mets -> hypoadrenalism

82
Q

Vomiting due to hyperCa - first line

A

Haloperidol

Ca ->D2 agonism
Haloperidol -> d2 antagonism

83
Q

Why is metoclopramide not recommended in young people

A

Acute dystonic reactions

84
Q

First line antiemetic for intracranial pathology

A

Cyclizine (+ dex if raised ICP)

85
Q

First line antiemetic for vestibular (movement related)

A

cyclizine

86
Q

First line antiemetic drug induced

A

haloperidol

87
Q

First line antiemetic pregnant

A

prochlorperazine

88
Q

First line antiemetic post op

A

droperidol and dex

or substitue ondansetron for either

89
Q

First line antiemetic nausea vomiting end of life

A

levomepromazine 6.25mg

90
Q

First line antiemetic obstructive bowel disorder end of life

A

hyoscine
then ocretide

91
Q

Cytarabine key side effect

A

irreversible cerebellar dysfunction

92
Q

What is given with paclitaxel ?

A

Dex and antihistamine as high rates of anaphylaxis

93
Q

What is meptazinol, when is it useful

A

partial mu opioid agonist.
Has a low risk of constipation

94
Q

Oral morphine to SC morphine? SC diamorphine

A

Half for SC
1/3 for diamorphine SC

95
Q

Haematuria, loin pain, HyperCa, renal mass, night sweats, varicocele

A

Clear cell renal Ca
(hypernephroma or renal adenocarcinoma)

96
Q

Von-hippel-lindau which tumours

A

Renal cell - often bilat
hemangioblastomas
Phaeos
Pancreatic neuroendocrine tumor.

97
Q

Superficial Bladder <2cm ca low risk Rx?
Superficial Bladder 2-3cm ca intermediate risk Rx?
Superficial Bladder ca >3cm HIGH risk

A

TURBT + Intravesical mitomycin C
TURBT + Intravesical mitomycin C (6 doses)
TURBT + intravesical BCG

98
Q

End of life IV hydration. Main issue? how often should they be examined

A

Overload
12hrly

99
Q

Na level in MRCP to cause seizures

A

<125

100
Q

Contraindication to metoclopramide

A

Bowel obstruction

(Congenital long QT and diagnosis of parkinsons are use with caution)

101
Q

Which antiemetic contraindicated in cardiac disease

A

domperidone

102
Q

Which antiemetics contraindicated in congenital long QT

A

Haloperidol and ondansetron

103
Q

name an acute phase protein

A

Ferritn

104
Q

Poor prognosis for breast Ca. High grade, positive lymph nodes. What about receptor status’ and age?

A

Progesterone/oestrogen negative status
HER2 positive
Age <40

All poor prognosis

105
Q

Risk of breast / ovarian Ca with BRCAs

A

BRCA1
70% Breast
30-60% Ovarian

BRCA2
55% breast
10-30% ovarian

106
Q

First line Ix for breast lump in <35

A

US as dense tissue

107
Q

Smoker chronic cough with neutrophils of 28. Normal platelets / Hb. Dx ?

A

paraneoplastic neutrophilia

(from Small cell lung Ca)

108
Q

Lung ca -> swelling of face, distended neck /upper arm vessels = ? Rx?

A

Superior vena cava syndrome

Stenting for immediate relief
Radiotherapy

109
Q

opiate induced constipation first line Rx

A

Senna
->lactulose / docusate

110
Q

Biggest cause of cancer death in women

A

lung ca

[breast Ca is most common Dx and second most death]

111
Q

Biggest cause of cancer death in men

A

Lung Ca

then Prostate

112
Q

Jaundice and painless enlargement of gall bladder. Where is Ca?

A

Ampulla of vata

[Gallbladder usually has pain]

113
Q

What is removed in whipples procedure

A

Gallbladder, head of pancreas and duodenum

114
Q

Rx of chronic pancreatitis related pain eg Cancer if already on high dose morphine

A

coeliac plexus block

115
Q

Imatinib used for what 2 cancers? Mechanism?

A

CML
GIST
[Both BCR-ABL translocation]

Tyrosine kinase inhibitor

116
Q

Small cell lung ca which chemo regime

A

cisplatin and etoposide

117
Q

Tumor lysis syndrome electrolytes

A

HyperK
HyperUrate
HyperPO4->HypoCa

118
Q

No capacity. No POA. Who can make a decision about surgery

A

Doctor performing the operation

119
Q

hypnagogic vs hypnapompic

A

Off to the land of gog
(when fall asleep = hypnagogic)

120
Q

Patient doesn’t want to know if they are dying can you tell them?

A

No

121
Q

Mutation of APML? which chromosome?
Key drug for Rx

A

retinoic-acid receptor alfa (RARa) mutation
t (15:17)

all-trans-retinoic acid [ATRA]

122
Q

Most common single place for neuro endocrine tumours (carcinoid)

A

Ileum

[somatostatin analogues (ocretide) key for symptom Rx]

123
Q

Most common single place for neuroendocrine tumours (carcinoid)

A

Ileum

[somatostatin analogues (octreotide) key for symptom Rx]

124
Q

Which thyroid cancer produces calcitonin

A

Medullary
c cells produce calcitonin

125
Q

Method of monitoring for recurrence of papillary/medullary thyroid Ca

A

Serum thyroglobulin levels

126
Q

What % thyroid Ca are papillary

A

85%

127
Q

What is R in tumour classification

A

R0 - no residual tumour
R1 - microscopic residual tumour
R2 - macroscopic residual tumour

128
Q

Quiet heart sounds and raised JVP which immediate Ix

A

Echo

129
Q

Risk factors for depression in palliative care
Which symptom?
Which blood finding?
Age?
PMH?

A

Pain
Hypercalcaemia
Young
Prev depression

130
Q

SOB end stage heart failure already on furosemide and morphine without clinical significant pulm oedema

A

Lorazepam

131
Q

Mycobacterium avium infection Rx

A

Ethambutol + rifabutin +clari/azithro

[macrolide + quinolone should be avoided due to risk of developing resistance]

132
Q

Bladder Ca that has invaded muscle rx? Which chemo in bladder cystectomy / metastatic disease

A

Radical cystectomy
+cysplatin chemo

133
Q

Where are glioblastomas found

A

Cerebral hemispheres - white matter

134
Q

Bone pain in metastatic breast Ca already on para/ibu/morphine

A

Bisphosphonates (usually IV zoledronate)

Bisphosphonates shown to improve bone pain and delay further mets

135
Q

Most common met to bone?

A

Bronchial

[Breast
Prostate]

136
Q

Classic chemo choice in Dukes colon ca

A

5-fluorouracil

137
Q

Weight loss lethargy nighsweats. Progressive kidney disease + proteinuria.
Green birefringence after congo red staining. Positive for lambda light chains?

A

Myeloma with renal amyloidosis

138
Q

NF2 most common tumour

A

Acoustic neuroma

139
Q

Most common lung Ca in non smokers

A

Adenocarcinoma

140
Q

What is the mutation that allows imatinib to work for GIST and CML?

A

Philadelphia
t (9:22)
[assoc with bcr-abl overexpression]

141
Q

Imatinib - what is it inhibitng when used for GIST

A

c-kit inhibitor

[bcr-abl TK inhibition in CML]

142
Q

fev1 requirement ability to tolerate pneumectomy

A

> 2L
[1.5L for lobectomy]

143
Q

Conversion of morphine to fentanyl patch

A

100mg oral morphine
25ug/hr fent

150mg
37ug fent

Approx dive by 4 and convert to ug/hr

144
Q

Subacute bowel obstruction in pal first line

A

Hyoscine

145
Q

Do you need to start senna with opiate analgesia in pal care

A

Yes according to NICE

146
Q

Cones and rods for dark / light vision? Retinitis pigmenosa has deficiency of what?

A

Rods - Dark
-Rhodopsin (night blindness)

Cones - light
[-Protein is coneopsin]

147
Q

What is the gold standards framework

A

For patients with life limiting conditions

148
Q

when fent over morphine

A

GFR <30

149
Q

Most common site for lymphoma that isnt lymp node

A

Upper gi - Stomach

MRCP PART 1 (22 decks)

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