Onco and palliation Flashcards
Lynch Syndrome: mutation
MLH1/MSH2
DNA mismatch repair genes
FAMILIAL ADENOMATOSIS POLYPOSIS COLI: mutation and mode of inheritance
APC
autosomal dominant
Retinoblastoma: mutation
Retinoblastoma (Rb) gene
germline mutation
Li Fraumeni syndrome: mutation and mode of inheritance
p53 suppressor gene
rare autosomal dominant
which cancers does Li Fraumeni syndrome increase the risk of? [4]
It leads to an increased risk of sarcoma and cancer of the breast, brain and adrenal glands.
MEN1 syndrome: where are the tumours
pituitary
parathyroid
pancreas
MEN2a syndrome: mutation and where are the tumours
RET oncogene
medullary thyroid
parathyroid
phaechromocytoma
MEN2b syndrome: mutation and where are the tumours
RET oncogene
medullary thyroid
mucosal neuroma
phaechromocytoma
what fraction of their daily opioid analgesia should be used as the breakthrough dose
1/6 to 1/10
which pain relief is appropriate for end of life for the renally impaired
alfentanyl
what three medications can be given for breathless in end of life
oxygen
morphine
midazolam
which medications can be given for nausea and vomiting in end of life [4]
levomepromazine
haloperidol
metoclopramide
cyclizine
which medications can be given for restlessness in end of life [3]
midazolam
levomepromazine
haloperidol
which medications can be given for respiratory tract secretions in end of life [3]
glycopyrronium
hyoscine hydrobromide
hyoscine butyl bromide
which anti emetic is most appropriate for chemotherapy related N&V
5HT3 antagonist e.g. ondansetron
what is an advantage of buprenorphine patches
does not accumulate in the renally impaired
Describe the meds used in the WHO pain ladder
Step 1: Non-opioid medications e.g. Paracetamol and NSAIDs
Step 2: Weak opioids e.g. codeine and tramadol
Step 3: Strong opioids e.g. morphine, oxycodone, fentanyl and buprenorphine
What is the most likely infective organism from an indwelling line?
Staph epidermis
most common symptom in SVC obstruction
dyspnoea
which cancer is most likely to cause SVC obstruction
small cell lung cancer particuarly right upper lobe
other: thymoma, lymphoma, mediastinal mass
what are the treatment options for SVC obstruction [3]
give dexamethasone
SVC stenting
treat the underlying cancer
features of SVC obstruction
dyspnoea
headache
facial plethora
distended neck veins e.g. pulseless JV
conjunctival and periorbital oedema
papilloedema, visual disturbance
swelling of face, neck and arms
where in the lung field are adenocarcinomas found?
peripheral
bronchoscopy turns out to be normal
how is agitation or restless in terminal illness treated?
midazolam
which lung cancer has the strongest association with smoking
squamous cell carcinoma
where are squamous cell lung cancer tumours most commonly found in the lung field
central near the large airways
which paraneoplastic syndromes are associated with squamous cell carcinomas
PTHrp related hypercalcaemia
HPOA
which opioids are appropriate for pain relief in the severely renally impaired i.e. <10 eGFR [2]
buprenorphine
alfentanil
sublingual fentanyl
these are excreted by the liver
which opioids can be used in mild to moderate renal impairment (10-50 eGFR) but not severe impairment
oxycodone PO or IV
mostly excreted by liver but some done by the kidneys too
what fraction of the daily morphine dose should daily breakthrough dose be
one sixth
what should be co-prescribed for all patients alongside opioids
laxatives
what is the conversion from
ORAL CODEINE TO ORAL MORPHINE
divide by 10
what is the conversion from
ORAL TRAMADOL TO ORAL MORPHINE
divide by 10
what is the conversion from
ORAL MORPHINE TO ORAL OXYCODONE
divide by 1.5-2
how is oxycodone tolerated compared to morphine in terms of side effects
Oxycodone generally causes less sedation, vomiting and pruritis than morphine but more constipation
what is the conversion from
ORAL MORPHINE TO SC MORPHINE
divide by 2
what is the conversion from
ORAL MORPHINE TO SC DIAMORPHINE
divide by 3
what is the conversion from
ORAL OXYCODONE TO SC DIAMORPHINE
divide by 1.5
what are the four options for treating metastatic bone related pain
strong opioids
bisphosphonates
radiotherapy
denosumab
which cancer metastasises and present as sclerotic lesions on the spine
prostate
three features of metastatic bone pain
pathological fractures
hypercalcaemia
raised ALP
best anti-emetic for intracranial causes
cyclizine
best anti-emetic for chemotherapy related nausea
ondansetron
best anti emetic for anticipatory nausea
lorazepam
best anti-emetic for vestibular causes of nausea
cyclizine
best anti-emetic for GI causes of nausea [2]
metoclopramide and domperidone
which opioid is contraindicated in the renally impaired
morphine
as it can accumulate and cause toxicity
Most common tumour causing bone metastases (in descending order)
prostate
breast
lung
Most common site (in descending order) for bone mets
spine
pelvis
ribs
skull
long bones
MoA of metoclopramide
D2 receptor antagonist
MoA of ondansetron
5HT3 antagonist
tumour marker for breast cancer
CA15-3
tumour marker for prostate cancer
PSA
tumour marker for pancreatic cancer
CA19-9
tumour marker for ovarian cancer
CA125
which cancers is AFP a tumour marker for [2]
hepatocellulr carcinoma, teratoma (germ cell)
tumour marker for colorectal cancer
CEA
tumour marker S-100 is for?
melanoma and schwannomas
tumour marker bombesin is for?
three cancers
Small cell lung carcinoma
gastric cancer
neuroblastoma
signs of morphine toxicity
who can this occur in?
reduced conscious level
slow respiratory rate
myoclonic jerks
pinpoint pupils
in the renally impaired
how much oral morphine does a transdermal fentanyl 12 microgram patch equates to
30mg
how much oral morphone does a transdermal buprenorphine 10 microgram patch equate
24mg
what oral solution can be used for mouth pain
Benzydamine hydrochloride mouthwash or spray
adverse effect of anthracyclines such as doxorubicin
cardiomyopathy
adverse effect of Vincristine [2]
peripheral neuropathy and paralytic ileus
adverse effect of docetaxel
neutropenia
adverse effects of cisplatin [3]
Ototoxicity, peripheral neuropathy, hypomagnesaemia
what investigation should be done for women with peritoneal malignancy or ascites
Ca125 looking for ovarian malignancy
treatment of bowel colic
same as resp secretion
hyoscine or glycopyronnium
which virus is associated with SCC of the oropharynx
HPV
