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Year 6 > Onco and palliation > Flashcards

Onco and palliation Flashcards

1
Q

Lynch Syndrome: mutation

A

MLH1/MSH2

DNA mismatch repair genes

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1
Q

FAMILIAL ADENOMATOSIS POLYPOSIS COLI: mutation and mode of inheritance

A

APC

autosomal dominant

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2
Q

Retinoblastoma: mutation

A

Retinoblastoma (Rb) gene

germline mutation

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3
Q

Li Fraumeni syndrome: mutation and mode of inheritance

A

p53 suppressor gene

rare autosomal dominant

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4
Q

which cancers does Li Fraumeni syndrome increase the risk of? [4]

A

It leads to an increased risk of sarcoma and cancer of the breast, brain and adrenal glands.

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5
Q

MEN1 syndrome: where are the tumours

A

pituitary
parathyroid
pancreas

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6
Q

MEN2a syndrome: mutation and where are the tumours

A

RET oncogene

medullary thyroid
parathyroid
phaechromocytoma

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7
Q

MEN2b syndrome: mutation and where are the tumours

A

RET oncogene

medullary thyroid
mucosal neuroma
phaechromocytoma

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8
Q

what fraction of their daily opioid analgesia should be used as the breakthrough dose

A

1/6 to 1/10

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9
Q

which pain relief is appropriate for end of life for the renally impaired

A

alfentanyl

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10
Q

what three medications can be given for breathless in end of life

A

oxygen
morphine
midazolam

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11
Q

which medications can be given for nausea and vomiting in end of life [4]

A

levomepromazine
haloperidol
metoclopramide
cyclizine

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12
Q

which medications can be given for restlessness in end of life [3]

A

midazolam
levomepromazine
haloperidol

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13
Q

which medications can be given for respiratory tract secretions in end of life [3]

A

glycopyrronium
hyoscine hydrobromide
hyoscine butyl bromide

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14
Q

which anti emetic is most appropriate for chemotherapy related N&V

A

5HT3 antagonist e.g. ondansetron

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15
Q

what is an advantage of buprenorphine patches

A

does not accumulate in the renally impaired

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16
Q

Describe the meds used in the WHO pain ladder

A

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

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17
Q

What is the most likely infective organism from an indwelling line?

A

Staph epidermis

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18
Q

most common symptom in SVC obstruction

A

dyspnoea

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19
Q

which cancer is most likely to cause SVC obstruction

A

small cell lung cancer particuarly right upper lobe

other: thymoma, lymphoma, mediastinal mass

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20
Q

what are the treatment options for SVC obstruction [3]

A

give dexamethasone
SVC stenting
treat the underlying cancer

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21
Q

features of SVC obstruction

A

dyspnoea
headache
facial plethora
distended neck veins e.g. pulseless JV
conjunctival and periorbital oedema
papilloedema, visual disturbance
swelling of face, neck and arms

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22
Q

where in the lung field are adenocarcinomas found?

A

peripheral

bronchoscopy turns out to be normal

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23
Q

how is agitation or restless in terminal illness treated?

A

midazolam

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24
Q

which lung cancer has the strongest association with smoking

A

squamous cell carcinoma

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25
Q

where are squamous cell lung cancer tumours most commonly found in the lung field

A

central near the large airways

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26
Q

which paraneoplastic syndromes are associated with squamous cell carcinomas

A

PTHrp related hypercalcaemia
HPOA

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27
Q

which opioids are appropriate for pain relief in the severely renally impaired i.e. <10 eGFR [2]

A

buprenorphine
alfentanil
sublingual fentanyl

these are excreted by the liver

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28
Q

which opioids can be used in mild to moderate renal impairment (10-50 eGFR) but not severe impairment

A

oxycodone PO or IV

mostly excreted by liver but some done by the kidneys too

29
Q

what fraction of the daily morphine dose should daily breakthrough dose be

A

one sixth

30
Q

what should be co-prescribed for all patients alongside opioids

A

laxatives

31
Q

what is the conversion from

ORAL CODEINE TO ORAL MORPHINE

A

divide by 10

32
Q

what is the conversion from

ORAL TRAMADOL TO ORAL MORPHINE

A

divide by 10

33
Q

what is the conversion from

ORAL MORPHINE TO ORAL OXYCODONE

A

divide by 1.5-2

34
Q

how is oxycodone tolerated compared to morphine in terms of side effects

A

Oxycodone generally causes less sedation, vomiting and pruritis than morphine but more constipation

35
Q

what is the conversion from

ORAL MORPHINE TO SC MORPHINE

A

divide by 2

36
Q

what is the conversion from

ORAL MORPHINE TO SC DIAMORPHINE

A

divide by 3

37
Q

what is the conversion from

ORAL OXYCODONE TO SC DIAMORPHINE

A

divide by 1.5

38
Q

what are the four options for treating metastatic bone related pain

A

strong opioids
bisphosphonates
radiotherapy
denosumab

39
Q

which cancer metastasises and present as sclerotic lesions on the spine

A

prostate

40
Q

three features of metastatic bone pain

A

pathological fractures
hypercalcaemia
raised ALP

41
Q

best anti-emetic for intracranial causes

A

cyclizine

42
Q

best anti-emetic for chemotherapy related nausea

A

ondansetron

43
Q

best anti emetic for anticipatory nausea

A

lorazepam

44
Q

best anti-emetic for vestibular causes of nausea

A

cyclizine

45
Q

best anti-emetic for GI causes of nausea [2]

A

metoclopramide and domperidone

46
Q

which opioid is contraindicated in the renally impaired

A

morphine

as it can accumulate and cause toxicity

47
Q

Most common tumour causing bone metastases (in descending order)

A

prostate
breast
lung

48
Q

Most common site (in descending order) for bone mets

A

spine
pelvis
ribs
skull
long bones

49
Q

MoA of metoclopramide

A

D2 receptor antagonist

50
Q

MoA of ondansetron

A

5HT3 antagonist

51
Q

tumour marker for breast cancer

A

CA15-3

52
Q

tumour marker for prostate cancer

A

PSA

53
Q

tumour marker for pancreatic cancer

A

CA19-9

54
Q

tumour marker for ovarian cancer

A

CA125

55
Q

which cancers is AFP a tumour marker for [2]

A

hepatocellulr carcinoma, teratoma (germ cell)

56
Q

tumour marker for colorectal cancer

A

CEA

57
Q

tumour marker S-100 is for?

A

melanoma and schwannomas

58
Q

tumour marker bombesin is for?

three cancers

A

Small cell lung carcinoma
gastric cancer
neuroblastoma

59
Q

signs of morphine toxicity

who can this occur in?

A

reduced conscious level
slow respiratory rate
myoclonic jerks
pinpoint pupils

in the renally impaired

60
Q

how much oral morphine does a transdermal fentanyl 12 microgram patch equates to

A

30mg

61
Q

how much oral morphone does a transdermal buprenorphine 10 microgram patch equate

A

24mg

62
Q

what oral solution can be used for mouth pain

A

Benzydamine hydrochloride mouthwash or spray

63
Q

adverse effect of anthracyclines such as doxorubicin

A

cardiomyopathy

64
Q

adverse effect of Vincristine [2]

A

peripheral neuropathy and paralytic ileus

65
Q

adverse effect of docetaxel

A

neutropenia

66
Q

adverse effects of cisplatin [3]

A

Ototoxicity, peripheral neuropathy, hypomagnesaemia

67
Q

what investigation should be done for women with peritoneal malignancy or ascites

A

Ca125 looking for ovarian malignancy

68
Q

treatment of bowel colic

A

same as resp secretion

hyoscine or glycopyronnium

69
Q

which virus is associated with SCC of the oropharynx

A

HPV

Year 6 (19 decks)

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