Oncological complications and treatment

Question 1

What are the medical complications of N+V

Answer 1

Dehydration
Electrolyte disturbances
Risk of aspiration pneumonia

Question 2

Define acute nausea and vomiting from chemo

Answer 2

Within 24 hours of receiving chemo

Question 3

Define delayed nausea and vomiting with chemo

Answer 3

24 hours to 7 days post chemo

Question 4

What is the most effective way of controlling post chemo nausea and vomiting?

Answer 4

NK1 antagonist
5Ht3 antagonist
Dexamethasone

Combination of all is best

Question 5

Where in the brain is the chemo receptor trigger zone

Answer 5

Area postrema

Question 6

What drug is most effective for acute vomiting

Answer 6

5HT3 antagonist (ondansetron or granisetron)

Question 7

What is anticipatory n+v and how do you treat it

Answer 7

Conditioned response to sights and smells

Lorazepam good treatment

Question 8

Which antiemetic constipate and what would you use instead

Answer 8

Ondansetron and cyclisine constipate so use metoclopramide instead

Question 9

Which opioid would you use in renal impairment

Answer 9

Fentanyl

Question 10

Codeine is what of morphine

Answer 10

1/10

Question 11

Tramadol is what of morphine

Answer 11

1/10th to 1/5th

Question 12

Oxycodone is what of morphine

Answer 12

Double the strength

Question 13

Hydro morphone is how many times stronger than morphine

Answer 13

7.5

Question 14

Methadone is how many times stronger than morphine

Answer 14

10

Question 15

How can you treat myoclonus as a result of opioids

Answer 15

Benzos

Question 16

What is good for bone pain

Answer 16

NSAIDS

Question 17

What is good for pain relief which will stimulate appetite

Answer 17

Corticosteroids

Question 18

What is good for neuropathic pain?

Answer 18

TCAs/ amitriptylline

Question 19

What is the most common metabolic oncology emergency

Answer 19

Hypercalcaemia >2.5mmol/l

Question 20

How does hypercalcaemia present

Answer 20

Dehydration 
Constipation 
Seizure
Weakness 
Myopathy 
Ecg changes 
Polyuria

Question 21

Treat hypercalcaemia

Answer 21

2.5-4 litres of saline in 24 hours

Bisphosphonates (IV panidronate)

Question 22

Why does SIADH occur in oncology

Answer 22

Chemo or small cell lung cancer

Question 23

What is the main sign on bloods of SIADH

Answer 23

<133 mol

Question 24

What’s the criteria for SIADH

Answer 24

Normovolaemia
Normal renal adrenal and thyroid function
Urine osmolalityb>100
Urine Na>30
No drugs causing hyponatraemia
Improvement of Na following water restriction

Question 25

Treat SIADH

Answer 25

Fluid restrict Treat cancer Demeclocycline

Question 26

Radicalar pain in oncology means

Answer 26

Cord compression

Question 27

What’s revthe urgent signs of cord compression

Answer 27

Loss of bowel or bladder control Severe or increasing numbness Severe pain and weakness that spreads into one or both legs making it hard to walk or get out of a chair

Question 28

What are the main symptoms of malignant pericardial effusion

Answer 28

Becks triad

Question 29

What are the symptoms of SVC obstruction

Answer 29

``` Dyspnoea Headache Facial oedema Venous distension Light headed Cough ```

Question 30

What is the main aim of investigations in SVC obstruction

Answer 30

To distinguish whether the blockage from within (clot; foreign body like in dwelling catheter; tumour in vessel like renal cancer) or out with and compression from mass like lung cancer or lymphoma

Question 31

How do you treat SVC obstruction

Answer 31

Stenting or thrombolysiswif clot

Question 32

What is the definition of neutropenia sepsis

Answer 32

Sepsis and neutrophils <0.5 (or <1 if chemo given within last 21 days) Check for neutropenia sepsis if had recently chemo and a fever >38

Question 33

What may mask a temp spike

Answer 33

Steroids

Question 34

67% of organisms causing neutropenia fever and gram what

Answer 34

Negative

Question 35

Peripheral lines may become infected by what organisms

Answer 35

Staph aureus | Coag neg staph

Question 36

Which abx in neutropenia sepsis

Answer 36

IV tazocin plus or minus gentamicin

Question 37

If neutropenia sepsis and pen allergy give

Answer 37

Teicoplanin and aztreonam

Question 38

What is pancoast syndrome?

Answer 38

Apical Lung ca and ipsilateral horners (miosis enophthalmos sunken eye ptosis and unilateral swelling

Question 39

What sort of lung cancer can be treated by radiotherapy

Answer 39

NSCLC

Question 40

What is the most common side effect of radiotherapy

Answer 40

Tiredness