oncology 1

Question 1

spinal cord compression symptoms

Answer 1

pain in spine
worse on coughing and straining
radicular pain - band like burning pain sometimes with hypersensitivity - precedes weakness
weakness, sensory changes, retention, constipation

Question 2

ix for spinal cord compression

Answer 2

MRI

Question 3

immediate management for spinal cord compression

Answer 3

dexa 16mg IV followed by 8mg PO BD at breakfast and lunch time to reduce vasogenic oedema

Question 4

surgery for spinal cord compression

Answer 4

single vertebral involvement 
no evidence of widespread mets
radio resistant primary - renal, sarcoma
prev RT ot site
unknown primary - get tissue

Question 5

radiotherapy for spinal cord compression

chemo

Answer 5

px supine

lymphoma, teratoma, SCLC maybe

Question 6

superior vena cava obstruction symptoms

Answer 6

swelling of face neck one or both arms (one arm suggests more distal)
distended veins
SOB
headache
lethargy 
in advanced - injected conjunctiva
sedation

Question 7

cause of SVCO from within

without

Answer 7

clot (DVT) - fast onset
foreign body
tumour in vessel - renal cancer

extrinsic compression from mass

Question 8

ix for SVCO

Answer 8

CXR (mass)
venogram (clot)
CT chest

Question 9

clot treatment SVCO

Answer 9

thrombolyse - alteplase

anti coag LMWH/warfarin

Question 10

for extrinsic compression SVCO

Answer 10

chemo for SCLC, lymphoma, teratoma
radio for malignancy causes
stent - rapid relief of symp but doesn’t treat cause

Question 11

SVCO may be partially treated by

Answer 11

interventional radiologists

Question 12

hypercalcaemia causes

Answer 12

humeral - often mediated PTH1P
local bone destruction - lung, breast, myeloma
tumour production of Vitae’s D analogues - esp lymphoma

Question 13

hypercalcaemia symptoms

Answer 13

nausea, anorexia, thirst, polydipsia, polyuria, constipated, confused, poor concentration, drowsy

Question 14

ix for hypercalcaemia

Answer 14

albumin to correct calcium
Yes to look for dehydration
phosphate decreased in hyperparathyroidism
no known malignancy - myeloma screen

Question 15

treatment of hypercalcaemia

Answer 15

IV saline to rehydrate
bisphosphonaes 60-90mg Pamidronate IV over 2 hours, make sure rehydrated first as can cause renal failure, takes 1w to work
systemic management of malignancy

Question 16

pericardial effusion causes

Answer 16

malignant, trauma, infection, post MI, CTD SLE RA, drugs hydrazine isoniazide, uraemia

Question 17

malignant pericardial tamponade

Answer 17

primary SOB, fatigue, palpitations, pericarditis symptoms,

Question 18

ix for pericardial tamponae

Answer 18

CXR, ECG, ECHO, cytology of pericardial fluid

Question 19

treatment for pericardial tamponade

Answer 19

pericardiocentesis, pericardial window, systemic treatment of malignancy

Question 20

pulmonary embolism symptoms

Answer 20

acute SOB increased RR increased HR decreased CO2 pleuritic chest pain unilateral leg swelling

Question 21

PE ix

rx

Answer 21

CTPA ABG sats ECG bloods

supportive, anti coag cancer px 6 months

Question 22

patient with cancer and PE risk

Answer 22

increased by recent surgery

Question 23

morphine breakthrough

Answer 23

1/6th of total daily dose

Question 24

convert morphine to syringe driver

Answer 24

half total dose

Question 25

100mg of codeine

Answer 25

10mg of morphine