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Y4 Gen Med > Oncology > Flashcards

Oncology Flashcards

1
Q

What is radical treatment?

A

Treatment with curative intent

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2
Q

What is adjuvant and neo-adjuvant treatment?

A

Adjuvant after radical therapy to reduce risk of recurrence

Neo-adjuvant prior to radical Tx

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3
Q

What units is radiotherapy prescribed in?

A

Gray Gy

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4
Q

“Radiation implanted / inserted in patient to deliver a dose of radiotherapy to local tumour”

A

Brachytherapy

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5
Q

Is the staging system used for lymphoma?

A

Ann Arbor

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6
Q

What does ambulant mean?

A

Patient can walk / mobilize

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7
Q

What are the stages of the WHO performance status?

A

0 fully active, no restrictions on activities
1 unable to do strenuous activities
2 able to walk + manage self care, unable to work, out of bed >50% waking hours
3 confined to bed/chair >50% waking hours, capable of limited self care
4 completely disabled unable to do any self care
5 death

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8
Q

Which opioid can be used in patients with impaired renal function?

A

Fentanyl

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9
Q

In impaired renal function using opioids - would that make the drug ineffective or cause toxicity?

A

Toxicity since decreased clearance

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10
Q

What are the indications, names, drug classes and doses for the anticipatory care meds?

A

Pain: morphine opioid - varying dose
Nausea: levomepromazine antipsychotic 2.5mg
Secretions: buscopan hyoscine butylbromide 20mg
Distress: midazolam benzodiazepine 2mg

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11
Q

What drug should be co-prescribed for all patients on strong laxatives?

A

Laxatives

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12
Q

Which opioid is used in patients with moderate renal impairment? What is used in patients with severe renal impairment?

A

Moderate: oxycodone
Severe: fentanyl or buprenorphine

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13
Q

Name 3 Mx options for metastatic bone pain

A

Opioids, bisphosphonates, radiotherapy

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14
Q

When increasing opioid dose … by how much?

A

30 - 50%

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15
Q

How do you convert from oral codeine to oral morphine?

A

X 10

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16
Q

How you convert from oral morphine to subcut morphine?

A

/ 2

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17
Q

What are the components of the WHO analgesic ladder?

A

1 non-opioid +-adjuvant
2 mild/moderate opioid + non-opioid +-adjuvant
3 strong opioid + non opioid +- adjuvant

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18
Q

What is the max daily dose of paracetamol?

A

4 grams

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19
Q

BCR-ABL

  • tyrosine kinase translocation between what chromosomes?
  • inheritance pattern?
  • what cancers is it assoc?
A

BCR-ABL Philadelphia

  • 9 and 22
  • always de novo
  • 100% CML, some AML/ALL
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20
Q

HNPCC

  • what inheritance pattern?
  • assoc what cancers?
  • what mutation?
A

HNPCC

  • AD
  • bowel > endometrial > ovarian
  • MLH/MSH
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21
Q

Retinoblastoma

  • autosomal dominant
  • what cancer?
  • what age group
  • Rb1 mutation
A

Childhood eye cancer

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22
Q

BRCA

  • inheritance pattern?
  • assoc cancers?
A

AD

Breast > ovarian

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23
Q

Chemotherapy side effects - which causes cardiomyopathy?

A

Anthracyclines (-orubicin) and herceptin

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24
Q

Chemotherapy side effects - which cause peripheral neuropathy?

A

Platinum agents (cisplatin, carboplatin)

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25
Q

What chemotherapy increases risk of endometrial cancer?

A

Tamoxifen

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26
Q

Chemotherapy side effects - which causes lung fibrosis?

A

Bleomycin

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27
Q

Name 3 antiemetics used in chemotherapy assoc N&V

A

Ondansetron + dexamethasone + aprepitant (used for acute vomiting or preventatively)
(Metoclopramide if prolonged)

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28
Q

Ondansetron causes diarrhoea or constipation?

A

Constipation

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29
Q

How frequently is MST morphine slow release prescribed? eg how long does it last

A

12hr

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30
Q 
Opioid side effects
-drowsy or alert
-paraesthesia or pruritus
-hallucinations or delusions
Also: nausea, myoclonus, constipation
A

Drowsy, pruritus, hallucinations

31
Q

How to convert oral oxycodone to oral morphine dose?

A

X2

32
Q

How to convert oral oxycodone to subcut oxycodone?

A

/ 2

33
Q

What 2 factors influence chemotherapy dose?

A

Body surface area and renal function

34
Q

Which cause diarrhea or constipation

  • Metoclopramide
  • Cyclizine
  • Ondansetron
A

Ondansetron + cyclizine constipate
Metoclopramide diarrhea
(so use in reverse situations)

35
Q

Which antiemetic can cause acute dystonic reactions?

A

Metoclopramide (D2 antagonist)

commoner in females

36
Q

What is the definition of neutropenic sepsis?

A

Fever >38 for >2hr when neutrophils <1X10

37
Q

What is the empirical ABx for neutropenic sepsis?

A

IV taz + gent

38
Q

What cultures are involved in a sepsis screen?

A

Blood + urine + stool + sputum

39
Q

What is the term for radiotherapy delivered inside the body?

A

Brachytherapy (eg radioactive seeds in prostate)

40
Q

In spinal cord compression what comes first - pain or weakness?

A

Pain precedes weakness

41
Q

Describe the pain in cord compression

A

Radicular band like, radiates around rib cage, worse on coughing

42
Q

UMN or LMN signs in cord compression?

A

UMN

43
Q

Malignant cord compression investigation?

A

Urgent MRI

whole spine

44
Q

What colour is CSF on T2 weighted MRI?

A

White

45
Q

Malignant cord compression initial Mx?

A

16mg IV dexamethasone followed by 8mg BD PO

to reduce vasogenic oedema

46
Q

Malignant cord compression Mx after dexamethasone?

A

Radiotherapy with or without surgery (anterior laminectomy)

47
Q

What is Pemberton sign?

A

Raise arms above head (obstruct brachiocephalic vein); brings on symptoms in SVCO

48
Q

Presentation of SVCO?

A

Swollen face/neck/arm, facial plethora, distended veins, SOB, HA

49
Q

Give 2 causes of SVCO

A

Extrinsic compression eg right sided lung cancer, lymphoma
Clot (fast onset)
Intrinsic compression eg foreign body line obstruction

50
Q

What is the 1st line Mx of SVCO caused by lung cancer?

A

Steroids + stent

51
Q

Name 2 causes of malignant hypercalcaemia?

A

Squamous cell lung cancer (paraneoplastic PTHrP secretion)
Melanoma
Bone met osteolysis

52
Q

What is the presentation of malignant hypercalcaemia?

A

Bones stones groans moans

Constipation, polyuria, anorexia, thirst, confusion, nausea

53
Q

What is the 1st line Mx of malignant hypercalcaemia?

A

Rehydrate
(Several L normal saline, aim 3-4 L over 24hr)
(Bisphosphonates used following rehydration)

54
Q

What are PTH levels in hypercalcaemia due to paraneoplastic ectopic PTH secretion?

A

Low or normal - since its PTHrP - not the same so not on the test
(check PTHrP levels)

55
Q

Pericardial tamponade

  • compresses which heart chamber?
  • smaller or enlarged complexes on ECG?
  • smaller or enlarged heart shadow on CXR?
  • normal or abnormal echo?
A

Compresses RA
Smaller complexes
Enlarged shadow
Abnormal echo see pericardial fluid

56
Q

What are the components of Beck’s triad for cardiac tamponade?

A

> JVP + diminished heart sounds + hypotension

57
Q

What is pulsus paradoxicus?

A

Breath in > raised intrathoracic pressure > decreased venous return > reduced blood pressure by >10

58
Q

What is Kussmaul’s sign

A

Rise in JVP on inspiration

59
Q

Kussmaul’s sign or pulsus paradoxicus - which seen in cardiac tamponade?

A

Pulsus paradoxicus

60
Q

Cardiac tamponade Mx

A

Pericardiocentesis

61
Q

Neutropenic sepsis definition

A

Infection + neutrophil <0.5

or <1.0 if chemo within last 21 days

62
Q

Neutropenic sepsis 1st line ABx

A

Piperacillin with tazobactam (Tazocin)

63
Q

In neutropanic sepsis - what do you do first - give ABx or sepsis screen?

A

Give ABx

64
Q

“Intracellular ions released from cells due to chemotherapy causing rising potassium + rising phosphate + falling calcium”

A

Tumour lysis syndrome

65
Q

Tumour lysis syndrome prophylaxis?

if high risk eg leukaemia / lymphoma

A

Allopurinol

66
Q

Tumour lysis syndrome

  • high or low potassium
  • high or low phosphate
  • high or low calcium
A

High K + phos

Low Ca

67
Q

SIADH

  • high or low serum Na
  • high or low urine Na
  • hypo or hypervolaemic
A

Low blood
High urine
Euvolaemic

68
Q

Are all woman w breast Ca checked for BRCA?

A

No

only if very young, strong FH, bilateral, breast + ovarian, male breast cancer

69
Q

US or mammogram - which is better in young / older women?

A

US younger

Mammo sensitivity increases with age

70
Q

OCP - which gynae cancers protective and which risk factors?

A

RF breast, endometrial
Protects cervical, ovarian
double check

71
Q

What is Troisier’s sign?

A

Metastatic LN from intra-abdominal cancer often in left supraclavicular fossa, Virchow’s node

72
Q

Cervical cancer can cause renal failure due to ureteric obstruction - T or F

A

True

73
Q

When starting a PTx on opiates what should you co-prescribe?

A

Paracetamol + laxative + antiemetic

74
Q

The pre-Tx ambulatory status is the most important prognostic factor in determining outcome for malignant cord compression - T or F

A

True

Y4 Gen Med (9 decks)

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