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Phase 4 - Katherine > Oncology > Flashcards

Oncology Flashcards

1
Q

Name 3 causes of new confusion in a patient on the ward

A

Sepsis
hypercapnia
hypercalcaemia
raised ammonia
AKI -> dehydration -> reduced opiate excretion
steroids
low Na
Brain mets

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2
Q

Mx of hypercalcaemia

A

saline -> bisphosphonates [zoledronate]
2- calcitonin

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3
Q

Adverse effects of zolendonic acid

A

osteonecrosis of jaw
gastritis
oesophagitis

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4
Q

Mx of raised ammonia

A

phosphate enemas

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5
Q

How does AKI cause confusion in patient on opiates?

A

Dehydration -> decreased opiate excretion -> increased levels of opiates -> confusion and sedation

mx - naloxone

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6
Q

Mechanism of steroid psychosis

A

-> reduced Na and increased K
-> reduced BP (due to low Na)

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7
Q

2 Drug causes of reduced NA

A

steroids
PPI - omeprazole / lanzoprazole
ssri
Carbamazepine
fluids (Eg 5% dextrose)

(rinitidine is good to change PPI)

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8
Q

What happens in the metastatic cascade

A

DIIE AEA [like someone shouting it]

Detachment
Invasion
Intravasation (blood or lymph)
Evasion of host defence
Adherence
Extravasation
Angiogenesis

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9
Q

When might you use radiotherapy - 3 indications

A

Pt medically unfit surgery,
anatomically unresectable, close proximity to vital structures,
neo-adjuvant to shrink structure,
adjuvant to decrease risk of recurrence,
palliative for bone/brain mets + spinal cord compression

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10
Q

2 main types of radiotherapy

A

External beam radiation therapy - using CT/MRI to target tumour

Internal radiation therapy - brachytherapy - radiation source placed near target tumour

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11
Q

Name 2 acute and 2 chronic comps of radiotherapy

A

Acute (during treatment or <2-3 weeks)
Fatigue (80%)
Skin - Erythema, dry and moist desquamation, irritation
GI - loss of taste, oral mucositis (complicated by yeast/bacterial superinfection), diarrhoea, nausea, vomiting
BM - cytopenias
Lungs - pneumonitis, fever, cough, dyspnoea

Chronic
Infertility
Lymphoedema
Delayed healing
Loss of salivary flow
Transverse myelitis, Lhermitte’s
Increased risk CV events/stroke
Hypothyroidism

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12
Q

Name 3 SEs of chemo

A

Myelosuppression - anaemia, infection, bleeding
One week after, FBC prior to admission

Alopecia

Infertility

Nausea, vomiting and diarrhoea
-Major cause of distress - use domperidone or metoclopramide

Fatigue

Teratogenicity

Mouth ulcers

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13
Q

What is extravasation

A

Problem with chemo -
pain, redness and inflammation -> may lead to skin necrosis + amputation (dissolving soft tissue).
May see brown demarcation of veins

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14
Q

Mx of extravasation

A

Topical agents e.g. dimethyl sulfoxide, heat, cold,

debridement and grafting may be required

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15
Q

Common severe reaction to chemo

A

Anaphlaxis - T1 hypersensitivity

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16
Q

What is the risk with chemo induced myelosupression

A

Neutropenic sepsis

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17
Q

Ix in anyone who has fever and recent chemo

A

FBC, LFT, U + Cr, CRP, lactate, blood cultures (multiple sites), urine culture, NOT LP (may introduce infx), swabs and cultures from central line (each part)

Worry about neutropenic sepsis

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18
Q

Pt presents with Sx of spinal cord compression (in onc) what exam should you do?

A

peripheral nerve

precuss spine

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19
Q

mets -> spinal cord compression
Ix for Dx?
Mx?

A

MRI whole spine,
->refer to neurosurgery/spinal surgery
-> Or if more widespread give radiotherapy

+ IV DEXAMETHASONE + prevention VTE + PPI
-Analgesia
-Lay flat

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20
Q

Dexamethasone

A

Just god shit keep it in the brain for all onc

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21
Q

Mx painful spine mets

A

Analgesia (NSAID/non-opiate/opiate)

Bisphosphonates if myeloma/breast cancer (lytic lesions)

Palliative radiotherapy

Vertebroplasty

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22
Q

3 precipitating factors for DVT in Ca

A

cancers tend to be prothrombotic

Surgery and chemotherapy may damage vessel walls (increased clots)

Patients tend to be less active

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23
Q

Describe 1 way malignancy can cause hyperCa

A

Secretion of PTH related peptide by tumour (humoral hypercalcaemia)

Local release of factors increasing osteoclast proliferation (local osteolytic hypercalcaemia) - including PTH-rP

Boney mets

Autonomous production of calcitriol by lymphoma

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24
Q

Name 3 Ix in HyperCa of malignancy

A

Total calcium
Elevated but influenced by albumin and calcium binding Igs (MM)

Serum ionised calcium
If abnormal albumin

Serum albumin
Adjusted serum calcium is (0.02 x [normal albumin - pt albumin]) + serum calcium

Resting ECG
?Shortened QT

Serum PTH
Elevated in PTH mediated i.e. primary hyperparathyroid/ ectopic hyperparathyroid

Serum phosphorus
Low in humoral

Serum calcitriol - high in calcitriol mediated

Skeletal survey - osteopenia, osteolytic lesions, pathological fractures + CXR lung cancer, TB, sarcoidosis

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25
Name 2 medications that worsen hypercalcaemia
Thiazide diuretics Calcitriol Calcium supplementation Antacids Lithium
26
Mx of mod/severe hyoer Ca
IV saline (dehydration) IV bisphosphonates (block bone reabsorption) Furosemide -avoid fluid overload
27
Most common cause of SVCS? What happens
Malignancy - its in the onc deck idiot 75% - lung ca Venous return from head, thorax and upper extremities is obstructed leading to an increased venous pressure
28
Name 3 sx/signs of SVC obstruction
FIXED (non-pulsatile) + RAISED JVP Oedema of face and upper extremities (80%) Dyspnoea (60%) - worse leaning forward Facial plethora (venous engorgement) Cough Distended neck veins + chest veins - worse leaning forward Hoarse voice
29
Ix in SVCO
Chest x-ray (widened mediastinum or mass in lung) CT thorax with contrast (collat vess, loc, sev, path), USS upper extremities (dilated SVC, thrombu
30
2 Options Mx of acute airway obstruction (comp of SVCO)
Secure airway (intubate/surgical) + local radiotherapy + corticosteroids (dexamethasone) OR Secure airway + percutaneous endovascular stent (bleeding risk, patency)
31
What is tumour lysis syndrome? most common Ca to get it with?
Combination of metabolic and electrolyte abnormalities occurring spontaneously following initiation of cytotoxic treatment in patients with cancer. Characterised by excessive cell lysis. Lymphoma
32
Lab findings in tumour lysis
hyperuricaemia, hyperphosphataemia, hyperkalaemia, ->Arrhythmia hypocalcaemia -> muscle cramps / tetany
33
Why do you get AKI in TLS
uric acid nephropathy (+ calcium phosphate deposition) [will also cause K to go up higher]
34
What is lambert-eaton myasthemic syndrome ? which Ca common?
AI disorder of NM junction SCLC
35
How does lambert-eaton present?
Limb weakness (proximal legs + arms) Dry mouth ( + metallic taste) Weakness Dysarthria, ptosis, diplopia, impotence
36
Name 3 Ix in lambert eaton
Nerve conduction studies - doubling of compound muscle action potential post exercise Anti VGCaC - positive Anti AChR - negative Chest CT - ? malignancy Serial LuFT - low FVC - ? resp crisis
37
Mx of lambert eaton if no resp weakness? resp weakness
-> treat cause + amifampridine ± pred intubation and ventilation + plasma exchange/IVIG
38
How does carcinoid syndrome present
flushing/diarrhoea (± wheeze, palpitations, telangiectasia, abdo pain)
39
What causes sx in carcionoid
serotonin (+ kinins) from neuroendocrine tumours
40
Dx of carcinoid
elevated urinary-5-hydroxyindoleacetic acid (24 hr)
41
Mx of carcinoid
octreotide - somatostatin analogue) + surgical resection
42
Name 3 Ca that met to bone
Breast - C Prostate - P Bronchus - M Myeloma - Thyroid
43
What is a sanctuary site?
an area that chemotherapy does not reach well e.g. brain and scrotum in ALL
44
period between chemo and becoming neutropenic
1-2 weeks
45
When would tazosin not be good for neutropenic sepsis? What could you give
if on high dose methotrexate - both act on folic acid give meropenem
46
What increases risk of becoming neutropenic on chemo
age more cytotoxic chemos multiple courses Hx of becoming neutropenic
47
What might you give with pts high risk becoming neutropenic
GCSF - boosts bone marrow to produce more [granulocyte stimulating factor]
48
moans bones stones and groans is?
Bone pain, vomiting diarrhoea, abdo pain, seizures, arrhythmias, Kidney stones
49
5 ca mets to bone
breast lung kidney prostate thyroid
50
Mx of TLS
allopurinol rasburicase Mx of HyperK Fluids [Consider dialysis]
51
Most common site of bony mets
Spine
52
Most common 3 tumours causing bony mets
1. Prostate 2. Breast 3. Lung
53
Tumour marker for pancreatic cancer
CA 19-9
54
1st line medication for secretions in palliative care
Hyoscine hydrobromide or hyoscine butylbromide
55
Conversion oral morphine to SC morphine
SC 0.5 oral dose
56
Codeine to morphine conversion
1/10 dose
57
Tramadol to morphine conversion
1/10 dose
58
What pain relief should you give CKD patients
Oxycodone Fentanyl if really severe (less than 10 egfr)
59
Metastatic bone pain treatment? (3)
Strong opiods Bisphosphonates Radiotherapy
60
1st line treatment for intractable hiccups in palliative care?
Chlorpromazine OR haloperidol
61
1st line antiemetic for intracranial cause of N+V?
Cyclizine
62
1st line antiemetic for palliative gi pain?
Domperidone
63
What kind of lung cancer is most strongly associated with smoking?
Squamous cell lung cancer
64
What HIV subtypes increase the risk of cervical cancer?
16, 18 and 33
65
What is the most common malignancy causing SVCO?
Small cell lung cancer
66
Breast cancer tumour marker?
CA 15-3

Phase 4 - Katherine (26 decks)

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