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Phase 3 > Oncology > Flashcards

Oncology Flashcards

1
Q

An 80 year old man with spinal mets from prostate cancer complains of increasingly severe back pain despite a high dose of morphine. Spinal cord compression is ruled out by MRI scan. What could you give to help his pain?

A

Radiotherapy

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2
Q

A 91 year old woman with multiple myeloma complains of severe abdo pain, vomiting and constipation. Her serum calcium is 3.6. What could you give to improve her symptoms?

A

IV fluids

Bisphosphonates

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3
Q

A 60 year old woman has developed bowel obstruction secondary to inoperable ovarian cancer. She is complaining of colicky abdo pain not controlled by high dose morphine. What could you give to help her symptoms?

A

Hyoscine butylbromide 20mg SC

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4
Q

A 45 year old woman has fungating metastatic breast cancer and is increasingly distressed by the malodorous discharge. What could you give to alleviate this?

A

Oral metronidazole or gel

Charcoal dressing

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5
Q

A 53 year old woman with inoperable cancer has pain due to posterior abdo wall infiltration, this has been controlled well with cocodamol 30mg, two tablets, 4 times a day.
She has been admitted with n and v, the cause of which is unknown. Because she cannot retain her analgesics, she has severe loin pain. What is the best option for controlling her pain until the vomiting settles?

A

Subcutaneous diamorphine by continuous infusion

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6
Q

What treatment is used for metastatic prostate cancer? How does it work?

A

Gonadorelin (LHRH) analogue to switch off testosterone

Induce hypogonadotrophic hypogonadism

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7
Q

What treatment is used for acromegaly as alternative to surgery? How does it work?

A

Acromegaly due to hypersecretion of growth hormone for pituitary hormone
Synthetic somatostatin analogues - GHIH
Suppress GH secretion from tumours, effective alternative to surgery

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8
Q

What type of tumours are VIPomas?

A

Neuroendocrine

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9
Q

What type of treatment do you use for VIPomas?

A

Somatostatin therapy

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10
Q

In which malignancy is CA125 a helpful serum marker?

A

Serious carcinoma of the ovary

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11
Q

In which cancers might CEA (carcinoembryonic antigen) be raised?

A

Colon
Rectum
Stomach
Oesophagus

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12
Q

In which malignancy are beta human chorionic gonadotrophin and alpha fetoprotein useful tumour markers?

A

Testicular tumour

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13
Q

Which tumour markers are used in the diagnosis of testicular carcinoma, particularly germ cell?

A

Beta HCG
Alpha fetoprotein
Lactate dehydrogenase

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14
Q

Other than testicular cancer, in which cancer might alpha fetoprotein levels also be used as a tumour marker?

A

Hepatocellular carcinoma

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15
Q

What is octreotide? What is it used to treat?

A

Somatostatin analogue used in the treatment of acromegaly and carcinoid syndrome

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16
Q

What is a recognised side effect of octreotide therapy due to it altering fat absorption and decreases gall bladder motility?

A

Cholelithiasis

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17
Q

What causes carcinoid syndrome?

A

Overproduction and release of polypeptides, amines, prostaglandins, particularly 5HT and serotonin, histamine and bradykinin

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18
Q

What are the typical symptoms of carcinoid syndrome?

A

Flushing
Diarrhoea
Bronchospasm

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19
Q

Why might you get right sided valvular lesions in carcinoid syndrome?

A

Neurohormonal induced fibrosis

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20
Q

Where do carcinoid tumours usually arise?

A

Digestive tract, particularly small intestine

Bronchi

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21
Q

What is the end product of serotonin metabolism and excreted in the urine making it a useful initial diagnostic test for carcinoid syndrome?

A

5-hydroxyindoleacetic acid

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22
Q

What is the most common type of parotid tumour?

A

Pleomorphic adenoma

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23
Q

What is the most common type of parotid tumour?

A

Pleomorphic adenoma

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24
Q

Secretion of which molecule from tumour cells leads to hypercalcaemia?

A

Parathyroid hormone related protein (PTHrP)

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25
Q

Why does renal failure occur in multiple myeloma?

A 
Hypercalcaemia
Hyperuricaemia
Dehydration
Amyloid deposition
Paraprotein excess
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26
Q

Why is ESR usually raised in multiple myeloma?

A

Presence of paraprotein in the serum

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27
Q

What protein is found in the urine in multiple myeloma?

A

Bence jones protein

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28
Q

How can you differentiate between multiple myeloma lesions and metastatic prostate Ca lesions on xray?

A

Metastatic prostate Ca - sclerotic lesions

MM - lytic lesions

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29
Q

What type of drug is cyclophosphamide?

A

DNA damaging alkylating agent

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30
Q

What is cyclophosphamide used to treat?

A

Lymphocytic leukaemia

RA

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31
Q

What is a rare but damaging side effect of cyclophosphamide?

A

Haemorrhagic cystitis

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32
Q

What types of cancer is cisplatin used to treat?

A

Lung
Bladder
Ovarian
Testicular

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33
Q

What is mechanism of action of cisplatin?

A

Platinum compound that causes DNA damage by causing cross links

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34
Q

What type of drug is 5-fluorouracil?

A

Anti metabolite which acts as a pyrimidine antagonist

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35
Q

What is the mechanism of action of doxorubicin?

A

Prevents DNA repair by acting as a topoisomerase II inhibitor - cytotoxic antibody

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36
Q

What is doxorubicin used to treat?

A

Acute leukaemia
Lymphoma
Some solid tumours

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37
Q

What are possible complications/side effects of radiotherapy?

A 
Mucositis
Anorexia/nausea/malaise
Alopecia/epilation
Skin ischaemia/ulceration
Bone necrosis/fracture
Mouth - xerostomia, ulceration
Lung fibrosis
Cardiomyopathy, pericardiofibrosis
Infertility, menopause
Strictures
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38
Q

What is the most common site for osteoclastomas (giant cell tumours)?

A

Around knee at distal femur

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39
Q

What are the cancerous causes of clubbing?

A 
Bronchial Ca
Mesothelioma
Lung mets
Thyroid Ca
Thymus Ca
Hodgkin's disease
Disseminated chronic myeloid leukemia (POEMS syndrome - polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes).
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40
Q

What is busulfan used for in haematological malignancy? What are the limitations?

A

Control tumor burden but cannot prevent transformation or correct cytogenic abnormalities

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41
Q

What is Kaposi’s sarcoma assocaited with?

A

HIV - AIDS defining illness

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42
Q

What infection causes Kaposi’s sarcoma?

A

Humanherpes virus 8

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43
Q

How can localised Kaposi’s sarcoma be treated?

A 
Cryotherapy
Intralesional injections of vinblastine
Alitretinoin gel (vit A, retinoid)
Radiotherapy
Topical immunotherapy (Imiquimod)
Surgical excision
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44
Q

How does Imiquimod work?

A

Signals to the innate arm of the immune system through the toll-like receptor 7 (TLR7), commonly involved in pathogen recognition
Cells activated secrete cytokines IFN-alpha, IL-6, and TNF-alpha

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45
Q

What should be considered first line to treat AIDS related kaposi’s sarcoma?

A

Highly active antiretroviral therapy

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46
Q

What tumours are associated with EBV?

A

Burkitt’s lymphoma

Nasopharyngeal cancers

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47
Q

What is Burkitt’s lymphoma?

A

High-grade non-Hodgkin lymphoma that develops from B lymphocytes in the germinal center
May affect jaw, CNS, bone marrow, bowel, kidneys, ovaries
Chromosomal abnormality t(8;14) translocation

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48
Q

Which cancer is associated with HPV?

A

Cervical carcinoma

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49
Q

Which is the most common childhood cancer?

A

Acute Lymphoblastic Leukaemia

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50
Q

Which age groups and sex carry the worst prognosis in ALL?

A

Less than 2
Older than 9
Male sex

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51
Q

What is the chromosomal abnormality associated with ALL?

A

Translocation in 11q23 region

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52
Q

What is given prophylactically in ALL to try and prevent meningeal involvement?

A

Cranio-spinal irradiation

Intrathecal methotrexate

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53
Q

Which primary malignancies are the most common cause of bone mets?

A

Breast
Prostate
Bronchus

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54
Q

How do bone mets tend to present?

A 
Bone pain
Lump
Pathological fracture
Hypercalcaemia
Cord compression
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55
Q

What is the most sensitive investigation to detect metastatic spread to bone?

A

Bone scintigraphy

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56
Q

What cancers are patients with hereditary non polyposis colonic carcinoma at risk of?

A

Colon
Endometrial
Ovarian

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57
Q

What causes the defect leading to HNPCC (lynch syndrome)?

A

Defect in mismatch repair genes important for DNA surveillance leading to microsatellite instability

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58
Q

At what age do patients with HNPCC tend to present?

A

40 years of age

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59
Q

What is Von Hippel Lindau disease?

A

Autosomal dominant condition associated with phaeochromocytomas, CNS haemangiomas and hypernephroma due to absence to vHL tumour suppressor gene

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60
Q

What is Peutz-Jeghers syndrome?

A

Autosomal dominant condition associated with mucocutaneous pigmentation and multiple GI hamartomas due to a defect in STK11 gene

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61
Q

Which cancer is acanthosis nigricans associated with?

A

Adenocarcinoma of the stomach

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62
Q

What are features of CLL?

A 
Lymphocytosis WCC >15, 40% lymphocytes
Painless lymphadenopathy
Hepatosplenomegaly
Anaemia (autoimmune haemolysis/bone marrow failure)
Thrombocytopenia
Infections (neutropenia)
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63
Q

What would be seen on a blood film in CLL?

A

Lymphocytes and smear cells

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64
Q

How do you treat CLL? And when?

A

Chlorambucil

When symptomatic, evidence of bone marrow failure, hypersplenism, automimmune haemolytic anaemia, thrombocytopenia

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65
Q

What do Reed Sternberg cells look like?

A

Multi nucleate

Polypoid

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66
Q

What are B symptoms of Hodgkins lymphoma?

A

Pel-Ebstein fever - spiking temperature
Night sweats
Weight loss of >10% body weight

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67
Q

What are some causes of cavitating lung lesions?

A 
Carcinoma
Abscess (staph, klebsiella, TB)
Lymphoma
Rheumatoid nodule
Wegeners granulomatosis
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68
Q

What does CA stand for in tumour markers such as CA 125 and CA 19-9?

A

Carbohydrate antigen

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69
Q

What are some causes of a raised CA 125?

A

Ovarian cancer
Endometrial cancer
Tumour of pancreas, GI tract, lung, breast
Benign gynaecological disease such as cyst and endometriosis
Early pregnancy
Follicular phase of menstrual cycle
Cirrhosis/hepatitis

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70
Q

When is the peak incidence of leukaemia in childhood?

A

2 years in females

3 years in males

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71
Q

How long does treatment usually last for in children with leukaemia?

A

2 years in girls

3 years in boys

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72
Q

What are good prognostic factors for ALL?

A

Age 3-7 years

Female sex

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73
Q

What are poor prognostic factors for ALL?

A

Age <1 or >9
White cell count above 100 at presentation
Philadelphia chromosome (translocation 9:22)

74
Q

What are the non metastatic consequences of renal carcinoma?

A

Synthesis of EPO - polycythemia
Hypercalcaemia through PTHrP synthesis
DIC
Leucopenia

75
Q

What are risk factors for bladder cancer?

A 
Smoking
Exposure to aniline dyes in printing and textile
Rubber manufacture
Cyclophosphamide
Schistosomiasis
76
Q

What is Turcots syndrome?

A

Adenomatous tumours of the colon and central nervous system

77
Q

Which cancer is Paget’s disease associated with?

A

Osteosarcoma

78
Q

Which cancer are women with PCOS at increased risk of?

A

Endometrial

79
Q

What are some characteristics of squamous cell lung cancer?

A 
Common in smokers
Centrally located 
Cavitate
Metastasise outside thoracic cavity
Ectopic PTH
80
Q

What are characteristics of adenocarcinoma of the lung?

A

Elderly, non smoking women

Situated at periphery of lung

81
Q

What are characteristics of small cell carcinoma of the lung?

A

Highly malignant, usually disseminated at presentation

Ectopic hormone production and paraneoplastic syndromes - ACTH and ADH

82
Q

What symptoms are suggestive that a CA 125 should be checked?

A 
Persistent abdominal distension
Pelvic or abdominal pain
Increased urinary urgency or frequency
Feeling full/loss of appetite
Symptoms suggestive of IBS
83
Q

What level of CA 125 warrants referral for an ultrasound scan?

A

> 35

84
Q

If a women presents with ascites and a pelvic mass what should you do?

A

Refer urgently to gynaecological oncology service

85
Q

What is the classic syndrome of carcinoid?

A

Diarrhoea
Flushing with hypotension
Telangiectasia
Bronchospasm

86
Q

What is CA15-3 a tumour marker for?

A

Breast cancer

87
Q

What is S-100 a tumour marker for?

A

Melanoma, schwannomas

88
Q

What is bombesin a tumour marker for?

A

Small cell lung carcinoma
Gastric cancer
Neuroblastoma

89
Q

What is Li Fraumeni syndrome?

A

Sarcoma, breast leukaemia and adrenal gland syndrome

Genetic mutation of p53 so predisposes to cancer development

90
Q

What class of drugs should be used to treat metastatic carcinoid syndrome?

A

Somatostatin analogue

91
Q

What class of drug should be used to treat prolactinoma with suprasellar extension?

A

Bromocriptine

92
Q

What are the conditions found in MEN1?

A

Parathyroid
Pituitary
Pancreas (insulinoma, gastrinoma)

93
Q

Name some tumour suppressor genes

A 
Von Hippel Lindau 
p53
Retinoblastoma 1
BRAC
APC
94
Q

Name some oncogenes

A

Myc
Erb
Ras
Ret

95
Q

What is the recommended investigation for female patients over 50 presenting with IBS type symptoms in the past 12 months?

A

CA 125

USS abdo pelvis if this is above 35

96
Q

A patient with acute leukaemia is admitted with febrile neutropenia. On day four of treatment with road spectrum antibiotics his fever deteriorates. A chest X-ray shows bilateral fluffy infiltrates. What is the likely diagnosis and what is the appropriate next step in management?

A

Pneumocystis jirovecii infection

Give co trimoxazole

97
Q

Which drugs are commonly used in palliative care?

A

Nausea and vomiting: cyclizine, levomepromazine, haloperidol, metoclopramide
Resp secretions: hyoscine butylbromide
Bowel colic: hyoscine butylbromide
Agitation/restlessness: midazolam, haloperidol, levomepromazine
Pain: diamorphine

98
Q

What are some different types of primary liver tumours?

A 
Cholangiocarcinoma
Hepatocellular carcinoma
Hepatoblastoma
Sarcoma
Lymphoma
Carcinoid
99
Q

How is a diagnosis of Hepatocellular carcinoma made?

A

CT/MRI
Alpha fetoprotein
Biopsy should be avoided as it seeds tumours through resection plane

100
Q

What is the management of hepatoceullar carcinoma?

A

Staging with liver MRI and CT chest, abdo, pelvis
Examine testis as it could account for raised alpha fetoprotein
Surgical resection
Tumour ablation

101
Q

What is the main risk factor for cholangiocarcinoma?

A

Primary sclerosing cholangitis

102
Q

What is a karnofsky performance status scale?

A

Used for cancer patients especially those undergoing chemo to assess functional status and ability to cope with intensive treatments

103
Q

What is the most common type of ovarian epithelial cell tumour?

A

Serous cystadenoma

104
Q

Which tumour is most commonly associated with ectopic ACTH production?

A

Small cell lung cancer

105
Q

What is a reed sternberg cell?

A

Binucleate, bilobed or multinucleate with abundant amphiphilic cytoplasm and owl eyed nucleoli surrounded by clear halo

106
Q

What are risk factors for ovarian cancer?

A

BRCA1/2

Many ovulations: early menarche, late menopause, nulliparity

107
Q

What are clinical features of ovarian cancer?

A 
Abdominal distension and bloating
Abdominal and pelvic pain
Urinary symptoms: urgency
Early satiety
Diarrhoea
108
Q

What are features of SVCO?

A 
Dyspnoea 
Swelling of face neck and arms 
Conjunctival and periorbital oedema 
Headache
Visual disturbance
Pulseless jugular venous distension
109
Q

What is the management of SVCO?

A

Dexamethasone
Balloon venoplasty
Stenting

110
Q

How are intractable hiccups managed in palliative care?

A

Chlorpromazine
Haloperidol
Gabapentin

111
Q

What are the features of MEN1?

A

Pituitary adenoma
Parathyroid hyperplasia
Pancreatic tumours

112
Q

What are features of MEN2A?

A

Parathyroid hyperplasia
Medullary thyroid carcinoma
Phaeochromocytoma

113
Q

What is Li Fraumeni syndrome?

A

Autosomal dominant
Germline mutations to p53 tumour suppressor gene
High incidence of malignancy, particularly sarcoma and leukaemia
Under 45 years with first degree relative affected

114
Q

What are features of MEN2B?

A

Mucosal neuroma
Marfanoid appearance
Medullary thyroid carcinoma
Phaeochromocytoma

115
Q

What should be coprescribed alongside goserelin for the first 3 weeks of treatment?

A

Cyproterone acetate
Anti androgen
Prevent the risk of tumour flare due to increased testosterone levels

116
Q

What treatment regime is employed in multiple myeloma?

A

Chemo: melphalan
Steroids
Thalidomide
Radiotherapy for bone pain

117
Q

What are renal complications of multiple myeloma?

A 
Bence jones cast nephropathy
Light chain deposition disease
Amyloidosis
Nephrocalcinosis
Chronic urate nephropathy
Acute renal failure
Renal vein thrombosis
Acute and chronic pyelonephritis 
Tumorous infiltration of kidney tissue
118
Q

Which gene is affected in familial adenomatous polyposis coli?

A

APC tumour suppressor gene

119
Q

What are features of malignant cells on histology?

A

Increased nuclear size
Nuclear and cellular pleomorphism
Lack of cell differentiation
Increased nuclear DNA content with dark staining on h and E slides
Prominent nucleoli or irregular chromatin distribution
Mitotic figures

120
Q

What is seen radiographically in patients with hypertrophic pulmonary osteoarthropathy?

A

Proliferative periostitis particularly at diaphysis of wrists, ankles, knees and elbows
Periosteal reaction

121
Q

With which malignancies is hypertrophic pulmonary osteoarthropathy associated?

A

Intrathoracic - particularly lung cancer

122
Q

Which cancers metastasise to bone?

A 
Breast 
Lung
Prostate  
Kidney
Thyroid
Myeloma
123
Q

What is the most common site metastatic cancer spread causing cord compression?

A

Thoracic spine

124
Q

How does metastatic spinal cord compression typically present?

A 
Pain  
Motor deficit
Sensory deficit
Altered bowel and / or bladder control
Cauda equina syndrome
125
Q

In which patients should you have a high index of suspicion for metastatic spinal cord compression?

A

A known cancer diagnosis
Severe, unremitting pain, especially if localised to upper or middle spine
Exacerbated by increased intra-abdominal pressure

126
Q

Below which spinal level can cauda equina syndrome occur?

A

Compression below the first lumbar vertebra

127
Q

How should metastatic spinal cord compression be investigated? What should be given while waiting for this?

A

Suspected spinal metastases without compression: MRI whole spine within 7 days
Suspected MSCC: MRI whole spine within 24 hours
Contact MSCC co-ordinator (or acute oncology unit) to arrange urgent investigations and management)
Give dexamethasone

128
Q

What is the management for metastatic spinal cord compression?

A

Start oral steroids: 16mg oral Dexamethasone daily
Consider adding PPI for gastro-protection
Analgesia e.g. morphine
Appropriate immobilisation e.g. nursed flat with log rolling
Consider starting LMWH for thrombo-prophylaxis if no contraindications
Radiotherapy
Surgery
Chemotherapy

129
Q

Why is dexamethasone helpful in metastatic spinal cord compression?

A

Venous stasis leads to venous hypertension
White matter (axonal) vasogenic oedema
Decreased spinal cord blood flow leads to ischaemia and infarction
Dexamethasone reduces the oedema

130
Q

In which metastatic spinal cord compression are steroids contraindicated? Why?

A

Lymphoma

Oncolytic effect of the steroid may impair tissue diagnosis

131
Q

What are 3 goals for radiotherapy in metastatic spinal cord compression?

A

Prevent neurological deterioration
Improve neurological function
Pain relief

132
Q

What are goals of surgery for metastatic spinal cord compression?

A

Circumferential decompression of the spinal cord

Reconstruct and immediately stabilise the spinal column

133
Q

For which types of metastatic spinal cord compression can chemotherapy be considered?

A

Some haematological malignancies e.g. lymphoma, plasma cell tumours
Small cell carcinoma of the lung

134
Q

What is neutropenic sepsis?

A

Temperature > 38°C and/ or signs of sepsis in a person with a neutrophil count of 0.5 x 109/L or less

135
Q

What are causes of hypercalcaemia of malignancy?

A

Humoral hypercalcaemia of malignancy: secretion of parathyroid hormone-related peptide by primary tumours
Local osteolytic hypercalcaemia: local release of PTHrP and other
factors by bone metastases which increases osteoclast proliferation and activity
Calcitriol production by lymphomas
Parathyroid (PTH) secretion by primary tumours

136
Q

Which cancers are commonly associated with hypercalcaemia?

A 
Renal cancer
Ovarian cancer
Breast cancer
Endometrial cancer
Human T-lymphocytic virus-associated lymphoma
Squamous cell carcinoma
Multiple myeloma
137
Q

What are the different grades of severity of hypercalcaemia?

A

Mild: total adjusted serum calcium 2.6 – 2.9 mmol/L
Moderate: total adjusted serum calcium 3.0 – 3.4 mmol/L
Severe: total adjusted serum calcium 3.5 mmol/L or above

138
Q

What are signs and symptoms of hypercalcaemia?

A 
Nausea and vomiting (often intractable)
Polyuria and polydipsia
Abdominal pain
Constipation
Confusion
Tiredness/ lethargy
Weakness
Stone formation
Corneal calcification
Mild aches and pains
Anorexia
Weight loss
Low mood
139
Q

What are causes of superior vena cava obstruction?

A

Mainly caused by extrinsic compression of superior vena cava by upper mediastinal lymph nodes
Extension of tumour in the vessel
Blood clot obstructing the lumen
Lung cancer, Lymphoma, Breast cancer, Testicular seminoma

140
Q

What are symptoms of superior vena cava obstruction?

A 
Cough
Dyspnoea
Chest pain (often at rest)
Headache
Facial/ neck or arm swelling
Dizziness
141
Q

What are signs of superior vena cava obstruction?

A 
Swelling of face/ neck or arm
Fixed raised JVP
Dilated veins on chest wall
Engorged conjunctiva
Cyanosis
Made worse by raising hands above head (pembertons sign)
142
Q

What investigations should be done for superior vena cava obstruction?

A

CXR: widened mediastinum or R sided mass in chest
CT scan (may include injection with contrast media to highlight collateral circulation)
Doppler scan: evaluate severity of the obstruction
MRI scan
Invasive contrast venography

143
Q

What are medical management options for superior vena cava obstruction?

A

Keep head elevated, consider oxygen
In an emergency, corticosteroids and diuretics may be indicated
Radiotherapy (in some lung cancer cases)
Chemotherapy
Anticoagulation if thrombosis cause or likely complication

144
Q

What are surgical treatment options for superior vena cava obstruction?

A

Stenting
Reconstructive surgery using autologous tissue
Insertion of a prosthesis

145
Q

Which cancers are most at risk of major haemorrhage?

A

Lung
Head and neck
Upper GI

146
Q

What are risk factors for major haemorrhage in cancer?

A

Local effects e.g. blood vessel invasion
Systemic effects: DIC
Drugs: LMWH, aspirin, warfarin, dexamethasone, NSAIDs

147
Q

What are common side effects of morphine?

A 
Nausea and vomiting
Drowsiness
Unsteadiness
Delirium
Constipation
148
Q

What antiemetic is useful to prescribe alongside morphine?

A

Haloperidol 1.5mg po nocte

149
Q

What are signs and symptoms of morphine toxicity?

A 
Myoclonic jerks
Agitation
Hallucinations
Confusion
Pin point pupils
Respiratory depression
150
Q

What dose adjustment is required to convert a morphine dose to oxycodone?

A

2 times more potent than oral morphine

i.e. 20mg morphine is equivalent to 10mg oxycodone

151
Q

What is the fentanyl equivalent dose to 60mg daily morphine?

A

25mcg/hour fentanyl equivalent to approx 60mg of morphine daily - 600mcg/day

152
Q

When might parenteral analgesia be appropriate?

A 
When oral medication not tolerated
Drowsy
Unable to swallow
Vomiting
Bowel obstruction
Confused
Poor absorption
153
Q

How do you convert morphine and diamorphine doses for a syringe driver?

A

To convert oral morphine to sc morphine DIVIDE by 2

To convert oral morphine to sc diamorphine DIVIDE by 3

154
Q

Which medications are considered adjuvant analgesics?

A 
Antidepressants
Anticonvulsants
Corticosteroids
Skeletal muscle relaxants
Smooth muscle relaxants (antispasmodics)
Bisphosphonates
NMDA-receptor-channel blockers
Anxiolytics
155
Q

Which drugs should be offered initially for neuropathic pain?

A

Amitriptyline
Duloxetine
Gabapentin
Pregabalin

156
Q

Which drug should be first line for diabetic neuropathy neuropathic pain?

A

Duloxetine

157
Q

Which cancer problems can steroids help with?

A 
Raised intracranial pressure (dose 8-16mg/day dexamethasone)
Nerve compression  (dose 4-8mg/day)
Hepatomegaly, liver capsule pain (dose 4-8mg/day)
Spinal cord compression (dose 16mg/day)
Bone pain (dose 4-8mg/day)
158
Q

What is the difference between nausea, retching and vomiting?

A

Nausea: Unpleasant feeling of need to vomit accompanied by autonomic symptoms (pallor, cold sweat, salivation, tachycardia, diarrhoea)
Retching: Rhythmic laboured spasmodic movements of diaphragm and abdo muscles (occurs with Nausea and results in Vomiting)
Vomiting: forceful propulsion of gastric contents through mouth

159
Q

What are the mechanisms of action of Metoclopramide, Domperidone, Cyclizine and Ondansetron?

A

Metoclopramide: D2 antagonist, 5HT3 antagonist, 5HT4 agonist
Domperidone: D2 antagonist, doesn’t cross BBB
Cyclizine: antihistamine
Ondansetron: 5HT3 antagonist

160
Q

Which antiemetic combinations should be avoided?

A

IV Metoclopramide + IV Ondansetron: may cause serious cardiac arrhythmias
Metoclopramide/Domperidone + Cyclizine: Metoclopramide/Domperidone are motility agents while Cyclizine slows down GI transit

161
Q

Which receptors are present in the CTZ?

A

D2

5HT3

162
Q

What are symptoms of gastric stasis?

A

Epigastric fullness
Early satiety
Large volume vomits (projectile)
Hiccups
Regurgitation (also if moving term ill pt)
(Minimal) Nausea quickly relieved by vomiting

163
Q

What factors may precipitate gastric stasis?

A

Stomach emptying problems (Autonomic eg Diabetes, Gastritis, Peptic Ulcer)
Compression of gastric outflow (Tumour, Hepatomegaly, Ascites)
Drug Side-Effects (Anti-Cholinergics, Opioids)

164
Q

How can gastric stasis be treated?

A

Reduce volume of oral intake: Little and often
Reduce Gastric secretions: PPI (Omeprazole)
Pro-kinetic agents: Dopamine D2-Antagonists: metoclopramide (also 5HT4 agonist), Domperidone

165
Q

What are symptoms of visceral or serosal irritation as a cause of nausea?

A 
According to the cause
Bowel obstruction, severe constipation, faecal impaction, liver capsule stretch, mesenteric metastases, pharyngeal irritation
Constant Nausea
Less or variable Vomiting
Fullness
166
Q

Which is the most effective antiemetic to use when the cause is visceral/serosal irritation?

A

Anti-Cholinergic (vs Vagus): Cyclizine

167
Q

What may be contributing factors to chemical or metabolic nausea and vomiting?

A

Chemical: Drugs (Opioids, Antibiotics, Digoxin, NSAIDs, SSRIs,
Chemotherapy)
Metabolic: Renal / Liver failure, Hypercalcaemia of Malignancy, Hyponatraemia, sepsis

168
Q

How should chemical or metabolic nausea and vomiting be treated?

A

Dopamine D2-Antagonist: Metoclopramide [Prochlorperazine]

5HT3-Antagonist: Ondansetron

169
Q

Which antiemetic should be used for motion sickness?

A

Cyclizine

170
Q

Which receptors are important in nausea and vomiting caused by raised ICP?

A

Stimulation of the Vomiting Centre: H1 and AChm receptors

171
Q

Which antiemetic should be used in raised ICP?

A

Cyclizine

172
Q

What is the spikes method of breaking bad news?

A

Setting up the interview
Assessing the patient’s Perception
Obtaining the patient’s Invitation
Giving Knowledge and information to the patient
Addressing the patient’s Emotions with Empathetic response
Having a Strategy and Summarising

173
Q

What is palliative care?

A

Approach that improves quality of life of patients and their families facing problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual

174
Q

What are some non medical interventions which could be useful for a palliative care patient complaining of SOB?

A

Electric fan
Positioning: sitting upright
Relaxation techniques
Open windows

175
Q

What are some medical interventions for SOB in palliative patients?

A 
Saline nebulizers
Salbutamol nebulisers
Oxygen
Low dose opioids
Benzodiazepines
176
Q

What are management options for noisy breathing/secretions in palliative patients?

A 
Positioning/ suction
Hyoscine butylbromide
Glycopyronium
Monitoring patient
Reassuring relatives
177
Q

What can be used for restlessness and agitation at the end of life?

A

Reassurance/ continuity of care and experienced staff
Careful use of oral lorazepam if needed
Sedation may be necessary in some cases e.g. midazolam or
levomepromazine

178
Q

Which cancers are caused by oncogene alterations?

A

Philadelphia chromosome
Rhabdomyosarcomas: ras oncogene
Burkitts lymphoma: c myc translocation from chromosome 8 to 14
Neuroblastoma: N yc proto-oncogene seen in proportion of patients with poor prognosis

179
Q

What blood test abnormalities are expected in multiple myeloma?

A 
Hypercalcaemia
Raised ESR
High urate
Renal impairment 
Low Hb
180
Q

What are the differences between MEN1 and 2a/b?

A

MEN1: parathyroid hyperplasia, pituitary, pancreas
MEN2a: medullary thyroid cancer, parathyroid, phaeochromocytoma
MEN2b: medullary thyroid cancer, phaeochromocytoma, marfanoid body habitus, neuromas

181
Q

What are the most common malignancies following solid organ transplant?

A

Skin
Cervical carcinoma in situ
Post transplant lymphoproliferative disorder (EBV driven)

Phase 3 (23 decks)

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