Oncology

Question 1

BRCA1 & BRCA2 chromosome mutations

Answer 1

BRCA1 - Chromosome 17

BRCA2 - Chromosome 13

Question 2

Hyoscine hydrobromide used for what?

Answer 2

Respiratory secretions in palliative care
Anticholinergic action

BONUS (also hypersalivation with antiphyscotics)

Question 3

Hyoscine butylbromide used for what?

Answer 3

Bowel colic with bowel obstruction

Hyoscine Hydrobromide = hydro = resp secretions
Hyoscine Butylbromide = Butt = bowel colic

Question 4

p53 tumour suppressor gene affected in what genetic condition that predisposes to CA? Which CA is predominant?

Answer 4

Li-Fraumeni syndrome

Sarcomas & leukaemias

Question 5

LiFraumeni Syndrome diagnosis

Answer 5

Sarcoma <45 yrs old

First degree relative x2 with CA <45 years
First degree relative with ca<45 yrs + 1st deg relative with sarcome any age

Question 6

FAP/Gardeners syndrome gene affected

Answer 6

APC gene on chromosome 5

BONUS: Other CA’s: thyroid cancer, retroperiotnial desmoid tumours, skull osteoma

Question 7

HNPCC/Lynch syndrome diagnostic criteria

Answer 7

Amsterdam criteria
Three or more family members with a confirmed diagnosis of colorectal cancer, one of whom is a first degree (parent, child, sibling) relative of the other two.
Two successive affected generations.
One or more colon cancers diagnosed under age 50 years.
Familial adenomatous polyposis (FAP) has been excluded.

Question 8

Bacteria linked to Guillian-Barré

Answer 8

Campylobacter

Question 9

BRCA2 gene associated with what and percentage risk

Answer 9

Breast 60%
Ovarian 25%
Prostate

Chromsome 13

Question 10

BRCA1 gene associated with what and percentage risk

Answer 10

Breast 75%
Ovarian 50%

Minimal colorectal risk also

Chromosome 17%

Question 11

HER2 +ve breast ca percentage

Answer 11

20%

Question 12

BRCA +ve breast ca percentage

Answer 12

5%

Question 13

Domperidone MoA

Answer 13

Dopamine D2 antagonist

Antiemetic, prokinetic, can promote lactaction (galactorreahae)

Question 14

Conversion from oral to SC morphine?

Answer 14

Divide by 2

Question 15

How do you work out PRN morphine dose?

Answer 15

1/6th total daily dose (TDD)

Question 16

Codeine to morphine conversion

Answer 16

Dose divided by 10

Question 17

What do you always prescribe with morphine?

Answer 17

Antiemetic and LAXATIVE

Question 18

Multiple Endocrine Neoplasia (MEN) 1 cancers

Answer 18

3 P’s:
Pituitary adenoma
Parathryroid Ca
Pancreatic CA

Question 19

Multiple Endocrine Neoplasia (MEN) type IIa cancers

Answer 19

Parathyroid ca
Medullary Thyroid ca
Pheocytochroma

Question 20

Multiple Endocrine Neoplasia (MEN) type IIb cancers

Answer 20

3 M's (+ pheochromocytoma):
Marfaniod habitus 
Medullary thyroid cancers 
Mucosal neuromas
Pheochromocytoma

Question 21

Chemo drug causing hypomagnesaemia

Answer 21

Cisplatin

cytotoxin DNA cross-linking, used in breast cancer, magnesium is monitored - remember Dr Chaudri’s clinic

Question 22

Tumour marker for medullary thyroid CA

Answer 22

Calcitonin (parafollicular cells secrete calcitonicn and this is where medullary thyriod ca originates)

Question 23

Small cell lung Ca tumour marker

Answer 23

Bombesin (also could monitor ACTH, ADH as these are hormones SCLC can secrete causing a parameoplastic syndrome)

Question 24

Lung fibrosis is a chemo SE of which drug notoriously?

Answer 24

Bleomycin

Question 25

Neutropenic sepsis definition

Answer 25

WCC <0.5 PLUS Temp >38 or symptoms of sepsis

Question 26

G6PD blood film shows?

Answer 26

Bite and blister cells | Hienz bodies with an extra stain

Question 27

Epstien Barr virus associated with which ca?

Answer 27

Burkitt's lymphoma (rapid B cell malignancy)

Question 28

Starry sky picture on lympho node biopsy associated with what?

Answer 28

Burkitt's lymphoma (associated with epstein barr virus)

Question 29

Where are the likely areas for melanoma to be found in males and females?

Answer 29

Males - trunk (chest & back) | Females - Limbs

Question 30

Commonest site for metastasis to the spine

Answer 30

1. Thoracic spine

Question 31

Risk factors for prostate CA

Answer 31

``` Age (>65) Black > White > Asian FHx BRCA2 Agent Orange exposure (vietnam war) Eating habits Taller people more likely to have aggresive disease ```

Question 32

Obesity cause increased cancer risk in which cancers?

Answer 32

``` Breast Bowel Oesophagela Pancreatic Kidney Liver Gastric cardia gallbladder ovarian thyroid myeloma meningioma ```

Question 33

Skin cancer risk factors

Answer 33

``` Age Cumulative UV exposure Sun beds Skin type (e.g. Fitzgerald Type 1) Hair colour (redheads) Moles and freckles (100+) FHx - CDKN2A mutation in FAMMM Autoimmune conditions (e.g. Chrons) HIV Obesity Occupation - airline pilots & cabin crew - related to UV exposure most likely ```

Question 34

Blood tranfusion effects on serum K+ and Ca2+

Answer 34

K+ - hyperkalaemia (raises ir by 30-40) treat with insulin/detrose Ca2+ - Citrated blood lowers Ca2+ - administer calcium gluconate/calcium chloride

Question 35

Name for sign to check imminent airway obstruction for SVCO

Answer 35

Pembleton's manoeuvre (lift arms up to side of face) look for signs of SOB after 1 min