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Medical Finals 2020 > Oncology > Flashcards

Oncology Flashcards

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USMLE® Step 1 flashcards
1
Q

What neutrophil count is considered neutropenic sepsis?

A

<1.0, but always suspect if a fever and immunocompromised

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2
Q

What antibiotics do you give in neutropenic sepsis according to NICE guidelines?

A

Piperacillin with tazobactam (tazocin), some hospital guidelines add gentamycin

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3
Q

What is your acute management of spinal cord compression?

A

Dexamethasone 16mg PO BD

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4
Q

What are features of malignant spinal cord compression?

A

Back pain
Lower limb weakness
Sensory changes
Bowel/bladder incontinence

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5
Q

A patient undergoing chemotherapy is suffering from nausea and vomiting. What antiemetic do you give them?

A

Metoclopromide/Domperidone

Then add in ondansetron with dexamethasone if not effective

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6
Q

What are some symptoms of SVC obstruction?

A 
SOB
Blurring of vision, headache
Bulging Forehead vein
Pemberton Sign - bilateral arm elevation causes facial plethora
Conjuctival and periorbital oedema
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7
Q

What is calcitonin a tumour marker for?

A

Medullary Thyroid

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8
Q

What is Ca 15-3 a tumour marker for?

A

Breast cancer

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9
Q

What is the most common cause of SVC obstruction?

A

SCLL

Lung Cancer

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10
Q

In a metastatic disease of unknown primary, what are the investigations that should be done in every patient?
What should be done in specific patients?

A

FBC, U&E, LFT, Ca2+, urinalysis, LDH
CXR
CT chest, abdo, pelvis
AFP and hCG

Myeloma screen (if lytic bone lesions)
Endoscopy (directed towards symptoms)
PSA (men)
CA 125 (women with peritoneal malignancy or ascites)
Testicular US (in men with germ cell tumours)
Mammography (in women with clinical or pathological features compatible with breast cancer)

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11
Q

Which is the most common kind of lung cancer in non-smokers?

A

Adenocarcinoma

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12
Q

What are the different stages in WHO Performance Status?

A

0 - full active, able to carry on activities as normal
1 - restricted in physical activity but able to carry out light work
2 - unable to work, >50% time up and about
3 - limited self-care, >50% bed or chair
4 - disabled, cannot carry out self-care, confined to bed or chair

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13
Q

What symptoms require immediate referral to a 2WW?

A

Frank haematuria
Breast changes
PR bleed in over 50 years old
Post-menopausal bleed

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14
Q

What tumour markers are commonly checked on a workup for a metastases of unknown origin?

A

PSA
Ca125
AFP
bhCG

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15
Q

What is the difference between adjuvant and neo-adjuvant?

A

Adjuvant - chemo given after definitive treatment
Neo-adjuvant - chemo given before definitive treatment - reduces risk of relapse, reduce micrometasases and allow for better excision margins

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16
Q

What are 5 side effects of chemotherapy? Which one of these should you counsel patients on prior to treatment?

A

Infertility - consider egg or sperm freezing

Nausea and vomiting
Alopecia
Peripheral neuropathy
Diarrhoea
Low WCC, immunocompromised
17
Q

What are some side effects of radiotherapy?

A 
Fatigue
Dry skin, erythema, mucositis
N+V
Diarrhoea
Dysphagia
Cystitis
18
Q

What kind of endocrine treatments are used in cancer management and which cancers are they used for?

A

Tamoxifen - breast cancer
Aromatase inhibitors - breast cancer
GnRH analogues - prostate cancer

19
Q

Give the name of 5 different complementary therapies and describe what they do

A

Reiki - moving your hand above the body to channel energy
Healing - spiritual or religion, redirecting energy flows
Homeopathy - treating like with like, dilutions
Acupuncture - use of fine sterile needles into parts of the body
Chiropractic - state licences, identifies strain and stiffness, stretching and manipulation of muscle and tissue

20
Q

How would a patient with raised ICP present and what is your management?

A

Headache (worse on coughing or bending forwards)

Urgent CT/MRI head
Dexamethasone 8-16mg
Mannitol for symptoms

21
Q

What is your immediate management in someone presenting with confusion, polydipsia, lethargy and a high calcium on blood tests?

A

IV Fluids

Then bisphosphonates

22
Q

Which types of cancer have a genetic component?

A

Colorectal
Breast
Endometrial
Ovarian

23
Q

What anti-emetic is used with intracranial tumours?

A

Dexamethasone

24
Q

How do you manage an SVC obstruction?

A

PO Dexamethason 8-16mg/24 hours
Balloon venoplasty/stenting
Tissue biopsy

25
Q

Tumour lysis syndrome is…?

A

Rapid cell death caused by the tumour resulting in increase in K+, urea and phosphate
Low calcium

Manage with good hydration and allopurinol
Haemodialysis

26
Q

What maintenance fluids should you give post-sepsis?

A

1L saline bags over 2/4/6/8 hours post-sepsis

27
Q

What might occur in raised intracranial pressure?

A

Cushing’s Response- nausea, vomiting, papilloedema
Headache
Visual problems
Coning

28
Q

What are some causes of high calcium?

A 
Hyperparathyroidism (PTH will be high)
Malignancy - bone metastases, myeloma (normal PTH)
Diuretics (thiazide)
Thyrotoxicosis
Sarcoidosis
Pheochromocytosis
29
Q

What antiemetics are not commonly used in palliative care?

A

Cyclizine and ondansetron

Use haloperidol or metoclopramide instead

30
Q

What do you give for excess secretions in palliative care?

A

Hyoscine butyl bromide

31
Q

What screening programmes are done in the UK?

A

Breast cancer (50-70, 3 years), Colon cancer (50-74, 2 years), Cervical cancer (25-49, 5 years, 50-65, 1 year)

32
Q

What is the most common kind of breast cancer?

A

Ductal 80% Lobular 15% Other 5%

33
Q

What kind of colorectal cancers arise from polyps?

A

Adenocarcinomas

34
Q

What electrolyte abnormalities do you get in tumour lysis syndrome?

A

Hyperuricaemia, hyperphosphataemia, hyperkalaemia
Hypocalaemia
Acute renal failure

35
Q

How might tumour lysis syndrome present?

A

Paralytic ileus, cardiac arrythmias, acute kidney injury

36
Q

How do you manage tumour lysis syndrome?

A

Hydration, correct the hyperkalaemia, supportive, give prophylaxis – Rasburicase or Allopurinol

37
Q

What are the 9 criteria for Wilson’s Screening Criteria (name 3).

A

The condition… should be an important health problem, the natural history should be understood, should have a recognisable latent of early asymptomatic but detectable
The test… should be acceptable, cost effective, accurate, reliable, sensitive and specific
The treatment… should be an accepted treatment, more effective if started early, policy on who should be treated

38
Q

What investigations should be done in someone with a raised total protein?

A

Bence Jones protein in the urine
Serum protein electrophoresis (to look for immunoglobulins)
X-ray skeletal survery

39
Q

What is the most common malignant neoplasm to affect the breast?

A

Adenocarcinoma

Medical Finals 2020 (25 decks)

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