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Medical School > Oncology > Flashcards

Oncology Flashcards

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USMLE® Step 1 flashcards
1
Q

Cancer therapy timings

  1. Adjuvant
  2. Neo-adjuvant
  3. Concurrent
A
  1. Given after definitive treatment
  2. Given before main treatment to shrink cancer
  3. 2+ cancer therapies given simultaneously
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2
Q

Radiotherapy

  1. Side effects - early
  2. Side effects - late
A
  1. Fatigue, pain, oesophagitis, pneumonitis, diarrhoea, N+V, skin reaction, cystitis, raised ICP, hair loss
  2. Fibrosis, stricture, osteonecrosis, fracture, malignancy
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3
Q

Chemotherapy

  1. Frequency of administration
  2. Blood count lowest when
  3. How many cycles
A
  1. 2-4 weeks to allow for blood count recovery
  2. 2 weeks (neutropaenia, thrombocytopaenia)
  3. 6 cycles - 5 months
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4
Q

Neutropaenic sepsis

  1. Triad
  2. Neutropaenia - definition
  3. Commonest cancers (2)
  4. Sepsis 6
A
  1. Neutropenia, anaemia, thrombocytopenia
  2. Neutrophil count <1.0
  3. Lymphoma, leukaemia
4. ABG - lactate, blood cultures, urine output
IV ABX (Taz/Gent, Mero + Vanc), oxygen, IV fluids
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5
Q

Chemotherapy hypersensitivity reaction

  1. Presentation
  2. Management
A
  1. Fever, low BP/O2, high HR, wheeze, OP oedema
2. Stop infusion
Supportive - stat O2 + IV fluids
Anti-histamine - 10mg chlorphenamine
IV steroid - hydrocortisone 200mg
Adrenaline 0.5ml of 1:1000 IM
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6
Q

Tumour lysis syndrome

  1. Risk factors (4)
  2. Presentation (5)
  3. Preventative drug
  4. Clinical definition
  5. Scoring system
A
  1. Treatment of bulky chemosensitive tumours, anti-cancer therapy use, existing renal impairment, malignant biochemical abnormalities
  2. High: urate, K+, phosphate
    Low Ca2+
    Renal failure
  3. Allopurinol/rasburicase immediately prior to + during 1st days of chemotherapy
  4. Laboratory TLS plus one or more of the following:
    High serum creatinine (1.5x upper limit of normal)
    Cardiac arrhythmia or sudden death
    Seizure
  5. Cairo-Bishop
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7
Q

Fitness in oncology

  1. Name of fitness scale
  2. Scale
  3. Fitness investigations for possible: surgery
  4. Chemotherapy
  5. Radiotherapy
A
  1. ECOG
  2. 0 = fully active, 5 = deceased
  3. Lung, cardiac
  4. Renal, liver
  5. Ability to lie flat, pacemaker
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8
Q

Lung cancer

  1. When to refer using suspected LC pathway (2)
  2. Urgent (2w) CXR in 40+ if
  3. Staging - investigations (2 stages)
  4. Further imaging in N-SCLC to establish eligibility for curative treatment
  5. Histology most associated with smoking
  6. Most associated with non-smoking

Endocrine extra-pulmonary manifestations

  1. Small cell (2)
  2. Squamous cell (1)
  3. Large cell (1)
  4. Other non-endocrine issues
A
  1. CXR findings suggest lung cancer
    Aged 40+ with unexplained haemoptysis
  2. 2+ unexplained symptoms, or smoke + 1 US:
    Cough / fatigue / SOB / chest pain / weight loss / appetite loss
  3. Thorax and abdomen CT with contrast
    Then bronchoscopy and biopsy
  4. PET scan
  5. Squamous cell carcinoma (near large airway, has clubbing)
  6. Adenocarcinoma (peripheral)
  7. ACTH (Cushing’s), ADH (dilutional low Na+)
  8. PTH (hypercalcaemia)
  9. HCG (gynaecomastia)
  10. Cerebellar degeneration, myopathy, polyneuropathy, myasthenic syndrome (Lambert-Eaton, when immune cells attack NMJs), thrombophlebitis migrans, anaemia, DIC, dermatomyositis, herpes zoster, acanthosis nigricans, clubbing, HPOA
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9
Q

Bony metastases

  1. How quickly is MRI needed if MSCC suspected
  2. First symptom
  3. If bony metastases suspected but no compression
  4. Management
  5. Pre-neurosurgery investigations (2)
A
  1. 24 hours
  2. Back pain
  3. 1 week
  4. Nursed flat, catheter
    High dose dexamethasone (16mg orally BD) + PPI
    Opioid analgesia
    Consider: neurosurgery, radiotherapy
  5. CXR, CT thorax/abdo
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10
Q

Acute hypercalcaemia

  1. Features
  2. Malignant causes
  3. Management
A
  1. Bones, stones, groans + psychic moans
    Also: corneal calcification, short QT, HTN
  2. Bone metastases, osteolytic tumours (e.g. myeloma), paraneoplastic syndrome (e.g. PTHrP from squamous cell LC), tumours producing vitamin D
  3. Rehydration (3-4L per day) + Zolendronic acid (IV)
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11
Q

Palliative care - management

  1. Anorexia
  2. Bowel colic and excessive respiratory secretions
  3. Convulsions
  4. Hiccups
  5. Dysphonia
  6. Muscle spasm
  7. N+V
  8. Restlessness/confusion
A
  1. Prednisolone / dexamethasone
  2. Hyoscine hydrobromide (bowel = butyl) (antimuscarinic)
  3. Prophylactic phenytoin / carbamazepine
  4. Chlorpromazine / haloperidol
  5. Morphine / diazepam
  6. Diazepam / baclofen
  7. Haloperidol / metroclopromide / ondansetron
  8. Haloperidol
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12
Q

Cytotoxic drugs - side effects

  1. Asparagine
  2. Cisplatin
  3. Vincristine/vinblastine
  4. Bleomycin
  5. Doxorubicin
  6. Cyclophosphamide
  7. Methotrexate
A
  1. Neurotoxicity
  2. Ototoxic, nephrotoxic (amifostine), low Mg2+
  3. ‘Christ my nerves (PN), blast my bones (myelosuppression)’
  4. Pulmonary fibrosis
  5. Cardiotoxic (dexrozoxane)
  6. Nephrotoxic, bladder toxic e.g. haemorrhagic cystitis (mesna)
  7. Nephrotoxic (leucovorin), myelosuppression (filgrastim), liver fibrosis, mucositis
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13
Q

Tumour markers

Monoclonal antibodies

  1. CA 15-3
  2. CA 19-9
  3. CA 125

Tumour antigens

  1. PSA
  2. Alfa-feto protein (AFP) (2)
  3. Carcinoembryonic antigen (CEA)
  4. S-100 (2)
  5. Bombesin (3)
  6. Calcitonin
A
  1. Breast
  2. Pancreatic
  3. Ovarian
  4. Prostate carcinoma
  5. Hepatocellular carcinoma, testicular teratoma
  6. Colorectal cancer
  7. Melanoma, schwannomas
  8. Small cell lung carcinoma, gastric cancer, neuroblastoma
  9. Medullary thyroid cancer
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14
Q

Genetics

  1. BRCA 1
  2. BRCA 2
  3. Li-Fraumeni syndrome (AD) - which gene, which malignancies (2)
  4. Lynch syndrome aka HNPCC (AD) (2)
  5. High risk identified using what
  6. Gardners syndrome - what it is (AD)
  7. Extra-colonic manifestation
  8. Which gene mutated
  9. Variant of what
A
  1. Breast (60%), ovarian (55%)
  2. Breast (60%), ovarian (25%), prostate
  3. p53 mutation - sarcoma, leukaemia
  4. Colonic, endometrial
  5. Amsterdam criteria (FAP excluded - no polyps)
  6. Familial colorectal polyposis
  7. Skull osteoma, thyroid cancer, epidermoid cysts, desmoid tumours
  8. APC
  9. Familial adenomatous polyposis (FAP)
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15
Q

Genes - type

  1. Cyclin D1.EGF
  2. p16
  3. p53
A
  1. Growth-promoting oncogene
  2. Tumour suppressor gene
  3. Tumour suppressor gene
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Medical School (28 decks)

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