Oncology and Haematology Flashcards
1
Q
Is tramadol a weak or strong opioid?
A
Weak
2
Q
Which opioids are suitable in renal failure?
A
Fentanyl and bupromorphine
3
Q
What drug is given to prevent tumour lysis syndrome?
A
Allopurinol
4
Q
What type of anaemia does alcohol abuse typically cause?
A
Macrocytic (due to folate deficiency)
5
Q
“Golf balls” on a blood smear indicate which condition?
A
Thalassaemia
6
Q
Frontal bossing is associated with which condition?
A
Beta thalassaemia
As well achondroplasia, acromegaly, rickets, fragile X, Marfans
7
Q
Haemophilia A is due to a deficiency in what?
A
Factor VIII
8
Q
What is the inheritance pattern of haemophilia?
A
X linked recessive
9
Q
Haemophilia B is due to a deficiency in what?
A
Factor IX
A.k.a. Christmas disease
10
Q
Reed Steenberg cells indicate what condition?
A
Hodgkin’s lymphoma
11
Q
What is osteosarcoma?
A
The most common type of bone cancer, often at the end of long bones
More common in children and adolescents
Commonly presents with pain in the affected bone
Characteristic sunburst like appearance of x ray
12
Q
A patient who is completely disabled, cannot self care and is totally confined to a bed or chair would level a performance status score of what?
A
4
0 is fully active, 5 is dead
13
Q
CEA is the tumour marker for which cancer?
A
Colorectal
14
Q
What tumour markers are used for testicular Ca?
A
Beta hCG
AFP
15
Q
CA19-9 is the tumour marker for which cancer?
A
Pancreatic Ca
16
Q
What are some uses of desmopressin?
A
Diabetes insipidus
Bed wetting
Haemophilia A
Von Willebrands Disease
17
Q
What is the deficiency in haemophilia A?
A
Factor VIII
18
Q
What is the inheritance factor of Von Willebrands disease?
A
Autosomal dominant
19
Q
What are the three myeloproliferative disorders?
A
Polycythaemia Vera
Essential thrombocytosis
Myelofibrosis
20
Q
What are some features of myelofibrosis?
A
Most commonly presents are fatigue (due to anaemia) but also hepatosplenkmegly, infections, fever, night sweats, weight loss
Fibrosis of bone marrow
Dry tap on bone marrow aspirate (so have to do trephine)
Trephine will show fibrosis and reticulum fibres
Tear drop shaped RBCs on blood film
21
Q
How is myelofibrosis treated?
A
Blood transfusions for anaemia (androgen therapy if severe)
Stem cell transplant in young px
Palliative measure
Prognosis ~ 5 years
22
Q
What are some common symptoms of myeloproliferative disorders?
A
Hepatosplenomegaly
Hyperuricaemia and gout
Thrombosis
Hyperviscosity symptoms e.g. headache, tinnitus, burning of palms and soles
23
Q
A dry tap on bone marrow aspiration is suggestive of which condition?
A
Myelofibrosis
24
Q
Which genetic mutation is seen in the majority of patients with a myeloproliferative disorder?
A
JAK2 mutation
25
What are some presenting features of polycythaemia Vera?
```
Hyperviscosity signs
Pruritis, especially after a bath
Splenomegaly
Plethora of face
Gout
Thrombosis
```
26
How can polycythaemia Vera be managed?
```
Venesection 1st line
Aspirin 75mg OD
Hydroxycarbamide if advanced
Allopurional for gout
Antihistamine for pruritis
```
27
How is essential thrombocythaemia managed?
Aspirin 75mg OD
| Hydroxycarbamide given to patients at higher risk of thrombosis
28
How is haemophilia treated?
Replace missing clotting factors
| Anticoagulants are contraindicated
29
Which histologically type of lung cancer is associated with a worse prognosis?
Small cell lung cancer
30
Which is more rapidly growing and more malignant: small cell lung cancer or non-small cell lung cancer?
SCLC
31
Which type of lung cancer is associated with asbestos exposure?
Mesothelioma
32
Which subtype of lung cancer is most strongly associated with smoking?
Squamous cell carcinoma
33
What is lymphangitis carcinomatosa?
Spread of cancer along the lung lymphatic, common due to breast, stomach, pancreatic, lung, colon Ca
34
What are the main investigations for lung cancer?
CXR
CT CAP
Broncoscopy and biopsy
PET if being considered for curative surgery
35
Which subtype of lung cancer is more sensitive to chemotherapy?
Small cell lung Ca
36
How does the management usually differ between the different lung Ca types?
SCLC usually more advanced at diagnosis but more chemosensitive, so often chemotherapy and palliation
NSCLC: surgical resection if low stage, chemoradiotherapy if more advanced (not as responsive to chemo as SCLC
37
Which type of lung Ca is most often associated with paraneoplastic syndromes?
Small cell lung cancer
38
What genetic conditions are a risk factor for colorectal carcinoma?
Lynch syndrome I & II
Familial adenimatous polyposis (FAP)
Gardner syndrome
39
What are some risk factors for colorectal carcinoma?
```
Diet (high processed and red meats, high fat, low fibre, high alcohol)
Smoking
Obesity
Males
Family history
Genetics (Lynch syndrome and FAP)
Crohns and ulcerative colitis
```
40
What is the screening process for colorectal carcinoma?
All men aged 60 to 74 are sent stool samples testing kits for faecal occult blood, every 2 years
Positive tests are then invited for colonoscopy
41
What cancer is Dukes staging used for?
Colorectal carcinoma
42
What is the inheritance pattern of familial adenomatous polyposis?
Autosomal dominant
43
Whereabouts in the colon do most colorectal cancers occur?
Rectum
44
What is Duke’s staging?
```
Used for colorectal carcinoma
A: confined to the mucosa
B: penetrated the muscularis mucosa (bowel wall)
C: lymph node involvement
D: distant metastases
```
45
Colorectal cancer that invades the bowel wall would be which stage of duke’s classification?
B
46
What is the gold standard investigation for colorectal carcinoma?
Colonoscopy with biopsy
47
Can radiotherapy be used in colorectal cancer?
If rectal cancer yes, but rarely in colon cancer due to risk of damage to the small bowel
48
How would surgical management of colorectal carcinoma differ if the tumour was low sigmoid/ high rectal, versus low rectal?
Sigmoid/ high rectum: anterior resection (allows preservation of anal sphincter)
Low rectum: abdomino-perineal resection (resulting in colostomy)
49
What is the difference between an anterior resection and abdomino-perineal resection for colorectal cancer?
Anterior resection: used for high rectal/ sigmoid tumours, preserves the anal sphincter
AP resection: used for low rectal tumours, results in permanent colostomy
50
Where does colorectal Ca commonly metastasise to?
Liver
51
Barrett’s oesophagus often causes which specific type of cancer?
Oesophageal adenocarcinoma
52
What histologically type is oesophageal cancer usually?
Upper 2/3rds oesophagus: squamous cell carcinoma
| Lower 1/3rd oesophagus: adenocarcinoma
53
What are some risk factors for oesophageal carcinoma?
```
Smoking
High alcohol intake
Barrett’s oesophagus
GORD
Achalsia
```
54
What is the usual investigation of choice in suspected oesophageal Ca?
Upper GI endoscopy
55
What is an Ivor Lewis procedure and what is it used for?
Oesophagectomy
Via laparotomy and right thoractomy
Used in oesophageal Ca, affected area is removed and anastamosis created between stomach and upper oesophagus
56
H Pylori is a risk factor for which cancer?
Gastric cancer
57
What is the most common type of invasive breast Ca?
Ductal carcinoma
58
What is the screening protocol for breast cancer?
All women aged 50 to 70 after invited for an mammogram every 3 years
59
What are the treatment options for breast carcinoma?
Surgery (WLE or mastectomy)
Radiotherapy (always recommended after WLE)
Biological therapy (Herceptin if HER2 receptor +ve)
Hormonal therapy (Tamoxifen if Oestrogen receptor +ve)
Chemotherapy
60
What is the most likely cause of a very smooth and mobile breast lump in a young woman?
Fibroadenoma aka breast mouse
61
What is the commonest cancer of childhood?
Acute lymphoblastic leukaemia
62
What genetic abnormality is strongly associated with chronic myeloid leukaemia?
Philadelphia chromosomal (abnormal chromosome 22)
63
What is the Philadelphia chromosome?
Abnormal chromosome 22 (reciprocal translocation from 9 to 22) most strongly associated with chronic myeloid leukaemia
64
Which haematological malignancy CN be treated with tyrosine kinase inhibitors?
Chronic myeloid leukaemia
65
Which leukaemia is often treated with a watch and wait approach?
Chronic lymphocytic leukaemia
As it most often presents in the elderly and it has a very slow progression so we observe patients and hold off treatment until they become symptomatic
66
How do Reed Steenberg cells characteristically look on microscopy?
Cells with 2 “owls eye” nuclei
67
Hodgkin’s lymphoma is thought to be associated with which virus?
Epstein Barr virus
68
What is the Ann Arbour staging used for?
Lymphoma
69
Describe the Ann arbour staging.
1 involves single lymph node region
2 involves lymph nodes on one side of the diaphragm
3 involves lymph nodes on both sides of diaphragm
4 involves extranodal sites e.g. liver, bone marrow
+A if no B symptoms
+B if B symptoms present
70
What are B symptoms?
Weight loss, night sweats and fever
| Used in staging of Hodgkin’s lymphoma to describe if present or absent
71
Do lymphomas commonly derive from B or T lymphocytes?
B lymphocytes
72
How does myeloma often present?
CRAB: hyperCa, renal failure, anaemia (normocytic normochromic), bone pain
Signs of bone marrow failure e.g. thrombopenia, increased infections
Hyperviscosity syndrome effects
73
Myeloma is due to proliferation of what cells?
Plasma cells, which are responsible for immunoglobulin production
74
In myeloma which monoclonal immunoglobulin is most commonly secreted by plasma cells?
IgG
75
What is MGUS?
= monoclonal gammopathy of uncertain significance
Elevated serum paraprotein but to a lesser extent than in myeloma, so we monitor these patients to ensure they do not progress to myeloma
76
What blood tests would you order in suspected myeloma, and what would they show?
FBC (anaemia, thrombocytopenia, neutropenia)
U&Es (raised Ca, raised creatinine)
Raised ESR
Raised serum monoclonal Ig
77
What is the name of the monoclonal paraprotein found in the urine in myeloma?
Bence Jones proteins
78
What are some risk factors for acute leukaemia?
```
Benzene exposure
Ionising radiation
Chemotherapy
Smoking
Down’s syndrome
```
79
For a patient with myeloma, which cells will be increased in their bone marrow?
Plasma cells
80
Chronic lymphocytic leukaemia is most often a monoclonal proliferation of which lymphocytes?
B cells
81
Which is the most common leukaemia in adults?
Chronic lymphocytic leukaemia
82
What is the mechanism of action of rivaroxaban?
Direct factor Xa inhibitor
83
Which cancer is associated with the presence of smudge cells on a blood film?
Chronic lymphocytic leukaemia
84
What investigations would you order for a suspected leukaemia?
FBC (low Hb, low platelets, low neutrophils, raised WCC if ALL/CLL, raised LDH)
Blood film (raised blast cells in ALL, AML, smudge cells in CLL, auer rods in AML)
BM aspirate and trephine
Cytogenetics (Philadelphia chromosome in CML)
CXR (enlarged mediastinum indicate lymphadenopathy)
Lymph node biopsy
LP (to see in CNS involvement)
Staging CT/ MRI
85
A blood film with increased blasts cells and auer rods indicates what?
AML
86
What will blood film show for AML?
Raised blast cells with auer rods
87
How may a patient with polycythaemia Vera present?
```
Hyperviscosity signs (tinnitus, headache, visual disturbance, burning in fingers and toes)
Pruritis, especially after a bath
Gout
Splenomegaly
Plethora
Thrombosis
```
88
FBC shows raised RCC, Hb, WCC and platelets in a patient complaint of headache and pruritis. What is the likely diagnosis?
Polycythaemia Vera
89
How would you treat polycythaemia Vera?
```
Venesection
Aspirin
Hydroxycarbamide
Antihistamines
Allopurinol
```
90
What mutation is associated with polycythaemia Vera?
JAK2
91
What is the 2 week wait referral criteria for suspected lung cancer?
Haemoptysis in a smoker over 40
92
What are some risk factors for prostate cancer?
Age
Family history
Afro-caribbeans
BRCA
93
What system is used to grade prostate cancer?
Gleason grading
| Higher grading indicates poorer differentiated tissue so a more aggressive cancer and risk of metastases
94
Which type of testicular cancer is found more commonly in younger patients?
Non-seminoma
95
What is the difference between a seminoma and a non-seminoma?
Non-seminoma aka teratoma found in younger patients, faster growing
Seminoma is found in older patients, slower growing, very radiotherapy sensitive
Both develop from germ cells in the testes
96
What is a Burr cell?
RBC with thorny projections on its membrane that indicates uraemia and liver disease
97
Howell Jolly bodies indicate what?
Hyposplenism
98
What cells are seen in the blood film in Fe deficiency anaemia?
Target cells
99
Bone marrow biopsy for a patient with myeloma will show an increase in what cells?
Plasma cells
100
How are red cells stored?
Refrigerated at 4 degrees
101
What is fresh frozen plasma and when is it indicated?
Contains clotting factors
| Used to correct clotting deficiency
102
What does cryoprecipitate mainly contain?
Fibrinogen, factor VIII, Von Willebrands factor
103
What boood products would you give for a px with thrombocytopenia?
Platelets
104
What ECG abnormalities can be seen in tumour lysis syndrome?
Due to the hyperK: tall T waves, prolonged PR and QRS, flattened P waves
105
Where is the most common site for melanoma in men and women?
Men: trunk (chest and back)
Women: arms and legs
106
What is the most common subtype of malignant melanoma?
Superficial spreading
107
Which type of melanoma is the most aggressive?
Nodular melanoma
| Lesions grow rapidly, invade deeply and metastasise early
108
Where are malignant melanoma likely to metastasise to?
```
BBLLL
Brain
Bone
Liver
Lungs
Lymph nodes
```
109
Which type of melanoma is usually found on the palms of the soles, or under fingernails and toe nails?
Acral lentiginous melanoma
| Moe common darker skinned people
110
Which type of melanoma is most common in darker skinned people?
Acral lentiginous melanoma
| Usually on palms or soles of under the nails
111
What type of melanoma is more common in older people?
Lentigo maligna melanoma
112
A patient on Zomorph 60mg BD would require what dose of SC PRN morphine?
PRN dose is 1/6th TDD
then oral to SC is 1/2
So if TDD is 120, oral PRN is 20mg, SC PRN is 10mg
113
What’s the most common side effect of radiotherapy for prostate cancer?
Frequent urination
| Also dysuria, haematuria, bowel symptoms
114
What is the best test to identify the cause of haemolysis?
Direct Coombs antiglobulin test
115
Positive Coombs test suggests what?
Autoimmune haemolysis
| Haemolytic Disease of the newborn
116
What does the direct Coombs test for and how?
Autoimmune haemolytic anaemia
| By testing to see if Coombs reagent will agglutinate to antibodies on the red blood cell surface
117
What is the difference between the direct and indirect Coombs test?
Direct test adds the Coombs reagent to washed red blood cells without plasma, to test for autoimmune haemolytic anaemia
Indirect test uses serum, used prior to blood transfusion and in prenatal testing of pregnant women
118
Which region of the spine is metastastic spine cord compression most common in?
Thoracic spine
119
What is the difference between watchful waiting and active surveillance for prostate cancer?
Watchful waiting has no definitive follow up plan (indicated if low Gleason score, elderly, multiple comorbidities)
Active surveillance has regular PSA measure, DREs, rebiopsy every 1-3years
120
How would you manage a patient displaying superior vena cava obstruction?
Dexamethasone
Diuretics
Stenting
Radiotherapy
121
What are some features that would indicate SVC obstruction?
```
Swollen face
Engorged neck veins
Breathlessness
Coughing
Headache
```
122
Which treatment for DVT is most appropriate in a patient undergoing chemotherapy?
Low molecular weight heparin
| Warfarin is less effective in chemo px and hard to achieve INR in range, no data available for use of DOACs
123
What are some short and long term side effects of chemotherapy?
Short term: alopecia, nausea and vomiting, increased infections, fatigue, mucositis, diarrhoea
Long term: memory impairment (chemo brain), secondary cancers, early menopause, infertility, peripheral neuropathy, cardiomyopathy, AKI, peripheral neuropathy
124
What are some early and late side effects of radiotherapy?
Early fatigue, anxiety and depression, hair loss if scalp, diarrhoea if bowel, skin erythema
Late: secondary cancer, telangiectasia, fibrosis, bowel structures
125
What is the difference between a Hickman and a PICC line?
Hickman line enters directly into the subclavian vein through to the vena cava
PICC line enters into the antecubital vein to the brachial vein then to the subclavian vein to the vena cava
126
What type of drug is imatinib?
Tyrosine kinase inhibitor chemotherapy agent
127
What is an example of an anti metabolite chemotherapy agent?
5-FU
| Methotrexate (folic acid antagonist)
128
How would you manage a patient presenting with superior vena cava obstruction?
Dexamethasone
Endovascular stent via the femoral vein
Diuretics e.g. furesomide
Radiotherapy/ chemotherapy
129
Prostate cancers most commonly arise from which zone of the prostate?
```
Peripheral zone
(Transitional zone is the area most protected by benign prostatic hypertrophy)
```
130
Active surveillance is suitable for patients with what Gleason score?
6
131
Which cancer give cannonball lung metastases?
Renal cell carcinoma
132
How would you manage a cancer patient presenting with hypercalcaemia?
IV normal 0.9% saline
IV bisphosphonates
Calcitonin is rapid correction needed
133
Where does colorectal Ca most commonly metastasise to?
Liver
134
Primary cancers that are likely to spread to the brain...?
Breast
Malignant melanoma
Lung
135
Lymphadenopathy with severe pain on alcohol consumption is characteristic of what condition?
Hodgkin’s lymphoma
136
Rouleaux formation on blood film is associated with which condition?
Myeloma
137
What is the richter transformation?
Complication of CLL when the leukaemic cells invade the lymph nodes and transform to high grade non-Hodgkin’s lymphoma which causes lymphadenopathy and acute illness (B symptoms)
138
Myeloproliferative disorders are associated with with genetic mutation?
JAK2
139
As well as allopurinol and fluids, what else can be given for tumour kudos syndrome?
Rasburicase
| Also tx hyperK
