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EOY4 > Oncology and Haematology > Flashcards

Oncology and Haematology Flashcards

1
Q

Is tramadol a weak or strong opioid?

A

Weak

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2
Q

Which opioids are suitable in renal failure?

A

Fentanyl and bupromorphine

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3
Q

What drug is given to prevent tumour lysis syndrome?

A

Allopurinol

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4
Q

What type of anaemia does alcohol abuse typically cause?

A

Macrocytic (due to folate deficiency)

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5
Q

“Golf balls” on a blood smear indicate which condition?

A

Thalassaemia

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6
Q

Frontal bossing is associated with which condition?

A

Beta thalassaemia

As well achondroplasia, acromegaly, rickets, fragile X, Marfans

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7
Q

Haemophilia A is due to a deficiency in what?

A

Factor VIII

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8
Q

What is the inheritance pattern of haemophilia?

A

X linked recessive

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9
Q

Haemophilia B is due to a deficiency in what?

A

Factor IX

A.k.a. Christmas disease

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10
Q

Reed Steenberg cells indicate what condition?

A

Hodgkin’s lymphoma

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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

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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

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13
Q

CEA is the tumour marker for which cancer?

A

Colorectal

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14
Q

What tumour markers are used for testicular Ca?

A

Beta hCG

AFP

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15
Q

CA19-9 is the tumour marker for which cancer?

A

Pancreatic Ca

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16
Q

What are some uses of desmopressin?

A

Diabetes insipidus
Bed wetting
Haemophilia A
Von Willebrands Disease

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17
Q

What is the deficiency in haemophilia A?

A

Factor VIII

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18
Q

What is the inheritance factor of Von Willebrands disease?

A

Autosomal dominant

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19
Q

What are the three myeloproliferative disorders?

A

Polycythaemia Vera
Essential thrombocytosis
Myelofibrosis

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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

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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

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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

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23
Q

A dry tap on bone marrow aspiration is suggestive of which condition?

A

Myelofibrosis

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24
Q

Which genetic mutation is seen in the majority of patients with a myeloproliferative disorder?

A

JAK2 mutation

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25
Q

What are some presenting features of polycythaemia Vera?

A 
Hyperviscosity signs
Pruritis, especially after a bath
Splenomegaly
Plethora of face
Gout
Thrombosis
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26
Q

How can polycythaemia Vera be managed?

A 
Venesection 1st line
Aspirin 75mg OD
Hydroxycarbamide if advanced
Allopurional for gout
Antihistamine for pruritis
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27
Q

How is essential thrombocythaemia managed?

A

Aspirin 75mg OD

Hydroxycarbamide given to patients at higher risk of thrombosis

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28
Q

How is haemophilia treated?

A

Replace missing clotting factors

Anticoagulants are contraindicated

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29
Q

Which histologically type of lung cancer is associated with a worse prognosis?

A

Small cell lung cancer

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30
Q

Which is more rapidly growing and more malignant: small cell lung cancer or non-small cell lung cancer?

A

SCLC

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31
Q

Which type of lung cancer is associated with asbestos exposure?

A

Mesothelioma

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32
Q

Which subtype of lung cancer is most strongly associated with smoking?

A

Squamous cell carcinoma

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33
Q

What is lymphangitis carcinomatosa?

A

Spread of cancer along the lung lymphatic, common due to breast, stomach, pancreatic, lung, colon Ca

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34
Q

What are the main investigations for lung cancer?

A

CXR
CT CAP
Broncoscopy and biopsy
PET if being considered for curative surgery

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35
Q

Which subtype of lung cancer is more sensitive to chemotherapy?

A

Small cell lung Ca

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36
Q

How does the management usually differ between the different lung Ca types?

A

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

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37
Q

Which type of lung Ca is most often associated with paraneoplastic syndromes?

A

Small cell lung cancer

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38
Q

What genetic conditions are a risk factor for colorectal carcinoma?

A

Lynch syndrome I & II
Familial adenimatous polyposis (FAP)
Gardner syndrome

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39
Q

What are some risk factors for colorectal carcinoma?

A 
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
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40
Q

What is the screening process for colorectal carcinoma?

A

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

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41
Q

What cancer is Dukes staging used for?

A

Colorectal carcinoma

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42
Q

What is the inheritance pattern of familial adenomatous polyposis?

A

Autosomal dominant

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43
Q

Whereabouts in the colon do most colorectal cancers occur?

A

Rectum

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44
Q

What is Duke’s staging?

A 
Used for colorectal carcinoma
A: confined to the mucosa
B: penetrated the muscularis mucosa (bowel wall)
C: lymph node involvement
D: distant metastases
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45
Q

Colorectal cancer that invades the bowel wall would be which stage of duke’s classification?

A

B

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46
Q

What is the gold standard investigation for colorectal carcinoma?

A

Colonoscopy with biopsy

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47
Q

Can radiotherapy be used in colorectal cancer?

A

If rectal cancer yes, but rarely in colon cancer due to risk of damage to the small bowel

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48
Q

How would surgical management of colorectal carcinoma differ if the tumour was low sigmoid/ high rectal, versus low rectal?

A

Sigmoid/ high rectum: anterior resection (allows preservation of anal sphincter)
Low rectum: abdomino-perineal resection (resulting in colostomy)

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49
Q

What is the difference between an anterior resection and abdomino-perineal resection for colorectal cancer?

A

Anterior resection: used for high rectal/ sigmoid tumours, preserves the anal sphincter
AP resection: used for low rectal tumours, results in permanent colostomy

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50
Q

Where does colorectal Ca commonly metastasise to?

A

Liver

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51
Q

Barrett’s oesophagus often causes which specific type of cancer?

A

Oesophageal adenocarcinoma

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52
Q

What histologically type is oesophageal cancer usually?

A

Upper 2/3rds oesophagus: squamous cell carcinoma

Lower 1/3rd oesophagus: adenocarcinoma

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53
Q

What are some risk factors for oesophageal carcinoma?

A 
Smoking
High alcohol intake
Barrett’s oesophagus 
GORD
Achalsia
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54
Q

What is the usual investigation of choice in suspected oesophageal Ca?

A

Upper GI endoscopy

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55
Q

What is an Ivor Lewis procedure and what is it used for?

A

Oesophagectomy
Via laparotomy and right thoractomy
Used in oesophageal Ca, affected area is removed and anastamosis created between stomach and upper oesophagus

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56
Q

H Pylori is a risk factor for which cancer?

A

Gastric cancer

57
Q

What is the most common type of invasive breast Ca?

A

Ductal carcinoma

58
Q

What is the screening protocol for breast cancer?

A

All women aged 50 to 70 after invited for an mammogram every 3 years

59
Q

What are the treatment options for breast carcinoma?

A

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
Q

What is the most likely cause of a very smooth and mobile breast lump in a young woman?

A

Fibroadenoma aka breast mouse

61
Q

What is the commonest cancer of childhood?

A

Acute lymphoblastic leukaemia

62
Q

What genetic abnormality is strongly associated with chronic myeloid leukaemia?

A

Philadelphia chromosomal (abnormal chromosome 22)

63
Q

What is the Philadelphia chromosome?

A

Abnormal chromosome 22 (reciprocal translocation from 9 to 22) most strongly associated with chronic myeloid leukaemia

64
Q

Which haematological malignancy CN be treated with tyrosine kinase inhibitors?

A

Chronic myeloid leukaemia

65
Q

Which leukaemia is often treated with a watch and wait approach?

A

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
Q

How do Reed Steenberg cells characteristically look on microscopy?

A

Cells with 2 “owls eye” nuclei

67
Q

Hodgkin’s lymphoma is thought to be associated with which virus?

A

Epstein Barr virus

68
Q

What is the Ann Arbour staging used for?

A

Lymphoma

69
Q

Describe the Ann arbour staging.

A

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
Q

What are B symptoms?

A

Weight loss, night sweats and fever

Used in staging of Hodgkin’s lymphoma to describe if present or absent

71
Q

Do lymphomas commonly derive from B or T lymphocytes?

A

B lymphocytes

72
Q

How does myeloma often present?

A

CRAB: hyperCa, renal failure, anaemia (normocytic normochromic), bone pain
Signs of bone marrow failure e.g. thrombopenia, increased infections
Hyperviscosity syndrome effects

73
Q

Myeloma is due to proliferation of what cells?

A

Plasma cells, which are responsible for immunoglobulin production

74
Q

In myeloma which monoclonal immunoglobulin is most commonly secreted by plasma cells?

A

IgG

75
Q

What is MGUS?

A

= 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
Q

What blood tests would you order in suspected myeloma, and what would they show?

A

FBC (anaemia, thrombocytopenia, neutropenia)
U&Es (raised Ca, raised creatinine)
Raised ESR
Raised serum monoclonal Ig

77
Q

What is the name of the monoclonal paraprotein found in the urine in myeloma?

A

Bence Jones proteins

78
Q

What are some risk factors for acute leukaemia?

A 
Benzene exposure
Ionising radiation 
Chemotherapy
Smoking 
Down’s syndrome
79
Q

For a patient with myeloma, which cells will be increased in their bone marrow?

A

Plasma cells

80
Q

Chronic lymphocytic leukaemia is most often a monoclonal proliferation of which lymphocytes?

A

B cells

81
Q

Which is the most common leukaemia in adults?

A

Chronic lymphocytic leukaemia

82
Q

What is the mechanism of action of rivaroxaban?

A

Direct factor Xa inhibitor

83
Q

Which cancer is associated with the presence of smudge cells on a blood film?

A

Chronic lymphocytic leukaemia

84
Q

What investigations would you order for a suspected leukaemia?

A

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
Q

A blood film with increased blasts cells and auer rods indicates what?

A

AML

86
Q

What will blood film show for AML?

A

Raised blast cells with auer rods

87
Q

How may a patient with polycythaemia Vera present?

A 
Hyperviscosity signs (tinnitus, headache, visual disturbance, burning in fingers and toes)
Pruritis, especially after a bath
Gout
Splenomegaly
Plethora
Thrombosis
88
Q

FBC shows raised RCC, Hb, WCC and platelets in a patient complaint of headache and pruritis. What is the likely diagnosis?

A

Polycythaemia Vera

89
Q

How would you treat polycythaemia Vera?

A 
Venesection
Aspirin
Hydroxycarbamide 
Antihistamines
Allopurinol
90
Q

What mutation is associated with polycythaemia Vera?

A

JAK2

91
Q

What is the 2 week wait referral criteria for suspected lung cancer?

A

Haemoptysis in a smoker over 40

92
Q

What are some risk factors for prostate cancer?

A

Age
Family history
Afro-caribbeans
BRCA

93
Q

What system is used to grade prostate cancer?

A

Gleason grading

Higher grading indicates poorer differentiated tissue so a more aggressive cancer and risk of metastases

94
Q

Which type of testicular cancer is found more commonly in younger patients?

A

Non-seminoma

95
Q

What is the difference between a seminoma and a non-seminoma?

A

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
Q

What is a Burr cell?

A

RBC with thorny projections on its membrane that indicates uraemia and liver disease

97
Q

Howell Jolly bodies indicate what?

A

Hyposplenism

98
Q

What cells are seen in the blood film in Fe deficiency anaemia?

A

Target cells

99
Q

Bone marrow biopsy for a patient with myeloma will show an increase in what cells?

A

Plasma cells

100
Q

How are red cells stored?

A

Refrigerated at 4 degrees

101
Q

What is fresh frozen plasma and when is it indicated?

A

Contains clotting factors

Used to correct clotting deficiency

102
Q

What does cryoprecipitate mainly contain?

A

Fibrinogen, factor VIII, Von Willebrands factor

103
Q

What boood products would you give for a px with thrombocytopenia?

A

Platelets

104
Q

What ECG abnormalities can be seen in tumour lysis syndrome?

A

Due to the hyperK: tall T waves, prolonged PR and QRS, flattened P waves

105
Q

Where is the most common site for melanoma in men and women?

A

Men: trunk (chest and back)
Women: arms and legs

106
Q

What is the most common subtype of malignant melanoma?

A

Superficial spreading

107
Q

Which type of melanoma is the most aggressive?

A

Nodular melanoma

Lesions grow rapidly, invade deeply and metastasise early

108
Q

Where are malignant melanoma likely to metastasise to?

A 
BBLLL
Brain 
Bone
Liver
Lungs
Lymph nodes
109
Q

Which type of melanoma is usually found on the palms of the soles, or under fingernails and toe nails?

A

Acral lentiginous melanoma

Moe common darker skinned people

110
Q

Which type of melanoma is most common in darker skinned people?

A

Acral lentiginous melanoma

Usually on palms or soles of under the nails

111
Q

What type of melanoma is more common in older people?

A

Lentigo maligna melanoma

112
Q

A patient on Zomorph 60mg BD would require what dose of SC PRN morphine?

A

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
Q

What’s the most common side effect of radiotherapy for prostate cancer?

A

Frequent urination

Also dysuria, haematuria, bowel symptoms

114
Q

What is the best test to identify the cause of haemolysis?

A

Direct Coombs antiglobulin test

115
Q

Positive Coombs test suggests what?

A

Autoimmune haemolysis

Haemolytic Disease of the newborn

116
Q

What does the direct Coombs test for and how?

A

Autoimmune haemolytic anaemia

By testing to see if Coombs reagent will agglutinate to antibodies on the red blood cell surface

117
Q

What is the difference between the direct and indirect Coombs test?

A

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
Q

Which region of the spine is metastastic spine cord compression most common in?

A

Thoracic spine

119
Q

What is the difference between watchful waiting and active surveillance for prostate cancer?

A

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
Q

How would you manage a patient displaying superior vena cava obstruction?

A

Dexamethasone
Diuretics
Stenting
Radiotherapy

121
Q

What are some features that would indicate SVC obstruction?

A 
Swollen face
Engorged neck veins
Breathlessness
Coughing
Headache
122
Q

Which treatment for DVT is most appropriate in a patient undergoing chemotherapy?

A

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
Q

What are some short and long term side effects of chemotherapy?

A

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
Q

What are some early and late side effects of radiotherapy?

A

Early fatigue, anxiety and depression, hair loss if scalp, diarrhoea if bowel, skin erythema

Late: secondary cancer, telangiectasia, fibrosis, bowel structures

125
Q

What is the difference between a Hickman and a PICC line?

A

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
Q

What type of drug is imatinib?

A

Tyrosine kinase inhibitor chemotherapy agent

127
Q

What is an example of an anti metabolite chemotherapy agent?

A

5-FU

Methotrexate (folic acid antagonist)

128
Q

How would you manage a patient presenting with superior vena cava obstruction?

A

Dexamethasone
Endovascular stent via the femoral vein
Diuretics e.g. furesomide
Radiotherapy/ chemotherapy

129
Q

Prostate cancers most commonly arise from which zone of the prostate?

A 
Peripheral zone
(Transitional zone is the area most protected by benign prostatic hypertrophy)
130
Q

Active surveillance is suitable for patients with what Gleason score?

A

6

131
Q

Which cancer give cannonball lung metastases?

A

Renal cell carcinoma

132
Q

How would you manage a cancer patient presenting with hypercalcaemia?

A

IV normal 0.9% saline
IV bisphosphonates
Calcitonin is rapid correction needed

133
Q

Where does colorectal Ca most commonly metastasise to?

A

Liver

134
Q

Primary cancers that are likely to spread to the brain…?

A

Breast
Malignant melanoma
Lung

135
Q

Lymphadenopathy with severe pain on alcohol consumption is characteristic of what condition?

A

Hodgkin’s lymphoma

136
Q

Rouleaux formation on blood film is associated with which condition?

A

Myeloma

137
Q

What is the richter transformation?

A

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
Q

Myeloproliferative disorders are associated with with genetic mutation?

A

JAK2

139
Q

As well as allopurinol and fluids, what else can be given for tumour kudos syndrome?

A

Rasburicase

Also tx hyperK

EOY4 (15 decks)

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