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Pathology and final year > ONCOLOGY and palliative > Flashcards

ONCOLOGY and palliative Flashcards

1
Q

WHAT IS INVOLVED IN THE ‘triple assessment’? FOR BREAST CANCER

A

mammogram
ultrasound
biopsy

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1
Q

What test is used for the national screening of bowel cancer for those aged 60-74?

A

faecal immunochemical test (FIT)

test for occult blood in stool

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2
Q

causes of false positive FIT

A

polyps and inflammatory bowel disease

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3
Q

which cancers commonly metastasise to bone

A

BLT with Mayo and a Kosher Pickle

Breast
Lung
Thyroid
Multiple myeloma
Kidney
Prostate

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4
Q

side effect of the following cytotoxic drugs:

cyclophosphamide

A

haemorrhagic cystitis
myelosuppression
transitional cell carcinoma

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5
Q

side effect of the following cytotoxic drugs:

doxorubicin

A

cardiomyopathy

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6
Q

side effect of the following cytotoxic drugs:

Vincristine

A

peripheral neuropathy

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7
Q

side effect of the following cytotoxic drugs:

bleomycin

A

lung fibrosis

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8
Q

side effect of the following cytotoxic drugs:

cisplatin

A

peripheral neuropathy
ototoxicity
hypomagnesaemia

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9
Q

causes of superior vena cava obstruction

A

common malignancies: small cell lung cancer, lymphoma
other malignancies: metastatic seminoma, Kaposi’s sarcoma, breast cancer
aortic aneurysm
mediastinal fibrosis
goitre
SVC thrombosis

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10
Q

management of SVCO

A
  1. alert oncology
  2. endovascular stenting
  3. steroids often given
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11
Q

what is Kartagener’s syndrome

A

a rare, autosomal recessive genetic ciliary disorder comprising the triad of situs inversus, chronic sinusitis, and bronchiectasis.

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12
Q

common sites of bone mets

A
  1. spine
  2. pelvis
  3. ribs
  4. skull
  5. long bones
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13
Q

common symptoms in palliative care

A

Breathlessness
constipation
N&V
Pain

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14
Q

common end of life symptoms

A

pain
secretions
breathlessness
agitation
N&V

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15
Q

management of breathlessness in palliative care

A

Treat underlying cause
O2 if hypoxic
low dose opioid (morphine sulphate IR 1mg PO PRN)
Mx of anxiety: short acting benzo eg lorazepam 0.5mg sublingual
non pharmacological: fan, CBT, relaxation techniques

16
Q

Managament options for constipation in palliative care

A

NB: do not use bulk forming agents

  • softening agents (lubricates stool)- eg. liquid paraffin, docusate sodium
  • osmotic agents (pull liquid into stool)- lactulose, movicol
  • stimulants (increase intestinal motility)- eg. senna

if pt already on one laxative and needs more, add one from a different class

17
Q

causes of nausea in palliative care

A

Delayed gastric emptying (eg. gastrirtis, obstruction)

CNS cause

Chemical disturbance, renal failure, drug induced

Labrynth disturbance

psychological

18
Q

best anti-emetic to use for each cause of nausea

A

delayed gastric emptying- metoclopromide/ domperidone

CNS and labrynth - cyclizine

chemical/ drug induced - haloperidol

post chemo, abdominal surgery and abdo radiotherapy- ondansertron (very constipating and causes QTc prolongation)

19
Q

dose, frequency and route of anti emetics:

haloperidol

A

1.5mg continuous SC infusion

20
Q

dose, frequency and route of anti emetics:

metoclopromide

A

30mg continuous SC infusion

21
Q

dose, frequency and route of anti emetics:

cyclizine

A

150mg Continuous SC infusion

22
Q

example drugs in each step of the pain ladder

A

step 1:
- paracetamol
- NSAIDS

step 2:
-codeine
- tramadol
- dihydrocodeine

step 3:
- morphine
- fentanyl
- diamorphine

23
Q

how to calculate PRN dose

A

add up the total dose in 24hrs and divide by 6

24
Q

conversion of step 2 to morphine

A

morphine 10x stronger than all step 2 drugs

25
Q

conversion of oxycodone to morphine

A

oxycodone 2x more potent than morphine

26
Q

calculating sustained/ modified release dose from PRN

A

times PRN dose by 6 then /2 as SR always 12hrly

27
Q

which opioids are safe in renal failure

A

egfr <10

  • fentanyl
  • Alfentanil
  • buprenorphine

egfr 20-40
- oxycodone

28
Q

which opioids accumulate in the kidneys

A

morphine
codeine
diamorphine
tramadole

oxycodone a bit

29
Q

anticipatory medications in end of life

A

Morphine sulphate (2.5-5mg SC 1-2hrly PRN) - pain and breathlessness

midazolam (2.5mg SC 1-2hrly PRN)- adgitation and breathlessness

glycopyrronium (0.2-0.4mg SC QDS PRN)- secretions

Haloperidol (0.5mg SC BD PRN) or cyclizine (50mg TDS SC PRN)- N&V

30
Q

management of SCC if surgery inappropriate
ie if too frail or mets in multiple locations

A

external beam radiotherapy

31
Q

bone pain treatment in boney metastasis

A
  1. opioids
  2. IV zolendronate
32
Q

what investigation to perform before initiating trastuzumab therapy for HER2 pos breast cancer

A

Cardiomyopathy is an important risk of trastuzumab treatment and therefore all patients should have a baseline ECHO before treatment

Pathology and final year (21 decks)

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