Oncology and Palliative Care

Question 1

Hartmann’s procedure

Answer 1

Indicated in patients with acute bowel obstruction or perforation

resection of the rectosigmoid colon with formation of a temporary end colostomy and anorectal stump

Question 2

Genetic mutations linked to colorectal cancer

Answer 2

APC gene - leading to polyps - hence malignancy (adenocarcinomas)

Question 3

Management of ER positive tumours

Answer 3

Treat with Tamoxifen (oestrogen receptor antagonist) if premenopausal or Anastrozole (aromatase inhibitor) if postmenopausal.

Question 4

Management of HER2 positive tumours

Answer 4

Receive Trastuzumab (otherwise known as Herceptin) which is a monoclonal antibody against the extracellular domain of the HER2 receptor

Question 5

What is the best investigation for obtaining histological information about this lesion?

Answer 5

core needle biopsy

Question 6

Breast cancer referral 2 ww

Answer 6

Any patient aged 30 or over with an unexplained breast lump or aged 50 or over with unilateral nipple changes should be urgently referred (appointment within 2 weeks) for further assessment.

Question 7

Serotonin syndrome

Answer 7

triad of serotonin syndrome: mental state changes, autonomic hyperactivity (diarrhoea and pupil dilatation) and tremor

• Commonly presents within the first couple of months of starting SSRI or drug interactions (tramadolol and sertraline)

Question 8

Tumour lysis syndrome

Answer 8

Typically presents few days after chemotherapy (common for haematological malignancies esp non-Hodgkin lymphomas)

++Uric acid leading to AKI (anuria)
++ Phosphate leading to hypocalcaemia (tetany (cramps) and vomiting)

Mx
- fluid resuscitation 500 mL 0.9% sodium chloride