Oncology and Palliative Care

Question 1

First-line for delirium in palliative care patients ?

Answer 1

Oral haloperidol

Question 2

Terminal phase of illness: which drug is used for agitation/restlessness?

Answer 2

Oral midazolam

Question 3

What is CA 15-3?

Answer 3

Tumour marker in breast cancers

Question 4

What to co-prescribe with steroids when patients has an advanced cancer?

Answer 4

Omeprazole

Question 5

Nausea and vomiting in intracranial tumours - what to prescribe?

Answer 5

Dexamethasone

Question 6

Breakthrough dose of morphine?

Answer 6

1/6th daily dose

e.g. if taking 60mg/day, use 10mg for breakthrough pain

Question 7

Which drug for chemotherapy-induced N+V?

Answer 7

Metoclopramide for low-risk of symptoms

5HT3 agonist (e.g. ondansetron) for high-risk

Question 8

Medical management of secretions

Answer 8

Subcutaneous hyoscine hydrobromide / hyoscine butylbromide

Question 9

What is carcinoembryonic antigen (CEA) ?

Answer 9

Tumour marker in colorectal cancer

Question 10

Vincristine / Vinblastine adverse effects?

Answer 10

Christ, my nerves!
Blast, my bones!

Vincristine = Peripheral neuropathy
Vinblastine = myelosuppression

Question 11

Most common lung cancer in non-smokers =

Answer 11

Adenocarcinoma

Question 12

Man positive pregnancy test?

Answer 12

Testicular teratoma

He’d be TERAfied
And there’d be a fetus (feto- Alpha-fetoprotein)

(Testicular teratoma raises 1. beta-HCG 2. AFP)

Question 13

Methotrexate adverse effects

Answer 13

Myelosuppression, mucositis, liver fibrosis, pulmonary fibrosis

Question 14

Cisplatin adverse effects

Answer 14

• nephrotoxicity (the primary dose-limiting side effect)
• ototoxicity
• peripheral neuropathy
• hypomagnesaemia

Question 15

Tumour lysis syndrome features = ?

Answer 15

Tumour Lysis Syndrome:

KUP without the C.

• Raised K+, Urea, and Phosphate.
• Low Calcium

Question 16

Tumour lysis syndrome medication =

Answer 16

Rasburicase

Question 17

Patients with FAP, what is the best prophylactic treatment?

Answer 17

Total proctocolectomy (removal of large bowel)

Carries nearly a 100% risk of developing cancer in large bowel by the age of 40

Question 18

3 key risk factors for cholangiocarcinoma

Answer 18

age >50, ulcerative colitis and PSC (primary sclerosing cholangitis)

Question 19

Immediate management of SVC obstruction

Answer 19

Dexamethasone

Question 20

Medication to relieve breathlessness at end of life ?

Answer 20

Subcutaneous morphine sulphate
(relieves feeling of breathlessness)

Question 21

Describe transcoelemic spread of metastasis

Answer 21

Spread across a body cavity, such as pleural, pericardial or peritoneal cavity.

e.g. ovarian cancer spreads across the peritoneum, mesothelioma spreads across the pleural cavity

Question 22

What is tumour seeding?

Answer 22

When malignant cells are dislodged during a biopsy or surgical intervention

Question 23

Chemotherapy drug causes dysuria, increased urinary frequency and haematuria 24-48 hours after treatment - what is the problem and which drug causes it?

Answer 23

Haemorrhagic cystitis

Cyclophosphamide

Question 24

Genetic mutation in the DNA mismatch repair genes (MSH1/MSH2) leads to which 3 cancers?

Answer 24

Colorectal, endometrial and ovarian cancers

(known as Hereditary non-polyposis colorectal cancer (HNPCC) or Lynch Syndrome)

Question 25

Pancoast tumour: 1 Stems from which lung cancer? 2. Causes which syndrome? 3. What are the features of this syndrome?

Answer 25

1. Adenocarcinoma 2. Horner's syndrome 3. Ptosis (drooping eyelid), miosis (small pupil), and anhidrosis (lack of sweat)

Question 26

FAP gene?

Answer 26

APC (leads to 100-1000 polyps developing) (HNPCC a.k.a. Lynch syndrome = MSH2 gene)

Question 27

Medication to reduce secretions from tumour sites?

Answer 27

Glycopyrronium

Question 28

Cisplatin side effects

Answer 28

Ototoxic/nephrotoxic + rarely causes peripheral neuropathy (Cispla-tingles)

Question 29

Painful mouth in palliative care

Answer 29

Benzydamine hydrochloride mouthwash