Oncology/palliative Flashcards
How to verify a death?
- confirm identity
- identify any obvious signs of life
- assess for verbal response
- assess for pain response (fingernail, trapezius, supraorbital squeeze)
- pupillary reflex (fixed and dilated)
- palpate carotid artery
- heart sounds for 2 mins
- breath sounds for 3 mins
How would you describe bone pain?
Dull achey pain
Worse on weight bearing and movement
How to treat bone pain?
- NSAIDs (ibuprofen, diclofenac)
- Radiotherapy
- Bisphosphonates
What are the cancer performance statuses?
0 = normal 1 = symptomatic but ambulatory, cares for self 2 = ambulatory >50% of the time 3 = ambulatory <50% of the time, nursing care required 4 = bedbound
First line treatment for animal bites
Erythromycin
Alternative to flucloxacillin for those allergic?
Erythromycin
Usually Tx options for colon cancer
Neo-adjuvant chemo therapy
Surgery
Ajduvant chemotherapy
Usual Tx pathway for rectal cancer
Radio
(+/- chemo)
Surgery
Usual treatment pathway for breast cancer
Chemotherapy (neo/adjuvant)
Surgery
Radiotherapy (if breast-conserving Tx)
Hormone therapy (if HR receptor positive)
Usual treatment pathway for lung cancer
Non-small cell = surgery +/- radio +/- chemo + immunotherapy
Small cell = chemo + radiotherapy
Usual treatment pathway for prostate cancer
Surgery (radical prostatectomy)
Radiotherapy
Brachytherapy (internal radiotherapy)
Symptoms/signs of superior vena cava obstruction
Headache/feeling of fullness Facial swelling Dyspnoea Cough Hoarse voice Prominent collateral vessels
Investigations and treatment for SVC obstruction
X-ray = widened mediastinum, changes to R lung field
CT contrast = tumour in R lung pressing on SVC
Dexamethasone 16mg + PPI cover
Urgent stenting
Radio/chemotherapy
LMWH if thrombus
Hypercalcaemia - why does malignancy cause it?
Tumours produce:
Transforming growth factor alpha = stimulates bone resorption Parathyroid hormone (PTH) related peptides = stimulates bone reabsorption and increases plasma calcium
Normal mechanisms involved in calcium homeostasis in the body
If hypocalcaemic =
- Parathyroid releases PTH which promotes 1) bone reabsorption from osteoclasts 2) kidneys to reabsorb more calcium 3) converts vitamin D which promotes bowels to absorb calcium
If hypercalcaemic =
- Thyroid releases CALCITONIN which 1) promotes osteoblasts to deposit calcium in bones 2) promotes kidneys to reduce calcium reabsorption
Hypercalcaemia Tx
If Ca2+ <3.0mmol/L = IV fluids
If Ca2+ >3.0mmol/L (or symptomatic) = 3L IV fluids in 24hours + bisphopshonates + consider calcitonin
Symptoms of hypercalcaemia
Stones = kidney stones, frequency, flank pain
Bones = osteoporosis, fractures, bone pain
Groans = nausea, decreased appetite, abdo pain, peptic ulcers
Thrones = constipation
Psychiatric overtones = confusion, dementia, delirium, depression
How does metaclopromaide work to prevent N&V? Based on this, what are the contraindications and potentiall SE?
Antidopaminergic & also stimulates gastric emptying
CI = bowel obstruction SE = acute dystonia (muscarinic SEs)
BRCA mutations are associated with which 2 cancers in men?
Breast
Prostate
What is the action of hyoscine hydrobromide?
Anti-muscarinic
can thus be used for bowel colic, emesis, secretions etc
Which subtypes of HPV are linked with cervical cancer?
16, 18, 33
Describe bone pain
Dull, achey pain
Worse on weight bearing/movement
Name some types of laxatives: softeners, stimulants, combination
Softners/osmotics = lactulose, movicol, laxido Stimulants = senna, bisacodyl Combination = movicol, co-dantrhisate
Name some types of laxatives: softeners, stimulants, combination
Softners/osmotics = lactulose, movicol, laxido Stimulants = senna, bisacodyl Combination = movicol, co-dantrhisate
