Oncology/palliative

Question 1

How to verify a death?

Answer 1

• 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

Question 2

How would you describe bone pain?

Answer 2

Dull achey pain

Worse on weight bearing and movement

Question 3

How to treat bone pain?

Answer 3

1. NSAIDs (ibuprofen, diclofenac)
2. Radiotherapy
3. Bisphosphonates

Question 4

What are the cancer performance statuses?

Answer 4

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

Question 5

First line treatment for animal bites

Answer 5

Erythromycin

Question 6

Alternative to flucloxacillin for those allergic?

Answer 6

Erythromycin

Question 7

Usually Tx options for colon cancer

Answer 7

Neo-adjuvant chemo therapy
Surgery
Ajduvant chemotherapy

Question 8

Usual Tx pathway for rectal cancer

Answer 8

Radio
(+/- chemo)
Surgery

Question 9

Usual treatment pathway for breast cancer

Answer 9

Chemotherapy (neo/adjuvant)
Surgery
Radiotherapy (if breast-conserving Tx)
Hormone therapy (if HR receptor positive)

Question 10

Usual treatment pathway for lung cancer

Answer 10

Non-small cell = surgery +/- radio +/- chemo + immunotherapy
Small cell = chemo + radiotherapy

Question 11

Usual treatment pathway for prostate cancer

Answer 11

Surgery (radical prostatectomy)
Radiotherapy
Brachytherapy (internal radiotherapy)

Question 12

Symptoms/signs of superior vena cava obstruction

Answer 12

Headache/feeling of fullness
Facial swelling
Dyspnoea
Cough
Hoarse voice 
Prominent collateral vessels

Question 13

Investigations and treatment for SVC obstruction

Answer 13

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

Question 14

Hypercalcaemia - why does malignancy cause it?

Answer 14

Tumours produce:

Transforming growth factor alpha = stimulates bone resorption
Parathyroid hormone (PTH) related peptides = stimulates bone reabsorption and increases plasma calcium

Question 15

Normal mechanisms involved in calcium homeostasis in the body

Answer 15

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

Question 16

Hypercalcaemia Tx

Answer 16

If Ca2+ <3.0mmol/L = IV fluids

If Ca2+ >3.0mmol/L (or symptomatic) = 3L IV fluids in 24hours + bisphopshonates + consider calcitonin

Question 17

Symptoms of hypercalcaemia

Answer 17

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

Question 18

How does metaclopromaide work to prevent N&V? Based on this, what are the contraindications and potentiall SE?

Answer 18

Antidopaminergic & also stimulates gastric emptying

CI = bowel obstruction
SE = acute dystonia (muscarinic SEs)

Question 19

BRCA mutations are associated with which 2 cancers in men?

Answer 19

Breast

Prostate

Question 20

What is the action of hyoscine hydrobromide?

Answer 20

Anti-muscarinic

can thus be used for bowel colic, emesis, secretions etc

Question 21

Which subtypes of HPV are linked with cervical cancer?

Answer 21

16, 18, 33

Question 22

Describe bone pain

Answer 22

Dull, achey pain

Worse on weight bearing/movement

Question 23

Name some types of laxatives: softeners, stimulants, combination

Answer 23

Softners/osmotics = lactulose, movicol, laxido
Stimulants = senna, bisacodyl
Combination = movicol, co-dantrhisate

Question 23

Name some types of laxatives: softeners, stimulants, combination

Answer 23

Softners/osmotics = lactulose, movicol, laxido
Stimulants = senna, bisacodyl
Combination = movicol, co-dantrhisate

Question 24

Which anti-emetic would you use for which cause of vomiting:

Toxic
Gastric stasis/ irritation
Cerebral

Answer 24

Toxic = haloperidol
Gastric stasis/ irritation = metaclopramide, domperidone
Cerebral = cyclizine, dexamethasone

Question 25

Symptoms felt for each cause of nausea/vomiting:

Toxic
Gastric stasis/ irritation
Cerebral

Answer 25

Toxic = constant nausea, small frequent vomits which do not relieve nausea.

Gastric stasis/ irritation = no background nausea, infrequent large vomits which relieve symptoms

Cerebral (raised ICP, anxiety) = early morning headache, little nausea, lots of vomiting

Question 26

Symptom management: SOB

Answer 26

Non-pharmacological = discuss fears, breathing techniques, use of a fan

Pharmacological = opioids, benzodiazepines

Question 27

At what point should you switch a PRN anticipatory medication to a subcut infusion?

Answer 27

If needing >2 doses

Question 28

Conversion of morphine PO to diamorphine SC

Answer 28

divide by 3

Question 29

Which type of lung cancer is more common in smokers?

Answer 29

Small cell

Question 30

Septic screen for neutropenic sepsis

Answer 30

Cultures –> bloods (x2), urine, sputum, throat, lines if present
CXR
Bloods –> FBC, LFT, lactate, CRP, u&Es
(Do NOT do rectal/vaginal examination - may cause bacteraemia)

Question 31

What is the two symptoms necessary to define neutropenic sepsis?

Answer 31

White cells <1x10^9 / L + Associated fever

Question 31

What is the two symptoms necessary to define neutropenic sepsis?

Answer 31

White cells <1x10^9 / L + Associated fever

Question 32

Treatment for neutropenic sepsis

Answer 32

BUFALO

Broad spectrum abx for 5 days (& change if source identified)

Question 33

Most common cancers that metastasise to bone

Answer 33

Prostate
Renal
Thyroid
Breast 
Lung

Question 34

Definitive treatment for MSCC

Answer 34

Surgery / Single beam radiotherapy