Oncology/ Palliative Flashcards
What is a common second line agent used when Pt. is already on one anti-emetic whilst on Chemo
Dexamethasone
Mucocutaneous Lesions
Trichilemmomas (small, wart-like growths on the face)
Oral papillomas (small nodules in the mouth, gums, and tongue)
Acral keratosis (skin thickening on hands/feet)
Facial papules (multiple skin-colored bumps)
Risk of Breast Cancer, Thyroid Cancer, Bowel cancer ( possible signs and symptoms)
Hamartomatous polyps (similar to Peutz-Jeghers but without mucocutaneous pigmentation)
What is your Dx?
Cowdens syndrome
What is the biggest risk factor for developing Breast Cancer, in Pt.’s previously treated for Hodgkins Lymphoma
Radiotherapy
What is the paraneoplastic Endo related problem in Sqamous cell Ca
PTH
What is the paraneoplastic Endo related problem in Small cell Ca
ADH, ACTH
what do you assess for metastatic germ cell tumour
beta HCG
What is a common cause of SOB in Pt. in severe lung Ca with no sings of infection/ effusion
Hyperaemia due to ventilation-perfusion mismatch
( note : their O2 Stats can still be >/=94%)
What is the MOA of Olaparib
Poly-ADP -ribose- polymerase (PARP) inhibitor
What is the Mx of Lamber Eaton Syndrome
3-4, Diaminopyridine
( Amifampyridine)
What is the effect of tamoxifen and breast Ca
It reduces the risk of recurrence in already affected breast and also prevents occurrence in the other breast.
what is the Tx for adrenal cortical adenocarcinomas
Mitotane
What re the two drugs used to treat Cushings
Ketoconazole and Metyrapone
What is the main Tx for SVC obstruction
SVC stenting
What is a side effect of Tamoxifen you should think of
Increases risk of blood clots
Increases risk of Endometrial Cancer
Increases Body weight
Note:
reduces risk of heart disease
reduces risk of osteoporosis
What is the mutation in villous adenoma
Somatic Adenomatous Polyposis Coli (APC) mutation
What is the relation between beta HCG and TSH
Profound increase in beta HCG –> can cause hyperthyroidism and therefor TSH will be reduced
What is a poor prognostic factor of Ewings Sarcoma
Anemia
How do you convert Oromorph to S/C diamorphine Pump dose
Calculate toll morphine uses ( regular +PRN) and then divide that by 3
which equals to the Toal dose of diamorphine S.c over 24 hrs
how do you interpret SA-AG
If SAAG >/= 11 - it indicates portal HTN ( cirrhosis, Cardiac failure, portal vein thrombosis )
If SAAG <11 (Malignancy, Nephrotic syndrome, TB , Pancreatitis )
A sudden risk in ALP , in someone with cirrhosis, wt loss, ascitis
What are you thinking ?
Hepatocellular CA
(HCC)
What is the cause of Hypercalcemia in breast Ca
PTHrP
What is the cause of Hypercalcemia in Lymphoma
Tmour production of 1,25-dihydroxy Vitamin D
if someone as focal seizures and BG of depression which antiepileitc would you use
( lamotrigine or Levetiracetam )
Lamotrigine
Note:
Levetiraceteam worsens mood disorders
What are the features of SMART syndrome
SMART Syndrome (Stroke-like Migraine Attacks after Radiation Therapy) – Key Points
Occurs years (1–10 yrs) post-brain radiation
Stroke-like deficits (reversible): Hemiparesis, aphasia, hemianopia
Migraine-like symptoms: Headache, aura, photophobia
Cognitive changes: Confusion, memory loss
Seizures (occasional)
MRI: Cortical swelling, T2/FLAIR hyperintensity, no infarction (DWI-negative)
Resolves over weeks to months
Management: Supportive, migraine treatment, steroids if needed
What is the oral morphine to Fently patch conversion
Oral Morphine —- Fentanyl patch
30mg/ day ——12mcg/hr
60mg/day ——-25mcg/hr
120mg/day ——–50mcg/hr
180mg/day——— 75mcg/hr
240mg/day———-100mcg/hr
Where do you see canon ball mets
the mets are seen in lungs
primary ca in Renal origin
What is the gene mutation in Peutz Jeghers Syndrome
STK11 ( Serine/ Threonine Kinase)
What is the mx of Carcinoid syndrome
Somatostatin analogues such as Ocreotide/ Lanreotide
What is the mx of Brachila plexus invitation from Ca
1st line - use pregabalin ( to control neuropathic pain)
If this fails; then proceed to ‘Brachial Plexus block’
What is the 1st line Chemotherapy regimen for ovarian cancer
Pacitaxel and Carboplatin
If 1st line fails/relapse
then use;
Gemcitabine and Carboplatin
Constipation, abdominal pains , Ascitis, and loss of weight in female
What are you thinking
Ovarian Cancer
What does left shift in blood film mean
more immature cells production
what is the mx of sqmous cell ca of lung that cannot be resected
PLATINUM BASED CHEMO + radiotherapy
What is the immediate initial Mx for SVC obstruction
Dexamethasone and LMWH
Specific Mx later is SVC stenting
Which blood test is sensitive for detecting tumour recurrence in Testicles
Beta HCG
What are some of the risk factors for developing HCC
Hep B, Hep C,
Dietary aflatoxin ( mouldy food in Africa and far east which affects gene mutation of p53),
Hemochromatosis
How do you calculate corrected serum calcium
Corrected serum Ca =
Measured Serum Calcium + ( 40 - Serum Albumin) x 0.027
What is the most common Ca associated with Cowden Syndrome
Breast Ca
Risk factors for ovarian Ca;
Early menarche
Late Menopause
Nulliparity
What does Parvo-cirsu infection cause
Anemia with suppressed BM production of RBC ( Low reticulocytes)
what is the most common form of oesophageal Ca
Adenocarcinoma ( lower 3rd)
Sqamous ( Upper and Middle )
what is the 1st line antiemetic in chemotherapy for emesis / Nausea / Vomting
Metoclopramide
what other ca is HNPCC at higher risk of
Endometrial Ca
What is the most specific tumor marker for testicular ca
Beta HCG
What blood test can you do prior to starting chemo, to assess pt;s who are at high risk of tumour lysis syndrome
asses LDH
( will be high) in pt’s at risk
what is the side effect of oxaplatin
Worsend peripheral neuropathy
What does Imatinib target in CML
BCR-ABL
What are the components of tumour lysis syndrome
Hyperkalemia, hyperphosphatamia, Hyperuricameia,
and/or hypocalcemia
What risk can you be exposed to, du to excess aromatase amines
Bladder Cancer
What is a common side effect to look out for, in someone who has had mantle radiotherapy
Thyroid disease
( commonly leads to hyperthyroidism)
What can you use in refractive hematuria in bladder ca, when bleeding fails to stop even after traneximic acid
Iliac Artery Embolisation
what cancer is Parkinsons associated with
Malignant Melanoma
What is a very common side effect of Cisplatin
Nephrotoxicity and Deranged electrolytes, specifically “Magnesium “
What are two main things to consider in someone who has cyclophosphamide Tx
In acute Tx - if hematuria -> think hemorrhagic cystitis
After years of Tx with cycle , if hematuria —> think Bladder Ca
How would you treat dermatomyositis
Steroids
What must you consider before you start someone on Fludarabine n CLL
Co-trimox ( as it causes increased risk of opportunistic infections)
How do you diagnose Paget’s disease
Biopsy !
What chemical is released by Carinoid tumour
Serotonin
Other than asbestos exposure, what other risk factor significantly increases risk of Mesothelioma
Significant previous radiation exposure
What anti-epileptic agent will you sue in palliative pt.s who have weeks to months to live
Levetiracetam
If only days of life -> Midaz
