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FINALS revision - @medicbotanist > Oncology + Palliative > Flashcards

Oncology + Palliative Flashcards

1
Q

What level do your neutrophils need to be below to be classed as having neutropenic sepsis?

A

Below 1 x 10^9

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2
Q

When should neutropenic sepsis be suspected?

A

Anyone who has had chemo in the past 6w

High Temperature

Infective presentation

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3
Q

What are 2 RF for neutropenic sepsis?

A

Central Venous Line

Poor nutrition

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4
Q

What does BUFALO say you need to do in Sepsis

A

Bloods: culture

Urine output

Fluids

Broad spec abx

Lactate

Oxygen

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5
Q

How would you treat neutropenic sepsis?

A

High dose broad spectrum antibiotics:

Piptazocin and Tazobactam

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6
Q

If you suspect that a patient will be a high risk of getting neutropenic sepsis. What should you give?

A
  1. Prophylaxis with anti bacterial and anti-fungal

2. Consider reducing their chemo dose.

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7
Q

What are 3 causes of malignant hypercalcaemia

A
  1. Lytic Lesions Bone mets
  2. Too high PTH
  3. Dehydration
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8
Q

What value is classed as a severely high calcium ?

A

A value of over 3.4

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9
Q

What is the management of malignant hypercalciaemia?

A

IV fluids

IV bisphosphonates

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10
Q

Why do you need to do a corrected level of calcium?

A

This is because 40% of calcium is bound to albumin.

It is only the unbound calcium that is important for us.

Hence why we need a corrected calcium value

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11
Q

How does malignant hypercalcaemia present?

A
  1. Moans
  2. Groans
  3. Stones
  4. Bones
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12
Q

Give two urinary symptoms of malignant hypercalcaemia?

A
  1. Poly dipsia

2. Polyuria

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13
Q

What is the most common cause of spinal cord compression?

Give a few examples

A

Secondary bone mets

Breast
Lung
Prostate

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14
Q

How does malignant spinal cord compression normally present?

A

It presents with a picture of worsening back pain.

Numbness and lower limb weakness

Bowel or bladder dysfunction

Abnormal nerve signs: including LMN signs below the compression

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15
Q

If you have a patient with nausea caused by gastric stasis.

What anti-emetic should you use?

A

Domperidone

Metoclopramide

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16
Q

If you have a patient with nausea caused by drug induced. What anti-emetic should you use?

A

Metoclopramide

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17
Q

What is the most common anti-emetic used in intra cranial caused nausea and vomiting?

A

Cyclizine

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18
Q

What two types of cancer are common cause of Superior Vena Cava Obstruction (SVCO)?

A

Small cell lung cancer

Lymphoma

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19
Q

How does SVCO normally present?

A

Flushed face

Visible dilated veins on face and neck

Oedema of the neck and face

Respiratory distress SOB, chest pain

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20
Q

What investigations would you want to do in someone with suspected SVCO?

A
  1. CT

2. CXR (will show widened mediastinum)

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21
Q

How do you acutely manage SVCO?

A
  1. Sit the patient up
  2. High Flow oxygen
  3. High dose Dex
  4. Endo vascular stent
22
Q

When does bowel cancer screening in the UK start?

What does it involve?

A

It starts at the age of 55 and you get a one off endoscopy

60-74 you get home testing every 2 years

23
Q

What does it mean when you describe a cancer as a grade?

A

It means how similar the tissue resembles the original cells.

For example a benign cancer will have a lower grade (as resembles more) than a malignant cancer.

24
Q

Give 3 examples of screening in the UK?

A

Bowel cancer

Breast cancer

Cervical Cancer

Foetal heel prick test

Triple AAA

25
Q

What are 3 characteristics that cancer cells have?

A

Evading apoptosis

Evading the immune system

Genome instability.

26
Q

Where do most chemo drugs work at in the cell cycle?

A

They work at the level of mitosis

27
Q

What is a neo-adjuvant?

What is an adjuvant?

A

When you give a drug pre surgery

When you give a drug post surgery

28
Q

How does radiotherapy work?

A

It uses high power radiation to produce free radicals and ROS that damages cells and DNA so that they can no longer replicate.

29
Q

How does the chemo dose in a curative vs palliative patient?

Why are the regimes different?

A

In a curative patient you would have: lower dose chemo but give it more times. This is supposed to reduce SE

If a palliative patient: give it at a higher dose and a one off

30
Q

What are 5 SE of Radiotherapy?

A

Nausea and Vomiting

Fatigue

Anorexia

Oesphagitis

31
Q

What period of time post radiotherapy are SE the worse?

A

Normally worse at around 2 w post radiotherapy

32
Q

What are 3 SE of Chemotherapy?

A

Heart Failure

Nausea and Vomiting

Bowel upset

Alopecia

Peripheral Neuropathy

33
Q

What are two ways to scale a patient’s performance status?

A

ECOG

WHO’s performance status

34
Q

What are 3 complications of chemotherapy?

A
  1. Alopecia: this is reduced by sitting them underneath a cold cap
  2. Nausea and Vomiting: give anti-emetics like ondansetron
  3. Anaphylaxisis: prevented by taking steroids the day before
  4. Extra vascularisation: this is when you give SC injections and it causes necrosis of large patches of skin. Prevented by using smaller ‘yellow’ needles.
35
Q

How do we prevent anaphylactic reactions in patients who are given chemotherapy?

A

You start them on steroids the day before

36
Q

What complication is related to the use of 5- FU creams?

A

Coronary Artery Spasm

37
Q

Who are 5-FU creams contraindicated in?

A

They are contraindicated in people with ACS

38
Q

If you had a patient older than 30 with suspected MSK malignancy. What are your first two thoughts?

A

Myeloma

Bone mets

39
Q

What would the zone of transition look like in a patient with
A. Benign bone disease
B. Malignant bone disease

A

Benign you would have a narrow zone of transition

Malignant you would have a wide zone of transition

40
Q

What does a periosteal reaction signify?

A

A bone reaction

41
Q

What is codman’s triangle sign seen on x-rays?

What cancer is it associated with?

A

This is when you get elevated periosteum

Associated with osteosarcoma

42
Q

What bone cancer is associated with onion skinning?

A

Ewings Sarcoma

43
Q

What criteria classifies kidney cancers?

A

Bosniak

44
Q

What is a syringe driver?

A

This is a machine that gives multiple medications to a patient over a 24 hr period.

45
Q

What are 4 cancer types that are associated with major haemorrhage?

A
  1. Head Cancer
  2. Neck Cancer
  3. Bowel Cancer
  4. Lung Cancer
46
Q

If you had a palliative patient with a haemorrhage how would you respond?

A
  1. Give midazolam

2. Use dark coloured towels

47
Q

Describe what the following abbreviations mean:

A. Planning target volume (PTV)
B. Clinical Target Volume (CTV)
C. Gross Target Volume (GTV)

A

A. Planning target volume (PTV): degree of movement

B. Clinical Target Volume (CTV): area of micro spread

C. Gross Target Volume (GTV): size on CT

48
Q

What unit is radiotherapy prescribed under?

A

Gray dose

49
Q

What is fractionation in terms of radiotherapy?

A

The total amount of radiotherapy given which is then split into dosages

50
Q

What type of cell makes up a sarcoma?

A

Mesenchymal cells

51
Q

What scoring system is used to grade a sarcoma?

A

FNCLCC

FINALS revision - @medicbotanist (20 decks)

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