Oncology + Palliative Care

Question 1

What cancer is common in Ashkenazi Jews?

Answer 1

Breast cancer via BRCA 1 and BRCA2

Question 2

What condition causes GI cancer increases the risk of endometrial cancer?

Answer 2

HNPCC

Question 3

What condition causes hamartomatous polyps and can cause GI cancer?

Answer 3

Peutz-Jeghers syndrome

Question 4

What is breast screening for women in the UK?

Answer 4

> 50 years every 3 years

Question 5

Explain the mechanism of the following chemotherapy agents:

Alkylating agents
Methotrexate/ 5-FU
Bleomycin

Answer 5

Alkylating agents- anti-proliferative drugs that bnd to alkylating groups on DNA = apoptosis : cyclophosphamide

Methotrexate/ 5-FU: Anti-metabolite - cell cycle effects, which effect DNA and protein synthesis

Bleomycin- anti-tumour antibiotics= interrupt DNA function

Question 6

Explain the mechanism of the following chemotherapy agents:

Topoisomerase inhibitors
Vinca-alkaloids and taxanes

Answer 6

Topoisomerase inhibitors- interrupt DNA winding

Vinca-alkaloids and taxanes: affect the spindles involved in cell division. EG: vincristine

Question 7

What defines neutropenic sepsis?

Answer 7

Temp >38C and <0.5 x 10 ^9 /L

Question 8

What abnormalities are found in the blood of Tumour lysis syndrome?

Management?

Answer 8

Increase:

• Urate
• Potassium
• Phosphate

Reduction:
-Calcium

Mx:
IV hydration + Phosphate binder (Aluminium hydroxide)

Question 9

What is most likely to cause migratory thrombophlebitis?

Answer 9

GI malignancies - Trousseau’s sign

Question 10

What tumor marker is used for breast cancer?

Answer 10

Ca 15-3

Question 11

What must be prescribed alongside strong opioids?

Answer 11

Laxatives and anti-emetics

Question 12

What 2 conditions must you be aware of when prescribing morphine?

Answer 12

Renal failure (clearance)
Intracranial bleed

Question 13

Which anti-emetic do you give in palliative care to a patient with intracranial disorders?

Answer 13

Cyclizine

Question 14

Which anti-emetic do you give in palliative care to a patient for the central trigger zone?

Answer 14

Metoclopramide

Question 15

Which anti-emetic do you give in palliative care to a patient with metabolic or drug-induced nausea?

Answer 15

Haloperidol

Question 16

Which anti-emetic do you give in palliative care to a patient with chemo/radiotherapy?

Answer 16

Ondansetron

Question 17

What drug can help reduce secretions in palliative care if repositioning does not work?

Answer 17

Hyoscine butylbromide

Question 18

What are the palliative care pain relief medications used in renal impairment patients?

Answer 18

Buprenorphine and Fentanyl (not renal excreted)

Oxycodone in mild-moderate impairment

Question 19

What is the conversion of morphine to oxycodone?

and oral -> sc morphine

Answer 19

2

Question 20

What cytotoxic agent causes cardiomyopathy?

Answer 20

Anthracyclines eg Doxorubicin

Question 21

What cytotoxic drug causes peripheral neuropathy?

Answer 21

Vincristine

Question 22

How do you calculate breakthrough analgesia?

Answer 22

1/6 of the daily morphine