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4th year medicine > Oncology/palliative: General > Flashcards

Oncology/palliative: General Flashcards

1
Q

Most commonly causing death

A

Lung > colorectal > breast > prostate

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2
Q

Most likely to metastasise to bone

A

Prostate > breast > lung

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3
Q

Treatment of SCLC

A

Chemo (usually systemic at presentation
Radiotherapy

Rarely surgery

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4
Q

Treatment of NSCLC

A

Surgery 30%
Radiotherapy
Chemo
Tyrosine kinase inhibitors

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5
Q

Management of bone pain

A

NSAIDs, bisphosphonates, radiotherapy

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6
Q

Most common cancers

A

Breast > lung > colorectal > prostate

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7
Q

Terminal drug for bowel colic

A

Hycosine butylbromide

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8
Q

Terminal drug for respirator secretions

A

Hycosine hydrobromide

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9
Q

Terminal drug for nausea and vomiting

A

Cyclizine
Levopromazine
Haloperidol
Metoclopramide

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10
Q

Terminal drug for agitation/restlessness/confusion

A

Midazolam

Also haloperidol, levopromazine

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11
Q

Terminal drug for pain

A

Diamorphine

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12
Q

Best antiemetic for:
GI cause
Toxic cause
Cerebral cause

A

GI cause - domperidone, metaclopramide, but not in Parkinson’s
Toxic cause - haloperidol
Cerebral cause - antihistamine

Ondansetron - also good for chemo/GI
Benzos - good adjuncts for chemo nausea

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13
Q

Para neoplastic syndrones SCLC

A

Hyponatraemia
Cushing’s (raised cortisol)
Lambert-Eaton syndrome (myasthenia)

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14
Q 
Laxatives:
Bulk-forming
Softeners
Stimulants
Combination
A

Bulk forming: fybogel
Softeners: lactulose, docusate
Stimulants: senna
Combination: movicol, co-danthramer

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15
Q

Four essential PRN medications all dying patients should be prescribed

A
  1. Anti-emetic - haloperidol/levomepromazine
  2. Analgesic - diamorphine
  3. Anti-secretory - hycosine hydrobormide
  4. Sedative - midazolam

If >2 SC PRN injections required, put in syringe driver and keep PRN

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16
Q

Converting oral morphine to SC diamorphine

A

Divide by 3

17
Q 
Neutropenic sepsis management:
ABx
If MRSA positive/line infection
If penicillin allergy
If C.diff suspected
Additional management
A

Tazocin
MRSA/line infection - add vancomycin
Pen allergy - vancomycin + aztreonam
If C.diff - add metronidazole

O2, IV fluids, caution with antipyretics (mask pyrexia), early senior involvement

18
Q

Colorectal cancer: risk factors (6)

A 
Lots of meat, little fibre
Inflammatory disease (UC, Crohn's)
HNPCC, FAP
Diabetes, obesity
Increasing age
Smoking, alcohol
19
Q

Colorectal cancer - commonest site for mets

A

Liver

20
Q

Management of colorectal cancer

A

Surgery - definitive treatment for localised disease
Radiotherapy - rectal only (brachytherapy)
Chemo - adjuvant for high risk

21
Q

Prostate cancer histological type

A

Adenocarcinoma (95%)

22
Q

Prostate cancer: risk factors (5)

A 
Increasing age
BRCA2
Developed countries
Family history
Afro-caribbean
23
Q

Gleason score

A

Prostate cancer grading based on 2 most predominant areas of tumour

24
Q

Prostate cancer: prognostic factors (2)

A

High BPH - poor prognosis

Extent of disease

25
Q

Management of prostate cancer (4)

A

Surgery for localised disease
Radiotherapy/brachytherapy if early
Hormonal therapy in advanced disease (LHRH agonists, oestrogen, anti androgens)
Chemo (docetaxel

26
Q

Breast cancer: risk factors (4) including in males (2)

A 
Increasing age
Oestrogen exposure
BRCA1/2
Family history
In males: gynaecomastia, Kleinfelter's
27
Q

Types of breast cancer

A

Invasive ductal carcinoma (develops from DCIS) 70-80%
Invasive lobular carcinoma (devlops from LCIS) 10%
Paget’s disease = infiltrating carcinoma of nipple epithelium (1%)

28
Q

Investigation of breast cancer

A

Triple testing

  1. Clinical examination
  2. Diagnostic radiography (USS/mammogram)
  3. Biopsy (core/open/FNA)

Also ER+PR status (+ve good because will respond to hormonal treatment)
HER2 status (+ve bad)
Ca15-3
Search for mets

29
Q

Management of breast cancer

A

Surgery - initial treatment of choice (mastectomy/WLE)
Radiotherapy - post-surgery
Chemotherapy - adjuvant
Hormone therapy if ER/PR+ (aromatase inhibitors, anti-oestrogens, ovarian ablation)

30
Q

Types of lung cancer

A 
Bronchial carcinoma (95%) - SCLC, NSCLC (squamous, adenocarcinoma, large cell, other)
Lung mets from: prostate kidney, breast, bone, GI
31
Q

Urgent CXR if (6)

A 
Hoarseness >3wk
Cough >3wk
Dyspnoea >3wk
Weight loss
Chest pain
Bone pain/met signs
32
Q

Lung cancer: prognostic factors (1 positive, 5 negative)

A

Positive: stopping smoking
Negative: advanced, mets, respiratory complications, weight loss, biochemical abnormalities

33
Q

Diagnosing dying patient

A 
Irreversible life-threatening illness
Stepwise change
Day to day change
Bed bound/profound weakness
Drowsy
Sips/no oral intake
No easily reversible cause
34
Q

Certifying death (5)

A 
Absence of central pulse
Absence of pupillary light response
Absence of corneal reflex
No motor response to supra-orbital pressure
Asystole on ACG

Observe for 5 minutes

35
Q

When to refer to coroner’s office (9)

A 
No doctor attended during last illness
Not seen by a doctor in last 14 days of life
Unknown cause
Death udring op/anaesthetic
Occupational
Medical mistake
Suicide/accident
In prison custody
Suspicious circumstances
36
Q

Courvoiser’s sign

A

Painless jaundice and enlarged gall bladder - upper GI cancer

37
Q

Virchov’s node

A

L supraclavicular node - gastric cancer

4th year medicine (22 decks)

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