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Y4 Cancer Care SA > Oncology Questions > Flashcards

Oncology Questions Flashcards

1
Q

Patient has been coughing more than 3 weeks and there is no reason for it what is the next step

A

go to the GP and check for lung cancer

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2
Q

If someone has suspected lung cancer what is the next imaging modality

A

Staging CT Scan - includes chest abdomen and pelvis
TNM staging

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3
Q

What is the are of the body where the lung cancer is least likely to spread

A

kidneys

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4
Q

malignant plural effusion investigation

A

Do an US guided aspirate

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5
Q

biopsy for lung cancer locations

A

bronchoscopy in proximal of airway
Endobronchial US - further down in airway in centre of chest from lymph
medical bronchoscopy - pleural effusion
lump in neck - US guided biopsy
lining of lung - medical thorascopy
small nodule - robotic bronchoscopy

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6
Q

what is the purpose of palliative treatment

A

to help people increase their quality of life, helps people in their last 24 months of life
good for symptom control and allows their family support too

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7
Q

when suspecting cancer of the brain what imaging do you need

A

MRI brain and spine with contrast

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8
Q

long term side effects of radiotherapy

A

fatigue - especially if its brain
dysphagia, sore throat, oral mucositis - can be seen in any,
dysphagia more common in head and neck cancer
erythema - radiotherapy dermatitis
sterility - pelvic area
lymphedema - breast! refer to clinic

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9
Q

why do people experience dry mouth years after having chemo/radio

A

mouth is dry years after chemo as all he glands have been fried off and so they can produce saliva

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10
Q

how to prevent bad diode effects or radiotherapy

A

young, fit and healthy as they will have the ability to produce new healthy cells fast

if they smoke, then that’s bad as they will slow down new cell regeneration

depends on where you’re treating and at what dose, higher dose means more side effects

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11
Q

if someone on radiotherapy who is usually an outpatient has to become an in patient because they are unwell what does this mean

A

it mean they are not tolerating their radiation dose and you’re doing something wrong

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12
Q

before starting immunotherapy what are some baseline levels you need to check

A

check adrenal function (cortisol)
thyroid function

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13
Q

in colon cancer if patient has rectal bleeding and you suspect colorectal cancer what are the next steps

A

can skip the fit testing and just move onto the examination and colonoscopy as fit testing will be positive by default

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14
Q

what are the key investigations needed for tumour lysis syndrome

A

ECG, U&E, calcium, uric acid
can cuase seizures (low calcium) arrhytmias (K) AKI / gout / joint pain(uric)

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15
Q

Pernicious anaemia presentation

A

tongue is noted to be large and smooth in appearence
is patient’s macrocytic anaemia, smooth tongue (glossitis), and other symptoms are suggestive of pernicious anaemia. Pernicious anaemia is a form of megaloblastic anaemia typically caused by the inability to absorb vitamin B12 due to autoimmune destruction of gastric parietal cells.

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16
Q

what is the most common cause of an ovarian tumour

A

epithelial cell tumour

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17
Q

which anti emetic is used when a patient has raised intercranial pressure, and vestibular sickness (sickness with movement) and physical bowel obstruction

A

cyclizine

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18
Q

what antiemetic can you give if someone is struggling with gastric statis and functional bowel obstruction (stasis)

A

metoclopramide
can cause extrapyrimdal symptoms

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19
Q

if there is medication relation nausea and vomiting then what is the best antiemetic

A

cyclizine

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20
Q

when to give dexamethasone in nausea and vomiting in palliative care

A

if there are liver or Brain mets or there is bowel obstruction

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21
Q

found melanoma what do you do

A
  1. excisional biopsy
    CONFIRMED
  2. WLE of melanoma and radiological investigation CT scan to rule out metastases
  3. discuss in an MDT coordinator, radiologist, histopathologist, surgeon based on location, dermatologist, medical and clinical oncologist. Core 8 members
  4. offer adjuvant therapy if high stage (melanoma is not chemo or radio sensitive, only offer radio if too much bleeding or pain) - give immunotherapy
  5. surveillance -> 5 year programme, the programme starts from the first excisional biopsy date for 5 years
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22
Q

differentials for auxiliary lump

A
  • breast cancer
  • infection related
  • lymphoma
  • recent tattoo, recent vaccination
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23
Q

unexplained auxiliary lump that seems suspicious

A
  1. request an US
  2. refer them to breast surgery for a biopsy
  3. given a triple assessment
  4. biopsy reported as a melanoma - to do referral to dermatology to a through skin check and refer to MDT
  5. do a full body CT scan as its spread (comes back clear and they also cant find the primary lesion)
  6. do a blocked section of lymph node OR immunotherapy
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24
Q

if patients refuse curative surgery and they accept immunotherapy, is this neoadjuvant, adjuvant or palliative

A

this is palliative treatment as she has refused curative surgery

25
before starting immunotherapy what conditions should you check for
AVOID in** autoimmune** conditions as it will heighten the immune system and make these worse!!! if they have any viral conditions like hiv, hepatitis kidney transplant as it will cause the transplants to be rejected as you are bumping up the immune system
26
if a patient has death rattles and reduced consciousness what does this suggest
they will die in the next 24 - 73 hours
27
in Catholics what do they need before they die
they need to be seen by a priest, otherwise they wont go the heaven similar with other religions
28
rational for PE in cancer for osce
cancer makes blood more thick and sticky so more likely to clot
29
if patient has cancer that is not curable how log will they need apixaban for
lifelong
30
how does apixaban work
it will prevent new blood clots forming, it will not break down any clots the body will break down the clots
31
which medications actually break down blood clots? relevant for stroke too
alteplase
32
struggle to swallow ppl what Is an alternative medication
fast tabs
33
what is a another form of citalopram
drops form
34
if someone has MSCC what is the management
1. IMMOBILISE THE PATIENT - dont want to cause further damage - VTE prophylaxis 2. request whole spine MRI within 24 hours 3. should offer radiotherapy within 24hrs / surgery 4. offer high dose dex 16 mg STAT (check bms first) then next day give 8mg BD (8am, 12pm) 5. analgesia 6. can consider surgery if they have a high performance status, not much cancer spread. bones above and below need to be healthy if complains of bladder retention can ask for a bladder scan ECG, full blood and clot
35
what are some signs seen on MSCC
UMN signs below the level of the lesion, due to damaged in the descending pathway between the brain and spinal cord Hypertonia Hyperreflexia (although reflexes may be absent at the level compressed) Clonus Upgoing plantars Sensory loss (a "sensory level")
36
how does a PET CT work and indentift cancer spread
rate of glucose uptake Cancer cells, being more metabolically active, consume more glucose than normal cells and hence light up on PET scans. This allows for the detection and localisation of cancerous growths in the body.
37
what are the two most common symptoms of hypercalcemia in a cancer patient
- nausea and vomiting - reduced consciousness
38
features of hypocalcemia
numbness, tingling arounds hand feet and mouth, muscle cramps and seizures
39
what does hyperkalemia look like on an ecg
tall tented t waves and broad QRS, flattened p wave and prolonged PR interval
40
bladder cancer steps
- present with blood in urine - urine dip - imaging such as US or flexible cystoscopy (diagnostic) for mass or hydronephrosis - 2nd line is CT urogram (post contrast phase and then delayed contrast phase to see the defect) not the same as a CT KUB (stones) - if all positive will come back and then go under GA for biopsy
41
non cancer causes for heamaturia
infection trauma stones IGA nephorophathy
42
cancerous causes for heamaturia
renal cell carcinoma transitional cell cancer of the upper tract TCC, urothelial cancer of bladder BPH, prostate cancer (only in late stage disease)
43
RCC
Renal parenchyma
44
definition of paraneoplastic syndrome
collection of symptoms related to presence of malignancy but not due to its direct or metastatic affect
45
paraneoplastic syndrome in renal cell cancer
hypercalcemia, (ectopic PTH like peptide) HTN polycythemia anemia - chronic disease pyrexia
46
risk factors vs TCC and SCC
TCC -> smoking SCC -> long term catheter, recurrent UTI, bladder stones, schistosomiasis
47
how to stage bladder cancer
after detection with a flexible cystoscopy for heamaturia then can do a TURBT transurethral resection
48
what is the new biopsy for prostate cancer
transerineal biopsy rather than trans rectal as it reduces the risk of infection -- then move onto Gleason score if Geason 3+ 3 = 6 - then WW/ AS (low risk) 3 + 4 = 7 = AS/ surgery 4+ 3 = treat 4+4 - treat
48
vincristine side effects
peripheral neuropathy
49
liver met or liver cancer
with cancer there will be a background of alcohol, or liver disease, met there may be multiple round hypo echoic lesions with the hepatocellular carcinoma there will be usually only one lesions and a relevant history
50
if patient is found to have lots of liver mets then what is the next step in the diagnostic workup
colonoscopy - the mets may be secondary to colorectal cancer
51
reasons for adjuvant chemo
designed to kill micromets or small tumours left over after surgery
52
what are some reasons someone will present to the oncology department
1. they will already have a cancer diagnosis when they are referred to oncology so they will come in for - onc emergency - treatment - cancer progression - side effects of medication
53
test prior to chemo
cortisol for renal function and thyroid
54
in people with cancer and thrombosis risk what should you offer
if no active GI bleed offer DOAC - if low risk of bleed and little drug t drug interaction if luminal or to do with the brain - LMWH
55
when trying to explain night sweats what can you say
- do you ever have to change your bedsheets in the middle of the night
56
what Is carcinoid tumour
its on the liver - due to the release of serotonin - causes wheeze, diarrhoea, facial flush and right sided heart failure
57
what is the definition of a red flag
when there are signs suggesting something more sinister (not necessarily just cancer), that warrants further investigations

Y4 Cancer Care SA (21 decks)

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