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MRCP 2 > palli/onc > Flashcards

palli/onc Flashcards

1
Q

acanthosis palmaris

A

paraneoplastic
usually pulm or gastric origin

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2
Q

diagnosing AML

A

low Hb, neutrophils, platelets
raised WCC
blasts and Auer rods on film
> 20% blasts

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3
Q

AML treatment

A

cytarabine, idarubicin, daunorubucin
gemtuzumab ozogamicin (CD33)
midostaurin (FLT3)

supportive: hydroxycarbamide allopurinol rasburicase

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4
Q

diagnosing adrenal tumours

A

CT, MRI
MIBG scan- MIBG similar to adrenaline and taken up by neuroendocrine tumour
adrenal v sampling

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5
Q

adrenal tumour treament

A

alpha blockers then surgery for phaeochromocytoma

ketoconazole and metyrapone to reduce steroid
spironolactone to block aldosterone
mifepristone to block cortisol
tamoxifen to block oestrogen

mitotane for metastatic

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6
Q

pain ladder

A
  1. paracetamol
  2. ibuprofen or weak opioid
  3. 1 + 2
  4. paracetamol + alternative NSAID
  5. paracetamol + weak opioid
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7
Q

pain ladder for cancer pain

A
  1. non opioid +/- adjuvant
  2. opioid +/- 1.
  3. stronger opioid +/- 1
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8
Q

diagnosing aspergillosis

A

serum aspergillus galactomannan
serum 1-3 beta D glucan
halo sign (nodule), air crescent

ABPA- elevated IgE, aspergillus IgE and IgG

chronic- IgG

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9
Q

bladder ca treatment

A

non muscle invasive:
CIS, Ta, T1- resection TURBT and single shot mitomycin C intravesically
greater than 3cm- 6 shots
high risk G3T1 - 2x TURBT and intravesical BCG or radical cystectomy

muscle invasive:
radical cystectomy, ileal conduit
radical RTx
neoadjuvant cisplatin

metastatic: platinum chemo

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10
Q

CIN staging

A

CIN1- mild dyskaryosis
CIN3- high grade, full thickness, requires surgery

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11
Q

cervical cancer staging

A

1a, 1b confined to cervix
2 extends beyond uterus but not pelvic wall or lower 1/3 vagina
3 extends to pelvic sidewall or lower 1/3 vagina or hydronephrosis
4 beyond bladder/rectum

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12
Q

alkylating chemo

A

cyclophosphamide
inactivates enzymes involved in DNA production

s/e: haemorrhagic cystitis, pulm fibrosis

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13
Q

antimetabolite chemo

A

interferes with purine or pyramidine synthesis
MTX (hepatic failure, pulm fibrosis)
5FU (palmar plantar syndrome, cardiotoxic)

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14
Q

antibiotics as chemo

A

anthracycline- doxorubicin
s/e: CCF

bleomycin
s/e: pneumonitis, fibrosis, rash

mitomycin c
s/e: kidney failure, stomatitis, rash, alopecia

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15
Q

vincristine

A

inhibits spindle formation and mitosis
s/e: neuropathy, bronchospasm, blistering

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16
Q

paclitaxel

A

stabilises microtubules, inhibits mitosis
s/E: sudden total alopecia, myalgia, peripheral neuropathy

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17
Q

topoisomerase inhibitors

A

e.g. irinotecan
s/e: cholinergic syndrome, profuse diarrhoea

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18
Q

CLL cells

A

CD5, CD19, CD23 monoclonal B lymphocytes

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19
Q

diagnosing CLL

A

raised WCC
lymphocytosis > 5
smudge/smear cells on film
CD5, 19, 20, 23 on cytometry

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20
Q

CLL treatment

A

fludrabine + cyclophosphamide + rituximab 1st line

alkylating agents, purine analogues, ibrutinib second line

allogenic SCT for TP53 after remission

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21
Q

CML

A

BCR ABL chr 9, 22 philadelphia
mature myeloids, basophils and eosinophils on smear
granulocyte left shift

tx: tyrosine kinase inhib (imatinib)
allogenic SCT

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22
Q

MRI sequences for CNS tumours

A

T1: CSF low signal (dark)
T2: CSF high signal (white)
FLAIR: for periventricular
STIR

23
Q

indications for stereotactic brain RTX

A

AVM lesions not amenable to coiling or clipping
vestibular schwannoma
mets

24
Q

indications for brain metastectomy

A

patient is fit
symptomatic lesions is accessible
good prognosis of primary

25
Q

indications for surgery for pituitary tumours

A

non functional with mass effects
cushings
acromegaly
acute visual deterioration
pituitary apoplexy

26
Q

colorectal TNM

A

to- no evidence
tis- in situ
t1- submucosa
t2- muscularis mucosa
t3- subserosa or non peritonealised tissues
t4- other organs or structures or perforates visceral peritoneum

n1- 1-3 regional nodes
n2- 4 regional nodes

adjuvant chemo for stage 3 FUFA

27
Q

colorectal cancer surgery abx prophylaxis

A

metro and cephalosporin at induction and 2 doses post op

28
Q

indication for endometrial biopsy

A

> 4mm thickness

29
Q

endometrial staging

A

FIGO
1: uterus body
2: uterus and cervix
3: beyond uterus within pelvis
4: bladder/bowel/beyond

30
Q

endometrial ca treatment

A

internal/external RTX
progesterone if still wanting to conceive
CTx stage 3-4

hysterectomy:
stage 1- hysterectomy and BSO
stage 2-3- radical hysterectomy with nodes, cervix and top of vagina
stage 4- debulking

31
Q

driving and seizures

A

inform after 1st episode
no driving for 6 months 1st seizure normal EEG
no driving for 12 months if abnormal

can drive if seizure free for 1y or nocturnal only for 3y
vocational or group 2 license requires seizure and antiepileptic meds free for 10y

32
Q

gastric ca Lauren classification

A

diffuse: poorly differentiated, aggressive
intestinal type: well differentiated and slow growing, more common in men

33
Q

first line antieplipetics

A

gen tonic clonic: valproate
focal: carbamaz
absence: ethosux

34
Q

treating gastric ca

A

resection for T1/2
gastrectomy for > t2 or > N0
adjuvant chemo
trastuzumab for HER2 metastatic adenocarcinoma
triple therapy to eradicate h pylori

35
Q

liver transplant criteria for liver ca

A

single tumour smaller than 5cm
no vasc or metastatic spread
AFP < 1000

36
Q

treatment for cholangiocarcinoma

A

resection or transplant if unresectable at presentation
capecitabine post resection

CTx if inoperable:
Gem/Cis
FOLFOX second line

palliative stenting to relieve jaundice

37
Q

diagnosing and treating hodgkins lymphoma

A

raised neutrophils, platelets, eosinophils, ESR, LDH
normocytic anaemia
LDH guides volume of disease
test for HIV
biopsy: reed sternberg

ABVD
BEACOPP
autologous SCT
adjuvant RTX for stage I or II

38
Q

lung cancer treatment

A

NSCLC:
CTX for stage 2/3 or not suitable for surgery
RX if surgery not suitable or can’t tolerate CTX

ablation for primary and secondary lung ca
photodynamic therapy for localised inoperable endobronchial ca

SCLC:
surgery for early stage
CTX +/- RTX for limited stage
CTX for extensive stage
repeat CTX for recurrence
RTX for palliation

39
Q

lung ca paraneoplastic syndromes

A

SCLC: lambert eaton, ACTH, SIADH

squamous: PTH and bony mets, TSH

large cell: gynaecomastia
adenocarcinoma: gynaecomastia, HPOA- periostitis, clubbing, arthritis

40
Q

BRCA1 and 2

A

BRCA1: chr 17 long arm, auto dom. assoc w/ female breast, ovarian, prostate, colon

BRCA2: chr 13 long arm. assoc w/ breast, ovarian

41
Q

indications for CTX for breast ca

A

premenopausal
lymph node positive
ER negative
grade III
large tumour
lymphovascular invasion

benefits of neoadjuvant:
monitor response and optimise CTx regime
reduce size to allow breast conserving surgery

42
Q

indications for mastectomy

A

> 4cm or multifocal or central

43
Q

NHL treatment

A

CHOP or FCR CTX
MTX + dex for primary CNS lymphoma

44
Q

pancreatic cancer treatment

A

neoadjuvant chemo if borderline resectable
adjuvant gemcitabine + capecitabine
folfirinox or gemcitabine or oxiplatin for metastatic

45
Q

peutz jeghers

A

auto dom STK11 chr 19
perioral and mucosal pigmentation
GI hamartomatous polyps
GI, pancreas, lung, breast, thyroid, uterus, ovaries, testes malignancy
2 yearly colonoscopy > 25y

46
Q

prostate ca diagnosis

A

transrectal ultrasound with 10-12 random biopsies
MRI for staging

47
Q

prostate ca staging

A

T1- clinically unapparent
T1a- incidental finding at TURP
T1b- incidental at TURP, > %5 tissue resected
T1c- identified on biopsy due to PSA
T2- palpable, confined to prostate
T2a- half a lobe or less
T2b- > half a lobe
T2c- both lobes
T3 extracapsular extension
T4 adjacent structures beyond seminal vesicles

Gleason grading 2 areas out of 5

48
Q

prostate ca treatment

A

T1 and 2 potentially curable
T3 and 4 considered advanced

radical RTX or prostatectomy
antiandrogens
LHRH antagonists

49
Q

types of testicular ca

A

seminomas:
homogenous macroscopic appearance
sheets of clear cells
classic, anaplastic and spermatocytic

non seminoma GCT:
embryonal- glands or papules
yolk sac- schiller duval (look like glomeruli)
choriocarcinoma- look like cytotrophoblasts
teratoma
most have mixed pattern

stromal tumours and lymphomas

50
Q

testicular tumour markers

A

AFP (non seminomas)
BHCG (mostly non seminomas)
LDH (non specific)
PLAP (seminomas)

51
Q

testicular ca treatment

A

radical orchidectomy
metastatic NSGCT: BEP CTX, resect residual masses
seminoma: carboplatin single dose post op
seminoma w/ mets: RTX +/- CTX

52
Q

tumour lysis syndrome

A

raised urea, potassium, phosphate
tx:
IV fluids
allopurinol (won’t treat hyperuricaemia)
urate oxidase (to treat hyperuricaemia)
sodium bicarb
calcium
dialysis
febuxostat

53
Q

NSE tumour marker

A

SCLC
neuroblastoma

54
Q

ca 19-9 cancers

A

pancreas
bowel
lung
gall bladder

MRCP 2 (12 decks)

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