Palliative + Oncology

Question 1

intracranial causes of nausea and vomiting - management

Answer 1

cyclizine

Question 2

gastro-intestinal pain in palliative care.

Answer 2

domperidone

Question 3

acute migraine, chemotherapy or radiotherapy-induced nausea and vomiting. It is a prokinetic agent which is unlikely to provide relief from nausea related to increased intracranial pressure.

Answer 3

metoclopramide

Question 4

chemotherapy antiemetic

Answer 4

ondanstetron

Question 5

Li-Fraumeni Syndrome

what gene? (1)
what cancers? (2)

Answer 5

p53 tumour suppressor gene

sarcomas leukaemia

Question 6

BRAC 1 and 2 - what genes? 92)
which cancers? (3)

Answer 6

chromosome 17 (BRCA 1) and 13 (BRCA 2)

ovarian cancer
breast cancer
prostate cancer

Question 7

Lynch syndrome:
how inherited? (1)
what type of cancer (2)

Answer 7

autosomal dominant

colon and endometrial cancer

Question 8

What is the Amsterdam criteria? (1)

Answer 8

Used to identify Lunch

Three or more family members with a confirmed diagnosis of colorectal cancer, one of whom is a first degree (parent, child, sibling) relative of the other two.
Two successive affected generations.
One or more colon cancers diagnosed under age 50 years.
Familial adenomatous polyposis (FAP) has been excluded.

Question 9

gardeners syndrome

Answer 9

Autosomal dominant familial colorectal polyposis
Multiple colonic polyps
Extra colonic diseases include: skull osteoma, thyroid cancer and epidermoid cysts
Desmoid tumours are seen in 15%
Mutation of APC gene located on chromosome 5
Due to colonic polyps most patients will undergo colectomy to reduce risk of colorectal cancer
Now considered a variant of familial adenomatous polyposis coli

Question 10

Adverse effects of chemotherapy:
Bleomycin? (1)

Answer 10

lung fibrosis

Question 11

Adverse effects of chemotherapy:
anthracyclines (doxorubicin)

Answer 11

cardiomyopathy

Question 12

Adverse effects of chemotherapy: methotrexate

Answer 12

myelosuppression, mucositis, liver fibrosis, lung fibrosis

Question 13

Adverse effects of chemotherapy: cisplatin

Answer 13

nephrotoxicity, ototoxicity, peripheral neuropathy, hypomagnaesia

Question 14

Hiccups in palliative care management

Answer 14

• chlorpromazine or haloperidol
  gabapentin

dexamethasone is also used, particularly if there are hepatic lesions

Question 15

palliative care: agitation/ confusion mangement

Answer 15

Underlying causes of confusion need to be looked for and treated as appropriate, for example hypercalcaemia, infection, urinary retention and medication. If specific treatments fail then the following may be tried:
first choice: haloperidol
other options: chlorpromazine, levomepromazine

Question 16

oral–> SC morphine conversion

Answer 16

Divide by two for oral to subcutaneous morphine conversion

Question 17

breakthrough morphine

Answer 17

1/6th total

Question 18

Raised beta-human chorionic gonadotropin with a raised alpha-feto protein level

Answer 18

The correct answer is: Non-seminomatous testicular cancer

Question 19

Palliative analgesia and renal failure:
- mild/moderate
- severe?

Answer 19

oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment
if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred

Question 20

what analgesia works for metastatic bone pain? (3)

Answer 20

opioids
bisphosphonates
radiotherapy

Question 21

How much to increase opioid dose by?

Answer 21

30-50%

Question 22

codeine to morphine

Answer 22

divide by 10

Question 23

Treatment Alzheimers:
1st line? (1)
2nd line?

Answer 23

1st= acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)

2nd= memantine (an NMDA receptor antagonist) - used in severe disease

Question 24

Donepezil:
when contraindicated? (2)

Answer 24

BRADYCARDIA
adverse events including insomnia

Question 25

Delerium:
management in Parkinsons

Answer 25

management can be challenging in patients with Parkinson’s disease, as antipsychotics can often worsen Parkinsonian symptoms
careful reduction of the Parkinson medication may be helpful
if symptoms require urgent treatment then the atypical antipsychotics quetiapine and clozapine are preferred

Question 26

Addenbrooks Cognitive Exam- cut off for dementia

Answer 26

82

Question 27

MMSE score - dementia cut off

Answer 27

24/30

Question 28

Dementia blood screen (5)
second test (1)

Answer 28

1. FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels.
2. neuroimaging is performed* to exclude other reversible conditions (e.g. Subdural haematoma, normal pressure hydrocephalus)

Question 29

STOPP drugs in elderly

Answer 29

CNS and Psychotropic Drugs:
Long-term benzodiazepines in older adults prone to falls.

Anticholinergics –> with cognitive impairment.
Cardiovascular Drugs:
Beta-blockers –> in diabetes mellitus and frequent hypoglycemia.
Loop diuretics –> dependent ankle edema without heart failure.
Gastrointestinal Drugs:
Proton pump inhibitors for peptic ulcers at full therapeutic dose >8 weeks.
Musculoskeletal Drugs:
NSAIDs in patients with moderate-to-severe hypertension or chronic kidney disease.
Endocrine Drugs:
Sulfonylureas with a long duration of action in patients with a history of hypoglycemia.

TCA in dementia –> worsening cognitive impairment

Question 30

Dementia + fluctuating cognition

Answer 30

Lew body dementia

Question 31

medications for LBD

Answer 31

both acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine can be used as they are in Alzheimer’s.

Question 32

Vascular dementia:
treatment

Answer 32

Only consider AChE inhibitors or memantine for people with vascular dementia if they have suspected comorbid Alzheimer’s disease, Parkinson’s disease dementia or dementia with Lewy bodies.

NOT aspirin unless for other cause

Question 33

Semantic dementia features

Answer 33

Here the patient has a fluent progressive aphasia. The speech is fluent but empty and conveys little meaning. Unlike in Alzheimer’s memory is better for recent rather than remote events.

Question 34

Vincristine causes what Sx

Answer 34

peripheral neuropathy

Question 35

Calcitonin is a tumour marker in

Answer 35

medullary thyroid cancer ( it originates from the parafollicular cells, which produce calcitonin.)

Question 36

Which cancer is last likely to be inherited? colorectal OR gastric?

Answer 36

GASTRIC is not very inheritable

Question 37

Raised beta-human chorionic gonadotropin with a raised alpha-feto protein level

Answer 37

Non-seminomatous testicular cancer