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Cancer Care > Passmed > Flashcards

Passmed Flashcards

1
Q

Why is B12 deficiency treated first in combined b12 and folate deficiency

A

To avoid subacute combined degeneration of the spinal cord.

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2
Q

B12 deficiency treatment

A

1mg IM hydroxocobalamin 3x weekly 2 weeks the. 3 monthly

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3
Q

B12 deficiency symptoms

A

Macrocyctic anaemia
Sore mouth and tongue
Neurological symptoms- dorsal column (vibration, proprioception)
Mood disturbances

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4
Q

Causes of B12 Deficiency

A

Pernicious anaemia
Vegan diet
Malabsorption disorder
Post gastrectomy
Metformin

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5
Q

Alternative to morphine in palliative patients with renal failure

A

Oxycodone

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6
Q

What is Richters transformation

A

CLL cells enter the lymph node and change into a high grade fast growing non-Hodgkin’s lymphoma

Patient v illl v quick

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7
Q

Richters transformation symptoms

A

Lymph node swelling
Fever without infection
Weightloss
Night sweats
Nausea
Abdo pain

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8
Q

What to do with patients over 60 with iron deficiency anaemia

A

Refer via 2ww for colonoscopy

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9
Q

Causes of iron deficiency anaemia

A

Blood loss (menorrhagia, GI bleed)
GI bleeding
Inadequate dietary intake
Poor intestinal absorption
Increased iron requirements (pregnancy)

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10
Q

Features of iron deficiency anaemia

A

Fatigue
SoB
Palpitations
Pallor
Koilonychia
Angular stomatitis
Atrophied glossitis

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11
Q

Iron deficiency anaemia Ivx

A

FBC - hypochromic micro cystic anaemia
Serum ferritin - usually low
TIBC/transferrin - high
Blood film - target cells, anisopoikilocytosis

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12
Q

Iron deficiency anaemia management

A

Find and treat cause
Oral ferrous sulphate
Iron rich diet

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13
Q

Causes of renal impairment in multiple myeloma

A

AL type amyloidosis, Bence Jones nephropathy, nephrocalcinosis, nephrolithiasis

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14
Q

Hyposplenism blood film

A

Target cells,
Howell-jolly bodies
Siderotic granules
Pappenheimer bodies
Acanthocytes

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15
Q

Iron deficiency anaemia blood film

A

Target cells
Pencil poikilocytes

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16
Q

Myelofibrosis blood film

A

Tear drop poikilocytes

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17
Q

Intravascular haemolysis blood film

A

Schistocytes

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18
Q

Megaloblastic anaemia blood film

A

Hypersegmented neutrophils

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19
Q

How often should sickle cell patients get a pneumococcal vaccine

A

Every 5 years

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20
Q

Prophylactic management of sickle cell

A

Hydroxyurea - increases HbF levels

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21
Q

Lead poisoning features

A

Abdo pain
Peripheral neuropathy
Fatigue
Neuropsychiatric features
Constipation
Blue lines on gums

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22
Q

Lead poisoning management

A

Various chelating agents - dimercaprol, EDTA

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23
Q

Risk of Iga deficiency in blood transfusion

A

Increased risk of anaphylaxis

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24
Q

Beta thalassaemia trait features

A

Mild hypochromic, microcytic anaemia
Raised HbA2

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25
Q

G6PD deficiency features

A

Neonatal jaundice
Gallstones
Splenomegaly
Intravascular haemolysis

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26
Q

G6PD deficiency blood film

A

Heinz bodies, bite cells, blister cells

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27
Q

G6PD inheritance

A

X-linked recessive

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28
Q

G6PD deficiency diagnosis

A

G6PD enzyme assay. 3 months post acute episode

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29
Q

Pancreatic cancer tumour marker

A

CA 19-9

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30
Q

Why use irradiated blood products

A

Reduces risk of graft v host disease by destroying T cells.
Required in Hodgkin’s lymphoma, immunocompromised,neonates

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31
Q

TACO symptoms (transfusion associated circulatory overload)

A

Htn, raised jvp, afebrile, S3 present

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32
Q

TRALI symptoms (Transfusion related acute lung injury)

A

Hypotension, pyrexia, normal jvp

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33
Q

Blood transfusion complications

A

GOT A BAD UNIT

Graft v Host disease
Overload
Thrombocytopenia

Alloimunisation

Blood pressure unstable
Acute haemolytic reaction
Delayed Haamolytic reaction

Urticaria
Neutrophillia
Infection
Transfusion related lung injury

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34
Q

What can cause an aplastic crisis in hereditary spherocytosis

A

Parvovirus

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35
Q

Hereditary spherocytosis features

A

Failure to thrive
Aplastic crisis
Jaundice
Gallstones
Splenomegaly
MCHC raised

36
Q

Hereditary spherocytosis ethnicity

A

Northern european

37
Q

Benign neutropenia ethnicity

A

Black Afro Caribbean

38
Q

Factors associated with poor prognosis in Hodgkin’s lymphoma

A

Presence of B symptoms
Age over 45
Male
Hb less than 10.5
Lymphocytes less than 600

39
Q

Most common cause neutropenic sepsis

A

Coagulase positive, gram negative bacteria- staphylococcus epidermidis

40
Q

How to convert morphine oral to subcutaneous

A

Divide by 2

41
Q

What does a ‘starry’ sky biopsy suggest

A

Burkitt lymphoma

42
Q

What is ITP

A

Idiopathic thrombocytopenic purpura
Immune mediated reduction in platelet count, antibodies directed against glycoprotein 2b or 3a

43
Q

Thrombocytopenia causes

A

ITP
DIC
Haem malignancy
Alcohol
Liver disease
Antiphospholipid syndrome
Pregnancy

44
Q

Symptoms of spinal cord compression

A

Back pain (may be worse lying down or coughing)
Lower limb weakness
Sensory changes
Urinary retention
Urinary/faecal incontinence

45
Q

Spinal cord compression Ivx

A

Whole spine MRI within 24hrs presentation

46
Q

Spinal cord compression mx

A

High dose oral dexamethasone
Urgent assessment for surgery or radiotherapy

47
Q

What can cause haemolytic anaemia in G6PD deficiency

A

Malaria prophylaxis

48
Q

Most common tumour to cause bony mets

A

Prostate
Breast
Lung

49
Q

Features of bone mets

A

Bone pain
Pathological fractures
Hypercalcaemia
Raised ALP

50
Q

Most common sites of bone mets

A

Spine
Pelvis
Ribs
Skull
Long bones

51
Q

Von willibrand disease -APTT, platelets + bleed time

A

Prolonged bleed time
Normal platelet count
Prolonged APTT

52
Q

Aplastic anaemia features

A

Normochromic, normocytic anaemia
Leukopenia
Thrombocytopenia

53
Q

Aplastic anaemia causes

A

Idiopathic
Drugs - phenytoin
Parvovirus, hepatitis
Radiation

54
Q

Universal donor of FFP

A

AB RhD negative

55
Q

Features of thrombotic thrombocytic purpura

A

Fever
Altered mental state - confusion, headache, seizure
Haemolytic anaemia
Reduced renal function
Thrombocytopenia

56
Q

What is TTP

A

Thrombotic thrombocytic purpura
Microangiopathic haemolytic anaemia

57
Q

TTP causes

A

Post infection
Pregnancy
Drugs - penicillin, oral contraceptives
SLE
HIV

58
Q

Dabigatran reversal agent

A

Idarucizumab

59
Q

Causes of hyposplenism

A

Post-splenectomy
Coeliac disease

60
Q

Hyposplenism blood film

A

Target cells
Howell-jolly bodies

61
Q

Breast cancer tumour market

A

CA15-3

62
Q

Ovarian cancer tumour marker

A

CA125

63
Q

Von willibrand treatment

A

Tranexamic acid for bleeding
Desmopressin
Factor vIII concentrate

64
Q

What causes electrolyte abnormalities in tumour lysis syndrome + what are they?

A

Release of intracellular contents into bloodstream
Hyperkalaemia, hyperuricaemia, hyperphosphataemia and hypocalcemia

65
Q

DIC typical blood picture

A

Dec platelets
Dec fibrinogen
Inc PT and APTT

66
Q

What type of anaemia is CLL associated with

A

Warm autoimmune haemolytic anaemia

67
Q

Prevention measures for tumour lysis syndrome

A

IV fluids
Rasburicase
Allopurinol (not alongside rasburicase)

68
Q

Define laboratory tumour lysis syndrome

A

Abnormally in 2 or more of the following occurring within 3 days before or 7 days after chemo
25% Inc Uris acid, potassium or phosphate
25% decrease in calcium

69
Q

Define clinical tumour lysis syndrome

A

Lab tumour lysis syndrome plus one of
Inc serum creatinine
Arrhythmia or sudden death
Seizure

70
Q

Reversal agent of rivatoxaban + apixaban

A

Andexanet Alfa

71
Q

Criteria for young person referral for leukaemia

A

0-24
Unexplained petechiae or hepatosplenomegaly
Immediate specialist assessment

72
Q

Anticoagulant for antiphospholipid syndrome in pregnancy

A

Aspirin + Lmwh

73
Q

ITP treatment

A

Oral prednisolone
Pooled normal human immunoglobulin

74
Q

What is evans syndrome

A

ITP in association with AIHA

75
Q

Causes of massive Splenomegaly

A

Myelofibrosis
CML
malaria
Gauchers syndrome
Visceral leishmaniasis

76
Q

Graft v host disease signs + symptoms (acute)

A

Painful maculopapular rash
Jaundice
Diarrhoea
Persistent N+V
Culture negative fever

77
Q

Chronic graft v host disease symptoms

A

Lichen planus, scleroderma, vitiligo
Corneal ulcers
Dysphagia,oral ulcers
Lung disease

78
Q

Most common lung cancer in non Smokers

A

Lung Adenocarcinoma
Peripheral leision

79
Q

What is calcitonin a tumour marker for?

A

Medullary thyroid cancer

80
Q

1st line abx for neutropenic sepsis

A

Tazocin

81
Q

What is anaemia with reticulocytosis indicative of

A

Haemolysis or bleeding

82
Q

Haemolysis blood results

A

Raised bilirubin (other LFTs normal)
Low haptoglobins
Raised LDH
Low Hb
High reticulocytes

83
Q

Threshold for platelet transfusion

A

<30 with significant bleeding. (Higher if bleeding at critical sites I.e CNS)

84
Q

What is used for emergency reversal of anticoagulants

A

Prothrombin complex concentrate

85
Q

What is Myelofibrosis

A

Myeloproliferative disorder caused by hyperplasia of abnormal megakaryocytes

86
Q

Myelofibrosis features

A

Elderly with symptomatic anaemia
High urate and LDH
tear drop poikilocytes

Cancer Care (4 decks)

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