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Medicine and Surgery Mushkies > Passmed Gerry, Immuno, Metabolic, Oncology, and Palliative Mushkies > Flashcards

Passmed Gerry, Immuno, Metabolic, Oncology, and Palliative Mushkies Flashcards

1
Q

In anaphylaxis, how frequently can you repeat adrenaline?

A

Every 5 mins

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2
Q

Anaphylaxis defn?

A

A severe, life threatening, systemic hypersensitivity reaction

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3
Q

Most common anaphylaxis causes?

A
  1. Food
  2. Drugs
  3. Venom
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4
Q

Adult anaphylaxis doses?

A

500, 200, 10

  1. Adrenaline 500mcg (0.5ml 1 in 1,000)
  2. Hydrocortisone (200mg)
  3. Chlorphenamine (10mg)
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5
Q

Anaphylaxis biphasic reaction frequency?

A

20%

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6
Q

How long should anaphylaxis pts be observed for after?

A

6-12 hours

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7
Q

How long do serum tryptase levels remain elevated after anaphylaxis?

A

12 hours

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8
Q

What is the first line sedative for delirium?

A

Haloperidol 0.5mg

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9
Q

Acetylcholinesterase inhibitor examples?

A

Donepezil, Galantamine, RIvastigmine

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10
Q

NMDA receptor antagonist example?

A

Memantine

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11
Q

Alzheimers management?

A
  1. Non-pharm = range of activities, cognitiive stimulation therapy, group reminiscence therapy
  2. Pharm
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12
Q

Pharm management of Alzheimers?

A
  1. AChesterase inhibitors first line e.g. donepezil

2. NMDA receptor antagonist e.g. memantine add-on

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13
Q

S/e of donepezil?

A

Insomnia

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14
Q

Relative c/i of donepezil?

A

Bradycardia

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15
Q

Dx of orthostatic HTN?

A
  1. SBP drop of 20mmHg
  2. DBP drop of 10mmHg
  3. Drop to 90mmHg systolic
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16
Q

Time b/w lying and standing BP?

A
  1. 5 mins lying down
  2. 1st minute of standing
  3. 3rd minute of standing
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17
Q

Drugs that cause postural hypotension?

A

NDAAABL

  1. Nitrates
  2. Diuretics
  3. Anticholinergic medications
  4. Antidepressants
  5. ACEi
  6. BBs
  7. L-Dopa
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18
Q

Investigation of falls?

A
  1. Bedside = basic obvs, BP, glucose, urine dip, ECG (x5)
  2. Bloods = FBC, U&E, LFTs, bone profile
  3. Imagine = CXR, CT head, cardiac echo
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19
Q

When should Abx be given for pressure ulcers?

A

Only if there are signs of infection

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20
Q

4 RFs for pressure ulcers?

A
  1. Malnourishment
  2. Incontinence
  3. Lack of mobility
  4. Pain
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21
Q

Pressure ulcer risk scoring system?

A

Waterlow score

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22
Q

Pressure ulcer grading?

A
  1. Grade 1 = non-blanchable erythema of intact skin
  2. Grade 2 = partial thickness skin loss involving epidermis/dermis/both
  3. Grade 3 = full thickness skin loss to underlying fascia
  4. Grade 4 = Extensive destruction, tissue necrosis, or damage to muscle, bone or
    supporting structures
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23
Q

Mx of pressure ulcer?

A
  1. Moist wound environment encourages wound healing –> hydrocolloing dressing and hydrogels, use of soap discouraged to avoid drying out the wound
  2. Tissue viability nurse referral
  3. Surgical debridement for selected wounds
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24
Q

Pathologic features of Lewy body dementia?

A

Alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas

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25
Q

Percentage of alzheimers pts with lewy bodies?

A

40%

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26
Q

Features of Lewy Body Dementia?

A
  1. Progressive cognitive impairment, may be fluctuating
  2. Parkinsonism
  3. Visual hallucinations
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27
Q

Scan for dx of Lewy Body Dementia?

A

DaTscan

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28
Q

Sensitivity and specificity of DaTscan for LBD?

A

90% sensitivity, 100% specificity

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29
Q

Pharm management of LBD?

A
  1. Donepezil and Memantine

2. Avoid antipsychotics as may develop irreversible parkinsonism

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30
Q

Medical mx of delirium in Parkinsons?

A

Oral lorazepam NOT haloperidol

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31
Q

Foods high in potassium?

A

BOKAST

  1. Bananas
  2. Oranges
  3. Kiwis
  4. Avocados
  5. Spinach
  6. Tomatoes
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32
Q

How can heparin cause hyperkalaemia?

A

Inhibition of aldosterone secretion

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33
Q

Causes of hyperkalaemia?

A
  1. AKI
  2. Drugs
  3. Metabolic acidosis
  4. Addison’s
  5. Rhabdomyolysis
  6. Massive blood transfusion
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34
Q

Drugs causing hyperkalaemia?

A
  1. K sparing diuretics, ACEi, ARBs, Spironolactone
  2. Ciclosporin
  3. Heparin
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35
Q

Mx of hyperkalaemia?

A
  1. Calcium gluconate
  2. Insulin/dextrose infusion
  3. Nebulised salbutamol
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36
Q

Features of hypocalcaemia?

A
  1. Tetany = muscle twitching, cramping and spasm
  2. Perioral paraesthesia
  3. Chronic = depression, cataracts
  4. ECG = prolonged QT interval
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37
Q

Raised ALP and raised calcium?

A
  1. Bone metastases

2. Hyperparathyroidism

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38
Q

Raised ALP and low calcium?

A
  1. Osteomalacia

2. Renal failure

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39
Q

4 causes of hypernatraemia?

A
  1. Dehydration
  2. Osmotic diuresis e.g. hyperosmolar non-ketotic diabetic coma
  3. Diabetes Insipidus
  4. Excess IV Saline
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40
Q

Most useful test in determining the cause of hypocalcaemia?

A

PTH

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41
Q

Hypocalcaemia mx?

A
  1. IV calcium gluconate 10ml 10% over 10 mins
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42
Q

Complication of too rapid hypo/hypernatraemia correction?

A
  1. Hyponatraemia correction –> central pontine myelinolysis

2. Hypernatraemia correction –> cerebral oedema

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43
Q

Mx of hyponatraemia?

A
  1. Fluid restriction
  2. Hypertonic saline
  3. Vaptans (ADH receptor antagonists)
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44
Q

4 situations where fluid intake should be less than urine output?

A
  1. HF/Cirrhosis
  2. SIADH
  3. Renal failure
  4. Psychogenic polydipsia
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45
Q

How do SSRIs cause hyponatraemia?

A

SIADH

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46
Q

Vit B7 aka?

A

Biotin

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47
Q

Biotin deficiency (B7)?

A

Dermatitis, seborrhoea

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48
Q

Vit B9 AKA?

A

Folic acid

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49
Q

Vit E aka?

A

Tocopherol

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50
Q

Vit K aqa?

A

Naphthoquinone

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51
Q

Maximum rate of K infusion that can be conducted without monitoring?

A

10mmol/hour

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52
Q

Is tx of asymptomatic hyperuricaemia to prevent gout recommended?

A

No

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53
Q

When should we suspect familial hypercholesterolaemia?

A
  1. Total cholesterol >7.5mmol/l AND/OR

2. Personal/FHx of premature CHD < 60 y/o

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54
Q

Thiazides cause hypo or hyperkalaemia?

A

Hypokalaemia

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55
Q

Advice for hypercalcaemic pt secondary to malignancy?

A

Maintain good hydration (3-4L of fluid per day)

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56
Q

Suppression of N&V with intracranial tumours?

A

Dexamethasone

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57
Q

What anti-emetics should be used for N&V due to chemo?

A
  1. Low risk = metoclopramide

2. High risk = ondansetron +/- dexamethasone

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58
Q

Ondansetron MOA?

A

5HT-3 receptor antagonist

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59
Q

Cyclizine MOA?

A

H1-antagonist used to treat inner ear induced nausea

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60
Q

Metoclopramide MOA?

A

D2-antagonist

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61
Q

6 Cytotoxic agent classes?

A
  1. Alkylating agents
  2. Cytotoxic antibiotics
  3. Antimetabolites
  4. Microtubule inhibitors
  5. Topoisomerase inhibitors
  6. Others
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62
Q

Alkylating agent example?

A

Cyclophosphamide

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63
Q

Cyclophosphamide MOA?

A

Alkylating agent, causes cross-linking in DNA

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64
Q

3 s/es of cyclophosphamide?

A
  1. Haemorrhagic cystitis
  2. Myelosuppression
  3. Transitional cell carcinoma
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65
Q

Cytotoxic Abs examples?

A
  1. Bleomycin

2. Doxorubicin

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66
Q

Bleomycin MOA?

A

Degrades preformed DNA

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67
Q

Bleomycin s/e?

A

Lung fibrosis

68
Q

Doxorubicin MOA?

A

Stabilizes DNA-topoisomerase II complex inhibits DNA & RNA synthesis

69
Q

Doxorubicin s/e?

A

Cardiomyopathy

70
Q

Antimetabolite examples?

A
  1. Methotrexate
  2. 5-FU
  3. 6-MP
  4. Cytarabine
71
Q

Methotrexate MOA?

A

Inhibits dihydrofolate reductase and thymidylate synthesis

72
Q

4 s/es of methotrexate?

A
  1. Lung fibrosis
  2. Liver fibrosis
  3. Myelosuppression
  4. Mucositis
73
Q

5-FU MOA?

A

Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase)

74
Q

3 s/e of 5-FU?

A
  1. Myelosuppression
  2. Mucositis
  3. Dermatitis
75
Q

6-MP MOA?

A

Purine analogue that is activated by HGPRTase, decreasing purine synthesis

76
Q

6-MP s/e?

A

Myelosuppression

77
Q

Cytarabine MOA?

A

Pyrimidine antagonist. Interferes with DNA synthesis specifically at the S-phase of the cell cycle and inhibits DNA polymerase

78
Q

Cytarabine s/e?

A
  1. Myelosuppression

2. Ataxia

79
Q

Microtubule inhibitor examples?

A
  1. Vincristine/vinblastine

2. Docetaxel

80
Q

Vincristine/vinblastine MOA?

A
  1. Inhibits formation of microtubules
81
Q

Vinblastine s/e?

A

Myelosuppression

82
Q

Vincristine s/es?

A
  1. Peripheral neuropathy (reversible)

2. Paralytic ileus

83
Q

Docetaxel MOA?

A

Prevents microtubule depolymerisation & disassembly, decreasing free tubulin

84
Q

Docetaxel s/e?

A

Neutropenia

85
Q

Topisomerase inhibitor example?

A

Irinotecan

86
Q

Irinotecan MOA?

A

Inhibits topoisomerase I which prevents relaxation of supercoiled DNA

87
Q

Irinotecan s/e?

A

Myelosuppression

88
Q

Cisplatin MOA?

A

Causes cross-linking in DNA

89
Q

Cisplatin s/e?

A
  1. Ototoxicity
  2. Peripheral neuropathy
  3. Hypomagnaesaemia
90
Q

Hydroxurea (hydroxycarbamide) MOA?

A

Inhibits ribonucleotide reductase, decreasing DNA synthesis

91
Q

Hydroxurea (hydroxycarbamide)

A

Myelosuppression

92
Q

Ca-125?

A

Ovarian cancer

93
Q

Ca 19-9?

A

Pancreatic cancer

94
Q

Ca 15-3?

A

Breast cancer

95
Q

AFP?

A

HCC, teratoma

96
Q

PSA?

A

Prostatic carcinoma

97
Q

CEA?

A

Colorectal cancer

98
Q

S-100?

A

Melanoma, schwannoma

99
Q

Bombesin?

A
  1. SCLC
  2. Gastric cancer
  3. Neuroblastoma
100
Q

Most common lung cancer in non-smokers?

A

Lung adenocarcinoma, although the majority of patients who develop lung adenocarcinoma are smokers

101
Q

Typical location of lung adenocarcinoma?

A

Peripheral lesions

102
Q

Squamous cell lung cancer paraneoplastic?

A

PTHrP –> hypercalcaemia

103
Q

2 associations of Squamous cell lung cancer?

A
  1. Finger clubbing

2. HPOA

104
Q

HPOA?

A

Hypertrophic pulmonary osteoarthropathy

105
Q

Large cell lung carcinoma typical location?

A

Peripheral

106
Q

Large cell lung carcinoma hormone secretion?

A

May secrete b-HCG

107
Q

Li-Fraumeni syndrome cause?

A

Germline mutation to p53 TS gene

108
Q

Germline mutation to p53 TS gene?

A

Li-Fraumeni Syndrome

109
Q

HRas?

A

Bladder cancer

110
Q

LiFraumeni inheritence?

111
Q

Li-Fraumeni syndrome features?

A

SBLA

  1. Sarcoma = blood vessels, nerves, adipose, muscular
  2. Breast
  3. Lymph/leuk
  4. Adrenal
112
Q

BRCA 1 Chr?

113
Q

BRCA 2 Chr?

114
Q

BRCA2 association in men?

A

Prostate cancer

115
Q

BRCA 1&2 also associated with?

A

Ovarian cancer (55% with BRCA1 and 25% with BRCA 2)

116
Q

Lynch syndrome inheritence?

117
Q

Main feature of lynch syndrome?

A

80% will get colonic and/or endometrial cancer, often at a young age

118
Q

What is Gardners syndrome?

A

AD familial colorectal polyposis

119
Q

Features of Gardners syndrome?

A
  1. Multiple colonic polyps
  2. Skull osteomas
  3. Thyroid cancer
  4. Epidermoid cysts
120
Q

Gardners syndrome mutation?

A

APC gene on Chr5

121
Q

Features of SVCO?

A
  1. Dyspnoea (most common sx)
  2. Swelling (of face, neck and arms, conjunctival and periorbital oedema may be seen)
  3. Headache (worse in morning)
  4. Visual disturbance
  5. Pulseless jugular venous distension
122
Q

SVCO Mx?

A
  1. general = dexamethasone, balloon venoplasty, stenting
  2. Small cell = chemo + radio
  3. Non small cell = radio
123
Q

Carcinogenic HPV subtypes?

A

HPV 16, 18, 33

124
Q

Raised b-HCG and raised AFP in a man?

A

Non-seminomatous testicular cancer, as raised AFP excludes a seminoma

125
Q

Earliest and most common sx of spinal cord compression?

126
Q

3 most common cause of neoplastic spine lesions?

A
  1. Lung
  2. Breast
  3. Prostate
127
Q

Mx of neoplastic spinal cord compression?

A
  1. High dose oral dexamethasone

2. Urgent onc assessment for consideration of radiotherapy or surgery

128
Q

MSSC?

A

Metastatic spinal cord compression

129
Q

Ix for ?spinal metastases?

A

Whole spine MRI

130
Q

FDG?

A

Fluorodeoxyglucose

131
Q

Main use of PET scan?

A

Evaluating primary and possibly metastatic disease

132
Q

Chemo agent causing cardiomyopathy?

A

Doxorubicin

133
Q

Woman with bone mets, most likely source?

134
Q

Most common cause of SVCO?

A

Small cell lung cancer

135
Q

Lung cancer with greatest smoking association?

A

Squamous cell lung cancer

136
Q

-mab?

A

Immune checkpoint inhibitor

137
Q

Ipilimumab?

A

CTLA4 inhibitor for advanced melanoma

138
Q

Nivolumab and pembrolizumab?

A

PD-1 inhibitor, for melanoma

139
Q

Initial management of neoplastic spinal cord compression?

A

8mg oral dexamethasone BD

140
Q

NICE palliative care pain guildelines?

A
  1. When starting treatment, offer patients with advanced and progressive disease regular oral modified-release (MR) or oral immediate-release morphine (depending on patient preference), with oral immediate-release morphine for breakthrough pain
  2. If no comorbidities use 20-30mg of MR a day with 5mg morphine for breakthrough pain. For example, 15mg modified-release morphine tablets twice a day with 5mg of oral morphine solution as required
  3. oral modified-release morphine should be used in preference to transdermal patches
  4. laxatives should be prescribed for all patients initiating strong opioid
  5. patients should be advised that nausea is often transient. If it persists then an antiemetic should be offered
  6. drowsiness is usually transient - if it does not settle then adjustment of the dose should be considered
141
Q

What is the breakthrough dose of morphine?

A

1/6th the daily dose of morphine

142
Q

Preferred palliative pain meds in CKD?

A
  1. Fentanyl
  2. Alfentanil
  3. Buprenorphine
143
Q

Metastatic bone pain palliative tx?

A
  1. Strong opioids
  2. Bisphosphonates
  3. Radiotherapy
  4. Denosumab
144
Q

When increasing the dose of opioids, the next dose should be increased by how much?

145
Q

Opioid s/es?

A
  1. Usually transient = nausea, drowsiness

2. Usually persistent = constipation

146
Q

Converting from oral codeine to oral morphine?

A

Divide by 10

147
Q

Converting from oral tramadol to oral morphine?

A

Divide by 10

148
Q

Oxycodone s/es vs. morphine?

A
  1. Less sedation, vomiting and pruritis than morphine

2. More constipation than morphine

149
Q

Converting from oral morphine to oral oxycodone?

A

Divide by 1.5-2

150
Q

Transdermal fentanyl 12ug patch equivalent?

A

30mg oral morphine daily

151
Q

Transdermal buprenorphine 10ug patch equivalent?

A

24mg oral morphine daily

152
Q

Converting from oral morphine to subcutaneous morphine?

A

Divide by 2

153
Q

Converting from oral morphine to subcutaneous diamorphine?

A

Divide by 3

154
Q

Converting from oral oxycodone to subcutaneous diamorphine?

A

Divide by 1.5

155
Q

Why is oral morphine half as strong as subcutaneous/IV morphine?

A

First pass metabolism

156
Q

Mx of hiccups in palliative care?

A
  1. Chlorpromazine
  2. Haloperidol, gabapentin also used
  3. Dexamethasone also used if there are hepatic lesions
157
Q

MST?

A

Morphine sulphate tablets

158
Q

2 main types of syringe driver?

A
  1. Graseby MS16A (blue): the delivery rate is given in mm per hour (blue hour)
  2. Graseby MS26 (green): the delivery rate is given in mm per 24 hours (green day)
159
Q

Commonly used drugs in syringe drivers?

A
  1. N&V = cyclizine, haloperidol, metoclopramide
  2. Resp secretions = hyoscine hydrobromide
  3. Bowel colic = hyoscine butylbromide
  4. Agitation/restlessness = midazolam, haloperidol, levomepromazine
  5. Pain = diamorphine is preferred
160
Q

Syringe driver for Respiratory secretions in palliative care?

A

Respiratory secretions = Hyoscine hydRobromide

161
Q

Syringe driver for Bowel colic?

A

Bowel colic = Hyoscine Butylbromide

162
Q

First line opioid in palliative pts in whom oral tx is not suitable?

A

Transdermal opioid patch formulations

163
Q

What vitamins does Pabrinex contain?

164
Q

What colour is Pabrinex?

165
Q

For what cells is thiamine essential?

A

Glial cells

Medicine and Surgery Mushkies (52 decks)

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