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Passmedicine Flashcards

1
Q

What is the mechanism of action of cyclophosphamide?

A

Alkylating agent - causes cross-linking in DNA

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2
Q

What are the adverse effects associated with cyclophosphamide?

A

Haemorrhagic cystitis
Myelosuppression
Transitional cell carcinoma

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3
Q

What is the mechanism of action of bleomycin?

A

Degrades preformed DNA

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4
Q

What is the mechanism of action of doxorubicin?

A

Stabilises DNA-topoisomerase II complex inhibits DNA and RNA synthesis

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5
Q

What are the adverse effects associated with bleomycin?

A

Lung fibrosis

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6
Q

What are the adverse effects associated with doxorubicin?

A

Cardiomyopathy

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7
Q

What are the adverse effects associated with methotrexate?

A

Myelosupression
Mucositis
Liver fibrosis
Lung fibrosis

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8
Q

What are the adverse effects associated with fluorouracil (5FU)?

A

Myelosupression
Mucositis
Dermatitis

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9
Q

What is the mechanism of action of methotrexate?

A

Inhibits dihydrofolate reductase and thymidylate synthesis

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10
Q

What is the mechanism of action of 5FU?

A

Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase

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11
Q

What is the mechanism of action of 6-mercaptopurine?

A

Purine analogue that is activated by HGPRTase decreasing purine synthesis

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12
Q

What is the mechanism of action of cytarabine?

A

Pyrimidine antagonist

Interferes with DNA synthesis specifically at the S phase of the cell cycle and inhibits DNA polymerase

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13
Q

What are the adverse effects associated with 6-metacaptopurine?

A

Myelosupression

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14
Q

What are the adverse effects associated with Cytarabine?

A

Myelosupression

Ataxia

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15
Q

What are the adverse effects associated with vincristine?

A 
Peripheral neuropathy (reversible)
Paralytic ileus
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16
Q

What are the adverse effects associated with docetaxel?

A

Neutropaenia

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17
Q

What is the mechanism of action of vincristine?

A

Inhibits formation of microtubules

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18
Q

What is the mechanism of action of docetaxel?

A

Prevents microtubule depolymerisation and disassembly, decreasing free tubulin

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19
Q

What is the mechanism of action of irinotecan?

A

Inhibits topoisomerase I which prevents relaxation of supercoiled DNA

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20
Q

What are the adverse effects associated with irinotecan?

A

Myelosuppression

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21
Q

What is the mechanism of action of cisplatin?

A

Causes cross linking in DNA

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22
Q

What is the mechanism of action of hydroxyurea?

A

Inhibits ribonucleic reductase, decreasing DNA synthesis

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23
Q

What are the adverse effects associated with cisplatin?

A

Ototoxicity
Peripheral neuropathy
Hypomagnesaemia

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24
Q

What are the adverse effects associated with hydroxyurea?

A

Myelosuppression

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25
Q

What tends to cause neoplastic spinal cord compression?

A

Usually vertebral body mets

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26
Q

In which types of cancer is neoplastic spinal cord compression most common?

A

Lung
Breast
Prostate

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27
Q

What are the features of neoplastic spinal cord compression?

A

Back pain (worse on lying down, coughing)
Lower limb weakness
Sensory changes
Neurological signs dependent on lesion site

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28
Q

What do lesions above L1 tend to cause in neoplastic spinal cord compression?

A

UMN signs in the legs

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29
Q

What do lesions below L1 tend to cause in neoplastic spinal cord compression?

A

LMN signs in the legs + perianal numbness

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30
Q

How do you manage neoplastic spinal cord compression?

A

High dose oral dexamethasone

Urgent oncological assessment for the consideration of radiotherapy/surgery

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31
Q

What dose of dexamethasone should be given in neoplastic spinal cord compression?

A

8mg BD

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32
Q

How can tumour markers be divided up?

A

Monoclonal Ab against carbohydrate/glycogprotein

Tumour antigens

Enzymes (e.g. alkaline phosphatase)

Hormones (e.g. calcitonin)

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33
Q

What tumour marker is associated with ovarian cancer?

A

CA 125

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34
Q

What tumour marker is associated with pancreatic cancer?

A

CA 19-9

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35
Q

What tumour marker is associated with breast cancer?

A

CA 15-3

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36
Q

What tumour marker is associated with prostate cancer?

A

PSA

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37
Q

What cancers are associated with alpha-feto protein tumour marker?

A

Hepatocellular carcinoma, teratoma

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38
Q

What tumour marker is associated with colorectal cancer?

A

CEA (carcinoembryonic antigen)

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39
Q

What cancers are associated with S-100 tumour marker?

A

Melanoma, schwannomas

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40
Q

What cancers are associated with bombesin tumour marker?

A

Small cell lung carcinoma, gastric cancer, neuroblastoma

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41
Q

What are the ten most common cancers in the UK?

A
  1. Breast
  2. Lung
  3. Colorectal
  4. Prostate
  5. Bladder
  6. Non-Hodgkin’s lymphoma
  7. Melanoma
  8. Stomach
  9. Oesophagus
  10. Pancreas
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42
Q

What three cancers cause the most deaths in the UK?

A
  1. Lung
  2. Colorectal
  3. Breast
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43
Q

Mutations in what two genes increase the risk of breast cancer?

A

BRCA 1 and 2

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44
Q

What conditions are linked with colorectal cancer?

A

Hereditary non-polyposis colorectal carcinoma

Familial adenomatous polyposis

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45
Q

Women who have HNPCC/Lynch syndrome are also more likely to get what other kind of cancer?

A

Endometrial cancer

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46
Q

What is the most common and earliest feature of neoplastic spinal cord compression?

A

Back pain

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47
Q

How is Li-Fraumeni syndrome inherited?

A

Autosomal dominant

48
Q

What causes Li-Fraumeni syndrome?

A

Germline mutations to p53 tumour suppressor gene

49
Q

What kinds of cancers are common in Li-Fraumeni syndrome?

A

Leukaemias, sarcomas

50
Q

When can you diagnose Li-Fraumeni syndrome?

A
  1. Individual develops sarcoma under 45 year olds
  2. 1st degree relative diagnosed with any cancer below 45 years and another family member develops malignancy under 45 years or sarcoma at any age
51
Q

Where is the BRCA 1 gene found?

A

Chromosome 17

52
Q

Where is the BRCA 2 gene found?

A

Chromosome 13

53
Q

What is the lifetime risk of developing breast cancer if you have a +ve BRCA gene?

54
Q

How associated are the BRCA genes with developing ovarian cancer?

A

BRCA 1 - 55%

BRCA 2 - 25%

55
Q

What other cancer is BRCA 2 associated with?

A

Prostate cancer

56
Q

How is lynch syndrome inherited?

A

Autosomal dominant

57
Q

What cancers are associated with lynch syndrome?

A

Colonic and endometrial cancer (at a young age)

58
Q

What criteria can be used to identify those at risk of having lynch syndrome?

A

Amsterdam criteria

59
Q

What is in the Amsterdam criteria?

A

3+ family members with confirmed diagnosis of colorectal cancer (1 of which is first degree of the other 2)
2 successive generations affected
1+ colon cancers diagnosed <50y
FAP has been excluded

60
Q

How is Gardeners syndrome inherited?

A

Autosomal dominant

61
Q

What is the presentation of Gardener’s syndrome?

A

Multiple colonic polyps

Skull osteoma, thyroid cancer, epidermoid cysts

62
Q

What mutation causes Gardener’s syndrome?

A

APC gene on chromosome 5

63
Q

What do most patients with gardener’s syndrome undergo prophylactically?

A

Colectomy to reduce risk of colorectal cancer

64
Q

What is Gardener’s syndrome a variant of?

A

Familial adenomatous polyposis coli

65
Q

What is the most common origin of bone mets in women?

A

Breast cancer

66
Q

What are the most common tumours causing bone mets (in descending order)?

A

Prostate
Breast
Lung

67
Q

What are the most common sites for bony mets?

A 
Spine
Pelvis 
Ribs
Skull 
Long bones
68
Q

What are clinical features of bony mets?

A

Bone pain
Pathological fractures
Hypercalcaemia
Raised ALP

69
Q

What are the most common side effects from chemotherapy?

A

Nausea and vomiting

70
Q

What factors may you more likely to experience nausea and vomiting whilst on chemotherapy?

A

Anxiety
Age <50
Concurrent opioid use
Type of chemo used

71
Q

What drugs are given to prevent nausea and vomiting whilst on chemotherapy?

A

If low risk: metoclopramide

High risk: 5HT3 receptor antagonist, e.g. ondansetron ++ dexamethasone

72
Q

What drug can be used to supress nausea and vomiting in someone with an intracranial tumour?

A

Dexamethasone

73
Q

How should you investigate a suspected MSCC?

A

MRI within 24 hours

74
Q

What are common findings/symptoms of spinal mets?

A 
Unrelenting lumbar pack pain 
Any thoracic/cervical pain 
Worse on sneezing, coughing, straining
Nocturnal
Assoc. w. tenderness
Neurological features
75
Q

How should you investigate suspected spinal mets?

A

Neurological features - urgent MRI, suspect spinal cord compression

No neurological features - whole spine MRI within a week

76
Q

How do immune checkpoint inhibitors work?

A

Cancers produce high levels of proteins that switch off T cells

CIs block this and reactive + increase the body’s own T cell population

Enhancing the immune systems ability to recognise + fight cancer cells

77
Q

How does ipilimumab work?

A

Checkpoint inhibitor that blocks CTLA-4 (cytotoxic T lymphocyte associated protein 4)

78
Q

What is ipilimumab used to treat?

A

Advanced melanoma

79
Q

How do nivolumab and pembrolizumab work?

A

Block PD-1 (programmed cell death protein 1)

80
Q

What are nivolumab and pembrolizumab used to treat?

A

Melanoma, Hodgkin’s lymphoma, non-small cell lung cancer, urological cancers

81
Q

How do Atezolizumab, Avelumab and Durvalumab work?

A

Check point inhibitors that block PD-L1

82
Q

What are Atezolizumab, Avelumab and Durvalumab used to treat?

A

Lung and urothelial cancer

83
Q

How are the checkpoint inhibitors administered?

A

Injection
IV infusion
May be given with or without chemo and in combination with other checkpoint inhibitors

84
Q

In what form are checkpoint inhibitors currently available?

A

Monoclonal antibodies designed against a specific protein

85
Q

What causes the side effects of the immune checkpoint inhibitors?

A

All immune cells are boosted by the drugs so over-active T cells produce side effects

86
Q

What are common side effects of immune checkpoint inhibitors?

A 
Dry, itchy skin and rashes
NV
Decreased appetite
Diarrhoea
Tiredness, fatigue
SoB, dry cough
87
Q

How do you manage the side effects from the immune checkpoint inhibitors?

A

As they are usually inflammatory in nature, corticosteroids usually help

88
Q

What monitoring should you do when a patient is on an immune checkpoint inhibitor?

A

Monitor liver, kidney and thyroid

89
Q

What kinds of tumours are immune checkpoint inhibitors currently able to treat?

A

Just solid tumours

90
Q

What do all check point inhibitors end in?

91
Q

With which cancer is SVCO most associated?

A

Lung cancer (esp. small cell)

92
Q

What are the features of SVCO?

A 
SoB
Swelling of face, neck, arms
Conjunctival + periorbital swelling
Headache (worse in morning) 
Visual disturbance
Pulseness jugular venous distension
93
Q

Apart from lung cancer what else can cause SVCO?

A 
Other malignancies, e.g. lymphoma, metastatic seminoma, Kapsoi's sarcoma, breast cancer
Aortic aneurysm
Mediastinal fibrosis
Goitre
SVC thrombosis
94
Q

How do you manage SVCO?

A

Dexamethasone, balloon venoplasty, stenting

If small cell: chemo + radio

If non-small cell: radio

95
Q

What does a PET scan demonstrate?

A

Glucose uptake

Images combined with CT to decide if lesions are metabolically active

96
Q

What are PET scans used for?

A

Evaluating primary + possible metastatic disease

97
Q

What lung cancer has the strongest association with smoking?

A

Squamous cell lung cancer

98
Q

Where is squamous cell lung cancer usually found?

A

Commonly near large airways

99
Q

Where is adenocarcinoma of the lung usually found?

A

Peripherally

100
Q

Where are small cell lung cancers most commonly found?

A

Near large airways

101
Q

What are the three types of non-small cell lung cancer?

A

Squamous cell
Adenocarcinoma
Large cell lung carcinoma

102
Q

What things are associated with squamous cell carcinoma?

A

PTHrP (hyperCa)
Finger clubbing
Hypertrophic pulmonary osteoarthropathy

103
Q

What is the most common lung cancer of non-smokers?

A

Adenocarcinoma

104
Q

What is the prognosis of large cell lung carcinoma?

A

V. poor, poorly differentiated tumours

105
Q

What hormone does large cell lung carcinoma most commonly secrete?

106
Q

What is Pemberton’s sign?

A

If a patient develops cyanosis of worsening of SoB or facial congestion on lifting their arms until the touch the side of their face

Sign of SVCO

107
Q

What is Kartagener’s syndrome?

A

Immotile cilia + situs inversus

108
Q

What HPV subtypes are carcinogenic?

A

16, 18, 33

109
Q

What are the non-carcinogenic subtypes of HPV and what do they cause?

A

6, 11

Genial warts

110
Q

Endocervical cells infected with carcinogenic strains of HPV develop into what?

A

Koliocytes

111
Q

What are the features of koliocytes?

A

Enlarged nuclei
Irregular nuclear membrane contour
Nuclear stains darker than usual (hyperchromasia)
Perinuclear halo may be seen

112
Q

How often are cervical smears done?

113
Q

What is a tumour marker in medullary thyroid cancer?

A

Calcitonin

114
Q

What investigations are recommended by NICE in metastatic disease of unknown primary?

A

FBC, UE, LFT, Ca, urinalysis, LDH
CXR
CT chest, abdo, pelvis
AFP, hCG

115
Q

What other investigations does NICE recommend for specific patients with metastatic disease of unknown primary?

A

Myeloma screen if lytic bone lesions
Endoscopy (symptoms)
PSA (men)
CA125 (women with peritoneal malignancy/ascites)
Testicular US
Mammography (women with clinical/pathological features compatible with breast cancer)

Oncology (5 decks)

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