Passmedicine Flashcards
(115 cards)
1
Q
What is the mechanism of action of cyclophosphamide?
A
Alkylating agent - causes cross-linking in DNA
2
Q
What are the adverse effects associated with cyclophosphamide?
A
Haemorrhagic cystitis
Myelosuppression
Transitional cell carcinoma
3
Q
What is the mechanism of action of bleomycin?
A
Degrades preformed DNA
4
Q
What is the mechanism of action of doxorubicin?
A
Stabilises DNA-topoisomerase II complex inhibits DNA and RNA synthesis
5
Q
What are the adverse effects associated with bleomycin?
A
Lung fibrosis
6
Q
What are the adverse effects associated with doxorubicin?
A
Cardiomyopathy
7
Q
What are the adverse effects associated with methotrexate?
A
Myelosupression
Mucositis
Liver fibrosis
Lung fibrosis
8
Q
What are the adverse effects associated with fluorouracil (5FU)?
A
Myelosupression
Mucositis
Dermatitis
9
Q
What is the mechanism of action of methotrexate?
A
Inhibits dihydrofolate reductase and thymidylate synthesis
10
Q
What is the mechanism of action of 5FU?
A
Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase
11
Q
What is the mechanism of action of 6-mercaptopurine?
A
Purine analogue that is activated by HGPRTase decreasing purine synthesis
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
13
Q
What are the adverse effects associated with 6-metacaptopurine?
A
Myelosupression
14
Q
What are the adverse effects associated with Cytarabine?
A
Myelosupression
Ataxia
15
Q
What are the adverse effects associated with vincristine?
A
Peripheral neuropathy (reversible) Paralytic ileus
16
Q
What are the adverse effects associated with docetaxel?
A
Neutropaenia
17
Q
What is the mechanism of action of vincristine?
A
Inhibits formation of microtubules
18
Q
What is the mechanism of action of docetaxel?
A
Prevents microtubule depolymerisation and disassembly, decreasing free tubulin
19
Q
What is the mechanism of action of irinotecan?
A
Inhibits topoisomerase I which prevents relaxation of supercoiled DNA
20
Q
What are the adverse effects associated with irinotecan?
A
Myelosuppression
21
Q
What is the mechanism of action of cisplatin?
A
Causes cross linking in DNA
22
Q
What is the mechanism of action of hydroxyurea?
A
Inhibits ribonucleic reductase, decreasing DNA synthesis
23
Q
What are the adverse effects associated with cisplatin?
A
Ototoxicity
Peripheral neuropathy
Hypomagnesaemia
24
Q
What are the adverse effects associated with hydroxyurea?
A
Myelosuppression
25
What tends to cause neoplastic spinal cord compression?
Usually vertebral body mets
26
In which types of cancer is neoplastic spinal cord compression most common?
Lung
Breast
Prostate
27
What are the features of neoplastic spinal cord compression?
Back pain (worse on lying down, coughing)
Lower limb weakness
Sensory changes
Neurological signs dependent on lesion site
28
What do lesions above L1 tend to cause in neoplastic spinal cord compression?
UMN signs in the legs
29
What do lesions below L1 tend to cause in neoplastic spinal cord compression?
LMN signs in the legs + perianal numbness
30
How do you manage neoplastic spinal cord compression?
High dose oral dexamethasone
| Urgent oncological assessment for the consideration of radiotherapy/surgery
31
What dose of dexamethasone should be given in neoplastic spinal cord compression?
8mg BD
32
How can tumour markers be divided up?
Monoclonal Ab against carbohydrate/glycogprotein
Tumour antigens
Enzymes (e.g. alkaline phosphatase)
Hormones (e.g. calcitonin)
33
What tumour marker is associated with ovarian cancer?
CA 125
34
What tumour marker is associated with pancreatic cancer?
CA 19-9
35
What tumour marker is associated with breast cancer?
CA 15-3
36
What tumour marker is associated with prostate cancer?
PSA
37
What cancers are associated with alpha-feto protein tumour marker?
Hepatocellular carcinoma, teratoma
38
What tumour marker is associated with colorectal cancer?
CEA (carcinoembryonic antigen)
39
What cancers are associated with S-100 tumour marker?
Melanoma, schwannomas
40
What cancers are associated with bombesin tumour marker?
Small cell lung carcinoma, gastric cancer, neuroblastoma
41
What are the ten most common cancers in the UK?
1. Breast
2. Lung
3. Colorectal
4. Prostate
5. Bladder
6. Non-Hodgkin's lymphoma
7. Melanoma
8. Stomach
9. Oesophagus
10. Pancreas
42
What three cancers cause the most deaths in the UK?
1. Lung
2. Colorectal
3. Breast
43
Mutations in what two genes increase the risk of breast cancer?
BRCA 1 and 2
44
What conditions are linked with colorectal cancer?
Hereditary non-polyposis colorectal carcinoma
Familial adenomatous polyposis
45
Women who have HNPCC/Lynch syndrome are also more likely to get what other kind of cancer?
Endometrial cancer
46
What is the most common and earliest feature of neoplastic spinal cord compression?
Back pain
47
How is Li-Fraumeni syndrome inherited?
Autosomal dominant
48
What causes Li-Fraumeni syndrome?
Germline mutations to p53 tumour suppressor gene
49
What kinds of cancers are common in Li-Fraumeni syndrome?
Leukaemias, sarcomas
50
When can you diagnose Li-Fraumeni syndrome?
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
Where is the BRCA 1 gene found?
Chromosome 17
52
Where is the BRCA 2 gene found?
Chromosome 13
53
What is the lifetime risk of developing breast cancer if you have a +ve BRCA gene?
60%
54
How associated are the BRCA genes with developing ovarian cancer?
BRCA 1 - 55%
| BRCA 2 - 25%
55
What other cancer is BRCA 2 associated with?
Prostate cancer
56
How is lynch syndrome inherited?
Autosomal dominant
57
What cancers are associated with lynch syndrome?
Colonic and endometrial cancer (at a young age)
58
What criteria can be used to identify those at risk of having lynch syndrome?
Amsterdam criteria
59
What is in the Amsterdam criteria?
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
How is Gardeners syndrome inherited?
Autosomal dominant
61
What is the presentation of Gardener's syndrome?
Multiple colonic polyps
| Skull osteoma, thyroid cancer, epidermoid cysts
62
What mutation causes Gardener's syndrome?
APC gene on chromosome 5
63
What do most patients with gardener's syndrome undergo prophylactically?
Colectomy to reduce risk of colorectal cancer
64
What is Gardener's syndrome a variant of?
Familial adenomatous polyposis coli
65
What is the most common origin of bone mets in women?
Breast cancer
66
What are the most common tumours causing bone mets (in descending order)?
Prostate
Breast
Lung
67
What are the most common sites for bony mets?
```
Spine
Pelvis
Ribs
Skull
Long bones
```
68
What are clinical features of bony mets?
Bone pain
Pathological fractures
Hypercalcaemia
Raised ALP
69
What are the most common side effects from chemotherapy?
Nausea and vomiting
70
What factors may you more likely to experience nausea and vomiting whilst on chemotherapy?
Anxiety
Age <50
Concurrent opioid use
Type of chemo used
71
What drugs are given to prevent nausea and vomiting whilst on chemotherapy?
If low risk: metoclopramide
| High risk: 5HT3 receptor antagonist, e.g. ondansetron ++ dexamethasone
72
What drug can be used to supress nausea and vomiting in someone with an intracranial tumour?
Dexamethasone
73
How should you investigate a suspected MSCC?
MRI within 24 hours
74
What are common findings/symptoms of spinal mets?
```
Unrelenting lumbar pack pain
Any thoracic/cervical pain
Worse on sneezing, coughing, straining
Nocturnal
Assoc. w. tenderness
Neurological features
```
75
How should you investigate suspected spinal mets?
Neurological features - urgent MRI, suspect spinal cord compression
No neurological features - whole spine MRI within a week
76
How do immune checkpoint inhibitors work?
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
How does ipilimumab work?
Checkpoint inhibitor that blocks CTLA-4 (cytotoxic T lymphocyte associated protein 4)
78
What is ipilimumab used to treat?
Advanced melanoma
79
How do nivolumab and pembrolizumab work?
Block PD-1 (programmed cell death protein 1)
80
What are nivolumab and pembrolizumab used to treat?
Melanoma, Hodgkin's lymphoma, non-small cell lung cancer, urological cancers
81
How do Atezolizumab, Avelumab and Durvalumab work?
Check point inhibitors that block PD-L1
82
What are Atezolizumab, Avelumab and Durvalumab used to treat?
Lung and urothelial cancer
83
How are the checkpoint inhibitors administered?
Injection
IV infusion
May be given with or without chemo and in combination with other checkpoint inhibitors
84
In what form are checkpoint inhibitors currently available?
Monoclonal antibodies designed against a specific protein
85
What causes the side effects of the immune checkpoint inhibitors?
All immune cells are boosted by the drugs so over-active T cells produce side effects
86
What are common side effects of immune checkpoint inhibitors?
```
Dry, itchy skin and rashes
NV
Decreased appetite
Diarrhoea
Tiredness, fatigue
SoB, dry cough
```
87
How do you manage the side effects from the immune checkpoint inhibitors?
As they are usually inflammatory in nature, corticosteroids usually help
88
What monitoring should you do when a patient is on an immune checkpoint inhibitor?
Monitor liver, kidney and thyroid
89
What kinds of tumours are immune checkpoint inhibitors currently able to treat?
Just solid tumours
90
What do all check point inhibitors end in?
-mab
91
With which cancer is SVCO most associated?
Lung cancer (esp. small cell)
92
What are the features of SVCO?
```
SoB
Swelling of face, neck, arms
Conjunctival + periorbital swelling
Headache (worse in morning)
Visual disturbance
Pulseness jugular venous distension
```
93
Apart from lung cancer what else can cause SVCO?
```
Other malignancies, e.g. lymphoma, metastatic seminoma, Kapsoi's sarcoma, breast cancer
Aortic aneurysm
Mediastinal fibrosis
Goitre
SVC thrombosis
```
94
How do you manage SVCO?
Dexamethasone, balloon venoplasty, stenting
If small cell: chemo + radio
If non-small cell: radio
95
What does a PET scan demonstrate?
Glucose uptake
Images combined with CT to decide if lesions are metabolically active
96
What are PET scans used for?
Evaluating primary + possible metastatic disease
97
What lung cancer has the strongest association with smoking?
Squamous cell lung cancer
98
Where is squamous cell lung cancer usually found?
Commonly near large airways
99
Where is adenocarcinoma of the lung usually found?
Peripherally
100
Where are small cell lung cancers most commonly found?
Near large airways
101
What are the three types of non-small cell lung cancer?
Squamous cell
Adenocarcinoma
Large cell lung carcinoma
102
What things are associated with squamous cell carcinoma?
PTHrP (hyperCa)
Finger clubbing
Hypertrophic pulmonary osteoarthropathy
103
What is the most common lung cancer of non-smokers?
Adenocarcinoma
104
What is the prognosis of large cell lung carcinoma?
V. poor, poorly differentiated tumours
105
What hormone does large cell lung carcinoma most commonly secrete?
beta-hCG
106
What is Pemberton's sign?
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
What is Kartagener's syndrome?
Immotile cilia + situs inversus
108
What HPV subtypes are carcinogenic?
16, 18, 33
109
What are the non-carcinogenic subtypes of HPV and what do they cause?
6, 11
| Genial warts
110
Endocervical cells infected with carcinogenic strains of HPV develop into what?
Koliocytes
111
What are the features of koliocytes?
Enlarged nuclei
Irregular nuclear membrane contour
Nuclear stains darker than usual (hyperchromasia)
Perinuclear halo may be seen
112
How often are cervical smears done?
3 yearly
113
What is a tumour marker in medullary thyroid cancer?
Calcitonin
114
What investigations are recommended by NICE in metastatic disease of unknown primary?
FBC, UE, LFT, Ca, urinalysis, LDH
CXR
CT chest, abdo, pelvis
AFP, hCG
115
What other investigations does NICE recommend for specific patients with metastatic disease of unknown primary?
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)
