Question Bank Qs Flashcards
What breakthrough dose should be prescribed for pain?
Breakthrough dose is 1/6th of daily morphine dose
For example - patient taking 30mg bd - total daily morphine dose is 30 x 2 = 60mg, so breakthrough dose is 1/6th = 10mg
What is the most useful test to establish if a patient has polycythaemia vera?
JAK2 mutation screen
What is the universal donor of fresh frozen plasma?
AB RhD negative
What is a Rouleaux formation?
A ‘rouleaux formation’ is a stacking of red blood cells seen in a blood film. It is characteristic of a myeloma.
What is the next step following x-ray for a patient with known or suspected lung cancer?
offered a contrast-enhanced CT scan of the chest, liver and adrenals.
(Non-contrast not as good, PET not offered at this stage)
Biopsy should not be performed before CT
What blood marker in blood tests can be an indication of lung cancer?
Raised platelets
What would be an appropriate investigation for a patient presenting with hoarse voice?
CT Chest
Even if chest x-ray is clear, could be a Pancoast tumour present
What hormonal change is seen in adenocarcinoma of the lung?
Gynaecomastia
It is thought that it is caused by an increased oestrogen/androgen ratio, or the tumour itself produces a substance causing hormonal change.
What is the typical presentation of Lambert-Eaton syndrome?
small cell lung cancer with weakness that is worse in the legs.
Differentiated from myasthenia gravis which is usually face and arms, and gets worse with muscle use
What are some contraindications to lung cancer surgery?
SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis, tumour near hilum
Assess general health
Stage IIIb or IV (mets present)
What lung cancer has the strongest association with smoking?
Squamous cell carcinoma
What peptide does squamous cell carcinoma release?
Parathyroid hormone related peptide
When do you decide to transfuse red blood cells?
Acute blood loss exceeds 30-40% of blood volume
If the Hb is below 70g/L in an otherwise fit patient [aim to keep Hb above 70g/L]
If the Hb is between 80-90 g/L in a patient with cardiovascular disease [aim to keep Hb between 80-100g/L]
These criteria can also be applied to critically ill patients without acute bleeding.
In all cases the clinical context must be considered and not just the patient’s Hb level.
When are platelets given prophylactically to prevent bleeding?
Reversible bone marrow failure including allogeneic stem cell transplant and critical illness
Chronic bone marrow failure if patient is receiving intensive treatment or to prevent persistent bleeding
What should a platelet level be when carrying out surgery?
At least 50 x 10 ^ 9
