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FPE > Random Cancer > Flashcards

Random Cancer Flashcards

1
Q

When can a blood sample taken be used for transfusion (time limit)

A

Within three months unless pregnant or recent transfusion in which case within 3 days

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2
Q

How long on leaving a fridge can blood products be used?

A

Use within 4 hours (finished in this time!)

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3
Q

How long are rbc and platelets typically given over?

A

Rbcs - 2-3 hrs

Plat - 30 mins

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4
Q

Do all blood products have to match abo?

A

Sometimes platelets, ffp and cryo dont match

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5
Q

Through what kit should a blood transfusion be given?

A

Specific blood giving set and any size of cannula

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6
Q

When should a blood giving set be replaced?

A

Using a different blood product
After 2 units or 8 hours
If blocked

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7
Q

When should blood be warmed? What shouldnt ever be done to warm blood?

A

If transfusing fast, during exchange transfusion or during operation
Should not use a radiator or non blood specific fluid warmer etc as will cause haemolysis

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8
Q

When should monitoring occur during blood transfusion? What should be checked

A 
Prior to collecting
After 15 mins
After 1 hour 
On completion 
Temp, resps, pulse, bp
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9
Q

What is a proportionate response to a patient on blood transfusion who develops a fever of 38.5 and a mild rash?

A

Initially stop then once assessed:
Slow transfusion rate
Administer paracetamol and antihistamine

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10
Q

Acute complications of a blood transfusion

A 
Haemolytic transfusion reaction
Febrile non haemolytic transfusion reaction
Sepsis 
Allergy
Transfusion related acute lung injury 
Fluid overload
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11
Q

Long term complications of blood transfusion

A

Iron overload
Infection
Graft vs host
Delayed haemolytic transfusion reaction

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12
Q

Cause of febrile non haemolytic transfusion reaction? Tx?

A

Cytokines in blood

Paracetamol

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13
Q

Cause of transfusion related acute lung injury

A

Antibodies in donor blood attacking host lymphocytes

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14
Q

Cause of graft vs host in blood transfusion. How to stop?

A

Donor t lymphocytes in blood attacking host

Use irradiated blood in at risk popn (certain immunmodeficient states)

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15
Q

At what hb should transfusion be considered in
Asymptomatic
Symptomatic
Haematological malignancy

A

70
90
100

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16
Q

When should transfusion be considered in acute blood loss?

A

Stage 3 shock

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17
Q

How long would it take a lab to group blood in an emergency? Crossmatch?

A

20mins

45mins

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18
Q

When can rhd+ blood be used in rhd- patients

A

In an emergency with males >16 and females >50

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19
Q

At what point would someone start to get spontanious serious bleeding with low platelets?

A

Under 10

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20
Q

Contraindications to platelet transfusion?

A

TTP

HIP

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21
Q

What level should you aim for platelets to be for major surgery? What about lumbar puncture or liver biopsy

A

100

50

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22
Q

When should platelets be considered in massive transfusion?

A

If 2x blood volume transfused likely platelets will drop

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23
Q

Are platelets useful in itp? What can be used?

A

Not usually but can give

Use steroids and or ivig

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24
Q

Roughly how much will one dose of platelets raise platelets by ?

A

20-40

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25
Q

Indications for ffp

A

Multifactor deficiencies with bleeding eg DIC

Emergency Warfarin reversal with beriplex contraindicated

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26
Q

Indications for cryoprecipitate

A

Fibrinogen

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27
Q

Indications for major haemorrhage protocol activation

A

=> 4 units given in one hour and expected to continue at this rate
Bleeding rate >150ml/min
50% blood lost in 3 hrs
Haemorrhagic shock with bp

28
Q

Difference between g+s and crossmatch

A

G+s looks at blood grouping

Crossmatch tests donors blood agains recipients preparing for donaton

29
Q

What neutrophil count triggers neutropenic sepsis pathway activation. What else is needed?

A

Neutrophils

30
Q

Causes of neutropenic sepsis

A 
Chemo - 5-10 days post 
Extensive radio
Haematological neutropenia 
Drugs
Infections
Autoimmune
Hereditory.
31
Q

Common agents in neutropenic sepsis

A

80% unknown, but often commensal eg. Staph aureus or strep

32
Q

What should be examined during a neutropenic sepsis exam

A

Systems
Lines
Mouth
Wounds/surgical sites

33
Q

What should be investigated in a case of neutropenic sepsis

A

Blood cultures - central, peripheral
Urine cultures
Swabs - lines, wounds
Imaging - consider cxr, axr, ct

34
Q

Appropriate abx for neutropenic sepsis

A

Tazocin, meropenem, ciprofloxacin

35
Q

Management other than abx for neutropenic sepsis

A

Fluids
Catheter
Consider gcsf

36
Q

What percentage of spinal cord compression is a first presentation of cancer?

A

20%

37
Q

Commonest cancer causes of spinal cord compression

A 
Breast
Lung 
Prostate
Kidney
Haem
38
Q

Quality of pain in metastatic spinal cord compression

A

Severe progressive nocturnal and band like

Associated with neuro deficite

39
Q

Investigation in metastatic spinal cord compression

A

Whole spine MRI

- whole as there are usually multiple areas involved

40
Q

Emergency treatment for metastatic spinal cord compression

A

16mg dexamethasone stat then 8mg BD
WITH PPI!!!
Immobilise

41
Q

Long term management of metastatic spinal cord compression

A

Radiotherapy
Chemo
Surgery

42
Q

What can causes superior vena cava obstruction?

A

Extrinsic - lung tumour, mediasteinal lymphadenopathy, aneurysm, goitre
Intrinsic - thrombus, tumour, indwelling catheter

43
Q

Presentation of superior vena cava obstruction

A 
Swollen head/neck
Distended veins
SOB
Headache 
Lethargy 
Injected conjunctiva
44
Q

Investigations in superior vena cava obstruction

A

CXR
Contrast CT chest
Angiography

45
Q

Treatment of superior vena cava obstruction

A 
Consider steroids (though poor evidence) 
Chemotherapy 
Radiotherapy 
Stent 
Anticoagulation
46
Q

Malignant causes of hypercalcaemia

A

PTHrP
Calcitrol production
Lytic bony disease

47
Q

Presentation of malignant hypercalcaemia

A 
Nausea
Anorexia
Polydispia polyurea
Constipation
Confusion
Drowsyness
48
Q

Required investigations in suspected malignant hypercalcaemia

A

Calcium, albumin, phosphate
PTH PTHrP
Malignancy screen

49
Q

Treatment of malignant hypercalcaemia (inc specific drug)

A

Fluids
Pamidronate
Calcitonin or steroids rarely

50
Q

Cancers that lead to high risk of tumour lysis syndrome

A 
High grade lymphoma
Acute leukaemia
Myeloma
Small cell lung
Inflammatory breast
51
Q

Factors released in tumour lysis syndrome

A

Uric acid
Phosphate
Potassium

52
Q

Comlications of tumour lysis syndrome

A

AKI

Electrolyte imbalance

53
Q

Patients at risk from complications of tumour lysis syndrome

A

Preexisting renal damage
Hypovolaemia
Urinary tract obstruction
High pretreatment LDH

54
Q

How to decrease risk of tumour lysis syndrome

A

Prehydration
Allopurinol
Rasburicase

55
Q

Complications of leukostasis

A 
Blurred vision
Tia/cva
Headache
Dysponea 
Priapism
56
Q

Treatement of leukostasis

A

Leukopheresis

57
Q

What tissues are likely to show up on a pet scan? What could be missed?

A

Kidneys, heart

Aggressive tumours only, indolent tumours have a slow metabolic rate!

58
Q

Advantage of single agent chemo

A

Convenience

Tollerence

59
Q

Advantage of multi agent chemo

A

Efficacy
Decreased resistance
Decreased toxicity

60
Q

Causes of chemo resistance

A

Decreased drug uptake
Increased drug efflux
Altered target
Catabolism

61
Q

Side effects of chemo

A 
Myelosuppression
Mucositis 
Gastritis
Diarrheoa
N+V+D
Alopecia
AKI
Infertility
Peripheral neuropathy 
Teratogenic 
Tumour lysis
Pulmonary fibrosis
Allergy 
Lethargy 
Dvt
Gout
62
Q

What infections are people on chemo at particular risk of?

A

Oral thrush
Aspergillioma
Hepatic candidia

63
Q

Three catagories of novel agent in cancer treatment and examples with use

A

Signal transduction pathway inhibitors - imatinib - CML by inhibition of BCR:ABL
Monoclonal antibodies - rituximab - lymphoma by binding CD20 on Bcells
Immunotherapy - BCG - bladder cancer by provoking immune reaction

64
Q

How can hair loss from cancer be reduced?

A

Cold capping

65
Q

What anaemia is most common in chemo patients? When may the other types be seen?

A

Normocytic
Micro with blood loss or poor nutrition
Macro with agents that inhibit dna synthesis

FPE (11 decks)

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