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Slide presentation practice Flashcards

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1
Q

Which oncological emergency would this be prescribed for as a first line treatment?

A

Hypercalcaemia

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2
Q

What would the regime for this solution be in cancer-related hypercalcaemia?

A

1L over 4 hours for the first 24 hours

Over 6 hours for the next 48 hours (WITH POTASSIUM)

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3
Q

After this had been given to a patient with cancer-related hypercalcaemia, what would be the next management step?

A

Bisphonates (IV): Pamidronate (or zaledronic acid)

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4
Q

What would your management plan be for someone who has had seizures or arrhythmias due to hypercalcaemia?

A

1) Normal saline (1L over 4hrs for the first 24 hrs, and then over 6 hours for the next 48 to 72 hours)
2) Bisphosphonates (Pamidronate (or zaledronic acid))
3) Calcitonin + corticosteroids (Salmon calcitonin (S/C or IM) and Oral prednisilone)

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5
Q

What causes this?

A

Superior Vena Cava Obstruction

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6
Q

What malignancies are most associated with this clinical sign?

A

Lung cancers

Lymphoma

Mediastinal Lymphadenopathy

Germ cell tumours

Thymoma

Oesophageal

Tumour-assocaited thrombus

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7
Q

What are the non-malignant causes of this clinical sign?

A

Non-malignant tumours (eg. goitre)

Mediastinal fibrosis

Idiopathic post-radiotherapy

Infection (eg. TB)

Aortic Aneurysm

Thrombus e.g. catheter

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8
Q

What other symptoms might you expect in a patient with this clinical sign?

A

Dyspnoea (worse lying flat)

Headache (worse on coughing)

Facial/arm/neck swelling

Cough

Hoarse voice

Cyanosis

Visual disturbance

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9
Q

What does this CXR show?

A

Superior vena cava obstruction

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10
Q

How would you investigate this?

A

CXR

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11
Q

How would you manage a patient with this problem?

A

16mg dexamethasone (with PPI)

Depends on cause: vascular stenting, chemotherapy, radiotherapy, LMWH (if thrombosis)

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12
Q

What is causing this patient’s discolouration?

A

Cyanosis due to superior vena cava obstruction

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13
Q

What is the problem on this MRI?

A

Spinal cord compression

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14
Q

What symptoms would you expect with this MRI result?

A

Back pain/Nerve root pain

Leg/motor weakness

Difficult controlling bladder/bowels

Urinary retention/bladder distention

Saddle anaesthesia

Loss of anal tone

Paraparesis and paraplegia

(Hyper-reflexia)

Clonus

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15
Q

What cancers are most associated with this?

A

Prostate

Breast

Lung

Myeloma and lymphoma

(Renal and thyroid less common)

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16
Q

What is the time frame for this investigation?

A

Must be done within 24 hours

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17
Q

How long do you have until the symptoms of this are likley to become irreversible?

A

48 hours

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18
Q

What other symptoms might you expect from this presentation?

A

Dyspnoea (worse lying flat)

Headache (worse on coughing)

Facial/arm/neck swelling

Cough

Hoarse voice

Cyanosis

Visual disturbance

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19
Q

What complication of cancer can cause this facial swelling?

A

Superior vena cava obstruction

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20
Q

What is this?

A

Fungating breast tumour

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21
Q

What are the differentials for a presentation like this?

A

Ductal papilloma

Fibrocystic disease

Abscess

Mastitis

(DCIS)

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22
Q

How would you investigate this?

A

Triple assessment:

Physical examination

Imaging (mammography for older women, ultrasound for younger women) - bilateral

Fine needle aspiration or biopsy

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23
Q

How would you manage this?

Study These Flashcards
A

Refer for surgery: mastectomy or conservative (wide local excision)

Biopsy lymphnodes (High risk of recurrence: remove all lymph nodes therefore no need for radiotherapy)

Radiotherapy

24
Q

What does this picture show?

Study These Flashcards
A

skin changes and nipple inversion during breast cancer

25
What is this a symptom of?
Breast cancer (Peau d'orange)
26
What does this scan show?
Bone metastases
27
What investigations would you do to suggest the need for this scan?
Rectal exam PSA (blood test) Transurethral biopsy
28
What symptoms might this pt have presented with?
protastatic symptoms: poor stream, nocturia, dribbling, frequency Bone pain, pathalogical fracture
29
What would you find on rectal examination?
Hard Craggy Enlarged Obliteration of median sulcus
30
What type of therapy is this?
Brachytherapy - radiotherapy
31
When would this be used?
Alternative to surgery in T1 and T2 Adjuvant to surgery In more advanced local disease
32
How long do you have to wait after resection (trans-urethral) to use this adjuvant therapy? Why?
6 weeks (to prevent risk of stricture developing)
33
What is this?
A syringe driver
34
When might this be used?
Dysphagia/aphagia Persistent vomiting, agitation, respiratory secretions Intestinal obstruction Malabsorption To gain constant pain relief/anit-emetic (avoid peaks and troughs) When patient in terminal stages of illness
35
What route does this provide medication through?
subcutaneous
36
How long does this device take to establish a stable dose in the patient? What can be done to provide pain relief during this time?
3-4 hours Can give a stat SC injection of appropriate medicines (eg. pain killers, anti-emetics etc.)
37
Which drugs are too irritant to be given in this way?
diazepam chlorpromazine prochlorperozine
38
Which drugs can be administered this way? What are they for?
diamorphine (pain) hyoscine butylbromide (buscopan) (anti-smasmodic - bowel spasm or urteric colic) cyclizine (vomiting or raised ICP) haloperidol (vomiting, terminal agitiation and vomiting) metaclopramide (vomiting) levomepromazine (vomiting and sedation) midazolam (confusion, seizures) Hyoscine hydrobromide (confusion, spasms, vomiting, respiratory secretions) glycopyrrolate (respiratory secretions)
39
What does this photograph show?
Extravasation
40
What symptoms would you expect a patient to report with this hand?
Burning pain Injection/cannulation site Stinging during drug administration
41
When would the symptoms of this complication of chemotherapy occur? How
During administration, but could present more slowly (be absent at administration) if drug is leaked slowly in to tissues
42
What are the long term effects of extravasation?
induration (usually a brown colour), persists for weeks ulceration (can occur in 1-4 weeks) pain (long term) dystrophy contractures loss of function of affected limb
43
How would you manage this if it occured in cancer patient on chemo?
1. Stop infusion (disconnect it, but keep what is left to work out how much has been given) 2. Explain what's occured (?leaflet) 3. Aspirate as much as possible 4. **DO NOT FLUSH CANNULA** 5. Mark and measure effected area 6. Pain relief 7. Raise effected area (+/- hot/cold compress) 8. Monitor pt 9. Other specific treatments depend on what drug was being used
44
What does this picture show?
Oral mucositis
45
How would you manage a patient who presented with this?
1. Stop chemotherapy treatment 2. Prescribe an emollient 3. ?analgesia
46
What else could this occur with (in pts who are receiving chemotherapy)?
Pulmonary fibrosis
47
48
49
What other symptoms would you want to ask this patient about?
Spontaneous nose bleeds Haematuria
50
What is this presentation indicative of?
thrombocytopenia
51
If a patient on chemotherapy presents with this problem, what would you suspect was the cause?
thrombocytopenia (chemotherapy induced)
52
What is this photo an example of?
PET being layed over a CT scan
53
What does this photo show?
PET and CT combined
54
What does this ultrasound show?
Testicular cancer
55
A 65-year-old woman with previous breast cancer presents to her GP with a 2-week history of increasing breathlessness. She has no cough or pyrexia. A chest x-ray is performed and she is referred back to oncology. What is the most likely diagnosis? Lung mets Lyphangitis carcinomatosis Pulmonary embolus Pleural effusion SVCO
Pleural effusion
56
A 30-year-old hockey player is admitted for observations after being knocked out during a match. His admission GCS is 14. An hour after admission his GCS falls to 8. He is taken for an emergency CT head. What does this can show? Acute extradural haematoma Acute intracerebral haemorrhage Acute subdural haematoma Depressed skull fracture Frontal lobe confusions
Extradural haematoma Eliptical shape. Subdural is usally more difffuse. Hx also fits more with extra-dural
57
What are the differentials for this leg?
Cellulititis DVT

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