Slide presentation practice Flashcards
Which oncological emergency would this be prescribed for as a first line treatment?
Hypercalcaemia
What would the regime for this solution be in cancer-related hypercalcaemia?
1L over 4 hours for the first 24 hours
Over 6 hours for the next 48 hours (WITH POTASSIUM)
After this had been given to a patient with cancer-related hypercalcaemia, what would be the next management step?
Bisphonates (IV): Pamidronate (or zaledronic acid)
What would your management plan be for someone who has had seizures or arrhythmias due to hypercalcaemia?
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)
What causes this?
Superior Vena Cava Obstruction
What malignancies are most associated with this clinical sign?
Lung cancers
Lymphoma
Mediastinal Lymphadenopathy
Germ cell tumours
Thymoma
Oesophageal
Tumour-assocaited thrombus
What are the non-malignant causes of this clinical sign?
Non-malignant tumours (eg. goitre)
Mediastinal fibrosis
Idiopathic post-radiotherapy
Infection (eg. TB)
Aortic Aneurysm
Thrombus e.g. catheter
What other symptoms might you expect in a patient with this clinical sign?
Dyspnoea (worse lying flat)
Headache (worse on coughing)
Facial/arm/neck swelling
Cough
Hoarse voice
Cyanosis
Visual disturbance
What does this CXR show?
Superior vena cava obstruction
How would you investigate this?
CXR
How would you manage a patient with this problem?
16mg dexamethasone (with PPI)
Depends on cause: vascular stenting, chemotherapy, radiotherapy, LMWH (if thrombosis)
What is causing this patient’s discolouration?
Cyanosis due to superior vena cava obstruction
What is the problem on this MRI?
Spinal cord compression
What symptoms would you expect with this MRI result?
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
What cancers are most associated with this?
Prostate
Breast
Lung
Myeloma and lymphoma
(Renal and thyroid less common)
What is the time frame for this investigation?
Must be done within 24 hours
How long do you have until the symptoms of this are likley to become irreversible?
48 hours
What other symptoms might you expect from this presentation?
Dyspnoea (worse lying flat)
Headache (worse on coughing)
Facial/arm/neck swelling
Cough
Hoarse voice
Cyanosis
Visual disturbance
What complication of cancer can cause this facial swelling?
Superior vena cava obstruction
What is this?
Fungating breast tumour
What are the differentials for a presentation like this?
Ductal papilloma
Fibrocystic disease
Abscess
Mastitis
(DCIS)
How would you investigate this?
Triple assessment:
Physical examination
Imaging (mammography for older women, ultrasound for younger women) - bilateral
Fine needle aspiration or biopsy
How would you manage this?
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
What does this picture show?
skin changes and nipple inversion during breast cancer
What is this a symptom of?
Breast cancer (Peau d’orange)
What does this scan show?
Bone metastases
What investigations would you do to suggest the need for this scan?
Rectal exam
PSA (blood test)
Transurethral biopsy
What symptoms might this pt have presented with?
protastatic symptoms: poor stream, nocturia, dribbling, frequency
Bone pain, pathalogical fracture
What would you find on rectal examination?
Hard
Craggy
Enlarged
Obliteration of median sulcus
What type of therapy is this?
Brachytherapy - radiotherapy
When would this be used?
Alternative to surgery in T1 and T2
Adjuvant to surgery
In more advanced local disease
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)
What is this?
A syringe driver
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
What route does this provide medication through?
subcutaneous
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.)
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)
What does this photograph show?
Extravasation
What symptoms would you expect a patient to report with this hand?
Burning pain
Injection/cannulation site
Stinging during drug administration
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
How would you manage this if it occured in cancer patient on chemo?
- Stop infusion (disconnect it, but keep what is left to work out how much has been given)
- Explain what’s occured (?leaflet)
- Aspirate as much as possible
- DO NOT FLUSH CANNULA
- Mark and measure effected area
- Pain relief
- Raise effected area (+/- hot/cold compress)
- Monitor pt
- Other specific treatments depend on what drug was being used
What does this picture show?
Oral mucositis
How would you manage a patient who presented with this?
- Stop chemotherapy treatment
- Prescribe an emollient
- ?analgesia
What else could this occur with (in pts who are receiving chemotherapy)?
Pulmonary fibrosis
What other symptoms would you want to ask this patient about?
Spontaneous nose bleeds
Haematuria
What is this presentation indicative of?
thrombocytopenia
If a patient on chemotherapy presents with this problem, what would you suspect was the cause?
thrombocytopenia (chemotherapy induced)
What is this photo an example of?
PET being layed over a CT scan
What does this photo show?
PET and CT combined
What does this ultrasound show?
Testicular cancer
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
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
What are the differentials for this leg?
Cellulititis
DVT
