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Year 4 PT > Oncology + Palliative + Anaesthetics + Pharmacology > Flashcards

Oncology + Palliative + Anaesthetics + Pharmacology Flashcards

1
Q

How does TNM staging work?

A

T1- less than 3cm
T3- bigger than 5cm
T4- invasion of other structures

N1- ipsilateral hilar/peribronchial lymph nodes
N2- ipsilateral mediastinal/subcarinal lymph
N3 - contralateral mediastinal or hilar/ supraclavicular

M0
M1

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2
Q

What do anti-sickness tablets usually end in?

A

-ZINE

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3
Q

What level is the spinal conus found? (Analgesics in pregnancy)

A

L1

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4
Q

Where is dexamethasone used?

A

mainly an anti-inflammatory but in surgery it is used a lot as an anti-emetic alongside cyclizine (not allowed to give cyclizine in children)

used in emergency spinal mets/compression- 16mg

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5
Q

What is the MACOCHA scoring system?

A

used to predict difficult tracheal intubation in intensive care unit patients:

Malampatti score 3 or 4 (score 5)
obstructive sleep Apnoea (score 2)
C-spine movement limited (score 1 like the rest below)
mouth Opening <3cm
Coma
Hypoxaemianon-Anaesthetist intubator

Score 0 to 12
Cut-off indicating difficult tracheal intubation is ≥ 3.

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6
Q

What cancers are associated with Li-Fraumeni syndrome?

A

early-onset breast, sarcomas and leukaemia

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7
Q

What is used to treat an overdose of anaesthesia?

A

An alkaline solution

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8
Q

What are the maximum doses for lidocaine, lidocaine and adrenaline, bupivacaine and bupivacaine and adrenaline?

A

-Lidocaine: 3mg/kg
-Lidocaine and adrenaline: 7mg/kg
-Bupivicaine: 2mg/kg
-Bupivicaine and adrenaline: 2.5mg/kg

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9
Q

Counsel a patient on methotrexate.

A

antimetabolite drug to reduce inflammation used for cancer, severe psoriasis not helped by anything else or severe rheumatoid arthritis and Crohn’s

-only take is once a WEEK
-prescribed folic acid (5mg) with methotrexate to stop side effects but do NOT take this on the same day
-men need to use effective contraception for 6 months after treatment

Side effects:
Myelosuppression
Pneumonitis
Mucositis
Pulmonary fibrosis
Liver fibrosis

CANNOT TAKE WITH:
Pregnancy and avoid trying for at least 6 months after stopping treatment
trimethoprim (abx) and co-trimoxazole (REMEMBER IF THEY ASK YOU TO PRESCRIBE ABX YOU CANNOT GIVE THESE)
NSAIDs
Aspirin
about to have live vaccine

FBC, U&Es, LFTs before and then weekly, then 2-3 months

Folinic acid to treat toxicity

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10
Q

What anatomical features do epidurals and spinals cross?

A

skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum Flavum, epidural spacespinal goes through all this ^ plus the dura and CSF

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11
Q

What are the general rules for drinking and eating before surgery?

A

For a general anaesthetic, you usually have to stop eating at least 6 hours beforehand. And you can drink sips of water up to 2 hours before.

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12
Q

What HPV virus is associated with cervical carcinoma?

A

16 & 18

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13
Q

What is pancuronium bromide?

A

Nicotinic receptor antagonist-blockade during surgery and intubation

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14
Q

What is the “milk of amnesia” used by anaesthetists to sedate patients before surgery?”

A

propofol

very quick acting and quickly and easily reversed.

need to constantly keep giving to keep patient sedated

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15
Q

When are these anti-emetics used:
-Haloperidol or metoclopramide
-Domperidone or Metoclopramide
-Cyclizine
-Ondansetron
-Levomepromazine

can give more than 1 anti-emetic

A

-nausea secondary to starting an opioid or hypercalcaemia = Haloperidol or metoclopramide
-squashed stomach from liver mets (feeling full/if someone hasn’t eaten in ages) = Domperidone or Metoclopramide
-Intracranial causes (from brain mets) = cyclizine usually first line to try
-chemo or radiotherapy related = Ondansetron (can make very constipated AND prolonged QT)
-multiple causes or if other options fail = Levomepromazine

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16
Q

SECRETIONS are common in the last days of life, what can be prescribed to treat this as well as BOWEL COLIC?

A

hyoscine hydrobromide

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17
Q

What drugs are commonly used by anaesthetists to prepare the patient for surgery?

A

pain management - fentanyl, opioid
sedation (sleep) - propofol
muscle relaxant - ROC (30-90mins), suxamethonium (5-10mins and works faster so used in emergency situations)

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18
Q

How do you convert from oral to subcutaneous morphine (syringe driver)?

A

Divide total oral dose by 2

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19
Q

How do you convert oral morphine to subcutaneous DIAmorphine?

A

Divide total daily dose by 3

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20
Q

Hiccups can be common in palliative care patients, how are they treated?

A

chlorpromazine

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21
Q

What drug can be used in anaesthesia when after a spinal block is put in the patient becomes hypotensive?

A

Metaraminol- giving 1ml IV at a time to see effect

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22
Q

How do you treat neutropenic sepsis?

A

low neutrophils and high temp

most commonly occurs 7-14 days after chemotherapy

start Tazocin immediately

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23
Q

What is the pancreatic tumour marker?

A

CA19-9

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24
Q

What drugs should normally not be stopped before surgery?

A

antiepileptics, antiparkinsonian drugs, antipsychotics, anxiolytics, bronchodilators, glaucoma drugs, steroids and thyroid or antithyroid drugs

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25
Q

What can be used to reduce the discomfort associated with a painful mouth that may occur at the end of life?

A

Benzydamine hydrochloride mouthwash or spray

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26
Q

What is used to grade breast cancer?

A

Nottingham score (3-9)

Grade I = 3 to 5 = well differentiated
Grade II = 6 to 7 = moderately differentiated
Grade III = 8-9 = poorly differentiated

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27
Q

What cancers are associated with Lynch syndrome, otherwise known as hereditary non-polyposis colorectal cancer?

A

1st = colorectal
2nd = endometrial
3rd = pancreatic

28
Q

How do you find the total amount of morphine in Co-codamol/codeine/tramadol?

A

total dose of co-codamol divided by 10

29
Q

What is the tumour marker for breast cancer?

A

CA 15-3

30
Q

Who can test for brain death?

A

two doctors on two separate occasions:
both be experienced and have at least 5 years post-grad, one must be a consultant and none can be from transplant team

31
Q

When increasing the dose of opioids in palliative care, how much should it be increased by?

A

30-50%

32
Q

What drug is preferred for agitation and confusion in palliative care?

A

haloperidol, however in the TERMINAL phase then midazolam is used

33
Q

What grading system is used in prostate cancer?

A

Gleason (primary pattern + secondary pattern = Gleason score)

34
Q

What are the guidelines to refer for a suspected cancer pathway (2 weeks) for bladder cancer?

A

-Aged 45 and over and have:
unexplained visible haematuria without UTI OR visible haemturia that persists after successful treatment of UTIs

-aged 60 and over and have:
unexplained non-visible haematuria AND either dysuria or a raised white cell count

35
Q

What drug is preferred for pain relief in palliative care?

A

Diamorphine

36
Q

What is the tumour marker for ovarian cancer?

A

CA 125

37
Q

What are the guidelines for a 2 week suspected breast cancer referral?

A

Aged 30 and over and have an unexplained breast lump with or without pain

OR

aged 50 and over with any of the following symptoms in ONE nipple only: discharge, retraction, any other changes of concern

38
Q

What are the most common tumours causing bone mets?

A

prostate: most common
breast
lung

39
Q

Where does prostate cancer most likely spread to?

A

bone

40
Q

What drug can you not give for people travelling on holiday by plane?

A

diazepam

41
Q

What is superior vena cava obstruction?

A

oncological emergency caused by the SVC being compressed usually due a lung cancer

dyspnoea
VISUAL disturbance
headaches
oedema
pulseless JVP

stent

42
Q

What are the contraindications to lung cancer surgery?

A

SVC obstruction
malignant pleural effusion
vocal cord paralysis
FEV < 1.5

43
Q

What anticoag is used in people with cancer?

A

DOACs

44
Q

When should patients with iron deficiency anaemia be investigated for colorectal cancer?

A

over the age of 60 should be referred for a 2 week wait colonoscopy

45
Q

What tumour marker is used in colorectal cancer?

A

carcinoembryonic antigen (CEA)

46
Q

What type of cancer can having Coeliac’s disease make you more susceptible to?

A

enteropathy-associated T cell lymphoma

47
Q

What adjuvant hormonal therapy is used for breast cancer and what are the side effects?

A

Pre and peri menopausal = tamoixfen: VTE, menstrual disturbance, hot flushes, endometrial cancer

post menopausal = anastrozole: osteoporosis, insomnia

48
Q

What cancer drug can cause hypomagnesaemia?

A

Cisplatin

49
Q

What is the management process for surgery for breast cancer?

A

no lymph nodes –> pre-op ultrasound and if + then do a sentinel node biopsy

lymph nodes –> surgery

50
Q

What is the most common breast cancer?

A

invasive ductal carcinoma

51
Q

How do you treat magnesium sulphate induced respiratory depression?

A

calcium gluconate

52
Q

What is the MOA of cyclizine?

A

H1 (histamine) antagonist

53
Q

What are they key features of choosing what anaesthetic agent to use: ketamine, propofol, suxamethonium

A

Ketamine:
-NMDA antagonist
-used in trauma
-causes nightmares

Propofol:
-GABA agonist
-anti-emetic

Suxamethonium:
-can cause malignant hyperthermia
-fast acting
-avoid in ophthalmology cases

54
Q

What is the difference between lidocaine and bupivacaine?

A

Bupivacaine takes longer to work and lasts for longer

55
Q

What cell type are cancers with hair, muscle, teeth, bone etc?

A

Teratoma

56
Q

What changes do you make to diabetes medication before surgery?

A

long dose insulin dose should be reduced by 20% on the day of surgery and the day before

ORAL medication should stay the same

57
Q

What must you tell the patient who is on levothyroxine about taking their medication? How is it monitored?

A

Take in the morning, 30 minutes before food and drinks

Antacids, calcium and iron elements need to be kept separate for at least four hours as affects absorption

TSH monitored 3 monthly until stable then once a year

58
Q

What is the long-term side-effect of taking omeprazole and what drugs can you not take with it?

A

C.Diff, b12 deficiency, osteoporosis and hypomagnesaemia

DO NOT TAKE WITH:
SSRI’s
Methotrexate
Clopidogrel

SMC

59
Q

What drugs can ramipril not be taken with?

A

Lithium and NSAIDs

60
Q

What are the side effects of taking lithium?

A

Tremor
Nephrotoxicity
Hypothyroidism
Weight gain
ICP
hypercalcaemia due to hyperparathyroidism

61
Q

What are the symptoms of a fat embolism?

A

Usually occur after a major bone break

Tachycardia
Tachypnoea
Confusion/agitated
Petechial rash

Treat broken bone
DVT prophylaxis

62
Q

How do you treat metastatic bone pain?

A

Analgesia, bisphosphonates or radiotherapy

63
Q

How do you reverse bupivacaine?

A

Phentolamine mesylate

64
Q

You are examining all patient and see this…what is it?

A

Portacath used to take blood, give fluids, blood, chemotherapy, antibiotics etc.

65
Q

If you suspect cancer, what must you say in the isce during the management section?

A

REFER UNDER A 2 WEEK-WAIT

66
Q

How do you assess an unwell post operative patient?

A

5 Ws

Wind —> atelectasis, pneumonia
Water —> UTI
Wound —> infection, collections from site
Walking —> VTE
Wonder drugs —> anaphylaxis, drug reactions

67
Q

What is included in end of life care?

A

MDT

4As: subcut, PRN
Analgesia (diamorphine)
Anti-emetic (haloperidol)
Agitation (midazolam)
Anti-secretory (hyoscine butylbromide)

Decide whether to be in hospital, home or hospice

Year 4 PT (14 decks)

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