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Y4 Cancer Care > Passmed Questions > Flashcards

Passmed Questions Flashcards

1
Q

What is the most common cause of large bowel obstruction?

A

colorectal cancer
tumours cause 60% of LBOs

particularly the case in more distal colonic and rectal tumours, as these tend to obstruct earlier due to the smaller lumen diameter

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2
Q

How does large bowel obstruction present?

A

absence of passing flatus or stool
abdominal pain
abdominal distention
nausea and vomiting are late symptoms that may suggest a more proximal lesion
peritonism may be present if there is associated bowel perforation

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3
Q

How can LBO be investigated?

A

Abdominal x-ray:
commonly used first-line

upper limits of normal diameter: 3cm for the small bowel, 6cm for the large bowel and 9cm for the caecum (3/6/9 rule)

presence of free intra-peritoneal gas indicates colonic perforation

CT scan

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4
Q

How can LBO be managed?

A

‘drip and suck’
NBM
IV fluids
nasogastric tube with free drainage

IV abx if perf
consider surgery

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5
Q

Subacute productive cough, foul-smelling sputum, night sweats →

A

?lung abscess

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6
Q

How can confined RCC be managed?

A

patients with a T1 tumour (i.e. < 7cm in size) are typically offered a partial nephrectomy
otherwise radical nephrectomy

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7
Q

Give 4 key features of myeloma

A

C - calcium raised
R - renal failure
A - anaemia (technically a pancytopenia)
B - bone pain

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8
Q

What is a ‘rouleaux formation’?

A

a stacking of red blood cells seen in a blood film. It is characteristic of a myeloma.

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9
Q

raised ESR + osteoporosis = what until proven otherwise?

A

multiple myeloma

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10
Q

Hypercalcaemia, renal failure, high total protein suggests what dx?

A

multiple myeloma

Impaired renal function is typical. Lower back pain is classical, a symptom of osteolytic lesions in the lower spine.

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11
Q

Rectal cancer on the anal verge can be managed with →

A

Abdomino-perineal excision of rectum

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12
Q

diagnostic investigation of choice for pancreatic cancer?

A

High resolution CT of pancreas

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13
Q

What side effects should the patient be warned about regarding prostate brachytherapy?

A

proctitis- inflammation of the rectum resulting in bloody diarrhoea

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14
Q

In an emergency setting, if a colonic tumour is associated with perforation the risk of an anastomosis is greater →

A

end colostomy

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15
Q

High-dose dexamethasone suppression test results with an adrenal adenoma?

A

Cortisol: not suppressed
ACTH: suppressed

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16
Q

High-dose dexamethasone suppression test results with a pituitary adenoma?

A

Cortisol: suppressed
ACTH: suppressed

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17
Q

When is pleural fluid considered exudative?

A

> 30g/L protein

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18
Q

What type of pleural effusion is caused by lung cancer?

A

exudative

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19
Q

Myasthenia gravis is associated with what tumours?

A

thymomas

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20
Q

How can myasthenia gravis be differentiated from Lambert- Eaton syndrome?

A

In myasthenia gravis key feature is muscle fatigability - muscles become progressively weaker during periods of activity and slowly improve after periods of rest

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21
Q

What can cause a raised serum amylase other than pancreatitis?

A

small bowel obstruction - due to pressure on the pancreatic duct

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22
Q

old man, bone pain, raised ALP =

A

Paget’s disease!!

23
Q

What is the preferred management option for patients with low-grade prostate cancer and significant co-morbidities?

A

watchful waiting

24
Q

What pain relief is availale to palliative patients with varying renal function?

A

first line = morphine sulphate
moderate renal impairment =oxycodone
end-stage renal failure = buprenorphine

25
Q

Options for mx of metastatic bone pain?

A

analgesia, bisphosphonates or radiotherapy

26
Q

What is the mechanism of action of hycosine hydrobromide?

A

Muscarinic receptor antagonist

27
Q

What may be useful in reducing the discomfort associated with a painful mouth that may occur at the end of life?

A

Benzydamine hydrochloride

28
Q

Bence Jones proteins in the urine suggest what?

A

multiple myeloma

29
Q

What is the prognosis like for polycythaemia rubra vera?

A

around 5-15% progress to myelofibrosis or AML
thrombotic events cause significant mortality

30
Q

The main components for managing sickle cell crisis are what?

A

analgesia, oxygen, and IV fluids

consider antibiotics if you suspect an infection, and transfusion if the Hb is low

31
Q

If investigating a suspected DVT, and either the D-dimer or scan cannot be done within 4 hours …

A

start a DOAC

32
Q

What may be seen on blood film in coeliac disease?

A

Target cells and Howell-Jolly bodies may be seen in coeliac disease → hyposplenism

33
Q

A sudden anemia and a low reticulocyte count in a patient with sickle cell =

A

aplastic crisis, may be due to parvovirus

34
Q

Sickle cell patient with new pulmonary infiltrates on chest x-ray, fever, cough and SOB =

A

Acute sickle chest syndrome

35
Q

Most common causes of massive splenomegaly in UK =

A

CML/myelofibrosis

36
Q

Which is the most common type of Hodgkin’s lymphoma?

A

nodular sclerosing

37
Q

Which types of Hodgkin’s lymphoma have the best and worst prognosis?

A

Lymphocyte predominant = Best prognosis
Lymphocyte depleted = Worst prognosis

38
Q

Positive clinical Tumour Lysis Syndrome requires any one of:

A

increased serum creatinine (1.5 times upper limit of normal)
cardiac arrhythmia or sudden death
seizure

39
Q

How can you definitively diagnose sickle cell disease?

A

haemoglobin electrophoresis

40
Q

A sudden decrease in haptoglobins suggests what?

A

intravascular haemolysis

41
Q

Pancytopaenia 5 years post-chemotherapy/radiotherapy →

A

?myelodysplastic syndrome

42
Q

What increases the risk of anaphylactic blood transfusion reactions?

A

IgA deficiency

43
Q

If neutropenic sepsis is suspected (i.e. recent chemo + fever) …

A

Immediately prescribe IV piperacillin/tazobactam- do not wait for blood results

44
Q

What is used in the prophylactic management of sickle cell anemia to prevent painful episodes?

A

Hydroxyurea - increases the HbF levels

45
Q

DVT investigation: if the scan is negative, but the D-dimer is positive →

A

stop anticoagulation and repeat scan in 1 week

46
Q

How often should sickle cell patients receive the pneumococcal polysaccharide vaccine?

A

every 5 years

47
Q

What can precipitate renal failure in patients with multiple myeloma?

A

NSAIDs

48
Q

Give some common drugs that can cause thrombocytopenia

A

NSAIDs
furosemide
penicillins, sulphonamides, rifampicin
carbamazepine, valproate
heparin

49
Q

A patient’s cytogenetic analysis shows the presence of the following translocation: t(9;22)(q34;q11).

Which haematological malignancy is most strongly associated with this translocation?

A

CML - Philadelphia chromosome - t(9:22)

50
Q

What common drugs can induce neutrophilia?

A

corticosteroids

51
Q

What blood results would be seen in sickle cell patients?

A

Low haemoglobin, normal MCV and raised reticulocytes

52
Q

What would you see on bone marrow aspirate of multiple myeloma?

A

plasma cells

53
Q

Raised haemoglobin, plethoric appearance, pruritus, splenomegaly, hypertension →

A

?polycythaemia vera

54
Q

Describe the bone profile of a patient with myeloma without metastasis

A

high calcium, normal/high phosphate and normal alkaline phosphate

Y4 Cancer Care (13 decks)

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