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MBChB - Full Clinical Topics > Cancer, Skin, Breast and Infection > Flashcards

Cancer, Skin, Breast and Infection Flashcards

1
Q

What 4 blood tests should be done on anyone with suspected metastatic disease?

A

FBC - Marrow infiltration can give anaemia and thrombocytopenia
Bone profile - hypercalcemia occurs with metastatic disease
U+E
LFT

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2
Q

What % of breast cancers are ER+ve?

A

80%

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3
Q

What % of breast cancers are HER2+ve?

A

15%

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4
Q

What is the criteria for neutropenic sepsis according to NICE?

A

Temp > 38
Neutrophils < 0.5x10(9)
Recent chemo

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5
Q

Which chemotherapy agent, used in Hodgkin lymphoma commonly causes damage to lung tissue?

A

Bleomycin

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6
Q

What common urine side effect of doxorubicin should patients be counselled on?

A

Makes urine red for 24 hours following treatment

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7
Q

What general principle of treating side effects of monoclonal antibodies should all doctors be aware of?

A

As it’s boosting immune system simple SE’s like diarrhoea may need high dose steroids to control

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8
Q

What are the different criteria for WHO performance status?

A

0- Normal
1- Restricted with strenuous activity but can do light work
2- Ambulatory and can self care but unable to do work, up and about >50% of waking hours
3- Symptomatic, in chair or bed >50% of the day
4- Completely disabled, no self care

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9
Q

A patient has been diagnosed with a brain tumour or brain metastasis, what action should they be prompted to take regarding lifestyle?

A

Inform DVLA

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10
Q

Which cancer is the BRAF mutation most commonly associated with?

A

Melanoma

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11
Q

What drugs are used to treat hepatitis C infeciton?

A

Ribavirin and interferon

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12
Q

As a general rule of thumb , what is the first choice antibiotics for anaerobic infections?

A

Metronidazole

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13
Q

The husband of a pregnant lady has chickenpox, what action should be taken?

A

She should be tested for VZV IgG. If positive, no action is needed. If negative give vaccine.

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14
Q

Which antibiotic is used first line for cellulitis?

A

Flucloxacillin

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15
Q

Which antibiotic is most strongly associated with c.diff infection?

A

Clindamycin

As v.active against most gut flora but not c.diff

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16
Q

Which are the only animals in the UK to carry rabies?

A

Bats

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17
Q

Which antibiotic is first line to be used for those who have had cellulitis due to an animal bite?

A

Co-amoxiclav

more broad spectrum than fluclox

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18
Q

When assessing a cellulitis which has pain out of keeping with clinical signs (more intense than the signs would suggest) - what should you be considering?

A

Deeper soft tissue infection (abscess etc.)

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19
Q

What is necrotising fasciitis? What are the key clues in the history?

A

Medical emergency, rapid progression of tissue necrosis, often following trauma/ surgery.

Key signs: Pain out of proportion to lesions, rapid spread of lesion, systemic unwellness, RF’s such as IVDU

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20
Q

How should necrotising fasciitis be treated?

A

Surgical debridement

Antibiotics are only supportive

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21
Q

How does staph aureus appear on a gram stain?

A

Gram positive cocci in clusters

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22
Q

What treatment is used for severe CAP (assuming CURB score >3)?

A

IV Co-amoxiclav and clarithromycin

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23
Q

A patient has an influenza infection requiring admission to AMU. How should they be managed with regard to infection control? (5)

A

Single room
Surgical mask within 2m (as influenza travels in droplets which can reach 2 metres)
FFP3 Mask if aerosol generating procedures
Apron, gloves, hand hygiene
Teach patient cough etiquette

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24
Q

You are a GP and you see a 28yoF who is 24 weeks pregnant. She visited her father yesterday in a nursing home. She is currently fit and well, but she mentions that her father was coughing and sneezing and was on treatment for that but she can’t remember the name. Yesterday you received an email from Public Health England reporting an influenza outbreak in nursing homes, including the one where the patient’s father resides.

What would be the best approach?

A

Start prophylactic Oseltamivir (75mg PO for 10 days)

She is at risk of complicated influenza and should be given prophylaxis

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25
Q

How long does an influenza illness take to resolve?

A

3-7 days

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26
Q

How long does someone who has had an influenza infection remain potentially contagious?

A

Up to 14 days

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27
Q

What is the most common causative organism of CAP?

A

Streptococcus pneumonia

H.influenzae

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28
Q

What is the most common causative organism of HAP?

A

Staph aureus

HAP after 4 days from admission, before this still same as CAP

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29
Q

What is the most common causative organism of pneumonia in those with COPD?

A

H.Influenzae

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30
Q

What is the most common causative organism of pneumonia in those who’ve been on holiday, presenting with dry cough?

A

Legionella

Also hyponatremia and derranged LFT’s

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31
Q

What is the most common causative organism of pneumonia in alcoholics?

A

Klebsiella pneumoniae

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32
Q

What is the most common causative organism of pneumonia in CF/ bronchiectasis?

A

Pseudomonas aeruginosa

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33
Q

What is the most common causative organism of pneumonia in the immunocompromised?

A

Pnemocystis jiroveci pneumonia

Especially if desaturation on exertion

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34
Q

Which medication is used to treat cytomegalovirus infections in the immunocompromised?

A

IV Ganciclovir

Then oral valganciclovir

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35
Q

When immunosuppressed patients are on broad spectrum antibiotics they are at higher risk of developing candidaemia (fungal blood infection). What is the test for this?

A

Serum fungal antigen test (beta-D-glucan test; BDG)

Very sensitive

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36
Q

What test is used to diagnose Aspergillus infections?

A

Serum galactomannan (GM) test

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37
Q

What is the most common infection sources in candidaemia? (2)

A

Lines
(Cannula, central line etc.)

Gut flora translocation following damage to gut lining

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38
Q

How is urticaria due to an allergic reaction likely to present?

A

Hives is urticaria (raised, itchy, nettle rash)
Itchyness
No systemic symptoms

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39
Q

What are the common causes of viral gastroenteritis (2)

A

Rotavirus

Norovirus

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40
Q

What is the most common cause of bloody diarrhoea in an immunocompromised patient?

A

CMV

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41
Q

Name the 5 most common bacterial causes of bloody diarrhoea (dysentery)?

A 
Campylobacter
Shigella
Salmonella
E.coli O157
C.Diff
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42
Q

What two viruses are most commonly associated with infectious mononucelosis?

A

EBV

CMV (similar symptoms to EBV)

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43
Q

What is the most common hepatitis in a) the UK, b) the world

A

a) Hep C

b) Hep B

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44
Q

Which hepatitis is spread by fecal/oral and which are spread by blood/ body fluids?

A

Fecal/ oral = A + E

Blood/ fluids = B, C, D

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45
Q

What is the most common acute hepatits?

A

Hep A

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46
Q

What test is used to diagnose acute hepatitis A infection?

A

IgM antibody

Appears as soon as symptoms start, this may be up to 6 weeks post exposure

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47
Q

What antibody suggests previous HepA infection, how long does it last?

A

IgG antibody to HepA (with no IgM) suggests past infection or vaccination. It appears soon after an illness has started (or vaccination) and is present for life

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48
Q

Which test is used to establish current Hep B infection?

A

HBsAg (surface antigen)
Acute disease = there for 1-6 months
Chronic disease = still present after 6 months

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49
Q

What does presence of the anti-HBs antibody suggest?

A

Immunity
(either from infection or immunisation)

Note won’t be present in acute stage

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50
Q

What does presence of the anti-HBc antibody suggest?

A

Infection with Hep B
First 6 months: IgM
After 6 months: IgG
Either current or previous HepB infection

anti-HBc is NOT present following immunisation so can distinguish

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51
Q

A patient has previously had HepB and gained immunity, what two antibodies will be shown in their serum?

A

Anti-HBs + Anti HBc

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52
Q

What antigen is monitored to assess the severity of HepB?

A

HBeAg

If HBeAg +ve then offer 48 week course of peginterferon alfa-2a

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53
Q

What treatment is offered for hepatitis C?

A

48week course of Peginterferon alfa-2a and ribavirin for all patients with Hepatitis C

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54
Q

What treatment is offered for acute HepA?

A

Supportive only

Avoid alcohol and possibly paracetamol

55
Q

What management should be offered for somone with Hep B + advice (4)

A
  • No intercourse until non-infective (HBeAg)
  • Supportive (rest, fluids, no alcohol etc)
  • Itch: Loose clothes, stay cool, avoid hot
  • If HBeAg +ve then offer 48 week course of peginterferon alfa-2a
56
Q

What test is used to assess whether there is Hepatitis C infection?

A

Anti- HCV serology

90% +ve after 3 months but some can take up to 9 months

57
Q

What test is used to distinguish previous HepC infection from a current one?

A

HCV RNA

If +ve for more than 2 months then the patient needs treatment with peginterferon alfa-2s and rivavirin

58
Q

Which is the best marker in the LFT’s to assess for viral hepatitis?

A

ALT raises significantly more than the others

59
Q

A 45-year-old woman presents for review. She has noticed a number of patches of ‘pale skin’ on her hands over the past few weeks. The patient has tried using an emollient and topical hydrocortisone with no result. On examination you note a number of hypopigmented patches on the dorsum of both hands. Her past medical history includes thyrotoxicosis for which she takes carbimazole and thyroxine. What is the most likely causes of her symptoms?

A

Vitiligo is more common in patients with known autoimmune conditions such as thyrotoxicosis.

60
Q

Name three associations of vitiligo?

A

T1DM
Addisons disease
Autoimmune thyroid disorders

61
Q

Name 4 management options for vitiligo?

A

Sunblock
Topical corticosteroids (if applied early)
Topical tacrolimus and phototherapy can be considered but used with caution

62
Q

Acanthosis nigricans is a dermatological manifestation of what?

A

Insulin resistance

Diabetes

63
Q

Bloody nipple discharge is most associated with what?

A

Duct papiloma

note these are benign and carry no increased risk of malignancy

64
Q

Brown-green nipple discharge is most commonly associated with…?

A

Duct ectasia

most common in menopausal women

65
Q

Do breast cysts increase your risk of breast cancer?

A

Yes they carry a very small increased risk of developing breast cancer

66
Q

What is the difference between a fibroadenoma and a phyllodes tumour?

A

Both benign

Fibroadenomas tend to shrink however phyllodes normally keep growing

67
Q

What is the most appropriate management for a 3.5cm fibroadenoma?

A

Surgical excision (most over 3cm)

68
Q

How do you explain duct ectasia to a patient? How is it managed?

A

As women progress through the menopause the breast ducts shorten and dilate. In some women this may cause a cheese like nipple discharge and slit like retraction of the nipple. No specific treatment is required.

69
Q

What treatment is used for symptomatic breast cysts?

A

Fine needle aspiration

70
Q

What % of breast lumps are cysts, and what age group most commonly experiences breast cysts?

A

15% of breast lumps are cysts

Most common in perimenopausal females

71
Q

How would you explain fibroadenoma’s to a patient?

A

Under the age of 25 years the breast is usually classified as undergoing development. Lobular units are being formed and a dense stroma is formed within the breast tissue. This may result in the development of fibroadenomas.

72
Q

What percentage of breast lesions are fibroadenomas in a) the population b) 18-25 year olds

A

a) 13%

b) 60%

73
Q

A 22yo female has a small 2cm asymptomatic lump suspected on imaging to be a fibroadenoma, what management is appropriate?

A

Watchful waiting

74
Q

A 22yo female has a small 4cm asymptomatic lump suspected on imaging to be a fibroadenoma, what management is appropriate?

A

Core biopsy

Fibroadenomas over 4cm should be biopsied to exclude phyllodes tumour

75
Q

What causes peu d’orange?

A

Oedema (not pulling on the skin)

76
Q

A patient who had Hodgkin’s Lymphoma as a 15 year old presents at age 32 with a breast lump, what is this likely to be?

A

Breast cancer

HL is treated with radiotherapy which gives a lifetime 50% risk of developing breast cancer

77
Q

What age is the cutoff for concern when taking a family history for breast cancer?

A

50

78
Q

A patient who had Hodgkin’s Lymphoma as a 15 year old presents at age 32 with a breast lump, what investigations should be done?

A

USS - Breast and axilla (as she’s young and has dense breast)
Mammogram (as US is rubbish to screen for other lumps)
Core biopsy (to complete triple assessment)

79
Q

What histological investigation is done for skin changes on the breast?

A 
Punch biopsy 
(for peu d'orange or paget's)
80
Q

Name three blood tests which should be done for a patient with suspected liver mets?

A

FBC
LFT (liver mets)
Bone profile (bone mets)

81
Q

How are HER2 receptor status reported?

A 
1+ = Negative
2+ = Inconclusive 
3+ = Positive
82
Q

What receptor status carries best prognosis in breast cancer?

A

ER+ve/ HER2+ve is the best prognosis

If HER2+ve, often more aggressive cancer but responds well to Herceptin and chemo, so more intensive treatment but good outcome

83
Q

What are the most common side effects of tamoxifen?

A

(Menopausal type)

  • Hot flushes
  • Vaginal dryness
  • Mood changes
  • Loss of sex drive
84
Q

What advice are patients on chemotherapy given regarding looking out for infections?

A

Take temperature twice a day (as symptoms are often very insidious when on chemo so can be easily missed)

85
Q

What advice should a lady who has had previous Hodgkin’s Lymphoma regarding treatment of her breast cancer lump?

A

Can’t do wide local incision plus radiotherapy as you can’t radiate the breast twice (risk of angiosarcoma)

Need to do mastectomy

86
Q

How do you stage Breast cancers and what investigation Is used?

A

TNM

Do CT of thorax, abdo, pelvis

87
Q

Name two side effects of isotenitoin?

A

Low mood
Tetratogenic
Dry mouth

88
Q

How much steroid cream do you need to treat the surface area of one hand palm?

A

A finger tip of cream

89
Q

What is the concern with putting steroid cream on the eyelids?

A

Cateracts

90
Q

What is acitretin and what are the side effects? (2)

A

Retinoid (vitA) derived - immunosuppresive used for psoriasis
SE: Tertagenecity, dyslipidaemia

91
Q

Name three side effects of azothioprine? (3)

A

Infection, liver dysfunction, anaemia, leucopenia

92
Q

How does seborrhoeic dermatitis usually present?

A 
Eczematous lesions (itchy and red) on:
- Scalp (dandruff), perioribital area, nasolabial folds and around ears (all sebum rich)

Associated with HIV and parkinsons

93
Q

What is the first three lines of management for seborrhoeic dermatitis in adults?

A

1- Head and shoulders
2- Neutrogena T/gel
3- Ketoconazole (topical)

94
Q

What is the main risk factor for developing PCP infection?

A

Low lymphocytes (specifically, not low neutrophils)

HIV, chemo etc.

95
Q

What is the most appropriate way to confirm a diagnosis of pertussis?

A

Nasal Swab

96
Q

How does Paget’s disease of the breast present? What is it?

A

Paget’s disease is an eczematoid change of the nipple associated with an underlying breast malignancy and it is present in 1-2% of patients with breast cancer. In half of these patients, 90% of such patients will have an invasive carcinoma.
- Eczema involving nipple first then areola, skin thickening and possible bloody discharge

97
Q

What is fibroadenosis?

A

Common in middle aged women - lumpy and painful breasts

- Symptoms worse prior to menstruation

98
Q

How does mammary duct ectasia present?

A

Most common around menopause
- Tender lump around areola +/- green nipple discharge
(if ruptures can cause inflammation)

It is dilation of the large breast ducts

99
Q

How does fat necrosis present in breast disease?

A

Obese women
Possibly following small trauma
- Inflammatory response, lump which can mimic breast cancer

100
Q

How does a breast absecess present?

A

More common in lactating women

Red/hot/tender swelling

101
Q

How should neutropenic sepsis be managed?

A 
Immediate hospital admission
ABCDE
Start sepsis 6
Escalate to oncology 
Do sepsis screen investigations
102
Q

What are the components of a triple assessment?

A

Examination (P1-5)
Imaging (M/U1-5)
Histology (B1-5)

103
Q

How is Lyme disease contracted and what is the most common presenting feature?

A

From deer tick bites

A circular rash at the site of the bite (pink/red/purple), looks like a target and usually >5cm
CALLED ERYTHEMA MIGRANS (which can be caused by a number of different things, not just Lyme)

  • Can also cause flu symtpoms (joint/ muscle pain, headache, fever, N+V)
104
Q

How do you manage a patient with Lyme disease and an erythema migrans rash?

A

Take out tick with tweezers

Oral doxycycline for 2-3 weeks

105
Q

Name three treatments for travellors diarrhoea?

A

Clear fluids
Rehydration salts
Anti-motility (Loperamide i.e. Imodium)

106
Q

Name 5 possible presenting features of malaria?

A 
- Anywhere from 6days to 6months following bite
Fever/ chills/ rigors
Headache
Cough
Myalgia
GI upset
Splenomegaly/ hepatomegaly
Jaundice
107
Q

What is the first line investigation for suspected malaria?

A

Thick and thin blood smears stained with Giemsa stain

108
Q

What is the usual first line treatment of malaria?

A

Chloroquine

Plus speak to ID consultant

109
Q

What comes under septic screen (i.e. to look for cause of a neutropenic sepsis)?

A 
Bloods: FBC, U+E, CRP
Urine dip and culture
Sputum culture
Stool culture 
CXR
ECG
110
Q

How does metastatic compression of spinal cord present? (3)

A

Back pain (worse on lying, throacic spine, night pain)
UMN signs?
Cauda equina symptoms

111
Q

How do you manage suspected spinal cord compression?

A

Send patient immediately to A+E
MRI in hosp
Dextamethasone
Urgent oncological assessment/ MDT

112
Q

How does SVC obstruction present?

A

Dyspnoea
Swelling of face, neck, arms
Periorbital oedema + visual changes

113
Q

What malignancies commonly cause SVC compression?

A

Lymphoma
Lung cancer
Thyroid cancer

114
Q

How do you manage SVC obstruction?

A

ABCDE
Immediate hospital admission
Steroids (oral dext)
Can then do stenting, surgery etc

115
Q

How do you manage a hypercalcaemic emergency?

A 
Commonly caused by squamous cell LC  
ABCDE
- Do ECG
Fluid resus 
Bisphonates following rehydration (takes 2-3 days to work)
Calcitonin works quicker
116
Q

Small cell lung cancer commonly makes which ectopic hormones?

A

ACTH

ADH

117
Q

How does hypercalacemia present?

A

Dehydration

Stones, moans, pyschic groans

118
Q

How does tumour lysis syndrome present?

A

Raised urate, raised potassium, raised phosphate, low calcium

119
Q

How do you treat tumour lysis syndrome?

A

Fluids
Stop chemo
Treat electolyte abnormalities
Refer to renal team

120
Q

CA15-3 is associated with?

A

Breast cancer

121
Q

CA19-9 is associated with?

A

Pancreatic tumour

122
Q

AFP raised is associated with what cancers?

A

Hepatocellular carinoma

Testicular teratoma

123
Q

An agitated patient on the ward can be sedated with what drugs?

A

Lorazepam

Halloperidol

124
Q

How do you reduce respiratory secretions?

A

Hyocine bromide

125
Q

When using steroids and emolients when would you use each one (if applying at same time)?

A

Emollient first

- Steroid on afterwards

126
Q

How do you treated scabies?

A

Permethrin

Treat whole family as very infective

127
Q

Name one agent used as prophylaxis for tumour lysis syndrome?

A

Allopurinol

128
Q

Ca 19-9 is a tumour marker for which cancer?

A

Pancreatic

129
Q

Ca 15-3 is a tumour marker for which cancer?

A

Breast

130
Q

Ca 125 is a tumour marker for which cancer?

A

Ovarian

131
Q

AFP is a tumour marker for which cancers?

A

Hepatocellular carinoma

Testicular teratoma’s

132
Q

CEA is a tumour marker for which cancer?

A

Colorectal

133
Q

What characterises denge fever?

A

Low platelet count with raised ALT in patient who has been abroad

MBChB - Full Clinical Topics (23 decks)

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