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Finals Revision > Oncology & Palliative Care > Flashcards

Oncology & Palliative Care Flashcards

1
Q

What is the commonest site of acute spinal cord compression?

A

Thoracic

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2
Q

What are some common cancers causing acute spinal cord compression?

A

Lung, breast, prostate, renal, myeloma

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3
Q

What are the 3 mechanisms of acute spinal cord compression?

A

Extradural metastases
Direct tumour extension
Crush fracture

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4
Q

What is the initial investigation you should do for acute spinal cord compression?

A

Urgent MRI whole spine

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5
Q

What is the management of acute spinal cord compression?

A

Dexamethasone 16mg IV then 8mg BD orally

Urgent radiotherapy +/- surgery

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6
Q

What is superior vena cava compression?

A

Obstruction of the vena cava that can also cause airway compression

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7
Q

What malignancies commonly cause superior vena cava compression?

A

NSCLC, lymphoma, metastaic seminomas, Kaposis sarcoma, breast cancer

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8
Q

What are some signs and symptoms of SVC compression?

A

Breathlessness, swelling of face/neck/arms, lethargy, puffy neck, non-collapsable/distended neck veins. Pemberton’s sign

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9
Q

What are the two mechanisms by which SVC compression occurs?

A

Blockage within the SVC (e.g. DVT, foreign body, tumour)

Blockage outwith the SVC (e.g. extrinsic compression from mass)

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10
Q

What investigations are important in SVC compression?

A

CXR, venogram, CT chest

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11
Q

What is the treatment of SVC?

A

Clot - thrombolysis

Extrinsic compression - steroids, stenting, radio/chemotherapy

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12
Q

What are the pathological causes of malignant hypercalcaemia?

A

Ectopic PTHrP production
Lytic bone destruction
Vit D analogue production

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13
Q

What are symptoms of malignant hypercalcaemia?

A

Lethargy, anorexia, thirst, confusion, weakness

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14
Q

What investigations should be done in malignant hypercalcaemia?

A

FBC, U&Es, calcium, phosphate, albumin, myeloma screen

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15
Q

How is malignant hypercalcaemia managed?

A

Rehydration then bisphosphonates

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16
Q

What is neutropenic sepsis a common complication of?

A

Chemotherapy

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17
Q

When does neutropenic sepsis usually occur?

A

7-14 days following chemotherapy

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18
Q

What is neutropenic sepsis defined as?

A

Neutrophil count less than 0.5 or less than 1 in chemotherapy patients PLUS
temperature >38 or other signs assoc with sepsis

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19
Q

What investigations do you do for neutropenic sepsis?

A

Basically everything - full infection screen, full blood screen, blood gases, ECG, CXR, AXR

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20
Q

If a patient is septic and has had chemo in the last 3 weeks, how should you manage them?

A

Assume neutropenic sepsis and treat them before blood results return

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21
Q

What is the treatment of neutropenic sepsis?

A

SEPSIS 6

Antibiotic - Pipercillin, Tazobactam +/- gentamicin if NEWS over 7

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22
Q

What organisms are most likely to cause sepsis?

A

Mostly gram negative (E.coli, Pseudomonas, Klebsiella)

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23
Q

What is tumour lysis syndrome?

A

Breakdown of tumour cells and subsequent release of chemicals from the cell

24
Q

What cancers is tumour lysis syndrome related to?

A

Lymphomas and leukaemias

25
Q

What may trigger tumour lysis syndrome?

A

Chemotherapy

26
Q

What electrolyte imbalance do you see in tumour lysis syndrome?

A

High potassium, high phosphate

Low calcium

27
Q

How is tumour lysis syndrome prevented?

A

IV allopurinol if at risk

28
Q

What other oncological emergencies are there?

A

SIADH, brain mets, malignant pericardial effusion, PE, DIC

29
Q

What are the main troublesome symptoms in end of life?

A

Pain, breathlessness, agitation, secretions and nausea

30
Q

What should be used for pain in palliative care?

A

WHO analgesic ladder

31
Q

What is important to start if using an opioid?

A

Laxative and anti-emetic

32
Q

What is used for background pain?

A

MST

33
Q

What drug is used for breakthrough pain?

A

Oramorph

34
Q

What is the breakthrough dose of oramorph?

A

1/6th of the background dose

35
Q

What are the symptoms of morphine toxicity?

A

Grogginess, feeling wiped out, hallucinations, myoclonic jerks

36
Q

What opioid should be used in poor renal function?

A

Oxycodone, buprenorphine or alfentanil

37
Q

What is the subcut dose of oramorph compared to the oral dose of oramorph?

A

HALF

38
Q

How do you convert an oral codeine dose to an oral morphine dose?

A

Divide dose by `10

39
Q

How do you convert an oral tramadol dose to an oral morphine dose?

A

Divide dose by 10

40
Q

How do you convert an oral morphine dose to an oral oxycodone dose?

A

Divide by 2

41
Q

How do you convert an oral morphine dose to a subcut morphine dose?

A

Divide by 2

42
Q

How do you covert an oral oxycodone dose to a subcut oxycodone dose?

A

Divide by 2

43
Q

How do you convert an oral morphine dose to a subcut diamorphine dose?

A

Divide by 3

44
Q

What dose of oral morphine is equivalent to 1mg of subcut alfentanil?

A

30g

45
Q

What drug is used for agitation in palliative care?

A

Midazolam

46
Q

What drug is used for secretions in palliative care?

A

Hyoscine butylbromide (Buscopan)

47
Q

What drug is used for nausea and vomiting in palliative care?

A

Levomopromazine

48
Q

What drug is used for breathlessness in palliative care?

A

Opioids help with breathlessness

49
Q

What do syringe drivers allow for?

A

A continuous sub cut infusion of fluids and drugs

50
Q

What does a PET scan measure?

A

Glucose uptake

51
Q

What tumour marker is used in breast cancer?

A

CA 15-3

52
Q

Why is dexamethasone used for brain metastases?

A

Reduces brain oedema to cause reduction in symptoms of raised ICP

53
Q

How are incontrollable hiccups in palliative care treated?

A

Chlorpromazine

54
Q

What is the tumour marker for pancreatic cancer?

A

CA 19-9

55
Q

What unit is radiotherapy prescribed in?

A

Grey

56
Q

How is a chemotherapy dose calculated?

A

Patients calculated surface area

Finals Revision (22 decks)

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