Oncological emergencies - writtens

Question 1

Mx of SVC obstruction

Answer 1

Dexamethasone

Consider stenting

Question 2

Causes of SVC obstruction

Answer 2

Malignancy: lung cancer, LNs, thymus

SVC thrombosis: due to CVC

Question 3

Facial plethora
Engorged neck veins
Orthopnea

Answer 3

SVC obstruction

Question 4

Ix for ?SVCO

Answer 4

• Sputum cytology - LUNG CA
• CXR
• CT
• Venography

Question 5

Peutz Jeghers
Visible features?
Risk?

Answer 5

Multiple telangiectasia on face, oral mucosa, palms

GI hamartamous polyps

• increased risk of CRC + other Ca

Question 6

BRCA genes

Answer 6

BRCA 1 = breast + ovarian

BRCA2 = breast

Question 7

HNPCC - what is it?

Answer 7

Increased risk of CRC (usually R sided)

Question 8

What is FAP

what surgery do they often have

Answer 8

Autosomal dominant Chr5 mutation
Promotes b-catenin (an oncogene)
- need another mutation eg Kras or p53

Panproctocolectomy + end ileostomy

100% risk of CRC

Question 9

Most common cancers - top 4

Answer 9

Skin
Breast/prostate
Lung
CRC

Question 10

Commonest mortality from cancer

Answer 10

Lung
Breast/prostate
CRC

Question 11

Febrile neutropenia - WCC?

Mx?

Answer 11

PMN <1x10^9

Isolation + barrier nursing
Broad spectrum IV ABx, antifungals, antivirals

COtrimoxazole

Question 12

Spinal cord compression - presentation?
Ix?
Mx?

Answer 12

LMN @level
Radicular pain
UMN below level

Ix: MRI spine
Mx: Dexamethasone + neurosurgical referral

Question 13

Specific sign in SVCO?

Answer 13

Pemberton’s sign

- Raise arms for >1 min –> facial plethora, wheeze, raised JVP

Question 14

Causes of hypercalcemia in malignancy - give 2

Answer 14

PTHrP

Lytic bone mets

Question 15

Symptoms of hypercalcemia

Answer 15

Confusion
Lethargy
Polyuria, polydipsia
Abdominal pain
Constipation
Renal stones

Question 16

Mx of lytic bone mets causing hypercalcemia?

Answer 16

• Aggressive rehydration
• Once normovolemic, give furosemide to make more room for fluids
• Bisphosphantes (once primary HPT is excluded)

Question 17

SE of cyclophosphamide

Answer 17

Haemorrhage cystitis

Question 18

SE of doxorubicin

Answer 18

Cardiomyopathy

Question 19

SE of bleomycin

Answer 19

Pulmonary fibrosis

Question 20

SE of 5FU

Answer 20

Mucositis

Question 21

Palliation radiotherapy - what symptoms can it be used to treat?

Answer 21

Bone pain
Haemoptysis
Cough
SOB
Bleeding

Question 22

Reactions to radiotherapy - early + late

Answer 22

Early: 
Fatigue
Ulcers
Diarrhoea
N+V
BM suppression
Cystitis

Late:
Lymphedema
Brachial plexopathy
infertility

Question 23

AFP is raised in…?

Answer 23

HCC

teratoma