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FStCP 2 > Cancer > Flashcards

Cancer Flashcards

1
Q

What are the signs and symptoms of post-traumatic stress?

A
  • Increased cortisol
  • Increased arousal (hypersensitivity, hyperreactivity etc)
  • Numbness/avoidance
  • Re-living traumatic events
  • Intense fear
  • Mind oscillating between ‘approach’ and ‘avoid’
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2
Q

What are the clinical criteria for a mood disorder?

A
  • Global effect
  • Persistent, disorder-specific feelings
  • A range of symptoms lasting 2 weeks or more
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3
Q

What is burnout?

A

A condition that occurs over time which is similar to a fatigued state or emotional exhaustion.

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4
Q

What is secondary trauma?

A

Emotional distress as a result of exposure to other people’s trauma. This has similar symptoms to PTSD.

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5
Q

What is vicarious trauma?

A

Where working with traumatised patients may transform the professional’s feelings, cognitive schemas (world view) and self-esteem.

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6
Q

Mild hypercalcaemia is defined as:

A

< 3.0 mmol/L

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7
Q

Moderate hypercalcaemia is defined as:

A

3 - 3.5 mmol/L

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8
Q

Severe hypercalcaemia is defined as:

A

> 3.5mmol/L

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9
Q

What are anti-emetics?

A

Medicines to prevent vomiting

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10
Q

What is the management of hypercalcaemia?

A
  • Rehydration with IV fluids
  • After 24h rehydrate with IV bisphosphonates
  • Daily bloods including renal function until Mg is normalised
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11
Q

Why do you need to monitor for fluid overload in hypercalcaemia?

A

This is a risk in the renal impaired and elderly

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12
Q

How long does it take to achieve a nadir of calcium?

A

2-4 days but can be up to 7

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13
Q

What are the clinical features of hypercalcaemia?

A
  • Polyuria
  • Thirst
  • Anorexia
  • Nausea
  • Constipation
  • Mood disturbance
  • Cognitive dysfunction/confusion/coma
  • Renal impairment
  • Shortened QT interval
  • Dysrhythmias
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14
Q

What are the causes of 90% of hypercalcaemia cases?

A
  • Malignancy

- Primary hyperparathyroidism

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15
Q

Which drugs cause hypercalcaemia?

A
  • Thiazide diuretics
  • Lithium
  • Theophylline
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16
Q

What are the endocrine causes of hypercalcaemia?

A
  • Thyrotoxicosis
  • Phaeochromocytoma
  • Adrenal insufficiency
  • Primary and tertiary hyperparathyroidism
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17
Q

What is PTHrP?

A

Parathyroid related peptide

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18
Q

How does PTHrP cause hypercalcaemia?

A

It is released by cancer cells and mimics parathyroid hormone and causes bones to release calcium.

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19
Q

What are the four causes of malignant hypercalcaemia?

A

1) PTHrP (80%)
2) Osteolysis (20%)
3) PTH (<1%)
4) Calcitriol (<1%)

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20
Q

How does osteolysis cause hypercalcaemia?

A

Because the bone is being destroyed by the cancer calcium is being released into the blood.

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21
Q

Mild hyponatraemia is defined as:

A

130 mmol/L

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22
Q

Moderate hyponatraemia is defined as:

A

125 - 129 mmol/L

23
Q

Severe hyponatraemia is defined as:

A

< 125 mmol/L

24
Q

What are the clinical features of hyponatraemia?

A
  • Gait instability/falls
  • Concentration and cognitive defects
  • Nausea
  • Vomiting
  • Headache
  • Confusion
  • Reduced consciousness
  • Seizures
  • Cardiorespiratory arrest
25
Q

What is the biggest danger in hyponatraemia?

A

Cerebral oedema

26
Q

If urine osmolality is < 100 mOsm/kg, what are the potential causes of the hyponatraemia?

A
  • Primary polydipsia
  • Inappropriate IV fluid
  • Low solute intake
27
Q

If urinary Na is > 30 mmol/L what are the potential causes of the hyponatraemia?

A
  • SIADH
  • ADH/vasopressin-like drugs
  • Salt-wasting
  • Vomiting
  • Hypoadrenalism
  • Cerebral salt-wasting
28
Q

If urinary Na is < 30 mmol/L what are the potential causes of the hyponatraemia?

A
  • Heart failure
  • Portal hypertension
  • Nephrotic syndrome
  • Hypoalbuminaemia
  • Third space loss
  • GI loss (diarrhoea and vomiting)
  • Previous diuretic use
29
Q

What is the management for mild to moderate hyponatraemia?

A

Treat with fluid restriction

30
Q

What is the management of severe hyponatraemia?

A
  • Give hypertonic saline or equivalent with close monitoring and serial blood tests
  • After a 5mmol/L rise stop infusion of hypertonic saline and treat according to the underlying diagnosis
31
Q

Why do you need to limit the rise in Na to ≤10 mmol/L in the first 24 hours in hyponatraemia?

A

Because if you raise the Na levels too quickly you can cause cerebral oedema.

32
Q

What is tumour lysis syndrome?

A

Where fast-growing cancers are treated and die quickly causing the dead cells to ‘clog up’ the kidneys.

33
Q

What toxins can cause acute kidney injury?

A
  • Systemic anti-cancer drugs
  • Antibiotics
  • Analgesics
  • Contrast
34
Q

What metabolic imbalances can cause AKI?

A
  • Hypercalcaemia

- Hyperuricaemia (high uric acid)

35
Q

What is a colonic volvulus?

A

Where part of the colon has become twisted.

36
Q

What are the causes of 90% of large bowel obstructions?

A

Large bowel cancer

37
Q

What is the management of a potential bowel obstruction?

A
  • Bloods
  • Erect CXR to check for air under the diaphragm in a perforated bowel
  • Abdominal XR
  • NBM
  • IV fluids
  • Correct any electrolyte imbalances
  • Correct any anaemia or coagulopathy
  • Urinary catheter to measure kidney function and fluid balance
  • Nasogastric decompression
  • Broad-spectrum ABx pre-operatively
38
Q

What are the symptoms of bowel obstruction?

A
  • Nausea
  • Vomiting
  • Severe abdominal pain
39
Q

What are the signs of bowel obstruction?

A
  • Sepsis
  • Abdominal pain and tenderness
  • Abdominal distention
  • Absence of bowel sounds
  • Presence of hernias
40
Q

What is pruritus?

A

Itchy skin

41
Q

What are the signs and symptoms of raised bilirubin?

A
  • Nausea
  • Vomiting
  • Jaundiced
  • Pruritus
  • Dark urine
  • Pale stools
42
Q

Painless jaundice is considered ________ ________ until proven otherwise.

A

Pancreatic cancer

43
Q

What are four benign causes of biliary obstruction?

A
  • Gallstones (choledocholithiasis)
  • Common bile duct stricture
  • Choledochal cyst
  • Primary sclerosing cholagitis
44
Q

What are seven malignant causes of biliary obstruction?

A
  • Pancreatic carcinoma
  • Cholangiocarcinoma
  • Gallbladder cancer
  • Hepatocellular cancer
  • Duodenal and ampullary cancer
  • Lymphoma
  • Metastases to regional organs and lymph nodes
45
Q

What imaging do you do if you suspect cancer in the abdominal region?

A

Abdominal CT followed by a CT thorax and pelvis to check for metastases

46
Q

What is ERCP imaging?

A

Endoscopic Retrograde Cholangio-Pancreatography

47
Q

What is MRCP imaging?

A

Magnetic Resonance Cholangio-Pancreatography

48
Q

What is PTC?

A

Percutaneous Transhepatic Cholagiography

49
Q

What investigations are required for suspected pancreatic cancer?

A
  • CT imaging
  • ERCP
  • MRCP
  • PTC
  • Biopsy
50
Q

What is the management of raised bilirubin as a result of gallbladder obstruction? What is an alternative?

A

Endoscopic biliary drainage (insertion of a biliary stent under ERCP guidance).

Alternative = percutaneous biliary drainage.

51
Q

What is the treatment for stages I and II pancreatic cancer?

A
  • 1st line = surgical resection
  • Pancreatic enzyme replacement
  • Preoperative biliary stent
  • Neo-adjunctive radiotherapy or chemo

Adjuvant chemo (complete resection) /chemoradiotherapy (incomplete resection) after surgery

52
Q

What is stage III pancreatic cancer?

A

Locally advanced unresectable

53
Q

What is the treatment for stage III pancreatic cancer?

A
  • Endoscopic stent insertion or palliative surgery
  • Chemo/radiotherapy
  • Pain management
  • Pancreatic enzyme replacement
54
Q

What is the treatment for stage IV pancreatic cancer?

A
  • Endoscopic stent insertion or palliative surgery
  • Chemotherapy
  • Pancreatic enzyme replacement
  • Olaparib (adjunct therapy)

FStCP 2 (2 decks)

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