Cancer Care EOB Exam Flashcards
(33 cards)
A 62-year-old man has presented to hospital with extreme breathlessness. He is known to have pancreatic cancer and didn’t tolerate palliative chemotherapy. A CTPA confirms a large saddle pulmonary embolism.
He has been commenced on treatment dose LMWH and a SCSD with morphine sulphate 160mg over 24 hours.
On further assessment he remains very breathless and frightened. He has no clinical findings to suggest infection. His oxygen saturations are 94% on air.
His family are concerned he is dying. He has previously expressed a wish to die at home.
What is the next BEST step to enable his preferences regarding care?
Give him a SC dose of midazolam 2.5mg to calm him and reduce his breathlessness
A 68-year-old man with known lung cancer (treated with palliative radiotherapy) is assumed to have developed a community acquired pneumonia. He has been admitted to hospital for IV antibiotics. His past medical history includes AF for which he has been taking warfarin 2mg once daily. Blood tests on admission reveal an international normalised ration (INR) of 6.4. There is currently no evidence of bleeding.
Which ONE of the following is the most appropriate next management step?
withhold his warfarin (because INR < 8 and no bleeding)
INR < 8 no bleeding : withhold warfarin
INR < 8 with bleeding: withhold and give 1-3mg Vitamin K
INR >8 with minor bleeding: withhold and give 1-3mg Vitamin K
INR > 8 with major bleeding: withhold, give 5mg Vit K and Prothrombin Complex Concentrate
A 68-year-old man has presented to ED with new onset confusion. He has a 3 month history of back and left arm pain.
Examination reveals he is tender over his thoracic spine and upper left humerus.
Investigation results are as follows;
platelets 390
Renal function: urea 40 creat 450
X-Ray left humerus: lytic lesions and a fracture
X-Ray skull: multiple lytic lesions
Which ONE of the listed investigations would be the most helpful in making a diagnosis?
Serum immunoglobulins and protein electrophoresis
Suspected Myeloma
A 54-year-old woman presents to her GP with a breast lump. She is keen to know what factors significantly increase her risk of breast cancer. Which ONE of those listed below is considered a significant risk factor?
Cosmetic breast implants
Early menopause
Late menarche
Obesity
Polycystic ovary syndrome
Obesity
A 25 year old woman presents with chest pain, breathlessness and cough triggered by exertion. On direct questioning she admits that the pain is worse after drinking alcohol.
CXR demonstrates a widened mediastinum.
CT CAP reveals a mediastinal lymph node mass measuring 12 x 6 cm and a small pericardial effusion.
Which ONE is the most likely diagnosis?
Hodgkin’s lymphoma
What should be given FIRST in the treatment of hypercalcaemia?
IV fluids
IV Pamidronate is given after fluid resus
A 22 yr old man is admitted with SOB and a dry cough 10 days after his first cycle of chemo for Stage IIB Hodgkins lymphoma.
His admission bloods show low WCC, low neutrophils and a raised creatinine.
What is the likely diagnosis?
Neutropenic sepsis
What is the single most useful test to determine if the cause of haemolytic anaemia is autoimmune?
Direct Anti-globulin test
A 54 year old gentleman has been recently diagnosed with stage IV glioblastoma. He complains of headache and intermittent projectile vomiting.
What would be an appropriate intervention to improve his symptom control?
Start him on Cyclizine 50mg TDS
A 67 year old woman with known metastatic breast cancer presents with severe nausea and vomiting. Based on the initial investigation results she is has been given 0.9% saline 125ml/hour for 24 hours to be followed by 4mg of zoledronic acid over 15 minutes.
Which ONE of the following antiemetics is most likely to be helpful whilst the more definitive treatment takes time to work?
Haloperidol
Her N+V is due to hypercalcaemia, and haloperidol is used for metabolic causes of emesis.
What can you give to a patient with neutropenic sepsis who is allergic to penicillin?
IV meropenem
SIADH (syndrome of inappropriate secretion of antidiuretic hormone) is a disorder of impaired water excretion which can be associated with lung malignancy.
Which ONE of the following statements would NOT support a diagnosis of SIADH?
A. Confusion, irritability, hallucinations
B. Low serum sodium with low serum osmolality and high urine osmolality
C. Nausea and vomiting
D. Normal serum potassium
E. Raised TSH
E. Raised TSH
A 53 year old man is receiving radical radiotherapy for localised prostate cancer.
He is keen to understand which ONE of the following is the most common acute adverse effect of radiotherapy
A. Desquamation of skin
B. Erectile dysfunction
C. Fatigue
D. Rectal bleeding
E. Urinary frequency
C. Fatigue
A 55 year old woman presented to her GP with a lump in her groin. She was found to have a 2x2cm right inguinal lymph node and was referred to the hematology team for further investigation but she failed to attend.
2 years later she represented to her GP; at this time she had a 3x3cm right inguinal node, a 2x2cm left axillary lymph node, and multiple small volume inguinal nodes. She was feeling well in herself.
Blood results: Hb 133, WCC 5.4, platelets 305.
What is the most likely diagnosis?
Low grade non-Hodgkin’s lymphoma
A 59-year-old man has adenocarcinoma of the lung with bone metastasis. He has previously had palliative radiotherapy for haemoptysis and right shoulder pain. He now presents with escalating pain in his lower thoracic spine and some tingling his right lower leg.
Blood results are as follows; Hb 110, WCC 8.0, platelets 434, eGFR 78m, Ca 2.50, ALP 872.
What would be the most appropriate management step?
Dexamethasone 16mg orally ASAP
A 39-year-old woman presents with sudden-onset severe breathlessness. 4 hours earlier she completed a 1 unit blood transfusion of red cells for symptomatic anemia. Her only significant past medical history is of heavy menstrual bleeding.
Examination: temp 38.1, pulse 94 beats/min, BP 88/65, RR 25/min, oxygen saturations are 89% on air. JVP is visible at 3.5cm and auscultation reveals bilateral basal crackles.
Which ONE would be the likely working diagnosis?
Transfusion Related Acute Lung Injury (TRALI)
In which region do two thirds of MSCC occur?
The thoracic region
What is the risk that the son of a woman with breast cancer will have inherited her BRCA mutation?
50%
A 45 year old woman with ALL requires a lumbar puncture and intrathecal chemotherapy as part of her treatment regime. A full blood count reveals the following results; Hb 89, WCC 1.2, platelet count 75. Her clotting screen is normal.
Which ONE of the following is the most appropriate next step?
A. Delay the lumbar puncture until the platelet count has recovered
B. Go ahead with the lumbar puncture
C. prescribe 1 bag (1 adult therapeutic dose) of platelets
D. Prescribe 2 bags (2 adult therapeutic doses) of platelets
B. Go ahead with the lumbar puncture
platelets need to be above 50 for surgery and 10 in general which they are
A 68-year-old man presents with difficulty in swallowing. He has been a heavy drinker for over 30 years. He previously had a bad experience during endoscopy so preferred to be investigated via a barium swallow. The barium swallow demonstrated a mass in the upper third of the esophagus.
What is the most likely histological diagnosis?
Squamous Cell Carcinoma
A 76 year old woman presents with LBO secondary to an underlying colorectal cancer. What is the most likely histological diagnosis?
Adenocarcinoma
Neoplastic cells can acquire resistance to onolcogy agents by several mechanisms .
Give ONE recognised mechanism of drug chemo-resistance.
Detoxification, target modification, and DNA repair
A 72-year-old woman has presented with a cough and unexplained weight loss. She has smoked since the age of 15. A chest X-ray has demonstrated an opacity in her left lung, which has been biopsied via bronchoscopy.
The histology report describes pleomorphic cells with frequent atypical mitotic figures. There are intercellular bridges and keratin pearls, along with areas of necrosis.
Which is the most likely diagnosis?
Squamous Cell Carcinoma
A 56-year-old woman with extensive peritoneal disease secondary to ovarian cancer has presented with multi-level large bowel obstruction. The surgical team do not think surgical intervention will be helpful.
A continuous subcutaneous infusion (syringe driver) with cyclizine has greatly improved her nausea but she continues to experience large volume vomiting.
Which ONE of the following is likely to be the most helpful intervention?
Add octreotide to the syringe driver
