Cancer, Skin, Breast and Infection Flashcards
(133 cards)
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
2
Q
What % of breast cancers are ER+ve?
A
80%
3
Q
What % of breast cancers are HER2+ve?
A
15%
4
Q
What is the criteria for neutropenic sepsis according to NICE?
A
Temp > 38
Neutrophils < 0.5x10(9)
Recent chemo
5
Q
Which chemotherapy agent, used in Hodgkin lymphoma commonly causes damage to lung tissue?
A
Bleomycin
6
Q
What common urine side effect of doxorubicin should patients be counselled on?
A
Makes urine red for 24 hours following treatment
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
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
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
10
Q
Which cancer is the BRAF mutation most commonly associated with?
A
Melanoma
11
Q
What drugs are used to treat hepatitis C infeciton?
A
Ribavirin and interferon
12
Q
As a general rule of thumb , what is the first choice antibiotics for anaerobic infections?
A
Metronidazole
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.
14
Q
Which antibiotic is used first line for cellulitis?
A
Flucloxacillin
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
16
Q
Which are the only animals in the UK to carry rabies?
A
Bats
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
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.)
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
20
Q
How should necrotising fasciitis be treated?
A
Surgical debridement
Antibiotics are only supportive
21
Q
How does staph aureus appear on a gram stain?
A
Gram positive cocci in clusters
22
Q
What treatment is used for severe CAP (assuming CURB score >3)?
A
IV Co-amoxiclav and clarithromycin
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
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
25
How long does an influenza illness take to resolve?
3-7 days
26
How long does someone who has had an influenza infection remain potentially contagious?
Up to 14 days
27
What is the most common causative organism of CAP?
Streptococcus pneumonia
| H.influenzae
28
What is the most common causative organism of HAP?
Staph aureus
| HAP after 4 days from admission, before this still same as CAP
29
What is the most common causative organism of pneumonia in those with COPD?
H.Influenzae
30
What is the most common causative organism of pneumonia in those who've been on holiday, presenting with dry cough?
Legionella
| Also hyponatremia and derranged LFT's
31
What is the most common causative organism of pneumonia in alcoholics?
Klebsiella pneumoniae
32
What is the most common causative organism of pneumonia in CF/ bronchiectasis?
Pseudomonas aeruginosa
33
What is the most common causative organism of pneumonia in the immunocompromised?
Pnemocystis jiroveci pneumonia
| Especially if desaturation on exertion
34
Which medication is used to treat cytomegalovirus infections in the immunocompromised?
IV Ganciclovir
| Then oral valganciclovir
35
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?
Serum fungal antigen test (beta-D-glucan test; BDG)
| Very sensitive
36
What test is used to diagnose Aspergillus infections?
Serum galactomannan (GM) test
37
What is the most common infection sources in candidaemia? (2)
Lines
(Cannula, central line etc.)
Gut flora translocation following damage to gut lining
38
How is urticaria due to an allergic reaction likely to present?
Hives is urticaria (raised, itchy, nettle rash)
Itchyness
No systemic symptoms
39
What are the common causes of viral gastroenteritis (2)
Rotavirus
| Norovirus
40
What is the most common cause of bloody diarrhoea in an immunocompromised patient?
CMV
41
Name the 5 most common bacterial causes of bloody diarrhoea (dysentery)?
```
Campylobacter
Shigella
Salmonella
E.coli O157
C.Diff
```
42
What two viruses are most commonly associated with infectious mononucelosis?
EBV
| CMV (similar symptoms to EBV)
43
What is the most common hepatitis in a) the UK, b) the world
a) Hep C
| b) Hep B
44
Which hepatitis is spread by fecal/oral and which are spread by blood/ body fluids?
Fecal/ oral = A + E
| Blood/ fluids = B, C, D
45
What is the most common acute hepatits?
Hep A
46
What test is used to diagnose acute hepatitis A infection?
IgM antibody
| Appears as soon as symptoms start, this may be up to 6 weeks post exposure
47
What antibody suggests previous HepA infection, how long does it last?
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
48
Which test is used to establish current Hep B infection?
HBsAg (surface antigen)
Acute disease = there for 1-6 months
Chronic disease = still present after 6 months
49
What does presence of the anti-HBs antibody suggest?
Immunity
(either from infection or immunisation)
Note won't be present in acute stage
50
What does presence of the anti-HBc antibody suggest?
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
51
A patient has previously had HepB and gained immunity, what two antibodies will be shown in their serum?
Anti-HBs + Anti HBc
52
What antigen is monitored to assess the severity of HepB?
HBeAg
| If HBeAg +ve then offer 48 week course of peginterferon alfa-2a
53
What treatment is offered for hepatitis C?
48week course of Peginterferon alfa-2a and ribavirin for all patients with Hepatitis C
54
What treatment is offered for acute HepA?
Supportive only
| Avoid alcohol and possibly paracetamol
55
What management should be offered for somone with Hep B + advice (4)
- 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
What test is used to assess whether there is Hepatitis C infection?
Anti- HCV serology
| 90% +ve after 3 months but some can take up to 9 months
57
What test is used to distinguish previous HepC infection from a current one?
HCV RNA
If +ve for more than 2 months then the patient needs treatment with peginterferon alfa-2s and rivavirin
58
Which is the best marker in the LFT's to assess for viral hepatitis?
ALT raises significantly more than the others
59
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?
Vitiligo is more common in patients with known autoimmune conditions such as thyrotoxicosis.
60
Name three associations of vitiligo?
T1DM
Addisons disease
Autoimmune thyroid disorders
61
Name 4 management options for vitiligo?
Sunblock
Topical corticosteroids (if applied early)
Topical tacrolimus and phototherapy can be considered but used with caution
62
Acanthosis nigricans is a dermatological manifestation of what?
Insulin resistance
| Diabetes
63
Bloody nipple discharge is most associated with what?
Duct papiloma
| note these are benign and carry no increased risk of malignancy
64
Brown-green nipple discharge is most commonly associated with...?
Duct ectasia
| most common in menopausal women
65
Do breast cysts increase your risk of breast cancer?
Yes they carry a very small increased risk of developing breast cancer
66
What is the difference between a fibroadenoma and a phyllodes tumour?
Both benign
| Fibroadenomas tend to shrink however phyllodes normally keep growing
67
What is the most appropriate management for a 3.5cm fibroadenoma?
Surgical excision (most over 3cm)
68
How do you explain duct ectasia to a patient? How is it managed?
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
What treatment is used for symptomatic breast cysts?
Fine needle aspiration
70
What % of breast lumps are cysts, and what age group most commonly experiences breast cysts?
15% of breast lumps are cysts
| Most common in perimenopausal females
71
How would you explain fibroadenoma's to a patient?
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
What percentage of breast lesions are fibroadenomas in a) the population b) 18-25 year olds
a) 13%
| b) 60%
73
A 22yo female has a small 2cm asymptomatic lump suspected on imaging to be a fibroadenoma, what management is appropriate?
Watchful waiting
74
A 22yo female has a small 4cm asymptomatic lump suspected on imaging to be a fibroadenoma, what management is appropriate?
Core biopsy
| Fibroadenomas over 4cm should be biopsied to exclude phyllodes tumour
75
What causes peu d'orange?
Oedema (not pulling on the skin)
76
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?
Breast cancer
HL is treated with radiotherapy which gives a lifetime 50% risk of developing breast cancer
77
What age is the cutoff for concern when taking a family history for breast cancer?
50
78
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?
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
What histological investigation is done for skin changes on the breast?
```
Punch biopsy
(for peu d'orange or paget's)
```
80
Name three blood tests which should be done for a patient with suspected liver mets?
FBC
LFT (liver mets)
Bone profile (bone mets)
81
How are HER2 receptor status reported?
```
1+ = Negative
2+ = Inconclusive
3+ = Positive
```
82
What receptor status carries best prognosis in breast cancer?
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
What are the most common side effects of tamoxifen?
(Menopausal type)
- Hot flushes
- Vaginal dryness
- Mood changes
- Loss of sex drive
84
What advice are patients on chemotherapy given regarding looking out for infections?
Take temperature twice a day (as symptoms are often very insidious when on chemo so can be easily missed)
85
What advice should a lady who has had previous Hodgkin's Lymphoma regarding treatment of her breast cancer lump?
Can't do wide local incision plus radiotherapy as you can't radiate the breast twice (risk of angiosarcoma)
Need to do mastectomy
86
How do you stage Breast cancers and what investigation Is used?
TNM
| Do CT of thorax, abdo, pelvis
87
Name two side effects of isotenitoin?
Low mood
Tetratogenic
Dry mouth
88
How much steroid cream do you need to treat the surface area of one hand palm?
A finger tip of cream
89
What is the concern with putting steroid cream on the eyelids?
Cateracts
90
What is acitretin and what are the side effects? (2)
Retinoid (vitA) derived - immunosuppresive used for psoriasis
SE: Tertagenecity, dyslipidaemia
91
Name three side effects of azothioprine? (3)
Infection, liver dysfunction, anaemia, leucopenia
92
How does seborrhoeic dermatitis usually present?
```
Eczematous lesions (itchy and red) on:
- Scalp (dandruff), perioribital area, nasolabial folds and around ears (all sebum rich)
```
Associated with HIV and parkinsons
93
What is the first three lines of management for seborrhoeic dermatitis in adults?
1- Head and shoulders
2- Neutrogena T/gel
3- Ketoconazole (topical)
94
What is the main risk factor for developing PCP infection?
Low lymphocytes (specifically, not low neutrophils)
| HIV, chemo etc.
95
What is the most appropriate way to confirm a diagnosis of pertussis?
Nasal Swab
96
How does Paget's disease of the breast present? What is it?
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
What is fibroadenosis?
Common in middle aged women - lumpy and painful breasts
| - Symptoms worse prior to menstruation
98
How does mammary duct ectasia present?
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
How does fat necrosis present in breast disease?
Obese women
Possibly following small trauma
- Inflammatory response, lump which can mimic breast cancer
100
How does a breast absecess present?
More common in lactating women
| Red/hot/tender swelling
101
How should neutropenic sepsis be managed?
```
Immediate hospital admission
ABCDE
Start sepsis 6
Escalate to oncology
Do sepsis screen investigations
```
102
What are the components of a triple assessment?
Examination (P1-5)
Imaging (M/U1-5)
Histology (B1-5)
103
How is Lyme disease contracted and what is the most common presenting feature?
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
How do you manage a patient with Lyme disease and an erythema migrans rash?
Take out tick with tweezers
| Oral doxycycline for 2-3 weeks
105
Name three treatments for travellors diarrhoea?
Clear fluids
Rehydration salts
Anti-motility (Loperamide i.e. Imodium)
106
Name 5 possible presenting features of malaria?
```
- Anywhere from 6days to 6months following bite
Fever/ chills/ rigors
Headache
Cough
Myalgia
GI upset
Splenomegaly/ hepatomegaly
Jaundice
```
107
What is the first line investigation for suspected malaria?
Thick and thin blood smears stained with Giemsa stain
108
What is the usual first line treatment of malaria?
Chloroquine
| Plus speak to ID consultant
109
What comes under septic screen (i.e. to look for cause of a neutropenic sepsis)?
```
Bloods: FBC, U+E, CRP
Urine dip and culture
Sputum culture
Stool culture
CXR
ECG
```
110
How does metastatic compression of spinal cord present? (3)
Back pain (worse on lying, throacic spine, night pain)
UMN signs?
Cauda equina symptoms
111
How do you manage suspected spinal cord compression?
Send patient immediately to A+E
MRI in hosp
Dextamethasone
Urgent oncological assessment/ MDT
112
How does SVC obstruction present?
Dyspnoea
Swelling of face, neck, arms
Periorbital oedema + visual changes
113
What malignancies commonly cause SVC compression?
Lymphoma
Lung cancer
Thyroid cancer
114
How do you manage SVC obstruction?
ABCDE
Immediate hospital admission
Steroids (oral dext)
Can then do stenting, surgery etc
115
How do you manage a hypercalcaemic emergency?
```
Commonly caused by squamous cell LC
ABCDE
- Do ECG
Fluid resus
Bisphonates following rehydration (takes 2-3 days to work)
Calcitonin works quicker
```
116
Small cell lung cancer commonly makes which ectopic hormones?
ACTH
| ADH
117
How does hypercalacemia present?
Dehydration
| Stones, moans, pyschic groans
118
How does tumour lysis syndrome present?
Raised urate, raised potassium, raised phosphate, low calcium
119
How do you treat tumour lysis syndrome?
Fluids
Stop chemo
Treat electolyte abnormalities
Refer to renal team
120
CA15-3 is associated with?
Breast cancer
121
CA19-9 is associated with?
Pancreatic tumour
122
AFP raised is associated with what cancers?
Hepatocellular carinoma
| Testicular teratoma
123
An agitated patient on the ward can be sedated with what drugs?
Lorazepam
| Halloperidol
124
How do you reduce respiratory secretions?
Hyocine bromide
125
When using steroids and emolients when would you use each one (if applying at same time)?
Emollient first
| - Steroid on afterwards
126
How do you treated scabies?
Permethrin
| Treat whole family as very infective
127
Name one agent used as prophylaxis for tumour lysis syndrome?
Allopurinol
128
Ca 19-9 is a tumour marker for which cancer?
Pancreatic
129
Ca 15-3 is a tumour marker for which cancer?
Breast
130
Ca 125 is a tumour marker for which cancer?
Ovarian
131
AFP is a tumour marker for which cancers?
Hepatocellular carinoma
| Testicular teratoma's
132
CEA is a tumour marker for which cancer?
Colorectal
133
What characterises denge fever?
Low platelet count with raised ALT in patient who has been abroad
