CLASP Flashcards
1
Q
what is vertebraplasty?
A
used in palliative care
cement added to spine to hold it together again
E.G after high steroid dose has destroyed bone
2
Q
when is O2 used in breathlessness?
A
only if they are hypoxic as well
3
Q
what produces SiADH?
A
small cell lung cancer
4
Q
what produces ACTH?
A
small cell (neuroendocrine)
5
Q
what is lambert-eaton myasthenic syndrome?
A
muscles problems, antibody related in pre-synaptic membrane, not hormone-related
6
Q
what indicates melanoma on histology?
A
brown pigments
7
Q
what can be used to determine if mets are from lung, liver, stomach etc?
A
immunohistochemistry
If premalignant part of tumour is present
8
Q
what is a carcinoid tumour?
A
neuroendocrine derived tumour usually in appendix/small bowel
yellow and assoc with serotonin
9
Q
how is a carcinoid tumour diagnosed?
A
Urine 5-HIAA and plasma
10
Q
what is required for carcinoid syndrome?
A
liver mets
chromogranin A
11
Q
Lymphoma?
A
B cell MALT
assoc w/ coeliac disease
12
Q
what cancer is kartageners syndrome associated with?
A
squamous cell carcinoma
cilia defect so affects lungs and fallopian tubes
13
Q
what does BCL2 do?
A
evasion of apoptosis
14
Q
what does P53 do?
A
spell checker
15
Q
what tumour stage do you look for mets?
A
not T1, only T2-4
16
Q
when is radio/chemotherapy used?
A
radio = local sit of malignancy chemo = systemic
17
Q
what are the endpoints for cancer treatments?
A
overall survival progression free survival disease free survival local control NOT TOXICITY FREE
18
Q
what is atelectasis?
A
lung collapse
19
Q
what is seen with asbestos exposure?
A
pleural effusion rounded atelectasis pleural plaques asbestosis adenocarcinoma (esp. w/ smoking) mesothelioma
20
Q
what is the worst indication with mesothelioma?
A
blue fibres (eg. amphipole)
21
Q
how does HPV cause cancer?
A
E6 targets P53 production
E7 targets pRB
(does not directly cause mutations however)
22
Q
can HIV cause cancer?
A
not directly
immunosuppressed making susceptible to cancer causing viruses
23
Q
what is plummer vinson?
A
increased risk of dysphagia, webs and then oesophageal cancer (squamous cell)
24
Q
what does lynch syndrome cause?
A
endometrial and colon cancer
25
who gets screened for lynch syndrome?
everyone with MSI (microsatellite instability = spelling mistakes)
26
example of hyperplasia?
lining of uterus
liver regeneration
testes
27
example of hypertrophy?
muscle (skeletal and cardiac)
28
example of atrophy?
leg in plaster cast
29
example of metaplasia?
barrets
| change from ciliated pseudostratified columnar epithelium in bronchi to squamous in response to smoking
30
squamous carcinoma in lung can only occur with smoking, true or false?
true
| usually isn't any squamous epithelium unless metaplastic change
31
anything shiny that's exposed to air?
non-keratinised
32
anything hard that's exposed to air?
keratinised
33
"heaped, rolled up edges"?
malignancy (means lesion is not well defined etc)
34
what is more common on greater/lesser curvature?
```
lesser = malignancy
greater = ulcer
```
35
signet rings?
nucleus pushed to the side
| = adenocarcinoma
36
does exrcise increase cancer risk?
yes
| bowel, breast and endometrial
37
breastfeeding cancer link?
reduced risk with breastfeeding
| - linked to oestrogen
38
vit A carotenoid?
reduced in smokers
| increases cancer risk when low
39
beta carotene?
anti-oxidant at low levels
| pro-oxidant at high levels
40
dairy guidelines?
2-3 milk portions
| 700mg calcium per day
41
acrylamide?
forms in starchy foods when burnt
| likely human carcinogen
42
transitional epithelium?
in bladder
43
epithelial tumour (carcinomas) almost never occur in children, true or false?
true
44
what cancers do children get?
blood
brain
bone
45
most common type of cancer?
carcinoma
46
older person with brain lesion?
metastatic carcinoma until proven otherwise
47
how does epithelial malignancy spread?
local growth
| spreads via haematogenous and lymphatic routes
48
where will lung, breast, GI and prostate tumours spread haematogenously?
```
lung = bone, brain, adrenal, liver
breast = similar to lung
GI = liver
Prostate = anywhere
```
49
what is a mesenchymal tumour?
derived of connective tissue
| sarcomas
50
where do sarcomas occur?
```
bone
cartilage
fat
fibrous tissue
muscle
blood vessels
nerves
```
51
defining feature of sarcoma?
local growth but don't often spread so can get very big
52
what do sarcomas lesions look like?
spindle cell lesions (cigar shaped)
53
diagnosis of sarcoma?
```
FISH
karyotyping (eg. ewings sarcoma = t11;22)
```
54
myeloid malignancy?
platelets
red cells
granulocytes
55
lymphoma presentation?
big lymph nodes in more than one area that doesn't fit with anatomical drainage of one location/area
large liver and spleen
less white cells
56
how are lymphoma cells different than other cancer cells?
not pleomorphic
| all look similar
57
glioma?
brain tumour
58
brain tumours don't spread, true or false?
true
59
most common causes of prostatism?
benign prostatic hyperplasia
| prostate cancer
60
what is PSA?
prostate specific antigen
type of tumour marker
can be high in prostate cancer of benign prostatic hyperplasia
61
sensitivity?
% of people with disease that have +ve test result
62
specificity?
where disease is absent, the % of people that will be diagnosed as healthy
63
positive predictive value?
likelihood of +ve test result meaning person has the disease
64
negative predictive value?
likelihood of a -ve test result meaning person is healthy
65
how is recurrence of prostate cancer checked?
PSA monitoring
66
ACG?
checks germ cells tumours and pregnancy
67
when does ALP rise?
cholestatic disease
pregnancy
cancer bone mets (osteoblasts make new bone after osteoclasts break it down, increasing ALP)
68
how are bone mets diagnosed?
isotope bone scan
69
failed ERCP?
possible malignancy
70
what causes more than1 area of pleural effusion (eg. bilateral)?
benign things
| HF, nephrotic syndrome
71
hypercalcaemia common in malignancy, true or false?
true (>2.55)
- stones
- bones
- groans
- moans (depression)
72
result of high calcium?
dehydration
73
how is calcium levels controlled?
parathyroid glands via PTH
74
how does PTH control calcium?
causes bone absorption (calcium absorbed from skeleton)
more calcium reabsorbed from renal tubules
indirectly - activates Vit D causing gut absorption of calcium
75
what is PTHrP?
parathyroid hormone related peptide
| same action as PTH but not picked up on in PTH assay
76
how is PTHrP detected?
really high calcium and very low PTH = presence of PTHrP
77
symptoms of cushings syndrome?
```
low K+
hypertension
nocturia
polydipsia
truncal obesity
plethora
ankle oedema
purpura of arms
```
78
what can cause cushings?
```
steroids
ectopic ACTH (small cell lung cancer)
```
79
radical treatment?
curative intent - at expense of side effects
80
palliative treatment?
non-curative - aims to improve QoL but not at expense of side effects
81
adjuvant therapy?
after surgery
| aimed at reducing recurrence
82
neo-adjuvant therapy?
before surgery
| usually shrinking a tumour before removal
83
local control?
time without recurrence or progression at specific tumour site
84
brachytherapy?
injecting tiny pellets of radioisotopes into tumour killing it from inside
85
systemic anti-cancer therapy (SACT)?
cytotoxic chemo
targeted therapy
immunotherapy
86
haematological effects of chemo?
neutropenia
| thrombocytopenia
87
GI chemo side effects?
diarrhoea
nausea
mucositis (mouth ulcers)
altered taste
88
how does external beam radiotherapy work?
breaks double strand causing cell to die
89
targeted cancer treatment?
monoclonal antibody
| tractuzumab/Herceptin
90
what cancer is radiotherapy good for?
squamous cancers
91
length of time between decision to treat and first chemo/brachytherapy treatement?
31 days
92
how can cancer cause facial swelling?
if tumour obstructs head and neck drainage (e.g SVC)
| treated with a stent
93
most common cancer inheritance?
multifactoral
94
most common mutation causing oncogene activation?
missence amino acid change
95
cancer is disease of somatic mosaicism?
yes
96
BRCA gene?
DNA strand breaks
97
hereditary colorectal cancer?
mismatched base
98
what does UV or chemical crosslinking cause?
xeroderma pigmentosa
99
what determines characteristic of cancer?
driver mutation
| not origin site
100
how does BRAF mutation cause melanoma?
activates KRAS pathway
| specific BRAF inhibitor effective
101
what is the Philadelphia chromosome?
genetic abnormality in chromosome 22 that causes leukaemia
102
how can driver mutations and genomic profiles of tumours be found?
NGS
103
what determines cancer behaviour?
somatic mutation
104
in a family with suspected inherited cancer gene, who would you test?
surviving affected relative
105
what is low cancer risk?
population risk
106
what is medium cancer risk?
3% 10 year risk
107
what is high cancer risk?
8% 10 year risk
108
what is MLH1 assoc with?
hereditary, nonpolyposis colorectal cancer
109
what does the MLH1 gene do?
DNA repair gene
110
what type of cancer is mesothelioma?
not a lung cancer
primary pleural malignancy
epithelial malignancy as mesothelial cells rest on basement membrane
111
how are asbestos fibres shown?
pearl stain (shows blue fibres)
112
rounded atelectasis?
asbestos
113
re-planning of stem cells?
metaplasia
114
name some viral carcinogens?
HPV
EBV
polyomavirus
HHV-8
115
how does plummer vinson syndrome present?
dysphagia
anaemia
oesophageal webs
116
risk of plummer vinson?
increased risk of oesophageal SCC
