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Diagnostic Tools Flashcards

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1
Q

how many people are diagnosed with cancer in their lives

a) 1/5
b) 1/3
c) 1/2
d) 3/4

A

b) 1/3

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2
Q

which two cancers have the worst prognoses?

a) breast
b) colon
c) lung
d) skin
e) prostate

A

c) lung

e) prostate

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3
Q

which two cancers have the best prognosis

a) acute myeloid leukemia
b) breast
c) colon
d) hodgkin’s lymphoma
e) prostate
f) testicular

A

d) hodgkin’s

f) testicular

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4
Q

what does TNM staging stand for?

A

tumour
node
metastasis

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5
Q

what does it mean if a cancer is stage 4?

a) cancer is small and limited
b) patient has weeks to live
c) tumour is larger than 4cm
d) cancer is metastatic

A

d) cancer is metastatic

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6
Q

what does grade 4 cancer mean?

a) resemble normal cells, well differentiated, not growing rapidly
b) undifferentiated cells, anaplastic

A

b) undifferentiated cells, anaplastic

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7
Q

which cancer does NOT commonly metastasise to the liver?

a) prostate
b) colon
c) lung
d) breast

A

a) prostate

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8
Q

which cancer does NOT commonly metastasise to the lung?

a) breast
b) thyroid
c) lung
d) kidney

A

b) thyroid

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9
Q

which cancer does NOT commonly metastasise to the brain

a) lung
b) breast
c) ovary
d) melanoma

A

c) ovary

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10
Q

which cancer does NOT commonly metastasise to the bone?

a) breast
b) bronchus
c) kidney
d) squamous cell
e) prostate
f) thyroid

A

d) squamous cell

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11
Q

which cancer does NOT commonly metastasise to the peritoneum?

a) ovary
b) GI tract
c) pancreas
d) throat

A

d) throat

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12
Q

which metastasis site is most common for head and neck, thyroid and lung cancers?

a) high cervical nodes
b) low cervical/supra-clavicular nodes
c) axilliary nodes

A

a) high cervical nodes

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13
Q

which lymphatic metastatic site is NOT common for lung, breast, melanoma and GI cancers?

a) high cervical nodes
b) low cervical/supra-clavicular nodes
c) axilliary nodes

A

a) high cervical nodes

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14
Q

which of these cancers does NOT not commonly metastasise to the inguinal lymph nodes?

a) breast
b) ovary
c) prostate
d) ano-rectal
e) vulva

A

a) breast

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15
Q

what is the most common end of life symptom?

a) confusion
b) sweating
c) breathlessness
d) death rattle

A

d) death rattle (56%)

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16
Q

is urinary dysfunction frequent at the end of life?

a) yes
b) no

A

a) yes

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17
Q

is pain or nausea and vomiting more common at the end of life?

a) nausea & vomiting
b) pain

A

a) pain (51%)

nausea and vomiting only 14%

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18
Q

what is the name for the framework put in place by a doctor if they wouldn’t be surprised if a patient died within a year?

a) silver
b) gold
c) liverpool care pathway
d) newcastle care pathway

A

b) gold

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19
Q

how many palliative care patients have a single identifiable cause of nausea and vomiting?

a) 1/5
b) 1/3
d) 1/2
d) 3/4

A

b) 1/3

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20
Q

how many palliative care patients have multiple causes of nausea and vomiting?

a) 1/5
b) 1/3
d) 1/2
d) 3/4

A

b) 1/3

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21
Q

what are the four types of nausea mediated by the vomiting centre?

A 
vestibular
gastric
toxic
cerebral
(it's Very Gross to Tactical Chunder)
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22
Q

what type of sickness is characterised by nausea and sudden vomiting on movement e.g. turning?

A

vestibular

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23
Q

what antiemetic is best to give in vestibular N&V?

a) haloperidol
b) metoclopramide
c) cyclizine

A

c) cyclizine

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24
Q

what type of sickness is characterised by early satiety, hiccoughs, heartburn, large vomits esp after eating and drinking, ‘sticking’?

A

gastric

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25
what antiemetic is best to give in gastric N&V? a) haloperidol b) metoclopramide c) cyclizine
b) metoclopramide
26
what type of sickness is characterised by persistent nausea, small vomits and retching?
toxic
27
what antiemetic is best to give in toxic N&V? a) haloperidol b) metoclopramide c) cyclizine
a) haloperidol
28
what type of cerebral sickness is characterised by nausea and vomiting triggered in certain situations?
anxiety/anticipatory
29
what drug therapy is best in anxiety/anticipatory N&V?
BZDPs
30
what type of cerebral sickness is characterised by an early morning headache, vomiting, neurological stigmata?
raised ICP
31
what antiemetic should be given alongside dexamethasone in N&V caused by raised ICP? a) haloperidol b) metoclopramide c) cyclizine
c) cyclizine
32
dolasetron and ondansetron are examples of what type of anti-emetic? a) dopamine receptor antagonist b) histamine antagonist c) anti-cholinergic agents d) 5-HT3 receptor antagonists
d) 5-HT3 receptor antagonists
33
what is the best use/most likely indication for use of ondansetron? a) post-operative N/V b) chemo-induced N/V c) palliative care N/V
b) chemo-induced N/V
34
5-HT3 receptor antagonists can cause potassium channel blockage. this will result in what ECG abnormality? (a side effect of the drug)
qt prolongation
35
haloperidol, prochlorperazine and domperidone are examples of what type of anti-emetic? a) dopamine receptor antagonist b) histamine antagonist c) anti-cholinergic agents d) 5-HT3 receptor antagonists
a) dopamine receptor antagonist
36
how is domperidone administered? a) orally b) bucally c) rectally
c) rectally
37
metoclopramide is a dopamine receptor antagonist but has what direct effect on the gut? a) akinetic b) prokinetic c) spasmodic d) anti-spasmodic
b) prokinetic
38
at high doses, metoclopramide can show effects of what other group of anti-emetics? a) histamine antagonist b) anti-cholinergic agents c) 5-HT3 receptor antagonists
c) 5-HT3 receptor antagonists
39
what is the best use/most likely indication for use of haloperidol or prochlorperazine? a) post-operative N/V b) chemo-induced N/V c) palliative care N/V
a) post-operative N/V
40
what type of anti-emetic is most likely to have these side effects?: sedation, EPSEs, neurologic malignant syndrome a) 5-HT3 b) dopamine c) anti-cholinergic d) histamine
b) dopamine
41
which neurological condition is contraindicated when considering prescribing dopamine receptor antagonists as anti-emetics?
parkinson's disease
42
which anti-emetic works by blocking H1 receptors which induce sickness by triggering chemoreceptor zones?
histamine antagonists
43
which anti-emetic is best to use in pregnancy? why?
histamine antagonists - not teratogenic
44
what is the best use/most likely indication for use of cyclizine or promethiazine? a) post-operative N/V b) drug-induced N/V c) palliative care N/V
b) drug-induced N/V
45
fill in the gaps for the following anticholinergic side effects: ___ as a hare, ___ as a bone, _____ as a bat, ___ as beet, ___ as a hatter
``` hot dry blind red mad ```
46
what group of anti-emetics do histamine antagonists share side effects with? a) 5-HT3 b) dopamine c) anticholinergic
c) anticholinergic AND DROWSINESS TOO
47
prostatic hypertrophy, urinary retention and closed-angle glaucoma are contraindications for the use of which antiemetic? a) histamine b) dopamine c) anti-cholinergic d) 5-HT3
a) histamine
48
hyoscine is an example of what type of anti-emetic? a) a) histamine b) dopamine c) anti-cholinergic d) 5-HT3
c) anti-cholinergic
49
aside from oral, how else can anticholinergic anti-emetics be administered?
transdermal patch
50
what type of anti-emetic is levomepromazine?
**broad-spectrum** (but it's main action is dopamine receptor antagonist)
51
what is the best use/most likely indication for use of levomepromazine? a) post-operative N/V b) drug-induced N/V c) palliative care N/V
c) palliative care N/V
52
what is the most dangerous side effect of levomepromazine?
agranulocytosis
53
drowsiness, dizziness, postural hypotension, photosensitivity and agranulocytosis are side effects of which anti-emetic? a) hyoscine b) levomepromazine c) ondansetron d) cyclizine
b) levomepromazine
54
alcohol, renal/hepatic failure, heart failure and high stroke risk are contraindications of which anti-emetic? a) levomepromazine b) hyoscine c) domperidone d) haloperidol
a) levomepromazine
55
which of these is NOT a reason why constipation is very common in palliative care? a) immobility b) overuse of laxatives c) reduced food/drink intake d) drugs e.g. opioids e) bowel pathology f) hypercalcaemia
b) overuse of laxatives
56
what counter-intuitive side effect can be caused by severe constipation?
overflow diarrhoea
57
how frequently should laxatives be reviewed in palliative care?
2 days
58
what therapies could be considered as step-ups in palliative care if the bowels haven't opened after 3 days of laxative therapy?
PR, suppositories, enema
59
give an example of bulk forming laxatives
fybogel
60
are bulk forming laxatives used frequently in palliative care? a) yes b) no
b) no
61
give an example of a stool softener laxative
lactulose | sodium docusate
62
what is a side effect of lactulose?
bloating | flatulence
63
give an example of a stimulant laxative
senna | dantron
64
which laxative should be avoided if a patient has colic? a) bulk forming b) stool softener c) stimulant
c) stimulant
65
movicol and co-danthrusate are combinations of which two types of laxative?
softener and stimulant
66
what laxatives are commonly used in treatment of opiod-induced constipation a) stimulant e.g. senna b) bulk-forming e.g. fybogel c) combination e.g. movicol
c) combination e.g. movicol
67
in general, if a patient can swallow, should analgesia always be given orally? a) yes b) no
a) yes
68
in palliative analgesia, should you leave paracetamol on the prescription even if morphine is also prescribed? a) yes b) no
a) yes
69
give an example of a weak opiod
codeine co-codamol dihydrocodeine
70
fill in the gaps for the possible dosages for co-codamol tablets _/500 __/500 __/500
8 15 30
71
how frequently can co-codamol be administered?
2 tablets QDS
72
what are the two formulations for morphine?
immediate release | modified release
73
after how long does immediate release morphine start to work?
30 mins
74
how long does immediate release morphine work for?
4 hours
75
how long does modified release morphine last for?
12 hours
76
what type of morphine is oramorph?
immediate release
77
what type of morphine is morphine sulphate?
modified release
78
what type of morphine is zomorph?
modified release
79
why are buprenorphine and fentanyl useful if a palliative care patient cannot swallow or tolerate a syringe driver?
can be given using a transdermal patch
80
name 3 other strong opiods except for morphine
fentanyl oxycodone methadone
81
name 2 drugs which can be used to treat neuropathic pain
amitriptyline gabapentin pregabalin
82
when calculating a PRN dose for morphine, what fraction of the total 24hr dose should it be?
1/6
83
when converting oral morphine to subcut morphine what do you divide the total 24hr dose by?
2
84
what other drug might you consider to reduce pain caused by swelling?
dexamethasone
85
what holistic treatment can often benefit patients with breathlessness at the end of their lives?
fan directed at face
86
how can opioid therapy help with breathlessness in palliative care?
decrease respiratory effort
87
how can BZDPs help with breathlessness in palliative care?
may calm anxiety or panic attacks causing hyperventilation
88
what is the commonly used name for hyoscine butylbromide?
buscopan
89
why is hyoscine butylbromide preferred over hyoscine hydrobromide?
doesn't cross blood brain barrier (hydrobromide may cause sedation or agitation)
90
in calcium homeostasis, what does the thyroid release when there is high calcium in the blood? a) calcitonin b) PTH
a) calcitonin
91
in calcium homeostasis, how does calcitonin affect the kidneys?
reduced absorption of calcium
92
in calcium homeostasis, how does calcitonin affect the bone?
promotes osteoblast deposit of calcium in bones
93
in calcium homeostasis, what does the parathyroid release when there is low calcium in the blood? a) calcitonin b) PTH
b) PTH
94
in calcium homeostasis, how does PTH affect the kidneys?
stimulates to absorb calcium | kidneys also convert Vit D to stimulate the bowels to absorb calcium
95
in calcium homeostasis, how does PTH affect the bone?
promotes osteoclasts to release calcium from bone
96
fill in the blanks: BRCA _ mutation is responsible for increased risk of early onset breast and male breast cancer. BRCA _ mutation is responsible for increased breast and ovarian cancer risk.
2 | 1
97
out of breast, colorectal and lung cancer, which two have stage 1 five year survival rates of around 80%?
breast and colorectal
98
out of breast, colorectal and lung cancer, which has a stage 4 five year survival rate of less than 6 months?
lung
99
what disease is QRisk2 a prediction algorithm for? a) stroke in AF b) CVD c) blood clot
b) CVD
100
``` which GP prediction algorithm considers: age, BP, smoker, cholesterol ratio, BMI, ethnicity, deprivation, FHx, chronic kidney disease, rheumatoid arthritis, AF, diabetes, antihypertensives a) QRisk2 b) CHAD2DS2-VASc c) HASBLED ```
QRisk2
101
if a QRisk2 score is over 10, what action is indicated? a) antihypertensive therapy b) statin therapy c) anti-coagulation
b) statin therapy
102
what disease is CHAD2DS2-VASc a prediction algorithm for? a) stroke in AF b) CVD c) blood clot
a) stroke in AF
103
``` what do these values mean in a CHAD2DS2-VASc score? C H A D S V A Sc ```
``` congestive heart failure hypertension age (>=75) diabetes stroke, tia or clot previously vascular disease age 65-74 Sex (female more at risk) ```
104
what disease is HASBLED a prediction algorithm for? a) major bleed in AF b) CVD c) blood clot
a) major bleed in AF
105
``` what do these values mean in a HASBLED score? H A S B L E D ```
``` hypertension abnormal liver/kidney stroke bleeding labile INR elderly >65 drugs/alcohol ```
106
what does a higher HASBLED score indicate?
prediction for how many patients with that score would have a bleed, out of 100

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