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Med School Finals > MFE, Oncology & Palliative Care > Flashcards

MFE, Oncology & Palliative Care Flashcards

1
Q

Confirmation of death checklist?

A

Check patient ID
Look for respiratory effort
Check for verbal response
Check for pain response
Assess pupillary reflexes
Palpate carotid artery (> 1 min)
Listen for heart sounds (> 1 min)
Listen for lung sounds (> 1 min)

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2
Q

“Just in case” medicines and indications?

A

Morphine sulphate (pain, breathlessness)
Midazolam (agitation, anxiety, breathlessness)
Hyoscine butylbromide (respiratory secretions)
Levomepromazine (N&V)

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3
Q

Pain management ladder?

A

Mild = paracetamol or NSAID (+ adjuvant)
Moderate = weak opioid + above
Severe = change weak to strong opioid

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4
Q

Weak vs strong opioids?

A

Weak = codeine, tramadol
Strong = morphine, oxycodone, fentanyl, alfentanil, methadone, buprenorphine

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5
Q

Opioids used in mild-moderate vs severe renal impairment?

A

Mild-moderate (eGFR < 90) = oxycodone
Severe (eGFR < 30) = alfentanil, fentanyl, buprenorphine

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6
Q

Adjuvant pain medications?

A

Anticonvulsants e.g. gabapentin
Antidepressants e.g. amitriptyline
Corticosteroids e.g. dexamethasone
Local anaesthetics e.g. lidocaine
Bisphosphonates e.g. zoledronic acid

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7
Q

Breakthrough opioid and oral to subcut morphine calculations?

A

Breakthrough opioid = 1/6th-1-10th of 24 hour dose
Oral to subcut morphine = divide by 2

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8
Q

How much should an opioid dose be increased each day if required?

A

30-50%

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9
Q

Morphine is an agonist of which opioid receptor?

A

Mu (µ) receptor

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10
Q

Signs of opioid toxicity vs withdrawal?

A

Toxicity = bradycardia, hypotension, hypothermia, sedation, coma, miosis
Withdrawal = tachycardia, diaphoresis, agitation, sneezing/yawning, mydriasis

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11
Q

List some oncological emergencies?

A

Hypercalcaemia
Cord compression
SVC obstruction
Tumour lysis syndrome
Neutropenic sepsis

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12
Q

Features and management of hypercalcaemia?

A

Bone pain
Kidney stones
N&V, constipation
Fatigue, depression, confusion
Management = IV fluids (1st line), IV bisphosphonate (2nd line)

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13
Q

Features, investigation and management of malignant spinal cord compression?

A

Back pain
Leg weakness
Incontinence
Sensory changes
Investigation = whole spine MRI < 24 hours
Management = dexamethasone, analgesia, radiotherapy or surgical decompression (if appropriate)

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14
Q

Main 3 cancers which cause bone metastases?

A

Prostate
Breast
Lung

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15
Q

Most common sites of bone metastases?

A

Spine (most common)
Pelvis
Ribs
Skull
Long bones

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16
Q

Management options for metastatic bone pain?

A

Strong opioids e.g. morphine
Bisphosphonates
Radiotherapy

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17
Q

Features, investigation and management of SVCO?

A

Breathlessness
Swelling of face/neck/arms
Pemberton’s +ve
Headache
Raised JVP
Visual changes
Investigation = CT chest
Management = dexamethasone, analgesia, radiotherapy or endovascular stenting (if appropriate)

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18
Q

Condition which puts patients most at risk of tumour lysis syndrome?

A

Haematological malignancy e.g. Burkitt’s lymphoma

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19
Q

Features and management of tumour lysis syndrome?

A

Myalgia
N&V
Fatigue
Heart palpitations
Urinary disturbance
Management = allopurinol, rasburicase

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20
Q

Biochemical features of tumour lysis syndrome and why?

A

Hyperkalaemia (from tumour cells)
Hyperphosphataemia (from tumour cells)
Hypocalcaemia (↑ PO = ↓ Ca)
Hyperuricaemia (purine catabolism of nucleic acids produces uric acid)

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21
Q

What is the most common pathway for AKI in tumour lysis syndrome?

A
  • High levels of serum PO bind Ca to form CaPO crystals
  • Crystals injure or obstruct tubules
  • Reduced urine output
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22
Q

Diagnostic criteria for neutropenic sepsis?

A

Temperature > 38.5 or 2 readings over 38 + neutrophils < 0.5 (or predicted to be < 0.5 in next 48 hours)

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23
Q

Empirical treatment for neutropenic sepsis?

A

IV tazobactam + piperacillin (tazocin)

24
Q

Screening tool for delirium and contents?

A

4-AT:
Alertness
Age/DOB/time/place
Months of the year backwards
Acute change or fluctuating course

25
Q

What is delirium? List some causes.

A

Acute state of confusion:
Pain
Infection
Electrolyte/metabolic
Constipation
Medications
Drug withdrawal
Change of environment

26
Q

Drug choices for agitation in delirium?

A

Haloperidol or olanzapine

27
Q

Examples of bulk forming, stool softening, osmotic and stimulant laxatives?

A

Bulk-forming = fybogel (ispagala husk), methycellulose
Stool softening = docusate
Osmotic = lactulose
Stimulant = senna, dulcolax (bisacodyl)

28
Q

Factors favouring delirium over dementia?

A

Acute onset
Fluctuating symptoms
Impaired consciousness
Poor attention span

29
Q

Tools for elderly patient medication reviews?

A

STOPP and START criteria

30
Q

What causes stress, urge, mixed, overflow and functional urinary incontinence?

A

Stress = increased abdominal pressure
Urge = detrusor overactivity
Mixed = stress + urge physiology
Overflow = blockage or detrusor underactivity
Functional = can’t get to toilet in time (bladder healthy)

31
Q

Investigations for urinary incontinence?

A

Bladder diary
Urine dipstick
Post-void USS

32
Q

Management of stress incontinence?

A

1st line = lifestyle changes, pelvic floor exercises
2nd line = duloxetine
3rd line = mid-urethral sling

33
Q

Management of urge incontinence?

A

1st line = lifestyles changes, pelvic floor exercises, bladder training
2nd line = tolterodine, solfenacin, oxybutynin (1st line), mirabegron (2nd line)

34
Q

Adjuvant for post-menopausal women with urinary incontinence?

A

Intravaginal oestrogen

35
Q

Most common cause of dementia?

A

Alzheimer’s disease

36
Q

Pathology of Alzheimer’s?

A
  • Widespread cerebral atrophy
  • ACh deficit from neuronal loss
  • Beta-amyloid plaques
  • Tau protein (microtubule-associated protein in neurons) aggregates to form neurofibrillary tangles
37
Q

Areas of brain most affected by atrophy in Alzheimer’s?

A

Cortex
Hippocampus

38
Q

Mutations associated with early-onset Alzheimer’s?

A

Amyloid precursor protein (APP)
Presenilin 1 (PSEN1)
Presenilin 2 (PSEN2)

39
Q

Mutation associated with late-onset Alzheimer’s?

A

ApoE4

40
Q

Drug options for Alzheimer’s?

A

1st line = cholinesterase inhibitor (donepezil, galantamine, rivastigimine)
2nd line = memantine

41
Q

Memantine mechanism of action?

A

NMDA-receptor antagonist
Prevents glutamate excitotoxicity (causes neuronal cell death)

42
Q

Investigations for dementia?

A

Cognitive assessment e.g. MMSE, Addenbrooke’s (ACE-III)
Blood tests
Head CT

43
Q

Features of vascular dementia?

A

Cognitive deterioration (stepwise)
Evidence of vessel disease
Focal neurological signs

44
Q

Features of Lewy body dementia?

A

Cognitive deterioration (fluctuating)
Visual hallucinations
REM sleep disorder
Parkinsonism

45
Q

Main protein in Lewy bodies?

A

Alpha synuclein

46
Q

Types of Lewy body dementia (LBD) and how to distinguish them?

A

Parkinson’s disease dementia = dementia presents > 1 year after motor symptoms
Dementia with Lewy bodies = dementia presents before, at the same time or < 1 year after motor symptoms

47
Q

Features of Alzheimer’s disease?

A

4 As:
Amnesia (short-term before long-term)
Aphasia (communication problem)
Agnosia (poor recognition)
Apraxia (loss of motor control)

48
Q

Key features of frontotemporal dementia (Pick’s disease)?

A

Early personality and speech changes

49
Q

BRCA gene risks in men vs women?

A

BRCA 1 and 2 in women increases risk of breast and ovarian cancer
BRCA 2 mutation in men increases risk of prostate cancer

50
Q

Cancer linked to CA 125, CA 19-9, CA 15-3, PSA, AFP, S-100 and CEA?

A

CA 125 = ovarian
CA 19-9 = pancreatic
CA 15-3 = breast
PSA = prostate
AFP = germ cell tumour, hepatocellular carcinoma
S-100 = melanoma, schwannoma
CEA = colorectal cancer

51
Q

Antiemetics used for reduced gastric motility?

A

Metaclopramide
Domperidone

52
Q

Antiemetics used post-chemotherapy?

A

Ondansetron
Haloperidol
Levomepromazine

53
Q

Antiemetics used in raised ICP?

A

Cyclizine
Dexamethasone

54
Q

Antiemetic for vestibular N&V?

A

Cyclizine

55
Q

Side effects of bleomycin, doxorubicin, vincristine, cyclophosphamide and cisplatin?

A

Bleomycin = lung fibrosis
Doxorubicin = cardiotoxic
Vincristine = peripheral neuropathy
Cyclophosphamide = haemorrhagic cystitis, transitional cell carcinoma
Cisplatin = peripheral neuropathy, ototoxicity

Med School Finals (18 decks)

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