MRCP 2 Flashcards
1
Q
Warfarin + new necrotic skin?
A
Warfarin induced skin necrosis
Occurs due to protein C deficiency
2
Q
Mechanism of warfarin induced skin necrosis ?
A
Deficiency of protein C
Protein C will fall when starting warfarin
WISN –> microthromboi in skin vessels and adipose tissue
3
Q
What type of malignancy is waldenstrom’s?
A
Lymphoplasmacytoid malignancy
Associated IgM
Features of hyperviscocity: Headache, visual disturbances, malaise, weight loss
4
Q
Should you give gentamicin in neutropaenic sepsis?
A
Add in gentamicin if specific microbiology indications
5
Q
What is the effect of st John’s wort?
A
Induced of P450
6
Q
What is normal in alpha thalassaemia ?
A
Protein electrophoresis is normal
7
Q
What receptors are seen on CLL?
A
Circulating clonal B lymphocytes
CD5, CD 29, CD 20, CD23
Immunophenotyping is diagnostic
8
Q
Prolonged APTT + does not correct on normal plasma + very bleedy?
A
Acquired inhibitor
- May represent an acquired haemophillia
9
Q
Management of unprovoked DVT?
A
- Detailed history
- CXR
- ECG
- Routine bloods
Only order tumour markers and scans if there are relevant signs or symptoms (may give false positives)
10
Q
In HIT should you continue anticoagulation?
A
HIT is hypercoagulable
Require non-heparin anticoagulant
Use a non heparin anticoagulant
e.g. Bivalirudin
11
Q
What are non heparin anticoagulants?
A
Bivalirudin
Fondaparinux
Direct oral anticoagulants
12
Q
What is the mechanism of unfractionated heparin ?
A
- Binds to antithrombin III
- Activates it
Binds directly to II, IX X - Prevents conversion of prothombin to thrombin
- Prevent conversion of fibrin to fibringoen
Additionally:
- Binds directly to thrombin
13
Q
What is the mechanism of low molecular weight heparin ?
A
- Binds to antithrombin III
- Activates it
Binds directly to II, IX X - Prevents conversion of prothombin to thrombin
- Prevent conversion of fibrin to fibringoen
DOES NOT BIND TO THROMBIN
14
Q
Cutaneous manifestation of pseudomonas?
A
Ecythma gangenosum
- Black lesions on skin
15
Q
Factors that make your think its MML?
A
Raised creatinine
Raised blood viscosity
Multiple lytic lesions
Bone pain
Anaemia
16
Q
Factors that make you think anti-phospholipid?
A
APTT that does not correct on normal plasma
Prone to clots
17
Q
What does PT measure?
A
Common + extrinsic pathway
18
Q
What does APTT measure?
A
Intrinsic pathway
19
Q
What does APTT measure?
A
Intrinsic pathway
20
Q
Factors involved in intrinsic pathway ?
A
12 –> 11–> 9 +8 –> common
21
Q
Factors involved in common pathway?
A
10 –> 5–> Prothrombin/ thrombin –> fibrinogen/fibrin
22
Q
Factors invovled in extrinsic pathway?
A
TF + 7 –> common pathway
23
Q
Inheritance of haemophillia?
A
X linked
24
Q
Haemophillia A - what factor?
A
Factor 8
25
Haemophillia B - what factor?
Factor 9
26
How to differentiate between intravascular and extravascular?
Haemosiderin in intravascular
27
What is the pathophysiology of paroxysmal nocturnal haemoglobinuria?
Glycopeptide deficiency - abscence of red cell membrane proteins
Deficient in CD 55 and CD 59
Prothrombotic
28
Diagnostic tests of PNH?
Absence of CD 55 and CD 59
Flow cytometry for abscence of CD 55 and CD 59
Hams test was originally used
29
Inheritance of G6PD?
X linked
30
WHO primary polycythaemia criteria?
Hb > 16
Haematocrit > .48
BM using hypercellularity
Jak 2 positive
Minor criteria:
EPO below normal range
31
Features of Type 1 HIT?
Occurs in first 48-72 hours
Count rarely falls below 100
No increase risk of thromboembolism
Count normally returns in 4 days
Can continue dalteparin
32
Features of HIT type 2 ?
Occurs day 5-10
Count falls to around 50
Increased risk of thromboembolism
Need to stop dalteparin
33
Smudge cells?
CLL
34
Features of hyper-eosinophilic syndrome?
Common in men 30-40
Lung invovlement
Cardiac involvement --> restrictive cardiomyopathy
May have angioedema and urticaria
Mnx:
High dose corticosteroids
If had FIP1L1 / PDGFRA mutation --> imatinib
35
What must be tested for in MALToma?
H pylori
If positive - treat with eradication therapy
36
APML translocation?
t 15:17
PML - RARA alpha fusion gene
37
Treatment of APML?
ATRA - arsenic trioxide treatment
38
Side effect of APML?
Differentiation syndrome - cytokine storm
39
Treatment of APML cytokine storm?
Dexamethasone
40
Most common cause of anaphylaxis in blood transfusion?
IgA deficiency
Defined as a IgA < 0.05
41
Management of a actively bleeding acquire haemophillia?
Recombinant factor VII
Support thrombin generation binding to activated platelets and bypasses need for factor VIII
42
WHat is the mechanism behind tranfusion associated lung injury?
anti-hla
anit-neutrophil
43
What is the time onset of TRALI?
Within 6 hours of transfusion
44
How is desforrioxime given?
Subcutaneous
8-10 hours per day for 5-7 days per week
45
Side effects of desforrioxime?
High frequency deafness
Retinopathy
46
Blood findings with CML?
Thrombocytosis - different size platelets ( anisothrombia)
Left shifted film
Basophillia
47
How is CML viewed?
Myeloproliferative disorder
48
Sickle cell: Treatment to reduced admission with pain episodes ?
Hydroxyurea
Increases foetal haemoglobin
49
Features of Hodgkin's?
Malignant proliferation of lymphocytes
25% constiutional symptoms
Rarely has alcohol induced pain
Reed Sternberg cells on biopsy
Causes patchy Bone marrow infiltration
Non-hodgkin's more likely to cause bone marrow infiltration
50
What is the mechanism of TTP onset?
Acquired disorder
Antibodies to ADAMST13
ADAMST13 cleave vonwilleband
Leads to multimer of von willebrand - platelets clump to
51
Pentad of TTP?
Fever
Micro agiopathic haemolytic anaemia
Thrombocytopaenia
Neuroligcal abnormalities
Kidney disease
In practice:
Schistocytes
Thrombocytopaenia
Elevated LDH sufficent to make diagnosis
Coagulation will be normal
52
Differentiate between TTP and HUS ?
Platelet count remains normal on HUS
Massive renal failure in HUS and very uraemic
53
Management of TTP?
Plasma exchange
54
Loss of protein from kidney, why are they anticoagulable?
Antithrombin III deficiency
55
TRALI: where are the antibodies?
Antibodies are anti HLA or anti granulocyte in the donor blood
56
What is the only unique factor to the extrinsic pathway?
Factor VII
57
For APML treatment, what is the derivative of the treatment ?
Involved retinoic acid receptor gene
Vitamin A
58
How to confirm Hodkin's lymphoma ?
PET guided CT for metabolic active lesion
59
Atypical lymphocytes with abnormal villous projections ?
Hairy cell leukaemia
Abnormal B cell - centric and centrally placed nuclei
60
How best to treat hair cell luekaemia
Responded very well to purine analogues cladribine and pentostatin
61
Antibitoic that exacerbates G6PD?
Ciprofloxacin
62
Inheritance of G6PD?
X linked recessive
63
Haemolysis vs liver disease ?
Conjugated - liver
Unconjugated - haemolysis
64
What type of antibody of cold agglutinin disease ?
IgM - suffer from cold reactive haemolysis
65
What anitbody is implicated in cold agglutiins ?
I antigen (big I)
66
Vincristine side effect?
Painless peripheral neuropathy
Constipation
Jaw pain
67
Mechanism of Cytarabine ?
Pyrimidine synthesis
68
Side effect of cytarabine ?
Alopecia
Pancytopaenia
GI upset
69
Side effect of doxorubicin?
Myocardial toxicity
Pancytopaenia
Mucositis
Peripheral neuropathy
70
How many blasts in marrow for AML?
>20%
71
Total protein high + albumin low
Think of reason - ? myeloma
72
Prognostic scoring for Waldenstroms?
Age < 65 - 0 points
age 66-75 - 1 point
age > 75 - 2 points
Beta 2 microglobulin > 4mg (1 point)
LDH > 250 ( 1 point)
Serum albumin < 35 ( 1 point)
73
Gum infiltration, organomegally, lymphadenopathy, monocytoid blasts, raised lysozyme levels?
AML subtype M4
Translocation 8:21
74
Beta thalassaemia minor - explain haemoglobins?
Reduced HbA
75
Mutations of Hb B ?
Hb C
HbD
HbE
Hb O
76
How many genes for HbA ?
4 genes
HbH disease if 3 deletion
Hydrops in 4 gene deletion
77
How many genes for Hb B?
2 genes
78
Increased HbA2 ?
Think Beta thal trait
HbA will not show on ratios - as there is more gene redundancy. Requires genetic testing
79
How to test for alpha thal?
Genetic testing
80
Best imaging for myeloma?
Whole body MRI
81
What are high risk features for tumour lysis syndrome?
High tumour burden
High grade tumours with rapid cell turnover
Pre-existing renal impairment or renal involvement by the tumour
Increased age
Treatment with highly active, cell-cycle specific agents
Concomitant use of drugs that increase uric acid levels (the list is available on the guidance)
82
What is considered low risk for tumour lysis ?
When there are no high risk features?
83
Management of low risk tumour lysis ?
Adequate hydration (consider IV fluids and allopurinol prophylaxis)
84
Management of medium risk tumour lysis?
7 day allopurinol + IVF
85
Management for high risk tumour lysis ?
Rasburicase and IV fluids (consider low dose chemotherapy)
86
What are these?
Acanthocytes - they all just different shapes
87
What is Zieve syndrome
Jaundice
Hyper-triglyceridaemia
Coomb's negative haemolytic anaemia
Alcoholism and recent binge.
88
Causes of acquire Coomb's positive haemolysis?
autoimmune: warm/cold antibody type
alloimmune: transfusion reaction, haemolytic disease newborn
drug: methyldopa, penicillin
89
Causes of acquire Coomb's negative haemolysis?
Microangiopathic haemolytic anaemia (MAHA): TTP/HUS, DIC, malignancy, pre-eclampsia
Prosthetic heart valves
Paroxysmal nocturnal haemoglobinuria
Infections: malaria
Drug: dapsone
90
What is used in treatment of hereditary angioedema?
1. IV CI inhibitor
2. FFP
91
What is used as a prophylaxis in hereditary angioedema?
Danazol
92
What is danazol?
A synthetic androgen
93
What is cryoglbulinaemia ?
Immunoglobulins which undergo reversible precipitation at 4 deg C, dissolve when warmed to 37 deg C. One-third of cases are idiopathic
94
What are the causes and features of cryoglobulinaemia type 1?
monoclonal - IgG or IgM
associations: multiple myeloma, Waldenstrom macroglobulinaemia
95
What are the causes and features of cryoglobulinaemia type 2?
mixed monoclonal and polyclonal: usually with rheumatoid factor
associations: hepatitis C, rheumatoid arthritis, Sjogren's, lymphoma
96
What are the causes of features of cryoglbouninaemia type 3?
polyclonal: usually with rheumatoid factor
associations: rheumatoid arthritis, Sjogren's
97
Features of type 1 cryoglobulinaemia?
Raynaud's only seen in type I
cutaneous
- vascular purpura
- distal ulceration
- ulceration
arthralgia
renal involvement
diffuse glomerulonephritis
98
How to manage cryoglbulinaemia?
treatment of underlying condition e.g. hepatitis C
immunosuppression
plasmapheresis
99
What is the cause of methaemoglobinaemia?
Drugs - nitric drugs
reduction of Fe3+ (ferric) to Fe2+ (ferrous)
100
Management of ITP?
first-line treatment for ITP is oral prednisolone
pooled normal human immunoglobulin (IVIG) may also be used
it raises the platelet count quicker than steroids, therefore may be used if active bleeding or an urgent invasive procedure is required
splenectomy is now less commonly used
101
Presentation of acute intermittent porphyria?
abdominal: abdominal pain, vomiting
neurological: motor neuropathy
psychiatric: e.g. depression
hypertension and tachycardia common
102
Diagnosis of acute intermittent porphyria?
Urinary screen for ALA and Prophybilinogen
103
General management for sickle cell crisis?
analgesia e.g. opiates
rehydrate
oxygen
consider antibiotics if evidence of infection
blood transfusion
104
When should exchange transfusion be used in sickle cell?
acute vaso-occlusive crisis (stroke, acute chest syndrome, multiorgan failure, splenic sequestration crisis
rapidly reduce the percentage of Hb S containing cells
105
DVT + Cancer: Duration of anticoagulation?
6 months
106
Why can G6PD levels be normal in a haemolytic episode?
Haemolysis
check levels in a couple of weeks time
107
Indications to treat in CLL?
Progressive marrow failure: the development or worsening of anaemia and/or thrombocytopenia
Massive (>10 cm) or progressive lymphadenopathy
Massive (>6 cm) or progressive splenomegaly
Progressive lymphocytosis: > 50% increase over 2 months or lymphocyte doubling time < 6 months
Systemic symptoms: weight loss > 10% in previous 6 months, fever >38ºC for > 2 weeks, extreme fatigue, night sweats
Autoimmune cytopaenias e.g. ITP
108
Treatment of CLL?
fludarabine, cyclophosphamide and rituximab (FCR) has now emerged as the initial treatment of choice for the majority of patients
Ibrutinib - for consolidation, or if FRC fails
109
What is a mimic for gastric cancer?
Myelfibrosis
massive spleen, vomiting, early satiety
110
Causes of TTP?
post-infection e.g. urinary, gastrointestinal
pregnancy
drugs: ciclosporin, oral contraceptive pill, penicillin, clopidogrel, aciclovir
tumours
SLE
HIV
111
What can eculizmab be used to treat? What is it?
Terminal complement protein C5
Used to treat paroxysmal nocturnal haemoglobinurea
112
What vaccine should patients with PNH and on eculizumab be given?
Nessira meningitis
Patients with C5 deficiency are at elevated risk of serious meningococcal infections and all patients being treated with eculizumab should receive a quadrivalent vaccine against the meningococcal strains A, C, W, and Y.
113
What is the management of JAK2 positive erythrocytosis?
Aspirin
Venesection < 0.45
114
Mechanism of dabigitran?
Direct thrombin inhibitor
115
Excretion of dabigitran?
Renal
116
Reversal of dabigitran?
Idarucizumab
117
Mechanism of rivaroxiabn?
Direct factor Xa inhibitor
118
Reversal of rivaroxiban?
Adexonate
119
Excretion of rivaroxiban?
Majority liver
120
Mechanism of apixaban?
Direct factor Xa inhibitor
121
Excretion of apixaban?
Mostly faecal
122
Reversal of apixaban?
Adexonate
123
Poor prognosis of CLL?
male sex
age > 70 years
lymphocyte count > 50
prolymphocytes comprising more than 10% of blood lymphocytes
lymphocyte doubling time < 12 months
raised LDH
CD38 expression positive
TP53 mutation
deletions of part of the short arm of chromosome 17 (del 17p) are seen in around 5-10% of patients and are associated with a poor prognosis
124
Good prognosis of CLL?
deletion of the long arm of chromosome 13 (del 13q) is the most common abnormality, being seen in around 50% of patients. It is associated with a good prognosis
125
If DVT less than 7 days before surgery, what should be done?
IVC filter + LMWH
126
What is the first line management of myelofibrosis?
Hydroxycarbamide
127
Features of porphyria cutanea tarda?
Hepatic porphyria
Blisters on sun exposure skin
elevated plasma porphyrins and elevated uroporphyrin I in the urine, and isocoproporphyrin in the faeces
subepidermal blisters with minimal inflammation, marked solar elastosis, thickening of the vessel wall in the papillary dermis and 'caterpillar bodies' in the roof of the blister.
classically photosensitive rash with bullae, skin fragility on face and dorsal aspect of hands
urine: elevated uroporphyrinogen and pink fluorescence of urine under Wood's lamp
128
Where is the defect in porphyria cutanea tarda?
defect in uroporphyrinogen decarboxylase
129
How do you manage porphyria cutanea tarda?
Chloroquine
130
How do you manage ITP when you need to raise platelets quickly?
Intravneous immunoglbulin
131
Consequences of gastrectomy ?
Vitamin B 12 deficiency
132
Management of congenital methahaemoglbin?
NADH methaemoglobin reductase deficiency
Management: Ascorbic acid
133
Ziev's syndrome ?
rare clinical syndrome of Coombs-negative haemolysis, cholestatic jaundice, and transient hyperlipidaemia
134
When should mast cell try-take be taken?
Immediately
Then one to two hours later
135
Anterior mediastinal mass + symptoms of myasthenia
thymoma
136
Abdominal pain, constipation, neuropsychiatric features, basophilic stippling?
Lead poisoning
Also:
dimorphic picture, significant reticulocytosis and high basophil numbers with cytoplasmic stippling.
Bilateral radial nerve palsies
137
When should neutropenic sepsis antibiotics be reviewed?
48 hours
138
What are the photosensitive porphyria ?
1) Neurovisceral - neuropathy, epilepsy, psychiatric disorders, abdominal, vomiting, constipation
2) Photosensitive - bullous eruption in sun exposed areas
3) Haemolytic
139
Mutation associated with myelofibrosis?
JAK2
140
Mutations seen in DLBCL?
BCL2 and TP53 mutations are seen in diffuse large B cell lymphoma.
141
What mutation is. seen in Burrito's lymphoma?
C MYC
142
What is Hyper IgM syndrome?
Hyper IgM syndrome is a heterogeneous group of disorders characterised by defective class-switch recombination leading to raised serum IgM with low levels of IgG and IgA
X linked
Hyper IgM syndrome characteristically presents with infections e.g. Pneumocystis pneumonia, hepatitis, diarrhoea
143
How does ATRA work?
Treatment is with all-trans retinoic acid (ATRA) to force immature granulocytes into maturation to resolve a blast crisis prior to more definitive chemotherapy
144
Anaphylaxis in blood products?
IgA deficiency
145
Management of hereditary spherocytosis/?
Splenectomy
146
What food shoulder neutropenic patients avoid?
Soft cheese
147
What is post thrombotic syndrome?
painful, heavy calves
pruritus
swelling
varicose veins
venous ulceration
148
Positive combs test at 37>0?
Warm haemolytic anaemia
149
Indications for irradiated blood?
150
Criteria for MGUS?
A monoclonal paraprotein band lesser than 30 g/L (< 3g/dL)
Plasma cells less than 10% on bone marrow examination
No evidence of bone lesions,anemia, hypercalcemia, or renal insufficiency related to the paraprotein
No evidence of another B-cell proliferative disorder
151
What supportive medication must be started in FRC?§
Co- trimoxazole
152
Deranged clotting in DIC + Emergent bleeding. How best to manage?
Fresh frozen plasma
153
Score above what in two level wells should support a doppler diagnosis?
Score of 2
154
CLL + New fevers + no signs of infection?
Richter transformation
155
Innate glycoprotein IIb/IIIa deficiency?
Glanzmann's thombasthenia
156
What does a PFA- 100 assay show?
The ability of platelets to coagulate
157
What are glycoprotein IIb/IIIa receptors?
Fibrinogen receptors
158
Rivaroxiabn, how long before procedure?
24 hours
159
Dabigatran , how long before procedure?
24-48 hours
160
Apixaban, how long before procedure?
24-48 hours
161
Fondaparinux, how long before prodecure?
36-48 hours
162
LMWH, how long before procedure?
12 hours prophylaxis,
24 hours treatment disease
163
Features of graft vs host skins disease?
Salary rash
14 days after transplant
164
Translocation of Burrito's lymphoma?
t(8:14)
165
Acutely elevated WCC in AML + stroke like symptoms?
Leukaphoresis
166
When should CMV seronegative blood be used ?
The use of CMV-seronegative blood products is reserved for CMV-seronegative individuals that are likely to proceed to haematopoietic stem cell transplant, or neonates
or if pregnant
167
Dapsone + dyspnoea?
methaemoglobinaemia
168
What is gaucher"s disease?
hepatomegaly and massive splenomegaly along with anaemia and thrombocytopenia. While all of the options listed can cause splenomegaly, only Gaucher's disease is associated with constriction of the diaphysis and flaring of the metaphysis of the femur, resulting in a deformity known as the Erlenmeyer flask deformity (named because it resembles the conical flask used by chemists).
169
Platelets not incrementing with MDS, what investigation?
HLA-matched platelets and single-donor platelets are used for individuals that are refractory to platelet transfusions and have developed anti-HLA or antiplatelet antibodies
170
What is the dose for adrenaline in anaphylaxis?
0.5ml of 1:1000
171
What antibiotic can cause eosinophillia?
Nitrofurantoin
172
Mutation in hairy cell leukaemia?
BRAF mutation
173
What informs surgical management for Breast cancer?
If presence of auxiliary lymphadenopathy
174
Breast cancer + no auxiliary lymphadenopathy?
Auxiliary ultrasound
175
Breast cancer + clinical auxiliary lymphadenopathy ?
Auxiliary lymph node
176
When is a mastectomy indicated in breast cancer?
Multifocal tumour
Central tumour
Large lesion in the breast
Ductal carcinoma in situ > 4 cm
177
When is a wide local excision indicated in breast cancer?
Solitary lesion
Peripheral tumour
Small lesion in the breast
Ductal carcinoma in situ < 4 cm
178
When is radiotherapy offered in breast cancer?
Stage T3-T4 in women who have had a mastectomy
Or women with 4 or more lymph nodes
179
When is hormone therapy indicated in breast cancer?
Positive for hormone receptors
Use tamoxifen for 5 years post diagnosis
180
What hormone drug should be used and when?
Tamoxifen --> pre and post menopsaul
Anastrozle --> post menopausal women
181
When is Neo-adjuvant chemotherapy used?
Downgrade tumours
182
Risk factors for breast cancer?
BRCA1, BRCA2 genes - 40% lifetime risk of breast/ovarian cancer
1st degree relative premenopausal relative with breast cancer (e.g. mother)
nulliparity, 1st pregnancy > 30 yrs (twice risk of women having 1st child < 25 yrs)
early menarche, late menopause
combined hormone replacement therapy (relative risk increase * 1.023/year of use), combined oral contraceptive use
past breast cancer
not breastfeeding
ionising radiation
p53 gene mutations
obesity
previous surgery for benign disease (?more follow-up, scar hides lump)
183
What is the mechanism of cyclophosphamide?
Akylinating agent
causing cross-linking of DNA
184
Adverse effects of cyclophosphamide?
haemorrhagic cystitis: incidence reduced by the use of hydration and mesna
myelosuppression
transitional cell carcinoma
185
Treatment for haemorrhgaic cystitis?
2-mercaptoethane sulfonate Na
a metabolite of cyclophosphamide called acrolein is toxic to urothelium
mesna binds to and inactivates acrolein helping to prevent haemorrhagic cystitis
186
Mechanism of bleomycin?
Degrades preformed DNA
187
Adverse effect for bleomycin?
Lung fibrosis
188
Mechanism of antracyclines?
Stabilizes DNA-topoisomerase II complex inhibits DNA & RNA synthesis
189
Adverse effect of anthracyclines?
Cardiomyopathy
190
Mechanism of methotrexate?
Inhibits dihydrofolate reductase and thymidylate synthesis
191
Mechanism of 5-FU?
Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase)
192
Mechanism of 6 mercaptourine?
Purine analogue that is activated by HGPRTase, decreasing purine synthesis
193
Mechanism of cytaarbne?
Pyrimidine antagonist. Interferes with DNA synthesis specifically at the S-phase of the cell cycle and inhibits DNA polymerase
194
Mechanism of vincristine?
Inhibits formation of microtubules
195
Mechanism of docetaxil?
Prevents microtubule depolymerisation & disassembly, decreasing free tubulin
196
Mechanism of irinotecan?
Inhibits topoisomerase I which prevents relaxation of supercoiled DNA
197
Mechanism of cisplatin?
Causes cross-linking in DNA
198
Mechanism of hydoxyurea/
Inhibits ribonucleotide reductase, decreasing DNA synthesis
199
What is the mechanism of checkpoint inhibitors?
Checkpoint inhibitors block inactivation of T cells and reactivate and increase the body’s own T-cell population, enhancing the immune systems own ability to recognise and fight cancer cells.
200
Mechanism of Ipilimumab and its use?
Melanoma
checkpoint inhibitor that blocks CTLA-4 (cytotoxic T lymphocyte-associated protein 4)
201
Mechanism of Nivolumab and its use?
pembrolizumab (Keytruda) blocks PD-1 (programmed cell death protein 1)
melanoma, Hodgkin's lymphoma, non-small cell lung cancer and urological cancers.
202
Side effects of immune checkpoint inhibitors?
Dry, itchy skin and rashes (most commonly)
Nausea and vomiting
Decreased appetite
Diarrhoea
Tiredness and fatigue
Shortness of breath and a dry cough.
203
Investigating cancer of unknown primary?
FBC, U&E, LFT, calcium, urinalysis, LDH
Chest X-ray
CT of chest, abdomen and pelvis
AFP and hCG
Myeloma screen (if lytic bone lesions)
Endoscopy (directed towards symptoms)
PSA (men)
CA 125 (women with peritoneal malignancy or ascites)
Testicular US (in men with germ cell tumours)
Mammography (in women with clinical or pathological features compatible with breast cancer)
204
Most common lung cancer in non-smokers?
Adenocarcinoma
205
Most common lung cancer in smokers?
squamous
206
Features of large cell lung cancer?
typically peripheral
anaplastic, poorly differentiated tumours with a poor prognosis
may secrete β-hCG
207
Causes of lymphoedema?
primary: inherited
secondary e.g. surgery, radiation, infection (classically filariasis) or injury resulting in damage to the lymphatic system
208
Management of spinal cord compression
High dose dexamethasone
209
Options of agitation in palliative care?
Halloperidol
other options: chlorpromazine, levomepromazine
210
Management of hiccups in palliative care?
chlorpromazine is licensed for the treatment of intractable hiccups
haloperidol, gabapentin are also used
dexamethasone is also used, particularly if there are hepatic lesions
Hiccups + nausea --> metoclopramide
211
How to convert beteen codine --> oral morphine?
divide by 10
212
How to convert between tramadol --> oral morphine ?
Divide by 10
213
How to convert oral morphine --> Oxycodone ?
Divide by 1.5 - 2
214
Convert between oral morpine --> subcut morphine/?
Divide by 2
215
Convert between oral morphine and subcut diamorphine?
Divide by 3
216
Convert between oral oxycodone --> subcut diamorphine
Divide 1.5
217
When increasing opiods, how much of an increase should you increase by?
30-50 %
218
How are people fed if radiotherapy mucositis expected?
PEG tube
219
Symptoms of spinal mets?
Unrelenting lumbar back pain
Any thoracic or cervical back pain
Worse with sneezing, coughing or straining
Nocturnal
Associated with tenderness
220
Features of SVC obstruction?
dyspnoea is the most common symptom
swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
headache: often worse in the mornings
visual disturbance
pulseless jugular venous distension
221
Common malignancies that cause SVC obstruction?
common malignancies: small cell lung cancer, lymphoma
other malignancies: metastatic seminoma, Kaposi's sarcoma, breast cancer
aortic aneurysm
mediastinal fibrosis
goitre
SVC thrombosis
222
Treatment of SVC obstruction?
Endovascular stenting
223
Ca 125?
Ovarian cancer
224
Ca 19-9
Pancreas
225
Ca 15-3
Ca 15-3
226
AFP?
Hepatocellular carcinoma, teratoma
227
CEA
Carcinoembryonic antigen (CEA)
228
S-100
Melanoma, schwannomas
229
Bombesin
Small cell lung carcinoma, gastric cancer, neuroblastoma
230
What can be used as a third line opiod in difficult to control pain ?
Methadone
231
What pain killer works through NMDA antagonism?
Methadone
232
Conversion of fentanyl to morphine?
100 micrograms fentanyl to 15 morphine
233
Prefered method of antiemetic if metabolic cause of vomiting?
Levomepromazine
234
Chance of acquiring cancer if BRCA 1 postivie?
55-60%
235
Imaging for SVC obstruction
CT chest
236
Transdermal fentanyl absorption is increased by heat (e.g. hot water bottle) or pyrexia, potentially leading to opioid toxicity
Transdermal fentanyl absorption is increased by heat (e.g. hot water bottle) or pyrexia, potentially leading to opioid toxicity
237
Complications of ketamine?
Can increase intracranial pressure
Monitor: headache, papilloedema, and vomiting
238
Vertebral collapse?
neurosurgery
239
Treatment for delayed phase vomiting from chemo?
Dexamethasone
240
Onset of immediate release morphine?
30 minutes
241
How can fentanyl lead to opiod toxicity?
Pyrexia increases transdermal absorption
242
TTF stain + adenocarcinoma histology
Non small cell lung cancer
243
Just know the fact : Causes for Non-Pitting Edema
1. Lymphedema
2. Myxedema
3. Lipedema
4. Angioedema
Just know the fact : Causes for Non-Pitting Edema
1. Lymphedema
2. Myxedema
3. Lipedema
4. Angioedema
