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MRCP PART 1 > Onc / palliative > Flashcards

Onc / palliative Flashcards

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1
Q

Side effect long term amiodarone

A

Hepato / pulm fibrosis
Hyper/Hypo thyroid
Corneal deposits
Pancreatitis
Long QT

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2
Q

supraclavicular fossa lymph node usually which tumour

A

Gastric
[Virchow’s node and

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3
Q

Infection assoc with 1/3 gastric tumours

A

H pylori

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4
Q

Metastatic gastic adenoma. What testing do you do? What is treatment if this is positive

A

HER2
[human epidermal growth factor receptor 2]

Trastuzumab

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5
Q

What is Zollinger-Ellison syndrome? Which syndrome are they linked to? Main symptoms ?

A

Gastrin secreting tumours -> gastric / duodenal ulceration
[Usually pancreatic in origin]

MEN1

Epigastric pain
Steatorrhoea (acid-related inactivation of digestive enzymes)
Diarrhoea - From acid secretion

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6
Q

Zollinger-Ellison syndrome - high serum gastrin levels and elevated basal gastric acid output.
Main Ix? 2 parts of medical RX?

A

Endoscopy + CT

High dose PPI
Surgical resection ( in most)
chemo
Somatostatin analogues - Eg Ocretide to reduce gastric secretion and diarrhoea

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7
Q

acrocyanosis

A

Blue discolouration of hands - especially when in cold

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8
Q

Poikilocytosis

A

Abnormal shape RBCs (making up >10%)

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9
Q

What is cryoglobulinemia? Conditions assoc? Ix?

A

abnormal blood proteins called cryoglobulins clump together at cold temperatures
Seen in myeloma / leukaemia / lymphoma
-Some infections too Eg HepC, HIV, toxoplasmosis, EBV, malaria

Incubate serum at 4°C

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10
Q

Some less common cancer markers…

Neurone specific enolase NSE

A

Small cell lung Ca
Neuroblastoma

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11
Q

Some less common cancer markers…

HCG

A

Testis

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12
Q

Some less common cancer markers…

Calcitonin

A

Medullary thyroid

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13
Q

Some less common cancer markers…

Parathormone

A

Parathyroid

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14
Q

Some less common cancer markers…

IgG, IgA, IgM, IgE

A

Multiple myeloma

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15
Q

Some less common cancer markers…

AFP - name 2

A

Liver
Testis
Yolk sac

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16
Q

Some less common cancer markers…
Ca 15-3

A

Breast
Bowel
Lung

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17
Q

how does late chemo toxicity usually present

A

Peripheral neuropathy
Ototoxicity

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18
Q

why do 5% of testis Ca have gynaecomastia

A

Tumour secretes HCG

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19
Q

Enzyme sometimes used for seminoma marker

A

PLAP
Placental alkaline phosphatase

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20
Q

2 main classes of testis Ca

A

-Seminoma

-Non-semonomas germ cell tumour (NSGCT)
Eg Yolk sac, teratoma, choriocarcinoma, embryonal

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21
Q

80% cure of testis Ca with orchidectomy.
What is offered to reduce the risk of relapse

A

Single dose carboplatin

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22
Q

Who gets resection of HCC? Transplant?

A

Need Childs-pugh class A for resection
[still 20% operative mortality]

Transplant
-Single tumour <5cm with no metastatic spread
-AFP <1000iu/ml

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23
Q

Which lung Ca usually has Mets at presentation

A

Small cell

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24
Q

Which lung Ca is usually more peripheral

A

Adenocarcinoma

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25
General differentiation between lung mets and primary lung Ca on CT
Primary - soft tissue mass with irregular borders Met - smooth and rounded
26
Paraneoplastic syndromes which lung Ca ? Hypovolaemic hyponatraemia Raised ACTH Hyper Ca Gynaecomastia Hyperthyroid Lambert-eaton Hypertrophic pulmonary osteoarthropathy
Hypovolaemic hyponatraemia - SIADH = small cell Raised ACTH - Small cell Hyper Ca - Squamous - from bony mets [rarely produces PTH too) Gynaecomastia - Large cell (large breasts) and adenocarcinoma Hyperthyroid - Squamous (produces TSH) Lambert-eaton - Small cell Hypertrophic pulmonary osteoarthropathy - Adenocarcinoma
27
What is lambert eaton? How is it differentiated from myasthenia gravis
Paraneoplastic from small cell -> proximal myopathy Weakness improves with repetitive movements
28
What is Hypertrophic pulmonary osteoarthropathy
Paraneoplastic from lung adenocarcinoma (and rarely small cell) Osteitis, Gross finger clubbing, and arthritis Long bones usually affected
29
What is pancoast found? Where does it affect? Sx? On CXR
Non small cell [in superior sulcus] Affects C8 nerve root -> pain down arm -may get hand muscle wasting - Horners syndrome CXR - shadow at apex + possible destruction of 1st/2nd ribs
30
Most common causes of fever (when neutropenic)
60% Gram positive - staph epi / strep viridans 30% gram neg - E coli, klebsiella, pseudomonas
31
Roll of MENSA in chemo
To prevent haemorrhagic cystis [given with some chemo drugs (cyclophosphamide/ifosfamide) to protect bladder]
32
A and C fibres in pain
A - Acute C - slower - chronic pain
33
Colorectal and endometrial cancer as a pair often in?
HNPCC
34
B symptoms hodgkins
Fevers Night sweats Weight loss
35
Main side effects of hyoscine
Anticolinergic -> Tachycardia, dry mouth, urinary retention
36
When might you think colorectal ca is more likely HNPCC than sporadic
Young <45 Second cancer eg endometrial Usually proximal colon Strong family Hx
37
NHS bowel screening in who
60-74 every 2 years
38
Diagnosis of SIADH
Concentrated urine Na >20 HypoNatraemia <125 High osmolality NO hypovolaemia, diuretics or oedema/ascities
39
What is demeclocycline used for
SIADH ->Blocks ADH and causes partial nephrogenic diabetes insipidus
40
Paraneoplastic cerebella degeneration is in tumours of breast, ovarian, fallopian tube... What is the antibody found
Anti-yo
41
Anti Hu found in
Small cell lung ca
42
Anti-ro
SLE
43
Anti-Tr
Hodgkins lymphoma [The reed cells]
44
Anti zic4
small cell lung ca
45
Gabapentin mechanism
Blocks a2d receptor
46
Pt lacks capacity and has no NOK. Who is best to contact re DNACPR decision
Independent mental health advocate
47
Pt treated with doxorubicin (chemo) then develops cardiac failure several months later what has happened
Chemo induced cardiomyopathy ->biventricular failure
48
Genetic risk factor for breast Ca (not BRCA ? Other risks
BRCA 1 and 2, TP53 COCP, HRT Early menarche, late menopause, nulliparity
49
In order, what are the 2 most common met sites from breast Ca
Bones Lungs
50
What should be given after resection of breast Ca
Tamoxifen
51
When would you get a mastectomy in breast Ca
>4cm multifocal central
52
ER and HER2 status in Breast Ca prognosis?
ER +ve = better prognosis HER2 = Poorer prognosis
53
Tachycardia, flushing, bronchoconstriction, diarrhoea, CV instability = ? ix?
Carcinoid syndrome 5-HAI
54
Cancer with bone mets + anaemia. What would be seen on blood film
Leukoerythroblastic blood film (nucleated erythrocytes and immature white cells of the neutrophilic myeloid series.)
55
Prostate Ca are adenocarciomas which area of prostate do they usually arise? BPH?
Peipheral zone BPH is in transition zone [Transition into old age]
56
What is the roll of LH agonists in prostate Ca ? Side effects? Eg?
Act on pit -> reduce LH secretion -> Leydig cells in testes produce less testosterone Loss of libido, flushing, malaise Goserelin, buserelin, gonadorelin, leuprolide, nafarelin. [-relin]
57
what is cyproterone acetate / flutamide / biclatumide
Anti androgen used in Protstate Ca
58
Main risks causing thyroid Ca
Radiation MEN2 BRAF gene
59
What is most common type of thyroid cancer? Which gene is this linked to - not part of multi-ca syndromes?
Papilliary BRAF
60
Which thyroid Ca in MEN2? produces what ? Diagnosis of MEN2 ?
Medullary Calcitonin RET- proto oncogene test
61
Rash over lots of areas, muscle weakness + something in history about Ca Eg Weight loss and bloating =
Dermatomyositis From ovarian/pancreas/breast and lung. Dont get thrown by rash and go for SLE ...
62
Most common location for thyroid Ca mets to
lung then bone
63
Genetic condition very closely assoc with RCCs
Von hipple lindau
64
How do RCCs present
Painless haematuria May have varicocoele from obstructed veonous drainage
65
Why dex in tumour pain Eg liver
Reduce oedema
66
Bar 5HAII what is senstitive marker of carcinoid
Chromogranin A
67
Differentiation on exam of serotonin syndrome vs NMS
Serotonin -Develops over 24hrs -Clonus clonus clonus -Agitation and sweating NMS -Develops over days / weeks - Rigidity and bradyreflexia
68
2 main pharma options for seritonin syndrome
Cryptoheptadine Propranolol MAIN RX IS TO COOL THEM DOWN
69
Clin trials stages are for what 1 2 3 4
1 - Pharmacokinetics + toxicity 2- measure effects of drug 3- Compare to conventional therapy 4- Long term toxicity
70
Chemo drugs side effects TOXMAN
C (ears) - Cisplatin carboplatin -> Ototoxicity T (eyes) - Tamoxifen ->Reduced acuity B (lungs) - bleomycin, bulsupham ->Fibrosis D with T (heart) - Doxorubicin Tratasizumab -> cardiac M liver - methotrexate Liver toxiticy C - kidney. Cisplatin and carbocystine O bladder (cycle) - cyclophosphamide - haemorrhage cystitis V - Vincristine - peripheral neuropathy 5,6,MPH - Bone marrow suppression 5-fluorouracil 6-mercaptopurine Methotrexate Paclitaxel Hydroxyurea
71
How does SCC skin ca get about
Lymphatics
72
Who can support a patient wishing to die at home? eg after big stroke
Mari curie nurses
73
Who are the specialist dementia nurses for home visits
Admiral nurses
74
Cancer nurses
Macmillan
75
who arranges care in community for complex patients
Community matron
76
Antiemetics receptors Aprepitant Domperidone Metoclopramide Ondansetron
Aprepitant - NK-1 receptor [used for very emetogenic chemo regimes] Domperidone/metoclopramide - Dopamine antagonist Ondansetron - 5HT pathway
77
Cisplatin mechanism
Causes cross linking of DNA to form adducts
78
Fluorouracil mechanism
Inhibits protein synthesis
79
Doxorubicin mechanism
topoisomerase inhibitor dOxO - tOpO
80
How long CPR if given fibrinolytic for known PE
60-90 mins
81
Metastatic lung ca. Now tired, hypotensive and hyperK. What has happened
Adrenal mets -> hypoadrenalism
82
Vomiting due to hyperCa - first line
Haloperidol Ca ->D2 agonism Haloperidol -> d2 antagonism
83
Why is metoclopramide not recommended in young people
Acute dystonic reactions
84
First line antiemetic for intracranial pathology
Cyclizine (+ dex if raised ICP)
85
First line antiemetic for vestibular (movement related)
cyclizine
86
First line antiemetic drug induced
haloperidol
87
First line antiemetic pregnant
prochlorperazine
88
First line antiemetic post op
droperidol and dex or substitue ondansetron for either
89
First line antiemetic nausea vomiting end of life
levomepromazine 6.25mg
90
First line antiemetic obstructive bowel disorder end of life
hyoscine then ocretide
91
Cytarabine key side effect
irreversible cerebellar dysfunction
92
What is given with paclitaxel ?
Dex and antihistamine as high rates of anaphylaxis
93
What is meptazinol, when is it useful
partial mu opioid agonist. Has a low risk of constipation
94
Oral morphine to SC morphine? SC diamorphine
Half for SC 1/3 for diamorphine SC
95
Haematuria, loin pain, HyperCa, renal mass, night sweats, varicocele
Clear cell renal Ca (hypernephroma or renal adenocarcinoma)
96
Von-hippel-lindau which tumours
Renal cell - often bilat hemangioblastomas Phaeos Pancreatic neuroendocrine tumor.
97
Superficial Bladder <2cm ca low risk Rx? Superficial Bladder 2-3cm ca intermediate risk Rx? Superficial Bladder ca >3cm HIGH risk
TURBT + Intravesical mitomycin C TURBT + Intravesical mitomycin C (6 doses) TURBT + intravesical BCG
98
End of life IV hydration. Main issue? how often should they be examined
Overload 12hrly
99
Na level in MRCP to cause seizures
<125
100
Contraindication to metoclopramide
Bowel obstruction (Congenital long QT and diagnosis of parkinsons are use with caution)
101
Which antiemetic contraindicated in cardiac disease
domperidone
102
Which antiemetics contraindicated in congenital long QT
Haloperidol and ondansetron
103
name an acute phase protein
Ferritn
104
Poor prognosis for breast Ca. High grade, positive lymph nodes. What about receptor status' and age?
Progesterone/oestrogen negative status HER2 positive Age <40 All poor prognosis
105
Risk of breast / ovarian Ca with BRCAs
BRCA1 70% Breast 30-60% Ovarian BRCA2 55% breast 10-30% ovarian
106
First line Ix for breast lump in <35
US as dense tissue
107
Smoker chronic cough with neutrophils of 28. Normal platelets / Hb. Dx ?
paraneoplastic neutrophilia (from Small cell lung Ca)
108
Lung ca -> swelling of face, distended neck /upper arm vessels = ? Rx?
Superior vena cava syndrome Stenting for immediate relief Radiotherapy
109
opiate induced constipation first line Rx
Senna ->lactulose / docusate
110
Biggest cause of cancer death in women
lung ca [breast Ca is most common Dx and second most death]
111
Biggest cause of cancer death in men
Lung Ca then Prostate
112
Jaundice and painless enlargement of gall bladder. Where is Ca?
Ampulla of vata [Gallbladder usually has pain]
113
What is removed in whipples procedure
Gallbladder, head of pancreas and duodenum
114
Rx of chronic pancreatitis related pain eg Cancer if already on high dose morphine
coeliac plexus block
115
Imatinib used for what 2 cancers? Mechanism?
CML GIST [Both BCR-ABL translocation] Tyrosine kinase inhibitor
116
Small cell lung ca which chemo regime
cisplatin and etoposide
117
Tumor lysis syndrome electrolytes
HyperK HyperUrate HyperPO4->HypoCa
118
No capacity. No POA. Who can make a decision about surgery
Doctor performing the operation
119
hypnagogic vs hypnapompic
Off to the land of gog (when fall asleep = hypnagogic)
120
Patient doesn't want to know if they are dying can you tell them?
No
121
Mutation of APML? which chromosome? Key drug for Rx
retinoic-acid receptor alfa (RARa) mutation t (15:17) all-trans-retinoic acid [ATRA]
122
Most common single place for neuro endocrine tumours (carcinoid)
Ileum [somatostatin analogues (ocretide) key for symptom Rx]
123
Most common single place for neuroendocrine tumours (carcinoid)
Ileum [somatostatin analogues (octreotide) key for symptom Rx]
124
Which thyroid cancer produces calcitonin
Medullary c cells produce calcitonin
125
Method of monitoring for recurrence of papillary/medullary thyroid Ca
Serum thyroglobulin levels
126
What % thyroid Ca are papillary
85%
127
What is R in tumour classification
R0 - no residual tumour R1 - microscopic residual tumour R2 - macroscopic residual tumour
128
Quiet heart sounds and raised JVP which immediate Ix
Echo
129
Risk factors for depression in palliative care Which symptom? Which blood finding? Age? PMH?
Pain Hypercalcaemia Young Prev depression
130
SOB end stage heart failure already on furosemide and morphine without clinical significant pulm oedema
Lorazepam
131
Mycobacterium avium infection Rx
Ethambutol + rifabutin +clari/azithro [macrolide + quinolone should be avoided due to risk of developing resistance]
132
Bladder Ca that has invaded muscle rx? Which chemo in bladder cystectomy / metastatic disease
Radical cystectomy +cysplatin chemo
133
Where are glioblastomas found
Cerebral hemispheres - white matter
134
Bone pain in metastatic breast Ca already on para/ibu/morphine
Bisphosphonates (usually IV zoledronate) Bisphosphonates shown to improve bone pain and delay further mets
135
Most common met to bone?
Bronchial [Breast Prostate]
136
Classic chemo choice in Dukes colon ca
5-fluorouracil
137
Weight loss lethargy nighsweats. Progressive kidney disease + proteinuria. Green birefringence after congo red staining. Positive for lambda light chains?
Myeloma with renal amyloidosis
138
NF2 most common tumour
Acoustic neuroma
139
Most common lung Ca in non smokers
Adenocarcinoma
140
What is the mutation that allows imatinib to work for GIST and CML?
Philadelphia t (9:22) [assoc with bcr-abl overexpression]
141
Imatinib - what is it inhibitng when used for GIST
c-kit inhibitor [bcr-abl TK inhibition in CML]
142
fev1 requirement ability to tolerate pneumectomy
>2L [1.5L for lobectomy]
143
Conversion of morphine to fentanyl patch
100mg oral morphine 25ug/hr fent 150mg 37ug fent Approx dive by 4 and convert to ug/hr
144
Subacute bowel obstruction in pal first line
Hyoscine
145
Do you need to start senna with opiate analgesia in pal care
Yes according to NICE
146
Cones and rods for dark / light vision? Retinitis pigmenosa has deficiency of what?
Rods - Dark -Rhodopsin (night blindness) Cones - light [-Protein is coneopsin]
147
What is the gold standards framework
For patients with life limiting conditions
148
when fent over morphine
GFR <30
149
Most common site for lymphoma that isnt lymp node
Upper gi - Stomach

MRCP PART 1 (22 decks)

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