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Y4 Gen Med > Oncology > Flashcards

Oncology Flashcards

(74 cards)

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1
Q

What is radical treatment?

A

Treatment with curative intent

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2
Q

What is adjuvant and neo-adjuvant treatment?

A

Adjuvant after radical therapy to reduce risk of recurrence

Neo-adjuvant prior to radical Tx

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3
Q

What units is radiotherapy prescribed in?

A

Gray Gy

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4
Q

“Radiation implanted / inserted in patient to deliver a dose of radiotherapy to local tumour”

A

Brachytherapy

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5
Q

Is the staging system used for lymphoma?

A

Ann Arbor

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6
Q

What does ambulant mean?

A

Patient can walk / mobilize

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7
Q

What are the stages of the WHO performance status?

A

0 fully active, no restrictions on activities
1 unable to do strenuous activities
2 able to walk + manage self care, unable to work, out of bed >50% waking hours
3 confined to bed/chair >50% waking hours, capable of limited self care
4 completely disabled unable to do any self care
5 death

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8
Q

Which opioid can be used in patients with impaired renal function?

A

Fentanyl

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9
Q

In impaired renal function using opioids - would that make the drug ineffective or cause toxicity?

A

Toxicity since decreased clearance

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10
Q

What are the indications, names, drug classes and doses for the anticipatory care meds?

A

Pain: morphine opioid - varying dose
Nausea: levomepromazine antipsychotic 2.5mg
Secretions: buscopan hyoscine butylbromide 20mg
Distress: midazolam benzodiazepine 2mg

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11
Q

What drug should be co-prescribed for all patients on strong laxatives?

A

Laxatives

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12
Q

Which opioid is used in patients with moderate renal impairment? What is used in patients with severe renal impairment?

A

Moderate: oxycodone
Severe: fentanyl or buprenorphine

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13
Q

Name 3 Mx options for metastatic bone pain

A

Opioids, bisphosphonates, radiotherapy

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14
Q

When increasing opioid dose … by how much?

A

30 - 50%

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15
Q

How do you convert from oral codeine to oral morphine?

A

X 10

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16
Q

How you convert from oral morphine to subcut morphine?

A

/ 2

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17
Q

What are the components of the WHO analgesic ladder?

A

1 non-opioid +-adjuvant
2 mild/moderate opioid + non-opioid +-adjuvant
3 strong opioid + non opioid +- adjuvant

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18
Q

What is the max daily dose of paracetamol?

A

4 grams

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19
Q

BCR-ABL

  • tyrosine kinase translocation between what chromosomes?
  • inheritance pattern?
  • what cancers is it assoc?
A

BCR-ABL Philadelphia

  • 9 and 22
  • always de novo
  • 100% CML, some AML/ALL
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20
Q

HNPCC

  • what inheritance pattern?
  • assoc what cancers?
  • what mutation?
A

HNPCC

  • AD
  • bowel > endometrial > ovarian
  • MLH/MSH
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21
Q

Retinoblastoma

  • autosomal dominant
  • what cancer?
  • what age group
  • Rb1 mutation
A

Childhood eye cancer

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22
Q

BRCA

  • inheritance pattern?
  • assoc cancers?
A

AD

Breast > ovarian

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23
Q

Chemotherapy side effects - which causes cardiomyopathy?

A

Anthracyclines (-orubicin) and herceptin

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24
Q

Chemotherapy side effects - which cause peripheral neuropathy?

A

Platinum agents (cisplatin, carboplatin)

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25
What chemotherapy increases risk of endometrial cancer?
Tamoxifen
26
Chemotherapy side effects - which causes lung fibrosis?
Bleomycin
27
Name 3 antiemetics used in chemotherapy assoc N&V
Ondansetron + dexamethasone + aprepitant (used for acute vomiting or preventatively) (Metoclopramide if prolonged)
28
Ondansetron causes diarrhoea or constipation?
Constipation
29
How frequently is MST morphine slow release prescribed? eg how long does it last
12hr
30
``` Opioid side effects -drowsy or alert -paraesthesia or pruritus -hallucinations or delusions Also: nausea, myoclonus, constipation ```
Drowsy, pruritus, hallucinations
31
How to convert oral oxycodone to oral morphine dose?
X2
32
How to convert oral oxycodone to subcut oxycodone?
/ 2
33
What 2 factors influence chemotherapy dose?
Body surface area and renal function
34
Which cause diarrhea or constipation - Metoclopramide - Cyclizine - Ondansetron
Ondansetron + cyclizine constipate Metoclopramide diarrhea (so use in reverse situations)
35
Which antiemetic can cause acute dystonic reactions?
Metoclopramide (D2 antagonist) | commoner in females
36
What is the definition of neutropenic sepsis?
Fever >38 for >2hr when neutrophils <1X10
37
What is the empirical ABx for neutropenic sepsis?
IV taz + gent
38
What cultures are involved in a sepsis screen?
Blood + urine + stool + sputum
39
What is the term for radiotherapy delivered inside the body?
Brachytherapy (eg radioactive seeds in prostate)
40
In spinal cord compression what comes first - pain or weakness?
Pain precedes weakness
41
Describe the pain in cord compression
Radicular band like, radiates around rib cage, worse on coughing
42
UMN or LMN signs in cord compression?
UMN
43
Malignant cord compression investigation?
Urgent MRI | whole spine
44
What colour is CSF on T2 weighted MRI?
White
45
Malignant cord compression initial Mx?
16mg IV dexamethasone followed by 8mg BD PO | to reduce vasogenic oedema
46
Malignant cord compression Mx after dexamethasone?
Radiotherapy with or without surgery (anterior laminectomy)
47
What is Pemberton sign?
Raise arms above head (obstruct brachiocephalic vein); brings on symptoms in SVCO
48
Presentation of SVCO?
Swollen face/neck/arm, facial plethora, distended veins, SOB, HA
49
Give 2 causes of SVCO
Extrinsic compression eg right sided lung cancer, lymphoma Clot (fast onset) Intrinsic compression eg foreign body line obstruction
50
What is the 1st line Mx of SVCO caused by lung cancer?
Steroids + stent
51
Name 2 causes of malignant hypercalcaemia?
Squamous cell lung cancer (paraneoplastic PTHrP secretion) Melanoma Bone met osteolysis
52
What is the presentation of malignant hypercalcaemia?
Bones stones groans moans | Constipation, polyuria, anorexia, thirst, confusion, nausea
53
What is the 1st line Mx of malignant hypercalcaemia?
Rehydrate (Several L normal saline, aim 3-4 L over 24hr) (Bisphosphonates used following rehydration)
54
What are PTH levels in hypercalcaemia due to paraneoplastic ectopic PTH secretion?
Low or normal - since its PTHrP - not the same so not on the test (check PTHrP levels)
55
Pericardial tamponade - compresses which heart chamber? - smaller or enlarged complexes on ECG? - smaller or enlarged heart shadow on CXR? - normal or abnormal echo?
Compresses RA Smaller complexes Enlarged shadow Abnormal echo see pericardial fluid
56
What are the components of Beck's triad for cardiac tamponade?
>JVP + diminished heart sounds + hypotension
57
What is pulsus paradoxicus?
Breath in > raised intrathoracic pressure > decreased venous return > reduced blood pressure by >10
58
What is Kussmaul's sign
Rise in JVP on inspiration
59
Kussmaul's sign or pulsus paradoxicus - which seen in cardiac tamponade?
Pulsus paradoxicus
60
Cardiac tamponade Mx
Pericardiocentesis
61
Neutropenic sepsis definition
Infection + neutrophil <0.5 | or <1.0 if chemo within last 21 days
62
Neutropenic sepsis 1st line ABx
Piperacillin with tazobactam (Tazocin)
63
In neutropanic sepsis - what do you do first - give ABx or sepsis screen?
Give ABx
64
"Intracellular ions released from cells due to chemotherapy causing rising potassium + rising phosphate + falling calcium"
Tumour lysis syndrome
65
Tumour lysis syndrome prophylaxis? | if high risk eg leukaemia / lymphoma
Allopurinol
66
Tumour lysis syndrome - high or low potassium - high or low phosphate - high or low calcium
High K + phos | Low Ca
67
SIADH - high or low serum Na - high or low urine Na - hypo or hypervolaemic
Low blood High urine Euvolaemic
68
Are all woman w breast Ca checked for BRCA?
No | only if very young, strong FH, bilateral, breast + ovarian, male breast cancer
69
US or mammogram - which is better in young / older women?
US younger | Mammo sensitivity increases with age
70
OCP - which gynae cancers protective and which risk factors?
RF breast, endometrial Protects cervical, ovarian *double check*
71
What is Troisier's sign?
Metastatic LN from intra-abdominal cancer often in left supraclavicular fossa, Virchow’s node
72
Cervical cancer can cause renal failure due to ureteric obstruction - T or F
True
73
When starting a PTx on opiates what should you co-prescribe?
Paracetamol + laxative + antiemetic
74
The pre-Tx ambulatory status is the most important prognostic factor in determining outcome for malignant cord compression - T or F
True

Y4 Gen Med (9 decks)

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