Oncology

Question 1

Causes of acute confusion?

Answer 1

Sepsis
Hypercapnia
Hypercalcaemia
Ammonia
AKI 
Steroids
Brain mets

Question 2

Mx of hypercalcaemia

Answer 2

Saline
Bisphosphonates

+/- calcitonin

Question 3

SEs of bisphosphonates?

Answer 3

Oesophagitis
Gastritis
Osteonecrosis (jaw, fem head)

Question 4

Mx of raised ammonia

Answer 4

Phosphate enema

Question 5

How does AKI cause confusion in a patient on opiates?

Answer 5

Dehydration –> decrease opiate excretion –> increased opiate level –> confusion + sedation

mx = naloxone

Question 6

Mechanism of steroid psychosis?

Answer 6

-> Reduced Na; therefore reduced water –> reduced BP

Question 7

Drug causes of hyponatraemia?

Answer 7

Steroids
PPI
SSRI
Carbamazepine
Fluids

Question 8

Metastatic cascade?

Answer 8

Detachment
Invasion
Intravasation
Evasion of host defence
Adherence
Extravasation
Angiogenesis

Question 9

Indications for radiotherapy?

Answer 9

Medically unfit for surgery
Anatomically unresectable
Neo-adjuvant
Adjuvant
Palliative (bone/brain mets/SCC)

Question 10

Types of radiotherapy

Answer 10

External beam

Internal - brachytherapy

Question 11

Comps of radiotherapy

Answer 11

Acute [fatigue, skin, GI, N+V+D, BM, lungs]

Chronic [infertility, lymphoedema, delayed healing, CV events, hypothyroid]

Question 12

SEs of chemo

Answer 12

Myelosuppression (usually worst 1 week after --> NEUTROPENIC SEPSIS!)
Alopecia
Infertility 
N+V+D
Fatigue
Teratogenicity
Mouth ulcers

Question 13

Extravasation?

Answer 13

Problem with chemo -pain, redness and inflam –> may lead to skin necrosis + need for amputation

Question 14

Mx of extravasation?

Answer 14

Topical agents

Debridement + grafting

Question 15

Severe reaction to chemo?

Answer 15

Anaphylaxis

quite common

Question 16

Ix in fever + recent chemo?

Answer 16

!!Neutropenic sepsis until proven otherwise!!

FBC, LFT, U+Es, CRP, lactate, Blood cultures, urine culture, NOT LP, swabs and cultures (from central line)

Question 17

Spinal cord compression pres?

Answer 17

Pain
Sensory loss
Weakness
+/- incontinence

Question 18

Ix in suspected SCC?

Answer 18

MRI whole spine

Question 19

Mx of SCC?

Answer 19

Dexamethasone, VTE prophylaxis, analgesia

Refer to neurosurgery/spinal

Question 20

Mx of painful spinal mets?

Answer 20

Analgesic ladder
Bisphosphonates
Palliative radio
Vertebroplasty

Question 21

Cause of hypercalcaemia in malignancy?

Answer 21

Osteolytic
Boney mets
Secretion of PTHrP

Question 22

Ix in hypercalcaemia?

Answer 22

Total calcium 
Ionised calcium
Serum albumin
ECG
PTH
Skeletal survey

Question 23

Medications which worsen hypercalcaemia?

Answer 23

Thiazide
Calcitriol
Antacids
Lithium

Question 24

Mx of hypercalcaemia?

Answer 24

IV saline
+/- IV bisphosphonates
Furosemide

Question 25

Cause of SVCO?

Answer 25

Malignancy 75% lung Ca 15% lymphoma

Question 26

Pres of SVCO?

Answer 26

Oedema of face + upper extremities Dyspnoea Facial plethora Cough Fixed (non-pulsatile) + raised JVP

Question 27

Ix in SVCO?

Answer 27

CXR | CT thorax with contrast

Question 28

Mx of SVCO?

Answer 28

Secure airway + dexamethasone | + radio / stent

Question 29

Tumour lysis syndrome? | Which cancers?

Answer 29

Metabolic and electrolyte abnormalities occurring spontaneously following initiation of cytotoxic treatment in patients with cancer Lymphoma

Question 30

Ix in tumour lysis syndrome?

Answer 30

Hyperuricaemia Hyperphosphataemia Hyperkalaemia Hypocalcaemia

Question 31

Pres of tumour lysis?

Answer 31

Arrhythmia (hyperK) Muscle cramps/tetany (hypoCa) AKI (uric acid nephropathy)

Question 32

LEMS? | Which cancer?

Answer 32

AI disorder of NM junction (Anti-VGCaC) | SCLC (often precedes cancer diagnosis by several years)

Question 33

Pres of LEMS?

Answer 33

Limb weakness (proximal) Dry mouth Dysarthria, ptosis, diplopia Weakness improves on use

Question 34

Ix in LEMS?

Answer 34

Anti-VGCaC +ve Anti-AChR -ve NCS --> muscle action potential increases with exercise

Question 35

Mx of LEMS? What if resp involvement?

Answer 35

Treat cause + amifampridine + pred Intubation + ventilation + plasma exchange

Question 36

Pres of carcinoid syndrome?

Answer 36

Flushing + diarrhoea | due to serotonin from neuroendocrine tumour

Question 37

Dx of carcinoid?

Answer 37

Elevated urinary 5-hydroxyindoleacetic acid

Question 38

Mx of carcinoid

Answer 38

Octreotide + surgical resection of tumour

Question 39

Cancers that met to bone?

Answer 39

``` Breast Prostate Bronchus Myeloma Thyroid ```

Question 40

What drug interacts with Tazocin? | Alternate abx?

Answer 40

If on MTX (both act on folic acid) | Give meropenem instead

Question 41

What can you give pts with high risk of neutopenic sepsis?

Answer 41

G-CSF [boosts bone marrow]

Question 42

What is bones, moans stones, psych overtones?

Answer 42

Bone pain Abdo moans [N+V+D+ pain] Kidney stones Confusion, agitation

Question 43

Mx of TLS?

Answer 43

Allopurinol/rasburicase Fluids +/- dialysis