Oncology + Immunology + Geri

Question 1

What are the pharmacological management options for dementia?

Answer 1

Mild to moderate Alzheimer’s disease: Acetylcholinesterase inhibitors
- Donepezil, Rivastigmine and Galantamine

Memantine (an NMDA receptor antagonist) reserved for patients with
→ moderate Alzheimer’s who are intolerant of, or have a contraindication to, acetylcholinesterase inhibitors
→ as an add-on drug to acetylcholinesterase inhibitors for patients with moderate or severe Alzheimer’s
→ monotherapy in severe Alzheimer’s

Question 2

What are the core symptoms of Lewy Body dementia?

Answer 2

• Fluctuating cognition
• Parkinsonism
• Visual hallucinations (other features such as delusions and non-visual hallucinations may also be seen)

Question 3

Causes of delirium?

Answer 3

• Infection: particularly urinary tract infections!

-metabolic: e.g. hypercalcaemia, hypoglycaemia, hyperglycaemia, dehydration

• change of environment
• any significant cardiovascular, respiratory, neurological or endocrine condition
• severe pain
• alcohol withdrawal
• constipation

Question 4

Oral morphine to subcutaneous morphine (syringe driver) dose conversion?

Answer 4

The equivalent parenteral dose of morphine (subcutaneous, intramuscular, or intravenous) is about half of the oral dose. If the patient becomes unable to swallow, generally morphine is administered as a continuous subcutaneous infusion.

Example convert from oral to s/c morphine:
patient’s regular dose = 60mg bd
= 120mg /day
= 120/2
= 60mg of subcutaneous morphine

Question 5

Where is the best site for IM adrenaline injection in anaphylaxis?

Answer 5

The best site for IM injection is the anterolateral aspect of the middle third of the thigh.

Question 6

Tumour marker of ovarian cancer?

Answer 6

CA 125

Question 7

Tumour marker of pancreatic cancer?

Answer 7

CA 19-9

Question 8

Tumour marker of breast cancer?

Answer 8

CA 15-3

Question 9

Tumour marker of prostate cancer?

Answer 9

Prostate specific antigen (PSA)

Question 10

Alpha-feto protein (AFP) is a tumor marker for…?

Answer 10

Hepatocellular carcinoma, teratoma

Question 11

Carcinoembryonic antigen (CEA) is a tumour marker for?

Answer 11

Colorectal cancer

Question 12

What are the symptoms seen in SVC obstruction?

Answer 12

• 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
• distended neck veins

Question 13

What is the most common cause of SVC obstruction?

Answer 13

Common Malignancies: SMALL CELL LUNG CANCER, lymphoma
other malignancies: metastatic seminoma, Kaposi’s sarcoma, breast cancer

• aortic aneurysm
• mediastinal fibrosis
• goitre
• SVC thrombosis

Question 14

What kind of cancers does HNPCC cause? (Lynch syndrome)

Answer 14

Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome is an autosomal dominant genetic condition that is associated with a high risk of:
- COLON CANCER
- ENDOMETRIAL CANCER

• ovary, stomach, small intestine, hepatobiliary tract, upper urinary tract, brain, and skin.

Question 15

Which type of lung cancer is most common in non-smokers?

Answer 15

Lung Adenocarcinoma

• typically peripheral
• most common type of lung cancer in non-smokers, although the majority of patients who develop lung adenocarcinoma are smokers

Question 16

Which HPV subtypes increase the risk of cervical cancer?

Answer 16

Human papilloma virus (HPV) infection is the most important risk factor for developing cervical cancer.

Subtypes 16,18 & 33 are particularly carcinogenic.

Question 17

Management for anaphylaxis?

Answer 17

1. IM Adrenaline: 0.5mg (0.5ml 1 in 1,000)
2. IV Hydrocortisone: 200 mg
3. IV Chlorphenamine: 10 mg

• Patients who have had emergency treatment for anaphylaxis should be observed for 6–12 hours from the onset of symptoms, as it is known that biphasic reactions can occur in up to 20% of patients.
• Sometimes it can be difficult to establish whether a patient had a true episode of anaphylaxis. Serum tryptase levels are sometimes taken in such patients as they remain elevated for up to 12 hours following an acute episode of anaphylaxis.

Question 18

BRCA 1 and 2 is associated with which cancers in females and males?

Answer 18

Carried on chromosome 17 (BRCA 1) and Chromosome 13 (BRCA 2).

Linked to developing breast cancer (60%) risk.

Associated risk of developing ovarian cancer (55% with BRCA 1 and 25% with BRCA 2).

BRCA2 mutation is associated with prostate cancer in men.

Question 19

Tumour marker for breast cancer?

Answer 19

CA 15-3

Question 20

Tumour marker for hepatocellular carcinoma?

Answer 20

Alphafeto protein (AFP)

Question 21

Calcitonin is a tumour marker for which cancer?

Answer 21

Calcitonin is a tumour marker in medullary thyroid cancer.

Medullary thyroid cancer is the only thyroid cancer that will cause a rise in calcitonin, as it originates from the parafollicular cells, which produce calcitonin.

Question 22

Raised beta-human chorionic gonadotropin with a raised alpha-feto protein level?

Answer 22

Non-seminomatous testicular cancer.

Apparently seen in ovarian cancer as well? passmedicine comment

Question 23

Features of Lewy Body Dementia?

Answer 23

1. Progressive cognitive impairment
   - Cognition may be fluctuating, in contrast to other forms of dementia.
2. Parkinsonism
3. Visual hallucinations (other features such as delusions and non-visual hallucinations may also be seen)

Question 24

Donepezil is avoided in which condition?

Answer 24

Donepezil is generally avoided (relative contraindication) in patients with bradycardia and is used with caution in other cardiac abnormalities.