Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Finals > Oncology / palliative > Flashcards

Oncology / palliative Flashcards

(80 cards)

Start Studying
1
Q

What are the 6 broad N&V syndromes?

A
  1. Reduced gastric mobility (e.g. due to opioids)
  2. chemically mediated (e.g. secondary to hypercalcaemia, opioids or chemotherapy)
  3. visceral/serosal (e.g. constipation, oral thrush)
  4. raised ICP (e.g. brain mets)
  5. vestibular (e.g. opioid, motion or base of skull tumours)
  6. cortical (e.g. anxiety, fear, pain and/or anticipatory nausea)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

N&V caused by reduced gastric mobility first line drug?

A

metoclopramide OR domperidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When should metoclopramide not be used?

A

When pro-kinesis may negatively affect the gastrointestinal tract, particularly in complete bowel obstruction, gastrointestinal perforation, or immediately following gastric surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

N&V caused by ‘chemically mediated’ drug options?

A

Ondansetron OR haloperidol OR levomepromazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

N&V caused by ‘visceral/serosal’ causes drug options?

A

Cyclizine and levomepromazine - first-line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

N&V caused by ‘raised ICP’ causes drug options?

A

Cyclizine

Dexamethasone can also be helpful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

N&V caused by ‘vestibular’ causes drug options?

A

Cyclizine - first line

metoclopramide or prochlorperazine - can be used if refractory vestibular causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

N&V caused by ‘cortical’ causes drug options?

A
  • may not be needed if short lasting
  • benzodiazapines e.g. lorazepam can be tried
  • cyclizine may be useful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you convert oral codeine to oral morphine dose?

A

divide by 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you convert oral tramadol to oral morphine dose?

A

divide by 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Oral morphine to subcut morphine conversion factor?

A

divide by 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Oral morphine to subcut dimorphine conversion factor?

A

divide by 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Oral oxycodone to subcut dimorphine conversion factor?

A

divide by 1.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Oral morphine to oral oxycodone conversion factor?

A

divide by 1.5 or 2 (depending on guidelines)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mild-moderate renal failure in palliative patients - which pain drug preferred?

A

oxycodone (instead of morphine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Severe renal failure in palliative patients - which pain drug preferred?

A

Alfentanil OR buprenorphine OR fentanyl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which tumour marker is associated with pancreatic cancer?

A

CA 19-9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which tumour marker is associated with breast cancer?

A

CA 15-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the tumour marker S-100 associated with?

A

Melanoma, schwannomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the tumour marker bombesin associated with?

A

Small cell lung carcinoma, gastric cancer, neuroblastoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How to calculate breakthrough dose of morphine?

A

1/6th of daily morphine dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management of secretions in a palliative setting?

A

Hyoscine hydrobromide OR hyoscine butylbromide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

In palliative care, if pain is not controlled on current dose of morphine then by how much do you increase dose?

A

30-50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a sarcoma?

A

A group of malignant tumours originating from mesenchymal tissue.

can be either bone or soft tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Presentation of sarcoma?
- Pain - more common in bone sarcoma - Swelling/ palpable mass - more common in soft tissue sarcoma - impaired function - pathological fracture - systemic features - weight loss, fever, fatigue
26
Investigations for sarcoma?
Imaging - CT, XRAY, PET, MRI biopsy
27
Management of sarcoma?
Surgery - complete resection radiation therapy chemotherapy Targeted therapy - depends on type Immunotherapy
28
Child with unexplained bone pain +/- swelling management?
very urgent direct access xray within 48 hours -> if features suggestive of sarcoma then urgent assessment within 48 hours.
29
X-RAY shows codman triangle + 'sun-burst' appearance = ?
osteosarcoma
30
Pre-menopausal woman + oestrogen receptor +ve breast cancer drug treatment?
Tamoxifen
31
Post-menopausal woman + oestrogen receptor +ve breast cancer drug treatment?
Anastrozole
32
Drug treatment in HER2 receptor +ve breast cancer?
Trastuzumab (Herceptin)
33
X-RAY shows 'onion skin' appearance = ?
Ewing's sarcoma
34
Risk factors for bowel cancer?
- FH - Familial adenomatous polyposis (FAP) - Hereditary nonpolyposis colorectal cancer (HNPCC), (Lynch syndrome) - IBD - Increased age - Diet (high in red and processed meat and low in fibre) - Obesity and sedentary lifestyle - Smoking - Alcohol
35
What is Familial adenomatous polyposis (FAP)?
An autosomal dominant condition involving malfunctioning of the tumour suppressor genes called adenomatous polyposis coli (APC). It results in many polyps (adenomas) developing along the large intestine. These polyps have the potential to become cancerous (usually before the age of 40).
36
How is FAP usually managed?
Patients have their entire large intestine removed prophylactically to prevent the development of bowel cancer (panproctocolectomy).
37
What is HNCPP?
It is an autosomal dominant condition that results from mutations in DNA mismatch repair (MMR) genes. Patients are at a higher risk of a number of cancers, but particularly colorectal cancer. Unlike FAP, it does not cause adenomas and tumours develop in isolation.
38
NICE 'two week' referral guidelines on suspicion of bowel cancer include?
> 40 years with abdominal pain and unexplained weight loss >50 years with unexplained rectal bleeding > 60 years with a change in bowel habit or iron deficiency anaemia
39
Presentation of bowel cancer?
- Change in bowel habit (usually to more loose and frequent stools) - Unexplained weight loss - Rectal bleeding - Unexplained abdominal pain - Iron deficiency anaemia (microcytic anaemia with low ferritin) - Abdominal or rectal mass on examination
40
Which test could you do in GP to screen for bowel cancer?
FIT (Faecal immunochemical tests)
41
What is the screening program for bowel cancer (scotland)?
FIT test every 2 years from ages 50-74y
42
Investigations for bowel cancer?
- colonoscopy +/- biopsy - GOLD STANDARD - sigmoidoscopy (if rectal bleeding only) - CT colonography (if patient unfit for colonoscopy) - staging CT - CT thorax, abdomen and pelvis (checks for metastases) - CEA - useful for checking risk of relapse or staging disease (NOT SCREENING)
43
Classification system for bowel cancer?
TNM (previously Duke's)
44
Management of bowel cancer?
Depends on patient but: - surgery - most common - chemotherapy -radiotherapy - palliative care
45
Which surgical operation if cancer is affecting caecum, ascending and proximal transverse colon?
Right hemicolectomy
46
Which surgical operation if cancer is affecting distal transverse and descending colon?
Left hemicolectomy
47
Which surgical operation if cancer is affecting sigmoid colon?
High anterior resection (sigmoid colectomy)
48
Which surgical operation if cancer is affecting sigmoid colon and upper rectum?
Low anterior resection
49
Which surgical operation if cancer is affecting anal verge?
Abdomino-perineal resection (APR)
50
What is a Hartmann's procedure + indications?
An emergency procedure that involves the removal of the rectosigmoid colon and creation of an colostomy. The rectal stump is sutured closed. The colostomy may be permanent or reversed at a later date. Common indications are acute obstruction by a tumour, or significant diverticular disease.
51
Most common type of anal cancer?
Squamous cell carcinoma (80%)
52
Most common cause of anal cancer?
HPV 16 and 18 (85%)
53
Presentation of anal cancer?
- Perianal pain, perianal bleeding - A palpable lesion - Faecal incontinence - A neglected tumour in a female may present with a rectovaginal fistula.
54
What cancers is tumour lysis syndrome associated with?
lymphomas germ cell tumours (testes)
55
prophylaxis for tumour lysis syndrome?
hydration (3L a day) +/- Allopurinal 300mg (max 7 days)
56
Presentation of tumour lysis syndrome?
- oliguria / AKI - cardiac arrhythmia - seizure - high K+ - high phosphate - high urate - low calcium
57
Management of tumour lysis syndrome?
- Fluid resus (IV, 3-4L a day) - correct cardiac arrhythmia + hyperkalaemia (calcium gluconate) - monitoring + allopurinol - if resistant then consider dialysis
58
Most common type of malignancy to cause bone invasion?
prostate thyroid breast myeloma lung
59
Which cancer can produce PTH as a paraneoplastic syndrome?
Squamous cell carcinoma of the lung
60
Management of hypercalcaemia?
IV fluids (1-3L) Then check calcium... - if between 2.5 to 3 mmol/l - disodium pamidronate - if >3mmol/l then zoledronic acid (bisophonates)
61
Presentation of malignant spinal cord compression?
- back pain - pain worse on coughing / straining - new difficulty walking - bladder/bowel issues
62
investigations for MSCC?
- full neuro exam - MRI full spine
63
Management of Metastatic spinal cord compression?
analgesia + PT/OT - steroids (dexamethasone) - START AS SOON AS POSSIBLE - radiotherapy or neurosurgery
64
What needs to be co-prescribed with dexamethasone and what should be monitored?
PPI and monitor BM
65
presentation of raised ICP?
- headache with nausea - weakness / vague symptoms - vomiting - personality changes / memory loss - visual disorders - seizures
66
Investigations for raised ICP?
- neuro exam - imaging - URGENT CT head and MRI
67
Management of raised ICP?
- steroids as soon as possible - surgery or radiotherapy
68
presentation of SVCO?
haemodynamic compromise redness of face facial swelling JVP distension cynanosis syncope coma
69
Investigations for SVCO?
CXR - widened mediastinum, mass lesion CT chest
70
Treatment for SVCO?
stent or radiotherapy - only if stridor or respiratory compromise dexamethasone - initial
71
Presentation of neutropenic sepsis?
7-14 days after chemotherapy fever low neutrophils
72
antibiotic for neutropenic sepsis
Tazocin (within 1 hour) if allergic to penicillin then teicoplanin and aztreonam
73
symptoms of opioid overdose?
pinpoint pupils drowsy resp depression choking / gurgling sounds pale, blue, cold skin hallucinations vivid dreams myclonic jerks
74
symptoms/signs of carcinoid syndrome?
- Flushing - diarrhoea - hypotension - bronchospasm - right heart valve stenosis (can also occur on left side if tumour originating in lungs) - cushings syndrome - if ACTH and GHRH is also released
75
Investigations for carcinoid syndrome?
urinary 5-HIAA plasma chromogranin A y
76
Management of carcinoid syndrome?
- somatostatin analogues e.g. octreotide - diarrhoea: cyproheptadine may help
77
Which areas of the body are not typically reached by chemotherapy?
CNS and testes
78
Neck lump + pain when drinking alcohol?
Hodgkins lymphoma
79
Cancers which commonly metastasis to the bone?
breast, lung, prostate, kidney and thyroid
80
Carcinoid syndrome management?
somatostatin analogue (e.g. octreotide) + surgery

Finals (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions