Oncology/ Palliative

Question 1

What is a common second line agent used when Pt. is already on one anti-emetic whilst on Chemo

Answer 1

Dexamethasone

Question 2

Mucocutaneous Lesions
Trichilemmomas (small, wart-like growths on the face)
Oral papillomas (small nodules in the mouth, gums, and tongue)
Acral keratosis (skin thickening on hands/feet)
Facial papules (multiple skin-colored bumps)

Risk of Breast Cancer, Thyroid Cancer, Bowel cancer ( possible signs and symptoms)

Hamartomatous polyps (similar to Peutz-Jeghers but without mucocutaneous pigmentation)

What is your Dx?

Answer 2

Cowdens syndrome

Question 3

What is the biggest risk factor for developing Breast Cancer, in Pt.’s previously treated for Hodgkins Lymphoma

Answer 3

Radiotherapy

Question 4

What is the paraneoplastic Endo related problem in Sqamous cell Ca

Answer 4

PTH

Question 5

What is the paraneoplastic Endo related problem in Small cell Ca

Answer 5

ADH, ACTH

Question 6

what do you assess for metastatic germ cell tumour

Answer 6

beta HCG

Question 7

What is a common cause of SOB in Pt. in severe lung Ca with no sings of infection/ effusion

Answer 7

Hyperaemia due to ventilation-perfusion mismatch

( note : their O2 Stats can still be >/=94%)

Question 8

What is the MOA of Olaparib

Answer 8

Poly-ADP -ribose- polymerase (PARP) inhibitor

Question 9

What is the Mx of Lamber Eaton Syndrome

Answer 9

3-4, Diaminopyridine
( Amifampyridine)

Question 10

What is the effect of tamoxifen and breast Ca

Answer 10

It reduces the risk of recurrence in already affected breast and also prevents occurrence in the other breast.

Question 11

what is the Tx for adrenal cortical adenocarcinomas

Answer 11

Mitotane

Question 12

What re the two drugs used to treat Cushings

Answer 12

Ketoconazole and Metyrapone

Question 13

What is the main Tx for SVC obstruction

Answer 13

SVC stenting

Question 14

What is a side effect of Tamoxifen you should think of

Answer 14

Increases risk of blood clots
Increases risk of Endometrial Cancer
Increases Body weight

Note:
reduces risk of heart disease
reduces risk of osteoporosis

Question 15

What is the mutation in villous adenoma

Answer 15

Somatic Adenomatous Polyposis Coli (APC) mutation

Question 16

What is the relation between beta HCG and TSH

Answer 16

Profound increase in beta HCG –> can cause hyperthyroidism and therefor TSH will be reduced

Question 17

What is a poor prognostic factor of Ewings Sarcoma

Answer 17

Anemia

Question 18

How do you convert Oromorph to S/C diamorphine Pump dose

Answer 18

Calculate toll morphine uses ( regular +PRN) and then divide that by 3
which equals to the Toal dose of diamorphine S.c over 24 hrs

Question 19

how do you interpret SA-AG

Answer 19

If SAAG >/= 11 - it indicates portal HTN ( cirrhosis, Cardiac failure, portal vein thrombosis )

If SAAG <11 (Malignancy, Nephrotic syndrome, TB , Pancreatitis )

Question 20

A sudden risk in ALP , in someone with cirrhosis, wt loss, ascitis

What are you thinking ?

Answer 20

Hepatocellular CA
(HCC)

Question 21

What is the cause of Hypercalcemia in breast Ca

Answer 21

PTHrP

Question 22

What is the cause of Hypercalcemia in Lymphoma

Answer 22

Tmour production of 1,25-dihydroxy Vitamin D

Question 23

if someone as focal seizures and BG of depression which antiepileitc would you use
( lamotrigine or Levetiracetam )

Answer 23

Lamotrigine

Note:
Levetiraceteam worsens mood disorders

Question 24

What are the features of SMART syndrome

Answer 24

SMART Syndrome (Stroke-like Migraine Attacks after Radiation Therapy) – Key Points

Occurs years (1–10 yrs) post-brain radiation
Stroke-like deficits (reversible): Hemiparesis, aphasia, hemianopia
Migraine-like symptoms: Headache, aura, photophobia
Cognitive changes: Confusion, memory loss
Seizures (occasional)
MRI: Cortical swelling, T2/FLAIR hyperintensity, no infarction (DWI-negative)
Resolves over weeks to months

Management: Supportive, migraine treatment, steroids if needed

Question 25

What is the oral morphine to Fently patch conversion

Answer 25

Oral Morphine ---- Fentanyl patch 30mg/ day ------12mcg/hr 60mg/day -------25mcg/hr 120mg/day --------50mcg/hr 180mg/day--------- 75mcg/hr 240mg/day----------100mcg/hr

Question 26

Where do you see canon ball mets

Answer 26

the mets are seen in lungs primary ca in Renal origin

Question 27

What is the gene mutation in Peutz Jeghers Syndrome

Answer 27

STK11 ( Serine/ Threonine Kinase)

Question 28

What is the mx of Carcinoid syndrome

Answer 28

Somatostatin analogues such as Ocreotide/ Lanreotide

Question 29

What is the mx of Brachila plexus invitation from Ca

Answer 29

1st line - use pregabalin ( to control neuropathic pain) If this fails; then proceed to 'Brachial Plexus block'

Question 30

What is the 1st line Chemotherapy regimen for ovarian cancer

Answer 30

Pacitaxel and Carboplatin If 1st line fails/relapse then use; Gemcitabine and Carboplatin

Question 31

Constipation, abdominal pains , Ascitis, and loss of weight in female What are you thinking

Answer 31

Ovarian Cancer

Question 32

What does left shift in blood film mean

Answer 32

more immature cells production

Question 33

what is the mx of sqmous cell ca of lung that cannot be resected

Answer 33

PLATINUM BASED CHEMO + radiotherapy

Question 34

What is the immediate initial Mx for SVC obstruction

Answer 34

Dexamethasone and LMWH Specific Mx later is SVC stenting

Question 35

Which blood test is sensitive for detecting tumour recurrence in Testicles

Answer 35

Beta HCG

Question 36

What are some of the risk factors for developing HCC

Answer 36

Hep B, Hep C, Dietary aflatoxin ( mouldy food in Africa and far east which affects gene mutation of p53), Hemochromatosis

Question 37

How do you calculate corrected serum calcium

Answer 37

Corrected serum Ca = Measured Serum Calcium + ( 40 - Serum Albumin) x 0.027

Question 38

What is the most common Ca associated with Cowden Syndrome

Answer 38

Breast Ca

Question 39

Risk factors for ovarian Ca;

Answer 39

Early menarche Late Menopause Nulliparity

Question 40

What does Parvo-cirsu infection cause

Answer 40

Anemia with suppressed BM production of RBC ( Low reticulocytes)

Question 41

what is the most common form of oesophageal Ca

Answer 41

Adenocarcinoma ( lower 3rd) Sqamous ( Upper and Middle )

Question 42

what is the 1st line antiemetic in chemotherapy for emesis / Nausea / Vomting

Answer 42

Metoclopramide

Question 43

what other ca is HNPCC at higher risk of

Answer 43

Endometrial Ca

Question 44

What is the most specific tumor marker for testicular ca

Answer 44

Beta HCG

Question 45

What blood test can you do prior to starting chemo, to assess pt;s who are at high risk of tumour lysis syndrome

Answer 45

asses LDH ( will be high) in pt's at risk

Question 46

what is the side effect of oxaplatin

Answer 46

Worsend peripheral neuropathy

Question 47

What does Imatinib target in CML

Answer 47

BCR-ABL

Question 48

What are the components of tumour lysis syndrome

Answer 48

Hyperkalemia, hyperphosphatamia, Hyperuricameia, and/or hypocalcemia

Question 49

What risk can you be exposed to, du to excess aromatase amines

Answer 49

Bladder Cancer

Question 50

What is a common side effect to look out for, in someone who has had mantle radiotherapy

Answer 50

Thyroid disease ( commonly leads to hyperthyroidism)

Question 51

What can you use in refractive hematuria in bladder ca, when bleeding fails to stop even after traneximic acid

Answer 51

Iliac Artery Embolisation

Question 52

what cancer is Parkinsons associated with

Answer 52

Malignant Melanoma

Question 53

What is a very common side effect of Cisplatin

Answer 53

Nephrotoxicity and Deranged electrolytes, specifically "Magnesium "

Question 54

What are two main things to consider in someone who has cyclophosphamide Tx

Answer 54

In acute Tx - if hematuria -> think hemorrhagic cystitis After years of Tx with cycle , if hematuria ---> think Bladder Ca

Question 55

How would you treat dermatomyositis

Answer 55

Steroids

Question 56

What must you consider before you start someone on Fludarabine n CLL

Answer 56

Co-trimox ( as it causes increased risk of opportunistic infections)

Question 57

How do you diagnose Paget's disease

Answer 57

Biopsy !

Question 58

What chemical is released by Carinoid tumour

Answer 58

Serotonin

Question 59

Other than asbestos exposure, what other risk factor significantly increases risk of Mesothelioma

Answer 59

Significant previous radiation exposure

Question 60

What anti-epileptic agent will you sue in palliative pt.s who have weeks to months to live

Answer 60

Levetiracetam If only days of life -> Midaz