Oncology & Palliative Care

Question 1

What is the commonest site of acute spinal cord compression?

Answer 1

Thoracic

Question 2

What are some common cancers causing acute spinal cord compression?

Answer 2

Lung, breast, prostate, renal, myeloma

Question 3

What are the 3 mechanisms of acute spinal cord compression?

Answer 3

Extradural metastases
Direct tumour extension
Crush fracture

Question 4

What is the initial investigation you should do for acute spinal cord compression?

Answer 4

Urgent MRI whole spine

Question 5

What is the management of acute spinal cord compression?

Answer 5

Dexamethasone 16mg IV then 8mg BD orally

Urgent radiotherapy +/- surgery

Question 6

What is superior vena cava compression?

Answer 6

Obstruction of the vena cava that can also cause airway compression

Question 7

What malignancies commonly cause superior vena cava compression?

Answer 7

NSCLC, lymphoma, metastaic seminomas, Kaposis sarcoma, breast cancer

Question 8

What are some signs and symptoms of SVC compression?

Answer 8

Breathlessness, swelling of face/neck/arms, lethargy, puffy neck, non-collapsable/distended neck veins. Pemberton’s sign

Question 9

What are the two mechanisms by which SVC compression occurs?

Answer 9

Blockage within the SVC (e.g. DVT, foreign body, tumour)

Blockage outwith the SVC (e.g. extrinsic compression from mass)

Question 10

What investigations are important in SVC compression?

Answer 10

CXR, venogram, CT chest

Question 11

What is the treatment of SVC?

Answer 11

Clot - thrombolysis

Extrinsic compression - steroids, stenting, radio/chemotherapy

Question 12

What are the pathological causes of malignant hypercalcaemia?

Answer 12

Ectopic PTHrP production
Lytic bone destruction
Vit D analogue production

Question 13

What are symptoms of malignant hypercalcaemia?

Answer 13

Lethargy, anorexia, thirst, confusion, weakness

Question 14

What investigations should be done in malignant hypercalcaemia?

Answer 14

FBC, U&Es, calcium, phosphate, albumin, myeloma screen

Question 15

How is malignant hypercalcaemia managed?

Answer 15

Rehydration then bisphosphonates

Question 16

What is neutropenic sepsis a common complication of?

Answer 16

Chemotherapy

Question 17

When does neutropenic sepsis usually occur?

Answer 17

7-14 days following chemotherapy

Question 18

What is neutropenic sepsis defined as?

Answer 18

Neutrophil count less than 0.5 or less than 1 in chemotherapy patients PLUS
temperature >38 or other signs assoc with sepsis

Question 19

What investigations do you do for neutropenic sepsis?

Answer 19

Basically everything - full infection screen, full blood screen, blood gases, ECG, CXR, AXR

Question 20

If a patient is septic and has had chemo in the last 3 weeks, how should you manage them?

Answer 20

Assume neutropenic sepsis and treat them before blood results return

Question 21

What is the treatment of neutropenic sepsis?

Answer 21

SEPSIS 6

Antibiotic - Pipercillin, Tazobactam +/- gentamicin if NEWS over 7

Question 22

What organisms are most likely to cause sepsis?

Answer 22

Mostly gram negative (E.coli, Pseudomonas, Klebsiella)

Question 23

What is tumour lysis syndrome?

Answer 23

Breakdown of tumour cells and subsequent release of chemicals from the cell

Question 24

What cancers is tumour lysis syndrome related to?

Answer 24

Lymphomas and leukaemias

Question 25

What may trigger tumour lysis syndrome?

Answer 25

Chemotherapy

Question 26

What electrolyte imbalance do you see in tumour lysis syndrome?

Answer 26

High potassium, high phosphate | Low calcium

Question 27

How is tumour lysis syndrome prevented?

Answer 27

IV allopurinol if at risk

Question 28

What other oncological emergencies are there?

Answer 28

SIADH, brain mets, malignant pericardial effusion, PE, DIC

Question 29

What are the main troublesome symptoms in end of life?

Answer 29

Pain, breathlessness, agitation, secretions and nausea

Question 30

What should be used for pain in palliative care?

Answer 30

WHO analgesic ladder

Question 31

What is important to start if using an opioid?

Answer 31

Laxative and anti-emetic

Question 32

What is used for background pain?

Answer 32

MST

Question 33

What drug is used for breakthrough pain?

Answer 33

Oramorph

Question 34

What is the breakthrough dose of oramorph?

Answer 34

1/6th of the background dose

Question 35

What are the symptoms of morphine toxicity?

Answer 35

Grogginess, feeling wiped out, hallucinations, myoclonic jerks

Question 36

What opioid should be used in poor renal function?

Answer 36

Oxycodone, buprenorphine or alfentanil

Question 37

What is the subcut dose of oramorph compared to the oral dose of oramorph?

Answer 37

HALF

Question 38

How do you convert an oral codeine dose to an oral morphine dose?

Answer 38

Divide dose by `10

Question 39

How do you convert an oral tramadol dose to an oral morphine dose?

Answer 39

Divide dose by 10

Question 40

How do you convert an oral morphine dose to an oral oxycodone dose?

Answer 40

Divide by 2

Question 41

How do you convert an oral morphine dose to a subcut morphine dose?

Answer 41

Divide by 2

Question 42

How do you covert an oral oxycodone dose to a subcut oxycodone dose?

Answer 42

Divide by 2

Question 43

How do you convert an oral morphine dose to a subcut diamorphine dose?

Answer 43

Divide by 3

Question 44

What dose of oral morphine is equivalent to 1mg of subcut alfentanil?

Answer 44

30g

Question 45

What drug is used for agitation in palliative care?

Answer 45

Midazolam

Question 46

What drug is used for secretions in palliative care?

Answer 46

Hyoscine butylbromide (Buscopan)

Question 47

What drug is used for nausea and vomiting in palliative care?

Answer 47

Levomopromazine

Question 48

What drug is used for breathlessness in palliative care?

Answer 48

Opioids help with breathlessness

Question 49

What do syringe drivers allow for?

Answer 49

A continuous sub cut infusion of fluids and drugs

Question 50

What does a PET scan measure?

Answer 50

Glucose uptake

Question 51

What tumour marker is used in breast cancer?

Answer 51

CA 15-3

Question 52

Why is dexamethasone used for brain metastases?

Answer 52

Reduces brain oedema to cause reduction in symptoms of raised ICP

Question 53

How are incontrollable hiccups in palliative care treated?

Answer 53

Chlorpromazine

Question 54

What is the tumour marker for pancreatic cancer?

Answer 54

CA 19-9

Question 55

What unit is radiotherapy prescribed in?

Answer 55

Grey

Question 56

How is a chemotherapy dose calculated?

Answer 56

Patients calculated surface area