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Y4 CCTs > Red Flags > Flashcards

Red Flags Flashcards

1
Q

Prostate Cancer

  • red flags symptoms
  • initial investigations used in GP
A

Symptoms:

  • visible haematuria
  • erectile dysfunction
  • lower urinary tract symptoms

Initial investigations: PSA, rectal examination

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2
Q

Breast Cancer

  • red flags symptoms
  • initial investigations used in GP
A

Symptoms:

  • over 30 with an unexplained breast lump
  • over 50 with nipple changes, discharge, retraction
  • skin changes suggestive of cancer
  • over 30 with axillary lymphadenopathy

Investigations at GP: breast examination

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3
Q

Lung Cancer

  • red flags symptoms
  • initial investigations used in GP
A

Symptoms:

  • haemoptysis
  • CXR suggestive of malignancy
  • SOB, cough, fatigue, chest pain, persistent chest infections
  • finger clubbing
  • loss of appetite
  • subclavicular or cervical lymphadenopathy

Ix: chest XR, FBC → platelets

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4
Q

Bowel Cancer

  • red flags symptoms (for different ages)
  • initial investigations used in GP
A

Symptoms:

  • over 40 with unexplained weight loss and abdominal pain
  • over 50 with unexplained PR bleeding
  • over 60 with iron deficiency anaemia or changes in bowel habit or positive FOB
  • under 50 with PR bleed AND abdo pain, or change in bowel habit or weight loss or iron deficiency anaemia

Ix: PR exam, FBC → anaemia

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5
Q

Oesophageal Cancer

  • red flags symptoms
  • initial investigations used in GP
A

Symptoms:

  • dysphagia
  • over 55 with weight loss and upper abdo pain, reflux or dyspepsia
  • over 55 with treatment - resistant dyspepsia, upper abdo pain with anaemia
  • raised platelets with nausea, vomiting, reflux or weight loss
  • nausea or vomiting with weight loss, dyspepsia or upper abdominal pain

Ix: anaemia, raised platelets, OGD

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6
Q

Ovarian Cancer

  • red flags symptoms
  • initial investigations used in GP
A

Symptoms:

  • ascities
  • pelvic/abdominal mass

Ix: USS, Ca 125

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7
Q

Malignant Melanoma

  • red flags symptoms
  • initial investigations used in GP
A

Symptoms:

3 points or more on the weighted checklist:

  • Major (2 points): change in size, change in shape, irregular colours
  • Minor (1 point): inflammation, oozing, change in sensation, diameter >7mm

Ix: dermatoscopy

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8
Q

Bladder Cancer

  • red flags symptoms (ages)
  • initial investigations used in GP
A

Symptoms:

  • over 45 with unexplained visible haematuria (without UTI) or recurrent visible haematuria after the infection was treated
  • over 60 with non-visible haematuria and dysuria or raised WCC

Ix: FBC → raised WCC

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9
Q

Uterus Cancer

  • red flags symptoms
  • initial investigations used in GP
A

Sympotms:

  • post-menopausal bleeding
  • over 55 with vaginal discharge with thrombocytosis or haematuria
  • over 55 with haematuria, anaemia, thrombocytosis OR high blood sugar levels

Ix: USS, FBC, HbA1C

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10
Q

A 46 year old lady comes to see you with a lump in the right breast.

List 3 potential signs on examination that would alert you to malignancy

A
  • descrete hard lump with fixation (with or without skin tethering)
  • unilateral bloody nipple discharge
  • unilateral eczematous skin change not responding to treatment
  • skin tethering/ peaud’ orange
  • nipple distortion /znieksztalcenie/ or change of recent onset
  • axillary lymphadenopathy
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11
Q

Risk factors for breast cancer

A
  • Family Hx in 1st degree relative
  • BRCA1 and BRCA2 → carry a very high risk but represent only <5% of cases
  • Age → 2% in <35, 5% in <40
  • the nulliparous or first child born >35 yo
  • early menarche/ late menopause
  • HRT → risk increases after >5 yrs duration and is significant with >10 yrs of use
  • radiation to chest
  • no having breast fed (it is considered to be protective)
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12
Q

A 46 year old lady comes to see you with a lump in the right breast.

What would you do as a GP? When might you consider referral?

A
  • History and examination
  • Refer using suspected cancer pathway if:
  • aged >30 years with unexplained breast lump with or without pain
  • aged >50 years with any of the following in one nipple only: discharge, retraction or other changes eg Pagets
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13
Q

Breast Cancer

  • What would you do, to make a diagnosis, if you were a specialist in a breast clinic?
A

Triple assessment:

  • clinical examination
  • USS / mammo (mammogram detects 90% of cancers but less accurate in younger women)
  • FNA/tissue diagnosis
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14
Q
A
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15
Q

What life and lifestyle risk factors are linked to lung cacner?

A
  • Smoking
  • Asbestos exposure
  • COPD
  • Previous history of cancer – esp head and neck
  • Occupational: aluminium, iron and steel. Exposure to arsenic, beryllium, cadmium, nickel, chromium compounds, coal, diesel engine exhaust, hematitie mining, MOPP chemo, DXT, production of rubber, crystalline silica dust, sulphur mustard
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16
Q

Lung cancer

When would you consider making a referral using the cancer pathway for an appointment within 2 weeks?

A
  • CXR findings suggestive of lung cancer
  • Aged >40 yrs with unexplained haemoptysis
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17
Q
A
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18
Q

Name 3 symptoms or signs which would prompt you to consider requesting an urgent CXR (within 2 weeks) in individuals aged >40 years

A
  • Persistent or recurrent chest infection
  • Finger clubbing
  • Supraclavicular or persistent cervical lymphadenopathy
  • Chest signs consistent with lung cancer or pleural disease
  • Thrombocytosis
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19
Q
A

Offer a CXR to those aged >40 with the following unexplained symptoms:

Cough, fatigue, SOB, chest pain, weight loss, appetite loss

  • 1 of the above symptoms for smokers / asbestos exposure
  • 2 of the above symptoms for never smokers
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20
Q

What alarm features would cause you to make a referral for an urgent direct endoscopy?

(symptom and range of age)

A
  • Dysphagia
  • Aged >55 yrs with: weight loss + any of: upper abdo pain/ reflux/ dyspepsia
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21
Q

What symptoms would prompt consideration of non-urgent direct access endoscopy?

age + symptoms

A
  • Haematemesis – but clinical judgement used
  • Aged >55 yrs with:
    1) treatment resistant dyspepsia
    2) upperabdo pain + anaemia
    3) Raised platelets AND any of N /V /weight loss/reflux/dyspepsia/upper abdo pain
    4) Nausea & vomiting AND any of weight loss/reflux/dyspepsia/upper abdo pain
22
Q

What symptoms might make you suspicious of pancreatic cancer? (age ranges and symptoms)

A
  • Jaundice in those aged >40 – refer using suspected cancer pathway
  • Patients aged >60 years with weight loss AND any of:

Diarrhoea, back pain, abdominal pain, N/V, constipation, new-onset diabetes

23
Q

Ix in pancreatic cancer

A
  • CT scan
  • USS if CT not available

*USS only images the head of the pancreas, CT images the whole pancreas and may detect other cancers

24
Q

What is the main factor determining prognosis in malignant melanoma?

A

Breslow thickness

  • measures in millimetres the distance between the upper layer of the epidermis and the deepest point of tumor penetration
  • the thinner the melanoma, the better the chance of a cure
25
Q

A 62 year old lady has had a “period type” post menopausal bleed.

List your differential diagnosis

A
  • HRT
  • Endometrial hyperplasia / carcinoma / polyps
  • Uterine sarcoma (rare)
  • Cervical carcinoma / polyps
  • Vaginal, vulval, ovarian cancers
  • Vaginal atrophy
  • Non gynae causes
26
Q

When to consider direct access USS in women aged >55? (gyn cancers)

A

Consider direct access USS in women aged >55 yrs

  • with unexplained PV discharge presenting for the first time OR if thrombocytosis OR haematuria
  • Visible haematuria AND any of anaemia/thrombocytosis/raised blood glucose
27
Q

Ix performed in FastTract clinic for suspected endometrial/gyn cancer

A
  • Transvaginal USS – including endometrial thickness
  • Endometrial biopsy – for histology
  • Hysteroscopy and biopsy
28
Q

What’s the threshold for endometrial thickness in terms of likelihood of endometrial ca?

A

Threshold is 5mm

  • >5mm → 7.3% likelihood of endometrial cancer
  • <5mm has negstive predictive value of 98%
29
Q

What patients (age ranges and symptoms) need 2ww referral for bowel cancer?

A
  • Aged >40 with unexplained weight loss and abdo pain
  • Aged >50 with unexplained rectal bleeding
  • Aged >60 with iron deficiency anaemia OR change in bowel habit
  • If positive FOB test
30
Q

When to consider* 2ww bowel ca referral?

*symptoms/ages that not usually will straight away alert 2ww referral

A
  • Rectal or abdominal mass
  • Unexplained anal mass or ulceration
  • <50 y & rectal bleeding PLUS abdo pain/changed bowel habit/weight loss/iron def anaemia
31
Q

What would you consider to identify a patient’s fitness for a colonoscopy?

A
  • MI in past 3/12
  • Fitness for bowel prep (moviprep) at home
  • Mobility - capable of climbing on to couch/lying flat / turning on side
  • On anticoagulants / anti-platelets/ iron tablets
32
Q

A 56 year old singer presents with 6 weeks of hoarseness

Differential diagnosis

A
  • Benign laryngeal conditions – voice overuse, nodules, functional dysphonias
  • Cancer of the larynx/ Other head and neck cancers eg lung Ca, lymphoma, thyroid Ca
  • Laryngeal nerve palsy (CVA, Parkinsons, MND, Myaesthenia gravis)
  • Infections – viral, bacterial staph/ strep, fungal or TB
  • Endocrine – hypothyroid, acromegaly
  • Congenital – glottis web, congenital cyst
  • GORD
  • Scarring (prolonged intubation or post radical radiotherapy/ surgery)
33
Q

Main risk factors for laryngeal cancer

A
  • Smoking
  • Alcohol
  • GORD
  • HPV – Ca larynx
  • Long term exposure to chemicals / fumes / pollutants
34
Q
  • What’s that sign? (name)
  • name 2 specific cancers that may cause that picture
A

Clubbing

  • Squamous Cell Carcinoma (bronchial carcinoma)
  • Mesothelioma
35
Q
  • Name the Ix performed (picture)
  • Name 4 possible causes
A

CT Brain – enhanced

  • Cerebral metastases
  • Lymphoma
  • Cerebral abscesses (HIV/TB/Toxoplasmosis)
  • Primary cerebral cancer
36
Q
A

Koilonychia

  • Iron deficiency anaemia (GI malignancy)
37
Q
A

CT Abdomen

  • Colonic adenocarcinoma
  • Breast cancer
  • Lung cancer
  • Stomach/Pancreas
38
Q
A

Virchows node / Troisiers Sign

  • Gastric carcinoma
  • Lung cancer
39
Q
A

Cannonball mets

  • RCC/Testicular cancer (seminoma)/Sarcoma/Colon cancer/Breast
40
Q
A
  • Ca Pancreas
  • Cholangiocarcinoma
  • Small bowel lymphoma
  • Duodenal carcinoma
41
Q
A

Barium Enema

  • Colon adenocarcinoma
  • Dukes Staging
42
Q
A

Sclerotic Metastases

  • Prostate carcinoma
43
Q
A

Nipple Inversion

Ultrasound/Needle aspiration/Mammogram

44
Q
A

Barium Meal

Linitis Plastica

45
Q
A
  • Thyroid cancer/Lymphoma/Lymphatic mets
  • SVC obstruction
46
Q

Name 3 malignant causes for haematuria

A

Prostate carcinoma/Transitional cell carcinoma/Renal cell carcinoma/Genital or Gynae cancers

47
Q
A

Multiple Myeloma

48
Q
A

Breast cancer/Bronchus/Prostate/Thyroid/Kidney

49
Q

Name 4 causes for elevated PSA

A
  • BPH
  • Prostate cancer
  • Prostatitis
  • TURP
  • Catheterisation
  • Retention
50
Q
A

Hepatocellular carcinoma

Cirrhosis due to:

  • Alpha 1 antitrypsin def
  • Haemachromatosis
  • Alcohol
  • PBC
  • HBC/HCV
  • OCP
  • Anabolic Steroids
  • Aflatoxins
  • Parasites
51
Q
A

Hypertrophic Osteoarthropathy

  • Lung cancer (SCC)
  • Chronic Liver disease
  • Chronic Lung sepsis

Sx: Dull bone pain, swelling occasionally

52
Q

Red flags for lower back pain

A
  • age < 20 years or > 50 years
  • history of previous malignancy
  • night pain
  • history of trauma
  • systemically unwell e.g. weight loss, fever

Y4 CCTs (14 decks)

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