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Flashcards in Back pain Deck (28)
1

common sites of the spine for degenerative spinal disease

cervical and lumbar area

2

medication that requires DEXA scan monitoring, and why

indication for medication

aromatase inhibitors; lower oestrogen levels which can accelerate bone loss

indicated in previous history of breast cancer

3

management by GP for suspected metastatic spinal cord compression

urgent (24-48 hours) MRI whole spine

4

7 symptoms suggestive of metastatic spinal cord compression

- progressive pain in spine
- severe unremitting spinal pain
- spinal pain aggravated by straining e.g. cough, sneeze, moving
- band like pain
- local spinal tenderness
- nocturnal spinal pain preventing sleep
- neuro symptoms: radicular pain, limb weakness, walking difficulty, sensory loss, bowel/bladder dysfunction

5

when should the MSCC coordinator be contacted

within 24 hours

6

2 curative treatments

- surgery
- radical radiotherapy

7

aim of palliative care?

- increase life expectancy
- improve symptoms now + in the future

8

adjuvant therapy

- occurs following surgery that has been curative
- systemic treatment aimed at reducing the chance of relapse

9

systemic treatment options for MSCC

- endocrine therapy
- chemotherapy
- HER2 targeted therapy
- bone targeted therapy

10

further blood tests following MSCC

FBC: bone marrow infiltration can lead to bone marrow suppression: anaemia + thrombocytopenia

Bone profile: hypercalcaemia

U + E: if hypercalcaemia found

LFTs: marker for liver mets

11

management of hypercalcemia from bone mets

1st line saline
2nd line IV bisphosphonate infusion

12

what is vertebroplasty?

injecting cement into a collapsed vertebral body, to help with pain control

13

Tamoxifen

selective oestrogen receptor modulator; which blocks receptors; preventing oestrogen from reaching them

14

aromatase inhibitors

prevent conversion of androgens to oestrogens; therefore reducing the level of oestrogen in the blood to undetectable levels

only effective in post menopausal women

15

hormonal treatments for ER positive cancer (3)

- Tamoxifen
- Aromatase inhibitors
- Fluvestrant

16

drug to lower oestrogen levels in post menopausal women

Aromatase inhibitors
Fluvestrant

17

% breast cancers that are Her2 positive

15

18

combination 1st line trx for Her2 positive breast cancer

- Pertuzumab
- Trastuzumab
- Docetaxel (chemotherapy)

19

mechanism of Trastuzumab

interacting with HER2 receptor and preventing it being stimulated by growth factors

20

what can be affected by both Pertuzumab + Trastuzumab

and consequently what must be assessed

cardiac function

LVEF prior to starting and at regular intervals while they continue to receive them

21

2 ways of measuring LVEF

- echo
- MUGA scan (multi gated acquisition scan... nuclear medicine scan)

22

What is denosumab

monoclonal antibody, RANK ligand inhibitor

23

denosumab can treat (2)

- metastatic cancers
- osteoporosis

24

what is denosumab effective at reducing

skeletal related events e.g. fractures, spinal cord compression, need for interventional surgery or radiotherapy

25

long term trx of bone mets

denosumab

26

2 important side effects of denosumab

- hypocalcaemia
- jaw osteonecrosis

27

Red flags in back pain

- previous hx malignancy
- age < 16 or > 50 years with new onset pain
- previous long standing steroid use
- recent serious illness
- recent significant infection

28

red flag signs

- saddle anaesthesia
- reduced anal tone
- hip/knee weakness
- generalise spinal deformity
- urinary retention