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Flashcards in Passmed Deck (46):
1

Paraneoplastic syndromes associated with small cell lung cancer:

SIADH, leading to fluid retention and euvolaemic hyponatraemia.

ACTH production, leading to excess cortisol production, causing Cushing's syndrome.

Lambert-Eaton syndrome

2

Paraneoplastic syndromes associated with squamous cell lung cancer:

Raised parathyroid hormone, leading to hypercalcaemia

Raised thyroid hormone

Clubbing

3

Transient side effects of opioid:

Nausea
Drowsiness

4

Persistent side effects of opioid:

Constipation

5

Oncological emergency associated with lung cancer:

Superior vena cava obstruction

6

Treatment for SVC obstruction

Steroid (e.g. dexamethasone) to dampen the inflammatory response to the tumour.

7

Symptoms of SVC obstruction

Raised ICP: headache, visual disturbances
Distended forehead veins
Swelling of face

Dyspnoea (most common)

Pemberton sign (cyanosis and dyspnoea on raising arms into air)

8

Tumour marker for ovarian cancer

CA 125

9

Tumour marker for pancreatic cancer

CA 19-9

10

Tumour marker for breast cancer

CA 15-3

11

Tumour marker for prostate cancer

PSA

12

Tumour marker for hepatocellular carcinoma

Alfa-feto protein

13

Tumour marker for colorectal cancer

Carcinoembryonic antigen (CEA)

14

Tumour marker for melanoma

S-100

15

Tumour marker for small cell lung carcinoma

Bombesin

16

Tumour marker for gastric cancer

Bombesin

17

Which type of lung cancer is most common in non-smokers?

Adenocarcinoma

18

Which type of lunch cancer doesn't present on bronchoscopy?

Adenocarcinoma

19

What dose of morphine should be used for breakthrough pain?

One-sixth of total daily morphine dose.

20

Tumour marker for germ cell tumour

Beta-hCG

21

Preferred opioids in patients with CKD:

Fentanyl
Alfentanil
Buprenorphine

22

Treatment for malignant spinal cord compression:

Dexamethasone

23

Treatment for metastatic bone pain:

Analgesia
Bisphosphonates
Radiotherapy

24

How do you convert from oral morphine to subcut morphine dose?

Divide oral morphine dose by 2.

25

When are transdermal patches appropriate analgesia?

Stable levels of pain (i.e. not palliative cancer patient)

Not opioid naive

26

Which cytotoxic agent is associated with liver fibroids, myelosuppression and oral mucositis?

Methotrexate

27

Which cytotoxic agent is associated with cardiomyopathy?

Doxorubicin

28

How do you convert from oral morphine to subcutaneous diamorphine?

Divide by 3.

So 30mg of oral morphine is equivalent to 10mg subcut diamorphine.

29

Treatment for nausea and vomiting in palliative care

Cyclizine
Metaclopramide
Haloperidol
Levomepromazine

30

Treatment for respiratory secretions in syringe drivers for palliative patients:

Hyoscine hydrobromide

31

Treatment for bowel colic symptoms in syringe drivers for palliative patients:

Hyoscine butylbromide

"Bowel = butyl"

32

Tumour marker for teratoma

Alfa feto-protein (also useful for liver cancer)

Beta-hCG

33

What route provides metastatic spread to the bone from prostate/breast/bladder/lung?

Batson venous complex

34

Syndrome associated with hereditary NON-polyposis colorectal cancer.

Lynch syndrome

35

What syndrome is a subtype of familial adenomatous polyposis?

Gardner's

36

How do you determine at what level a case of spinal cord compression is occurring?

Lesions above L1:
- Upper motor neuron signs in legs (increased tone, spasticity, reflexes)

Lesions below L1:
- Lower motor neuron signs (decreased tone, reflexes)
- Perianal numbness

Furthermore, tendon reflexes tend to be increased below the level of the lesion, and absent at the level.

37

Treatment for spinal cord compression

Dexamethasone

Urgent oncological assessment.

38

Tumour marker for medullary thyroid cancer

Calcitonin

39

How do you treat nausea and vomiting in intracranial tumours?

Dexamethasone

40

Most common sites for bony metastasis:

In descending order:
- Spine
- Pelvis
- Ribs
- Skull
- Long bones

41

Hiccups in palliative care should be treated with:

Chlorpromazine
Also, haloperidol

42

Potential side effect of cyclophosphamide:

Haemorrhagic cystitis

43

Potential side effect of bleomycin:

Lung fibrosis

44

Potential side effect of vincristine:

Peripheral neuropathy

45

BRCA2 is associated with which cancer in men?

Prostate

46

Treatment for agitation and confusion in palliative care:

First line: Haloperidol
In terminal phase: Midazolam