Mrcp Part 2 - Oncology/palliative

Front 1

Pituitary adenoma

Back 1

If fit for surgery - octreotide to reduce tumour size then Transphenoidal resection, and followed by radiotherapy for ACTH level is persistently high post-op

If not fit for surgery - ketoconazole to reduce cortisol secretion by acting on P450 enzymes

Front 2

Risk of exposure Vs cancer

Back 2

Aflatoxin (diet) in mold - HCC

Aniline dye - bladder ca

Front 3

Side effects of chemotherapy

Back 3

Rituximab - fever and rigors

Capecitabine - palmar plantar syndrome

Read up on the rest

Front 4

lung Ca/mets

Back 4

Cannonball - Think renal cell carcinoma

Peripheral masses - colorectal ca

Primary:

1)Squamous cell - hypercalcaemia, tend to be more central, may lead to central necrosis/cavitation, male smokers

2)Small cell - often has metastasised at presentation, may cause SIADH, raised ACTH

3)Adenocarcinoma - most common, tend to be peripheral tumours, with mets to pleura and lymph nodes

Front 5

FAP

Back 5

Hypertrophy of retinal pigment epithelium

Dental abnormalities eg supernumerary teeth and dentigerous cysts

Osteomas of the skull and mandible

Fibromas

Epidermoid cysts

Front 6

Ewing's sarcoma

Back 6

Poor prognostic factors:

- Anaemia

- raised LDH

- male

- >12years old

Front 7

Lambert eaton

Back 7

Treat: 3-4-diaminopyridine

In severe cases steroid or other immunosuppressant

Front 8

Breast ca complications

Back 8

Front 9

Extravasation injury

Back 9

- Stop infusion, aspirate from cannula as much as possible, then remove the cannula

- topical steroid

- Doxorubicin/daunorubicin are prone to ulceration hence consult plastic surgeon

- vinca alkaloid: apply heat compress

Front 10

MEN1/2A/2B

Back 10

parathyroid hyperplasia - think of symptoms of hypercalcaemia N+V abdo pain, depression

MEN1 - pancreatic tumours can be insulinoma, gastrinoma, VIPoma, etc

Front 11

RCC

Back 11

Nephrectomy

Pazopanib/sunitinib

Front 12

5-FU toxicity

Back 12

DPD deficiency

Front 13

Glioblastoma multiforme

Back 13

Diagnosis: MRI ring-enhancing lesion

1st line: debulking surgery

2nd: radiotherapy + temozolamide

3rd: chemotherapy

Front 14

Mantle radiotherapy (for Hodgkin) side effects

Back 14

Thyroid disease - hence must do TFT

Breast Ca - hence must do breast MRI

Front 15

Stage 3 ovarian ca

Back 15

Hysterectomy + BSO

Chemo: carboplatin + paclitaxel

Front 16

Lymphoma cells surface antigens

Back 16

CD19

CD20

CD22

CD79a

Front 17

RET oncogene

Back 17

Medullary thyroid carcinoma

MEN type 2a and 2b

Front 18

Breakthrough opioid

Back 18

1/6 of total daily MST dose

Front 19

Multiple myeloma

Back 19

Bortezomib (proteasome inhibitor)

Dexamethasone

Thalidomide

Front 20

Radiation colitis

Back 20

Loperamide +/- colestyramine

Octreotide

Front 21

Metastatic melanoma

Back 21

Pembrolizumab (binds to PD-1 receptor)

Front 22

Secondary cancer of Hodgkin's Lymphoma

Back 22

AML

Breast ca

Lung ca