Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Rosens > 112. Oncologic Emergencies > Flashcards

112. Oncologic Emergencies Flashcards

(110 cards)

Start Studying
1
Q

Febrile neutropenia definition

A

ANC below: mild: 1000 to 1500, moderate 500 to 1000 less than 500 severe. current guidelines suggest that and see less than 500 or expected drop below the threshold within 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How to calculate the absolute neutrophil count

A

Percent granulocytes plus percent bands times total white blood cells divided by 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where are the most common sources of neutropenic fever?

A

Pneumonia, anorectal lesion, skin infection, pharyngitis, or urinary tract infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Definition of fever in federal neutropenia

A

Single temp greater than 38.3 or a greater or sustained temperature of 38 for one hour or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diagnostic testing for neutropenia

A

Blood cultures from two sites, one can be done from the central line. Where is the other should be done properly, white blood differential, urine analysis and urine culture, chemistries and renal and hepatic function tests. VBG for lactate.
Consider CDiff, chest x-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When should patients were a febrile neutropenia receive antibiotics?

A

Prior to confirming infection given high mortality
Parental broad-spectrum, antibiotic, such as pip, Tazo or Carbapenem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Multinational Association of Supportive Care in Cancer: clinical features

A

age <60
onset of fever while outpatient
overall moderate sx burden
absence dehydration
no prior fungal infection or solid tumor tyoe
no copd hx
absence of hypotension
asx or overall mild symptom burden

score >/=21 suggests low risk complication; likely resolution fever <5d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clinical features and corresponding point value of clinical index of stable febrile neutropenia:

A

eastern coop oncology group performance status >/=2
stress induced hyperglycemia
copd
chronic cardiovascular disease
mucositis of grade >/=2
monocyte coun <200 per microL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If pt with febrile neutropenia show signs of shock, what should they add to broad spectrum beta lactam with antipseudomonal coverage?

A

+ FQ or aminoglycoside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What abx for neutropenic pt with CAP?

A

levo 750mg IV a24h or azithro 500mg IV q24h and doxy 100mg BID

TMP for pcp if necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

For neutropenic pt with GI sx, what abx to give?

A

cefepime 2g IV q8h and metronidazole 500mg PO q8h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What febrile neutropenia patients can be managed as outpt?
criteria:

A
  1. low risk criteria MASCC 21 or less
  2. no evidence of pneumonia, line infection, cellulitis or organ failure
  3. reliable daily f/u with oncology
  4. clinical stability in ER 4h or longer
  5. low suspicion of infection with drug R organism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Metastatic SC compression: where does lesion most often come from?

A

extradural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Metastatic SC compression: how does cord injury normally occur?

A

occlusion of epidural venous plexus leading to breakdown of BBB and vasgenic edema
if untx - arterial obstruction –> cord ischemia and infarct

less common direct compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Metastatic SC compression: what cancers typically cause this?

A

prostate
breast
lung ca

RCC
nonHodgkin lymphoma
MM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Metastatic SC compression: where mc?

A

thoracic

lumobosacral

cervical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Metastatic SC compression: clinical features?

A

back pain (mc)
weakness (extremity often first pre. weakness)
sensory loss
autonomic function loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Metastatic SC compression: diagnostic testing

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Metastatic SC compression: tx in ED

A

CS: 10mg bolus IV then 16mg oral per d
if paraplegic consider first dose of 100mg IV then 96/day orally in divided doses
initiation of defin tx - surgery, rad therapy or both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Metastatic SC compression: how do steroids work?

A

temporize vasogenic cord edema but damage occurs without source control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Malignant pericardial disease: mc three?

A

pericarditis
neoplasm
effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Malignant pericardial disease: how can this occur as an effusion?

A

lymphatic flow becomes obstructed by proximal malignant LN
so mets spread to pericardial lining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

mc cancers causing pericardial effusion?

A

lung
breast
heme
melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Kussmaul sign

A

paradoxial incr in JVP with inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Beck's triad
hypotension elevated JVP muffled heart sounds
26
Malignant pericardial disease: ddx?
acs hf or valve failure pe pleural effusion pneumonia ptx
27
Malignant pericardial disease: pericardial effusion work up?
cxr ecg tte
28
Malignant pericardial effusion findings on ecg?
nonsp st or t change low amp qrs electrical alternans
29
Malignant pericardial disease: management of pericardial effusion?
drainage by subxiphoid approach likely will recur so needs LT f/u fluid sampling for cytology or tumor marker analysis
30
Hypercalcemia: what two main hormones incr serum ca regulation? what decr?
PTH calcitriol - incr serum ca decr: calcitonin
31
Hypercalcemia: what are two places active vitamin D works on?
bone - osteoclast activation to release GI - to incr dietary ca uptake and dietary phosphate
32
Inactive vit d to active by which enzyme?
1 alpha hydroxylase
33
To incr ca: PTH acts on what two organs
kidneys: incr ca reuptake, decr phos reuptake bone: osteoclast
34
How do cancer patients experience Hypercalcemia: 4 methods
synthesis PTHrP overproduction calcitriol bone osteolysis due to direct tumor spread less common ectopic production of PTH
35
PTHrP producing cancers?
squamous.- head and neck, lung, esophageal, cervical, ovarian, endometrial
36
Cacitriol overproduction in which cancers?
hodgkin and non lymphomas
37
Hypercalcemia: sx
weakness lethargy confusion abdo pain n/emesis constipation polyruia polydipsia kidney injury
38
Hypercalcemia: ecg
qt interval shortening to dysr and heart block
39
Hypercalcemia: which ca measurement needed?
free ca as lots bound to albumin
40
Hypercalcemia: Tx ED
1. fluids ++ as helps to incr removal: 1-2L bolus, then 200-250ml/hour -->. +/- dialysis above if needed to support u/o 2. bisphosphonates: inhibit bone turn over: pamidtronade 90mg over 2-4 hours or zolendronate 4mg over 15-30 mins *expect decr 3-4mg/dl but probably not for 7-10d 3. calcitonin SC 4-8 units/kg q6h (faster 12-24h onset) 4. Denosumab to block RANK ligand * esp if renal clearance bad
41
Rosen's indications for admission for Hypercalcemia:
Ca >14 acutely incr
42
TLS: why does this occur?
desctruction of malignant cells so rapid that body mechanism for unwanted products are overwhelmed
43
TLS: 4 abnormal electrolyte/lab values
Hyperuricemia HyperK Hyperphos HYPOcalcemia AKI often as well
44
TLS: what other organ affected often
kidney
45
TLS: typical cancers causing this?
Burkitt lymphoma ALL
46
TLS: PT risk factors (aside from type of ca)
preexisting renal failure hypovolemia hyperuriciemia
47
TLS: sx/presentation
nausea/emesis lethargy confusion edem seizure myalgias and tetany dysrh --> cardiac arest
48
TLS: ecg
qt interval prolongation due to hypoca, p wave flattening, PR and QRS interval prolongation T wave peaking due to hyperk
49
TLS: diagnostic testing
chem 10 - K, phosphate, ca (ionized), BUN, Cr uric acid ON ICE if had rasburicase already LDH
50
TLS: management ED
1. 3L/m2/d (as high as 5-6L /d) 2. DialysisCRRT if Cr really bad/oliguria at BL 3. Limit dietary intake 4. Don't tx hypoca as secondary to excess phosphate 5. shift K (insulin, bicarb, beta agonist), ca gluconate if needed, etc usual tx 6. hyperuric: allopurinol, febuxostat or rasburicase
51
TLS: nephrotoxic compound of ca phosphate: how to hypocalcemia tx or when to?
don't tx as higher risk for getting this only time to tx is cardiac dysr, neurologic (seiz, coma), hyperK
52
TLS: mechanism allopurinol in hyperuriciemia
analog of uric acid precuros hypoxanthine to competitively inhibit enzymatic conversion of xanthine to uric acid xanthine watch kidneys though!!
53
TLS: hyperuricemia with tx of feboxostat - how does this work?
noncompetitive inhib of xanthine oxidase enzyme not as good as allopurinol
54
TLS: hyperuricemia - how does rasburicase work?
recombinant enzume of urate oxidase, turns uric cid into allantoin
55
TLS: rasburicase dose
0.05-0.15mg/kg x1 dose (adult typc 6mg)
56
What is a CI to rasburicase?
G6PD deficiency as hydrogen peroxide is a byproduct of drug and can trigger hemolytic crisis
57
Complications of rasburicase
methemoglobinemia hemolytic crisis of G6PD deficient
58
Leukostasis level
CLL 500 vs AML <100 (really depends on ca)
59
Leukostasis: complications
retinal hemorrhage CNS typical MI acute limb ischemia priapism Renal vein thrombosis renal infarction
60
Leukostasis: what might you see on VBG o2 if it waits to be sent?
leukocytes will eat o2 so it looks falsely low
61
Leukostasis: ED management
1. reduction of blood viscosity via IV fluids 2. avoid RBC as will incr viscosity 3. leukaphresis and or 4. dose of hydroxyurea (works 24-48 hr) and or 5. chemo agents per oncology, but watch for TLS
62
SVC syndrome: when is flow compromised?
20-40mmhg
63
SVC syndrome: mc malignancies causing?
lung ca lymphoma
64
SVC syndrome: outside of neoplasm, what is second mc cause?
thrombus
65
SVC syndrome: hx symptoms
upper extreimity, chest or face edema or erythema -possible sobm dysphagia, cp, cough
66
SVC syndrome: signs on PE
elevated JVD edema, flushing or cyanosis of the face, arms, upper trunk vc paralysis blurred vision, horner sydrome are possible pleural effusion
67
SVC syndrome: dx
cellulits or deep tissue infection of face neck (ludwig angina) thoracic inlet syndrome obstruction of -DVT in IJ or subclavian vein)
68
SVC syndrome: diagnostics
thoracic and contract enh CT typically like to know what ca prior - may ned bronch/bx
69
SVC syndrome: tx
Elevated HOB, supplemental o2, anticoag if b thrombus know the cancer +/- rads if appropriate +/- endovascular stenting
70
Monoclonal antibody therapies: mc ca?
lymphmas colon lung h+N Breast
71
Monoclonal antibody therapies: basic physiology
nonconjugated antibodies bind to tumor target, marking tumor for kill by antibody depn cell mediated cytoxicity and compliment dependent
72
Monoclonal antibody therapies: typical infusion reaction for alemtuzumab, ibritumomab, trastuzumab
type I anaphylaxis like
73
Monoclonal antibody therapies: which one causes sudden cardiac death?
cetuximab colon/lung/H+N
74
Monoclonal antibody therapies: which specifically causes cardiomyopathy?
trastuzumab
75
Monoclonal antibody therapies: which specifically causes hepatotoxicity?
inotuzumab
76
Monoclonal antibody therapies: how to work up
if looks like sepsis, infectious w/u if cardiac - usual neuro - brain imaging
77
Monoclonal antibody therapies: management
Largely supportive High temp - antipyretics, mild infction - histamine blocker HD sypport as needed if worried about anaphylaxis tx it
78
Monoclonal antibody therapies: which can cause PML?
brentuximab ofatumumab rituximab
79
Monoclonal antibody therapies: rituximab notable complications?
severe infusion reaction TLS severe mucocutaneous reactions PML
80
T lymphocyte checkpoint inhibitor therapies and complications: how do these work?
reduce T cell tolerance to allow T cell immune response against tumor specific antigen bearing cancer cells (as these attack T cells normally)
81
T lymphocyte checkpoint inhibitor therapies and complications: which 2 checkpoints is self tolerance achieved by?
prevent mature t cells into peripheral tissues from attacking self antigen bearing cells (inhibit these) --> TLA-4, PD-1
82
T lymphocyte checkpoint inhibitor therapies and complications: most feared complication?
hypophysitis - immune mediated pitu disease which can cause shock due to GC deficiency and colitis
83
T lymphocyte checkpoint inhibitor therapies and complications: cardiac issues
pericardial effusion myocarditis
84
T lymphocyte checkpoint inhibitor therapies and complications: endocrine
hypophysitis: anorexia, fatigue, headache, nausea, diplopia, confusion, temp intol... 6-12 weeks post starting thyroid dysfunc
85
T lymphocyte checkpoint inhibitor therapies and complications: GI
colitis diarrhea hepatotoxicity
86
T lymphocyte checkpoint inhibitor therapies and complications: hematologic
neutropenia anemia ITP
87
T lymphocyte checkpoint inhibitor therapies and complications: skin
intraoral lesion skin toxicity
88
T lymphocyte checkpoint inhibitor therapies and complications: neurologic
MG GBS
89
T lymphocyte checkpoint inhibitor therapies and complications: pulmonary
pneumonitis
90
T lymphocyte checkpoint inhibitor therapies and complications: renal
AKI
91
T lymphocyte checkpoint inhibitor therapies and complications: rheum
vasculitis myalgias arthralgias
92
T lymphocyte checkpoint inhibitor therapies and complications: general management
supportive, specific to presentation if sp to qol - consider taking to oncology: prednisolone, methylpred if hypophysitis
93
T lymphocyte checkpoint inhibitor therapies and complications: diagnosing and treating hypophysitis
visual field test, MRI brain, pitu function test meythlpred 1-2mg/kg/d IV
94
T lymphocyte checkpoint inhibitor therapies and complications: colitis dx and tx
ct imaging abdo pelvis, test for cdiff, colonoscopy/endoscopy considerations consider predn and if severe, infliximab
95
Adoptive cell transfer therapy and complications/Chimeric Antigen Rector (CAR) - T cell therapy: what is this?
pt own t cell is reprogrammed to attack ca cell after harvest from leukophoresis
96
Chimeric Antigen Rector (CAR) - T cell therapy: what CD are these 2 (tisagenleleucel and axicabtagene ciloleucel) designed to attack?
CD-19, B cell sp
97
Chimeric Antigen Rector (CAR) - T cell therapy: 2 major complications
cytokine release syndrome immune effector cell associated neurotoxicity syndrome
98
Chimeric Antigen Rector (CAR) - T cell therapy: Cytokine release syndrome - what is this?
uncontrolle ck release leading to life thr inflamm (60% pt so ++ prevalent) --> end organ dysfun and looks like spesis as fever, malaise, fatigue, rash, hypotension
99
Chimeric Antigen Rector (CAR) - T cell therapy: Cytokine release syndrome onset from therapy?
~3d
100
Chimeric Antigen Rector (CAR) - T cell therapy: immune effector cell-associated neurotoxicty syndrome -what is this?
cns undergo immune cell mediated damage (50% CAR-T)
101
Chimeric Antigen Receptor (CAR) - T cell therapy: Immune effector cell associate neurotoxicity syndrome: symptoms
confusion, aphagsia, headach,e tremor, behaviour change, peripheral numbness **expressive aphasia
102
Chimeric Antigen Receptor (CAR) - T cell therapy: Immune effector cell associate neurotoxicity syndrome: which type of aphasia is very sn and sp to this?
expressive
103
Chimeric Antigen Receptor (CAR) - T cell therapy: Immune effector cell associate neurotoxicity syndrome: median onset post tx
4d
104
Chimeric Antigen Receptor (CAR) - T cell therapy: Immune effector cell associate neurotoxicity syndrome: how to work up in ED
1. tx as sepsis until provden otherwise and or stroke if necessary: image, septic work up, +/- eeg/ +/- LP MRI may show t2 hyperinensity in wm and thalami, csf can show elevated levels of pro nad leykocytes (needs cultures to r/o meningitis)
105
Chimeric Antigen Receptor (CAR) - T cell therapy: Immune effector cell associate neurotoxicity syndrome: management in the ED (once know not sepsis, stroke, etc):
Low grade CRS: tx symptomatically More severe: Tocilizumab and CS following this if no response Supportive: IVF, vasopressors, respiratory support
106
Chimeric Antigen Receptor (CAR) - T cell therapy: Immune effector cell associate neurotoxicity syndrome: how does tocilizumab work for this?
anti IL 6 receptor antibody for Cytokine release syndrome
107
What antibiotics have antipseudomonal coverage
with imipenem, meropenem, ceftazidime, or cefepime is as effective as traditional dual therapy with an antipseudo- monal penicillin (piptazo) and aminoglycoside
108
When should vancomycin be included for febrile neutropenia pt?
Hypotension or cardiac involvement suspected cath infection + blood cultures of a + organism known colonization with MRSA or cephalosporin R pneumococcus
109
Cairo Bishop score for TLS
Meet more than 2/4 of lab in same 24h criteria: lab TLS: uric acid >8 K >/=6 Phos >/=4.6 Ca /=1.5 x ULN N cardiac arrh seizure tetany or other symp
110
Which cancers cause hypercalemia
Hem: leuk, lymphoma, MM Head and neck Breast Lung ovarian renal endometrial

Rosens (83 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions