EXAM #3: ONCOLOGIC EMERGENCIES II Flashcards

1
Q

What is the definition of Malignant Spinal Cord Compression?

A

Compression of the spinal cord or cauda equina by an extra dural tumor

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2
Q

Outline the pathophysiology of MSCC?

A

Cord compression leads to interrupted blood flow and cord infarction

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3
Q

What is the most frequent site of MSCC?

A

T-spine

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4
Q

What are the signs and symptoms of MSCC?

A

1) Localized pain
2) Radicular pain
3) Lhermitte’s Sign
4) Motor/Sensory signs
5) Bowel/bladder incontinence

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5
Q

What is the test of choice to diagnose MSCC if a patient CANNOT have a MRI?

A

CT myelogram

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6
Q

How is MSCC treated?

A

1) Glucocorticoids
2) Radiation
3) Surgery/ decompression

Surgery is the treatment of choice*

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7
Q

What is Tumor Lysis Syndrome (TLS)?

A

Syndrome caused by rapid death of a rapidly proliferative volume of cells

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8
Q

What are the characteristics of TLS?

A

1) Hyperkalemia
2) Hyperuricemia
3) Hyperphosphatemia
4) Hypocalcemia
5) Metabolic acidosis
6) Acute kidney injury

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9
Q

What type of cancer is TLS common in?

A

Hematologic malignancies

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10
Q

What is the timeline for the diagnosis of TLS?

A

3 days prior to 7 days after chemotherapy

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11
Q

Outline the pathophysiology of TLS.

A
  • Lysed tumor cells release K+ and nucleic acid that are metabolized to uric acid
  • Hyperphosphatemia leads to hypocalcemia
  • Cytokines are released that cause systemic inflammatory response
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12
Q

What induces acute kidney injury in TLS?

A

Hyperuricemia

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13
Q

What patients are at high risk for TLS?

A

1) Pre-existing chronic renal insufficiency
2) Oliguria
3) Volume depletion
4) Hypotension
5) Acidic urine

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14
Q

How is TLS managed?

A

1) Hydration
2) Allopurinol
3) Rasburicase

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15
Q

What is the mechanism of action of Allopurinol?

A

Blocks the conversion of xanthine and hypoxanthine to uric acid

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16
Q

What is the mechanism of action of Rasburicase?

A

This is urate oxidase–catalyzes the oxidation or uric acid to water soluble allantoin

17
Q

Why does cancer predispose one to PE?

A

Hypercoaguability due to cancer

18
Q

What is the gold standard for diagnosing PE?

A

CT pulmonary angiography (CTPA)

19
Q

What is the treatment for a PE?

A

Anticoagulation

1) Heparin
2) Coumadin

20
Q

What are the most common symptoms of a PE?

A

Dyspnea
Pleuritic chest pain
Cough
Calf or thigh pain

21
Q

What are the most common signs of PE?

A

Tachypnea
Tachycardia
Rales
JVD

22
Q

What are the risk factors for a PE?

A
Malignancy
Immobility 
Trauma- ortho 
Surgery 
Central catheter 
Obesity