Oncology

Question 1

Neutropenic sepsis aetiology

Answer 1

Aggressive chemo

Multiple rounds of chemo

Question 2

Neutropenic sepsis clinical features

Answer 2

Temp > 37.5
In > 2 places
> 1 hour apart

Fever + Chemo = ??? Neutropenic sepsis ???

Other features of sepsis/source

Question 3

Neutropenic sepsis investigations and management

Answer 3

Sepsis 6
Neutrophils < 1x10^9

IV Tazocin
Once confirmed - Gentamicin

Prevention

• GCSF - Granulocyte stimulating factor
• Ciprofloxacin

Question 4

Tumour lysis syndrome

Answer 4

Increased breakdown/lysis of cells
Release of cellular content into the blood

Potassium
Phosphate
Uric acid

Question 5

Tumour lysis syndrome risk factors

Answer 5

Dehydrated patients
Pre-existing renal disease

Fast growing/large cancers

• Lymphoma - Burkitt’s
• Leukaemia - ALL

Question 6

Tumour lysis syndrome clinical features

Answer 6

Uric acid - Gout
Hyperkalaemia - Weakness, chest pain, arrhythmias
Hyperphosphataemia
Hypocalcaemia - Tetany, muscle cramps, peri-oral paraethesia
AKI - Oliguria

Question 7

Tumour lysis syndrome investigations and diagnosis

Answer 7

ECG - Arrhythmias - Long QT - Hypocalcaemia
Potassium ^
Phosphate ^
Calcium - LOW
Uric acid ^
U&E - AKI

Diagnosis - One of…

• Creatinine ^
• Arrhythmia
• Seizure

Question 8

Tumour lysis syndrome management and prevention

Answer 8

IV fluids
Treat hyperkalaemia
Rasburicase - Metabolises uric acid

Prevention

• Hydration
• Allopurinol
• Rasburicase

Question 9

Spinal cord compression aetiology

Answer 9

Tumour - Mets
Spinal cord tumours - Meningioma

Abscess
EDH
Disc prolapse

Osteophytes
Pott’s disease

Trauma

Question 10

Cancers that metastasise to the bone

Answer 10

BLT with Ketchup Please

Breast
Lung
Thyroid
Kidney
Prostate

Question 11

Spinal cord compression investigations and management

Answer 11

MRI spine

Management - Shrink tumour

• Analgesia
• IV Dex (+ PPI / BM monitoring)
• Surgery
• Radiotherapy

Question 12

SVCO aetiology

Answer 12

Apical lung tumour

Lymphoma

Question 13

SVCO presentation

Answer 13

Distended neck veins
Non pulsatile JVP

Dizziness, headaches, visual disturbances
Engorged conjunctiva
Facial flushing

Chest pain, palpitations, dyspnoea
Swollen arm
Cyanosis

Pemberton’s sign - Bilateral arm elevation causes facial plethora (increased blood flow)

Question 14

SVCO investigations

Answer 14

Contrast venography
CXR
Doppler USS
CT

Question 15

SVCO managment

Answer 15

O2
High dose dex

Decompression

• Endovascular stenting
• Radio/chemo