Acute oncology

Question 1

Aetiology of neutropaenic sepsis

Answer 1

Commonly seen in cancer patients under chemotherapy. May also be seen in TB patients, and RA patient with Felty’s syndrome.

Question 1

Neutropaenic sepsis definitions

Answer 1

Fever >38°C (>101°F) for 1 hour

With an absolute neutrophil count (ANC) of ≤500 cells/microlitre

Question 2

Management in neutropaenic sepsis

Answer 2

Organ support
Empirical antibiotics [Mero + Amik or Tazocin]
G-CSF

Question 3

Symptoms of cord compression

Answer 3

Back pain, numb, paraesthesia, weakness, hyperreflexia, sensory loss, muscle weakening or wasting

Question 4

Anterior cord syndrome

Answer 4

Blood supply lost in the anterior portion of SC.

loss of motor function below the level of injury, loss of sensations carried by the anterior columns of the spinal cord (pain and temperature), and preservation of sensations carried by the posterior columns (fine touch and proprioception)

Question 5

Management of acute malignant cord compression

Answer 5

ABCDE approach if acutely unwell (i.e. spinal shock)

Areflexia and autonomic dysfunction  urgent steroids

Immediate:
o Corticosteroids
 Dexamethasone (NICE)
 Corticosteroids provide relief from pain, reduce tumour-associated oedema, and may be oncolytic for some tumours.
o Surgery and Radiation therapy
 Studies have reported that surgery followed by radiation is more effective than radiation alone in treating patients with spinal cord compression caused by metastatic cancer

Question 6

Types of shock

Answer 6

Hypovolaemic
Cardiogenic
Distributive
Obstructive

Question 7

Hypovolaemic shock causes

Answer 7

Hemorrhage, DKA, burns, D+V,

Question 8

Cardiogenic shock causes

Answer 8

AMI-CS, HF-CS, Secondary CS, post-cardiotomy CS

Question 9

Obstructive shock causes

Answer 9

R circulation: PE, RVOTO, IVC/SVCO
L circulation: tamponade, tension PTX

Question 10

Distributive shock causes

Answer 10

Anaphylaxis, sepsis, neurogenic shock

Question 11

Role of steroids in shock

Answer 11

Only if caused by Addison’s at the moment