Emergency Conditions

Question 1

At what level is cauda equina from?

Answer 1

Below L1/L2

Question 2

Signs and symptosm of MSCC

Answer 2

Back pain
Altered bowel/bladder habits
Saddle numbness/sensory disturbance
Sphincter disturbance (late sign - incontinence, hesitation, retention or constipation)

Question 3

Cauda equina symptoms

Answer 3

Nre lower back/buttock/perineum/thig/leg pain
Loss of sensation/tingling (saddle area)
Leg weakness
Bladder, bowel ans sexual dysfunction
Loss of anal reflex

Question 4

How quickly does treatment needs to be started for MSCC for symptoms to be reversed?

Answer 4

24-48 hours after onset

Question 5

MSCC treatment

Answer 5

Dexamethasone (8mg) BD plus PPI
Radiotherapy
Surgery
Chemotherapy

Question 6

MSCC surgery indications

Answer 6

Prognosis >3 months
Uncertain cause, so needing biopsy
Radio resistant tumours (melanoma, sarcoma)
Unstable spine
Solitary vertebral metastasis

Question 7

Statistics with MSCC

Answer 7

30% survive longer than 1 year
70% who could walk at time of diagnosis, will continue to walk
5% pts with paraplegia will regain ability to walk
Loss of sphincter control is poor prognostic sign

Question 8

What are some common causes of SVCO?

Answer 8

Compression or invasion of SVC by:
mediastinal lymph nodes
tumour
thrombus in region of right main bronchus

Question 9

SVCO incidence

Answer 9

5-10% of those of who have a cancer in the right bronchus

Question 10

SVCO Symptoms

Answer 10

Breathlessness
Dizziness
Visual changes
Headache
Swelling fo face, arm and neck

Question 11

SVCO signs

Answer 11

Periorbital oedema
Vessel distension in neck vessles
Engorged conjunctivae
Dilated veins in neck, back and chest
Blue/purple discolouration of face and chest

Question 12

SVCO treatment

Answer 12

O2 if needed
Dexamthasone (16mg, ideally PO)
Ref to oncology team to consider:
surgery/stenting, radiotherapy, chemotherapy

Question 13

Pathophysiology of hypercalcaemia

Answer 13

Increased osteoclast activity causing increase release of calcium into blood stream plus reduced excretion or urinary calcium.

Question 14

Incidence of tumour induced hypercalcaemia

Answer 14

in 20% of cancer population

Question 15

Common tumours linked to hypercalcaemia

Answer 15

SCC of bronchus
Breast cancer
prostate cancer
multiple lyeloma
other SCCs

Question 16

Signs and smyptms of hypercalcaemia

Answer 16

Depression
Muscle weakness
Thirst
Drowsiness, lethargy adn fatuges
Confusion
Nausea and vomiting
Constipation

Question 17

Hypercalcaemia treatment

Answer 17

IV fluid replacement
Bisphosphonates

Question 18

Prognosis in patients with hypercalcaemia

Answer 18

80% will survive less than 1 year

Question 19

Give the different levels of neutropaenia

Answer 19

mild 1-1.5 x10^9
moderate0.5-1 x10^9
severe <0.5 x10^9

Question 20

Define neutropaenic spesis

Answer 20

Severe neutropaenia with signs/symptoms of infection

Question 21

Causes of seizures in palliative care pts

Answer 21

Pre-existing epilepsy diagnosis
Brain metastases
Derangement of metabolites e.g. hypoglycaemia, hypercalcaemia