EXAM #3: ONCOLOGIC EMERGENCIES Flashcards Preview

Hematology and Oncology > EXAM #3: ONCOLOGIC EMERGENCIES > Flashcards

Flashcards in EXAM #3: ONCOLOGIC EMERGENCIES Deck (35):
1

What is the most common cause of cancer (lifestyle factor)? What is number two?

1) Smoking
2) Obesity

2

What causes SVC Syndrome?

Mediastinal mass

3

What is a common cause of a mediastinal mass in a smoker?

Lung cancer

4

What is the result of a mediastinal mass compressing the SVC?

Blood flows through venous collateral networks, returning blood to the heart via the IVC or azygous vein

5

What is the definition of SVC Syndrome?

Any condition, benign or malignant that causes obstruction of blood flow through the SVC

6

Where does the SVC drain blood from?

Head
Arms
Upper torso

7

What are the signs of SVC Syndrome?

1) Presence of venous collaterals
2) Edema of the head, neck, arms, upper chest, larynx*, and brain*
3) Dyspnea, headache, cyanosis, chest pain, confusion*, coma*

8

What are the two most common malignant causes of SVC syndrome?

1) Lung cancer
2) NHL

9

What are the benign causes of SVC Syndrome?

1) SVC stenosis/ thrombosis due to venous catheter/ pacemaker wire
2) Fibrosing mediastinitis

10

What is the gold standard for imaging/diagnostics for SVC Syndrome?

Chest CT with contrast

11

How is SVC Syndrome treated?

1) SVC endovascular stent
2) Treat underlying cause

12

What are the treatments that would be appropriate for treating malignancy causing SVC Syndrome?

- Radiation
- Chemotherapy

****Steroids and diuretics don't really help*****

13

What is the treatment for LIFE-THREATENING SVC Syndrome?

SVC Endovascular Stent

14

A 50 year-old patient presents to the ED w/ a fever of 103. She is s/p chemo for metastatic breast cancer one week ago. What is this until proven otherwise?

Neutropenic fever

15

What is mucositis?

Inflammation of the mucous seen in neutropenic fever

16

What is the definition of neutropenic fever?

- Single temp greater than 101 F or sustained temp greater than 100.4

AND

- Absolute Neutrophil Count less than 500

17

How do you calculate the ANC?

WBC x % neutrophils + %bands

18

Outline how neutropenic fever commonly develops?

- Cytotoxic antineoplastic therapy
- Compromises the integrity of GI tract
- Allows the translocation of bacteria/fungi

19

What is an absolute MUST for the treatment for neutropenic fever?

Broad-spectrum empiric antibiotics within 60 minutes of arrival to the ED

20

How do you evaluate patients with suspected neutropenic fever?

1) Detailed history and PE (naked)
2) Labs and culture
3) CXR

21

What PE procedure should you NOT do in a patient with a suspected neutropenic fever?

Rectal exam (DRE)

22

What is the most common cause of documented infections in neutropenic patients?

Infection from patients endogenous gut flora

23

Though fungal infections are uncommon causes of infection in neutropenia, what is Candida infection commonly associated with?

Central venous catheter associated infections

24

What increases the risk/ need for anti-fungal agents in neutropenia?

Prolonged neutropenia

25

Is GM-CSF a part of the normal treatment for acute neutropenia?

No--it doesn't work fast enough

26

What is pulsus paradoxus?

Variable pulse with respiration

27

What is a common cause of a very narrow pulse pressure?

Cardiac Tamponade/ pericardial effusion

28

What is the EKG manifestation of cardiac tamponade?

Electrical alternans

29

What is the CXR finding that is pathogonomic for pericardial effusion?

Water-bottle sign

30

What is the gold standard for diagnosing pericardial effusion?

ECHOcardiogram

31

What is malignant pericardial effusion associated with?

1) Lung cacner
2) Breast cancer
3) Leukemia
4) Lymphoma
5) Prior chemo or radiation

32

What determines the severity of symptoms in pericardial tamponade?

How rapid the accumulation of fluid occurs

33

What are the signs of Cardiac Tamponade?

1) Tachycardia
2) JVD
3) Diminished heart sounds
4) Pulsus paradoxus
5) Reduced pulse pressure
6) Electrical alternans

34

What is the emergent treatment for Pericardial Tamponade?

Pericardiocentesis

35

What is the procedure for recurrent pericardial effusion?

Pericardial window