Gen Surg - Oncological OSCE Flashcards
(34 cards)
What defines febrile neutropenia?
Temp >38.0°C in a patient with bone marrow suppression, leading to reduced neutrophils and impaired immune response.
What are the most common causes of febrile neutropenia?
Recent chemotherapy (within 6 weeks), radiation affecting bone marrow.
What is the most common bacterial cause?
Usually gram-positive bacteria, but can also be gram-negative or fungal
What are the symptoms of febrile neutropenia?
Fever (often only symptom)
Hypotension
Local signs of infection (but may be absent)
Can rapidly progress to sepsis → septic shock
What is the 5-step management plan for febrile neutropenia?
Check vitals
IV fluid resuscitation if hypotensive
Draw bloods (CBC, renal function, blood cultures)
Start broad-spectrum antibiotics (e.g., gentamicin + amoxicillin)
Repeat blood & urine cultures
What is the most common oncological cause of hypercalcaemia?
Squamous cell lung cancer secreting parathyroid hormone-related peptide (PTHrP)
What are other oncological causes of hypercalcaemia?
Bone metastases (lytic lesions release calcium)
Tumour secreting IL-1
What are the early symptoms of hypercalcaemia?
Polyuria & polydipsia
Mild psych disturbances (confusion, fatigue)
Dyspepsia
Muscle weakness
What are severe symptoms of hypercalcaemia (>3.5 mmol/L)?
Abdominal pain, vomiting
Cardiac arrhythmias
Renal stones, pancreatitis, coma
What is the most common non-oncological cause of hypercalcaemia?
Primary hyperparathyroidism (80-90%)
How do you manage hypercalcaemia?
IV fluids (first-line)
Treat underlying malignancy (chemo, hormonal therapy)
If short-term control needed: bisphosphonate (zoledronic acid)
What is the most common cause of spinal cord compression?
Extradural metastatic tumours from lung, breast, prostate cancer or lymphoma/myeloma.
What is the hallmark symptom of spinal cord compression?
Back pain that often radiates and worsens with lying down
What are other symptoms of spinal cord compression?
Tingling, sensory loss, muscle weakness
Clumsiness
Bowel/bladder dysfunction
What is the key differential diagnosis of spinal cord compression?
Slipped disc
Pulled muscle
Arthritis
Infection, compression fracture
What key signs should be checked on examination of spinal cord compression?
Vertebral bone tenderness
Sensory loss (abdominal sensory level)
Palpable bladder (urinary retention)
Tone, power, reflexes
What are the first-line investigations?
MRI of whole spinal cord (gold standard)
Bloods: FBC, U&E, LFTs, CRP, tumour markers
How do you manage spinal cord compression?
High-dose dexamethasone (16mg/day)
If life expectancy >6 months → Surgical decompression (laminectomy)
If metastatic disease → Radiotherapy or chemotherapy
What is the most common cause of SVC obstruction?
Lung cancer, lymphoma
What other conditions can cause SVC obstruction?
Retrosternal goitre, sarcoidosis of lungs or lymph nodes
What are the hallmark symptoms of SVC obstruction?
Facial oedema
Distended neck veins
Dyspnoea &/or cough
What is a key differential diagnosis?
Right ventricular dysfunction
Cardiac tamponade
What investigations should be ordered?
CXR (may show widened mediastinum)
Contrast CT (to localise tumour and plan biopsy site)
Bloods (FBC, U&E, tumour markers)
What is the management for SVC obstruction?
Dexamethasone ± diuretics (reduce oedema)
Radiotherapy or chemotherapy (depends on tumour type)
Transvenous stent insertion (if rapid symptom relief needed)
