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KChan Saves the World > KC Onc and Special Pop > Flashcards

KC Onc and Special Pop Flashcards

1
Q

*What are 2 Definitions of fever in febrile neutropenia

A

A single temperature at or above 38.3° C
A sustained temperature of at least 38.0° C for at least 1 hour

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2
Q

*What are 2 Definitions of neutropenia

A

ANC less than 500 cells/mm 3
An ANC expected to drop below this threshold within 48 hours

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3
Q

*4 biochemical changes in tumour lysis syndrome

A
  • HYPERuricemia (i.e. high uric acid, source is DNA, which is metabolized to uric acid)
  • HYPERphosphatemia (phosphate primarily intracellular electrolyte)
  • HYPOcalcemia (due to binding of phosphate)
  • HYPERkalemia
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4
Q

*2 reasons to treat hypocalcemia in TLS

A

Hypocalcemia with 1) cardiac (e.g. dysrhythmia, heart block) 2) neurologic (e.g. seizure, coma) instability
- Can also give calcium if hyperkalemia with ECG changes

Otherwise should avoid giving calcium just for hypocalcemia; supplemental calcium will only increase calcium-phosphate deposition in the viscera

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5
Q

*What are 5 non-infectious causes of fever in an oncology patient

A

VTE, drug side effect (ex. chemo), tumor burden, transfusion reaction, inflammation

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6
Q

*what is the classic triad of hyperviscosity?

A

Classically presents with the triad of neurological deficits, visual changes, and mucosal bleeding.

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7
Q

*Treatment of hyperviscosity

A

Plasmapheresis (temporizing measures: hydration, phlebotomy, hydroxyurea)

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8
Q

*What are high risk criteria in patients with febrile neutropenia?

A

Opposite of MASCC score:
Severe symptoms
Hypotension
COPD
Heme cancer with prev. fungal infection
Dehydration
Inpatient
Over 60yo

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9
Q

*What are the indications for IV vancomycin in a patient with febrile neutropenia?

A

Hypotension or CVS unstable
Clinically suspected catheter infection
Positive culture for gram+ organisms
Known colonization MRSA (or ceph resistant pneumococcus)
?other: skin/soft tissue infection, pneumonia (page 1498)

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10
Q

*What is the appropriate PO antibiotic regimen for a patient with febrile neutropenia being discharged home?

A

Amox/Clav + cipro
“moxifloxacin monotherapy has shown similar outcomes”

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11
Q

*Lymphoma patient on chemo presents with increasing SOB and pleuritic CP, afebrile. 5 Differential Diagnoses

A
  • Pulmonary embolism
  • Pericardial effusion/tamponade
  • Pericarditis/myocarditis
  • Pneumonia
  • Pneumothorax
  • Mass/airway obstruction
  • Acute heart failure
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12
Q

*3 treatments of tumour lysis syndrome

A
  • Intravenous fluids, as high as 5-6 L daily
  • Prevent/treat hyperuricemia (allopurinol and rasburicase)
  • Correct other electrolytes
    consider dialysis)
    Caveats:
  • Calcium: To minimize risk of calcium phosphate nephropathy, calcium should only be given in setting of cardiac (e.g. dysrhythmia, heart block) or neurologic (e.g. seizure, coma) instability
  • Potassium: Management of hyperkalemia same as any other etiology, including use of calcium
  • Uric acid: Allopurinol to decrease production, rasburicase to increase elimination
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13
Q

List 5 features associated with low risk febrile neutropenia

A

[Box 115.1] - MASCC criteria
Hx: age <60, fever while outpatient, no hx of prior fungal infection, no hx of COPD
O/E: asymptomatic or mild symptom burden, no dehydration, no hypotension

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14
Q

Which with febrile neutropenia can be treated as an outpatient

A

1) meet low risk criteria (MASCC score => 21)
2) no evidence of PNA, line infection, cellulitis, or organ failure
3) have reliable follow up with their oncologist
4) have demonstrated clinical stability during an observation in the emergency department that lasts at least 4 hours

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15
Q

Which cancers are most likely to cause spinal cord compression

A

Prostate, breast, lung

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16
Q

List 4 ultrasound findings of cardiac tamponade

A

pericardial fluid, RV diastolic collapse, RA systolic collapse, plethoric IVC

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17
Q

What is pulsus paradoxus

A

> 10 mmHg change in systolic blood pressure between the inspiratory and expiratory phases of the cardiac cycle

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18
Q

What is Kussmaul’s sign

A

paradoxically increased JVP with inspiration

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19
Q

List 3 cancers associated with hypercalcemia

A

Lung, lymphomas, esophagus, head and neck, cervical, endometrial

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20
Q

What diuretic should be avoided in hypercalcemia

A

Thiazides (increase calcium reabsorption)

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21
Q

List 5 risk factors for tumor lysis syndrome

A

Tumor related: high proliferation rate, large tumor burden, increased WBC, bone marrow involvement, kidney involvement, high sensitivity to chemo agents
Host related: low urine output, CKD

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22
Q

List 2 cancers at a particular risk for tumor lysis syndrome

A

lymphoma, leukemia

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23
Q

List 2 reasons why high WBCs counts in cancer are particularly prone to causing leukostasis

A

Blast cells are larger and less deformable than WBCs leading to increased viscosity
Leukemic cells may trigger additional endothelial adhesion mechanisms

24
Q

List 3 cancers and 3 non cancerous causes of SVC syndrome

A

Cancers: lung, thyroid, breast, lymphoma
Non cancers: thyroid goiter, tuberculosis, pacemaker wires, indwelling central line, thoracic aortic aneurysms, pericardial effusion, post radiation

25
Q

List 2 medications that can be used in invasive fungal infections

A

Amphotericin B, caspofungin

26
Q

Which medications can be used to treat listeria infections

A

Ampicillin, gentamicin, Septra
Vanco, cephalosporins are not effective

27
Q

Which medications can be used to treat legionella infections

A

Azithromycin or levofloxacin (respiratory fluoroquinolone)

28
Q

List 5 causes of bilateral infiltrates in the immunocompromised patient

A

Viruses: CMV, RSV, influenza
Bacteria: PCP
CHF, TRALI, radiation injury, chemo induced toxicity, ARDS, pulmonary hemorrhage, cancer

29
Q

List 5 causes of focal infiltrate in the immunocompromised patient

A

Bacterial: Legionella, MRSA, TB
Fungi: aspergillosis, mucormycosis,
PE, cancer

30
Q

List 5 side effects of corticosteroid use

A

adrenal insufficiency, peptic ulcer disease, pancreatitis, psychosis, glaucoma, poor wound healing, hyperglycemia, avascular necrosis of the bone, spontaneous fractures

31
Q

List 6 causes of functional asplenia

A

sickle cell disease, ulcerative colitis, celiac disease, sarcoidosis, amyloidosis, RA, SLE

32
Q

*Define and give two examples for different types of restraints (chemical, physical, environmental)

A

a. Chemical
1. versed
2. ketamine
b. Physical
1. 4 point restraints
2. Mittens
c. Environmental
1. Placing the stretcher in slight Trendelenburg with the guardrails up
2. A locked room with CCTV and security monitoring

33
Q

*5 considerations for safety when using waist restraints?

A
  1. Make sure the patient doesn’t have the restraints on too tight
  2. Make sure they don’t have open wounds, abdo surgical sites
  3. Make sure there’s nothing compromising their ability to breath freely
  4. Make sure they have normal peripheral pulses
  5. Make sure they can urinate
34
Q

*5 things to consider for your own safety when seeing a violent patient?

A
  1. Do not see patient if they’re actively violent
  2. Let security know that you’re seeing a potentially violent patient, ask them to stand nearby
  3. Leave the door slightly open, stand near the door to allow quick escape
  4. Make sure the patient has been searched for weapons, devices, needles
  5. Do not bring anything with you that could be potentially used as a weapon
35
Q

*List 3 classes of antipsychotic medications and give one example of each (to restrain a patient)

A
  • Benzos (Midaz)
  • Typical Antipsychotics (Haldol)
  • Atypical antipsychotics (Risperdal)
36
Q

*When using waist restraints, what are 3 considerations to decrease the risk of asphyxiation?

A
  • Avoid prone position
  • Use of chemical sedation if patient continues to struggle against physical restraint
  • Frequent re-assessments/Monitoring
  • Position changes
  • Remove restraints as soon as possible
37
Q

Describe 10 elements of verbal de-escalation

A

[Box 189.4] see photo

38
Q

*Name 5 causes of pneumonia in immunocompromised patients?

A

CMV
Aspergillus
Candida
Pseudomonas
Staph aureus

39
Q

*Recognize PCP, what is the prophylaxis for this condition?

A

Septra

40
Q

*When is the infectious risk highest for a transplant patient and over what period does the risk decline?

A

1-6 months, declines after?

41
Q

*What are 5 complications of lung transplant?

A

Anatomic
- Anastomosis
- Pneumothorax
- Hemothorax
- Pleural effusion
- Empyema
- Persistent air leaks
Rejection (25% in first year)
Infection
- CMV most common opportunistic infection post lung transplant
Drug toxicity

42
Q

List 3 bacterial, viral, and fungal opportunistic infections

A

Bacterial: pseudomonas, mycobacterium, listeria, nocardia, clostridium
Viral: HIB, HBV, EBV, HCV, HSV, VZV, CMV
Fungal: candida, cryptococcus, aspergillus, histoplasma, strongyloides

43
Q

List 5 medications that can interact with anti-rejection medications

A

Antibiotics: rifampin, fluoroquinolones, macrolides, aminoglycosides, fluconazole, amphotericin
Anti convulsants: carbamazepine, phenobarbital, phenytoin
Cardiac meds: colchicine, diltiazem, verapamil

44
Q

What are the SPICE organisms and what is their clinical relevance

A

SPICE: Serratia, providencia, indole-positive proteus, citrobacter, enterobacter
Also pseudomonas and acinetobacter

These bacteria have inducible AmpC Beta lactam genes that can create B lactam resistance despite apparent sensitivity
Avoid third generation cephalosporins
Needs 4th generation cephalosporins ex. cefepime, carbapenems, aminoglycosides, or fluoroquinolones

45
Q

List 4 categories of complications post organ transplant

A

Anatomic/surgical, rejection, infection, drug toxicity

RAID

46
Q

List 3 vascular and 3 non vascular complications of solid organ transplant

A

Vascular: thrombosis, stenosis, AV fistula, pseudoaneurysm, bleeding
Non vascular: complications to bile ducts, bronchi, ureters - leaks, obstructions from scarring or migration

47
Q

What are the three phases to transplant rejection

A

Hyperacute: days in the peri-operative periods, occurs d/t preformed antibodies or ABO incompatibility
Acute: days to week with constitutional sx
Chronic: months to years with chronic rejection, fibrosis, inflammation

48
Q

List 4 categories of transplant medications, side effects, and examples of each

A

Induction agents/mono clonal antibodies ex. Alemtuzumab - risk of immunosuppression
Calcineurin inhibitors ex. Tacrolimus, cyclosporin - risk of nephrotoxicity, neurotoxicity
Rapanycin inhibitors ex. Sirolimus - risk of nephrotoxicity, impaired wound healing, pneumonitis
Antimetabolites ex. azathioprine, mycophenolate - risk of hepatotoxicity and bine marrow depression
Corticosteroids

49
Q

List 4 physiologic changes in the transplanted heart

A

Increases resting heart rate to 95-110 due to lack of parasympathetic tone
Medications affecting autonomic nervous system ex. Atropine will have no use
Increased risk of silent or asymptomatic MI
Donor and recipient SA nodes may show two different P waves

50
Q

What is the most common vascular complication post hepatic transplant

A

Hepatic artery thrombosis

51
Q

*5 medical interventions you would do

A

HIV PEP
Hep B PEP
Gono/chlam treatment
Trich treatment
Tetanus
Levonorgestrel + antiemetic

52
Q

*4 populations at risk

A

Homeless,
Those with severe disabilities (eg, serious injury, chronic disease, chronic mental health problems),
Incarcerated men and women,
Children.
College-aged women (especially freshman),
Nonheterosexuals,
Those who use drugs and alcohol,
Sex workers.

53
Q

*3 signs in a male

A

The anal and rectal examination should include visualization to look for potential foreign bodies and gross injury, such as tears, abrasions, bleeding, erythema, hematoma, fissures, engorgement, and friability.

54
Q

*2 reasons for urine tox screen in the sexual assault patient

A

• Period of unconsciousness
• Period of loss of motor control
• Amnesia or confused state with suspicion of sexual assault
• Patient suspicion or belief that she or he was drugged prior to or during sexual assault
And
• Less than 72–96 hours since assault (depending on jurisdictional protocol)

55
Q

What is the ideal imaging in the non fatal strangulation patient

A

CTA neck +/- CT head if concerns for hypoxic brain injury

56
Q

List 5 signs on history that may suggest human trafficking

A

[Box 59.1]
see photo

KChan Saves the World (24 decks)

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