Oncologic Emergencies

Question 1

What do the following have in common: Neutropenic fever, tamponade, cord compression, CNS metastases with symptoms?

Answer 1

need to be treated immediately

Question 2

What do the following have in common: coagulopathies, tumor lysis, leukostasis, hyperviscosity, severe thrombocytopenia, INR over 9?

Answer 2

need to be treated same day

Question 3

What do the following have in common: SVC Syndrome, most hypercalcemia, most CNS mets without edema, INR 5-9?

Answer 3

need to be treated same day or the next day

Question 4

Presents as back pain, inflammation, and paresthesias. Usually occurs in diseases with vertebral body mets, not hematogenous dural mets

Answer 4

spinal cord compression

Question 5

What comes first in cord compression, autonomic dysfxn or motor/sensory?

Answer 5

motor/sensory dysfxn

Question 6

Imaging needed for cord compression

Answer 6

MRI / CT [+/- myelogram] of the WHOLE spine

Question 7

Medication that can be helpful for cord compression, brain metastases

Answer 7

Decadron

Question 8

Presentation includes: headache, seizures, altered mental status, or focal deficits

Answer 8

brain metastases

Question 9

Most commonly from lung or breast cancer if no prior known primary

Answer 9

brain metastases

Question 10

Pharmacological therapy for brain metastases

Answer 10

decadron to reduce edema and dilantin if seizure suspected

Question 11

Presentation includes nonspecific sx’s: somnolence, headache, blurry vision, dizziness

Answer 11

hyperviscosity/leukostasis

Question 12

commonly occurs with Waldenstrom’s. less commonly with multiple myeloma or polycythemia Vera, essential thrombocytosis

Answer 12

hyperviscosity

Question 13

Tx for hyperviscosity

Answer 13

hydration, apheresis for IgM, plus chemotherapy. Hydroxyurea/aspirin for ET

Question 14

Most commonly in AML

Answer 14

leukostasis (blast crisis)

Question 15

Sx include altered mental status, coma common, but other organs also involved.
Hypoxia, renal insufficiency

Answer 15

leukostasis (blast crisis)

Question 16

Cancers that commonly cause cardiac tamponade

Answer 16

lung and breast cancers

Question 17

Presentation includes left or right sided failure, pulsus paradoxus, big heart on CXR

Answer 17

cardiac tamponade

Question 18

Surgical therapy for cardiac tamponade

Answer 18

subxiphoid pericardial window or balloon pericardiotomy

Question 19

collection of three medical signs associated with acute cardiac tamponade. The signs are low arterial blood pressure, distended neck veins, and distant, muffled heart sounds

Answer 19

Beck’s triad

Question 20

abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration

Answer 20

pulsus paradoxus

Question 21

Usually from bronchogenic carcinomas. Presents with facial edema, symmetric or asymmetric upper extremity edema, SOB common, but not hypoxic

Answer 21

SVC syndrome

Question 22

Tumor of pulmonary apex. Presents with progressively enlarging veins over the anterior chest wall

Answer 22

Pancoast tumor

Question 23

Tx for SVC

Answer 23

radiatin of tumor, heparin or corticosteroids.

Question 24

Occurs in tumors with high body burden and high chemosensitivity. Usually high-grade lymphomas or leukemias (Burkitt’s, ALL)

Answer 24

tumor lysis syndrome

Question 25

Few clinical symptoms other than being ill with obvious lab abnormalities due to renal failure

Answer 25

tumor lysis syndrome

Question 26

Metabolic abnormalities associated with tumor lysis syndrome due to rapid turnover of tumor cells

Answer 26

hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia

Question 27

Metabolic levels that kill

Answer 27

high K+ and low Ca++

Question 28

What should you do if phosphate level is greater than 7?

Answer 28

switch NaHCO3 to NS to prevent Ca-PO4 deposits in kidney

Question 29

Cancers most commonly associated with hypercalcemia

Answer 29

breast, lung, multiple myeloma

Question 30

Presentation includes: Fatigue, N/V, constipation, anorexia, apathy, decreased consciousness most common

Answer 30

hypercalcemia

Question 31

Why are patients volume depleted with hypercalcemia?

Answer 31

due to calcium-induced renal tubular defects

Question 32

Tx of hypercalcemia

Answer 32

volume repletion, furosemide, IV pamidronate (Aredia)

Question 33

Predicts short survival

Answer 33

hypercalcemia

Question 34

Cancer that commonly causes SIADH

Answer 34

small cell lung cancer

Question 35

Labs include decreased BUN/serum osmolarity and increased urine osmolarity and sodium levels

Answer 35

SIADH

Question 36

Presentation includes: anorexia, irritability, N/V, constipation, muscle weakness, myalgia, abnormal reflexes, papilledema

Answer 36

SIADH

Question 37

Tx for SIADH

Answer 37

limit fluid intake to 500-1000ml/day, furosemide, Na+ replacement if neuro sx

Question 38

May initially be very subtle, then rapid development of hypotension, dyspnea, sepsis

Answer 38

neutropenic fever

Question 39

When does most neutorpenia occur?

Answer 39

10-15 days after chemotherapy is given

Question 40

Antibiotic tx for neutropenic fever without a suspected source

Answer 40

Cefipime, Moxifloxacin, Pip/Gent, Aztreonam

Question 41

Sx include: Mucosal bleeding most common epistaxis, gingival bleeding, bullous hemorrhages. Cutaneous bleeding, petechiae, ecchymoses, Menorrhagia

Answer 41

thrombocytopenia

Question 42

Tx for thrombocytopenia

Answer 42

Prednisone if patient is well. IV-IG if patient ill

Question 43

Tx for overanticoagulation due to warfarin

Answer 43

2 units FFP and 5 mg IV vitamin K

Question 44

Tx for overanticoagulation due to heparin or LMWH

Answer 44

protamine sulfate

Question 45

Tx for overanticoagulation due to fondaparinux (Arixtra)

Answer 45

Factor VII