Oncologic Emergencies Flashcards Preview

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Flashcards in Oncologic Emergencies Deck (60)
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1
Q

Examples of mechanical emergenciesq

A

PE, spinal cord compression, SVC syndrome, urinary obstruction, carcinomatous meningitis, malignant effusion

2
Q

Metabolic emergencies

A

tumor lysis, hypercalcemia, SIADH, hyperuricemia, adrenal insufficiency

3
Q

hematologic emergency

A

cytopenias, febrile neutropenia, hyperviscosity, bleeding clotting

4
Q

key buzzwords for SVC case study

A

facial swelling, puffiness of eyes, cough, no smoking history, URI for a week, felt faint while coughing, right side pleural effusion , plethora of face, dilated veins over thorax

5
Q

SVC extends from the..

A

R and L innominate veins into the RA and completely encircled by lymph nodes

6
Q

Besides cancers what else can cause SVC syndrome?

A

10% cases: indwelling catheter, infectious: TB, histo

7
Q

horners syndrome

A

found with SVC, when nerves to eye are compressed as well

8
Q

horner’s syndrome triad

A

pstosis, loss of hemifacial sweating, constricted pupil

9
Q

what diagnostic test is required for SVC syndrome?

A

biopsy prior to starting therapy, usually order a CXR and MRI or venogram to see if clot is present

10
Q

6 stages of SVC treatmnet

A
  1. radiation 2. chemo 3. anticoag (if central line and /or no response) 4. steroid 5. stent 6. surg
11
Q

spinal cord compression buzzwords

A

mid thoracic back pain increasing worse with standing, mild weakness in legs

12
Q

what are the two most common onc emergencies

A

spinal cord compression and SVC syndrome

13
Q

What cancers typically cause spinal cord compression

A

breast, lung, thyroid, kidney, prostate

14
Q

what does weakness with SCC mean?

A

URGENT intervention!

15
Q

what is typically present at diagnosis with SCC

A

back pain, bowel and bladder dysfunction

16
Q

what 2 diagnostic test best SCC

A

plain x ray and MRI of spinal cord

17
Q

SCC treatment

A
  1. suspicious? give dexamethasone, 16 mg dialy IV/PO q 6 hours wean over 2wks 2. send to consutl neurosurg and radiation onc
18
Q

what is most significant prognostic variable for SCC

A

severity of weakness, and then rapid onset of neuro sx and rapid progression = poor prognosis

19
Q

non ambulatory without proximal gravity leg function..

A

only 5% regain ambulatory function

20
Q

what percent of brain metasis are solitary?

A

50%

21
Q

incidence of brain metastases

A

30% of cancer patients

22
Q

what is presentation brain metases

A

increased fatigue, N/V, edema, early morning headaches, sizures can be first sign (melanoma 50%!!), hemorrhage common (with melanoma, gestational cancer, and testicular cancer)

23
Q

what are 2 images brain metastases

A
  1. Head CT noncontrasted make sure they are not bleeding, contrast? 2. MRI contrast ..best for location number and metastatic staging..
24
Q

what 3 areas of brain is the MRI with contrast best at seeeing

A

cerebellum, temporal lobes, and brain stem

25
Q

Brain metastases treatment

A
  1. steroids (edema) - decadron 2. consolt radiation (WBRT, SRS) 3. Surgery/NSU: solitary lesions 4. anticonvulsant therapy not indicated routinely
26
Q

if brain metastases seems to be worsening what test order?

A

CT: looking for CNX leptomeminingeal dz

27
Q

what 5 cancers associated with carcinomatous meningitis

A

lymphoma, leukemia, breast, lung, melanoma (BLLLM)

28
Q

buzzwords carcinomatous meningitis

A

facial numbness, HA, spinal cord compression sx,

29
Q

DX of carcinomatous meningitis

A

LABS: CSF cytology: elevated CSF pro, WBC with lymphocytosis. Low glucose *key lumbar puncture has high opening pressure above 160 mm

30
Q

treat carcinomatous meningitis

A

intrathecal chemotherapy, radiation

31
Q

intrathecal chemo

A

chemo injected between layers of meninges .. hence for carcinomatous meningitis

32
Q

buzzwords malignant pericardial effusion

A

see: mediastinal widening, cardiac silhouette enlarged, dilated neck veins CP retrosternal, tamponade

33
Q

what are the 3 tests used to differentiate between pleural effusion and pericardial?

A

CXR, Echo, chest CT

34
Q

Pleural effusion

A

dypnea, CP, cough, percussion = dull

35
Q

treat pericardial effusion

A

pericardiocentesis, pericardial window

36
Q

pleural effusion treatment

A

thoracentesis, chest tube or thoracoscopy with pleural sclerosis or pleurex. cath (pt can drain their cath till stops draining) KEY: malignant effusions continue to reoccur until get scarring of pleural cavity

37
Q

PE/DVVT treatment

A

anticoagulation: warfarin option.. but hard with diet and chemo so probably Lovenox (LMWH Enoxaparin)

38
Q

PE/DVT diagnosis

A

US for DVT, VQ scan, spiral CT

39
Q

what NHL med has cardiotoxitiy properties

A

doxorubicin

40
Q

equation for Ca corrected

A

calcium + ((4- albumin bound ca) X0.8)

41
Q

key hypercalcemia signs

A

constipation, frequent urination, short QT, dry mucous membranes, muscle weakness, fatigue, coma fofusion, N/V stomach pain

42
Q

4 main hypercalcemia tx

A
  1. IV fluids: 1.5-3 L per 24hrs
  2. bisphosphonates: Zolendronate or Pamidronate
  3. Calcitonin: slows bone resorption and increase pee out calcium
  4. Consider furosemide
43
Q

when admit a pt with hypercalcemia?

A

when Ca is over 12 - worry about altered mental status, low renal function , arrhythmias, lives alone and or poor ER access

44
Q

what is number one most common onc ER?

A

hyponatriemic condition, especially with small cell lung cancer

45
Q

4 main causes of low sodium

A
  1. left perihilar mass
  2. multiple low attenuation liver lesions
  3. FNA liver lesion: spread from small cell lung cancer
  4. SIADH
46
Q

SIADH

A

ectopic ADH..keep way too much water, associated with SCLC

47
Q

what is main concern with low na?

A

cerebral overhydration! .. see progression of altered mental status, obtundation, coma, respiratory arrest

48
Q

low na treatment

A

treat underlying malignancy, water restriction, demeclocycline, hypertonic saline if severe

49
Q

how could febrile neutropenia present?

A

diffuse myalgias, chills, temp 102, WBC 0.3

50
Q

When does febrile neutropenia most commonly occur

A

during or after 1st cycle of chemo..caused by bacterial, viral or fungal exposure with low WBC

51
Q

Dx criteria for febrile neutropenia

A
  1. single temp above 38.5 (101.3)
  2. 3 temps over 38 or 100. 4 within 1 day (4 hr apart)
  3. ANC less than 500/mm or 500-1000 with downward trend
52
Q

mortality rate of neutropenia

A

95%

53
Q

timeframe for treatment of febrile neutropenia

A

4 hours for abx for gram negative rod (worry about sepsis)

54
Q

BLT kosher pickle

A

cancer associated with SCC: breast, lung, thyroid, kidney, prostate

55
Q

4 steps of febrile neutropenia workup

A
  1. CXR
  2. UA and culture
  3. Blood cultures - 2 sets!
    - peripheral and central venous line
  4. examine other sites: sinuses, perianal, skin mucous membrane
56
Q

febrile neutropenia tx

A
  1. empiric broad spectrum abx: cefepine, ceftazadine, impipenim, meropenem
  2. 2-3 days still bad.. MRSA? vancomysin
  3. if longer than 5 days consider antivirals or antifungals
57
Q

Post febrile neutropenic episode tx

A

transition to oral abx: ciprofloxacin or augmentin, consider preventative measures (GF: filgrastim, pegfilgrastim)

58
Q

buzzwords sepsis/ SIRS (systemic inflammatory response syndrome caused by infection)

A

Fever more than 38.3 (100.9), AMS (measles..rash appears delayed), hyperglycemic but low BP, tachy pnea and cardia

59
Q

Sepsis / SIRS tx

A
  1. IV abx 2. IV fluids 3. vasopressors, blood products, 4. treat organ failure (ie hemodialysis), 5. mechanical ventilation
60
Q

risk factors small bowel obstruction

A

post op adhesions, tumor, begning (inflammatory lesion, vascular tumors, )