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Oncological Emergencies Flashcards

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1
Q

What are oncological emergencies?

A

Any clinical oncological situation that requires diagnostic attention and therapeutic intervention

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2
Q

Varices over the chest is likely due to what cause?

A

Increase pressure/blockage in the IVJ

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3
Q

What are the tumors that can cause Periorbital edema, and respiratory symptoms?

A

Mediastinal tumors

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4
Q

What is superior vena cava syndrome?

A

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

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5
Q

What areas does the SVC drain?

A

Head
Arms
Upper torso

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6
Q

What are the ssx of SVC syndrome?

A

JVD
Edema of the head/neck/ upper chest
Larynx

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7
Q

What are the emergency parts of SVC syndrome?

A

Impairment of breathing/pharynx

Confusion/coma

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8
Q

What is the most common malignancy causing SVC syndrome?

A

Lung CA and NHL

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9
Q

What are the benign causes of SVC syndrome?

A

Thrombosis d/t intravascular devices

Fibrosing mediastinitis

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10
Q

What is the diagnostic study of choice for SVC syndrome?

A

CT w/ contrast

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11
Q

Why do you want contrast with imaging for SVC syndrome?

A

Outline venous

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12
Q

What is the treatment for SVC syndrome?

A

SVC stent

Treat underlying disease (xrt or chemo)

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13
Q

Are diuretics indicated for SVC syndrome?

A

No

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14
Q

Are steroids indicated for SVC syndrome?

A

No

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15
Q

The role of stenting in SVC syndrome?

A

Dependent on the tumor type, and the anticipated response to therapy and the severity of the symptoms

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16
Q

Why is it not a big deal about the thrombogenic nature of stents in SVC syndrome?

A

CA has poor prognosis, and they probably will die of CA sooner than the stent

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17
Q

Breast CA with fever, tachycardia, and hypotension is probably what?

A

Infections secondary to myelosuppression

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18
Q

What is neutropenic fever?

A

Neutropenia induced infection and fever

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19
Q

What is the absolute neutrophil count in neutropenic fever?

A
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20
Q

What are the three different syndromes that present in neutropenic fever?

A
  1. Microbiologically documented infection
  2. Clinically documented infection
  3. Unexplained fever
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21
Q

What is the sign of neutropenic fever?

A

Mucositis

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22
Q

What is the treatment for neutropenic fever?

A

Empiric abx/antifungals

Remove infected devices

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23
Q

What are the important bits of evaluating neutropenic fevers? (General, labs (4), imaging)

A 
Meticulous H&P
CBC w/ diff
LFTs
CMP
Cultures

CXR

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24
Q

What is the cause of neutropenic fever?

A

Effects of chemo on mucosal barriers and the immune system

Obstruction of lymphatics, biliary tract, or UG system

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25
What is the cause of most infections in neutropenic fever?
Gut flora
26
What are the usual gram + agents that cause neutropenic fevers?
staph strep
27
What are the usual gram -agents that cause neutropenic fevers?
e.coli | Pseudomonas
28
What are the usual fungal agents that cause neutropenic fevers?
Candida | Aspergillus
29
What are the usual viral agents that cause neutropenic fevers? (4)
Herpes simplex Herpes zoster CMV EBV
30
How fast must broad spectrum abx be administered for neutropenic fever?
60 minutes
31
Is GSF usually indicated for neutropenic fever?
Not usually
32
What is pulsus paradoxus?
Variable pulse strength with respiration
33
What is the sensitivity of CXR with pericardial effusion?
Very low
34
What is the cause of alternating electrical magnitude on an EKG?
Pericardial effusion
35
What is the test of choice for diagnosing a pericardial effusion?
Echocardiogram
36
What is pericardial tamponade?
Accumulation of fluid in the pericardial sac surrounding the heart
37
Pericardial tamponade is usually caused by what?
Malignant disease most commonly Lung CA, beast CA, leukemia, lymphomas or previous chemo
38
What are the ssx of pericardial tamponade?
Cough, CP, SOB, weakness Tachycardia, JVD, peripheral edema Pulsus paradoxus
39
What is the treatment for pericardial effusion?
Pericardiocentesis
40
What is malignant spinal cord compression?
Tumor that compresses the spinal cord, that may lead to paraplegia d/t spinal cord infarction
41
What are the common etiologies of malignant spinal cord compression?
Lung Breast Prostate Multiple Myeloma
42
What is the most frequent site of spinal cord compression in malignant spinal cord compression?
Thoracic
43
What are the SSx of malignant spinal cord compression?
Localized back pain worse with movement Lhermitte's sign Bowel and bladder dysfunction
44
What are the ssx of cauda equina?
Decreased patella and achilles reflex LE weakness Bowel/bladder dysfunction
45
What is the diagnostic study of choice for malignant spinal cord compression?
MRIs
46
What is the treatment for malignant spinal cord compression?
Steroids XRT **Surgical intervention**
47
What is tumor lysis syndrome?
Syndrome caused by the rapid death or cell turnover of a large colume of rapidly proliferating cells
48
What are the characteristics of tumor lysis syndrome (metabolic effects)?
``` Hyperkalemia Hyperuricemia Hyperphosphatemia Hypocalcemia Metabolic acidosis ```
49
What is the major organ damage with tumor lysis syndrome? How?
Acute kidney injury Deposition of uric acid crystals in the renal tubule
50
Why is uric acid increased in tumor lysis syndromes?
Metabolism of nucleic acids
51
What causes the hypocalcemia in tumor lysis syndrome?
Hyperphosphatemia
52
What is the major issue problem with hyperkalemia in tumor lysis syndrome?
Arrhythmias
53
What is the major issues of CaPO3 release in tumor lysis syndrome?
Precipitate throughout the body, can cause serious dysrhythmias
54
What causes the inflammatory response seen in tumor lysis syndrome?
Release of cytokines
55
What is the primary means of excreting xanthine and phosphate?
Renal
56
What are the CAs that are at high risk for tumor lysis syndrome?
High grade lymphomas Acute leukemias ANy rapidly proliferating tumors
57
What is the prophylactic treatment for tumor lysis syndrome?
Hydration Allopurinol Rasburicase
58
What is rasburicase?
Drug that catalyzes the oxidation of uric acid to the more water soluble allantoin
59
What are the high risk group of tumor lysis syndrome?
Preexisting renal insufficiency Hypotension Acidic urine
60
What is the acute treatment of tumor lysis syndrome?
Dialysis
61
What is the MOA of allopurinol?
Blocks the conversion of xanthine and hypoxanthine to uric acid
62
What is the therapy for PE?
tPA or heparin
63
When are V/Q scan performed for PEs?
Absolute contraindications to contrast

Hematology (32 decks)

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