Oncological Emergencies Flashcards Preview

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Flashcards in Oncological Emergencies Deck (63):
1

What are oncological emergencies?

Any clinical oncological situation that requires diagnostic attention and therapeutic intervention

2

Varices over the chest is likely due to what cause?

Increase pressure/blockage in the IVJ

3

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

Mediastinal tumors

4

What is superior vena cava syndrome?

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

5

What areas does the SVC drain?

Head
Arms
Upper torso

6

What are the ssx of SVC syndrome?

JVD
Edema of the head/neck/ upper chest
Larynx

7

What are the emergency parts of SVC syndrome?

Impairment of breathing/pharynx

Confusion/coma

8

What is the most common malignancy causing SVC syndrome?

Lung CA and NHL

9

What are the benign causes of SVC syndrome?

Thrombosis d/t intravascular devices

Fibrosing mediastinitis

10

What is the diagnostic study of choice for SVC syndrome?

CT w/ contrast

11

Why do you want contrast with imaging for SVC syndrome?

Outline venous

12

What is the treatment for SVC syndrome?

SVC stent
Treat underlying disease (xrt or chemo)

13

Are diuretics indicated for SVC syndrome?

No

14

Are steroids indicated for SVC syndrome?

No

15

The role of stenting in SVC syndrome?

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

16

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

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

17

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

Infections secondary to myelosuppression

18

What is neutropenic fever?

Neutropenia induced infection and fever

19

What is the absolute neutrophil count in neutropenic fever?

20

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

1. Microbiologically documented infection
2. Clinically documented infection
3. Unexplained fever

21

What is the sign of neutropenic fever?

Mucositis

22

What is the treatment for neutropenic fever?

Empiric abx/antifungals
Remove infected devices

23

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

Meticulous H&P
CBC w/ diff
LFTs
CMP
Cultures

**CXR**

24

What is the cause of neutropenic fever?

Effects of chemo on mucosal barriers and the immune system

Obstruction of lymphatics, biliary tract, or UG system

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