Flashcards in Oncological Emergencies Deck (63):
What are oncological emergencies?
Any clinical oncological situation that requires diagnostic attention and therapeutic intervention
Varices over the chest is likely due to what cause?
Increase pressure/blockage in the IVJ
What are the tumors that can cause Periorbital edema, and respiratory symptoms?
What is superior vena cava syndrome?
Ay condition, benign or malignant, that causes obstruction of blood flow through the SVC
What areas does the SVC drain?
What are the ssx of SVC syndrome?
Edema of the head/neck/ upper chest
What are the emergency parts of SVC syndrome?
Impairment of breathing/pharynx
What is the most common malignancy causing SVC syndrome?
Lung CA and NHL
What are the benign causes of SVC syndrome?
Thrombosis d/t intravascular devices
What is the diagnostic study of choice for SVC syndrome?
CT w/ contrast
Why do you want contrast with imaging for SVC syndrome?
What is the treatment for SVC syndrome?
Treat underlying disease (xrt or chemo)
Are diuretics indicated for SVC syndrome?
Are steroids indicated for SVC syndrome?
The role of stenting in SVC syndrome?
Dependent on the tumor type, and the anticipated response to therapy and the severity of the symptoms
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
Breast CA with fever, tachycardia, and hypotension is probably what?
Infections secondary to myelosuppression
What is neutropenic fever?
Neutropenia induced infection and fever
What is the absolute neutrophil count in neutropenic fever?
What are the three different syndromes that present in neutropenic fever?
1. Microbiologically documented infection
2. Clinically documented infection
3. Unexplained fever
What is the sign of neutropenic fever?
What is the treatment for neutropenic fever?
Remove infected devices
What are the important bits of evaluating neutropenic fevers? (General, labs (4), imaging)
CBC w/ diff
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
What is the cause of most infections in neutropenic fever?
What are the usual gram + agents that cause neutropenic fevers?
What are the usual gram -agents that cause neutropenic fevers?
What are the usual fungal agents that cause neutropenic fevers?
What are the usual viral agents that cause neutropenic fevers? (4)
How fast must broad spectrum abx be administered for neutropenic fever?
Is GSF usually indicated for neutropenic fever?
What is pulsus paradoxus?
Variable pulse strength with respiration
What is the sensitivity of CXR with pericardial effusion?
What is the cause of alternating electrical magnitude on an EKG?
What is the test of choice for diagnosing a pericardial effusion?
What is pericardial tamponade?
Accumulation of fluid in the pericardial sac surrounding the heart
Pericardial tamponade is usually caused by what?
Malignant disease most commonly Lung CA, beast CA, leukemia, lymphomas or previous chemo
What are the ssx of pericardial tamponade?
Cough, CP, SOB, weakness
Tachycardia, JVD, peripheral edema
What is the treatment for pericardial effusion?
What is malignant spinal cord compression?
Tumor that compresses the spinal cord, that may lead to paraplegia d/t spinal cord infarction
What are the common etiologies of malignant spinal cord compression?
What is the most frequent site of spinal cord compression in malignant spinal cord compression?
What are the SSx of malignant spinal cord compression?
Localized back pain worse with movement
Bowel and bladder dysfunction
What are the ssx of cauda equina?
Decreased patella and achilles reflex
What is the diagnostic study of choice for malignant spinal cord compression?
What is the treatment for malignant spinal cord compression?
What is tumor lysis syndrome?
Syndrome caused by the rapid death or cell turnover of a large colume of rapidly proliferating cells
What are the characteristics of tumor lysis syndrome (metabolic effects)?
What is the major organ damage with tumor lysis syndrome? How?
Acute kidney injury
Deposition of uric acid crystals in the renal tubule
Why is uric acid increased in tumor lysis syndromes?
Metabolism of nucleic acids
What causes the hypocalcemia in tumor lysis syndrome?
What is the major issue problem with hyperkalemia in tumor lysis syndrome?
What is the major issues of CaPO3 release in tumor lysis syndrome?
Precipitate throughout the body, can cause serious dysrhythmias
What causes the inflammatory response seen in tumor lysis syndrome?
Release of cytokines
What is the primary means of excreting xanthine and phosphate?
What are the CAs that are at high risk for tumor lysis syndrome?
High grade lymphomas
ANy rapidly proliferating tumors
What is the prophylactic treatment for tumor lysis syndrome?
What is rasburicase?
Drug that catalyzes the oxidation of uric acid to the more water soluble allantoin
What are the high risk group of tumor lysis syndrome?
Preexisting renal insufficiency
What is the acute treatment of tumor lysis syndrome?
What is the MOA of allopurinol?
Blocks the conversion of xanthine and hypoxanthine to uric acid
What is the therapy for PE?
tPA or heparin