Oncological Emergencies Flashcards
(36 cards)
Which cancers are most likely to metastasize to the spinal cord
Lung, breast, prostate
Where is the most common location of spine mets
Thoracic spine
What are signs of spinal mets (spinal cord compression)
Pain that worsens when lying down or with coughing or bowel movement, Late neurologic signs such as incontinence and loss of sensory function
What are PEs to do with suspected spinal cord compression
vertebral percussion, DTRS (increased), Babinski’s, valsalva maneuver.
What are ssx of caudal equina
Although it is a compression, it has a lower motor neuron lesion presentation, with decreased DTRs and flaccidity, along with urinary and bowel incontinence or retention, saddle paresis
What imaging is done for suspected spinal lesion
X-ray may reveal lytic areas, but CT and MRI are better for intra spinal lesions and compression fractures
What common complain should be taken more seriously when in a cancer patient
Complaints of back pain must be thoroughly worked up regardless of whether they think there is a reasonable etiology for said back pain
What is appropriate treatment for someone with local pain from indwelling catheter, especially if catheter was for chemotherapy
Send them to the ER for eval since chemo agents tend to be so toxic
What are pertinent negatives in a headache workup for R/O of brain tumor or other space occupying brain lesion
Visual field changes, vomiting (projectile or not), focal neurological deficits (weakness, numbness), seizures, mental status change
What cancers most commonly metastasize to the brain (5)
lung cancer, breast cancer, renal cell cancer, colon cancer and melanoma
What normally causes Superior Vena Cava Syndrome/Obstruction
Usually the result of the direct obstruction of the superior vena cava by malignancies such as compression of the vessel wall by lung cancer, thyroid mass (multi nodular goiter), thymoma, etc
What is the most common cause of Superior vena cava syndrome (SVCS)
bronchogenic carcinoma
What is the most common cause of paraneoplastic syndrome
bronchogenic carcinoma
What are the ssx of SVCS
- Shortness of breath is the most common symptom, followed by facial or arm swelling
- Headache
- Venous distention in the neck and distended veins in the upper chest and arms.
- Lightheadedness
- Cough
- Sleeping propped up
What is Trousseau’s sign of malignancy
Episodes of vessel inflammation due to blood clot (thrombophlebitis) which are recurrent or appearing in different locations over time
What is Trousseau’s sign of hypocalcemia
Carpal spasm from maintaining BP cuff above systolic BP. May also have Chvostek’s sign (tapping of the inferior portion of the cheekbone will produce facial spasms)
What is Horner’s syndrome
unilateral anhydrosis, ptosis, myosis
What is the classical finding of cardiac tamponade
Beck’s triad: hypotension, muffled heart sounds, JVD
What is seen on CXR in cardiac tamponade
Cardiomegaly, clear lung fields “water bottle heart”
What labs/imaging are ordered in cardiac tamponade
CXR, then U/S and EKG
What is the classic EKG fringing in cardiac tamponade
EKG classically shows electrical aternans as well as low voltage (diminished height) of T waves
What is febrile neutropenia
temperature of 101° F (38.3° C) or more and an absolute neutrophil count (ANC) less than 500 per mm3
How is cardiac tamponade treated
Cut a hole in the pericardial sack, or use a sclerosis agent to scar down the pericardial sack
What are common effects of hypercalcemia
stones (renal or biliary), bones (bone pain), groans (abdominal pain, nausea and vomiting, thrones (constipation and polyuria) and psychiatric overtones (depression 30-40%, anxiety, cognitive dysfunction, coma).
