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Oncological Emergencies Flashcards

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1
Q

Classical type of back pain associated with spinal cord compression

A

radiating around the rib cage

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2
Q

What should be the FY’s first act if patient suspected of impending spinal cord compression

A

arrange urgent MRI spine and start dexamethasone 8mg bd.

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3
Q

commonest cause of spinal cord compression

A

2ndary malignancy in the spine

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4
Q

most common sites for mets to the spine

A 
breast
lung 
prostate
thyroid 
kidney
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5
Q

other causes of spinal cord compression

A 
infection (epidural abscess) 
disc prolapse 
haematoma 
intrinsic cord tumour 
myeloma
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6
Q

presentation of spinal cord compression

A 
pain in spine 
weakness - bilateral or unilateral 
altered sensation 
urinary retention 
constipation 
fecal incontinence
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7
Q

characteristics of pain in the spine in spinal cord compression

A

worse on coughing or straining

radicular in nature - band-like burning pain +/- hypersensitivity

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8
Q

do weakness and pain present at the same time in spinal cord compression

A

no - pain precedes weakness

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9
Q

1st line Ix for suspected spinal cord compression

A

MRI

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10
Q

Initial Mx of spinal cord compression

A

16mg IV, then 8mg PO bd - breakfast and lunchtime

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11
Q

What is the aim of giving steroids in spinal cord compression

A

reducing vasogenic oedema

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12
Q

what is vasogenic oedema

A

specific type of cerebral oedema where the excess fluid has entered the ECF in the brain due to breakdown of the BBB

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13
Q

pathogenesis of vasogenic oedema from spinal cord compression

A

cord compression prevents blood vessels and nerves in the spine providing nutrients to the brain
leads to breakdown of neurones in the brain and ischaemia
after a few hours the BBB starts to breakdown, with leakage into the ECF in the brain - leading to vasogenic oedema

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14
Q

what are the more specific therapies for spinal cord compression

A

radiotherapy
chemotherapy
decompressive laminectomy

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15
Q

Of the specific therapies for spinal cord compression, what is the mainstay of Tx

A

Radiotherapy

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16
Q

What course of XRT is given for spinal cord compression

A

20Gy/5#

(20Gy over 5 fractions) - palliative course

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17
Q

What is the difference in XRT given for palliative and curative intent

A

Palliative intent - tends to be a shorter period of time (1-3 wks) with smaller dose fractions

Curative intent - tends to be a longer period of time (5-7 wks) with larger dose fractions

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18
Q

What area is radiated in spinal cord compression

A

abnormal area plus 1 or 2 vertebrae

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19
Q

What makes a patient NOT suitable for decompressive laminectomy for spinal cord compression

A
  • more than a single vertebral region of involvement
  • evidence of widespread mets
  • non-radio resistant primary
  • no previous XRT to site (try this first)
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20
Q

When is chemotherapy suitable for spinal cord compression

A

when the tumour is very sensitive

  • lymphoma
  • teratoma
  • SCLC (not always)
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21
Q

is superior vena cava obstruction always an emergency?

A

No!
there must be AIRWAY COMPROMISE along with tracheal compression
- if there isn’t there is time to plan optimal treatment

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22
Q

T/F:

SVCO leads to swollen chest wall veins on the back

A

False

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23
Q

T/F:

SVCO may be caused by left sided lung tumours

A

False

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24
Q

T/F:

SVCO may be treated with anticoagulation

25
T/F: SVCO may be partially treated by interventional radiologists
True
26
T/F: SVCO is best diagnosed by MRI thorax
False
27
Intrinsic causes of SVCO
clot (DVT) Foreign body (e.g. line) Tumour in vessels (e.g. from renal Ca)
28
Extrinsic causes of SVCO
Compression from mass - lung Ca or lymphoma
29
symptoms and signs of SVCO
``` Symptoms: SOB Swelling of face, neck, one or both arms Headache Lethargy ``` Signs: early - puffy neck, veins intact late - distended neck and chest wall veins, swollen neck, arms and face. advanced - injected conjunctiva, sedation
30
Initial Ix for SVCO
depends on the suspected cause: CXR - is there a mass Venogram - is there a clot CT chest
31
Tx of SVCO if being caused by a clot
Thrombolysis - anteplase | Anticoagulation - LMWH or warfarin
32
Tx of SVCO if being caused by extrinsic compression
Steroids - dexamethasone PO 8-16mg/24h SVC stenting - rapid relief of symptoms but doesn't treat cause Chemotherapy - used for SCLC, lymphoma and teratoma XRT - used for other malignant causes
33
in malignant hypercalcaemia, what is the single most useful blood test to perform after the corrected Ca level
U&Es - to look for dehydration
34
what is the first Tx to be initiated in a patient with malignant hypercalcaemia
IV fluids
35
causes of malignant hypercalcaemia
lytic bone mets myeloma production of osteoclast activating factor or PTH-like hormones by the tumour
36
symptoms of malignant hypercalcaemia
"stones, groans, bones, psychic moans" nausea, anorexia, confusion, polyuria, constipation, thirst
37
Ix for suspected malignant hypercalcaemia
``` Calcium levels Corrected calcium levels U&Es Phosphate If no known malignancy - myeloma screen ```
38
Tx of malignant hypercalcaemia
1. Rehydration - a few litres of 0.9% saline 2. Bisphosphonates - 60-90mg of panidronate IV over 2 hours 3. Systemic Mx of malignancy
39
Why should the patient always be rehydrated before bisphosphonates are started in malignant hypercalcaemia
Bisphosphonates can cause renal failure
40
causes of pericardial tamponade
``` trauma lung/breast Ca - malignant pericardial tamponade pericarditis myocardial infarct bacteria e.g. TB viral infection ``` Rare: increased urea, radiation, myxoedema, dissecting aorta, SLE
41
Pathophysiology of pericardial tamponade
pericardial fluid collects, due to any of the causes increased intapericardial pressure compresses the ventricles heart cannot fill CO drops right atrium collapses, increasing venous backpressure pumping stops
42
signs of pericardial tamponade
falling BP rising JVP muffled heart soudns increased JVP on inspiration - Kussmaul's sign Pulsus paraxoxus - pulse fades on inspiration
43
symptoms of pericardial tamponade
SOB fatigue palpitations symptoms of pericarditis - relief on sitting forward symptoms of advanced Ca (if malignant caused)
44
Ix for pericardial tamponade
Echo CXR ECG Cytology of pericardial fluid
45
CXR appearance of pericardial tamponade
globular heart left heart border straight or convex right cardiophrenic angle <90 degrees Enlargement of cardiac silhouette
46
Mx of pericardial tamponade
pericardiocentesis pericardial window - operation to allow pericardial fluid to drain into pleural cavity systemic Mx of malignancy
47
definition of neutropenic sepsis
sepsis plus a neutrophil count <0.5 or <1 if chemotherapy within last 21 days
48
how soon should a patient with suspected neutropenic sepsis be assessed?
within 15 mins of presentation
49
if neutropenic sepsis is suspected, how soon should Abx be initiated?
within 1 hr - take bloods and cultures first but DO NOT WAIT for for results
50
What is the empirical Tx of neutropenic sepsis
IV Tazocin | - Piperacillin and Tazobactam
51
What Abx should be given in neutropenic sepsis if the patient is pen allergic
Teicoplanin + Aztreonam
52
T/F: a patient with Ca has a very low risk of Pulmonary Embolism
False
53
T/F: a patient with Ca who has a PE should not be thrombolysed as risks of bleeding are too great
False
54
T/F: a patient with Ca has no proven benefit for taking LMWH to reduce the risk of PE if they are ambulant
True
55
Ix for suspected PE
``` CTPA ABGs O2 sats ECG Bloods - FBC< U&Es, baseline clotting, D-dimers CXR ```
56
ECG appearance in PE
can be noraml tachycardia RBBB inverted T wave in V1-V4
57
CXR appearance in PE
oligaemia of affected segement dilated pulmonary artery linear alectasis wedge-shaped opacities
58
Mx of PE
Supportive: O2, IV fluids Massive PE : thrombolysis Anticoagulation: LMWH - eg. dalteparin or enoxaparin for at least 3 months. If malignancy - 6 months. Also start warfarin Recurrent PE : consider Rivaroxaban

Oncology (1 decks)

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