Oncological Emergencies Flashcards
(22 cards)
When is neutropenic sepsis most likely to occur?
7-14 days after chemotherapy
In neutropenic sepsis, the neutrophil count is less than what?
0.5 x 10 to the 9
If it is anticipated that a patient will become neutropenic as a result of their treatment, what antibiotic prophylaxis is offered?
A fluoroquinolone (i.e. ciprofloxacin, levofloxacin)
Where there is clinical suspicion of neutropenic sepsis, when should antibiotics be offered?
Immediately
What is the empirical antibiotic therapy for neutropenic sepsis?
Piperacillin with tazobactam
If patients with neutropenic sepsis are still unwell after 48 hours, what antibiotic regimen should be offered?
Meropenem +/- vancomycin
If a patient with neutropenic sepsis is not responding after 4-6 days of antibiotics, what should be investigated for?
Fungal infection
What is the most common cause of spinal cord compression?
Extradural metastases
What is the investigation of choice for suspected spinal cord compression?
Urgent MRI of the whole spine
How is spinal cord compression managed initially?
PO dexamethasone
What are some longer term options for the treatment of spinal cord compression?
Radiotherapy or decompressive surgery
Which malignancy is most likely to cause SVC obstruction?
Lung cancer
What happens to the JVP in SVC obstruction?
It is raised, but not pulsatile
What is the investigation of choice for a suspected SVC obstruction with airway compromise?
Urgent contrast-enhanced CT
How may an SVC obstruction be managed?
Dexamethasone, balloon venuplasty and SVC stenting
What are the 3 main causes of hypercalcaemia of malignancy?
Bony mets, myeloma or production of osteoclast activating factor or PTH related peptide by the tumour
How is hypercalcaemia managed?
Rehydration and IV bisphosphonates
What is the initial treatment for raised ICP?
PO dexamethasone
Tumour lysis syndrome is most likely to occur upon starting chemotherapy for which malignancies?
Leukaemia, lymphoma, myeloma
In tumour lysis syndrome, there is a rise in what three things?
Urate, potassium and phosphate
How is tumour lysis syndrome prevented?
Good hydration and allopurinol 24 hours before chemotherapy
What treatment is indicated for patients with tumour lysis syndrome causing renal failure?
Haemodialysis
